Family Therapy: Theories, Modalities, And Efficacy
Updated November 25, 2019
Reviewer Karen Devlin, LPC
Family therapy is a form of therapy in which an entire family is engaged in therapy, to reach a group resolution, rather than an individual seeking out personalized therapy plans. Family therapy can be engaged when an entire family's dynamic has grown problematic or may be enlisted to help when a single family member's behavior or struggles have created familial discord. So what exactly is family therapy?
Family Therapy: A Definition
Family therapy is any form of therapy that enlists an entire family as a client, rather than a single person. Family therapies can all look very different from one another, both in terms of what is worked on during therapy sessions, and the manner of delivery. Some family therapy sessions require that all family members be present during a session, while others might intentionally splice and separate family members throughout treatment. Some therapies focus on parent-child engagement and interactions, while others focus on each member of the family to treat individual concerns, before bringing the family together for treatment as a whole.
Family therapy seeks to treat a family unit to improve communication, relations, and dynamics within a family, to create a harmonious home life. Family therapy is most commonly engaged when children are still in the home, but people of all ages and home lives may come into family therapy and benefit from the tenets it has to offer. Ultimately, family therapy is a form of therapy that treats relationships, without the specific focus on a romantic relationship.
Family Therapy Theories
Family therapy theories essentially function as the basis from which all family therapy modalities spring. Theories are used to identify the most effective forms of treatment, whether that means engaging a family as a single unit, separating a family to treat individual issues, or treating a family through different lenses depending on the day, tackling situations and issues as they arise.
Some family therapy theories see families as, essentially, a small society, in which there are specific, unique roles and relationships, and deviating from these roles and relationships is the greatest source of conflict or contention. Within this theory, then, mental health professionals work to restore some sense of equilibrium, allowing each family member to return to the role they are best suited to, and re-instilling the family with a sense of peace and order.
Other family therapy theorists view the family unit as just that: a single unit, with working parts that must all work toward the same goal. In this theory, families are regarded as one "person" during treatment, which allows each of the members of the family to have equal time and importance in sessions, and encourages each of the family members to support and uplift one another, just as you would support all pieces of your own body; after all, you are unlikely to value an arm over a leg, so why would you value one member of the family over another?
Main Family Therapy Modalities
There are five widely recognized family therapy modalities: Structural Therapy, Milan therapy, Strategic Therapy, Narrative Therapy, and Transgenerational Therapy. Each of these forms of therapy seeks to improve familial relationships and create a more stable, healthy life at home.
Structural Therapy is the most popular form of family therapy and sees the family as a unit with multiple functioning pieces. Each person in the family has a specific role that they fulfill, and deviating from these roles is the greatest source of conflict within a family. Therapy, then, seeks to check out any reason for the upset in familial roles and works on integrating everyone back into the roles they were originally intended to fulfill. This modality works to evenly distribute power, communication, and respect, to move forward as a single, functional system.
Milan Therapy is similar, in that it views a family as a single system, with a series of symbiotic systems embedded within it. It differs somewhat from Structural Therapy, though, in that it focuses far more on the natural behaviors within a family, and seeks to guide those natural behaviors, with a focus on reactions and feedback. Family members are encouraged to listen and respond carefully to one another while allowing each other to have their own lives and functions essentially.
Strategic Therapy focuses far more on patterns within families, and less on viewing the family unit in a particular way. As its name suggests, a strategic approach is one that allows therapists and family members to engage in more hands-on approaches to conflict resolution, as both are instructed to focus on any patterns of behavior that have emerged or developed over time, and attempts to intercept and redirect these patterns actively.
Narrative Therapy is the most individualistic of the family therapy modalities and focuses on supporting and encouraging each family member. This modality operates under the notion that individuals being at their absolute best and believing in their power will create the greatest, most effective family dynamics, and that conflict resolution is a simple matter of improving self-esteem and self-perception.
Transgenerational Therapy does exactly what it seems: it works on the conflicts that arise between different generations through breaking down any communication barriers that exist, and cultivating understanding, despite different mores or expectations. This particular modality suggests that most familial conflicts come from the differences between generational behaviors and expectations, and soothing these differences is a simple matter of improving communication and encouraging open-minded attitudes.
Which Family Theory Is Best?
As one study concluded, there is not a single form of family therapy that is distinctly advantageous over another; some modalities work well for some families, and others work well for other families. Ultimately, it is the presence of psychotherapy at all that consistently demonstrates significantly different outcomes, rather than the use of a single, distinct family therapy theory or modality.
Some forms of family therapy are more likely to suit a particular problem, however. If communication between different generations is the primary problem-if grandparents and parents are struggling, or parents and children are struggling-Transgenerational Therapy might be the most effective form of therapy, to reach a sincere resolution.
If family dynamics as a whole are being tested, Structural Therapy may be the best therapeutic method to repair family dynamics and instill peace. Communication breakdowns and not understanding your role in your family could be helped through Milan Therapy, and a family filled with low self-esteem and self-doubt can be helped by Narrative Therapy.
Ultimately, though, your family is likely to be better off, regardless of the exact form of therapy you engage. The most conclusive study of therapy as a whole consistently found that people who enlist therapy as a means of self-improvement and self-help report better life outcomes than those who do not, so any type of family therapy is likely to offer at least some insight into and improvement of familial relationships and family dynamics.
When choosing a modality and a therapist, be sure to do some research. Make sure the modality you've chosen to enlist suits your actual needs and make sure your therapist is properly certified for that modality. Because different forms of therapy require different techniques, therapists are not qualified to deliver all forms of therapy but are instead able to take on certain specialties.
Family Therapy Delivery
Just as there are different therapy types, there are different ways therapy can be administered. Some therapists have entire families come to a session in an office, where families are encouraged to air their grievances and identify any issues they might have. Some therapists encourage families to be seen in a more natural setting, such as a home or school, to observe the family in their typical habitat and to get a more accurate feel of how the family interacts. Some therapists deliver therapy online, where family members can feel more comfortable engaging with their therapist and one another.
Family Therapy's Modalities
Family therapy has existed for many years, with a primary goal of improving familial ties and relationships. While individual therapy focuses on a single person's problems, family therapy seeks to treat an entire family's concerns or diagnoses. There are many reasons to enlist the help of a family therapist. Some families have children or adults with special needs and need help navigating all of the complexities that accompany the situation. Some families have a family member struggling with an addiction, or even a series of addictions, and need help learning how to cope effectively. Some families simply struggle to communicate and keep harmony among themselves and seek out a professional to help them learn more effective listening and speaking.
Family therapy is somewhat new in the overall history of psychotherapy but has at least 60 years of theory and practice behind it. Family therapy theories are all different in their approach to healing and treating families, but they are all working toward the same goal: improving family dynamics and strengthening familial relationships. Whether you visit with a therapist in an actual office, or you visit with a therapist via an online therapy portal, the result is the same: improved family dynamics, improved communication, and more harmonious home life.