Family Therapy

Definition, when used, principles, sessions, model, techniques, research evidence, practice approach

Three sections follow:

1. Background Material that provides the context for the topic

2. Suggestions for Practice

3. A list of References

Feedback welcome!

Background Material

Evolution of family therapy

The development of practice called ‘family therapy’ began 60 to 70 years ago and represented a significant paradigm shift in counselling and psychotherapy. Instead of a focus on individual issues, its focus was on ‘the space between’ people (connections, patterns, processes) in families. The relationship became the client, rather than the individuals within the work. Therapy considered the patterns and behaviours in families which promote and sustain symptoms and problems for individuals and the family itself (Shaw, 2019).  

Family therapy is founded on fundamental beliefs around family structure, processes and behaviour:

• Structure               The family is a social system which supports the survival, stability and welfare of its members. It is more than the sum of its parts. Understanding how the extended family, school, work, church, and cultural group interlock and intersect assist in understanding why individuals act the way that they do.

• Process and behaviour  Family roles, routines, rituals are all illustrations of the way a family operates. Therapy seeks to identify what gets in the way of moving in the direction family members know they need to go.

• Conceptualising problems            Family therapy theory breaks with the tradition of linear causality (A causes B). For example, thinking that a child’s behaviour is the result of parental mismanagement rather than considering the way in which the children and parents reciprocally.

Family therapy now involves methods that coordinate and integrate different methods of treatment.  It has developed into evidence based treatment for many complex problems (Shaw, 2019).

Definition

A family unit is a group of people who care about each other. In family therapy, a group can consist of many different combinations of loved ones, such as parents/guardians and their children, siblings, grandparents, aunts and uncles, friends, and kinship caregivers (Cleveland Clinic, 2022).

In family therapy, a psychologist works collaboratively with family members to improve communication, reduce conflict, and explore unhelpful patterns that may be contributing to a client’s difficulties.  The dynamics and patterns of the culture or system within the family are explored as well as how the structure of the family unit is impacting on each person.  Families learn to safely express, explore and process thoughts, emotions and experiences with each other, to appreciate each other's needs and perspectives, to build on each person's strengths and resources, and to navigate new and healthy ways of relating to each other.  Depending on the situation, sessions may involve the whole family or smaller groupings, such as parent and child, or siblings (Cherry, 2025; Little Window, n.d.; Rivett & Buchmuller, 2018; Sydney Psych Hub, n.d.).

Family therapy aims to:

• Be inclusive and considerate of the needs of each member of the family and/or other key relationships (systems) in people’s lives

• Recognise and build on peoples’ strengths and relational resources

• Work in partnership ‘with’ families and others, not ‘on’ them

• Be sensitive to diverse family forms and relationships, beliefs and cultures

• Enable people to talk, together or individually, often about difficult or distressing issues, in ways that respect their experiences, invite engagement and support recovery (AAFT, n.d.).

On the whole, family therapists work with the family group together as that approach offers the best chance of helping change interactive and relational patterns. The therapist needs to ‘see’ the family system behave as it does normally and then (with agreement) help “nudge” or “perturb” the system, so that it begins to change (Rivett & Buchmuller, 2018).

Principles

The approach of a family therapist should be:

• Respectful & inclusive – valuing each person’s perspective and encouraging all voices to be heard

• Evidence-based – using proven therapeutic approaches to support lasting change

• Collaborative – working together with the whole family to set goals and find solutions

• trengths-focused – recognising the family’s existing resilience and building on these strengths (Sydney Psych Hub, n.d.)

Clinicians actively involve the family because of the valuable knowledge, resources and potential the family possess.  These are harnessed as a means of assisting the person seeking assistance (McGrath et al., 2023).  This approach is supported by Strawa who lists several principles around family therapy:

• Understanding family context and relationships is essential to supporting a person’s mental health needs.

• Practitioners recognise that people and their families have, and can develop, skills to support mental health needs and recovery.

• Family members are often a person’s closest social relationship. People can often receive effective support through their family members.

• Regardless of the level of direct family involvement with the approach, communication between practitioners, clients and their families should be collaborative and respectful.

• The culture and language traditions of each family should be respected and diversity across and within families should be appreciated (Strawa, 2022).

What Family Therapy Can Help With

Separation, divorce, or blended Families        Navigating changes in family structure and maintaining stability for children

Conflict or communication breakdowns          Recurring arguments, tension, or misunderstandings

Parenting challenges      Differing approaches to parenting, setting boundaries, or supporting a child’s behaviour

Supporting family members with mental health, behavioural and neurodivergent  concerns        Working together to better understand and respond to their needs, e.g. stress, anger, anxiety disorders, eating disorders, mood disorders, personality disorders, substance use disorder, conduct disorder, oppositional defiant disorder, autism spectrum disorder and attention-deficit hyperactivity disorder.

Adjustment to life transitions     Moving, new siblings, or changes in work/study demands

Grief and loss     Supporting the family unit through difficult times

Impact of stress or trauma on the family         Working to rebuild safety, connection, and trust

Strengthening family bonds and resilience    Building positive connections, shared values, and supportive routines (Cleveland Clinic, 2022; Cherry, 2025; Sydney Psych Hub, n.d.).

Models and Theoretical Frameworks

There are different models and theoretical frameworks that many therapists are trained/educated to use when supporting families and individuals through crises. The most common ones noted when searching available literature were:

Cognitive Behavioral Therapy (Silva, n.d.)

Systemic Family Therapy (Silva, n.d.; Royal Life Centers, n.d.’ Cleveland Clinic, 2022; Rivett & Buchmuller, 2018)

Structural Family Therapy (Silva, n.d.; Royal Life Centers, n.d.; MHA, 2025; Cleveland Clinic, 2022; Rivett & Buchmuller, 2018)

Narrative Therapy (Silva, n.d.; MHA, 2025; Cherry, 2025; Rivett & Buchmuller, 2018)

Transgenerational Therapy (Royal Life Centers, n.d.)

Communication Therapy (Royal Life Centers, n.d.)

Family Psychoeducation (Royal Life Centers, n.d.; Cherry, 2025;)

Relationship Counselling (Royal Life Centers, n.d.; Cleveland Clinic, 2022)

Bowenian Family Therapy (MHA, 2025; Cherry, 2025)

Milan and Postmodern Approaches (MHA, 2025; Rivett & Buchmuller, 2018)

Solution-focused Approaches (MHA, 2025)

Attachment Therapy (MHA, 2025)

Emotion-focused Systemic Work (MHA, 2025)

Strategic Family Therapy (MHA, 2025; Cleveland Clinic, 2022; Rivett & Buchmuller, 2018)

Functional Family therapy (Cleveland clinic, 2022; Cherry, 2025)

Rivett and Buchmuller (2019) suggest using Integrative Family Therapy as a valid approach; this therapy incorporates research findings and practice from a range of therapies and interventions.  Integrative family therapy is focused on the therapeutic alliance between family and therapist, with collaboration as its basic foundation.  This approach is discussed further in the Suggestions for Practice section below.

Barriers

Headspace, an organisation that supports young people with mental health issues, prefers to use family therapy when counselling young people.  The organisation is aware of the barriers people can face when family therapy is suggested as a strategy.  Consult the original article for an outline of barriers (McGrath et al., 2023).  The strategies for overcoming the barriers suggested by Headspace raise a number of issues that are relevant for practitioners faced with engaging a family in therapy.

1.  Talk to young people:

• Encourage young  people to think about what it might be like to have their family involved in care, and the possible benefits.

• Reassure the young person that in most situations family appreciate knowing something about what is going on so they can provide appropriate support and care. If they’re not aware of what’s going on, then it’s difficult for them to know what is needed.

• Establish prior agreement from the start of work with the young person about what information will be shared with family. This agreement can be revisited and reviewed on a regular basis.  

• At the outset, ensure the young person is clear about the limits of confidentiality and the situations where information would need to be provided to others (McGrath et al., 2023). 

The Headspace article discusses how to manage confidentiality in detail and is worth consulting – the McGrath et al. reference below has a link.

2.  Talk to the family:

• Let families know that their involvement is important and that everyone can work together to support the young person.

• Build rapport with the family and actively encourage them to talk about their experiences and concerns; respond in a non-blaming, non-judgmental way.

• Provide opportunities for varying levels of involvement (i.e., attending sessions, phone contact, family work, support from family worker, external referral, groups etc.).  Not all the family will want to be involved all the time, and this is often not appropriate or necessary (McGrath et al., 2023).

Assessment (Rivett and Buchmuller, 2018)

In assessing family relationships, therapists look at a range of aspects of family life.  A number of empirical methods are available to help therapists assess family life.  Some of these include:

• The Family Assessment Device (The McMaster Model), covering family problem solving, communication, family roles, emotional responsiveness, emotional connection and behavioural control strategies.

• Family Adaptability and Cohesion Scale (The Circumplex Model), covering family cohesion (closeness/distance), flexibility (rigid/chaotic), and communication.

• The Beavers Systems Model, covering family competence and family style.

• SCORE (Systemic Clinical Outcome and Routine Evaluation), a short self-report questionnaire that measures strengths and adaptability, feeling overwhelmed by difficulties and disrupted communication.

If using a specific approach to family therapy, the therapist may use an appropriate assessment approach, (e.g. Strategic Family Therapy examines the family’s communication), but the alternative is to rely upon a conversation because, ultimately, therapy is about ‘meeting’ another person. 

A genogram or family tree can help the therapist and family orientate to each other in the early assessment session.  Some common family tree symbols are shown.  There is also software available to help therapists construct family trees.

The purpose of the assessment session(s) is to create a description of what is happening in the family. There are a number of areas that may be explored as part of assessment:

• Family scripts, e.g. expectations that certain family members will have problems or exceed the achievements of the elder family members.

• Styles of parenting.

• Parental cohesiveness.

• Intergenerational structures, e.g. grandparents caring for children.

• Levels of closeness.

• Communication styles.

• Family rules.

• Family beliefs.

• Vertical stresses on family life, e.g. death of a family member.

• Gender expectations.

• Cultural expectations and wider societal responses to them.

• Family flexibility in response to life cycle changes or external challenges.

The outcome of the assessment should ensure that family strengths are highlighted because these can help the family deal with presenting isues.  The assessment should make sense to the family: it needs to be constructed in a collaborative way.

Once the family description has been formulated, the next task is to engage the family in change.  There can be obstacles to overcome at this time:

• The family isn’t living together.  (Attempt to help separated families work together in the long-term interests of the children.)

• Parents are hostile to each other.  (Meet the parents separately to help them understand how they can help their children.)

• Factors may prevent family members having the capacity to work on psychological issues, e.g. severe mental health difficulties, substance or alcohol misuse problems.  (Work with other interventions such as substance misuse programs.)

• Contextual pressures, e.g. financial, overcrowding, social challenges, major family trauma. (Utilise support services when possible.)

• Family members are stuck in blaming another family member or possibly an outside system and cannot accept any responsibility for making change happen. (Recognise the impact these attitudes have on family members and invoke safeguarding procedures.)

• Some families just don’t want to change! (Spend time uncovering why change is resisted but, in the end, the family have to choose.)

• The therapist struggles to work with the family.  (Sometimes, in the interests of the family, the therapist may need to ask a colleague to take on the case.)

Family-Inclusive Approaches

Family therapy sessions are flexible and adapted to the unique needs of each family. Depending on the situation, treatment may include:

• Collaborative discussions that give each family member a chance to share their perspective in a safe and respectful space

• Developing practical communication tools to reduce misunderstandings and manage conflict more effectively

• Exploring family patterns and dynamics to identify unhelpful cycles and build healthier ways of relating

• Strengthening problem-solving and decision-making skills to navigate challenges together

• Supporting parents or caregivers with strategies to guide children’s behaviour and emotional wellbeing

• Fostering empathy, understanding, and stronger emotional connections between family members

• Planning for the future with clear, shared goals that promote resilience and unity (Sydney Psych Hub, n.d.).

Australian and international evidence supports the following family-inclusive approaches:

• Psychoeducation for family members

• Practical support (e.g. help with referrals), social support (e.g. to expand social networks), and emotional support (e.g. being empathetic towards family members)

• Coordinated care between families and others providing mental health support, (‘wraparound’ services)

• Information sharing between family and services (both directions)

• Including family members in the development of a person’s care plan, including goal setting (Strawa, 2022).

Evidence of Effectiveness

Empirical studies and meta-analyses of family therapy, either alone or part of multimodal programs, have demonstrated its efficacy for a very wide range of presenting problems. For adults, these include relationship distress, psychosexual problems, anxiety and mood disorders, intimate partner violence, alcohol problems, schizophrenia and adjustment to chronic illness or injury. For children these include sleep, feeding and attachment problems in infancy, child abuse and neglect, conduct problems, emotional problems (such as grief, anxiety, depression, self-harm and bipolar disorder), eating disorders and somatic problems, enuresis, encopresis, medically unexplained symptoms, poorly controlled asthma and diabetes, and first-episode psychosis (Shaw, 2022).

The results are often dramatic, with studies suggesting that the average family fares better after treatment and at six– to twelve-month follow-up than 71 per cent of families in control groups. It also shows reduced use of health services, involves fewer sessions and has greater benefits than individually based treatments.  This may be due to the critical mass of enthusiasm to create change that can develop among family members, a momentum that can be sustained in response to the ambivalence, caution or reticence of an individual to change (Shaw, 2022).

Cherry (2025), Cleveland Clinic (2022) and MHA (2025) support Shaw’s analysis of the effectiveness of family therapy, citing specific research studies.  

Suggestions for Practice

There are a variety of formal approaches to family therapy that are available for social workers to use and for the general public to engage.  A number of these are listed in the material above, each with its more specialised area of practice.  Many of these require specific training before being authorised to use them.

This should not stop social workers from utilising family-inclusive approaches, as described above, into their treatment approach when they and their clients can see advantages in doing so.  This strategy has the potential to provide further, a ‘critical mass’ support to assist the person (and family) with addressing the problem that brought the person to therapy.  In these situations, social workers would probably not be using one of the formal approaches because of the formal training required.  Rather, they would be drawing upon their generalist social work strategies and practice approaches as well as aspects of the material outlined above.  Rivett and Buchmuller (2018) refer to this as ‘integrative family therapy’. 

In integrative family therapy an awareness of family therapy, and its benefits, along with feeling competent in a range of practice approaches, enables the social worker, with the client’s permission, to incorporate the family into the work with the client.  As Constable (2016) points out, including the family broadens the strengths-based approach the social worker will be using with the client.  It involves family members discovering their personal strengths and the strengths they have as a family.  With their permission, full understanding and cooperation, families can then be utilised to assist the client in managing the issues they are finding problematic. 

Integrative family therapy will be used when social workers can see that incorporating the family will be an advantage mainly for the client but also, in many cases, for the family.  Initially social work with families will probably be learned in the field and discussed in regular supervision meetings, where social workers will be able to refine their approach and improve their skills (Constable, 2016).

Developing a therapeutic alliance with both client and family is the key to effective family therapy.  However, the approach has to fit the problem rather than a therapeutic alliance being enough.  One of the ways that family therapists can explicitly address the therapeutic alliance is to actually ask about how they should work with the family. For example, “Do you have any concerns about us meeting together in this way?” Or “What topics do you really not want to talk about?” Or “How should we manage if someone in the family gets upset?” (Rivett & Buchmuller, 2018).

Features of an integrative family therapy include:

• Ideas around why the person has a disorder are discussed and analysed with the family

• Parents are encouraged to take some responsibility of managing a younger person’s disorder

• The disorder is separated from the individual to galvanise the family against the disorder, not the person

• Families often reorganise around the person’s issues

• Change occurs through changes in how family members behave towards each other—in their individual and relational patterns and understandings

• As treatment progresses, the therapist becomes less expert and aims to help the family manage ‘safe uncertainty’ (Rivett & Buchmuller, 2018).

Samudio (2018) discusses “doing family therapy as a new social worker”, suggesting that work with families can be problematic: “an uphill struggle fraught with missed appointments, hard-to-reach parents, children who can only be seen during school hours, and family members who sometimes undermine the clinician’s treatment with their own views about mental health”.  Samudio suggests persistence is worth it for the benefits it offers and makes the following suggestions. 

Look at how families identify themselves. Ask: “Would you say that your family is close or distant?” “Can you detail everyone you consider ‘family’?” The answers can help inform treatment and provide informal supports to help the family.

Respect where each member of the family is in his or her current level of functioning and speak to that level.  Before giving suggestions, reflect: “Can the family sustain this suggestion without help from me?” If not,  be patient as the family develops a new understanding of its current challenges and the solutions to them.

Honour the family’s current set of skills.

Developing a therapeutic alliance can be difficult, especially if a family is resistant to treatment. A few key ways to develop a positive alliance include:

• Being on time and present during the session;

• Actively listening and asking for clarification instead of assuming;

• Being flexible with the family’s schedule;

• Delivering value to the family by triaging needs (remember Maslow);

• Allowing the family’s voice to be heard in treatment.

Be aware of countertransference and discuss it in supervision to ensure clinician’s own perspectives, experiences, and beliefs about families do not adversely shape treatment. 

Get a good picture of a family’s culture by looking at everything from race, gender, and socioeconomic status to religious ideals, family rituals, and external support systems. Ask about these items and also explore:

• Previous negative experiences in treatment;

• Coping efforts and beliefs about hope;

• Family organization (communication, leadership, roles); and

• The family’s basic needs.

Develop a strategic treatment plan that details the goals of treatment. The treatment plan should illustrate a clinical loop: assessment, diagnosis, goals, and termination.

1. Gather all the important information about the family (history, resources, needs, and commitment to treatment).

2. Assign a mental health diagnosis to the identified patient.

3. Use the assessment and diagnosis to create a goal that will help the family decrease symptoms and/or increase coping strategies.

4. Discuss termination in this plan, so the family understands that treatment will end once goals are met.

This clinical loop will help assess the progress of the family’s treatment and pinpoint where adjustments need to be made as treatment evolves.

References

AAFT: Australian Association of Family Therapy.  (n.d.). About us.  https://www.aaft.asn.au/about/family-therapy/

Cherry, K. (2025).  How family therapy works.  Verywell Mind.  https://www.verywellmind.com/family-therapy-definition-types-techniques-and-efficacy-5190233

Cleveland Clinic.  (2022). Family Therapy.  https://my.clevelandclinic.org/health/treatments/24454-family-therapyLittle Window.   (n.d.).  Our therapies: Family therapy.  https://www.littlewindow.com.au/family-therapy

Constable, R.T. (2016). Social work and family therapy: Interdisciplinary roots of family intervention.  Nauki o Wychowaniu Studia Interdyscyplinarne, 3(2): 147-160.  http://dx.doi.org/10.18778/2450-4491.03.09 

McGrath, J., Kinlyside, D., Presland, E., Phillips, J., Harvey, K., Brogden, L., & Sharrock, N. (2023).  Family inclusive practice handbook.  headspace.  https://headspace.org.au/professionals-and-educators/health-professionals/resources/treatment-guidelines/

MHA: Mental Health Academy. (2025, November 3). Bringing the family to therapy. https://www.mentalhealthacademy.com.au/blog/bringing-the-family-to-therapy

Rivett, M., & Buchmuller, J.  (2018). Family therapy: Skills and techniques in action.  Routledge.  https://cdn.oujdalibrary.com/books/360/360-family-therapy-skills-and-techniques-in-action-(www.tawcer.com).pdf

Royal Life Centers. (n.d.).  What are the types of family therapy approaches?  https://royallifecenters.com/types-of-family-therapy-approaches/

Samudio, M. (2018, April 19).  Doing family therapy as a new social worker: The do’s and don’ts.  New Social Worker.  https://www.socialworker.com/feature-articles/practice/doing-family-therapy-as-a-new-social-worker-dos-and-donts/

Shaw, E. (2019). Evolution of family therapy.  InPsych, 41(4).  https://psychology.org.au/for-members/publications/inpsych/2019/august/evolution-of-family-therapy

Silva, J. (n.d.).  4 types of family therapy.  My Wellbeing.  https://mywellbeing.com/therapy-101/4-types-of-family-therapy 

Strawa, C. (2022). Family inclusive approaches when working with young people accessing mental health support.  Australian Institute of Family Studies.  https://aifs.gov.au/resources/short-articles/family-inclusive-approaches-when-working-young-people-accessing-mental

Sydney Psych Hub. (n.d.). What is family therapy?  https://sydneypsychhub.com.au/family-therapy/