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With increasing life and social demands on children, teenagers, and college students, stress, anxiety, depression, eating disorders, addiction, and other serious mental health challenges continue to rise. Frequently, individual therapy and parent guidance are recommended and implemented for support. However, after working in the field for over 25 years, I have come to recognize that family therapy is frequently absent or minimal in this therapeutic journey. This is often the case even with partial hospitalization and intensive outpatient programs, where the child may be at serious risk.
This is surprising and confusing, as so often in the depths of mental health challenges, the family is under tremendous stress. Hence, family conflict, parental disagreements, poor communication, barriers to participation and involvement (especially for parents of 16-year-olds and above), misinformation, and lack of cohesive family engagement ensue. Our mental health challenges do not occur in isolation; they are embedded in the family system and impact all family members in profound ways. Family therapy could be a powerful intervention to support not only the client but also create bridges and integration to navigate, guide, and lead the family to healing.
What Family Therapy Is (and Isn’t)
Family Therapy is a well-established therapeutic approach that includes any and all family members who may be significantly involved in the client’s life and care. Family members are invited to join sessions as needed, in parts or whole. Typically, the first few sessions include all necessary family members to establish rapport, trust, boundaries, goals, and the rules of confidentiality (or not). Essentially, it is made clear that no secrets can be kept, as honesty and transparency are part of the therapeutic conflict-resolution and healing process. As family therapy progresses, it may be helpful to break up the sessions into groups of parents, siblings, child and parents, etc., to address the unique dynamics between certain family members. The goal is still to circle back with all family members in therapy to ensure progress and enhanced communication.
Common Scenarios Where It Helps
Family therapy can be very productive in many different situations. In the more urgent realm, if the client is thinking about or actively self-harming, has suicidal ideation, or has made an attempt, family sessions are key to discuss safety protocols, triggers, honesty, communication, and coping. Keeping the client safe and regulated when they are so vulnerable is necessary, and family understanding and scaffolding can be very helpful during this high-risk period.
Another more typical situation in which family therapy is highly effective is during pre-adolescence, adolescence, and the transition to college stages. As children begin to explore individuation, separation, boundaries, and identity, a number of higher-risk options arise that pre-teens, teens, and college students have to grapple with. Social media, gaming, screen time, alcohol, vaping, drugs, sexuality, sex, and gender identity are common high-conflict triggers for family members. Parents typically are desperate to create safe rules and boundaries, and siblings may be left reeling in the tension and fights. Families often describe the home environment as “toxic” and seek help to better navigate these turbulent waters.
Additionally, family life stressors of separation, divorce, new births, chronic illness, and death are situations in which family therapy could enhance communication, planning, grieving, coping, and healing. In these moments, individual family members are likely to have disparate needs with conflicting goals and expectations. Oftentimes, instead of working as a cohesive unit with mutual goals, family members may stagnate, become frustrated, or get emotionally drained. These struggles arise from difficulties with balancing life transitions, family expectations, and unforeseen stressors. Although individual therapy is often beneficial, engaging in family therapy alongside collaborative individual therapy enables the family to better discern their individual needs vs. the family system’s needs. Family therapy allows a safe space for all family members to share their feelings, triggers, and barriers to healthy processing.
Common Questions
How long does it usually take?
Since the stressors are usually prolonged, ongoing family therapy is typically more beneficial than sporadic sessions, as it takes time and effort to resolve these significant family challenges. Having individual and family therapists collaborate is incredibly helpful, so all team members are supporting the family in similar directions and have a more systemic and global understanding of the family’s situation.
Can family therapy work if not everyone participates?
Sometimes, individual family members refuse to participate due to very high conflict. In these moments, it is still possible for the other family members to engage in sessions, and the family therapist can hopefully communicate with all providers involved with family members.
Conclusion
In sum, families are complex systems that benefit from a unique understanding of the intricate play between multiple individuals. It’s not uncommon for families to get stuck in unhealthy patterns that stem from unresolved conflicts, mental health challenges, and competing needs.
Family therapy identifies the core family struggles and enables family members to change, adapt, and grow within the family system. A thoughtful family approach provides a safe and supportive environment to help families successfully navigate conflict, improve communication, and rebuild trust.
