Family therapy can provide an avenue to both individual and collective healing for a multitude of different issues.
The origins of family therapy did not emerge until the 1940s and 1950s (Carr, 2012). Researchers and clinicians challenged the dominant psychoanalytic view of emotional disorders by proposing that these disorders were symptoms of troubled family relationships rather than subconscious issues (Goldenberg, 2017).
Research on psychotherapeutic work with family came from theories rooted in sociology, anthropology, and biology to create an in-depth understanding of the complex family interaction (Goldenberg, 2017).
Having developed significantly throughout the years, family therapy techniques are foundational to the healing process. We look at family therapy techniques you can apply in your practice and the scenarios they are best suited for.
Family therapy is a type of therapy that addresses family or relational conflict and helps improve communication and interaction between members (Carr, 2012).
There are many variations of family therapy techniques, but most fall within four dominant models: structural family therapy, Bowenian or intergenerational family therapy, strategic family therapy, and systemic family therapy (Milan model).
1. Structural family therapy
Structural family therapy was developed by Salvador Minuchin (1974), who theorized that a family needs to maintain a certain hierarchy in order to remain healthy.
A technique often employed in this type of family therapy is the completion of a structural map, where boundaries and hierarchies of the family are outlined. Once the map is presented, a therapist can encourage members to change in ways that create a healthier structure or dynamic between members.
2. Bowenian family therapy
One of the first comprehensive theories of family therapy was created by Murray Bowen (1971), who believed that the goal of therapy was self-differentiation.
Self-differentiation is the ability to separate the specific issues or symptoms of various family members. Bowenian therapy techniques include using genograms to identify intergenerational family dynamics, pointing out the dynamics between members through psychoeducation, and working with individual family members on specific issues (Bowen, 1971).
3. Strategic family therapy
Strategic family therapy maintains that family problems occur through repeated maladaptive family interactions (Carr, 2012).
Strategic family therapy techniques involve motivating the family to change behavior patterns through homework, experimentation, paradoxical intention, and work outside the therapy session.
4. Systemic family therapy
Systemic family therapists believe that family members develop problematic symptoms or mental health issues to cope with the behavior of other members (Carr, 2012).
In this form of therapy, the therapist is a neutral figure with the goal of getting family members to question their understanding of the family system in order to change distressful behaviors.
Circular questioning is the primary therapeutic technique used in systemic family therapy (Carr, 2012). Circular questioning encourages clients to think about connections between family members by introducing other people’s perceptions and different views of situations. This video provides a good example of circular questioning.
Circular questioning in systemic family therapy
4 Family Therapy Techniques for Better Communication
Communication is a foundational but often overlooked aspect of healthy relationships. Most people assume they know how to communicate, which can exacerbate any underlying problems within the family system (Durante et al., 2023).
There are several effective family therapy techniques that can help improve communication in relationships.
1. Active listening
Active listening techniques involve paraphrasing what another family member says. The goal of active listening is to understand another person’s perspective so they feel heard and understood (Durante et al., 2023). This can build trust and improve general levels of communication.
2. Positive reinforcement
Positive reinforcement is a behavioral psychology technique that encourages good behavior (Durante et al., 2023). A specific behavior can be targeted (such as getting a child to complete their homework), and a tangible reward is selected once the behavior is completed (such as allowing extra screen time or going out for ice cream).
Positive reinforcement is an effective way to increase positive behavior for any member of the family.
3. Soft start-ups
Soft start-ups are a method of communicating a need to a partner or loved one that avoids a defensive reaction. According to The Gottman Institute, soft start-ups involve using “I” versus “you” and describing how one feels in the situation rather than placing blame (Lisitsa, n.d.).
Saying “I do not feel heard right now,” rather than “you never listen to me,” is a much more effective way to communicate.
4. Mindful body language
Body language is a more powerful way to communicate than with words (Durante et al., 2023). Therefore, paying attention to body language can greatly impact how a message is received and interpreted.
Getting clients to pay attention to eye contact, eye rolling, sighing, crossed arms, clenched fists, and frowning can be an effective way to improve communication. This can be done in a family therapy session by simply pointing out observed body language and asking clients to practice changing it.
These detailed, science-based exercises will equip you or your clients to build healthy, life-enriching relationships.
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4 Family Therapy Activities for Anxiety
Relationship conflict within families and intimate partners is significantly higher when one or more of the individuals struggles with an anxiety disorder (Chambless, 2012).
There are numerous activities that can help families and relationships deal with an anxiety disorder.
1. Thought record
Family members can create a thought record of negative and anxious thoughts when they come up. This can be done in a journal or notebook and brought to family therapy sessions. In session, family members will share their anxious thoughts, and other family members can help the client come up with thought replacements.
2. Exposure therapy
Exposure therapy involves gradually exposing an individual to something that causes fear or anxiety (Cleveland Clinic, n.d.).
Exposure therapy activities in family therapy might involve identifying something that one member is avoiding due to fear. This might be anything from a type of animal to social settings.
Family members can create an “exposure hierarchy” with the anxious member. This hierarchy starts with the most terrifying experience (holding a spider) and ends with something less scary (such as looking at a picture of the spider). Family members can work with the individual to move through the hierarchy gradually and provide a safe space of comfort so that the anxious client can overcome their fear.
3. Behavioral activation
Behavioral activation is a technique that helps individuals understand and experience how behavior affects emotions (Carr, 2012). Behavioral activation activities can be introduced and applied in family therapy settings to help one or more members with anxiety.
Behavioral activation activities for anxiety can include deep-breathing exercises (such as square breathing, three-part breathing, or mindful breathing), exercising, scheduling positive activities to reduce avoidance, and identifying goals and values.
Family members can review the most effective activities and implement them in their daily and weekly lives.
4. Feel-good file
Family members will create a manila folder and label it the “Feel-Good File.” It can be decorated and designed by individuals.
Family members will write down one positive strength for another family member on an index card. These index cards are compiled into the client’s file so each member eventually has a folder full of their own strength cards.
Family members can use these folders and refer back to their personal strengths during times of stress and anxiety.
3 Family Therapy Interventions for Depression
Depression is the most common mind-brain illness and affects tens of millions of Americans (Dietz, 2020).
These effects can dramatically impact relationships and families for generations. There are several effective family therapy interventions that can minimize the negative impact depression has.
1. Cognitive-Behavioral Therapy
Although Cognitive-Behavioral Therapy (CBT) is often used for individuals, CBT techniques can be effectively applied to family therapy (Yulia et al., 2016).
The goal of CBT is to help family members identify faulty thinking patterns and change them, which results in positive emotional and behavioral outcomes (Yulia et al., 2016). It teaches family members that they cannot always change circumstances, situations, or other people, but they can change their perception and response.
2. Interpersonal psychotherapy
Interpersonal psychotherapy is a structured, short-term form of therapy that focuses on relationships, communication, and here-and-now problems (Dietz, 2020).
It can be a helpful treatment for depression by addressing specific issues within the family system and working on collaborative problem-solving skills to reduce negative thoughts and feelings.
3. Psychoeducation
Psychoeducation on depression, depressive symptoms, and underlying causes can be helpful for families. Psychoeducation involves educating individuals and family members about the brain, chemical imbalances, symptoms, and treatment of depression (Suijit et al., 2020).
It can provide insight about the disorder, identify effective problem-solving techniques, prevent relapse, and improve relationships.
3 Family Therapy Strategies for Dealing With Addiction
According to the National Institute on Drug Abuse (2023), treating addiction is most successful when the needs of the whole person are addressed.
Addiction is a complex issue and is typically thought about in three phases: treating withdrawal, treating the root causes of addiction, and preventing relapse. Several family therapy strategies are useful in treating addiction. These include contingency management, 12-step facilitation, and brief strategic family therapy.
1. Twelve-step facilitation
Twelve-step facilitation is much like the 12-step process of Alcoholics Anonymous and is not necessarily a medical treatment for addiction, but a complementary addition to support treatment (National Institute on Drug Abuse, 2023).
As the name implies, it is a strategy that involves 12 weeks following the themes of acceptance, surrender, and active involvement in recovery.
2. Contingency management
Contingency management is a therapeutic strategy that uses positive reinforcement to encourage sobriety and recovery (National Institute on Drug Abuse, 2023).
Rewards and privileges are given when clients attend counseling sessions or meetings, attain drug-free milestones, or take medication as prescribed.
3. Brief Strategic Family Therapy (BSFT)
BSFT is an intervention that focuses on practical, problem-focused, and planned strategies (Szapocznik et al., 2013). Some of these strategies include:
Practical strategies may include behavioral contracts, where clients sign a contract agreeing to do or not do certain things related to the addiction
Problem-focused strategies focus on maladaptive family interactions as they relate directly to the addiction. Implementing clear rules, increasing parental involvement, creating guidelines and routine communication are examples of this.
Tracking is another strategy used as a method of systematically identifying family interactions to address strengths and weaknesses (Szapocznik et al., 2013). These interactions are recorded and linked back to addictive behaviors to create an effective treatment plan for both the individual and the family involved.
3 Family Therapy Exercises for Trauma
When a crisis or trauma occurs, it impacts all members of the family. Individuals react and respond to trauma and major life events differently. Family therapy exercises can help members support and collaborate to heal from the trauma.
1. Genogram creation
Constructing a genogram allows clients to visually map out family relationships, history, and dynamics. It can reveal patterns of trauma transmission across generations, which leads to understanding and discussion among family members.
2. Narrative therapy
Narrative therapy encourages each family member to share their story related to a specific trauma. This can help in understanding differing perspectives, validating experiences, and creating empathy among family members.
3. Family sculpting or role-play
Role-play activities and family sculpting explore family relationships, dynamics, and the meaning of the trauma. This can help family members understand various perspectives and lead to healthy healing.
3 Family Therapy Approaches for Anger Management
Anger is a natural emotion. Experiencing anger when feeling threatened or attacked is a survival technique that has helped humans survive since the beginning of evolution (Williams, 1993).
However, anger can cause a lot of distress and conflict in relationships when it is not managed appropriately.
1. Play therapy
Play therapy can be an effective technique to help children in families deal with anger (Nelson et al., 2012). Anger in children can be a sign of social, school, or environmental factors within their lives.
Play therapy techniques such as drawing to express feelings, role-play with dress-up, and age-appropriate games can be helpful teaching tools for children struggling with anger management (Nelson et al., 2012).
2. Emotional regulation training
Regulating emotions is not about suppressing them. As mentioned, anger can serve a purpose as a powerful emotion. Learning to regulate emotions is about training clients to identify and feel the emotions but not respond irrationally to them.
Things like naming and identifying anger, meditation, mindfulness, physical activity, and learning to pause before responding are all pieces of emotional regulation training.
Anger management training involves identifying specific triggers and responses, learning strategies to diffuse or avoid, and changing thoughts and attitudes about anger (Williams, 1993).
Clients will record specific incidents where they felt angry and identify a theme that triggers the emotion. Clients are also taught to become more aware of individual responses to these situations and work to find alternate responses.
CBT is often included in anger management training as a way to identify specific thoughts (such as rumination) that lead to increased levels and prolonged duration of anger.
3 Family Therapy Techniques for Grief
Grief is a very individual experience, and it’s difficult to navigate within a family unit or in a relationship.
There are many types of grief, but ultimately, it is the emotional suffering experienced when something or someone is taken away (Lichtenthal & Breibart, 2015).
Kubler-Ross famously established the five stages of grief in 1969. These stages can emerge in any order, at any time, and include denial, anger, bargaining, depression, and acceptance (Simon et al., 2011).
Various family therapy techniques can be used to help families and family members move through the grief process.
1. Making sense of loss
This is also known as “positive reframing,” which can be cognitive, focusing on thoughts, or emotional, focusing on feelings (Lichtenthal & Breibart, 2015).
It is hard to see positives in grief and loss, and clients may only be open to this technique during certain stages of the grief process. Making sense of loss or positive reframing is not discarding the negative aspects of it, but focusing on positive memories, lessons learned, or things that still connect the client with the person lost.
2. Creating new traditions
It is often helpful to create new routines, rituals, and traditions after the loss of a loved one or major life change. In family therapy sessions, members can discuss and brainstorm ideas of things they want to try, experience, or continue for holidays, vacations, milestones/major dates, etc.
The establishment of new traditions can help family members process grief and move on to enjoy a “new normal” (Lichtenthal & Breibart, 2015).
3. Find identity and purpose
Individuals can experience grief for many reasons. These include more than losing someone important. It can be the loss of health, the loss of a career, or any major life transition that involves change and loss.
Helping family members find a new identity and purpose after the change and loss can bring healing and hope to both the individual and the family unit (Simon et al., 2011).
Helpful Resources From PositivePsychology.com
PositivePsychology.com has a wealth of resources that can be used in family therapy.
The Interpersonal Skills Acronyms worksheet is based on the DEARMAN, GIVE, and FAST concepts found in Dialectical Behavior Therapy. It can help couples and family members communicate, interact, and respect one another during times of conflict or disagreement.
Codependency is a common problem in relationships and generally begins with maladaptive behaviors found in the family unit. This worksheet — Codependent Relationships: Beliefs, Attributes, and Outcomes — outlines the difference between codependent and healthy relationships and can be a helpful guide for clients.
Relationships and families can be complex, dynamic, and multifaceted. Family therapy is based on the idea that the family is a system of different parts.
When one member of the family struggles with mental health issues, it affects the entire family system. Family members often adapt to mental health issues by getting stuck in unhealthy behavior patterns.
This article has outlined a few of the mental health issues, family therapy techniques, and activities that can be addressed through therapy. Family therapy can help all members make positive changes and work toward individual and collective healing.
What are the main techniques of strategic family therapy?
The main techniques of strategic family therapy include joining, family mapping, modifying interactions, reframing, creating boundaries, and family sculpting (Carr, 2012).
What are the 5 stages of family therapy?
According to Carr (2012), the five stages of family therapy are building rapport, assessment, restructuring and communication enhancement, resolution/healing, and integration and maintenance.
What is the most common type of family therapy?
Structural therapy is one of the most popular and common types of family therapies used to date (Goldenberg, 2017).
References
Bowen, M. (1971). The use of family theory in clinical practice. In J. Haley (Ed.), Changing families. Grune & Stratton.
Carr, A. (2012). Family therapy: Concepts, process and practice. John Wiley & Sons.
Chambless, D. (2012). Adjunctive couple and family intervention for patients with anxiety disorders. Journal of Clinical Psychology, 65(5), 548–560.
Cleveland Clinic. (n.d.). Exposure therapy. Retrieved November 28, 2023, from https://my.clevelandclinic.org/health/treatments/25067-exposure-therapy.
Dietz, L. J. (2020). Family-based interpersonal psychotherapy: An intervention for preadolescent depression. American Journal of Psychotherapy, 73(1), 22–28.
Durante, J., Sims, J., Jarin, J., Gold, M., Messiah, S., & Francis, J. (2023). A review of practices to support better communication, counseling and adherence. Adolescent Health, Medicine and Therapeutics, 14, 97–114.
Goldenberg, I. (2017). Family therapy: An overview. Cengage Learning.
Lichtenthal, W., & Breibart, W. (2015). The central role of meaning in adjustment to the loss of a child to cancer: Implications for the development of meaning-centered grief therapy. Current Opinion in Supportive and Palliative Care, 9(1), 46–51.
Lisitsa, E. (n.d.) How to fight smarter: Soften your start-up. The Gottman Institute. Retrieved November 28, 2023, from https://www.gottman.com/blog/softening-startup/.
Minuchin, S. (1974). Families and family therapy. Tavistock Publications.
National Institute on Drug Abuse. (2023) Treatment and recovery. Retrieved November 28, 2023, from https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery.
Nelson, W., Finch, A., & Ghee, A. (2012). Anger management with children and adolescents. In P.C. Kentall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (pp. 92–139). Guilford Press.
Simon, N. M., Wall, M. M., Keshaviah, A., Dryman, M. T., LeBlanc, N. J., & Shear, M. K. (2011). Informing the symptom profile of complicated grief. Depression and Anxiety, 28(2), 118–126.
Suijit, S., Singh, O., & Aurora, M. (2020). Clinical practice guidelines for psychoeducation in psychiatric disorders general principles of psychoeducation. Indian Journal of Psychiatry, 62(2).
Szapocznik, J., Zarate, M., Duff, J., & Muir, J. (2013). Brief strategic family therapy: Engaging drug using/problem behavior adolescents and their families into treatment. Social Work and Public Health, 28, 206–223.
Williams, R. (1993). Anger kills. Random House.
Yulia, L., Mueser, K., Wyka, K., Shreck, E., Jespersen, R., Jacobs, M., Griffin, K., Gaag, M., Reyna, V., Beck, A., Silbersweig, D., & Walkup, J. (2016). Development of a group and family-based cognitive behavioral therapy program for youth at risk for psychosis. Early Interventions inPsychiatry, 10(6), 511–521.
About the author
Dr. Melissa Madeson, Ph.D., believes in a holistic approach to mental health and wellness and uses a person-centered approach when working with clients.
Currently in full-time private practice, she uses her experience with performance psychology, teaching, and designing collegiate wellness courses and yoga therapy to address a range of specific client needs.
Dealing with a family feud?
Depression is the most common mind-brain illness and affects tens of millions of Americans (Dietz, 2020).
When a crisis or trauma occurs, it impacts all members of the family. Individuals react and respond to trauma and major life events differently. Family therapy exercises can help members support and collaborate to heal from the trauma.
Grief is a very individual experience, and it’s difficult to navigate within a family unit or in a relationship.
