A Happy Home

What is family therapy and who is it for?

Writing by Ana Dorta

Artwork by Tal Doron

You’ve likely heard a lot about the many benefits of therapy—it can help you open up, tackle issues that may impact your mental well-being, and is often instrumental in overcoming challenging situations. 

When we hear the word “therapy,” we typically think of private therapy sessions. We envision ourselves sitting on a couch, one-on-one with a therapist, revealing our innermost thoughts and secrets. While this type of therapy can certainly be effective, for some individuals, a different kind of therapy can be equally, or perhaps even more, beneficial. 

According to Kelly Keck, a licensed mental health counselor and co-owner of Pleasantville Wellness Group, human beings rarely “exist in a vacuum.” There are certain dynamics and relationships that affect how good (or bad) we feel on a day-to-day basis, and the most impactful ones are often the relationships we have with members of our very own family. 

For many children and families, adding family therapy sessions to the therapeutic process can improve family dynamics and help struggling family members heal.

What is family therapy?

“Individual therapy can be a very individual pursuit, and the work you do with your clinician doesn’t always translate into what happens in the family dynamic, especially if it isn’t being communicated back to the family,” says Keck. “The family piece is going to be way more inclusive, and it’s going to hold every part of the family accountable; they all have to do the work.”

Elliot J. Rosen, Ed.d., a licensed marriage and family therapist with Scarsdale-based Westchester Parenting Coordination, says family therapy and individual therapy address different issues. 

“Oftentimes, in family therapy, what we say is that we’re looking for interpersonal issues as opposed to intrapsychic issues,” he explains. “Family therapy is focused on relationships. While individual therapy, which certainly addresses relationships, is most typically geared to intrapsychic things that are our own personal issues, our own personal psyches, and what our experiences are.”

Family therapy is often a second step and tends to supplement individual therapy sessions. It’s often prompted by a child who is struggling, and this child should also continue to receive individual treatment during the family therapy process. 

Who should consider family therapy?

If you’re a family with a child who is struggling to communicate with their parents or siblings, with a child who has significant developmental or educational disorders, or with a child who is demonstrating nonpreferred behaviors, you should consider family therapy.

“If one of those children is taking up a lot of air in the household and requires a ton of attention and time, everyone will likely benefit from family therapy,” Keck says.

Family therapy can also address certain family dynamics that might have caused problems for generations. 

“We look at the structure of the family, the parenting, the sibling relationships, as well as intergenerational issues,” Rosen explains. “The parents’ history can have an impact on the present family functioning. Sometimes there are themes that go from generation to generation.”

Additionally, he says, families experiencing particularly difficult circumstances will also benefit. For example, a death in the family or an estranged adult child can affect the entire family dynamic. In these situations, family therapy can help everyone process their emotions together while learning how to understand and support each other during challenging times. 

This is true for families with young children, teens and even adult children. Rosen explains that significant issues with adults in a family often arise after unforeseen circumstances, like the loss of a loved one. 

“Issues that may have been unidentified, covert or avoided now rise to the surface and can no longer be ignored,” he explains. “Working with a family of adults can be challenging and complicated. It’s not at all unusual to observe a family who seems as though they’ve regressed 20 or 30 years and are fighting the same battles that never were resolved.” 

There are some situations, however, in which family therapy may not work or for which it cannot be the only solution. 

“Family therapy is less helpful when there are members of the family who have severe psychiatric illness,” Rosen explains. “For example, if a child has been diagnosed as schizophrenic, borderline personality disorder or has severe symptoms of anorexia, those kinds of illnesses are treated individually.” 

In those circumstances, Rosen explains, it is always necessary for family therapy to supplement traditional treatment. In other words, it cannot be the sole solution. 

Rosen also suggests that it often comes down to picking the right therapist. 

“If you feel like the person gets it, that, to me, is so important.”

What to expect

Family therapy sessions function a bit differently than your traditional individual therapy sessions. After a clinician suggests family therapy (in conjunction with individual therapy), they will usually reach out to the family therapist to share relevant information about the child’s background. And they’ll often remain in contact throughout the process.

From that point, family members meet together with the therapist. During the initial session, the therapist will normally ask about the family’s history. They’ll want to know what a routine day in the household looks like and what triggers might impact the child or the family dynamic. 

All family members are given the opportunity to share their thoughts and emotions, which helps the therapist determine what may be causing a child or family to struggle. 

Similar to traditional therapy, the goal of family therapy is for all members to learn strategies and tools they can employ at home to help shift overall dynamics. 

But in order to do so, transparency is key, even when a session might feel draining or exhausting. The end goal of family therapy is a shift in dynamics, something that takes patience, cooperation and vulnerability from all parties involved. 

Hesitant? You’re not alone.

While many families ultimately find therapy beneficial, they’re often hesitant to give it a try. There are logistical challenges, such as finding time in busy schedules for all family members to meet, but the greatest obstacles are generally emotional and/or some family members’ reluctance to buy in.

“Everyone has to hold some semblance of responsibility when you’re sitting in family therapy,” Keck says. “I think that piece is difficult for a lot of people. The idea that everyone needs to do some work versus the individual child doing the work on the thing that they’re coming in for.” 

Rosen says siblings often tend to be the most reluctant members to participate. 

“When there’s a problem with a kid in a family and one kid is acting out more than another or the others, very often the siblings will say, ‘I don’t want to be there. I’m not the problem. He’s the problem.’” 

However, Rosen says, it’s essential for everyone involved to understand the value and buy-in to the process for family therapy to work. 

And sometimes, according to Keck, clinicians are reluctant to suggest family therapy because they fear parents might think the recommendation is the therapist’s way of blaming the parents for their child’s struggles. Despite this concern, however, an increasing number of clinicians are recommending this approach. 

“Without a doubt, more people are using family therapy than I’ve seen in my career,” Keck says. “It’s great that parents are open to being a part of this process. I think they’re going to see quicker results and longstanding results in the mental health of their children if they’re also involved in the process.”

The results are noteworthy

According to the American Association for Marriage and Family Therapy (AAMFT), “since 1970, there has been a 50-fold increase in the number of marriage and family therapists. At any given time, they are treating over 1.8 million people.” 

And the Cleveland Clinic found that almost 90 percent of people “report an improvement in their emotional health,” and nearly 66 percent report an “improvement in their overall physical health,” thanks to family therapy. 

“When I speak with parents about family therapy, they say the process of interacting with their child with a clinician present has been eye-opening for them,” says Keck. “It’s given them a very active place to sort through what they wouldn’t have seen otherwise.” 

This article was published in the March/April 2024 print edition of Connect to Northern Westchester.