Family Systems Therapy

What is family systems therapy?

Family systems therapy is a form of psychotherapy that approaches problem-solving through the lens of relationships, dynamics, and patterns that exist within family units.

This therapy views each person’s experiences and challenges within the context of all the other people in the family. It also considers the nuanced character of the family unit as a whole.

Family systems therapy assumes that the actions of each family member affect all the members of the family, even if the connection is not obvious at first. The focus of treatment in family systems therapy may be something that clearly affects everyone in the family, such as the death of a loved one. Or it may be a more individual concern, such as one family member’s mental illness.

In either case, a family systems therapist helps members create positive change around the issue at hand by recognizing, analyzing, and learning to rewrite deeply ingrained family dynamics.

It’s also important to note that being biologically related or living in the same household aren’t necessary for family systems therapy; family members can include significant individuals who may not live with, or be related to, the other members.


How does family systems therapy work?

Family systems therapy works in large part by helping families and individuals 1) identify the underlying patterns of the family unit, and 2) how those patterns may shape individual and group experiences. A few of the common theoretical concepts often used in family systems therapy include:

  • The identified patient: The identified patient is the person who is seen to be responsible for the family’s seeking therapy. This may be someone with a challenging mental, behavioral, or physical condition. In many cases, the identified patient is a child. Part of the goal of family therapy is to help the family avoid scapegoating the identified patient and look for other areas of family dynamics that may be contributing to problems.

  • Self-differentiation: Family systems theory relies on the idea that people must work toward achieving balance between trusting themselves and trusting others. If one member of a family is too willing – or not willing enough – to sacrifice their perspective and ideas to the perspectives and ideas of the other members, this can throw the family’s dynamics out of balance.

  • Multi-generational dynamics: Family systems therapy often involves an examination of how the patterns of one generation of a family may repeat in the next generation. For example, a woman who grew up with an overly strict mother may play this same role with her own children, even if she does not wish to do so.

  • Triangulation: Triangulation is the idea that while three individual can often form a stable support network for each other, this particular family arrangement can also lead to two individuals allying against or scapegoating the third individual. For example, two siblings may view themselves as the responsible ones in the family and define their third sibling as a “problem child.” It’s especially common for a child to become triangulated in their parents’ relationship, with one or both of the parents directing affection, frustration, or other strong emotions at the child instead of the other parent.

By working with a therapist to recognize these patterns and others, family members can become aware of potentially harmful dynamics that were previously unknown. Therapy sessions provide a safe space for all members of the family to learn about the family’s patterns, work through any conflict, and try out new roles and patterns that may serve the family and individuals better.

The therapist can moderate sessions as needed, and make sure that everyone’s voice is heard and addressed equally in treatment.

How is a family systems therapy session typically structured?

As in most forms of psychotherapy, you’ll likely spend your first session or two building rapport with your therapist and identifying the issues you’d like to focus on in therapy. You may spend some sessions doing individual work, or in small subset groups with other family members.

From there, the therapist guides the family unit in developing a treatment plan that addresses the goals of all the family members. Activities within sessions may vary widely. You’ll likely work together to identify the underlying structures and patterns in your family, and come up with ideas for creating positive change. You may also engage in role-playing activities or communication exercises to work toward understanding the perspectives and emotions of the other members of the family. Additionally, many family systems therapists assign written or behavioral homework between sessions, which you may be asked to complete individually or as a group.

Generally speaking, a family systems therapist will not pass judgment or side with any particular member(s) of the family. Rather, the therapist’s role is to advocate equally for all members of the family and guide the family unit in reaching its own conclusions about the best courses of action.

Family systems therapy usually takes place over multiple sessions, which may include some sessions with the entire family present and others with only individuals or subsets of the family.


What mental health conditions is family systems therapy good for?

Family systems therapy is often used for families in which a child or a teenager is experiencing a mental health or behavioral challenge. That said, family systems therapy can be a helpful tool for just about any family in which members are experiencing conflict or distress related to their family relationships. This may be particularly true when the entire family has experienced a loss, trauma, or other major change such as divorce or remarriage.

Because individual mental health concerns are often linked to family relationships, especially as experienced in childhood, family systems therapy can also be used as a treatment for issues that outwardly seem to affect only one individual. These conditions might include substance use disorders or other addictions, eating disorders, trauma-related conditions, and personality disorders.

How effective is family systems therapy?

Studies have shown family systems therapy is very effective for a variety of mental health conditions affecting both children and adults.

A 2016 review by researchers in the United Kingdom synthesized the findings of several studies to reveal it is a helpful, cost-effective treatment. Some studies have also suggested that it can be helpful in families where one or more members are struggling with physical health conditions.

What should I look for in a family systems therapist?

While family systems therapy can be provided by a wide range of practitioners (including psychologists, social workers, counselors), family systems therapists are often licensed marriage and family therapists (LMFTs).

Regardless of their exact certifications, look for these qualities in a family systems therapists:

  • Advanced training and experience working specifically with families

  • A therapist who has experience with the particular kind of issue or family structure you’d like to address, such as:

    • Divorce

    • Children with behavioral challenges

    • Trauma

    • Substance abuse  

It may be helpful to get input from all involved members of the family, to make sure that everyone is comfortable with the therapist and engaged in treatment from the start.

Find family systems therapists near you

Find therapists who are specialized and trained in family systems therapy on Zencare, below. Search by insurance, fees, and location; watch therapist introductory videos; and book free initial calls to find the right therapist for you!

New to therapy? Learn about how to find a therapist here.