Family Systems Therapy

Authored by Helen Parson

Edited by Alexander Bentley


Reviewed by Dr Ruth Arenas Matta

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An individual’s family affects who they are and who they become. A family unit influences a number of habits and how a member sees the world. It can also teach a family member a variety of customs and cultural norms. Just as the family can have a positive effect on an individual member, it can also affect them negatively. The family unit is an area in which a number of mental health issues can begin. Individuals can have a variety of unresolved problems created and existing in their family units.

Family systems therapy is used to combat these issues and help people resolve the problems that exist. Family systems therapy is a form of psychotherapy that enables members of a family to work together to understand the dynamics of the group. It also sheds light on each individual’s actions and how those affect the entire family unit.

Origins of family systems therapy

Family systems therapy had a number of influences in its development. One of the most significant individuals in the realm of family system therapy was Dr. Murray Bowen. Bowen was a medical doctor with a focus on psychiatry. His decision to work in the psychiatry field came thanks to working directly with patients as a military doctor during World War II.

Bowen’s research focused on the family and it being an emotional unit. He released his family systems theory in the late 1960s and his research investigated family patterns of individuals suffering from schizophrenia who received treatment along with his own family of origin.

He discovered that what one family member experiences can and does affects everyone in the group. Bowen’s work also found that the family is interdependent on each individual within the group, and that each member has a far reaching emotional bond directly impacting other immediate and distant members of the same unit. If one individual feels a disconnection from their family, then it is likely caused by trauma. Family can impact individuals in major ways both good and bad. Damage can be caused within the family unit due to members seeking validation from others. For example, a son seeking his father’s love. If validations and approval are not achieved, long lasting damage can be created.

How does family systems therapy work?

Family systems therapy sessions enable families to work individually and as a unit to find solutions to problems that affect one or multiple members. Sessions allow each member to share and express their thoughts and feelings. The family works together to resolve the problems and relieve the issues and stressors they experience.

An individual will explore their role within the family unit during family systems therapy sessions. They will also learn how to support others in hopes of rebuilding a healthy unit.

Bowen claimed that each individual’s emotions, behaviors, and personality was based entirely on their birth order. Birth order results in an individual’s role in their family of origin. It also influenced their coping mechanisms and abilities to deal with emotional family issues. A family is more than just each individual. It is about how each member affects the others and the interactions that occur.

When is family systems therapy used?

Family systems therapy has been helpful for people suffering from mental health issues including:

  • Depression
  • Bipolar disorder
  • Anxiety
  • Addiction
  • Personality disorders
  • Eating disorders


Psychological problems often manifest early in life and yet not present until teenage or adulthood.

Family systems therapy is designed to help families struggling with conflict. Individuals and couples experiencing problems as a result of their families of origin may benefit from the therapy as well. In addition, families with members suffering from physical or mental disabilities have been found to benefit from family systems therapy.

Family systems therapy in the context of addiction

According to Chicago-based Shereen El Gazzar, a leading Marriage and Family Therapist, “Traditional therapy views the addict as the “identified patient” or “the problem,” and treatment tends to focus solely on getting the addict to be sober. However, family therapists hold a different view. They carry a systemic lens, which means they view the addict as ‘a whistle blower’ who shows that something is not right within the family system.

In other words, there is an unspoken emotional wound within the family and the addict is the symptom bearer who brings the issue to the surface to be dealt with. This is not to assign blame to the family. Oftentimes, they are exhausted and they are doing their best—and yet, they feel stuck in an unhealthy cycle.

Family systems therapy views addiction as a ‘we’ problem instead of a ‘me’ problem and seeks to restore support, trust and harmony among family members.”

Families affected by addiction

Humans in general are meaning makers. They like to make meaning or have a story around their experience or what they are going through. When families come to treatment, El Gazzar says “they usually view the addict as: “selfish”, “liar” and “inconsiderate.” And equally, the addict sees their family members as “punitive,” “invalidating,” and unempathetic to the pain they are going through.

In other words, each member carries an internal construct of the other as the “bad” one—and anger or apathy is the bi-product of their thinking. As a family therapist, my role is to undo this dynamic. I intervene on an interpersonal and intrapsychic level.”

Top Tips for Families Affected by Addiction

According to expert family addiction therapist Timothy Harrington from, the three most important things to remember for a family affected by addiction are:

1. Make the same effort you expect your loved one to make on their journey toward optimal health.

2. Work with a family system specialist that empowers you right away with tools that help you model what it’s like to be healthy in an adult relationship with a person who’s not doing what you want them to do.

3. The focus of the family system recovery process is connection, not direction, meaning that we get to focus on how we are like the person experiencing addiction, not how we are different.

Family Systems and Addiction Prevention

Family Systems can be used effectively in addiction prevention according to Dr. Gilberto Gerra, an addiction expert who runs the Drug Prevention and Health Branch for the United Nations Office of Drug and Crime (UNODC). Dr Gerra notes that as many as “two-thirds of all people in treatment for addictions report an element of childhood emotional trauma”. And that, “addiction is one dysfunctional response to this unhealed trauma”. Dr Gerra and the UNDOC have four simple steps all parents and guardians can use to dissipate the cumulative effect of emotional neglect.

  1. Share your undivided attention, start small and then scale up.
  2. Model support and relational engagement
  3. Provide real supervision, and don’t give up when it gets tough
  4. Regular digital detox periods in the home


Benefits of family systems therapy

Family systems therapy is a holistic approach designed to heal individuals and families. One of the main benefits of family systems therapy is getting members of a family of origin to sift through their problems. A mental health professional leads the members of a family through the journey of healing. With their guidance, individuals are able to work on their issues in a safe environment.

There are a number of benefits to using family systems therapy, including:

  • Further understanding of healthy boundaries
  • A better understanding of family patterns and dynamics
  • Improved communication
  • Better problem-solving skills
  • A strong sense of empathy
  • Greater anger management skills to reduce conflict


But how does family systems therapy bring a family closer together and quell issues within it? Through the use of family systems therapy sessions, individuals and groups can find:

  • The family is brought closer together after an issue or crisis
  • Honesty is created among family members
  • Builds trust between family members
  • Develops a supportive family network
  • A reduction in the sources of tension and stress the family experiences
  • Helps family members forgive and move on from conflict
  • Enables family members to return from isolation


Dialectic Behavior Therapy

Dialectic Behavior Therapy, or DBT, is an evidence-based treatment that offers plenty of skills that can be helpful for couples and families. One of the pillars of DBT is mindfulness. It suggests that people become aware of what is happening within them and between them. Then, they choose to proceed wisely in order to disrupt old patterns of destructive behavior.

As a specialist DBT Practitioner El Gazzar explains, “for example, if a person feels angry, the first step is to slow down to name their anger and notice where it manifests in their body. They also become aware of their urge to argue with their partner, but instead they use their wise mind and decide not to act on their impulse. It is not always easy to take the higher road. Therefore, DBT offers plenty of skills to regulate emotions such as: paced breathing—inhaling for a count of three and exhaling for a count of five. This helps to calm the nervous system down. Other options are: exercising and tense muscle relaxation. These are skills that help one return to an emotional baseline instead of being angry at a partner or a family member.”

Why does family therapy work?

Family systems therapy enables individuals and their families to create healthy relationships. Many of the individuals who experience the therapy have not had healthy relationships with their family members in the past. Through the therapy, they are able to create a network of positive communication and maintain it.

Individuals can see each problem through a lens and learn how it affects everyone. Families are able to reach the root of their issues and heal from the ground up. Problems within families can be complex and range from drug and alcohol addiction to mental health issues to tragic events. Family systems therapy has been proven successful and has helped a large number of families. Perhaps more importantly, it has helped individuals recover from the conflicts that caused their problems in the first place.

What is Family-Based Therapy for Eating Disorders?

Adolescents with eating disorders may undergo family-based treatment to heal issues such as bulimia and anorexia. Also known as the Maudsley method, family-based therapy also focuses on other feeding and eating disorders experienced by kids and teens.

Family-based therapy is often delivered to clients in an outpatient setting by trained professionals. Clients attending residential treatment centers and partial hospitalization may also under go family-based therapy for eating disorders. Family-based therapy should be considered as a first-line offering for young people suffering from eating disorders.

How does family-based therapy work?

Family-based therapy was developed at London’s Maudsley Hospital. It primarily focuses on the improvements of weight restoration and the normalizing of a person’s eating behaviors and patterns. The observations take place at the individual’s home with the family completely involved in the process, treatment, and delivery.

Parents are responsible for giving clients a majority of the treatment. They take responsibility of their adolescent’s during the first stage of the treatment. Family-based therapy is a combination of treatments that have been used to heal young people suffering from anorexia.

Unfortunately, nearly 50% of parents of adolescents suffering from anorexia discontinue family-based therapy treatment due to ongoing psychological distress, further eating disorder symptoms, and possibly a decrease in the communication within the family.

What are the benefits of family-based therapy?

Family-based treatment has plenty of positive benefits. For one, it could possibly prevent hospitalizations along with the potential of further medical trauma. Weight restoration can be quicker by treating adolescents at home.

The cost of treating a child at home of their eating disorder is much lower. Parents can certainly benefit from the price of at-home treatment over residential care, hospital stays, or in-patient programs to treat eating disorders.

Moreover, parents can provide a strong backbone to the treatment. Bonds between parents and children enable the adolescents to be empowered during the treatment process.

The road to recovery

Parents lead family-based therapy from the beginning. They will be aided and supported by specialists in eating disorders. The specialists will offer advice about food and meals. Parents and the adolescent’s clinical team will typically meet weekly to map out the route to recovery.

Prior to family-based therapy beginning, parents will speak with a therapist and psychiatrist. Families are usually encouraged to eat meals together in their “therapy room”. Meals may be videoed for the clinical team to view and give feedback.

Family-based therapy sessions target the adolescent’s eating disorder straight on. The child or teenager is unlikely to enjoy being confronted about their eating disorder. Conflict may result in the short-term. Parents shouldn’t negotiate or deter from their goals. By sticking to the plan, conflicts should be resolved quickly.

There are three phases to family-based therapy. These phases include:

  • Weight restoration
  • Returning the control of eating to the child/teen
  • Creating a sense of identity


Having the support of loved ones at home has been proven successful for adolescents recovering from eating disorders. With the support of skilled professionals, parents can help their children recover from the dangers of an eating disorder.


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