Family Systems Therapy

What is family systems therapy?

Family systems therapy is a form of psychotherapy in the family therapy field that approaches problem-solving through the lens of relationships, dynamics, and patterns that exist within family units. This type of therapy is often called the Bowen family systems theory of human behavior.

This therapy type views each person’s experiences and challenges within the context of the nuclear family emotional system. It considers the nuanced character of the whole family as an emotional unit and how the demands and dynamics of the system can affect human behavior.

Family systems theory assumes that the actions and emotions of each family member impact family relationships, even if the connection is not obvious at first. The focus of treatment in family systems approach may be something that clearly affects everyone in the family, such as the death of a loved one or marital conflict. Or it may be a more individual concern, such as an individual family member’s mental illness, physical, or emotional problems.

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 isn’t necessary for family systems theory to be valid; members can include people in the same family as well as significant individuals who may not live with or be related to the other members. The societal emotional process sees the conflict of human relationship systems not only in the family, but also in the workplace, like a larger family system!

How family systems therapy works

Family systems theory works largely in part by helping families and individuals 1) identify the underlying relationship patterns of the family unit, and 2) how those family patterns may shape individual and group experiences.

The identified patient is the person perceived as responsible for the family system 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.

Develop by Kerr and Bowen in 1988, Bowen’s family systems theory involves the integration of eight interlocking concepts of family systems theory including:

• Triangulation: Triangulation is the idea that while three individuals can often form a stable support network for each other, this 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 parents directing affection, frustration, or other strong emotions at the child instead of the other.
• Differentiation of Self: Family systems theory relies on the idea that people must work toward achieving balance between trusting themselves and trusting others. Differentiation of Self assumes that every person in the family system is unique and develops a sense of self that may be similar. 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 poor and strong differentiation can throw the family’s dynamics out of balance.
• Nuclear Family Emotional Process: Comprised of four relationship patterns that dictate how the family functions, these nuclear family emotional processes can overlap. For instance, impairment of a child or dysfunction of a spouse can lead to marital conflict that results in emotional distance.
• Family Projection Process: When there are disturbances in the family emotional system, and family conflict ensues, the family projection process outlines the process by which parents impart their unresolved emotional issues on one or more of their children. This process usually has 3 steps that begin with more focus on a child thinking there is an issue, detect behavior from the child that confirms the existing fear, and finally the parent treats the child as though there is something truly wrong. Ultimately, this is a self-fulfilling prophecy as the child manifests those perceived inadequacies.
• Multi-generational Transmission Process: Family systems therapy often involves an examination of how the family patterns of one generation may repeat in the next generation. For example, the multi-generational transmission process predicts that 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. This can also be looked at from the perspective of developing a greater or lesser sense of self. The level of differentiation dictates relationship patterns, lifestyles, and stable nuclear family relationships.
• Emotional Cutoff: Over the generations, the differentiation of family members may lead to increasingly significant differences in health, stability (emotional and financial), and other aspects of one’s life. Generally, more differentiation results in higher stability, but often it can instigate problems with others in the family system. Emotional cutoff is the action of creating emotional distance or cutting emotional contact with others to manage unresolved issues.
• Sibling Position: In Bowen’s family systems theory, incorporating the work of Dr. Walter Toman, sibling position intones that individuals who grow up in the same sibling position (1st born, middle, or youngest child) have predictable, common characteristics. Although differentiation will determine their behavior, the sibling positions of the parents can also affect the family process which influences the outcomes of the children.

By working with a therapist to recognize these patterns and others, family members can become aware of potentially harmful dynamics that were previously unknown. Family 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 a family systems therapy session is typically structured

As in most forms of psychotherapy, you’ll likely spend your first session or two building rapport with your therapist and naming the issues you’d like to focus on in family 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 emotional system 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 theory 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 family systems theory can help with

Bowen family systems theory 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 theory 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.

Effectiveness of family systems theory

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 to look for in a family systems therapist

While family systems therapy can be provided by a wide range of practitioners and mental health professionals (including psychologists, social workers, and 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 therapist:

• 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.

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