What Happens in Family Therapy?

Family therapy for addiction or mental health conditions may come as an unexpected aspect of treatment. If you’re not the one getting treatment, why are you getting involved? Many families initially wonder the same thing.

Many family members also want to, and would, do anything to help their loved one get better. If that means going to family therapy, they’ll do it in a heartbeat, even if it’s unexpected. Others may feel more skeptical and resistant, depending on the nature of their family dynamics and their mental health literacy. 

However, each group will likely have the same question: what’s family therapy like? What happens? 

We’ll help you learn more about it and what to expect in this article. You can also explore more about family therapy and group work by listening to our recent podcast episode with Dr. Claudia Black.

What Is Family Therapy?

Some family members first assume family therapy means hearing everything they did wrong and getting blamed for their loved ones predicament. That’s false. If behaviors from family did contribute to the patient’s condition, that will likely come up, but in a respectful, compassionate way. Family therapy isn’t a trick for the patient and their therapist to gang up on family members—it’s meant to restore loving relationships and heal their family dynamics.

The therapist, psychologist, or counselor who leads family therapy strives to help both the patient and their loved one verbalize and work through problems with respect and love, not judgment or blame. Through open communication, patients and their families can resolve issues, forgive, and learn how to modify potentially harmful behaviors. 

Many treatment centers strongly suggest and offer family therapy as part of their core treatment. That’s because family therapy has the power to heal relationships, improve the support system of the person in treatment, and give the whole family unit hope in recovery. You can also attend family therapy as a stand-alone service, without your loved one being in a residential or outpatient program.

Goals and Reasons for Family Therapy

The ultimate goal of family therapy is to help the person in treatment get better. Since family is often an extension of ourselves, their involvement in this healing is often crucial. 

And, after patients leave treatment, the closest and most impactful support system they return to is often their family. Discussing concerns, past issues, and resolving conflict in family therapy can create a stronger support system for when they get back. 

Another crucial reason for family therapy is to give loved ones the chance to heal. They often have their own recovery journeys to walk, even if they weren’t the one struggling with an addiction or a mental health concern. For example, some family members fall into codependency as a way to have some grasp at control over their loved one’s condition. Family therapy can help you recognize your own recovery needs and process the experience of your loved one’s condition without guilt, anger, or self-responsibility.

What Family Therapy Looks Like: First and Continuing Sessions

Family therapy typically begins once your loved one has stabilized, expressed approval for family therapy, and has shown initial progress in their treatment. This means your sessions could start anywhere from a couple weeks to 1+ months after they admit into treatment. It’ll depend on their preferences and progress. Once they’re ready and their treatment team determines it beneficial, you’ll come in for your first session.

Before that, you’ll likely meet with the family therapist to go over expectations, ask questions, and become more comfortable in the space. This might happen as soon as your loved one admits into treatment or just before your first official session.  

First Session

Your very first family therapy session will likely include these key parts:

1. Setting expectations together.
2. Agreeing (and even signing a written contract) on how you will conduct yourself and treat others in your session. For example, you may all sign a contract promising to listen without interrupting or to not raise your voices.
3. Outlining what your goals are for family therapy and how the therapist will know if they’re being met.
4. Defining a direction and plan for your future sessions.
5. If time allows, diving into how everyone’s feeling and any conversations they’d like to have now, or something they’d like to understand about their loved one in treatment.

You’ll likely sit in a small, private room—probably the therapist’s office, or the designated family therapy room if the treatment center has one. Your sessions will stay confidential and what’s shared won’t leave the room. Before you leave, your therapist may check in with how you’re all feeling and how you think the session went.

Continuing Sessions

Treatment centers vary in how often they provide family therapy. Some will schedule it once a week or once every couple weeks; others will designate 3-5 consecutive days for loved ones to engage in education and family therapy. This format is called a family week, or family program. Family programs often split their focus between 1) education and multi-family support groups and 2) family therapy with the patient and their loved ones. 

If your loved one isn’t participating in a residential or outpatient treatment program and instead attending family therapy as a stand-alone treatment, your sessions may be more regular and adaptable to your schedules. For example, you could request weekly or bi-weekly appointments. 

In continuing sessions, you’ll build off the goals and outlines set in your first session. They may also flow more organically, addressing issues as they arise or as they come to mind. For example, you may talk about something that happened recently or, during your session, your discussions may remind you of a past event you want to go over.

You’ll check in continuously with others and the therapist to ensure you’re meeting the goals set in the beginning, and that you’re finding the therapy beneficial. If you have changes or suggestions in mind, you may discuss these at the very beginning or end of the session.