Family and Systemic Therapy

What is family and systemic therapy?

Family and systemic therapy is often just called family therapy. It is a talking therapy that can include more than one person. You look at how you affect each other, care for each other and deal with problems.

Here, family means any group of people who see themselves as one and matter to each other. It can be a couple or a parent and an adult child. It can also be brothers and sisters or other relatives.

Systemic means seeing each person as part of wider systems, such as a family, a workplace and a community. In this view, what one person does affects the whole system.

Histories of family therapy usually date it from the 1960s. It grew out of research in the United States in the 1950s into how families communicate.

Sources: AFT: family and systemic therapy, Beels 2002, Ray 2019

How it works

A family therapist looks at the patterns between people, rather than at one person's faults. Each person's view is part of the picture.

The aim is not to blame anyone. It is to help people work together in ways that feel safer and kinder.

Some therapists work in a team. A colleague may watch the session and share their thoughts with you part way through. In some NHS services, the team sits to the side or behind a one-way screen.

Sources: AFT: family and systemic therapy, AWP: systemic family therapy

What sessions look like

A session usually lasts from 50 minutes to an hour and a half. It depends on who comes. Sessions with children may be shorter, with time for play and drawing.

A typical course is six to eight sessions, in person, online or by phone. On the NHS, you are likely to be offered around six.

You do not all have to talk together from the start. Some people see the therapist alone first, to decide what they want to share.

You can also come on your own. Then the therapist looks at your problems in the light of your relationships, family history and culture. You do not need a diagnosis to start.

Sources: AFT: family and systemic therapy, AFT: individual therapy

Who it may suit

It can be a good fit if:

• The same argument keeps coming back, whoever starts it
• One person has become "the problem", and everyone is worn out
• A separation, a new step-family or a death has changed who belongs where
• You and a parent or an adult child want to talk about the past without a fight
• Brothers and sisters disagree about the care of a parent
• You want to change your part in a family pattern, even if nobody else will come

Joint sessions are not the place to start if someone in your family frightens you. Respect, a domestic abuse charity, says couples therapy is not safe when a relationship is abusive.

Family therapists have a duty to protect each person's needs. That can mean seeing someone alone.

Internal family systems therapy shares some of the words, but it is a different approach. It looks at the parts inside one person, not at the people in a family.

Sources: Respect: domestic abuse support, AFT: code of ethics

Structural family therapy

Salvador Minuchin and colleagues developed structural family therapy in the 1960s. It is used most in services for children and families.

It looks at who is in charge in a family, the smaller groups within it and the boundaries between them. Parents are one of those smaller groups.

The therapist may ask family members to talk to each other in the session. That way, a pattern can be seen and then changed. It also inspired the Maudsley approach, a family therapy for young people with anorexia.

Sources: Minuchin Center: structural therapy, PCIT International: overview, Vetere 2001, Jiménez et al. 2019, Nichols & Fellenberg 2000, Carr 2025

Parent-child interaction therapy

Parent-child interaction therapy, or PCIT, is for parents of young children whose behaviour is hard to manage. It is meant for children aged about two to seven. Sheila Eyberg developed it in the 1970s.

A therapist watches from behind a one-way mirror. They coach the parent through a small earpiece as the parent and child play. First the child leads the play, then the parent does.

For children who stammer, speech and language therapists use a different approach with a similar name.

ViaCara is for adults. If you want PCIT for your child, start with our pages for under-18s and their families.

Sources: PCIT International: overview, Lieneman et al. 2017, Funderburk & Eyberg 2011, CPFT: speech and language therapy

What NICE covers, and where it stops

NICE's recommendations for family therapy are mainly for children and young people. It says "offer" when the evidence of benefit is clear and strong. It says "consider" when the benefit is less certain.

For adults, NICE does not recommend family therapy for depression or eating disorders. It does not recommend it for post-traumatic stress disorder or obsessive-compulsive disorder either.

For depression, NICE says to consider behavioural couples therapy when a relationship is part of the problem. That is a behavioural approach, not a systemic one.

For adults with psychosis or bipolar disorder, NICE says to offer family intervention to the families they live with. This page does not cover that work.

Sources: NICE: guideline decisions, NICE NG69, NICE NG134, NICE CG115, NICE CG158, NICE NG222, NICE NG116, NICE CG31, NICE CG178, NICE CG185

Finding a family therapist

Family therapists train for four years, part time, to master's level. Most already work in health or social care when they start. The Association for Family and Systemic Psychotherapy (AFSP) accredits the courses.

Once qualified, they can join the register kept by the UK Council for Psychotherapy. The Professional Standards Authority accredits that register.

Anyone in the UK can call themselves a psychotherapist or a counsellor. So check that your therapist is on an accredited register.

On the NHS, it is offered by children's and adult mental health services. Services vary across the UK, and waiting lists can be long. The AFSP suggests asking your GP what is available near you.

Ask whether a therapist sees families together, one person alone or both. If you hope to bring others in later, say so at the start.

Sources: AFT: routes to training, PSA: UKCP register, POST: regulation of professionals, PSA: accredited registers, AFT: accessing therapy

The evidence

A 2016 review pooled 37 trials of systemic therapy for adults with a mental health condition. It did better than no treatment, and about as well as other established talking therapies. The authors said the number of trials was still limited.

A 2025 review of 30 trials in adult depression found the same pattern. Many of those trials were small. The authors also noted that systemic therapy is a broad group of approaches, not one method.

For anorexia, a 2019 Cochrane review found a small amount of low-quality evidence. It suggested family therapy may beat usual care at first. Too little evidence exists to compare it with other talking therapies.

Our family relationships page starts from what is happening at home, rather than from the name of a method.

Sources: Pinquart et al. 2016, Vossler et al. 2025, Fisher et al. 2019