LuAnn Pierce, LCSW: There really isn’t a set timeframe for family therapy. Like any therapy, the initial sessions are spent getting acquainted and building rapport. In family therapy, the therapist is establishing relationships with more people and that is critical. Every member of the family needs to feel safe before s/he will speak openly. So, in essence, that can impact how long it will take to make progress.
In addition to establishing trust, another factor that determines the length of time is what issues are being addressed. For families who are learning to set limits for teenagers, therapy may take four to six sessions; if the teenager has behavioral or emotional concerns it could take longer. Families who are dealing with sexual abuse of a child could be in therapy for years. It is not unusual for the family to come in for one reason, and discover other issues that need to be addressed.
In general, therapy has a beginning, middle, and an end. In the beginning stage, you are getting acquainted and building trust. During this time, the therapist is assessing the concerns to determine how to proceed. Once the therapist has a good understanding of the issues, s/he will work with the family to set goals for therapy.
The middle stage of therapy is when the real work happens. There will usually be open discussion about the issues, learning new skills, homework to practice the new skills, and reporting on what is and isn’t working to determine what needs to be tweaked. This stage should continue until you find solutions that work.
The end stage is a time to monitor progress and ensure that things continue to improve, which usually decreases how often you come in for sessions until you decide it is time to end therapy. Some people come back periodically for check-ins.
Darren Haber, MA, MFT: I know we live in hectic times, but change requires weekly sessions—I believe—because change is difficult on an individual level, and with couples or families it can be very difficult.
A family is a “system,” and any systemic change requires a team effort that is consistent, dedicated and patient. It’s like learning a completely new language that each family member can speak and understand. Since most families come to therapy as a last resort, when all else has failed—often in the midst of a crisis—when longstanding problems are threatening to break the family apart, the process requires even more patience and dedication. First, the fires have to be put out before the underlying fractures and ruptures can be defined and healed so that this new language—this different way of relating—can become established.
In general, I think that given the complexity of the family system, or network of relations—especially if some or all of the family is new to therapy, which has a learning curve of its own—families should expect to commit, at the very minimum, six to nine months. And, this means weekly sessions since consistency is so essential.
Of course, every family is different and some are more adaptable than others. Most, however, are resistant to change. This belief comes from my specialization in addictions, which can cause severe trauma and family wounding. Twelve months as an initial commitment to family therapy would be even better.
Keep in mind that these are suggestions since each situation, each family, and each specific problem will correspond to very different time commitments. And honestly, it’s very hard to predict how specific systems will respond to certain interventions. Psychology is an art as much a science, and due to the complexity of family work, which is a collaboration between therapist(s) and participants, it is very difficult if not impossible to pin down a timeline.
Perhaps an even more pithy response to the question would be: as long as it takes to meet the goals that everyone agrees are the bottom line. For instance, being able to communicate without attacking or avoiding each other, or being able to take a vacation or have dinner together with some semblance of unity, and so forth. It often takes many years for dysfunctional and dysphoric patterns to establish themselves in families; patience is required to untangle them and build new ones. But it is possible, and the changes can be liberating indeed.
Deborah Klinger, MA, LMFT, CEDS: The answer to this is: it depends! It depends on a number of factors, such as the nature of the issues that brought the family to therapy, how individual family members are affected by the issues, how long the issues have been around, and the family’s ability to cope well with adversity.
Family therapy typically is shorter-term than individual therapy. Often, family therapy begins when one family member displays a behavior or develops a problem that calls for professional help—substance abuse, for example. In that case, the family member might be in individual therapy, with family therapy as an adjunctive treatment. Sometimes a child’s behavioral problems motivate a family to seek therapy, and all family members participate in family therapy as the primary treatment modality. In other cases, a change that affects the whole family might cause a sub-group of the family to seek family therapy. For example, the parents divorce, and one parent opts for family therapy with the children.
Families who function well—that is to say, they are flexible and adaptable to change and have effective tools and resources for navigating challenges—are likely to need less time in therapy than those who lack healthy coping strategies and whose responses to challenges tend to be rigid. The latter types of families need more time in therapy to learn skills and acquire tools for handling challenging situations, dealing with uncomfortable emotional states, and navigating interpersonal relationships.
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