Couples, family & group therapy

Family therapy can include parents, children, siblings, grandparents or other loved ones. It can improve how a family works together, or support a family when one member is struggling.

Couples therapy helps partners with communication, trust, parenting, money, intimacy and how a mental health condition affects the relationship.

Group therapy brings several people together with a trained therapist. Peer support connects you with people who have lived through similar struggles. Both can ease the feeling of being alone.

• Functional family therapy: often for children’s behaviour, improving communication and parenting
• Strategic: short-term, focused on practical changes
• Structural: looks at boundaries, who holds authority, and patterns, using real family interactions in the room
• Systemic: sees the family within its wider world, like culture, faith and money stress

• The therapist asks each person about their concerns and goals
• Everyone practises listening and saying how they feel
• The family notices unhelpful patterns and tries new ones
• If someone has a mental health condition, the family learns about it together

Family therapy averages about 12 sessions for short-term issues; complex issues can take months or years. You and the therapist set goals and the schedule together. It is usually led by a Licensed Marriage and Family Therapist (LMFT), but also psychologists, social workers or counselors.

Family therapy can help with conflict, grief, divorce, big changes, a family member’s illness, or supporting a neurodivergent family member.

In parent training, parents learn ways to encourage helpful behaviour in children, often using praise and rewards for steps in the right direction. Therapists can also coach parents on working with schools.

Some children’s therapies, like Trauma-Focused CBT, include sessions with the child and caregiver side by side, plus joint sessions. See the Therapies for trauma guide.

Teens often do best when they feel respected and have a say. Some teen therapies, like adapted versions of DBT, bring family members in. Teens can ask the therapist what stays private and what parents will hear.

The Gottman Method, developed by psychologists John and Julie Gottman, identified four patterns that predict trouble, which they call the “Four Horsemen”: criticism, defensiveness, contempt and stonewalling. Therapy involves assessment, feedback and practical tools to manage conflict and build friendship.

Emotionally Focused Therapy, closely linked with psychologist Sue Johnson, is based on attachment: our deep need to feel safe and connected with the people we love. It helps couples spot the negative cycle they get caught in and reach for each other in new ways.

• A big change (a baby, illness, loss) has shaken things
• Closeness has dropped, and you feel more like roommates
• Mental or physical health concerns are affecting you both
• The same arguments keep going round in circles
• Trust has been hurt
• You want to strengthen a good relationship

Both partners need to be willing to take part and do the work. Practising skills at home, like planned time together, keeps sessions from turning into venting. Counselling can also help a couple decide whether separating is the healthiest path.

The National Domestic Violence Hotline offers free, confidential support. Call 1-800-799-7233 or text START to 88788.

One-to-one therapy gives you a private space to talk about what is happening and plan your next steps, at your pace. See the Domestic violence: the basics guide.

• Feeling less alone: others “get it”
• Learning from other people’s experiences
• Often cheaper than individual therapy
• Practising communication skills in a safe space
• The boost of helping someone else

Several studies suggest group therapy is as effective as individual therapy. It may take a few sessions before you notice change. Many approaches, like CBT, ACT, CPT, DBT skills and IPT, can be run in groups.

Most groups agree to keep what’s said private. You don’t have to share everything at once. Many people find it easier after a session or two.

• Better quality of life
• Feeling more engaged with and satisfied by services
• Fewer hospital readmissions and inpatient days
• Stronger self-management

• Community mental health and recovery centers
• Online peer groups (check they are moderated and safe)
• Peer-led support groups run by mental health nonprofits
• Some hospitals, clinics and veterans’ programs

Supporting someone can be tiring. Peer support groups for families, and therapy for yourself, can help you keep going.

Licensed Marriage and Family Therapists are specifically trained to help couples and families. Psychologists, clinical social workers and counselors may also offer couples, family or group therapy.

• Do you have experience with families or couples like ours?
• How will you make sure everyone is heard?
• Will you ever see us separately?
• How do you handle safety concerns?
• What are your fees, and do you take our insurance?

A Cleveland Clinic psychologist suggests trying three or four sessions before changing direction. If it still isn’t working, it’s OK to look for someone else.

Ask your primary care provider, insurance company or EAP, or use FindTreatment.gov, SAMHSA’s locator for mental health services. The Therapy: the basics guide helps you choose and prepare.

Find A Helpline lists free, confidential helplines in many countries. In an emergency, contact your local emergency number.