Types of Family Therapy: How Each Approach Works and Which One Fits Your Family

Family therapy isn’t one method. It’s a group of approaches, each built for different problems, from teen depression and eating disorders to substance use and behavior concerns. The main types of family therapy include structural, strategic, Bowen (family systems), narrative and experiential therapy, plus newer approaches built for specific problems, like attachment-based family therapy for teen depression and family-based treatment for eating disorders. The right fit largely depends on who in your family is struggling and with what.

Unlike individual therapy, which focuses on one person’s thoughts, feelings, and behaviors, family therapy looks at how family members affect one another. It treats relationships and interactions as part of what can contribute to emotional and behavioral challenges, and part of what can help improve them.

This blog will cover different types of family therapy, including how they work and which family problems they’re best suited to treat.

What are the different types of family therapy?

There are many approaches to family therapy. Some were built for specific problems and have been tested in clinical trials; others are older frameworks that shaped the field and still influence how many therapists work with families. We’ll start with the first group.

Family therapy for teen depression and suicidal thoughts

Attachment-based family therapy (ABFT) is most commonly used for teen depression and suicidal thoughts. It can also help people with anxiety, trauma, or eating disorders.

It’s based on the premise that the quality of relationships between a child/adolescent and their parents can impact mental health. The family therapist will have sessions just with the parents and just with the kid/teen struggling with their mental health to better understand both sides, and then meet all together in joint sessions.

In the kid’s solo sessions, they will identify attachment issues with the parents that might be contributing to the problem. In the parent’s solo sessions, parents are urged to reflect on their own upbringing and understand how early experiences shape how they respond to their child today.

Then, in joint sessions, the patient and their parents work on forming a secure attachment and building trust. The goal is that as tension eases and trust builds, the teen’s symptoms improve.

Note: If your teen is talking about wanting to die or harming themselves, don’t wait for a family therapy appointment. Call or text the 988 Suicide & Crisis Lifeline at any time, or call 911 if there is immediate danger.

Family therapy for eating disorders

Family-based treatment (FBT), sometimes referred to as the Maudsley approach, is commonly used for teens with eating disorders such as anorexia nervosa and bulimia nervosa.

In the first phase, parents take charge of their teen’s eating, including what and when they eat. As the teen’s weight and eating stabilize, parents gradually hand responsibility back. The therapist guides parents through each step.

For many families, this allows treatment at home. Teens who are medically unstable may still need inpatient or residential care first. FBT also treats the eating disorder, not the teen or the parents, as the problem, which helps ease blame and guilt.

Family therapy for substance use disorder and behavioral issues

Approaches commonly used for substance use disorder and behavioral issues include Multidimensional Family Therapy (MDFT), Brief Strategic Family Therapy (BSFT), Functional Family Therapy (FFT), and Multisystemic Therapy (MST).

These approaches are often used when a teen’s substance use comes with other behavior that puts them at risk, such as severe aggression, fighting, or involvement with the juvenile justice system, says Sarah Taormino, LMHC, LCPC, a Clinical Supervisor at Charlie Health.

These family therapy approaches have many similarities, and some therapists may blend different aspects to fit a family’s needs.

• Multidimensional Family Therapy (MDFT): MDFT works by “intervening in four connected domains”: youth, parent, family, and community. Overall, it also improves family communication, teaches parenting skills, and reduces parenting stress. Youth in MDFT will learn to improve emotional regulation, communication skills, and overall behavior.
• Brief Strategic Family Therapy (BSFT): Rather than viewing the child’s behavior as the problem, BSFT looks at the whole family and the patterns in how its members interact and handle problems. Patterns that keep repeating can keep a family stuck, and “the goal of BSFT is to break those cycles,” Taormino explains.
• Functional Family Therapy (FFT): FFT is unique in that “it doesn’t believe in necessarily restoring authority to the parents,” Taormino says. FFT doesn’t try to put complete power in the parent’s hands; instead, it gives the patient more autonomy. From here, Taormino says the therapist and family can ask, “How do we make it work better or in a healthier way?” The therapist identifies interaction patterns within the family that encourage or enable problematic behavior and then teaches healthier ways to interact, which in turn fosters healthier behaviors.
• Multisystemic Therapy (MST): Multisystemic therapy looks at all the different systems that a kid is involved with, Taormino explains. The premise is that all different systems and the connections between them impact a child/teen’s behavior. This includes not just the family at home, but also their school, peer group, and neighborhood. The therapist will help identify which systems are contributing to the problematic behavior and work toward creating a solution with the family and involved systems. Ultimately, it promotes healthier behavior within all systems.

Classic forms of family therapy for mental health and behavioral issues

Many of these newer approaches grew out of the following foundational models, and family therapists often draw on more than one. The research on them is more limited than on the approaches above, but their ideas still guide a lot of family therapy today.

Bowen family systems theory

Bowen family therapy focuses on the family’s emotional experience as a whole, Taormino says, and uses “genograms” to map the family tree. “If a therapist is meeting with a parent and a kid, they would be asking the parent what their experience of being parented was like, as well as what your grandparents’ experience of being raised was like, and how is that showing up in the here and now,” she explains.

This helps parents recognize patterns passed down through generations, so they can respond more calmly instead of repeating what they learned growing up.

Structural family therapy

Structural family therapy focuses on structure and hierarchy within the family, helping parents take a clear leadership role, Taormino explains. Parents set clear boundaries and put structure in place.

One family member is usually identified as the one who is struggling, she says, but blame doesn’t land on that person. Structural family therapy treats their difficulties as rooted in how the larger family system is working.

The therapist helps the family identify and change patterns that contribute to that person’s difficulties.

Narrative family therapy

According to Michael White, one of the founders of narrative family therapy, the view is, “The person is not the problem; the problem is the problem.” Rather than aiming to directly reduce symptoms, narrative family therapy empowers families to change their relationship with the problem, along with the stories (or narratives) they tell themselves about it.

Strategic family therapy

Strategic family therapy is an older form of therapy that underpins brief strategic family therapy (BSFT) mentioned above. Similarly, its premise is that mental health concerns and behavior problems grow out of how a family communicates and interacts. Strategic family therapy aims to build healthier communication patterns.

Experiential family therapy

Similar to general experiential therapy, experiential family therapy uses different types of experiences and tools to address mental health concerns, rather than just talk therapy.

This could involve creating art, role-playing, using props, or any other multisensory techniques a family therapist might use. By using these tools, family members can express emotions beyond words and may even uncover subconscious feelings. Sharing these experiences together can also build connection and empathy between family members.

This approach can be a good fit for families who find it hard to put their feelings into words, or for younger children who may not open up in traditional talk therapy. Research shows that experiential family therapy can be useful for neurodivergent families, such as when there is autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) present.

Systemic family therapy

Systemic family therapy looks at how the whole family system affects the family members’ well-being. Symptoms or behavioral issues are understood as part of the family’s relationships rather than a flaw in one family member. Therapists often use “circular” questions, such as asking one family member how they think another is feeling, to help everyone see the bigger picture and understand each other’s perspectives.

What is Internal Family Systems therapy?

Internal Family Systems therapy (IFS) is not a type of family therapy, despite its name; rather, it’s an individual therapy to get in touch with the different parts within oneself.

An IFS therapist helps clients see their thoughts and feelings as different internal parts, each with its own role. For example, you have “exiles,” which are often called the inner child, the most vulnerable version of yourself. Then, there are the “managers,” who take care of your day-to-day functions, and the “firefighters,” who react to and handle emotional emergencies.

This framing helps people connect more with themselves and build self-acceptance. Research suggests the therapy is useful for chronic pain, depression, and post-traumatic stress disorder. It can also help you build self-compassion and self-forgiveness overall. Read our guide for more information on IFS.

How to choose the right form of family therapy?

For best results, choose a form of family therapy that best aligns with your family’s needs. “A helpful question for parents to ask is, ‘What’s my goal in seeking family therapy? What’s my why?’” Taormino explains. “Then, see which one seems to align closest with that.”

After reading this blog, you should have a better idea of the different types of family therapy and what each can help with. Here’s a quick recap.

Therapy modality	What it’s best for
Attachment-based family therapy (ABFT)	Teen depression, suicidal thoughts, anxiety, trauma, or eating disorders
Family-based treatment (sometimes referred to as the Maudsley approach)	Eating disorders such as anorexia nervosa, bulimia nervosa
Multidimensional Family Therapy (MDFT)	Teen substance use, aggressive behavior, mental health conditions, and emotional difficulties
Brief Strategic Family Therapy (BSFT)	Teen substance use, family conflict, behavior problems, depression, and anxiety
Functional Family Therapy (FFT)	Conduct disorder, substance use, behavior problems, depression, anxiety, and youth involved with the juvenile justice or child welfare systems
Multisystemic Therapy (MST)	Serious, persistent behavior problems, substance use, and juvenile justice involvement
Bowen family systems	General family conflict, intergenerational trauma, anxiety, behavioral problems, substance abuse
Structural family therapy	General family conflict, families with unclear hierarchies/boundaries, behavioral problems, substance abuse, anorexia nervosa, psychosomatic illnesses in children
Narrative family therapy	Trauma, mental health conditions, developmental challenges
Strategic family therapy	General family conflict, depression, anxiety
Experiential family therapy	Expressing emotions non-verbally, neurodivergence (ADHD and autism)
Systemic family therapy	Substance abuse, mental health conditions, general family conflict

When you’re looking for a family therapist, ask for a consultation first. Many offer a free 15-minute call where you can ask questions and learn more about their experience and training.

You can share what your family is dealing with, ask if they have experience treating that concern, and they can tell you whether the modality they practice might be a fit. Note that many family therapists blend modalities for a well-rounded approach. They can also let you know what approach may be best based on your child/teen’s age.

The type of therapy isn’t the only thing that affects how well family therapy works. The relationship between your family and the therapist, known as the therapeutic alliance, matters too. Research on family therapy has linked a stronger alliance to better outcomes.

In family therapy, that relationship has to work for everyone in the room. When each family member feels comfortable, heard, and respected by the therapist, and the family agrees on what it’s working toward, therapy has a better chance of helping. If your teen or another family member doesn’t feel that way, it’s reasonable to look for a different therapist.

How Charlie Health can help

If you or a loved one is struggling with mental health, Charlie Health can help. Charlie Health is a virtual behavioral health provider delivering high-acuity treatment for kids, teens, and adults facing serious mental health disorders and substance use disorders.

We provide more than once-weekly therapy through our virtual intensive outpatient program (IOP) — and online family therapy is an important part of the programming for kids and teens.

By involving parents and caregivers in treatment, we help families build the communication, trust, and skills that support progress at home.

If you think your child or teen might benefit from Charlie Health’s IOP, fill out this form.