By Greg Burnham, MS, LMFT

Is your family in crisis mode—feeling like the proverbial you-know-what has hit the fan? Are you trying to change as a family in hopes that one person will change? Do you want to do family work just so your child will go to school, start doing X behavior, or stop doing Y behavior? Are you simply trying to have a conversation without it turning into a war?

Is your focus on personal growth and evolution within your family? Do you see your co-parenting relationship—or lack thereof—interfering with your ability to navigate your relationship with your child? Do you, or does someone in your family, long for deeper relationships? Does home feel empty or distant? Does your family feel misaligned? Do you want to shift the tone of your relationships?

Or maybe you're exhausted and have no energy left to make changes. Do you feel like no matter what you do, nothing improves? Have you tried everything? Do you believe that you don’t need to change, but the other person does?

These are just a few of the nuanced patterns that show up when families enter treatment—whether that’s hospitalization, supportive living, residential treatment, day treatment, or intensive outpatient programs (IOP). Each pattern carries layers of pain, history, trauma, success, hope, and sometimes hopelessness. Most of us know that family can be both beautiful and painful.

Since this is a blog post, not a book, I’ll share some thoughts based on years of combined experience from myself and my colleagues. My goal is to help you consider how to approach the family therapy process.

What Is Family Therapy, Really?

Most people haven’t truly experienced family therapy. In my unofficial poll over the years, I’ve found that most families have attended therapy together, but the focus was usually on the individual receiving treatment—not on the family system as a whole. Even in couples therapy, many people go in hoping to change their partner. Therapists often reinforce this pattern by continuing to focus on the individual rather than the entire system.

Understanding the distinction between different types of therapy can be helpful:

Individual therapy (focused on one person’s personal growth)
Parenting therapy (focused on parenting strategies and challenges)
Family therapy (focused on the family system as a whole)

The hardest distinction to make is between family therapy and parenting therapy. We often think we’re doing family therapy when, in reality, we’re focused on the child we’re parenting—not the family system. The key to differentiating them is simple: Was the session focused on family patterns and the system as a whole, treating each person as an equal contributor? If not, it was likely individual or parenting therapy.

The Rip Tide of Therapy

The forces that pull us away from family therapy and into individual or parenting therapy are strong—like a rip tide. We may believe we’re doing family work when we’re actually shifting focus to individuals. To be clear, individual and parenting therapy can be incredibly valuable. But if we truly want to create change within the family, we have to engage in family therapy.

At the start, my job is often to be a kind, broken record—gently but persistently reinforcing the difference between individual/parenting therapy and family work. My role is to keep guiding the process back to family therapy, despite the natural pull toward focusing on individuals.

Overcoming the Fear of Blame

It’s not uncommon for someone in the family to resist family therapy because they feel blamed for their child’s struggles. That sense of blame can be a huge hurdle. Our culture tends to operate from a mindset of finding someone or something to blame when things go wrong—so we can “fix” it. But real healing doesn’t come from assigning blame.

Alternative Pathways to Family Work

Not every family is ready to dive into deep family therapy. Here are some alternative ways to approach the process:

You decide that addressing family system issues feels too painful right now, so you focus on individual work first.
You engage in family therapy but keep it skill-based, avoiding deeper emotional work if it leads to feelings of blame.
You take a step back from a “therapy” mindset and simply focus on breathing and being present.
You allow yourself more time to transition emotionally into a no-blame approach. Shame can be a major barrier to change, and as long as shame dominates your mindset—feeling like you “failed” as a parent—it can be hard to move forward.
You start by simply identifying patterns in your family without feeling pressured to change them. Over time, this can calm the nervous system enough to allow for slow, organic shifts.

Acceptance: There Is Nothing to Fix

All families struggle. There is nothing to fix because nothing is broken. You are not broken.

One of the hardest parts of growth within a family is realizing that the way you’ve done things in the past wasn’t ideal—and wishing you had done things differently. This realization often leads to either justifying past actions or feeling deep shame about what you “should” have done. Hopefully, with time, it leads to acceptance: This is the human journey.

We all say and do things within our families that are difficult for others. Logically, we understand this. Emotionally, it’s painful. And sometimes, that pain becomes a barrier to growth.

Easing Into Family Therapy

Think of family therapy like easing into cold water. Breathe. Center yourself. Be present. Practice self-compassion. Ensure that your environment is safe. Check in with yourself.

Or, if you’re the kind of person who likes to jump in all at once—go for it. You can figure it out as you flounder.

Oh, and did I mention self-compassion? Yes? Well, I’ll say it again—because you’re going to need it.

Navigating Family Therapy: Understanding the Process