Family Counselling: A Complete Guide to Working Through Issues Together

Every family has its tensions. Disagreements about money, parenting styles, or how to spend the holidays. Misunderstandings that fester. Old wounds that never quite healed. These are normal parts of family life.

But sometimes the problems become more than occasional friction. Communication breaks down entirely. The same arguments repeat endlessly. Family members stop talking, or can't be in the same room without conflict erupting. Children are caught in the middle. Someone's mental health is suffering.

When family problems reach this point, family counselling can help. This guide explains what family therapy actually involves, who it's for, and how it might help your family find a way forward.

What Is Family Counselling?

Family counselling (also called family therapy or systemic therapy) brings family members together to work on their relationships with the help of a trained therapist.

Rather than focusing on one "problem person," family therapy views difficulties as patterns within the family system. Everyone plays a role; everyone is affected; everyone can be part of the solution.

This doesn't mean everyone is equally to blame for problems. It means that change happens more effectively when the whole system shifts rather than just one individual.

What Family Therapy Is Not

It's not about finding a scapegoat. The therapist won't identify one person as "the problem" and fix them.

It's not a courtroom. The therapist won't decide who's right and wrong or take sides.

It's not forced reconciliation. Sometimes healthier boundaries, rather than closer relationships, are the outcome.

It's not just for "dysfunctional" families. Ordinary families facing difficult circumstances often benefit.

When Does Family Counselling Help?

Family therapy can be valuable in many situations.

Communication Breakdown

When family members:

• Talk past each other without connecting
• Avoid difficult topics entirely
• Can't discuss differences without escalating
• Feel unheard or misunderstood
• Have stopped communicating meaningfully

A therapist helps families develop new communication patterns—learning to listen, express needs clearly, and navigate disagreements constructively.

Conflict and Arguments

When families experience:

• Repetitive arguments that never resolve
• Explosive conflicts that cause lasting damage
• Cold wars and prolonged silences
• Alliances forming within the family
• Physical or verbal aggression

Family therapy helps identify the underlying dynamics driving conflict and develop healthier ways of managing disagreements.

Life Transitions

Major changes that affect the whole family:

• Divorce or separation
• Blending families after remarriage
• Death of a family member
• Serious illness or disability
• Children leaving home
• Caring for ageing parents
• Major financial changes
• Relocation

Even positive transitions can strain family relationships. Therapy helps families adapt and maintain connection through change.

Supporting a Family Member

When one person's struggles affect everyone:

• A family member with mental health difficulties
• Addiction affecting the family
• A child with behavioural problems
• Eating disorders
• Chronic illness
• Trauma recovery

Family therapy helps the whole family understand what's happening, communicate supportively, and develop healthier patterns that aid recovery rather than accidentally maintaining problems.

Historical Issues

When the past keeps affecting the present:

• Unresolved childhood experiences
• Multigenerational patterns repeating
• Old hurts that were never processed
• Family secrets that create distance
• Inheritance or family business disputes

Understanding family history helps break patterns that have been passed down for generations.

Who Attends Family Counselling?

"Family" in family therapy is flexible. It doesn't require everyone living under one roof.

Nuclear family: Parents and children living together.

Extended family: Grandparents, aunts, uncles, cousins who play significant roles.

Blended families: Step-parents, step-siblings, half-siblings navigating complex dynamics.

Adult children and parents: Working through relationship difficulties that persist into adulthood.

Siblings: Brothers and sisters working on their relationship independently of parents.

Couples with children: When relationship issues are affecting the whole family.

Any combination: The therapist works with whoever is relevant to the presenting concern.

Who Doesn't Have to Attend

Not everyone needs to be present, and not everyone will want to be. Family therapy can proceed with:

• The family members willing to participate
• Different combinations in different sessions
• Individual sessions alongside family sessions

Sometimes the most resistant family member eventually joins after seeing others benefit. Other times, change happens without their direct participation.

What Happens in Family Therapy Sessions?

Initial Contact

Before the first session, the therapist typically:

• Speaks with whoever made contact to understand the situation
• Clarifies who will attend
• Explains how sessions work
• Discusses confidentiality (different from individual therapy)
• Arranges practical details

First Session

The therapist will:

• Help everyone feel welcome and heard
• Ask each person their perspective on the problem
• Observe how family members interact
• Begin understanding the family's patterns
• Clarify goals for therapy
• Explain their approach

Early sessions often feel tense—families aren't used to discussing difficult things with an outsider. A skilled therapist creates safety while gently exploring sensitive areas.

Ongoing Sessions

Depending on the approach and your family's needs:

Understanding patterns: The therapist helps identify recurring dynamics. For example, perhaps whenever Dad raises a topic, Mum dismisses it, the teenage daughter sides with Mum, and Dad withdraws—then nothing gets discussed.

Exploring history: Understanding how current patterns developed. What did each person learn about conflict, communication, or emotion in their family of origin?

Experimenting with change: Trying new ways of interacting in the session. If Dad usually withdraws, what happens if he stays engaged? If Mum usually dismisses, what happens if she listens first?

Practicing outside sessions: Taking new skills into daily family life and reviewing what happened.

Processing difficult feelings: Some sessions involve significant emotion as family members share their experiences honestly.

Different Approaches

Several models of family therapy exist:

Structural family therapy: Focuses on family organisation—boundaries, hierarchies, and coalitions. Particularly useful when roles are unclear or inappropriate.

Systemic therapy: Emphasises circular patterns of interaction and how meaning is constructed within relationships.

Strategic family therapy: More directive, with the therapist actively intervening in patterns.

Narrative therapy: Helps families reauthor their stories and identities.

Emotionally focused family therapy: Addresses attachment and emotional bonds within the family.

Most therapists integrate approaches depending on what your family needs.

Confidentiality in Family Therapy

Confidentiality works differently in family therapy than individual therapy.

Between family members: The therapist won't keep secrets between family members who attend together. If you share something in an individual conversation with the therapist, they may encourage you to share it with the family or may need to do so themselves.

Outside the family: What happens in sessions stays between the family and therapist, with typical exceptions (safeguarding concerns, legal requirements).

With children: Special considerations apply when children are involved. The therapist balances children's need for privacy with parents' need to understand.

The therapist will explain their confidentiality policy clearly. If anything is unclear, ask.

Family Therapy with Children

When children are involved, sessions adapt to be age-appropriate.

Younger children might express themselves through play, drawing, or activities rather than direct conversation.

Adolescents need their perspective genuinely heard—they're often more perceptive about family dynamics than adults expect.

The balance between child and adult needs can be tricky. Parents need to parent; children need to be children. The therapist helps maintain appropriate boundaries while ensuring everyone's voice is heard.

Sometimes children meet with the therapist alone, then join family sessions. Sometimes the reverse. The structure depends on what your family needs.

How Long Does Family Therapy Take?

Family therapy often works on a shorter timescale than individual therapy.

• Brief interventions: 4-6 sessions for specific, focused issues
• Standard treatment: 10-20 sessions for more complex situations
• Longer-term: Monthly sessions over an extended period for deeply entrenched patterns

Sessions are typically longer than individual therapy—often 90 minutes—to allow time for multiple family members to speak.

The right length depends on:

• Complexity of the issues
• How entrenched the patterns are
• Family members' engagement and willingness to change
• Practical constraints (scheduling everyone together isn't easy)

What Makes Family Therapy Work?

Research consistently shows family therapy is effective for many issues. Key factors that help:

Multiple Perspectives

Hearing how others experience the same situation often produces breakthrough moments. "I had no idea you felt that way."

Changing Patterns in Real Time

Individual therapy involves talking about relationships. Family therapy involves experiencing them directly, which enables faster change.

Shared Responsibility

When everyone works together, no one person carries the burden of "fixing" things.

New Understanding

Learning about family history and each person's perspective creates compassion and context.

Systemic Change

Changes that happen within the family's natural environment tend to stick better than changes made in isolation.

Challenges in Family Therapy

Family therapy isn't always easy. Common challenges include:

Logistics: Coordinating schedules for multiple people is genuinely difficult.

Reluctant participants: Not everyone may want to attend. Unwilling attendance rarely works well.

Escalating conflict: Sometimes things get worse before they get better as suppressed issues surface.

Historical pain: Addressing long-buried hurts is painful for everyone.

Different goals: Family members may want incompatible outcomes.

Secrets: Hidden information can complicate therapy.

A skilled therapist navigates these challenges, but they require patience and commitment from the family.

Frequently Asked Questions

What if one family member won't participate?

Therapy can still help with whoever will attend. Change in one part of the system often affects the whole family, even those not in the room.

Is family therapy suitable for very young children?

Yes, though techniques adapt significantly. Therapists working with young families use play, observation, and parent coaching alongside direct work with children.

How much does family therapy cost?

Private family therapy in London typically costs £100-£180 per session (90 minutes). Some NHS services offer family therapy, though waiting lists can be long. Some insurers cover family therapy—check your policy.

Can family therapy work online?

Yes, though it presents some challenges with multiple participants. Many families have found video family therapy effective, particularly when distance or scheduling makes in-person attendance difficult.

What's the difference between family therapy and couples therapy?

Couples therapy focuses on the romantic partnership. Family therapy includes children or other family members. When children are significantly affected by parental issues, family therapy may be more appropriate than couples-only work.

Should we try family therapy or individual therapy first?

It depends on the situation. If the problem is clearly relational, family therapy makes sense. If one person is dealing with individual issues (depression, trauma) that then affect the family, individual therapy might come first. Often both happen simultaneously.

What if family therapy reveals things I'd rather not know?

This is a real concern. Therapy may surface painful information. Discuss with your therapist how to handle revelations. Sometimes the known truth, however painful, is more manageable than unnamed tension.

Finding a Family Therapist

When looking for a family therapist:

Check qualifications: Look for training in family or systemic therapy specifically. Many excellent individual therapists lack family-specific training.

Professional registration: In the UK, family therapists may be registered with UKCP, AFT (Association for Family Therapy), or BACP.

Experience with your issues: Ask about experience with situations similar to yours.

Practical fit: Can they offer session times that work for everyone? Are they accessible location-wise?

Initial consultation: Most therapists offer a preliminary conversation. Use it to assess whether they feel like a good fit for your family.

When Family Therapy Isn't Appropriate

Family therapy isn't suitable for every situation:

Active domestic abuse: Bringing victim and abuser together can increase danger. Individual safety must come first.

Active psychosis or severe mental illness: Individual stabilisation may be needed first.

Substance abuse denial: If substance abuse is the issue but the person denies it entirely, family therapy has limited effectiveness until some acknowledgment exists.

When it would cause harm: Sometimes maintaining distance is healthier than working on relationships.

A good therapist will help you assess whether family therapy is right for your situation.

Moving Forward

Family relationships matter. They shape who we are, how we relate to others, and our sense of belonging in the world. When these relationships struggle, the ripple effects touch everything.

Family counselling offers a structured space to understand what's happening, communicate more effectively, and find ways forward. It requires courage to sit in a room with family members and honestly address difficulties. But the potential rewards—genuine connection, resolution of old wounds, healthier patterns—are worth the discomfort.

If your family is struggling, know that help exists. The patterns that have developed over years can shift, sometimes surprisingly quickly when the right support is in place.

While my primary practice focuses on individual therapy, I work with relationship and family dynamics as they affect individuals. For specialist family therapy, I can recommend experienced colleagues. If you're unsure what kind of support your family needs, I'm happy to discuss options in an initial consultation.

Families can change. Yours can too.