How Family Counseling Can Help You and Your Family
by Michael A. Michnya, MEd, LPC
People are relational beings, and our primary relationship unit is the family. A family is a system, and each member of that system has a relationship with each other member, creating a complex network of relationships. Since a change in any member will affect all other members, when one family member struggles, everyone in the family is affected. And therein lies the case for family counseling.
Human experience of identity has two elements; a sense of belonging and a sense of being separate. The laboratory in which these ingredients are mixed and dispensed is the family, the matrix of identity.
~ Salvador Minuchin, founder of Structural Family Therapy
According to some estimates, the odds of you even being born are one in 400 trillion, truly astronomical and incomprehensible odds. Every individual is unique, and it should be no surprise that when two unique individuals start a family, even greater complexity will arise. Each comes from a different family, with different beliefs, values, and customs. In pluralistic nations like the United States, each may have different cultural, ethnic, and religious backgrounds as well. The larger the family, the more complicated family life can be.
No matter how well your family functions, at some point it is likely that you and your family will face tough times or struggle to cope with some issue. It could be as simple as a transition from one stage of life to the next, such as having children or growing old, or as complex as recovery from addiction or trauma. Any family situation or change that causes stress or conflict, or powerful, unresolved emotions like grief or anger is appropriate for family counseling. But whatever the issue, family counseling can help.
What is family counseling?
Simply put, family, couples or marriage counseling, family therapy, family systems therapy, or marital and family therapy, are among the various labels for the branch of psychotherapy that treats psychological, cognitive and behavioral problems not merely as within an individual member, but within the context of that person’s primary support network, the family.
Because a family is a ‘system’ of interconnected relationships, as noted above, any change in one part of the system will affect the other parts of the system. Family counselors are trained to understand family systems and relationships, to identify and interrupt dysfunctional patterns, to connect and build on existing strengths and resources, and to help family members learn and apply new and more effective relationship skills.
The issues that family counseling can address include:
- Conflicts about parenting, finances, health care, and major life decisions
- Physical, mental health/illness, cognitive, behavioral, substance use or addictive disorders
- Children’s school problems or conflicts with peers, siblings or parents/step-parents
- Relationship or boundary issues
- Certain types of family violence
- Ineffective communication and stress management
- Problems with in-laws or other extended family members
- Adjustments to changes in the family such as birth, death, remarriage, or a family member’s illness
- Balancing personal needs, work and social responsibilities with family life
- Recovery from traumatic events (such as infidelity, natural disasters, unexpected deaths, etc.)
- Deciding on or coping with separation or divorce
- Planning for and sharing visitation or custody of children
But more than merely alleviating suffering or addressing problems and conflict, family counseling can also help families build on their strengths to live happier, fuller, more engaged and meaningful lives. Family counseling can help members build strength and support, move from distrust and guilt to reconciliation and forgiveness, foster hope and understanding and lead to agreement and peacefulness.
Feelings of worth can flourish only in an atmosphere where individual differences are appreciated, mistakes are tolerated, communication is open, and rules are flexible – the kind of atmosphere that is found in a nurturing family.
~ Virginia Satir, author and Family Therapy pioneer, widely known as ‘the Mother of Family Therapy’
Is Family Counseling Effective?
Study after study has demonstrated the effectiveness of family counseling with a wide variety of problems, from anti-social behavior and eating disorders to substance misuse, mental illness and trauma recovery, from infancy through old age, and for many different cultures. But, as in any complex system or endeavor, successful outcomes depend on a number of factors, including the skills and experience of the counselor, and the willingness of family members to both participate in treatment and to do between-session work toward change. Types of family counseling that have been studied include:
- Bowenian Systems Family Therapy
- Experiential Family Therapy
- Structural Family Therapy
- Strategic Family Therapy
- Cognitive Behavior Couples Therapy (CBT)
- Multi-Systemic Therapy (MST)
- Multi-Disciplinary Family Therapy (MDFT)
- Functional Family Therapy (FFT)
- Family Problem Solving
- Solution Focused Brief Therapy (SFBT)
- Narrative Therapy
- Gottman Method Couples Therapy (GMCT)
Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.
~ Cynthia L. Rowe University of Miami, Miller School of Medicine , Journal of Marital and Family Therapy Jan. 2012
From highly structured brief treatments like Functional Family Therapy, to more open-ended approaches, research suggests that when family and individual counseling are provided together, results may be more effective than individual treatment alone for adults, children or teens with addiction, mental illness, or behavioral problems.
Family counseling can be effective for families in which infants have sleeping, feeding and attachment problems. Interventions can help ameliorate severe feeding problems and improve weight gain and later child development in infants and children as well as family adjustment. In addition, parent-training programs can help reduce both common child behavior problems and also more severe conduct disorders for children with co-morbid cognitive, neurological or attention-deficit disorders.
Family counseling can decrease child maltreatment and the risk of further abuse and child out-of-home placements for at-risk families. Various family counseling models have been shown to improve parental engagement in child-directed interactions, foster child-parent attachment, and help parents develop and implement alternatives to physical punishment as a disciplinary strategy (for oppositional and other child problem behaviors), Skill-building interventions can help both parents and children develop skills for regulating angry emotions, communicating and managing conflict that can lead to improved individual adjustment and family functioning, as well as deter the development of conduct disorders in children. (Carr, 2018)
For adolescent offenders, family
counseling has been shown to improve functioning in life domains, behavioral and emotional needs, and reduce substance use, other risky behaviors and recidivism.
People in recovery from mental illness or addictive disease are more likely to seek and stay in treatment and have better long-term outcomes when their families are appropriately involved in their treatment and care. Family counseling can provide both education about their loved ones’ diseases, as well as help family members learn critical coping skills.
For people with mental illness, a combination of family counseling and individual treatment can increase medication compliance, reduce psychiatric symptoms as well as rates of relapse and re-hospitalization, and relieve stress.
Research suggests that people with addictive disease are often more likely to enter or re-enter treatment and less likely to drop out of treatment when they participate in family counseling. Family counseling can help to reduce continued use of alcohol or drugs, discourage relapse, and promote long-term recovery. When relapses occur, they are likely to be shorter and less severe with support in family counseling. Family counseling can also help to reduce the risk of other family members using drugs or alcohol.
Family counseling benefits other family members in other ways as well. By identifying negative patterns and fostering positive changes in family dynamics, family counseling reduces the sense of stress that other family members may feel.
Research shows that participation in family counseling can help family members improve their mental health, psychological and emotional functioning, increase parenting effectiveness, reduce children’s behavior problems, improve couple and family relationships, help the whole family get along better, and even improve how the family participates in the community and relates with its neighbors.
Family counseling can be such an effective way to help both the individual and the family as a whole, participants are usually very satisfied with the services they receive. According to studies by the American Association of Marriage and Family Therapists, the overwhelming majority of those surveyed reported the counseling they received was good or excellent (98%), gave them the help they needed (97%), and helped them learn useful tools (93%). In addition, family counseling can lead to positive results in up to a third fewer sessions, and can cost from 20% to 40% less than treatment with a psychiatrist or a psychologist. Family counseling may not be easy, but the outcome can be well worth the effort.
What Happens During Family Sessions?
The best way to resolve any problem in the human world is for all sides to sit down and talk.
~ Dalai Lama
A family counselor will usually meet with all family members initially but may meet with individual family members or subsets of the family from time to time as well. In your initial session, your counselor is likely to obtain your consent for treatment, ask you to complete various forms and questionnaires, explain your rights and responsibilities as a client and provide basic information about his/her approach, role and competence.
Over the first few sessions, your family counselor will typically focus on gathering data to better understand why you and your family are seeking treatment, what everyone thinks about the problem(s) that brought you to counseling, what each would like to change and what your family has already tried. Your family counselor may ask you to talk among yourselves briefly to better observe and assess the dynamics and interactional patterns between family members..
The length of the assessment process depends upon the practice setting and theoretical orientation of the counselor, but once completed, the family counselor will develop an initial treatment plan with the family. That initial plan will include both what the family wants to achieve and the counselor’s recommended interventions.
Treatment typically begins after the family agrees to the initial treatment plan, but in some settings, treatment begins the minute you and your family meet with the counselor. The very act of seeing a family counselor introduces a new dynamic into the family to which every member must react.
Counseling is always a dynamic process and each interaction the counselor has – directly or indirectly – will have some effect on everyone, the implications of which are neither easily quantified nor readily predictable.
Family counselors typically focus on helping family members change boundaries, communication and relational patterns in an effort to resolve the presenting issues. How they do this depends in part upon the model or type of family counseling, but many family counselors blend elements from different theories as needed to meet each family’s unique situation and needs.
Family therapists view the therapeutic relationship as a means to an end rather than as an end in itself. Family therapists see beyond the problematic patterns in the family to the potential healing power of family relationships.
~ Joseph A. Micucci, The Adolescent in Family Therapy: Harnessing the Power of Relationships
How Long Does Family Counseling Take?
Family counseling is often brief treatment, typically lasting an average of five to 20 sessions. How many family sessions your family will need to achieve a successful outcome depends on a number of factors. Important variables in the overall length of treatment include the complexities of your specific situation, the willingness and ability of your family to participate in treatment, and the type of family therapy.
The most important factor in counseling (for all types, by the way) is not the type of treatment, but the ‘therapeutic alliance’ (a jargony way of saying how well a client ‘feels felt’ – heard and understood – by the counselor). A family counselor develops strong relationships with each family member in an effort to serve the whole family. The stronger the connection between the counselor and each family member, the more likely your family will stay in counseling and do the hard work to make the changes you need to make.
The length of an individual session varies by practice setting. In most community mental health agencies and other insurance-based counseling practices, sessions typically last the standard 45-55 minute ‘therapy hour’. This ‘industry standard’ is based on the medical insurance practice of reimbursing providers for a 45-minute psychotherapy ‘procedure’. (While this is a reasonable amount of time for an individual session, rarely is that enough time for most family sessions. )
At Fooks-Michnya Associates, couples and family sessions typically last 80-90 minutes or longer, approximately twice as long as the industry standard. (As we don’t accept any private insurance, we’re not limited by the insurance industry.) In our experience, most couples and families need at least that much time – and sometimes more – to do any meaningful in-session work.
How Much Does Family Counseling Cost?
Unfortunately, since the medical model dominates payment for all counseling services, many insurance plans will not cover couples or family sessions unless one family member has been diagnosed with a mental illness, behavioral health, emotional or substance use disorder. While somewhat surprising given the positive outcomes noted above as well as the reduction in other medical costs, the real question may be ‘can we afford not to try family counseling?”.
A series of twenty-two studies conducted over twenty years, using US databases involving over 250,000 cases of routine systemic therapy (some variation of couples or family counseling with families of people diagnosed with relationship problems, schizophrenia, depression, sexual, somatoform, substance misuse, and other disorders), demonstrated that systemic (family) therapy was both more cost-effective than individual therapy and led to reduced medical costs (Crane and Christenson, 2014) because people who engaged in family counseling (especially frequent health service users) used fewer medical services after family counseling. “The medical cost offset associated with couple and family therapy covered the cost of providing therapy, and in many cases led to overall cost savings” (Carr, 2018).
A family counseling session doesn’t cost any more than an individual counseling session, no matter how many people are in the room. Nationwide, rates average about $100 per session but can range from $60 to $350 (or more) per session depending upon where you live and the degree, demand for and expertise of the provider (psychiatrists are the most expensive). Most community mental health agencies and some private practitioners offer sliding-scale fees, and if your provider accepts your insurance, your out-of-pocket cost will typically be the ‘specialty co-pay’ rate.
As a licensed provider of Intensive In-Community Services, Fooks-Michnya Associates, LLC, accepts NJ Medicaid for children referred by the NJ Children’s System of Care. We do not accept any private health insurance, however. We charge $100 per session if you come to us, $113 per hour (90-minute minimum) for house calls to you, payable by cash or personal check at the beginning of the session. We provide a receipt with both diagnoses and billing codes so that our clients can request reimbursement from their health insurance company at the out-of-network rate.
Communication is to relationships what breath is to life.
~ Virginia Satir
Choosing the Right Counselor for Your Family
Since you’re on our website, that means you’ve found us! If you like what you’re seeing here, feel free to contact us for an initial consult. If we can’t help you, you can ask your primary care physician for a referral or see if your friends have worked with anyone they can recommend. Your health insurance company may provide a list of therapists, or you can search online for a family counselor near you.
For more about how to figure out if your counselor is right for you, read our post ‘Seven Tips to Getting Effective Therapy.’