As practitioners we choose a mode of therapy that is appealing to us; one that suits our assumed understanding of the world and human difficulties and our preferred way of interacting. As family therapists we can now be assured that there is a significant body of literature attesting to the efficacy of family therapy for anxiety, suicidal ideation, eating disorders, substance use disorders, abusive behaviours, and schizophrenia, and for various formats of FT, including telehealth and web‐based delivery. However, in enjoying what we do and how we do it, it is easy to assume that our clients are equally comfortable and while there are studies of client experiences of family therapy most focus on outcome rather than in-session experiences.
A Synthesis of Client’s Experience
Todd et al (2025) argued that it is important for family therapists to ‘hear and learn from the voices of family members as the active partners of FT interventions.’ They undertook a systematic review, ‘to provide a contemporary and comprehensive overview of client perspectives on what is helpful and what is not helpful during FT sessions.’ As the last review was in 2012, they argued that it was time for another. Eleven studies qualified and from these four overarching themes were identified: therapist qualities contributing to the therapeutic alliance: practitioners’ use of therapeutic techniques, intervention delivery, and family engagement with the process.
Therapist Qualities Contributing to Alliance
Therapeutic alliance was the most frequently cited positive element. This was supported by the therapist’s qualities and characteristics including kindness, empathy and genuine care for the family and outcome of therapy. Viewing the family as ‘the client’ as opposed to targeting one person and seeing the family as part of several systems that were not functioning well, was also experienced as helpful. In addition, respect for their clients’ values, lifestyles, and worldviews all contributed to a positive alliance.
Practitioner’s Use of Counselling and Therapy Techniques
While families may not use the terminology of reframing and circular questioning, these activities were identified as helpful in providing alternative views to a presenting difficulty. Attentive and empathic listening that supported reflection, awareness and insights were also helpful as these also encouraged others to see a new perspective. Experiential activities that focused on the whole family and system rather than the individual and fun and interesting tasks that encouraged collaboration and communication created positive interactions and emotional expression.
Intervention Delivery
A collaborative feedback informed approach which placed client goals at its centre was preferred. Interventions which reinforced family strengths and resources was experienced as encouraging and motivating as was advice and knowledge conveyed in age appropriate and jargon free language. Families also identified skills coaching as helpful.
Family Engagement
Families valued the opportunity to attend together to speak openly about their concerns and noted positive outcomes after the first session. They appreciated flexibility in terms of different configurations including wider family, sibling subsystems and various child and parent groupings depending on the situation.
What Was Unhelpful?
Families also identified aspects which they did not find helpful including ‘being expected to share before they felt comfortable; when the process, format, content, or proposed solutions did not address their needs; when they did not observe sufficient progress in the early stages; and when therapists took sides or were unable to manage conflict during sessions.’
In Conclusion
Effective work as a family therapist requires a range of both conceptual and practical skills. Clearly understanding how best to engage these, enhances the outcome and experience for all participants.
Todd, E., Pond, R., Coomber, K. (2025) Client Perspectives of Family Therapy: A Qualitative Systematic Review Journal of Marital and Family Therapy, 2025; 51:e70024 https://doi.org/10.1111/jmft.70024
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