Family systems therapy: How to break old patterns and heal together

What is family systems therapy?

Family systems therapy is based on the principle that families operate as interconnected systems. Each person’s behavior affects everyone else, and no one’s struggles exist in isolation.

“Family systems therapy works by understanding that each individual is a part of their greater family system,” says Sarah Pearce, a licensed clinical social worker with Thriveworks. “What impacts the individual will impact the whole system.”

This is why individual therapy sometimes falls short for family issues. You can help one person develop better coping skills or communication techniques, but if the family’s underlying patterns don’t shift, those changes often don’t stick. Family relationships shape thoughts, emotions, and behaviors in ways that can only be addressed by working with the whole system.

Instead of focusing on who’s causing problems, family systems therapy examines the patterns between people—the cycles of interaction that keep families stuck. “The circular perspective focuses on the cycles underlying behaviors, which allows the whole family to focus on growth and change rather than focusing or blaming one person,” says Barbara Thomas, a licensed marriage and family therapist with Thriveworks.

The Bowen theory foundation

Family systems therapy draws from Bowen theory, developed by psychiatrist Murray Bowen in the 1950s. While studying families where someone had schizophrenia, Bowen realized the diagnosis didn’t just affect the individual, but it affected the entire family’s functioning. This insight applies to any issue a family faces: Symptoms develop within the family system, not in isolation.

“One way to think of this theory is that ‘the whole is greater than its parts,’” says Natalie Kazarian, a licensed marriage and family therapist based in California. When one person shows symptoms, the whole family unit is showing symptoms in some way.

What this looks like in practice

Here’s a common scenario Pearce sees: Parents send their “problem child” to therapy, expecting major behavior changes that will improve the whole family. Despite months of sessions, they don’t see the results they hoped for.

“What’s missing is the parents’ role in the child’s behavior escalation,” Pearce explains. “If the parent is unable to see that their own use of an elevated voice when they’re upset is now being mirrored in the child’s behavior—such as yelling at their siblings—it’s very difficult to change the child’s functioning without changing that of the adult.”

When that same family chooses family systems therapy instead, the parents can recognize their own impact, engage in honest communication about patterns, and collaborate on strategies for change. “When families are able to have these open, vulnerable conversations, major growth takes place,” Pearce says.

What family systems therapy can help with

Family systems therapy can address virtually any struggle within the family, as well as how individual mental health issues affect the entire unit. Here’s what it commonly helps with:

1. Coping with major life transitions. Divorce, death, job loss, or a child leaving for college can shake a family’s foundation. Family systems therapy helps members support each other through these shifts rather than withdrawing, blaming, or falling into old defensive patterns.
2. Breaking generational patterns. “Oftentimes there’s an intergenerational component—patterning is passed down,” Kazarian says. You might not realize you’re repeating your parents’ conflict style until therapy helps you connect the dots. Between generational trauma and learned communication patterns, these cycles deeply shape how family members relate to one another.
3. Redefining family roles. As children grow up, old roles stop working. Kazarian sees families where parents struggle to let go of control as their kids seek independence, creating constant tension. Therapy helps families redefine roles in ways that support growth while maintaining connection.
4. Establishing healthy boundaries. Many families struggle with boundaries (or lack thereof), leading to enmeshment or resentment. A therapist can help everyone set and maintain boundaries that improve both relationships and individual mental health.
5. Supporting substance abuse recovery. When someone has a substance use disorder, it affects every family relationship. Family systems therapy addresses enabling behaviors, improves communication, and builds a support system that promotes lasting recovery, whether the person struggling is a child or parent.
6. Addressing suicidality. For individuals experiencing suicidal thoughts, family systems therapy creates a safe space for open dialogue about a topic many families avoid. It provides psychoeducation and helps the whole family understand how to support their loved one.

Viewing the family as a unit is often more effective than individual work alone for these issues. “No one is an island, and we all are responding to our environments,” Kazarian says. “Viewing the individual as part of a greater whole helps shift the dynamics between these parts.”

RELATED: Are you in an enmeshed relationship? Here’s what to know

How this differs from individual therapy

In individual therapy, you’re only responsible for your own actions. “If someone else is causing dysfunction in their lives, it’s the individual’s responsibility to communicate their feelings, needs, and expectations of that person,” Pearce says.

In family systems therapy, when one person identifies a problem, the whole family engages in problem-solving together. Everyone takes ownership of their role in the pattern and commits to changing it.

Common approaches within family systems therapy

Family therapists tailor their approach based on what will help your family most. Here are three common modalities they might use:

Bowen family systems therapy

This approach focuses on how family members are deeply emotionally connected: How one person functions depends on how others do. Any change in one person creates a ripple effect through the entire system.

Key concepts your therapist might work on include:

• Differentiation of self (maintaining your own identity within the family)
• Multigenerational patterns (recognizing what’s been passed down through generations)
• Emotional cutoff (understanding when and why family members distance themselves)

Structural family therapy

Structural family therapy examines how your family is organized: who makes decisions, how authority flows, where boundaries are (or aren’t). Your therapist will assess the current structure, then help you restructure roles to create clearer boundaries, more functional leadership, and healthier communication patterns. The goal is strengthening your family’s foundation by identifying unhealthy patterns and building new ones.

Narrative therapy

Narrative therapy helps families externalize their struggles—to see the problem as something affecting the family rather than someone in the family being the problem. Instead of “Sarah is the difficult one,” it becomes “Our family is dealing with communication breakdowns that make Sarah feel unheard.”

This shift helps everyone feel less blamed and more empowered to tackle challenges together.

What happens in a family systems therapy session

Walking into your first family systems therapy session, you might feel nervous or unsure what to expect. Here’s what typically happens.

The therapist sets the stage.

Your therapist will explain their role: They’re a neutral third party, not there to take sides or assign blame. Most therapists start with the whole family together, giving each person a chance to voice their concerns and feelings, Pearce says.

You do the real work—the therapist guides it.

“I often joke with families that I am not the one doing the real work; they are,” Pearce says. “My role as a therapist is to keep the family on track, monitor patterns of dysfunction or behavior changes, and provide resources.”

You and your family members will do most of the talking while the therapist guides the conversation. “If therapy were a soccer game, the family is on the same team, their opponent is the challenge in the family system—like life changes, anxiety, or depression—and the therapist is the referee, making sure everything is on track, in bounds, by the rules, and fair,” Pearce says.

It requires active participation, not passive listening.

Many people expect therapy to work like a class: You show up, listen to the expert, follow instructions, and things improve. That’s not how this works.

“Family systems therapy requires each member of the family to participate, listen, reflect, and implement changes,” Pearce says. “It involves an active role in change, problem-solving, and support rather than a passive experience.”

Most of the behavior change happens outside the therapy office. The conversations and realizations in sessions are critical, but it’s what you do between appointments—how you interact at home, whether you practice new communication patterns, whether you’re willing to see your own role in family dynamics—that determines progress.

Your therapist might assign “homework” between sessions to keep momentum going.

What often surprises families

Families often discover they’re more aligned than they realized. “Once they begin to communicate with one another effectively, understand each other, and build an alliance to their common goal, they’re often surprised to understand how similar they are rather than different,” Pearce says.

What progress looks like

This is gradual work, not a quick fix. Patterns that have existed for years—or generations—won’t resolve in a few sessions. But families who commit to the process see real change.

Early signs of progress include:

• Recognizing the dysfunctional patterns you’ve been stuck in
• Seeing your family dynamics with new clarity
• Starting to shift those patterns, even in small ways

“Identifying these struggles and the dysfunctional patterns in the family are the first steps,” Kazarian says. Being honest and vulnerable with yourself, your family, and your therapist creates momentum for real change.

Over time, you’ll notice:

• Everyone understands their role in the family more clearly
• Family members express emotions more openly and understand each other’s feelings better
• Conflict decreases overall and isn’t centered on blaming one person
• Boundaries become clearer and healthier
• Communication improves—you can talk about hard things without it escalating
• You resolve conflicts more constructively instead of falling into old patterns

How family systems therapy creates lasting change

When everyone commits to the work—both in sessions and at home—family systems therapy creates lasting pattern changes and behavioral shifts.

“This therapy style focuses on second-order change, which is deeper than just behavior reduction or symptom reduction,” Thomas says. “Family systems therapy focuses on the core conflict, family roles, cycles of behavior, family history, and generational ties to identify lasting change and pattern recognition to break generational trauma cycles.”

The work you do together in family therapy also ripples into individual well-being. “The goal for family systems therapy is to allow healthy growth and communication for each individual in the family system,” Thomas says. “With changes in the family network, each individual can grow.”

If your family is ready to explore whether therapy could help, talking with a licensed family therapist can provide the structured, compassionate support you need to break old patterns and build healthier ones.

Frequently asked questions

Who is family systems therapy best for?

Family systems therapy works best for families experiencing recurring conflicts, struggles with family roles, generational patterns they want to break, or ongoing tension that won’t resolve. It’s also beneficial when one family member has a mental health diagnosis—like depression, anxiety, or substance use disorder—that’s affecting the whole family. You don’t need to be in crisis to benefit; many families seek this therapy proactively when they notice communication breaking down.

Does everyone in the family have to attend?

Ideally yes, but not everyone needs to participate for therapy to help. Family systems therapy works best when all family members attend, but even working with some of the family creates positive changes that ripple through the whole system. If one family member refuses to participate, therapy can still help those who do attend understand the dynamics better and change their own contributions to problematic patterns.

How long does family systems therapy usually take?

Most families need at least eight sessions to see meaningful progress, though therapy may continue for several months to a year depending on how deeply rooted the patterns are. Your therapist can give you a better estimate once they understand your family’s specific situation and goals.

How is family systems therapy different from individual therapy?

Family systems therapy examines how everyone contributes to and is affected by the family as a whole, while individual therapy focuses on helping one person manage their own thoughts and behaviors. In family systems therapy, when one person identifies a problem, the whole family engages in problem-solving together as a team rather than expecting one person to change on their own.