Family as Medicine: Why Family Therapy Should Be Considered Before Individual Therapy

With rates of adolescent depression, anxiety, and suicide on the rise and made even worse by the global pandemic, the mental health community now more than ever should be focused on what works.

Family therapy and family-based treatments have almost forty years of research to support their effectiveness with serious child and adolescent depression, oppositional behavior, and substance abuse. Several evidence-based models of family therapy exist with clinically proven outcomes, such as Attachment-Based Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, and more.

As an example, Attachment-Based Family Therapy (ABFT) has been designated as an empirically proven program for the treatment of adolescent depression by the Promising Practices Network and high ratings in SAMHSA’s National Registry of Evidenced-based Programs and Practices. In one study (Diamond el al, 2010) after 12 weeks of ABFT, in comparison to treatment as usual, almost 7 of out 8 study participants reported scores on the Suicide Ideation Questionnaire that were below the clinical cutoff and in a range consistent or below that of a non-clinical sample.

My research (Sunseri, 2019) has demonstrated the link between problematic family dynamics and childhood mental illness. Conversely, a well-functioning family can be a powerful buffer against mental illness. The demonstrated effectiveness of family therapies can likely be attributed to their ability to create a more secure safety net in the home, one that provides the child with support and stability from very people who love that child the most. 

Interestingly, strong family support and connection are not just correlated with mental health, but also with physical health. One study (Okkonen & Vanhanen, 2006) found that patients with high family support undergoing coronary artery bypass surgery experienced less pain and better recovery than those with low family support.

Yet despite having substantial research support, family-based therapies are rarely considered as a first line treatment for serious child and adolescent mental illness. Almost all parents are offered individual therapy for their child, or other types of treatments that are directed at the individual child such as IOP, PHP, medication, or residential treatment.

Individual therapy alone in many cases is ineffective and needlessly delays the onset of treatments that work. It’s time for the mental health community to consider family-based therapies as first line treatments for serious child and adolescent mental illness.

Diamond, G., Wintersteen, M., Brown, F., Diamond, G., Gallop; R., Shelef, K., & Levy, S. (2010) Attachment-Based Family Therapy for Adolescents with Suicidal Ideation: A Randomized Controlled Trial. Journal of the American Academy of Child & Adolescent Psychiatry. 49(2), 122–131.

Okkonen, E. & Vanhanen, H. (2006). Family support, living alone, and subjective health of a patient in connection with a coronary artery bypass surgery. Issues in Cardiovascular Nursing, 35(4), 234-244.

Sunseri, P.A. (2019). Hidden Figures: Is Improving Family Functioning a Key to Better Treatment Outcomes for Seriously Mentally Ill Children? Residential Treatment for Children & Youth, 37(1), 1-19.