Family Therapy Models: A Literature Review

02 Feb Family Therapy Models: A Literature Review

The past several decades have seen a major surge in the offering and utilization of family therapy. Several major contributors to family systems theory have shaped the models that are used in family therapy today. Some of the most influential contributors are Alfred Adler, Rudolf Dreikurs, Murray Bowen, Virginia Satir, Salvador Minuchin, Jay Haley, Cloe’ Madanes, and the Milan group (Corey, 2009).

Alfred Adler and Rudolf Dreikurs- Adlerian Therapy

The concept of family therapy began in the early 1900’s, when Alfred Adler, formerly a friend and devotee to Sigmund Freud, began offering family therapy in an open public format, so that other families could view and learn. He referred to the family system as the “family constellation” and brought about the idea that children are greatly affected by their birth order (Corey, 2009).

The Adlerian approach evaluates “people’s efforts to compensate for their self-perceived inferiority to others” (Adler Graduate School, 2007, Para 5).  The birth order, or one’s position in the family constellation, may be directly related to this issue of perceived inferiority, “particularly if early experiences of humiliation occurred; a specific physical condition or defect existed; or a general lack of social feeling for others was present.”

Rudolf Dreikurs is credited with refining Adler’s theory into a practical model for parent training, helping parents understand that a child’s misbehavior is usually guided by a feeling of not belonging to one’s social group. This can lead to a child acting out based on “one of four mistaken goals: power, attention, revenge, or avoidance (inadequacy)” (Para 2). The idea is to help the parents learn how to encourage cooperation without either punishment or reward, but through helping the child feel like a valuable contributing member of the family unit (Rudolf Dreikurs, 2008).

Murray Bowen- Multi-Generational Family Therapy

Several years after Adler initiated the practice of family therapy, Murray Bowen began developing his family systems theory. He described the family as a system that connected all the individuals within it together and further asserted that no one individual within the system could operate without affecting the other members of the family. Bowen further asserted that predictable patterns of interaction can be found across generations, within families, and that problems stemming from an individual’s family of origin need to be resolved before the individual can thrive in a new family unit (Corey, 2009).

Bowen put forth a remarkable idea that therapeutic change must take place with the family in therapy together and not with a lone individual. This was a drastic diversion from the psychoanalytic, behaviorist, and humanistic approaches that worked on the premise that all change can and should be handled on an individual basis (Corey, 2009).

An additional major contribution by Bowen was the development of the theory of differentiation of the self. He asserted that individuals must work towards individuation from their families of origin in order to develop a healthy sense of self-identity and to be able to take responsibility for the direction of their own lives (Bowen Center, 2004).  A well-differentiated individual has a clear sense of who he or she is and is confident enough to handle conflict without the fears and other overpowering emotions that can result from over-dependency. On the other hand, a person with a well-differentiated sense of self also recognizes and embraces his or her own appropriate dependence on others.

This focus on interdependence in families led to the concept of triangulation, which also originated with Bowen who asserted that triangles, or relationship units of three individuals, are the smallest ‘stable’ relationship system because it takes little pressure on a system of two to involve a third person (Bowen Center, 2004). However, even the triangular system is always in a state of unrest, as one person always feels like the outsider trying to become an insider. Triangulation issues, Bowen asserted, can cause major problems within a family.

It was Bowen’s belief that these problems within the family could be resolved by first examining the multigenerational patterns of interaction, secondly by determining how those patterns are contributing to the current problems, and then by working with the family to stop the cycle. The individual must change within the context of the family system (Bowen Center, 2004).

Virginia Satir- Communications & Experiential Therapy

Working at about the same time as Bowen and ascribing to the same belief that the individual can only thrive within the context of a healthy family system, Virginia Satir devoted her 45-year career to developing and promoting her model of human validation. Satir focused on the basic human need of self-esteem. She believed that when family members can communicate openly and affectionately with each other, they can build self-esteem within each individual (Satir, 1988).

Satir felt that the “identified patient” in each family, though the person carrying that label could change from time to time, was really a representation of underlying issues, likely stemming from the marital relationship. She viewed the marital relationship between the mother and father as the foundation for all other connections within the family unit, and thus the key element to examine when problems with the children arise (Pottenger, 1981).

Satir went on to say that if there was a problem within the couple relationship, there must be a self-esteem issue underneath it all. The emphasis Satir placed on building self-esteem and trust is best explained in her own words:

The stronger one’s self-worth, the easier it is to have and maintain the courage to change one’s behavior. The more one values oneself, the less one demands from others. The less one demands from others, the more one can feel trust. The more one trusts oneself and others, the more one can love. The more one loves others, the less one fears them. The more one builds with them, the more one can know them. The more one knows another, the greater is one’s bond and bridge with them. Self-worth behavior will thus help end the isolation and alienation between persons, groups, and nations today. (Satir, 1981, p. 33)

Salvador Minuchin- Structural Family Therapy

In 1959, working with colleagues Dick Auerswald and Charles King, Salvador Minuchin began developing a three-stage process for working with low-income black families at the Wiltwyck School, a New York residential center for inner-city delinquent youth. Minuchin found that an aggressive approach was necessary to achieve change within these troubled families (Marie Mont Schools, 2008).

Within the structure of the family, Minuchin described three subsystems: the spouse subsystem, the parental subsystem, and the sibling subsystem. He also discussed three types of boundaries: rigid boundaries involving a disengagement and disconnect between subsystems in the family, diffuse boundaries involving enmeshment with everyone involved in everyone else’s business, and clear boundaries which are firm but flexible, allowing appropriate and healthy communication and adaptation (Kafka, 2008).

Minuchin believed “that an individual’s symptoms are best understood from the vantage point of interactional patterns within a family and that structural changes must occur in a family before an individual’s symptoms can be reduced or eliminated” (Corey, 2009, p.416). The three-stage structural approach to family therapy involves Phase 1: The therapist joins the “family dance” in the leadership position, Phase 2: The therapist “mentally maps out” the family’s system structure and Phase 3: The therapist works to change the family structure (Marie Mont Schools, 2008).

Jay Haley and Cloe’ Madanes- Strategic Family Therapy

Jay Haley came to work with Minuchin at the Philadelphia Child Guidance Center in the late 1960’s where he continued to work with Minuchin until 1974 when he and Cloe’ Madanes started the Family Therapy Institute of Washington D.C. Because Haley and Minuchin worked together during the formative years of their therapy models, it should be no surprise that strategic family therapy shares a great deal in common with structural family therapy. In fact, since the 1970’s the two models have been used as a combination approach by many therapists, referred to as structural-strategic family therapy (Corey, 2009).

Both models seek to reorganize dysfunctional or problematic structures in the families; boundary setting, unbalancing, reframing, ordeals, and enactments all became part of the family therapeutic process. Neither approach deals much with exploration or interpretation of the past. Rather, it is the job of structural-strategic therapists to join with the family, to block stereotyped interactional patterns, to reorganize family hierarchies or subsystems, and to facilitate the development of more flexible or useful transactions. (Corey, 2009, p. 416)

Although the two models share so much in common, strategic family therapy does have some unique contributions to family therapy. Haley and Madanes developed it as a short-term approach designed to target and solve a specific problem. Unlike Satir’s model, strategic therapy treats the problems as real. In other words, the identified problem is not merely a symptom of another underlying issue. It is, in fact, a problem that can be specifically addressed. When utilizing strategic therapy, the therapist needs to 1) identify these resolvable problems within the family, 2) set goals for resolving them, 3) create a plan to obtain those goals, 4) evaluate the responses and 5) evaluate the therapy outcome (, 2008).

Palazzoli, Boscolo, Cecchin, and Prata (The Milan Group)- Milan Family Therapy

The Milan group described a paradox that families bring when they come to therapy—they want the problem issue or problem person fixed, but they want their current family system to remain unchanged. The Milan group, like Satir, believed that a problem in an individual is actually representative of a problem with the family system as a whole and that causing change in an individual inevitably causes change in the system (Tucker, 2007).

The Milan group felt that it was important to understand client histories and thus understand their context. They proposed that linear thinking and speaking were not conducive to the therapeutic process and therefore utilized a more circular approach in thinking, communication, and intervention. Feedback was thus an important part of the therapeutic process (Tucker, 2007).

he Milan group focused their work on freeing themselves and their clients from the “tyranny of linguistics.” The Milan group stated that rather than label or diagnose, which they felt led to further difficulty, fear, and cementation of problems, the family should be redirected to reframe their conception of the issue into something that could be perceived as adaptive or even healthy. Thus, the family would question their basic assumptions and beliefs about the issue at hand. The idea was to get the family to look between right and wrong, problem and solution, and broken and whole at what could lie between, allowing them to approach things with a more flexible frame of mind and a sense of unity. (Tucker, 2007).


While there are clearly unique aspects of each model of family therapy, there are also many commonalities. One common theme is that regardless of what or where the “problem” lies, it is within the family, not the individual, that responsibility for the problem and impetus for changing it lie. The key concept is that no one person operates entirely in a vacuum.  Beyond families, even relationships at the workplace and in the community can be viewed as systems. The family therapy approach views the family unit as the central unit of society and the mainspring of human potential.

We previously submitted a blog post entitled “Substance Use and the Family” which details the effects of substance abuse on families.  While this post about Family Therapy Models does not add anything to that subject, it does highlight the importance of involving family in therapy.  At Cold Creek Wellness Center both our inpatient and outpatient drug rehab programs include six-week family therapy program that includes private counseling.  This is an example of Cold Creek’s comprehensive therapy approach, where we offer our clients a full range of the most effective therapies and service.  This has proven to be the most effective approach to overcoming addiction.

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