Family therapy for autism spectrum

disorders
Review question

What is the evidence that family therapy can help to improve communication,
strengthen relationships, and enhance coping, mental health and well-being for people
who have autism spectrum disorders (ASDs) or their family members, or both?

Background

People with ASD often experience difficulty with knowing how to communicate with
others, and with developing and maintaining friendships and relationships. They can
also find it difficult to manage changes to their routine. People with ASD tend to rely on
family members, including parents and siblings, well into adulthood. Family members of
people with ASD sometimes experience stress, anxiety and depression.

Several research studies have investigated the benefits of talking therapies for
individuals with ASD or for family members. While study findings suggest that these
therapies can improve communication and coping, and mental health and well-being,
outcomes are usually reported for the person with ASD or family members, but not both.

Family therapy is designed to help people within the family make sense of difficult
situations, and help them work together to develop new ways of thinking about and
managing these difficulties. It is important to find out if family therapy can be helpful for
people with ASD and their relatives given that the core symptoms of ASD, and
additional difficulties people can experience, often impact on the family unit.

We searched for all the available evidence, published or unpublished, up until 16

January 2017, which examined family therapy for ASD.

Study characteristics

While there have been a few studies investigating the benefits of

family therapyinterventions for ASD, none have compared family therapy with either no
treatment, a group of people waiting to start treatment, or another type of
psychological therapy. There is one study awaiting classification.

Quality of the evidence

There is limited high-quality evidence available about whether family therapy is helpful
for people with ASD or their family members. More research studies are needed to
evaluate the effectiveness of family-focused interventions to enhance communication,
reduce stress and improve coping.

Authors' conclusions:

Few studies have examined the effectiveness of family therapy for ASD, and none of
these are RCTs. Further research studies employing methodologically
robust trial designs are needed to establish whether family therapy interventions are
clinically beneficial for enhancing communication, strengthening relationships,
augmenting coping and reducing mental health morbidity for individuals with ASD and
family members.

Read the full abstract...

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You may also be interested in:
 Auditory integration therapy for autism spectrum disorders
 Early intensive behavioral intervention (EIBI) for
increasing functional behaviors and skills in young
children with autism spectrum disorders (ASD)
 Social skills groups for people aged 6 to 21 years with
autism spectrum disorders (ASD)
 Early intervention delivered by parents for young children
with autism spectrum disorders
 Acupuncture for people with autism spectrum disorders
(ASD)

Health topics:
Child health > Developmental, psychosocial, and learning problems > Autism spectrum disorder
Developmental, psychosocial & learning problems > Developmental problems > Autistic spectrum
disorder

Published:
16 May 2017
Authors:
Spain D, Sin J, Paliokosta E, Furuta M, Prunty JE, Chalder T, Murphy DG, Happé FG
Primary Review Group:
Developmental, Psychosocial and Learning Problems Group

Link: https://www.cochrane.org/CD011894/BEHAV_family-therapy-autism-spectrum-disorders
What is Family Therapy and What Are Its Goals And
Benefits?
27 JUN 2017

18 COMMENTS

Sharing is caring.

“Why family therapy… because it deals with family pain.” – Virginia Satir
As the quote from Virginia Satir suggests, family therapy is necessary to
address family pain and heal a family’s wounds.

We all start this life with a family, whether that family is composed of blood
relatives, adopted parents, or a foster family. This family that we acquire when
we are born influences every aspect of our lives, from our first moments to our
last.

Our family affects who we are and who we become, both for the better and for
worse. We learn our vocabulary, our habits, our customs and rituals, and how
to view and observe the world around us.

We also learn how to love, and how to interact with others from these first
important relationships. If we are born into a healthy family with healthy
relationships, we are likely to learn how to maintain healthy relationships. If we
are born into a dysfunctional family that struggles to connect, we may also
struggle to connect with others.
While it is certainly unlucky to be born into the second kind of family, it’s not
an unchangeable situation. Nearly all families deal with some sort of
dysfunction at one time or another, yet most families retain or regain a sense
of wholeness and happiness.

Family therapy offers families a way to do this – a way to develop or maintain

a healthy, functional family.

This article contains:

 What is Family Therapy / Family Counseling?

 What is a Family Counselor Trained For?
 What is the Goal of Family Therapy?
 Family Psychotherapy: Taking it One Step Further
 What are the Benefits of Family Therapy?
 6 Examples and Exercises
 Recommended Books
 A Take Home Message
 References
The Positive Psychology Toolkit

Become a Science-Based Practitioner!

The Positive Psychology toolkit is a science-based, online platform containing
135+ exercises, activities, interventions, questionnaires, assessments and
scales.

What is Family Therapy / Family Counseling?

Family therapy or family counseling is a form of treatment that is designed to
address specific issues affecting the health and functioning of a family. It can
be used to help a family through a difficult period of time, a major transition, or
mental or behavioral health problems in family members (“Family Therapy”,
2014).
As Dr. Michael Herkov explains, family therapy views individuals’ problems in
the context of the larger unit: the family (2016). The assumption in this type of
therapy is that problems cannot be successfully addressed or solved without
understanding the dynamics of the group. The way the family operates
influences how the client’s problems formed and how they are encouraged or
enabled by the other members of the family.

Family therapy can employ techniques and exercises from cognitive therapy,
behavior therapy, interpersonal therapy, or other types of individual therapy.
Like with other types of treatment, the techniques employed will depend on
the specific problems the client or clients present with.
Behavioral or emotional problems in children are common reasons to visit a
family therapist. A child’s problems do not exist in a vacuum; they exist in the
context of the family and will likely need to be addressed within the context of
the family (Herkov, 2016).

It should be noted that in family therapy or counseling, the term “family” does
not necessarily mean blood relatives. In this context, “family” is anyone who
“plays a long-term supportive role in one’s life, which may not mean blood
relations or family members in the same household” (King, 2017).

According to Licensed
Clinical Social Worker Laney Cline King, these are the most common types of
family therapy:

 Bowenian: this form of family therapy is best suited for situations in which
individuals cannot or do not want to involve other family members in the
treatment. Bowenian therapy is built on two core concepts, triangulation
(the natural tendency to vent or destress by talking to a third party) and
 differentiation (learning to become less emotionally reactive in family
relationships).
 Structural: Structural therapy focuses on adjusting and strengthening the
family system to ensure that the parents are in control and that both
children and adults set appropriate boundaries. In this form of therapy, the
therapist “joins” the family in order to observe, learn, and enhance their
ability to help the family strengthen their relationships.
 Systemic: The Systemic model refers to the type of therapy that focuses on
the unconscious communications and the meaning behind family members’
behaviors. The therapist in this form of treatment is neutral and distant,
allowing the family members to dive deeper into their issues and problems
as a family.
 Strategic: This form of therapy is more brief and direct than the others, in
which the therapist assigns homework to the family. This homework is
intended to change the way family members interact, assess and adjust the
way the family communicates and makes decisions. The therapist takes the
position of power in this type of therapy, which allows other family members
who may not usually hold as much power to communicate more effectively
(King, 2017).

What is a Family Counselor Trained For?

“In this therapy, the therapist takes responsibility for the outcome of the
therapy. This has nothing to do with good or bad, guilt or innocence, right or
wrong. It is the simple acknowledgement that you make a difference.” – Eileen
Bobrow
As the different types of therapy described above show, a family therapist may
be called upon to take on many different roles. These many roles require a
family therapist to undergo a great deal of training, formal education, and
testing to ensure that the therapist is up to the task.

While therapists may have differing methods and preferred treatment

techniques, they must all have at least a minimum level of experience with the
treatment of:

 Child and adolescent behavioral problems

 Grieving
 Depression and anxiety
 LGBTQ issues
 Domestic violence
 Infertility
 Marital conflicts
 Substance abuse (All Psychology Schools, 2017)

In order to treat these and other family issues, therapists must:

 Observe how people interact within units

 Evaluate and resolve relationship problems
 Diagnose and treat psychological disorders within a family context
 Guide clients through transitional crises such as divorce or death
 Highlight problematic relational or behavioral patterns
 Help replace dysfunctional behaviors with healthy alternatives
 Take a holistic (mind-body) approach to wellness (All Psychology Schools,
2017)

In order to gain the skills necessary to perform these functions, a family

therapist usually obtains a bachelor’s degree in counseling, psychology,
sociology, or social work, followed by a master’s degree in counseling or
marriage and family therapy.
Next, the therapist will most likely need to complete two years of supervised
work after graduation, for a total of 2,000 to 4,000 hours of clinical experience.
When these requirements are met, the therapist will also likely need to pass a
state-sanctioned exam, as well as completing annual continuing education
courses.

This education and training will allow a therapist to help the clients who come
to the therapist for guidance with a wide range of problems, including:
 Personal conflicts within couples or families
 Unexpected illness, death, or unemployment
 Developing or maintaining a healthy romantic relationship at any stage
 Behavioral problems in children
 Divorce or separation
 Substance abuse or addiction
 Mental health problems like depression and anxiety

This wide range of problems makes it clear that the answer to “What is a
family therapist NOT trained to do?” may be shorter than the question of what
they ARE trained to do!

To learn more about how marriage and family therapists are trained and how
they practice their craft, the following websites are great resources:

 The American Association for Marriage and Family Therapy website

 The All Psychology Schools website
 The Careers in Psychology website
 The Marriage and Family Therapist Licensure website
 The Learn website

What is the Goal of Family Therapy?

“To put the world right in order, we must first put the nation in order; to put the
nation in order, we must first put the family in order; to put the family in order,
we must first cultivate our personal life; we must first set our hearts right.” –
Confucius
In a nutshell, the goal of family therapy is:

To work together to heal any mental, emotional, or psychological problems

tearing your family apart. (Lee, 2010)
In order to help a family work together towards a healthy family life, family
therapists aim to aid family members in improving communication, solving
family problems, understanding and handling special family situations, and
creating a better functioning home environment (Family Therapy, 2017A).
More broadly, the goals of family therapy depend on the presenting problems
of the clients. For example, the goals differ based on the following scenarios:

 A family member is suffering from schizophrenia or severe psychosis:

The goal is to help other family members understand the disorder and
adjust to the psychological changes that the patient may be undergoing.
 Problems arising from cross-generational boundaries, such as when
parents share a home with grandparents, or children are being raised by
grandparents:
In this case, the goal is to improve communication and help the family
members set healthy boundaries.
 Families deviating from social norms (unmarried parents, gay couples
raising children, etc.):
The goals here are not always to address any specific internal problems,
but the family members may need help coping with external factors like
societal attitudes.
 Family members who come from mixed racial, cultural, or religious
backgrounds:
The goal in this case is to help family members further their understanding
of one another and develop healthy relationships.
 One member is being scapegoated or having their treatment in individual
therapy undermined:
When one family member is struggling with feeling like the outcast or
receives limited support from other family members, the goal is to facilitate
increased empathy and understanding for the individual within their family
and provide support for them to continue their treatment.
 The patient’s problems seem inextricably tied to problems with other family
members:
In cases where the problem or problems are deeply rooted in problems with
other family members, the goal is to address each of the contributing issues
and solve or mitigate the effects of this pattern of problems.
 A blended family (i.e., step-family):
Blended families can suffer from problems unique to their situations. In
blended families, the goal of family therapy is to enhance understanding
and facilitate healthy interactions between family members (Family
Therapy, 2017B).
Family Psychotherapy: Taking it One Step Further
We tend to think of therapy and psychotherapy as two different forms of
treatment, but in fact, they are the same thing. This ambiguity is enhanced
when we introduce the term “counseling” as well.
In truth, therapy is simply a shortened form of the word “psychotherapy”
(www.drpatrick.com). However, counseling is sometimes called “talk
therapy,” blurring the lines even further (Eder, “What is the Difference”).
Generally, counseling is applied in situations where an individual (or, in the
case of family counseling, a family) engages the services of a counselor or
other mental health professional to help with a specific problem or set of
problems. Therapy, or psychotherapy, is a more in-depth and usually long-
term form of treatment in which the client or clients discuss a wider range of
issues and chronic patterns of problematic feelings, thoughts, and behaviors
(Eder, “What is the Difference”).

A family who is struggling with a situation that brings added stress, such as
the death of a family member, addiction, or dire financial straits, may benefit
from counseling to help them through their struggle

s to emerge on the other

side as a stronger and more cohesive unit.
If a family is struggling with more chronic mental or behavioral problems, such
as a father dealing with schizophrenia, a mother fighting depression, or a child
who has been abused, psychotherapy is likely the better choice.

This type of therapy is appropriate for families with problems such as these
because a family therapist has a different perspective on treatment than an
individual therapist. While the individual therapist works with one client on
solving or curing a problem, the family therapist views problems in the context
of the “system” of the family. To solve a problem in a system, you need to
consider all parts of the system.
Fixing the alternator in a car will not fix the problem if it also has flat tires, a
faulty transmission, and a plugged exhaust pipe.
Issues within a family are similar to the car with several problems. A parent
struggling with alcoholism is not a problem in isolation; the parent’s struggle
has likely affected their spouse and their children as well. A family therapist
believes that problems must be addressed at the level of the whole family
rather than on an individual level (Schwartz, 2009).

What are the Benefits of Family Therapy?

This more holistic approach to treating problems within a family has proven to
be extremely effective in many cases. In family therapy, families can work on
their problems with the guidance of a mental health professional in a safe and
controlled environment.

The benefits of family therapy include:

 Better understanding of healthy boundaries and family patterns and

dynamics
 Enhanced communication
 Improved problem solving
 Deeper empathy
 Reduced conflict and better anger management skills (10 Acre Ranch,
2017)

More specifically, family therapy can improve the family relationships through:

 Bringing the family together after a crisis

 Creating honesty between family members
 Instilling trust in family members
 Developing a supportive family environment
 Reducing sources of tension and stress within the family
 Helping family members forgive each other
 Conflict resolution for family members
 Bringing back family members who have been isolated (American Addiction
Centers, 2017).
In addition, family therapy can enhance skills required for healthy family
functioning, including communication, conflict resolution, and problem solving.
Improving these skills for each member of the family increases the potential
for success in overcoming or addressing family problems. In family therapy,
the focus is on providing all family members with the tools they need to
facilitate healing (Teen Treatment Center, 2014).

6 Examples and Exercises

If family therapy sounds like a treatment that would benefit you and your loved
ones, the best course of action is to find a licensed professional with whom
you can build a good working relationship and address the problems your
family is facing. However, if you’re not quite ready for this step or there are
obstacles between you and getting treatment, there are many exercises and
suggestions that you may find to be a good alternative.

The exercises and techniques below are meant to be used within the context
of a therapeutic working relationship, but some also have applications for
those who wish to explore the possibilities of family therapy before committing
to a long-term treatment with a therapist. If you are a therapist or other mental
health professional, you may find these exercises to be useful additions to
your therapy toolbox.

The Miracle Question

This exercise can be used in individual, couples, or family therapy, and is
intended to help the client(s) explore the type of future they would like to build.
We all struggle at times, but sometimes the struggle is greater because we
simply do not know what our goals actually are.

The Miracle Question is an excellent way to help the client or clients probe
their own dreams and desires. When used in the context of couples or family
therapy, it can aid clients in understanding what they significant other or family
member needs in order to be happy with their relationship.
This Miracle Question is posed as follows:

“Suppose tonight, while you slept, a miracle occurred. When you awake
tomorrow, what would be some of the things you would notice that would tell
you life had suddenly gotten better?” (Howes, 2010)
While the client may give an answer that is an impossibility in their waking life,
their answer can still be useful. If they do give an impossible answer, the
therapist can dive deeper into the clients’ preferred miracle with this question:
“How would that make a difference?”

This question aids both the client and the therapist – the client in envisioning a
positive future in which their problems are addressed or mitigated, and the
therapist in learning how they can best help their client in their sessions.

You can learn more about this exercise at this link.

Colored Candy Go Around

If you’re looking for a fun and creative icebreaker or introduction to family
therapy, this exercise can be a great way to start.

To engage in this exercise with your family, you need a package of Skittles,
M&Ms, or a similar colorful candy. Distribute seven pieces to each family
member, and instruct them to sort their candy by color (and refraining from
eating it just yet!).

Next, ask a family member to pick a color and share how man they have. For
however many candies of this color they have, instruct them to give the same
number of responses to the following prompts based on the color:

 Green – words to describe your family

 Purple – ways your family has fun
 Orange – things you would like to improve about your family
 Red – things you worry about
 Yellow – favorite memories with your family

When the first family member has given their answers, tell them to choose the
next family member to answer the same prompt based on the number of
candies that person has. Once the prompt has been answered, the candies
can be eaten.

When all family members have responded to these prompts, initiate a

discussion based on the answers provided by the family. The following
questions can facilitate discussion:

1. What did you learn?

2. What was the most surprising thing you learned about someone else?
3. How will you work towards making changes/improvements?

Given the high sugar content in this exercise, you can see that this is a great
game to play with young children! If this sounds like a useful exercise that you
would like to try with your family, you can find further information and
instructions on page 3 of this PDF from therapist Liana Lowenstein.

Emotions Ball
This is a simple exercise, requiring only a ball and a pen or marker to write
with. You may even recognize it, as it is frequently used with children and
teenagers in many contexts, as it takes the pressure off of talking about
emotions for those who may be uncomfortable sharing their feelings.
A beach ball is a perfect ball for this activity, as it is big enough to write
several emotions on and it is easy to throw back and forth in a circle. Write
several emotions on the ball, such as “joyful,” “lonely,” “silly,” or “sad.”
Gather your family into a circle and begin to toss the ball back and forth
between family members. When a family member catches the ball, have them
describe a time when they felt the emotion facing them. Alternatively, you
could have the catcher act out an emotion, an activity especially suited for
children.

The intent of this exercise is to discuss emotions with your family, and practice
listening to one another and expressing your feelings.

You can read more about this exercise here.

The Family Gift

This exercise can help a therapist to get to know a family better. If you are
using it without the guidance of a therapist, it can help you to further your
understanding of your own family and provoke thoughtful discussion.

To give this exercise a try, gather a variety of art supplies and a gift bag.
Explain to the family that they are going to create a gift from the materials
provided. This gift will be a gift for the whole family, that everyone in the family
wants. They must decide together on this gift and how it can be used within
their family.

They have 30 minutes to decide on this gift and craft it. Once they have
created the gift, they must place it in the gift bag.

Within the context of family therapy, this exercise provides the therapist with a
look at the inner workings of the family, how they make decisions and
complete tasks as a unit.

If you are engaging in this exercise as a family without the presence of a

therapist, it can help you to start a meaningful conversation.

Use these questions or prompts to facilitate the discussion:

1. Describe your gift.

2. Tell how you each felt as you were creating your gift.
3. Who made the decisions? For example, who decided what the gift should
be?
4. Were two or more people in your family able to work well together?
5. Did anyone cause any difficulties or disagreements, and if so, how was this
handled?
6. Is there anything about the way you did the activity that reminds you of how
things work in your family at home?
7. How can the gift help your family? What else can help your family?

There is a wealth of information to be gained from observing these types of

interactions or engaging in these kinds of discussion.

To read more about this exercise, see pages 3 and 4 of the PDF mentioned
earlier.

Mirroring Activity
This fun exercise is a great way to help family members relate to each other
and work together.

The activity can be explained to a family by the therapist with the following
instructions:

“I want you to stand in front of me just right there (pointing to a spot about two
feet in front of the practitioner). You are going to be my mirror. Everything I do
you will try to copy, but the trick is to copy me at exactly the same time that I
am doing it, so you are my mirror. I will go slowly so you have a chance to
think about where I will be moving so we can do it exactly at the same time. We
can’t touch each other. I will lead first and then you will take a turn leading.
Ready? Here we go!”

First, the therapist can

model this exercise with one of the family members, then that person can take
a turn leading another. This is an especially useful exercise for children, but it
can be used with family members of any age.

Engaging in this exercise requires the family members to give each other their
full attention, cooperate with one another, and communicate with both words
and body language. It allows the family members to become more in tune with
one another, and can be applied with siblings, a parent and child, or even
couples in marriage counseling.

To see the instructions and read more about this exercise, see page 20 of this
booklet, also from Liana Lowenstein.

Genogram
A genogram is a schematic or graphic representation of a client’s family tree.
However, unlike the typical family tree, the genogram provides far more
information on the relationships among members of the family.

It can be used to map out blood relations, medical conditions in the family,
and, most often in the case of family therapy, emotional relationships.

Genograms contain two levels of information, that which is present on the

traditional family tree and that which provides a much more comprehensive
look at the family:

 Basic Information: name, gender, date of birth, date of death (if any).
 Additional Information: education, occupation, major life events, chronic
illnesses, social behaviors, nature of family relationships, emotional
relationships, social relationships, alcoholism, depression, diseases,
alliances, and living situations (GenoPro, 2017).

By including this additional information, the therapist and client(s) can work
together to identify patterns in the family history that may have influenced the
client’s current emotions and behaviors. Sometimes the simple act of mapping
out and observing this information can make clear things which were
previously unnoticed.

The information on emotional relationships can include points of interest and

any aspects of the relationship that may have impacted the client(s), such as
whether the relationship is marked by abuse, whether a marriage is separated
or intact, if a relationship is characterized by love or indifference, whether a
relationship could be considered “normal” or dysfunctional, etc.
This exercise could be completed individually, but it is likely to be most
effective when completed in conjunction with a qualified professional.

You can read more about the genogram here, and learn about how to use
them in family therapy here.

Recommended Books
 The Seven Principles for Making Marriage Work: A Practical Guide from the
Country’s Foremost Relationship Expert by John M. Gottman
This is an excellent read for any non-professionals who wish to learn more
about what family therapy can do for couples. Although this is intended for
married couples, any individuals in a long-term relationship can benefit from
this resource of practical wisdom. The Seven Principles for Making Marriage
Work comes from renowned author and relationship expert Dr. John M.
Gottman.
 Why Marriages Succeed or Fail: And How You Can Make Yours Last by John M.
Gottman
Another entry from Dr. Gottman, this book provides an in-depth look at the
inner workings of marriage and gives advice on how to ensure that your
marriage is one of the successful ones.
 Family Therapy: Concepts and Methods by Michael P. Nichols and Sean Davis
Those with only a casual interest in family therapy may not find much of
interest in this book, but anyone who wishes to gain a deeper understanding
of the theory and practice of family therapy will find this book invaluable. It
gives the reader a solid foundation in the techniques, methods, and academic
foundations of family therapy. If you are interested in becoming a family
therapist, or simply learning more about the practice of therapy within the
context of the family, this book is a perfect place to start.

 Essential Skills in Family Therapy: From the First Termination by JoEllen

Patterson, Lee Williams, Todd M. Edwards, Larry Chamow, Claudi Grauf-
Grounds, and Douglas H. Sprenkle
This book is a fantastic resource for those with little or no experience in family
therapy. The language is simple and accessible, and each chapter provides a
guide for students and newly minted therapists who wish to prepare for their
first sessions. Topics include intake and assessment, treatment planning,
relationship on building and maintaining the therapeutic relationship, and
problem solving when treatment is not progressing.
 The Family Therapy Treatment Planner by Frank M. Dattilio, Arthur E.
Jongsma, Jr., and Sean D. Davis
This is another helpful resource for new therapists. The Family Therapy
Treatment Planner will aid the therapist in planning treatment for clients,
dealing with health insurance companies and health providers, and navigating
the complex ocean of rules and regulations. In addition, this book includes
many treatment plan options, a sample treatment plan, and guidelines on
dealing with the most common presenting problems for family therapists.

A Take Home Message

Family therapy is a way for you and your family to learn how to maintain
healthy family relationships, communicate effectively with family members,
and work cooperatively to solve family problems. This type of therapy is
unique, in that problems are viewed through a broader lens and as part of the
complex system of the family.

This perspective allows family therapists to help families get to the root of their
problems and facilitates healing for all members of the family, whether the
problem is related to substance abuse or addiction, abuse, mental health
disorders, unexpected or dire circumstances, or just the ordinary everyday
stress we all struggle with on occasion.

This piece described the benefits and goals of family therapy, introduced four
of the most common types of therapy, contrasted family counseling with family
psychotherapy, and provided examples of the exercises and techniques used
in family therapy.

My hope is that you find this information useful whether you are interested in
engaging with a family therapist, becoming a family therapist, or just learning
more about family therapy.

If you have ever participated in family therapy or if you have practiced family
therapy in your work as a mental health professional, we’d love to hear about
your experiences in the comments. Did you find engaging in family therapy
helpful? Did you get to reap the benefits described here? If you have practiced
family therapy, what are some of the most valuable things you have learned
from your practice?

Thank you for reading!