In-Person Family Therapy

Body language speaks volumes: In-person family therapy allows the therapist to respond to all verbal and non-verbal interactions

Family therapy has a lot going on. While online therapy has the obvious benefit of permitting families dispersed outside of the New York area to come together and realize they can do family therapy, there is also the trade-off of not being able to observe the family doing its thing in its entirety. In the family therapist’s office (even in the waiting room), we can see every kind of verbal and non-verbal communication, including body language that speaks volumes when words fall short. Who sits next to whom? Who is off to the side in the waiting room? Is there silence? Is there arguing? Playfulness? Joy? Grief? Is a younger kid or teen grabbing a toy or making art? Is one family member talking over the others? Is another careful not to interrupt? Who makes eye contact with whom? Who avoids speaking? While some of these interactions can appear on screen, many don’t.

Why is this important? Because family therapists need to receive the family as they are, as unedited as possible.

The inconvenience of getting everyone together for in-person family therapy can be a key part of the process

The inconvenience of in-person family therapy, while important to manage and consider, is also an important part of the process. The logistics of bringing multiple family members together at the same time, whether in person or online, is often the biggest challenge of the early days of family therapy. Any family that’s ever tried to organize a family dinner or a family vacation can speak to that. Of course, mixed feelings about digging into deeper issues and exploring parts of the past that the family shares can also show up in fraught navigation of logistics.

We find it meaningful when family members make the time, regardless of whether they’re doing in-person therapy or remote therapy. However, doing so in person shows a special commitment—it’s a statement that one is willing to be inconvenienced to engage in improving one’s relationship with family members, repairing rupture, and committing to resolving issues when moving forward.

Though surmountable, video calls with multiple family members pose challenges not found in in-person family therapy

We’ve all been on Zoom calls with three or four (or more!) people. Who speaks first, sound and connection issues, and different camera qualities can all get in the way of the task at hand. Sometimes, a few family members are in the same room on the same device, which can pose a challenge for everyone to be heard and seen on screen. 

While we’ve developed a particular decorum with video conferencing that helps get work done, both in and out of therapy, this isn’t necessarily conducive to family therapy. While civility is welcome, if an absence of civility is part of the problem that brings a family into treatment, we need to see that mess. We also need to be able to make space for talking about hard things, and video calls are much too easy to jump off of when things get tough.

A family breathing together in the same room can be a reminder of shared humanity

It sounds so simple, but as family therapists who prefer in-person therapy, we discovered during the pandemic just how important breathing together in person is to therapy. This is something we previously took for granted. Listening to breath, pacing our breathing, and offering breathing together as an intervention when the work becomes challenging are essential tools of therapy. In in-person family therapy, it’s quite common for a family therapist to invite family members to breathe in the room together as a kind of symbolic reminder of their shared humanity and values.

A therapist’s office is a neutral space organized for families to do a specific kind of emotional work

Family members are not merely present in the same room together for in-person family therapy; they’re in the same room that’s not a space of work or home, or a device where they hold meetings, consume media, or multitask. The therapist’s office is a neutral space organized to do a specific kind of emotional work that the therapist owns and manages. This can allow for ease in letting the family therapist take charge and take control. A family therapist needs to be able to hold authority and step in if things get too intense. A family also needs to be able to leave some of the difficult things that happened in session behind with the therapist to attend to another day.