While individual therapy focuses on the thoughts, behaviors and emotions of one person, family therapy focuses on the relationships, and aims to understand and validate the experiences of all family members. The goal of family therapy is to bring clarity to all relationships, and to foster repair and closeness if family members choose. Family therapists believe that problems exist between people, not within people.

In the addiction context, a family therapist will explore with the family how substance use is embedded in a cycle of interaction within the family. For example, many young adults and parents are in what we call a fugitive/detective dynamic. The more the young adult acts like a fugitive (hiding, lying) the more a parent acts like a detective (snooping, chasing) — and visa versa. In addition, family therapists can provide additional education about substance use for the whole family and support family members in reducing their unhelpful behaviors and increasing their effective behaviors.

Family therapists help identify new skills and then coach family members in the practice of these new skills.

Anxiety, anger, frustration and a deep worry often interfere with parents renovating their approach to family life. Family therapists can also put the substance use in a different context by addressing other challenges and highlighting other resiliencies in the family — for example, understanding what is working in the teen's life, or asking, “If we weren't here to talk about this person's substance use, what would we be talking about as a family?”

Many research projects demonstrate that Family Therapy is very helpful, although there are time‐based and/or economic barriers as to why it's often not offered, implemented or practical.

In our work at CASA (National Center on Addiction and Substance Use), we've been engaged in a research project attempting to distill the core elements of family therapy from evidence-based therapies, and have identified four of the most important components of these family therapy models: Family Engagement, Relational Reframing, Family Behavior Change, and Family Restructuring.