Filial Therapy: Parent-Led, Child-Centered Play Therapy

Although parents usually receive regular progress reports, they are rarely directly involved in those therapy sessions, though communication between the child and parents about the counseling sessions is often encouraged.

In contrast, with filial therapy, the parents are present during every session and even run most of the sessions themselves. In the first few sessions, the counselor will instruct parents on how to participate in interactive play and mindful play with their child. The counselor practicing filial therapy will also focus on training parents and caregivers on effective parenting methods and basic play practices. For the first few play sessions, the therapist will demonstrate play practices with the child, and then the parents will take the therapist’s place with the mental health professional coaching them as needed.

What a typical filial therapy program looks like

The general steps of a filial therapy program are as follows:

1. The therapist provides the parents with a detailed explanation of filial therapy—what it entails, the research behind it, and what it sets out to achieve. During this process, the therapist takes any cultural perspectives into account and provides culturally sensitive interventions.
2. The child engages in play sessions with the therapist while the parents observe the basic steps and skills required.
3. Parents take charge of a play session as the counselor supervises their progress. After the session, the counselor provides feedback. The sessions are conducted with one parent and one child at a time, as each parent-child relationship is unique.
4. The play sessions are moved to the family home, but the parents still have the opportunity to visit and talk with the counselor to discuss their concerns. Often, parents record their play sessions at home so that the counselor can review the videos and offer feedback.

The entire therapy process normally includes 15 to 20 sessions of one hour each. This process can take anywhere from three to six months and may last longer depending on whether the family desires follow-up sessions. Rather than a day-to-day practice, filial therapy typically takes place on a weekly basis. The counseling may also be conducted in a group setting, such as a community support group intended to strengthen families.

Just as with other forms of play counseling, the counselor and parents usually have regular meetings throughout the counseling. This connection allows them to assess the progress being made and to address any challenges or concerns. The parents and counselor may also discuss themes or patterns of behavior that become evident during the family's sessions.

Benefits of group filial therapy

Filial therapy was first used in group counseling sessions that involved clusters of unrelated families, all seeking therapeutic change. It is still practiced in this way in some instances.

During group sessions, each caregiver directly works with and focuses on their child, but they can also find emotional support in being among other parents who are learning the techniques with their children. In this setting, parents can see how other caregivers directly employ the techniques and play therapy activities, and may be better able to evaluate their own attempts. In addition to observing other families, parents may benefit from being able to give and receive constructive feedback within the group.

Core techniques parents learn in filial therapy

Parents are in charge of leading filial therapy sessions, which may seem intimidating. However, filial therapy techniques and parent skills tend to be straightforward and simple to employ.

Four basic skills a filial therapist may teach parents

The four basic skills taught to parents in the filial therapy flexible model are:

• Structuring - The parent generally identifies the play area and its boundaries. They usually also decide what toys to include.
• Empathic Listening - The parent may learn how to be in tune with and reflect the emotions of the child. In other words, parents learn to set aside their feelings and attend fully to their child’s behaviors and emotions through empathetic listening.
• Child-Centered Imaginary Play  - The parent typically watches the child at play and takes part only by following the child's lead. This is called non-directive play or child-centered imaginary play. In general, the child is not pushed toward exploring any particular topic—not even the ones parents think may be affecting them the most.
• Limit Setting - The parent learns to set rules as to what will and will not be accepted during the play session. Limit-setting should typically encourage safe and responsible play, but the rules should be few and not too limiting. For example, displays of aggression should be allowed, providing they are not severe enough to lead to property damage or injury.

Many parents find these skills beneficial, even outside the course of practice in sessions.

Filial therapy in adoption and foster care families

Filial therapy may be particularly helpful for families who are fostering children or have adopted children. As the filial therapy process tends to focus on fostering a secure attachment and healthy parent-child bond, it can help families grow closer and gain a better understanding of each other throughout the fostering and adoption processes.

Practical setup for parent-led play sessions at home

Caregivers generally need at least a 6x6 area in which to conduct sessions. This area should be distraction-free with no electronics. A variety of toys are recommended:

• Emotional release toys: Pillow, soft foam ball
• Make-believe toys: Toy food, doctor kit
• Creative expression toys: Paper and crayons, clay
• Family/nurturing toys: Dolls, blankets
• Aggressive play toys: Dinosaurs, toy soldiers
• Construction toys: Building blocks, Lincoln logs

The toys listed above are just examples. There are many other options that can be used for each toy category. It’s recommended to keep all of these toys in a bin that only comes out when filial therapy sessions occur, rather than allowing them to be used day to day.

How clinicians and parents learn filial therapy

Clinicians can learn about filial therapy through specialized training and certification programs. For example, the International Institute of Filial Therapy Professional Education offers a filial therapy program. Meanwhile, parents typically learn all they need to know from the therapist they work with. They can also seek out additional resources online or from their local library.

Socioemotional benefits of working with a filial therapist

During nondirective filial therapy, children are typically given a safe and fun outlet to express themselves, communicate with their parents, and learn useful skills. Likewise, parents can improve their listening skills, which may help them better understand their children. Parents often become more attentive and understanding, which can establish trust between them and their children. Parents may also develop more confidence in their parenting skills during nondirective filial therapy, which can improve parent-child relationships.

Within the setting of the child-centered play area during filial therapy, the child may be empowered to explore feelings they may not otherwise express. The parents have the opportunity to see and understand the underlying emotions that might be driving the child's behavior in nondirective play sessions. This bonding time can boost the child's self-esteem and reduce troubling behavior. Filial therapy also allows parents to learn how to handle frustrating situations by using the parenting techniques they learned from therapists in earlier sessions.