Filial Therapy

Medically reviewed by Nikki Ciletti, M.Ed, LPC and Majesty Purvis, LCMHC
Updated July 14, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

While many types of counseling focus on the interactions between therapists and clients, filial therapy is a form of child-centered play therapy that focuses on the relationship between a child and their parents or guardians.

During filial therapy, therapists instruct parents on how to interact with their children and then oversee sessions where the parent(s) and child play. As the children play with their parents, they may develop a stronger attachment that translates into a healthier relationship in their everyday life and improved family functioning.

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What is filial play therapy?

Filial therapy is defined as “a short-term intervention that incorporates a combination of play therapy and family therapy,” overseen by a therapist. In essence, filial therapy is a form of child parent relationship therapy that can help parents and children better connect, address family problems or traumatic events, and prevent undesirable behaviors from reoccurring in the future.

While this child-centered play therapy technique was developed in the 1960s, research has since demonstrated that it is an effective strategy for creating a more healthy family system, as well as improving treatment outcomes for mental health conditions in younger children, such as ADHD and certain anxiety disorders.

What conditions can filial therapy help treat?

Filial therapy was originally developed to help treat social, emotional, and behavioral conditions in children, as described in the seminal text on the topic, Strengthening Parent Child Relationships Through Play, published by Professional Resource Press. However, filial therapy is now recognized as an effective method for helping not only children, but also their caregivers and the entire family as a whole, including children and families in foster care situations. 

Some of the conditions filial therapy can help with include:

  • Anxiety
  • Depression
  • Oppositional defiant disorder (ODD)
  • Aggression disorders
  • Inattention and hyperactivity including attention deficit hyperactivity disorder (ADHD) and its subcategories
  • Attachment issues
  • Trauma, including symptoms of post-traumatic stress disorder (PTSD)

Explaining age limits for filial therapy

Filial therapy aims to help children ages three to twelve through the use of play and imagination. The counseling may prove ineffective for children younger than three years old as children in that age range typically have not yet begun to engage in imaginative play. Children over the age of 12 may no longer be able to engage in the kind of imaginative play where they freely express themselves. Teenagers are often best helped by taking a verbal approach to their counseling, rather than filial therapy or any form of play therapy.

How does filial therapy work?

Though it is a form of play therapy, filial therapy is different from most other forms of play counseling. In most types of traditional play therapy, a counselor will meet with a child’s parents first to discuss concerns with the child's development, behavior, or learning, as well as the parent or guardian's involvement and parental techniques. After the initial discussion, the therapist will work with the child over a matter of weeks or months during individual weekly play sessions. 

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Although parents 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 encouraged.
In contrast, with filial therapy, the parents are present during every session and will 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 and the therapist will assume the role of quiet observer and coach.

The general steps of filial therapy 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 or talk with the counselor to discuss their concerns.

Parents may also choose to join a support group to give and receive encouragement as they continue to work on strengthening family relationships.

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. The counseling may also be conducted in a group setting, such as a community support group intended to help strengthen families.

A mental health professional may utilize various therapy techniques when providing filial therapy. Filial therapy may also be paired with other types of interventions, typically incorporating other professional psychology and adolescent psychiatric nursing care approaches.

Just as with other forms of play counseling, the counselor and parents will 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. It cannot be overemphasized that the entire point, purpose, and focus of filial therapy is to promote the growth of all involved and to strengthen familial relationships.

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 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 benefit from being able to give and receive constructive feedback within the group.

Techniques taught in filial therapy

Parents are in charge of leading filial therapy sessions, which may seem intimidating, but filial therapy techniques are straightforward and simple to employ.

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

  • Structuring - The parent sets the stage, so to speak, by identifying the play area and its boundaries. They also decide what toys to include.
  • Empathic Listening - The parent learns how to be in tune with and reflect the emotions of the child. In other words, the parent discovers how to be more sensitive to the child's emotions and more empathetic when responding to them.
  • Child-Centered Imaginary Play  - The parent 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. 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, within reason.

Socioemotional benefits of filial therapy

Research suggests that filial therapy may help reduce feelings of depression in children, and decrease parental concerns with children's behavior.

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

Within the setting of the child-centered play area during filial therapy, the child feels empowered to explore feelings they may not otherwise express. The parents have the opportunity to see and understand the underlying emotions which might be driving the child's behavior in nondirective play sessions. This bonding time can boost the child's self-esteem, reduce troubling behavior, and improve the relationship between the child and parents.

Filial therapy also allows the parents to learn how to handle frustrating situations by using the parenting techniques they learned from therapists in earlier sessions.

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Online therapy as an option

Filial therapy isn’t the only option for parents who are coping with doubts or issues related to parenting. If you find yourself overburdened or insecure in your role as a parent, you may benefit from discussing your concerns with a licensed therapist. Online therapy through a service like BetterHelp makes it easy to connect with a therapist from your home, so you can sneak a session in while your child is at school or taking a nap.

A literature review found that the effectiveness of online therapy was similar to that of traditional in-person therapy for a wide range of conditions. The results of this research suggest virtual therapy may help parents facing challenges including inter-relationship difficulties with their children and spouses, as well as their choice of parenting style.

Takeaway

A type of play therapy, filial therapy focuses on the relationship between parent and child. Filial therapy or other forms of family therapy may help you better connect with your children and address relationship struggles. While it won’t solve problems immediately, it may help you improve your family life over time.
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