Filial Therapy: Treating Social, Emotional, And Behavioral Concerns In Children
By Nadia Khan
Updated May 21, 2020
Reviewer Kay Adkins, LPC
While most therapies require the involvement of a therapist, filial therapy is a form of child-centered play therapy which focuses on the relationship between a child and his or her parents or guardians.
Designed explicitly for children between the ages 3 to 12, filial therapy consists of therapeutic sessions in which a child expresses themselves and learns through the act of play.
What Can Filial Therapy Be Used to Treat?
Filial therapy was originally developed for the treatment of social, emotional and behavioral issues in children. Its application has since been widened, however, with the theories and practices of filial therapy being applied to many different issues facing children.
Some of the conditions treated by filial therapy are:
- Anxiety disorder - A range of conditions characterized by excessive worry and nervousness
- Depression - Manifested very differently in childhood and adolescence than it is in adulthood
- Oppositional defiant disorder (ODD) - Demonstrated as irritability, defiance and spitefulness
- Aggression - Displays of hostility which may or may not be accompanied by violence
- Inattention and hyperactivity - Including attention-deficit hyperactivity disorder (ADHD)
- Attachment issues - These usually develop before the age of 5 and can have long-lasting effects
- Trauma - Including post-traumatic stress disorder (PTSD) resulting from car accidents; physical, sexual and emotional abuse; and bullying
Explaining The Age Limits for Use of Filial Therapy
Filial therapy is based on helping children aged 3 - 12 through the use of imaginative play. The therapy may prove ineffective for children younger than 3 years old since they have not yet begun to engage in imaginative play. For children over the age of 12, they may no longer be able to engage in the kind of imaginative play where they freely express themselves. These teenagers are often best helped by taking a verbal approach to their therapy.
How Does Filial Therapy Work?
Filial therapy is very different from most other forms of play therapies. Play therapist Nina Rye explains that in most types of play therapies, a therapist will meet the parents first. At that time, the child's developmental, behavioral, and learning issues, as well as the parent or guardian's involvement and parental techniques, will be discussed. After that, the therapist will work with the child over a matter of weeks or months.
Aside from regular progress reports, parents are hardly involved in those therapies, though communication between child and parents about the therapy sessions is always encouraged.
In filial therapy, however, the parents are present during every session and will even run most of the sessions themselves. In the first few sessions, they are taught directly and through observation how to engage in therapeutic play with their child. The therapist also guides parents in effective parenting methods and basic play practices. With the therapist assuming the role of coach, it is the parents or guardians who will then run the remaining sessions.
The general steps are as follows:
- The therapist collects information on the child's development and needs, and observes the family interacting with each other.
- Parents are given a detailed explanation of filial therapy - what it entails and what it sets out to achieve.
- The therapist engages in therapeutic play with the child while the parents observe how the basic steps and skills are carried out.
- Parents take charge of a play session with the therapist supervising their progress and providing feedback.
- The sessions are conducted with one parent and one child at a time since each parent-child relationship is unique.
- The sessions are moved to the family home but the parents still have the opportunity to visit with the therapist and discuss their concerns.
- Parents may choose to join a support group to give and receive encouragement as the family continues to work through the issues they face.
The entire course of therapy normally includes 15 - 20 sessions of one hour each. It can span anywhere from 3 - 6 months, but may last longer depending on whether or not the family wishes to have follow-up sessions with the therapist. The therapy may also be conducted in a group setting (the benefits of which are outlined in the next section).
Just as with other forms of play therapy, in filial therapy, the therapist and parents will have regular meetings throughout the duration of the therapy. This allows them to assess the progress being made and to address any challenges or concerns. They may also discuss themes or patterns of behavior which become evident from the family's interactions during the sessions.
It cannot be overemphasized that the entire point, purpose, and focus of filial therapy is to promote growth of all involved (not just the child) and to strengthen relationships in a family.
Benefits of Group Filial Therapy
The theory and methodology behind filial therapy developed in the 1960s by Bernard and Louise Guerney. Although it is quite often used with single families, the creators of filial therapy began it as group therapy sessions, involving groups of unrelated families. It is still practiced in this way in some instances.
During group sessions, each parent works with and focusses on their child but has the benefit of emotional support from being among other parents who are learning the techniques, just as they are. They can see how other parents employ the techniques and are better able to evaluate their own attempts. Parents also benefit from being able to give and receive constructive feedback within the group.
Techniques Taught in Filial Therapy
The methodology of filial therapy is described as "deceptively simple" by family therapist Dr. Risë VanFleet. "The ease with which the techniques in filial therapy are executed, go a long way in relieving any burden parents might feel with being the ones "in charge" of the sessions. By extension, it helps to allay their fears or concerns that they will not be able to properly run the sessions on their own.
The four basic skills taught to parents in filial therapy 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 in the play area.
- Emphatic 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 a non-directive play. The child is not pushed toward exploring any particular topic - not even the one's 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. The rules should be few and not too limiting. For example, displays of aggression should be allowed, within reason.
Social, Emotional, and Behavioral Benefits of Filial Therapy for Both Children and Parents
During filial therapy, children have a safe and fun outlet to express themselves and communicate with their parents. Likewise, parents can increase their listening skills, which will help them better understand their children. As parents become more attentive and understanding, it helps to establish trust between them and their child. They also further develop their confidence as parents.
Within the setting of the play area, the child feels empowered to explore feelings they may not otherwise express. The parents get the opportunity to see and understand the underlying emotions which might be driving the child's behavior.
Allotting this bonding time between each child and each parent gives parents the chance to pay special attention to a specific child. This can boost the child's self-esteem, reduce any troubling behavior, and better the relationship between the child and parents overall.
Filial therapy can also provide a suitable location for a child to improve his or her problem-solving skills through the act of play. It also gives the parents the opportunity to learn how to handle frustrating situations through the parenting techniques that they learned from the therapist in earlier sessions.
Flexibility is one of the strong points of filial therapy. It can be tailored to suit each unique family dynamic and the particular issue which led to the referral in the first place. The flexibility of the approach makes it highly transferable, so parents can use the techniques they have learned in settings outside of the therapy sessions.
Other Means of Expression
Yet another way for a child or parent to express the tension within their relationship is to talk about these concerns using a talk therapy approach such as those that are offered through BetterHelp, an online platform that allows the client to speak to a professional through messaging, by phone, or by video chat.