Family therapy is unlike most appointments families are used to. There is no diagnosis at the end and no prescription to take away. Here is what to expect, from first contact to the end of an initial assessment.
Most family therapists will have a brief initial phone call with one or both parents before booking an assessment. This gives the therapist a sense of the presenting concerns and allows you to ask questions about their approach. It is also an opportunity to discuss who should attend the first session — the therapist will have a view on this, and it is worth discussing openly.
Some therapists send a brief pre-assessment questionnaire asking about the family structure, the history of the difficulty, and what each family member hopes to gain from therapy. Completing this in advance makes the first session more productive.
The first one or two sessions are an assessment — an opportunity for the therapist to understand the family, hear everyone’s perspective, and begin to form a picture of the presenting difficulty in its relational context. The therapist will ask questions about the family’s history, the current concerns, how different family members understand what is happening, and what each person would like to be different.
Systemic therapists are trained to ask questions in ways that open up new perspectives rather than confirm existing ones. You may find that a question you have never been asked before prompts a different way of thinking about a familiar problem. This is intentional — it is part of how systemic therapy works.
Keep it honest and age-appropriate. You might say: “We’re going to meet someone whose job is to help families talk to each other better. Everyone gets to have their say.” Avoid framing it as going because someone has done something wrong. Children often respond better to family therapy than parents expect — the space to be heard by a neutral adult is frequently a relief.
At the end of the assessment sessions, the therapist will share their initial understanding of the family’s situation and propose a plan for the work — including the likely focus, who will attend sessions, how frequently, and an initial estimate of how many sessions might be needed. This plan is collaborative, not prescriptive — you and your family are partners in designing the approach.
Family therapy confidentiality is more complex than individual therapy, because multiple people are involved. The therapist will explain their confidentiality policy clearly at the outset — including what they will share between family members, what is kept within the sessions, and the circumstances under which they would need to share information externally (such as a safeguarding concern). Ask about this at the first session if it is not addressed proactively.