Client Perspectives of Family Therapy: A Qualitative Systematic Review

This qualitative systematic review aimed to synthesize and discuss family members' perspectives of helpful and unhelpful factors in family therapy (FT) sessions, to benefit the application of FT interventions and training. Eleven studies met eligibility criteria and were critically appraised and thematically synthesized. Four themes resulted: therapist qualities contributing to the therapeutic alliance, practitioners' use of therapeutic techniques, intervention delivery, and family engagement with the process. Helpful factors included therapist warmth, kindness, and genuine care; therapist connecting with family in a sensitive, respectful, and nonjudgmental manner; effective use of therapeutic techniques that facilitated self-reflection, emotional expression, communication, and perspective-taking; therapy sessions conducted collaboratively with active family participation; focusing on family strengths and resources; and tailoring format to family needs. Unhelpful factors included participants sharing before ready, therapist siding with a family member, therapy process not matching family needs, and insufficient progress early on. Implications for practice and future research are discussed.