New cpt code for family therapy
A Quick Overview of Family CPT Codes (90846 and 90847)
There's a lot of information out there about family CPT codes, spread across multiple sources. So, we thought we’d consolidate it for you. Here’s what you need to know about 90846 and 90847.
Want to learn more about CPT codes? Read A Quick Overview of CPT Codes on our blog.
What are family codes?
The CPT codes 90846 and 90847 are used for face-to-face or telehealth family psychotherapy sessions of 26 minutes or longer.
The main difference between these codes is that 90846 is used for appointments when the patient is not present, and 90847 is used for appointments when the patient is present. Often, these appointments entail family participation in the treatment process of a person in that family.
If a married couple identifies as a family, they may qualify for the family code as well depending on the insurance. When it’s a child being treated, it’s usually with the expectation that intervention in their family interactions will improve their emotional or behavioral disturbances.
If a family member is brought into individual psychotherapy sessions intermittently or briefly, you don't have to bill these family codes. You can use individual psychotherapy codes, 90832, 90834 or 90837. Just make sure the intent of the session/s is not the family member's benefit. The patient can get some benefit by having the family member there, but if both people are benefiting, then you must use 90846 or 90847, since family sessions are about all individuals in the session benefiting from the service.
Billing these codes
To bill 90846 or 90847, you must choose one person in the family as the identified patient (ideally the primary holder of the insurance or the one with the more severe symptoms).
List only that person's name and diagnosis on your claim and no one else's in the family. Also, be clear about the focus of the session in your documentation.
You generally can’t bill 90846 or 90847 when the service being performed is taking a family history or requesting a brief update on the patient’s behavior prior to or after the individual session takes place. Family counseling also doesn’t typically include the supervision of or therapy with professional caretakers or staff.
In terms of same-day billing, family therapy codes can be reported on the same day as psychotherapy codes 90832-90834 and 90836-90838 if the services are separate and distinct. You can also typically bill individual and family therapy codes on the same day if they’re two separate counseling sessions, with one including only the patient and the other including both the family member and the patient.
Billing 90846 and 90847 on the same day as each other for the same patient is often not allowed, regardless if it’s two separate sessions.
Getting reimbursed
Insurance policies differ when it comes to family codes.
Some insurance providers, like Medicare, cover family psychotherapy services only when the primary purpose of the visit is the treatment of the patient’s condition. Examples of this include:
- When there is a need to observe and correct, through psychotherapeutic techniques, the patient’s interaction with family members
- When there is a need to assess the conflicts or impediments within the family, and assist, through psychotherapy, the family members in the management of the patient
You may also run into limitations such as:
- Only being able to bill family codes a certain number of times a year
- Specific age-requirements for children being treated
- Adult patients not being covered
As you can see, being reimbursed for family therapy appointments can vary quite widely. Make sure you find out when you can use these codes before proceeding with these sessions.
Good luck!
Sources: CPT® (Current Procedural Terminology), American Medical Association; Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual, APA Practice Organization; Coding and Billing Guidelines, Centers for Medicare & Medicaid Services; Does Insurance Cover Couples Therapy?, GoodTherapy; Billing for Couples and Family Therapy, Barbara Griswold, LMFT
Talk with a member of our Success team and learn how TherapyNotes™ can help.
* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.
Get more content like this, delivered right to your inbox.
Subscribe to our newsletter. Couples and Family Therapy Billing Guide
CPT Code 90847 and procedure code 90846 can be challenging to bill. Here's a guide on how to bill mental health family therapy CPT codes 90847 and 90846. We will teach you the differences between family and couples or marriage counseling.
NOTE: This guide has been updated in 2022 to reflect current CPT Code 90847 reimbursement rates.
Unlike individual therapy sessions, using the correct code to bill mental health family therapy depends on the members of the family in session.
We are going to explain both CPT Code 90847 and CPT Code 90846 for couples and family therapy, walk through four hypothetical treatment scenarios and explain how to bill each example.
By the end of this article you’ll know what codes to use, when, to bill family therapy for mental health CPT codes 90847 and 90846.
We’ll also explain which Add-on codes to use in conjunction with billing codes 90846 and 90847 as well as the 90847 reimbursement rates for family therapy with or without the patient present.
If you’d prefer to just have us help you do this, we provide an insurance billing service exclusively for mental health providers and we’re happy to help.
Article Index
- 90847 Description
- Reimbursement Rates
- Time Length
- Billing Instructions
CPT Code 90847 Description
- 90847 – Family or couples therapy with the patient present.
These sessions need to be at least 26 minutes in length. This is the CPT code for ongoing couples therapy or marriage and family therapy for two clients. You cannot bill both clients, this is considered one “service code” and will most often reimburse at a higher rate.
(Source) (Source)
CPT Code 90846 Description
- 90846 – Family or couples therapy without the patient present.
These sessions need to be at least 26 minutes in length.
- 90837 – Individual therapy for 60 minutes.
These sessions need to be at least 53 minutes in length.
If medical management services are performed, use the 25 modifier. Interactive complexity services CPT code 90785 are not allowed with this service.
If you’d rather not worry about remembering any of this, we can help you decipher these situations into maximally paid claims on your behalf with our mental health billing service.
90847 Reimbursement Rates for Family & Couples Therapy
Medicare lists the national payment amount for couples and family therapy as:
CPT Code 90847 Reimbursement Rate (2022): $111.15— Family psychotherapy with the patient present Medicare reimbursement rate.
CPT Code 90847 Reimbursement Rate (2020): $107.19
CPT Code 90847 Reimbursement Rate (2021): $102.59
CPT Code 90846 Reimbursement Rate (2022): $107.37— Family psychotherapy without the patient present Medicare reimbursement rate.
CPT Code 90846 Reimbursement Rate (2020): $103.
58
CPT Code 90846 Reimbursement Rate (2021): $99.10
CPT Add-On Code +99354 Reimbursement Rate (2022): $140.26— Additional time up to 1 hour and 45 minutes for a diagnostic interview
CPT Add-On Code +99354 Reimbursement Rate (2020): $132.09
CPT Add-On Code +99354 Reimbursement Rate (2021): $129.10
CPT Add-On Code +99355 Reimbursement Rate (2022): $101.32— Additional time up to three hours for a diagnostic interview (must be used with +99354)
CPT Add-On Code +99355 Reimbursement Rate (2020): $100.33
CPT Add-On Code +99355 Reimbursement Rate (2021): $96.31
(Source)
Each insurance company will reimburse for different amounts for the above CPT codes depending on your license, location, relationship with that insurance company, and the type of plan the client may have.
Not all add on codes or family therapy codes are allowed by insurance, so please call to verify eligibility and benefits before seeing your clients (or we can do it for you).
90846 & 90847 Time Length
CPT Code 90847 Time Frame: 50 to 74 Minutes
There are technically no maximums for coding family therapy sessions with CPT codes 90846 and 90847.
If you do want to bill additional time for providing services, we recommend at least 74 minutes of family therapy service before considering using an add-on billing code for additional time rending couples therapy or family therapy services.
CPT Code 90846 Time Frame: 50 to 74 Minutes
Medicare lists the minimum required time for couples therapy or family therapy with or without the patient present at 50 minutes. (Source)
CPT Code 90847 Video Guide
90846 & 90847 Add-On Codes for Extra Billing Time
If your services are longer than 74 minutes, often the case with marriage counseling or family therapy codes, use +99354 to bill an additional 30 minutes of time.
So if your session is between a bit over an hour and 1 hour and 45 minutes, use +99354.
If your session for couples therapy or family therapy is longer than 1 hour and 45 minutes, add +99355 to your claim form for an additional 44-45 minutes of services. CPT code +99355 covers couples and family therapy sessions between 1 hour and 45 minutes and 2 hours and 30 minutes.
- First 74 minutes: CPT Code 90846 or 90847
- 75 to 1 hour and 45 minutes: Code 90846 or 90847 +99354
- 1 hour and 45 minutes to 2 and a half hours: 90846 or 90847 +99354 +99355
| Couples or Family Therapy CPT Code | Add-On CPT Code for Extended Session | Length of Session | Services Rendered |
|---|---|---|---|
| 90846 90847 | 99354 | 80-124 minutes | Couples or Family Therapy, Extended Session, 1:20 hrs - 2:04 hrs |
| 90846 90847 | 99354 99355 | 125-154 minutes | Couples or Family Therapy, Extended Session, 2:05 hrs - 3:34 hrs |
| 90846 90847 | 99354 99355 99355 | 155-184 minutes | Couples or Family Therapy, Extended Session, 3:35 hrs - 4:06 hrs |
| 90846 90847 | 99050 | N/a | Services performed outside of business hours. |
| 90846 90847 | 99051 | N/a | Planned services performed in the evening, weekend, or during a holiday. |
Family Therapy Insurance Billing Scenario
Let’s say three people all attend therapy:- Client A (mom),
- Client B (child),
- and Client C (child).
Let’s say that Client B is the person who is specifically needing treatment. Client A and Client C are part of the reason that treatment is needed, as it’s a family matter. Then Client A, the mother, due to her own distress, decides to enter treatment.
Let’s say these folks have 4 total sessions. Here’s what they look like:
Session 1) They all attend therapy together.
Session 2) The following week, the mother, Client A is seen about the child in treatment, Client B.
Session 3) The next day, Client B is seen individually.
Session 4) A week later, the mother, Client A, decides that she needs to seek out therapy as well and sees the therapist about her own treatment needs.
How to Bill These Family Therapy Sessions
Session 1: We use billing code 90847 for family therapy with the patient (Client B) present. Use Client B’s information when filing the claim, including their diagnosis code.
Session 2: We use billing code 90846 for family therapy with the patient (Client B) not present. Use Client B’s information and diagnosis code when filing out the claim form. We may want to add additional diagnoses here as we learn more about the treatment situation.
Session 3: We use billing code 90837 here for treatment with the client, Client B. Even if this client is seeking therapy about their family issues, they are seeking individual therapy. Use Client B’s information on the claim forms too.
Session 4: We are also using billing code 90837 for the new client, Client A, as Client A is now requesting their own treatment (about their family issue). Use Client A’s information and diagnosis when filing this form.
90847 Billing Guidelines
Medicare suggests that providers do not bill 90847 when performing a family history or E/M counseling services. Use Evaluation and management sessions for billing according to the proper allotted time. See our mental health CPT code guide for more. SourceMedicare requires that providers conduct family therapy only when the services are required to have a direct impact on the treatment of a single individual. See Noridian’s guidelines.
Summary
Always use the person who is the primary treatment seeker on your claims forms. They are the person who is seeking treatment, even if a family member is attending therapy to their benefit (90847). So even if they are not in session, like with 90846, their information is to be used.
If all of this is too much, feel free to drop us a line about our mental health billing service for therapists. We handle these sorts of questions daily.
Family Therapy and Benefits for HSE Employees – News – HSE for Its Own – National Research University Higher School of Economics the immediate environment in providing assistance and on preferential consultations for university staff.
Systemic therapy is one of the main therapeutic areas worldwide. The system approach assumes that for comprehensive assistance, it is necessary to take into account the system of relationships in which a person is included.
The most stable and long-lasting system of relationships that accompanies a person all his life is the family. However, each person is included in a variety of other more or less stable systems of interaction, which makes systemic therapy useful for helping in various difficult life situations, not only family relationships.
Moreover, even those difficulties that are often considered individual - for example, addictions - are very difficult to solve without taking into account what kind of life a person lives and who makes up his immediate environment.
How family therapists work
There are variations: in one logic, a systems therapist interacts with all people living together, while other directions allow working with one person, but always taking into account the life context of a person experiencing difficulties.
In this format, the work often involves a parent or child-parent pair.
The main task is to find that strategy of human behavior that will help both him and his entire immediate system of relations to exist without difficulties.
This kind of help is in great demand, because people face difficulties in relationships throughout their lives, and joyful and productive relationships are the most important condition for a successful and happy life.
How family therapists are trained at HSE
HSE has a master's program in Systemic Family Therapy. We train specialists in workshop mode, with a lot of training. We focus students primarily on private professional practice and work in clinical and other helping organizations. Training in the program corresponds to the world practice of training such specialists.
In the first year of study, our students, mastering all the main schools of the systems approach, undergo training supervision, observe the work of leading experienced systemic therapists “behind the mirror” and then discuss it with them.
In the second year, students undergo clinical practice - they work in several clinical centers with families who have encountered diseases of any of the family members.
After studying with us for two years, they are ready to work with the whole family, couple, parents, teenagers, with a diverse and wide range of people's needs.
The program focuses on research into the life of the Russian family, as well as education and the promotion of family therapy. We hold regular open lectures, allowing people to better understand how the help of a systems specialist can be useful to them.
Why Program Specialists Don't Counsel HSE Employees
During self-isolation, together with other HSE specialists, we launched a survey of university employees about the problems and psychological difficulties that have arisen. It seems to me that it was a very good decision to involve specialists in family therapy in the development of this questionnaire.
Many people during quarantine spent more time with their families than they used to.
The answers to the questions asked in the questionnaire showed quite clearly that, to a lesser extent, people encountered, for example, the difficulties of remote work (although they also existed), and to a greater extent, the need to combine parental care with work, with marital , partnerships. People felt overwhelmed, so the demand for help in building family relationships, which is always relevant, escalated.
In response to this request, the university was faced with the task of supporting its employees. Despite the fact that unconditionally professional and well-known specialists work on the master's program, they cannot take on this support. This violates the ethical standards of work - after all, the professionals teaching in the program are included in the general system of working relations with those whom they would have to help. The confidentiality necessary for work and the neutral position of specialists are violated.
The solution was to recommend and engage organizations, including professionals, who are able to provide such assistance. The HSE Center for Psychological Counseling has entered into cooperation agreements with the Center for Systemic Family Therapy, the Society of Family Therapists and Counselors, and the Center for the Study of Eating Disorders; negotiations are underway with the Scientific and Practical Center for Mental Health of Children and Adolescents. G.E. Sukhareva. Thus, the University Counseling Office can now provide its employees with a "data bank" of specialists who can provide them with psychotherapeutic and counseling assistance, primarily on requests relating to family relations.
Many alumni of our program from different years work in these organizations, and all of them are ready to provide services to HSE specialists at a reduced rate. I really hope that this form of assistance will be successfully tested and will be useful.
Center for Systemic Family Therapy
To make an appointment, call 8 (967) 004-24-00, tell the administrator that you are from the Higher School of Economics to receive a discount on consultation.
It is important to indicate this before the consultation, and take your HSE pass with you to the appointment.
Eating Disorders Research Center
If you would like to see a mental health professional, you can call the Eating Disorders Research Center at 8 (495) 126-06-71. Also indicate that you are an HSE employee. There is a 50% discount on medical appointments for our employees.
In the near future, a page with a list of psychologists and psychotherapists of the Society of Family Therapists who are participating in the HSE cooperation project will also be launched, indicating contacts, appointment locations, and information on the basis of which you can choose and contact a psychotherapist yourself.
The master's program in Systemic Family Therapy has its own YouTube channel. Here you can find materials of open events held by program specialists.
Family Therapy: Approaches, Techniques and Methods
SELECT A PSYCHOLOGIST
alter
A TRAINING GUIDE
Family therapy is not only work with marital relationships.
If one of the family members has problems, their roots can go deep into family history and habitual behavior patterns. So, the problems of a child are often offered to be solved not in a children's, but in family psychotherapy.
There are two main approaches: systemic family therapy and emotion-focused therapy. The first considers the family as a whole and adjusts the system itself. The second works mainly with relationships within a couple, helps partners get out of an impasse, restore intimacy and trust.
Contents
1. Systemic family therapy: the family is a single organism
2. What is the family system
3. How the CCT works
4. Genogram
5. Circular interview
6. Positive reformulation
7. What problems are solved at SST
8. Emotionally Focused Therapy: staging a “pair dance”
9. Basic principles of EFT
10.
How EFT works
11. When is it time for therapy?
12. Case study
13. What to read?
Systemic family therapy: the family is a single organism
Systemic family therapy (SFT) does not consist of individual therapy for each family member. The client in this case is the family as an organism, a single whole. In the system, everyone is connected with everyone, so any violations in one of the family members can lead to disharmony for everyone else.
“A family is a system. Each person is an element of this system that influences it. Relationships between elements also affect the system. If one family member has a symptom - for example, alcoholism - this will be reflected not only in him, but also in his family. His relationship with his wife will also be special, and will also affect the entire system. If his wife protects and protects him, there will be one relationship in the family, if she gets angry and makes scandals, it’s completely different.
”
Olesya Kruglushina, Systemic Family Therapist
Unlike other therapeutic approaches, CCT did not grow out of philosophy or medicine. It is based on biology and cybernetics. In the 1930s, L. von Bertalanffy introduced the concept of "General Systems Theory". Its idea is based on an organismic view of the world:
- The whole is greater than the sum of its parts
- All parts and processes influence each other
Family counseling existed before, it just happened within existing schools : for example, psychoanalytic, humanistic, gestalt therapy. In the 1970s, the concept of systemic-family views on therapy began to develop. Subsequently, FTA developed differently in the US and Europe. Now this approach is recognized at the state level in many countries.
Historical background
What is the family system
According to the SST, the life of the family system is subject to two laws: Any changes are perceived as a threat to the system.
Therefore, in SST it is important to work with the resistance that inevitably arises. In order to preserve the order of things, the family is ready to endure any restrictions. The client wants the problem to leave the family, but is not ready to change for this.
Development Law
However, the family system cannot be frozen. The age of family members changes - accordingly, their relationships also change. Children are born, and then grow up and begin to live independently.
Murray Bowen, one of the well-known CCT practitioners, formulated 8 concepts of the family system. They are interconnected - to understand how the system works, you need to see the essence of each concept and its impact on the others.
Differentiation "I"
A person with a high level of differentiation can build emotional contact with the family without losing the boundaries of personality. If the level is low, then the person will be inclined to merge and symbiosis with the family.
From a therapeutic point of view, this is not the best model. The therapist teaches each family member to separate from the rest while maintaining good contact.
Emotion Triangle
When there is conflict between two people, they often use a third person to find a way out of the conflict. As a rule, in this way parents use the child to influence each other. This creates a "pathological emotional triangle". In fact, the conflict cannot be resolved in this way. But, according to the law of homeostasis, the family continues to support it. For this, someone may even act to their own detriment (for example, a child maintains poor school performance, because because of this the whole family gets together, does homework with him and solves a common problem).
Projective processes
Children involved in the emotional triangle often begin to “repeat” after their parents. They react similarly to stressful situations, experience similar emotions: for example, anxiety, resentment or aggression.
The process of transmission of negative patterns from generation to generation
If parents had a low level of differentiation, children are likely to adopt it. And later they will pass it on to their children. So dysfunctional patterns of behavior can "live" in the family for so many generations that it will be difficult to change them.
Emotional break
Some family members decide to break emotional contact with the family in order to resolve their problems. This does not always help: sometimes a broken relationship brings even more discomfort. The therapist will teach this family member the differentiation of the Self: it is not necessary to break the connection in order to maintain individuality.
Sibling position
Older, middle and younger children behave differently because of different expectations from their parents. Subsequently, this behavior can become part of their character and influence the rest of their lives.
For example, older children often start behaving like "little adults" from an early age, which can lead to hyper-responsibility and anxiety.
Social emotional process
Social changes affect the institution of the family. Also, different social currents and opinions can affect the atmosphere in a single family. Therefore, in therapy it is very important to look at the social context.
The emotional process of the nuclear family
"Everyone affects everyone." If there are disagreements, conflicts or violence between some family members, this is reflected in the rest and can even lead to mental disorders.
The goal of systemic family therapy is to highlight negative patterns of behavior. find their roots, work through and help the family find a balance between emotional contact and individualization.
How the CCT works
In the first session, the therapist clarifies the problem and the history of the family. It focuses on the main points:
Relationships in all family members
Relationships and communication features appear in significant situations. The therapist asks family members to take turns describing an event and looks at their interactions—in the stories themselves and in the course of therapy.
Public and unspoken rules in the family
Rules are how a family lives, how responsibilities are distributed in it, how family members communicate with each other. Examples of a family rule: "The woman is responsible for all housework", "Children have no right to argue with their elders." Not everyone may agree with the rule, but they still abide by it.
Family myths
A family myth is an unspoken image of a family that is supported by all its members. For example: “We are a friendly family and never swear.” Conflicts and contradictions in such a family can be hushed up so as not to destroy the myth. For the sake of the myth “Mom is our savior”, all other family members will constantly get into trouble so that there is someone to save. Anyone who threatens the myth with his behavior can be severely punished - up to and including exclusion from the system.
Family boundaries
Each family member has an idea of who belongs to the family. This representation can be different: for example, the wife includes her parents in the system, while the husband does not consider them members of the family. This discrepancy leads to serious disagreements.
“Before the family comes to the session, I form a hypothesis: what is happening to these people that brought them to therapy. At the session, the first stage is the collection of information and acquaintance. I ask about professions, education, background. This is very important and affects relationships. After all, if he is a professor of mathematical sciences, and she is a manicurist, most likely they speak different languages. I ask if the person has “his” place in the apartment where he can be alone. Information that at first glance has nothing to do with a family problem can be very important. ”
Olesya Kruglushina, systemic family therapist:
“The systems approach can work with the whole family, with a couple and even individually. Sometimes not all family members want to come to therapy. It happens that a client stays or comes to individual work - and becomes an agent of change in his family. SST allows you to build a line of therapeutic work quite flexibly. For example, in working with a family where there is a teenager, family meetings can be sequentially organized, paired, individual with a teenager and each parent, and then again joint sessions. This is decided on a case-by-case basis."
Anna Guseva, systemic
family therapist:
As a rule, work in the STS is divided into 4 stages:
Making a family diagnosis
"Family diagnosis" is not a medical term and not a psychiatric conclusion. This is the reason why there is a problem in the family.
Elimination of the conflict
After the main conflict has been clarified, it must be eliminated. To do this, the therapist uses specific techniques to reduce the anxiety associated with the problem and teach family members to respond differently.
Reconstruction
Reconstruction is a change in the dysfunctional model itself, which causes conflicts. If you don't change it, it's a problem. most likely to return some time after therapy.
Support
Discussing the results, expressing thoughts and feelings on this issue reinforces the effect of therapy. So after the request is satisfied. it is helpful to have a few supportive sessions. There are cases when the family visits the therapist regularly - to prevent subsequent problems.
In the course of his work, the systemic family therapist uses various techniques that are unique to this type of therapy.
Genogram
The easiest way to trace the history of a family is to use the genogram technique. The therapist draws a detailed family tree with the family. On it, he notes the ties between relatives and important moments in history: marriage and divorce, the peculiarities of raising children and communicating with parents.
The genogram clearly shows what expectations each spouse has from family life.
“Since childhood, we have adopted certain family rules. How a family should function, how a wife and husband should behave, how to raise children, how to distribute finances. This is passed down from generation to generation. When we draw a genogram, a family symptom is immediately visible. There is always a relationship: some generations already had the same symptom. It is also seen that family rules in one and the other genus may not coincide.
For example, in the family the boys' wives were very protective, relieved of any work, "fed" and took care of them. And in the husband's family there was a rule "You are a man, you must help." Such a couple will quarrel even because of mopping: each will strive to do it on their own. As a result, the wife will feel rejected (“He doesn’t need my care and love”), and the husband will feel humiliated (“Is there nothing I can do?”).
Olesya Kruglushina, systemic family therapist:
Circular interview
Circular interview is a technique that is widely used in family therapy. The therapist takes turns asking all family members the same question—sometimes worded differently. A circular interview helps to clarify the attitude of each family member to a problematic situation - as well as to show everyone the hidden motives of their actions and words. However, the therapist usually does not ask about the thoughts and feelings of the client. It only shows how the whole situation looks from the outside, what patterns it reflects - and it becomes clear to everyone why this situation is happening.
Examples of questions in a circular interview:
— How does the situation look like now?
— When did the situation first arise? Why do you think this happened?
— How do you deal with this situation?
- What do you get when this situation occurs?
— If the situation continues in the future, what will it lead to?
Positive reformulation
Once the therapist has made a “family diagnosis”, he helps the client change his attitude towards the problem.
First, he tells the family that their problem is not unique and that many are experiencing it. It takes some of the stress off. Then he draws attention to the advantages of the situation and positive motives for behavior. For example, “you are so protective of your son because you are a very caring person, and you are afraid of losing him.” Then he draws attention to the fact that the chosen behavior does not correspond to the motives that prompt it - it even contradicts them. For example, by overprotecting the child, the mother does not contribute to his safety - because in this way he does not learn to cope with difficult situations.
The last step of this work is prescription . The therapist helps the family formulate a new rule and gives homework to follow it.
What problems are solved at SST
SST deals with any problems related to family relations. You can contact a therapist if:
You find it difficult to negotiate and resolve conflicts within a couple (even if you are not officially married)
One of the family members has an emotional or mental disorder that affects relationships within the family
The child has problems with socialization, academic performance or health (especially for psychogenic diseases)
You cannot find a common language with the child or teenager
The composition of the family has changed: a new child has appeared or, on the contrary, the child has grown up and started an independent life.
All family members need to adapt to new conditions
You are going through a divorce and creating new families
You are experiencing the death of a family member
“Most requests are related to marital and parent-child relationships. Individual clients come with very different questions: difficulties in creating long-term relationships, dissatisfaction in relationships with a partner and the world, experiencing crises and losses, the inability to decide on some important life choices, addictions.
Perhaps the most complex requests for each specialist will be different. Someone is better at dealing with divorces or parent-child relationships - and he will “transfer” clients with addiction to colleagues. Some find it difficult to work with conflicting families, while others find it difficult to work with distant ones. But for difficult cases, there are always supervisions and personal psychotherapy.”
Olesya Kruglushina, Systemic Family Therapist:
CCT can be short-term: some problems can be solved in a few sessions.
This usually refers to problems that have arisen recently. If the tension has built up over the years, more time will be needed. But it is impossible to accurately determine the required number of sessions - it is individual for each family.
Emotionally Focused Therapy: staging a “couple dance”
Emotionally Focused Therapy (EFT) is designed for couples. It helps to overcome the crisis of relations, to make them closer and more trusting. One of the founders of the approach compared EFT to choreography: "the therapist acts as a choreographer for staging a pair dance."
EFT was based on the attachment theory of psychoanalyst John Bowlby. He worked with children - in particular, he observed how children develop and behave in orphanages. Bowlby noted that these children often suffer from emotional problems and find it difficult to establish contacts and long-term relationships. He suggested that this is due to the lack of experience of close attachment to the mother.
Then John Bowlby began to develop his theory of attachment, according to which the behavior of people in relationships depends on what kind of contact they had in childhood with their parents (in particular, with their mother). The fear of loneliness or overprotection is formed in childhood and remains with people for life. Because of this, they develop insecure attachment styles that prevent them from building strong close relationships.
EFT was created by Canadian psychologists Susan Johnson and Leslie Greenberg. They started developing the approach in the 80s. Methodologically, it is similar to the synthesis of Rogers' client-centered therapy and CCT. From client-centered therapy, EFT took the emotional involvement of the therapist and the nonjudgmental acceptance of the client. From SST, the idea that relationships are affected by negative patterns.
The approach has been constantly developed and improved. In 1998, Susan Johnson created The International Center for Excellence in Emotionally Focused Therapy, which trains and certifies EPT therapists and conducts clinical research.
It is now an internationally recognized method of couples therapy.
Background
Basic Principles of EFT
Bowlby found that many people develop insecure attachment styles that interfere with relationships. The goal of EFT is to help change the attachment style to one that is secure and secure. A person with a secure type of attachment is not afraid of being abandoned or "strangled" by love, does not control a partner and does not manipulate him. He enjoys an emotional connection, a relationship for him is a “safe bay”, where you will always be accepted and supported.
Emotions are the key to creating a secure attachment
As the name suggests, EFT focuses on emotions. Through emotions we perceive and evaluate reality. Negative emotions once led to the formation of an insecure attachment style.
The need for affection is healthy and natural
All people desire affection: it is genetically determined.
Historically, those who knew how to call for help and accept support survived. Only the ways in which people try to satisfy the need for attachment can be maladaptive.
Interaction is cyclical and forms patterns
One reaction provokes another. The behavior of the couple “enters” a cycle from which it is difficult to break out.
Change occurs through new emotional experience
In therapy, the couple receives new emotions - from communication with the therapist and with each other. This experience provokes change.
How EFT works
Johnson and Greenberg formulated 3 stages of work in EFT, each of which consists of several steps:
Step 1. Formation of a therapeutic alliance and discussion of the request.
Step 2: Finding the Negative Cycle
Step 3: Dealing with the Emotions That Triggered the Cycle
Step 4: Redirecting the Problem: Common Enemy – Negative Cycle that Causes Stress and Conflict
Step 5: Talking Out Needs and Emotions . Partner interaction.
Step 6: Work on acceptance: The therapist teaches partners to express empathy and support, to accept each other's needs and emotions.
Step 7. Work on the style of attachment: the "withdrawal" partner learns to engage in an emotional connection, and the "accusing" partner learns to behave more freely.
Step 8. Form new ways to behave and discuss problems.
Step 9. Use the skills learned in therapy outside the office. Consolidation of results.
At each stage, the therapist uses techniques specific to EFT.
Reflection Technique
This technique is borrowed from Rogers' Client Centered Therapy. The therapist "returns" to the client his vision of the situation. He literally repeats the words of the client, highlighting the most emotional and significant moments with intonation. This contributes to the creation of a therapeutic alliance.
Confirmation Technique
The therapist accepts the client's thoughts and feelings; shows that they are completely normal and natural.
Confirmation is not approval. It is important for the therapist to remain neutral and not take sides with either partner. Its purpose is to show partners that their emotions are important and their reactions are understandable.
Empathic Suggestion Technique
The therapist guesses what deep emotions may lie behind the client's story. Sometimes we mask true, primal emotions with ones we have "learned" to experience—more socially acceptable and less traumatic. In therapy, it is important to “raise” the primary emotions and work through them.
Feeling Questions
When a therapist notices a particular reaction in a client, he may ask, "What did you feel at that moment?" "What prompted you to do this?" By asking questions, he invites the client to explore his own emotional world.
Amplification Technique
When during therapy it is possible to identify the primary emotion, the therapist deliberately focuses the client's attention on it, asks clarifying questions, provokes introspection.
As a rule, the client in this case resorts to an avoidance strategy: it is difficult and uncomfortable to discuss the primary emotion. The task of the therapist is to carefully work with resistance, not to put pressure on the client and support him.
The therapist may use a metaphor to ask the client what this emotion looks like, what it is like. If the client responds to the process, the therapist asks the client to share the experience with a partner.
Restructuring Interactions
Using the circular interview (a technique borrowed from CCT), the therapist finds negative cycles in partners' interactions and draws their attention to these cycles. Partners see how they themselves create conflict.
Reframing the problem
When a cycle is found, it is presented in therapy as a common enemy. The partners team up to defeat him. They no longer feel guilty or angry - they just got into a cycle that needs to be broken.
Enactment technique
The therapist sets a certain topic of conversation and asks the partners in the session to discuss it.
In doing so, the therapist prompts some cues and interactions, guiding the conversation. Often, the acting-out technique provides clients with a strong emotional experience that helps them open up and moves them towards a stronger relationship.
EFT is suitable for all couples who want to strengthen their relationship: learn to hear each other better, spend more time together, stop quarreling, restore the freshness of feelings.
Studies show that up to 75% of couples overcome relationship difficulties after EFT. The effect of therapy lasts for a long time, because partners receive an effective tool to cope with further crises. They no longer return to the negative cycle.
When is it time for therapy?
There is a sad statistic: families come to therapy when they are already talking about divorce or separation. In this case, building relationships can be very difficult. Many therapists even refuse to work with couples who have decided to separate.
“There is a habit in the Russian mentality “not to wash dirty linen in public”. People are afraid or ashamed to seek help from a therapist. And they turn already when the point of no return has been passed. In my practice, there was a case: a client called with a request to improve relations. In the course of questioning, it turned out that his wife had been living with another person for six months and had sent documents for divorce. When I said that my maximum in this situation was to help them divorce less traumatically, he refused and decided to look for another therapist. Apparently, with a “magic pill” for his wife.”
Olesya Kruglushina, systemic family therapist:
Indications for therapy are not necessarily protracted serious problems. It will be useful for many families to take a course in order to establish contact, identify hidden negative emotions and work through them, raise happier children. After all, therapy is always not only a solution to problems, but also personal growth.
Case study
“The parents of a five-year-old girl applied. The girl could not adapt to kindergarten: she did not want to go, she was sick all the time. Parents were at the doctors, they did not find a somatic cause - and they were sent to a family therapist.
In the first session, I started asking parents what kindergarten means to them. The answer was: "This is the place where children are handed over." They conveyed this idea to the child. But not a single person wants to be “handed over” somewhere. It turned out that dad's family had a traumatic story with a terrible kindergarten. Therefore, at first we worked with dad's beliefs: what can be interesting and fun in the garden.
I gave homework: to follow exactly how parents talk about this topic with their daughter. After a few sessions, this problem was solved, and she began to go to the garden with pleasure, she ceased to be afraid of it.
Olesya Kruglushina, systemic family therapist:
What to read?
Introduction to Systemic Family Therapy.
