Key terms on this page (6)
- Systemic
- Seeing a problem as part of the patterns between people, not only inside one person. The core lens of family therapy.
- Identified patient
- The family member whose symptoms bring the family in. Family therapists often find the problem is held by the whole system.
- Genogram
- A family tree that also maps relationships, illnesses, losses and patterns across generations.
- Play therapy
- Therapy that uses play, toys and art as the main language, usually with children aged about 3 to 12.
- Assent
- A child’s own agreement to treatment, sought even when a parent gives the legal consent.
- Therapeutic factors
- The ways a group helps people, such as learning you are not alone, described by Irvin Yalom.
Why your training covers more than one person
Problems rarely live inside one person. A child’s outbursts make sense next to a parent’s divorce; a man’s depression lifts when his marriage changes. Graduate programs teach you to see that, and to work with whoever needs to be in the room.
How much each program emphasizes it depends on the license. Marriage and family therapy programs teach couples and family work from the first semester. Counseling programs accredited by CACREP must cover group counseling as a core area. Social work trains you to see a person inside their family, school and community. Some states write this into the rules: California, for example, requires LMFT applicants to log at least 500 hours diagnosing and treating couples, families and children, and Texas requires counselor applicants whose program began on or after 1 August 2017 to take a couples, marriage or family counseling course. Requirements differ by state, so check yours.
Who is in the room changes the rules
Here is the practical difference each configuration makes. Pick one to see who your client is, who signs the consent, and the mistake new clinicians most often make with it.
Who is in the room?
Two adults, one relationship
- Who is the client
- Often the relationship itself. Decide, and write down, whether you treat the couple as the unit or one partner with the other joining.
- Who consents
- Each adult consents for themselves. Both sign the informed consent, which should spell out how you handle secrets.
- Confidentiality
- Agree a secrets policy before you begin: will you hold something one partner tells you alone, or not? Many clinicians use a “no secrets” policy.
- Common mistake
- Starting conjoint work before screening each partner alone for intimate partner violence. Couples work can raise the danger when one partner fears the other.
- A good first move
- Ask each partner, separately, whether they feel safe at home and free to speak honestly in the room.
Couples and families
Couple and family therapy has its own families of theory. You will meet Bowen’s ideas about how anxiety passes through generations, structural therapy’s attention to boundaries and hierarchy, strategic and solution-focused approaches, narrative therapy, and newer models with strong research behind them such as emotionally focused couple therapy. You do not need to master them before school. You do need to understand the shift they share: the pattern between people is the thing you treat.
Two practical habits matter from your first couple. Agree a policy on secrets before you start, in writing, because the AAMFT code says a therapist may not reveal one member’s confidences to the rest of the client unit without that person’s written permission. And screen each partner alone for intimate partner violence before conjoint sessions begin. When one partner fears the other, couples therapy can make things more dangerous, not less.
Children and adolescents
Young children rarely explain what is wrong in words. Play therapy gives them another language: a sand tray, a dollhouse, drawing, a game. Child-centered play therapy follows the child’s lead; other approaches are more directive. Much of the work is with parents too, from coaching them in how to respond to their child to approaches in which parents learn to run play sessions themselves.
Adolescents are a different room. Confidentiality matters more to a teenager than almost anything you will say, and it is the first thing to settle. The law adds its own layer: who can consent to a minor’s treatment, and what parents can see, varies by state. In California, since 1 July 2024, minors 12 and older can consent to outpatient mental health treatment themselves if the clinician judges them mature enough. With separated parents, ask for the custody order or parenting plan before the first session, not after.
Groups
Groups range from psychoeducation (a structured class, such as a DBT skills group or a parenting group) to process groups where the relationships among members are the work. Irvin Yalom described the therapeutic factors that make groups help, among them universality (I am not the only one), hope, altruism and learning from how others respond to you. Group work is efficient, and for some problems, such as social anxiety or grief, it can offer what individual therapy cannot.
It also has its own craft. Screen every member before the first session. Explain that you are bound by confidentiality but the other members are not bound in the same way. Decide whether the group is closed (the same members start and finish) or open to new members as it goes.
Three trainees, three rooms
Invented composites, not real people.
Rosa
MFT trainee, community clinic
CouplesHer first couple asked to start right away. Her supervisor had her meet each partner alone first. One disclosed fear at home, and the plan changed to individual work and safety planning.
Kwame
Counseling intern, elementary school
ChildrenA seven-year-old would not answer questions but built the same scene in the sand tray every week. The pattern, shared with his supervisor and the parents, opened up what words had not.
Lena
MSW intern, outpatient program
GroupsShe co-led a skills group. The hardest session was the one after a member broke group confidentiality, and repairing it taught her more than any lecture on group process.
How to get ahead before and during school
- Draw your own genogram, three generations back. It is the fastest way to start thinking systemically.
- Look up your state’s minor-consent age and custody rules now, so they are familiar before your first child client.
- Choose a practicum site that sees the population you are least comfortable with. That is where supervision is worth most.
- Ask to co-lead a group early. Most clinicians learn group work by doing it beside someone experienced.
- If you want to work with young children, ask whether your program offers a play therapy course and a playroom.
What to read
- Family Therapy: Concepts and Methods (Nichols and Davis), a standard survey of family therapy models.
- Genograms: Assessment and Treatment (McGoldrick, Gerson and Petry), the reference for drawing and reading them.
- Play Therapy: The Art of the Relationship (Landreth), the classic introduction to child-centered play therapy.
- The Theory and Practice of Group Psychotherapy (Yalom and Leszcz), the book most group courses are built on.
For the developmental side of children and families, see Human development, and for the theories themselves, Theories of therapy and the evidence.
Myths worth dropping
Myth
“Family therapy means everyone has to come.”
Actually
Systemic therapists often work with one person or part of a family. The lens is systemic even when the room is small.
Myth
“Play therapy is just playing.”
Actually
Play is the medium; the work is the therapist’s attention to what the child expresses and how the relationship changes.
Myth
“Group therapy is therapy for people who can’t afford individual sessions.”
Actually
For some problems, such as social anxiety or grief, a group offers things individual therapy cannot.
Next · Step 10
Culture and difference
Whoever is in the room brings a culture, a language and a history with power. Next: cultural humility, identity, and how to work well with an interpreter.
Questions people ask
Do I need to be an LMFT to see couples and families?
No. Counselors, social workers and psychologists see couples and families too, within the training and competence they have. MFT programs simply center it from the first semester, and some states, California among them, require MFT trainees and associates to log a set number of hours with couples, families and children.
What is play therapy, and do I need a special credential for it?
Play therapy uses toys, art and play as the main way a young child communicates in therapy. You can use play-based methods within your license and training. The Registered Play Therapist (RPT) credential from the Association for Play Therapy is optional, and requires a license plus specific play therapy training and supervision.
Can a teenager see a therapist without a parent’s permission?
It depends on the state. Many states let minors above a certain age consent to outpatient mental health care themselves. In California, since 1 July 2024, minors 12 and older can consent to outpatient treatment if the clinician judges them mature enough. Check your own state’s law before you rely on it.
Is what people say in group therapy confidential?
You, the therapist, are bound by confidentiality. Other group members are not bound in the same legal way, so the clinician cannot promise that every member will keep what they hear private. Good practice is to say so plainly and ask members to agree to keep it within the group.
Sources
Checked 28 October 2026. Consent, custody and reporting rules vary by state; check your own state’s law and board.
- California Business and Professions Code §4980.43 — LMFT experience: at least 3,000 hours, including at least 500 hours diagnosing and treating couples, families and children.
- Texas Administrative Code, 22 TAC §§681.82–681.83 — Counselor academic requirements: 60 semester hours for programs begun on or after 1 August 2017 (§681.82), including a couples, marriage or family counseling course (§681.83(d)).
- California Board of Psychology, AB 665 legislative advisory — Minors 12 and older may consent to outpatient mental health treatment if mature enough, effective 1 July 2024.
- CACREP 2024 Standards — Group counseling and group work as a foundational curriculum area for accredited counseling programs.
- AAMFT Code of Ethics — Standard 2.2: confidences within couple, family or group treatment.
- AMFTRB — The national examination in marital and family therapy.
- Association for Specialists in Group Work — Best practice and training standards for group workers.
- Association for Play Therapy — Registered Play Therapist credential requirements.