Strategic Family Therapy: How It Works, Cost, & What to Expect

Core Concepts of Strategic Family Therapy

There are three principles that guide SFT: all family members are connected, a family’s habits impact the behavior of its members, and intervention needs to be targeted to the problem and meet the needs of the family.

Family Members Are Connected

The first principle falls under the umbrella of family systems: because all of the family members are connected, what impacts one member also impacts the entire  family. Additionally, challenges with one family member can be an indication that there is a deeper issue within the system that needs to be addressed.²

Family’s Habits Impact the Behavior of Its Members

The second principle of SFT is that a family’s habits impact the behaviors of its members. An example would be a child who becomes defiant or disrespectful because they see that their parents argue less when they are receiving most of their attention. Inserting behaviors into the relationship between caregivers is called triangulation. It can be common for both children and adolescents to adopt certain behaviors to take the attention off of other dysfunctional interactions.²

Intervention Needs to Be Targeted

The third principle of SFT is that an intervention needs to be targeted to the problem and meet the needs of the family. An example would be helping a family to create a structure of rules and consequences for children or adolescents. Also, interventions can be centered around improving the interactions and communication among family members.²

What Can SFT Help With?

Strategic family therapy is specifically designed for children and adolescents diagnosed with conduct disorders, substance use disorder, aggressive behaviors, and noncompliance.³ SFT is most commonly used for adolescents who have some contact with the juvenile justice system due to delinquency, substance abuse, behavioral problems, parental abuse, or risky sexual behaviors. Sessions usually consist of the whole family meeting together with a therapist to address the presenting challenges.⁴

What Are Strategic Family Therapy Sessions Like?

Strategic family therapy is considered a short-term intervention that tends to last an average of 12 sessions. In your first appointment, expect your therapist to ask each family member to share their perspective, observe the dynamics, and to assess how the interactions and communication patterns contribute to problem behaviors. This is a great opportunity for you to ask questions about the therapeutic process and limits to confidentiality.² Sometimes, based on the referral, the therapist may have to verify that your family is participating in sessions.

In the first few sessions, the therapist works to build trust and makes note of any alliances within family members or any triangulation that may be occurring. Additionally, the therapist may start to try to reduce negative portrayals of other family members by providing a positive perspective.

In the subsequent sessions of SFT, the therapist focuses specifically on engagement. Oftentimes, family members may point to the adolescent as being the problem and may struggle with the idea that the adolescent’s choices reflect what is going on within the family dynamics.² The therapist works to improve communication between members and bring to light issues they may have repressed or ignored.

Each SFT session lasts from an hour to ninety minutes and is commonly used with families that consist of single parents and stepfamilies, as well as multigenerational families.⁵

Strategic Family Therapy Examples

SFT is most commonly used as an intervention for substance abuse, aggression, risky sexual behaviors, or delinquency.⁵ While referrals often come from the juvenile justice system, they could also come from a school system or parent. The role of the therapist is family preservation and preventing the adolescent from being placed outside of the home. Additionally, there is an emphasis on reducing the adolescent’s problem behaviors and developing family support.⁶

Cost of Strategic Family Therapy

The average family therapy session fee is between $150 and $250. While a court system can mandate therapy services, in many situations, you are responsible for the session fee and associated costs of therapy.  The average overall cost of SFT when working with a therapist that has been trained in Brief Strategic Family Therapy is $3,500. This intervention option is more cost-effective than residential treatment centers or an out-of-home placement for adolescents.³

Is SFT Covered by Insurance?

SFT is typically covered by most mental health insurance plans. However, your out-of-pocket cost will depend on your specific plan and the amount of your deductible.⁷ If you have questions about what your plan covers, and the reimbursement services, take a moment to call the customer service number on the back of your insurance card and ask to verify your benefits.

Some therapists decide to be out-of-network providers with health insurance companies and can provide you with a superbill to submit to your insurance for reimbursement.⁸

How to Find a Strategic Family Therapist

If you’re using your insurance to pay for SFT, contact the member services number on the back of your insurance card and request a list of in-network family therapists near you. Another resource to find a therapist that specializes in SFT is to ask a school counselor or forensic social worker within the court system for a referral list. There are also multiple online therapy directories where you can specifically search for SFT therapists.

Many therapists offer a free call or consultation where you have an opportunity to ask questions about their practice and approach. During this consultation, verify that the therapist is in-network with your insurance or can provide you with the documentation needed to request reimbursement.

Who Can Offer SFT?

To specialize in SFT and to be recognized as Brief Strategic Family therapist, individuals must have a master’s degree in social work, counseling, marriage and family therapy, psychology, or a related field. There are some instances when training can occur for an individual with a bachelor’s degree and a certain amount of experience. Training itself is made up of multiple workshops, a qualifying exam, and four to six months of ongoing supervision as well as yearly reviews by a qualified supervisor.⁹

Is Strategic Family Therapy Effective?

Studies show that strategic family therapy is effective in treating adolescents with mental illnesses, substance abuse, and other adjustment diagnoses. It increases family cohesion, adaptability, and parental structure.¹⁰ Adolescents engaged in SFT can experience improvement with conduct challenges and increased self-esteem and self-confidence. There is a high level of family participation in therapy and as a result, more parent-child bonding and increased problem-solving skills occur too.¹¹

How Is Strategic Family Therapy Different Than Other Family Options?

SFT is different from other family therapy interventions in that it is designed to be strategic and focused on directives and solutions. The therapist takes a formal leadership stance and guides the conversations, coaching family members on better ways to communicate and interact. There is less focus on family boundaries and an assumption that family members are constantly communicating.

SFT also operates based on the idea that problems are perpetuated by actions and individuals are resistant to change. In Brief Strategic Family Therapy, the therapist is not as actively involved but still maintains therapeutic leadership and focuses on improving communication patterns and highlighting family strengths while also blocking patterns that need to change.¹²

Final Thoughts on Brief Strategic Family Therapy

If your family is struggling to communicate and an adolescent member is displaying problem behaviors like delinquency, substance abuse, or risky sexual behaviors, your entire family unit may benefit from SFT. Remember, you’re not alone in your struggles, and it’s never too late to ask for help.