Family Therapy
Family therapy is a type of psychotherapy that involves members of a patient's family system in the treatment process to improve communication, resolve conflicts, and support the patient's recovery from behavioral health or substance use conditions. Family involvement is a well-established predictor of positive treatment outcomes, particularly in adolescent behavioral health and adult substance use disorder treatment.
How Family Therapy Works
Family therapy sessions are facilitated by a licensed clinician trained in systemic approaches. Sessions may include the patient and one or more family members, a couple, or the entire family unit. The therapist works to identify dysfunctional interaction patterns, strengthen healthy communication, establish appropriate boundaries, and align the family system in support of the patient's treatment goals.
Common evidence-based family therapy models include Structural Family Therapy, which focuses on reorganizing family hierarchies and boundaries; Strategic Family Therapy, which targets specific problematic interaction patterns; and Multidimensional Family Therapy (MDFT), which is particularly effective for adolescent substance use.
Family Therapy in Behavioral Health Programs
Most residential treatment and IOP programs include family therapy as a required treatment component. Programs typically offer weekly family sessions, multi-family groups, family psychoeducation workshops, and family involvement in discharge planning. For facilities treating adolescents, family participation is especially critical and often mandated by accreditation standards and best-practice guidelines.
Telehealth and Family Therapy
Telehealth has significantly expanded access to family therapy by eliminating geographic barriers. Family members who cannot travel to the treatment facility — whether due to distance, work obligations, or their own health issues — can now participate in sessions via secure video platforms. EHR systems that integrate telehealth scheduling with clinical documentation streamline this process.
Documentation and Compliance
Family therapy documentation must clearly identify all participants, the therapeutic approach used, clinical observations about family dynamics, interventions applied, and how the session supports the patient's treatment plan goals. When family members are not the identified patient, clinicians must be careful about what information is shared and documented, particularly regarding the patient's substance use history under 42 CFR Part 2 protections.
Billing for Family Therapy
Family therapy is billed using CPT codes 90846 (family psychotherapy without the patient present) and 90847 (family psychotherapy with the patient present). Some payers also recognize 90849 for multi-family group therapy. Reimbursement requires that the session is documented as medically necessary for the identified patient's treatment plan, even when the focus is on family system dynamics.
FAQs
When is family therapy used in treatment?
Family therapy is used throughout the treatment continuum — from residential care through outpatient follow-up. It is most commonly incorporated during IOP and residential programs, often beginning in the first two weeks of treatment.
Is family therapy required in behavioral health programs?
While not universally mandated, most accreditation bodies (CARF, Joint Commission) and best-practice guidelines strongly recommend family involvement. Many residential and IOP programs require a minimum number of family sessions as part of the treatment protocol.
How is family therapy billed differently from individual therapy?
Family therapy uses distinct CPT codes (90846 and 90847) separate from individual therapy codes (90834, 90837). Reimbursement rates vary by payer, and some insurers require separate pre-authorization for family sessions.
Can family therapy be conducted via telehealth?
Yes. Telehealth family therapy has become widely accepted, with most payers covering video-based family sessions at the same rate as in-person visits. This is particularly valuable when family members are geographically distant from the treatment facility.
Learn More
- Mental Health CPT Codes Guide — Family therapy codes 90846 and 90847 explained
- Telehealth for Therapists — Delivering family therapy via video