How joint sessions work: who comes, who speaks and what the therapist does

“And what actually happens there? Are we going to sit in a circle and talk about feelings?” This question is often put to me by the family member least enthusiastic about a joint session — most often the father or the teenager. Behind it lies a perfectly legitimate fear: that this will be an ambush, that he will have to talk about things he doesn’t want to, and that he will leave the room the loser.

So it is only fair that you should know in advance what a session really looks like. Not in theory, but step by step: who comes, where we sit, who speaks first, what happens if an argument breaks out halfway through, what I do, what you take home with you and how many sessions lie ahead of you at all.

In this piece I describe how joint family sessions run with me. Some things are common to all systemic therapists, some are a matter of style. If you are looking for a general description of a first visit to a therapist, you will find it in the piece on the first session — this one is about what is particular to more than one of you coming.

Who comes — and who doesn’t always have to

The first surprise for many: not everyone has to come, and not everyone has to come every time. Who is in the room is a therapeutic decision and it changes as the process goes on.

• To the first session I invite those the issue directly concerns. If it is tension between the parents and a teenager, three of them come. If it is the relationship between an adult daughter and her mother, the two of them come. If the difficulty is spread across the whole family, the whole household comes.
• Small children come less often than people think. A preschool child in a room where adults are discussing their distress is out of place — and it is often the child in whom the symptom shows. So with small children I work mainly through the parents: they come once so that I can meet them and see them in relationship, and after that most of the work is parental work.
• Whoever doesn’t want to come, doesn’t — and that is not the end of it. A member dragged along against their will is as a rule a worse investment for joint work than their absence. It often happens that the person who refused the first time joins after the third or fourth session, once they hear at home that it wasn’t a courtroom.
• Separate sessions are part of the process, not an exception. With a teenager I usually meet alone at least once; with the parents too. This is not secrecy but necessary hygiene: everyone needs a space where they don’t have to watch what someone else might do with their words. What travels on from those sessions and what doesn’t, we agree out loud — I explain confidentiality in the piece on confidentiality in therapy.
• Grandparents, adult children’s partners, siblings. Sometimes I invite someone who isn’t part of the everyday household to a single session, because they are central to the pattern. Such a session is often the most moving one in the whole process.

The first ten minutes: where we sit and who begins

The chairs are in a semicircle and nobody has an assigned place. This is no small thing — who sits next to whom, who picks the chair furthest from the table, who leaves an empty seat between themselves and their brother tells me more in the first few seconds than many a sentence. Salvador Minuchin called this reading the structure, and it really is one of the fastest sources of information a therapist has.

I begin with the frame, not the content. I say how much time we have, what the purpose of this session is and how it will run. Then I ask a deliberately neutral question: “Who is going to tell me what brings you here today?” I don’t choose. Who speaks first and how the others behave while they do is already the first piece of information about how this family shares its voice.

Then comes what families usually find most unusual: I ask each person separately, including those who have come “only because they had to”. Even if the answer is “I don’t know”, I have said something important — that in this room everyone gets their own space, regardless of how much of it they have at home. Very often it is precisely the person who was least motivated who is the most engaged a few sessions later.

The rules we set at the start

A joint session without rules turns within five minutes into what happens at home every day — and you don’t need to pay a therapist for that. So I state the rules out loud and refer back to them calmly later on.

• No interrupting. Everyone gets their own time and that time is protected. If listening is hard for someone, they may write it down — and their turn will come.
• Everyone speaks for themselves. In the first person. “That was hard for me” instead of “you always”. This is not linguistic cosmetics; a first-person sentence is simply harder to reject, because there is nothing in it to argue with.
• No gathering evidence. A session is not a hearing. We don’t prove past events and we don’t rule on what really happened. What interests us is how it was for each person — and what keeps repeating. Why there will be no verdict I explained in detail in the piece on looking for the pattern rather than the culprit.
• No retaliation at home. What was said in the room is not used as a weapon at home. With families with teenagers this rule is often the most important of all.
• The right to say “not today”. Everyone may keep something to themselves. Therapy is not baring yourself on command and nobody is obliged to say everything.

What I do

The shortest answer: I make the conversation possible. The slightly longer answer has five parts.

I lead. I decide who speaks, when a topic is closed and when we move on. For families in chronic conflict this is often the first relief — someone else is holding the wheel.

I stop escalation. When a conversation starts spiralling downwards — voices rise, reproaches multiply, someone is getting ready to leave — I interrupt. Not in order to prevent conflict: conflict in the room is valuable, because we can see it live. I interrupt because past a certain point nobody hears anything any more. Physiologically this is well described: at high arousal the capacity to listen effectively switches off.

I translate. A very large part of my work is translation. “You’re never home” often means “I miss you”. “Leave me alone” often means “I can’t cope with your worry, because I’m afraid I’ll disappoint you”. Translation is not prettifying — it is returning a message in a form the recipient can take in.

I notice the pattern and name it. Instead of commenting on the content, I often describe what has just happened: “I notice that every time your mother talks about her worry, your father looks at the floor and your son looks out of the window. Does that happen at home too?” A sentence like that often produces a silence more productive than half an hour of discussion.

I ask the quietest one. In every family there is someone who speaks least — and often knows most. The child who watches. The father who has stepped back. The sister who doesn’t get involved. When you invite such a person into the conversation, the system almost always shifts, because their silence was part of the balance. Why that is so I explained in the piece on the family as a system.

Alongside all this I am constantly looking after something that is among the strongest predictors of success in family therapy research: a balanced alliance. Michael Robbins and colleagues showed that an unbalanced alliance — when one member feels a considerably stronger connection with the therapist than another — predicts the whole family dropping out of therapy early. So I regularly check whether anyone feels overlooked, and I ask that outright.

What one session looks like from start to finish

Every session is different, but the arc is surprisingly similar. It lasts about fifty minutes, often somewhat longer for a first session with several members.

The second point deserves an explanation. Minuchin introduced a technique we call enactment: instead of the family telling me about an argument, I invite them to discuss the contentious topic between themselves, here and now, as they would at home. During that I mostly stay quiet and watch. Two minutes of such a conversation reveal more than half an hour of reporting — and, most importantly, the pattern can then be changed live, not merely described.

What happens between sessions

Therapy doesn’t happen in my room. It happens between one Wednesday and the next. So we end almost every session with something concrete — an agreement, an experiment, an observation task. What is typical is small, almost absurdly small things:

• Father and son go somewhere on their own once a fortnight, with no agenda and no talk about school.
• For a week, the mother asks not a single question about school. Not one. She just watches what happens.
• Each person writes down, on their own, when there was half an hour that was good at home that week — and what was different then.
• The parents take twenty minutes a week for a conversation that is not about the children.
• When the familiar argument begins, whoever notices first says the agreed word and they wait ten minutes.

The tasks are deliberately not big. A family in distress has no reserves for grand feats; it does have reserves for one small change that can be repeated. And because this is a system, a small change in the right place shifts the relationships everywhere — that is in fact the essence of systemic work.

The typical arc of the whole process

Family therapy is as a rule shorter than individual therapy. A very rough but honest picture looks like this.

Sessions one to three: tension and finding your place. Everyone is checking whether the therapist will be fair. There is often “testing” in this period — someone is late, someone doesn’t come, someone says something meant to bring me over to their side. This is normal and part of building trust.

The middle: working on the pattern. Once it is clear that there will be no verdict, people open up. This is the period that often becomes hardest — pain shows beneath the anger and there are more tears in the room than raised voices. Why therapy can hurt first at this point is described in the piece on why therapy hurts first.

The final stretch: consolidating. Sessions thin out — to once a fortnight, then once a month. The family tries out the new ways on its own and comes mainly to check in. Quite often we agree on one follow-up session in three months’ time.

How many sessions that adds up to varies a great deal. Often between eight and twenty, sometimes fewer, sometimes more; what affects it I have described in the piece on how long therapy lasts. This form is well supported by research: Alan Carr’s reviews show good effects of systemic interventions for childhood and adolescent difficulties, and meta-analyses of systemic therapy with adults show effects comparable to other established approaches.

What happens if something goes wrong

Since this is a question people rarely ask out loud, let me answer it myself.

Someone gets up and leaves. It happens — most often to a teenager. I don’t run after them and I don’t dramatise it. I tell the others that leaving is also a message, and we carry on. They almost always come back next time, especially if there were no consequences at home. If there were, that is the next topic.

Someone cries and can’t speak. Nothing needs fixing. We give it time, and I suggest a break if needed. Tears in a family room are often the first moment when the other members see something they haven’t seen at home.

An argument goes over the edge. I interrupt, divide the attention, sometimes take a short break or speak with each person for two minutes. When this keeps happening, I change who is in the room: for a while I work separately and only then jointly again.

Someone says therapy isn’t helping. That is the best material there is. I take such a sentence seriously, not personally — and I put it at the centre of the session. Behind it there is often a feeling that someone in this room didn’t hear them, and that is exactly what needs repairing.

The family stops coming. Early endings are more common in family therapy than in individual therapy. So I talk about the possibility of leaving right at the start and ask that someone tell me outright, by phone if need be. An ending that is spoken is useful; an ending that happens through silence leaves everyone at exactly the point they were at.

And an important limit: where there is violence, active addiction or an unmanaged mental health crisis in the family, joint sessions are as a rule not the first step. Then safety and appropriate treatment come first, and joint work comes later and under clear conditions.

Practical details

I hold sessions in Ljubljana within family therapy. I am a therapist in training in marriage and family therapy and I work under regular supervision — which in practice means that I consult a supervisor regularly about the process (without personal details) and that there is a second pair of eyes behind what happens in the room. For me that is a safeguard; for you it is a guarantee.

If you aren’t sure who should come at all, or whether your situation is suitable for joint work, that is no obstacle to a first step. Write to me here and we’ll arrange it — who comes to the first session is a purely technical question we can settle in a few sentences.

And a last thought for the one who wouldn’t go to a session. You don’t have to arrive convinced. It is enough that you arrive. Many a person who sat there the first time with folded arms watching the clock is, a few weeks later, the one proposing the next appointment.