Filial therapy

Filial therapy is quite different from other therapies because the goal of this type of therapy is to teach caregivers basic play therapy skills to use with their own children.

Filial therapy focuses on the idea that parents can learn the skills to be therapeutic individuals for their children and become the beneficial change agents that children need.

Background on filial therapy

Bernard and Louise Guerney developed filial therapy in the 1960s due to the recognition that a limited number of providers were trained to work with children. They felt that they could improve the outcomes for children and families by teaching parents to use play therapy techniques at home.

Filial therapy has roots in a number of psychological theories including family systems, psychodynamic, and client-centered therapies. However, filial therapy is more of a psychoeducational process as the aim is not to provide therapy to the family, but to teach the parents about play therapy and healthier ways to respond as parents.

Garry Landreth helped filial therapy become more common in the 1980s as he recognized that the original year-long requirement was difficult on many families and helped adapt the program to a shorter, less demanding 10-session requirement.

Filial therapy techniques and values

Filial therapy is closely tied to client-centered play therapy as the method taught by the therapist to the parents. As such, therapists should be comfortable with child-centered play therapy prior to undertaking filial therapy. This process focuses on open, honest, and non-judgmental communication.

Client-centered therapy places empathy, acceptance, non judgment, and congruence as its highest values, and this translates to filial therapy as well. These core values are why filial therapy believes in the power of caregivers to become therapeutic change agents in their families’ lives.

Additionally, while filial therapy can be practiced with individual families, it has been shown to have great effectiveness when used in a group therapy setting. The therapist is encouraged to use whichever format they are most comfortable with or to use a combination of the two depending on the sessions. The introductory sessions may be easily completed as a group session with multiple families allowing the later sessions to be more individualized or one on one with families to provide help and feedback for their specific needs.

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In addition to general values, there are four basic techniques taught in filial therapy:

• Structuring: Ensuring that parents are able to structure their home sessions effectively.
• Empathic listening: Learning to actively listen to understand without judgment.
• Child-centered imaginary play: Allowing the child to lead the play and direct involvement.
• Limit setting: Allowing the child to have free play, but placing limits based on safe play and directed aggression.

Effectiveness of Filial Therapy

Filial therapy is considered an evidence-based treatment which means there has been substantial research on the outcomes associated with it. Evidence from research studies shows that both parents and children benefit from this therapy process because the relationship tends to improve overall as communication skills are gained, connection and play are valued, and empathy grows.

Filial therapy has been shown to be effective in managing a number of concerns, including attention disorders, anxiety, oppositional behaviors, and issues related to adoption or fostering. The focus on the relationship rather than specific parenting techniques empowers families to maintain limit-setting and structure while encouraging empathetic connection to foster relationship building.

Limitations of filial therapy

There are some concerns about the limitations of filial therapy as it relates to cultural sensitivity as sometimes particular skills taught by the therapist may conflict with some cultural beliefs. It is important that therapists and their clients talk about cultural expectations and ensure that beliefs are considered and respected when providing care.

Additionally, some of the studies conducted on filial therapy have provided information to suggest flaws in the design due to parent reports of improvement being the primary report. Occasionally, one parent’s report may differ from the other parent’s, or teacher reports from school may suggest different concerns than the parent’s report did. This highlights the importance of seeking multiple sources as a means to judge the success of treatment.

Filial therapy timeline and steps

Originally, filial therapy was supposed to last around one year and include significantly more sessions than it does now, however, modern therapists recognized the cost and time limitations placed on families and set up more realistic plans for filial therapy which consists of fewer sessions and less time.

Modern filial therapy tends to follow a prescribed session-by-session set of guidelines and expectations.

A typical course of sessions in filial therapy should last 12-24 weeks, with the latter being more common as parents should be given multiple weeks in between sessions seven through ten in order to practice and solidify skills while also having the opportunity to seek guidance regularly.

Billing for Filial Therapy

Filial therapy is, first and foremost, family therapy when done with individual families. It would be covered under CPT code 90847, family therapy with the patient present. For any sessions that do not include the child, the appropriate code is 90846.

Sessions coded 90847 or 90846 must be a minimum of 26 minutes long to qualify for billing.

Additionally, if providing filial therapy in a group setting, it may be necessary to adjust billing to accurately reflect group coding for multiple family groups. In this instance because the group will include family members from multiple family groups working on the same problem then 90849 is the appropriate code rather than the general group therapy code for individuals 90853.

It is important to check with each insurance company that you are paneled with because not all insurance companies consider family therapy a routine service. Some insurance coverage will only allow payment for it under very specific circumstances that must be documented appropriately. It is always best practice to review billing and coding for each company that you are paneled with and ensure that clients know what their out of pocket costs will be prior to beginning any program.