Psychotherapy What Is Filial Therapy? By Kendra Cherry Kendra Cherry Facebook Twitter Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. Learn about our editorial process Updated on September 08, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD LinkedIn Twitter Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print SDI Productions / Getty Images Table of Contents View All Table of Contents What Is Filial Therapy? Techniques What Filial Therapy Can Help With Benefits Effectiveness Things to Consider How to Get Started What Is Filial Therapy? Fillial Therapy Filial therapy, also known as filial play therapy, is a type of child-centered relationship enhancement family therapy. It was first introduced during the 1960s and has been shown to be an effective intervention for helping families with young children. Filial therapy focuses on using psychoeducation to teach parents how to engage in one-on-one play therapy interventions with their children. This practice aims to help children develop and improve their relationships utilizing non-directive play activities. It was one of the first types of family therapy interventions and helps improve relationships between caregivers and children. By teaching parents play therapy skills, filial therapy allows parents to become active in helping their kids overcome problems. This therapy also helps children develop new skills while also strengthening the family unit. Play therapy can have several benefits, but research suggests that it is most effective when parents play an active role in the process. Filial therapy assumes that while children may not remember every specific experience of their childhood, the ways that others respond to them play a role in confirming, reinforcing, and validating their behaviors and emotions. These automatic and involuntary responses to interpersonal interactions are known as interpersonal reflexes. Over time, this leads to consistent patterns of interpersonal responding that carry on throughout childhood and adulthood. Through filial therapy, children can develop healthier ways of communicating and interacting with others by establishing a pattern of attentive, responsive, and reflective interactions. Techniques of Filial Therapy Once parents have learned these techniques, they continue to engage in weekly play sessions with their children. These sessions occur at home and continue for a period of around six months to a year. However, parents can continue to utilize filial therapy for as long as they want and as long as a child remains sufficiently motivated. During filial therapy, parents are taught to use four primary techniques to engage in play therapy with their children. These techniques are: StructuringChild-Centered Imaginary PlayEmpathetic Listening Limit Setting Structuring Play sessions last for half an hour and occur in a highly-structured context. Parents learn to begin a play session by setting up a specific area for play. Once the area has been created, children are told they can play however they want. Child-Centered Imaginary Play Parents watch their children engage in imaginary play. The goal is to observe the child without interfering or attempting to give directions or suggestions. During these play sessions, parents impose few limitations or consequences. The structured context in which play sessions occur is designed to help kids take initiative, express themselves freely, and promote independence and self-regulation. Empathetic Listening As the child plays, parents will observe, listen, and offer commentary on what the child is doing. The purpose of this activity is to reflect on what a child may be doing, feeling, or experiencing as they play. Parents learn to acknowledge their children's initiative, their actions, and their expressions of emotions. These observations occur with acceptance and without judgment. Limit Setting There are few rules in the play session, but parents learn to intervene when a child engages in aggressive or destructive actions. Children are free to play as they want but must follow basic safety guidelines and are not allowed to engage in behaviors such as hitting, destroying toys, or climbing on the furniture. What Filial Therapy Can Help With Filial therapy can help treat various issues and conditions that affect children's behavioral, social, and emotional functioning. It may be used to treat: Adoption or foster care issues Aggressive behaviors Anxiety Attachment issues Attention-deficit hyperactivity disorder (ADHD) Depression Issues arising from chronic illness Oppositional defiance disorder Trauma Benefits of Filial Therapy Filial therapy can have several important benefits for both children and parents. Children Gain new skills and a sense of masteryIt can improve a child's self-conceptLearn to take greater responsibility for their actionsGain a better understanding of their feelings Parents Gain greater insight into their children's motivationsBecome more trusting and accepting of their child's independenceLearn to set more effective limits and consequencesBecome more confident in their skills as parents Filial therapy also helps children and their parents become more open and receptive to one another. It can help kids develop a more secure attachment, improve communication, reduce negativity, and ultimately improve the stability of the family unit. Effectiveness The impact of filial therapy has been studied since its introduction in the 1960s. One of the earliest investigations found that people who used filial therapy remained engaged in treatment longer than people who used traditional treatment approaches. One study found that families that participated in a filial treatment called child-parent relationship therapy (CPRT) experienced significant improvements in family satisfaction, cohesion, communication, and flexibility. This approach also improves parents' empathy, acceptance, and self-esteem. Research has found that filial therapy contributes to positive changes in the family environment, improving child behavior and reducing parental stress. A 2019 study found that filial therapy helped reduce symptoms of depression in children with cancer and decreased symptoms of stress, anxiety, and depression in their parents. Recap Filial therapy can help improve family functioning and address issues such as anxiety, depression, and behavioral issues. It can also be useful for lowering parental stress. Things to Consider It is important to recognize that filial therapy differs considerably from other types of traditional interventions. Instead of being led by a therapist, the therapist’s function is to teach parents the techniques they can apply in parent-led play sessions. Filial therapy also does not distinguish between intervention and prevention. The techniques that parents use are the same in either case. While this can help improve parenting skills and foster healthy child development, additional support and treatment may be needed for children diagnosed with a mental health condition. Filial therapy can be helpful alongside other cognitive, behavior, emotion, or learning interventions in such cases. This approach to therapy requires parents to take an active role and function as agents of change in their child's life. As parents learn to engage in play therapy, they must remember to adhere to important principles to make play therapy effective. This includes being warm, friendly, accepting, respectful, patient, and non-directive. At the same time, parents must utilize caution to avoid criticizing, praising, questioning, leading, interrupting, moralizing, or initiating new activities. Finding a way to balance being involved and attentive without attempting to interfere with the play process can be a challenge for many parents. How to Get Started If you are interested in trying filial therapy with your children, it can be helpful to get an idea of how the process works. A basic filial therapy program consists of 10 sessions. During the first sessions, the therapist introduces the program, learns more about the problem, and demonstrates the process. They also demonstrate the process, review each session, and model play session skills with parents and children. Sessions four through six focus on parents engaging in supervised play sessions and preparation for conducting these sessions at home. Next, parents begin conducting sessions with their children in a home setting. Later sessions with the therapist are focused on reviewing the progress of home sessions and discussing how the skills learned during play therapy can be incorporated into everyday life. To find a therapist, consider asking your child’s pediatrician for a referral or contact mental health professionals in your area to learn if they have training and experience with filial therapy. Can Children Use Online Therapy? 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychological Association. Filial play therapy. Horowitz LM. The study of interpersonal problems: a Leary legacy. J Pers Assess. 1996;66(2):283-300. doi:10.1207/s15327752jpa6602_7) Cornett N, Bratton SC. Examining the impact of child parent relationship therapy (CPRT) on family functioning. J Marital Fam Ther. 2014 Jul;40(3):302-18. doi: 10.1111/jmft.12014 Guerney LF. Filial therapy program. In DH Olson (Ed.), Treating Relationships. Lake Mills, IA: Graphic Publishing Co., Inc; 1976. Rennie R, Landreth G. Effects of filial therapy on parent and child behaviors. International Journal of Play Therapy. 2000;9(2):19-37. doi:10.1037/h0089434 Ebrahimi E, Mirzaie H, Saeidi Borujeni M, Zahed G, Akbarzadeh Baghban A, Mirzakhani N. The effect of filial therapy on depressive symptoms of children with cancer and their mother's depression, anxiety, and stress: A randomized controlled trial. Asian Pac J Cancer Prev. 2019;20(10):2935-2941. doi:10.31557/APJCP.2019.20.10.2935 American Counseling Association. Filial therapy: An attachment based, emotion focused, and skill training approach. By Kendra Cherry Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. 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