Psychotherapy What Is Family Constellation Therapy? By Amy Marschall, PsyD Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. Learn about our editorial process Updated on February 24, 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 Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print SDI Productions / Getty Images Table of Contents View All Table of Contents Types Techniques What Family Constellations Can Help With Benefits Effectiveness Things to Consider How to Get Started Family constellation therapy is a therapeutic intervention that a therapist might use in order to gain insight and information into a client’s family history, dynamics, and possible dysfunctional patterns. German therapist Bert Hellinger developed this intervention based on components of Gestalt therapy and psychodynamic therapy. When utilizing the family constellation, the therapist has people who are not related to the client take on roles of various family members to act out dynamics related to the client’s concerns. This technique is considered a form of expressive therapy, and the goal is to help the client work through a concern or develop better insight into a conflict. Types of Family Constellations Since a traditional family constellation involves humans standing in as the client’s family members, it is often done in a group setting. Group members can take turns as the main client and stand in for each other’s family members. Group Setting The therapist directs the family members’ posture, position, and words, although sometimes the activity involves minimal talking. The client might interact directly with their relatives in the constellation or stand aside and watch the interactions unfold. Individual Setting The family constellation can also be done individually. The client could use a sand tray or other creative expressive therapy technique, using toys or figurines to represent their various family members. Similarly, they could use art therapy techniques to draw their family tree and indicate the various dynamics within the family. Individual family constellations do not allow the client to role-play family interactions with other physical humans, but the therapist and client can work together over a longer period of time to map out relationships and notice patterns. Additionally, some clients might not feel comfortable engaging in the group setting. Either option can be beneficial in providing insight into the client’s family. Techniques in Family Constellation Therapy In the group setting, therapists typically use drama therapy with the other people in the group to create the family constellation. The client can observe interactions between members in real time to gain insight, or they might role play interactions with group members to practice a confrontation or address a past trauma. This type of role play can be a form of psychodrama. Individual family constellations can include drawing, painting, or using objects to represent family members. The therapist can point out their own observations and will encourage the client to look for patterns and relationships that the client had not previously considered. Exploration of these patterns can make the client aware of connections between themselves and various members of their family as well as intergenerational trauma and transgenerational patterns related to mental health and relationships. What Family Constellations Can Help With A therapist might suggest a family constellation for a number of presenting concerns, and a client might decide to consider this intervention for a number of reasons, including: The client wants to break dysfunctional or harmful patterns in their relationships that might be related to dynamics that they learned from their family of origin A couple wants to better understand each other’s history and how their families of origin affect what they each bring to the relationship The client wants to confront an abuser from childhood who is deceased, unreachable, or who the client does not feel safe contacting The client wants to gain insight into how patterns from their childhood continue to impact their mental health Family constellations are not limited to specific diagnoses, but they can be beneficial for those struggling to overcome childhood trauma, experiencing complicated feelings after the death of a relative, or various mental health diagnoses, including depression and anxiety. Benefits of Family Constellations Clients who utilize the family constellation might experience catharsis following this intervention because it allowed them to work through conflict, trauma, and difficult past experiences in a safe environment. Because the family constellation draws the client’s attention to patterns and dynamics they had not previously considered, they will likely develop improved insight into their behaviors. This can lead to healthier communication and more fulfilling relationships. Family constellations also create a powerful space for processing traumatic events from the client’s past. What Is Insight-Oriented Therapy? Effectiveness Psychological researchers have extensively studied family constellations as an evidence-based treatment for various mental health concerns. An analysis of available literature suggests that, when conducted by therapists with appropriate training, a family constellation can lead to “significant improvements” towards a client’s treatment goals; however, if a therapist does not use this intervention correctly, it can have no effect on treatment outcomes. Although data about overall treatment outcomes are mixed, family constellations have been found to help reduce feelings of stigma around mental health and neurodivergence; specifically, parents of autistic children can work through feelings of stigma using the family constellation. Things to Consider Family constellations can be intense, and participation might bring up strong feelings or memories related to traumatic or stressful events. Clients considering this treatment intervention should ensure that they feel comfortable with their therapist and ask any questions or present concerns they have about doing the family constellation. Clients need to consider whether they feel comfortable doing a family constellation with a group of people whom they likely do not know. If they feel safer with an individual approach to the family constellation, the therapist can provide them with options for creating their family constellation with objects or toys. Clients should also have a self-care plan in place to ensure that they can cope with any emotions brought up by the family constellation in a healthy way. Clients will often require ongoing therapy following the family constellation exercise to address traumas, memories, and upsetting dynamics that came up during this activity. Criticism of Family Constellation Therapy Critics of this intervention have noted that Hellinger held misogynistic, homophobic, and other problematic views, including having an abuse survivor act out thanking their abuser for the “experience.” However, many therapists who use Hellinger’s techniques reject these attitudes and take a more progressive approach to family constellations. Also, remember that you have the right to decline any therapeutic activity if it does not feel right to you. How to Get Started If you are already in therapy, you can ask your therapist if they feel equipped to utilize the family constellation in your treatment. If they are not properly trained, you can ask them about referrals to groups that offer this intervention, or they can provide you with interventions that could offer the same benefit and fall under their scope of practice. You might have to develop coping skills that work for you prior to engaging in a family constellation exercise. Because this intervention can be emotionally charged, it is important that you are prepared to manage feelings that come up for you in a healthy way. If you want to work through dysfunctional family experiences and develop insight into how patterns within your family have shaped you, or you hope to make positive changes in your relationships going forward, a family constellation can be a helpful part of your treatment plan. Ask a Therapist: How Do I Know What Type of Therapy Is Best for Me? 3 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. Hellinger, B., & Ten Hövel, G. Acknowledging what is: conversations with Bert Hellinger. Phoenix, AZ: Zeig Tucker & Theisen Publishers; 1999. Toman, W. Family constellation: Its effects on personality and social behavior. 4th Edition. New York, NY. Springer Publishing Company; 1993 Konkolÿ Thege B, Petroll C, Rivas C, Scholtens S. The effectiveness of family constellation therapy in improving mental health: A systematic review. Family Process. 2021;60(2), 409–423. By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.