Family Reunification Therapy: Complexities, Pitfalls, and Therapeutic Tips

Introduction

Since its introduction into the court system in 2000, Family Reunification Therapy (FRT) has become an emerging form of treatment in both social work and clinical psychology. Despite becoming a treatment of choice for difficult family systems, it has yet to be formally standardized or systematically researched.

Early reviews by Sauber (2013) and Kleinman (2017) focused on the lack of formal training, certification, and established ethical guidelines associated with the delivery of FRT. Other investigations have reported on positive outcomes relative to the reunification of children with substance addicted parents, family system approaches to reunification, the use of group FRT programs in residential settings, and an integrative, empirically informed, single-therapist framework for FRT (Marsden & Varavei, 2025; Ritzi et al., 2022;  Singh et al., 2025; Smith, 2016).

In the absence of a uniform treatment approach, the field has operated primarily under a set of treatment guidelines, most notably those described by Faust (2017; 2022). The current paper offers an in-depth clinical look into FRT through two cases that illuminate the complex nature of this type of work: one that was prematurely terminated and one that proved successful. In both cases, the author served as the FRT therapist. Suggestions are given for providers both interested in and working in this field.

FRT and the Role of the Therapist

FRT is a treatment approach that emerged within the court system and is often ordered in high-conflict divorce cases in which the child or adolescent has become estranged from one of the primary caregivers for a significant period of time. This is often due to report(s) of physical, sexual, or psychological maltreatment. In some cases, however, these reports may lack corroborating documentation from legal or child welfare systems, such as the Illinois Department of Child and Family Services.

While there are no required qualifications outside of being a licensed mental health professional, FRT therapists should have experience working with children, adolescents, and family systems. FRT therapists may be assigned by the court or referred by lawyers or mental health providers in the community.

The most significant role of the FRT therapist is to conduct a thorough assessment of the family system with the goal of establishing engagement and connection with each family member and each of the professionals assigned to the case. It is imperative that everyone involved in the case buy into the approach, with the pace of the reunification based on the therapist’s assessment of what the minor can handle without any undue harm or pressure.

The Typical Paradigm for Family Reunification Therapy

The typical FRT case consists of a custodial parent who resides with the minor(s) and the estranged parent. The estranged parent may still have custodial rights but has not seen or spoken to the minor(s) in months, or in some cases years. In some instances, a full psychological evaluation of the minor(s) and each parent has been completed. Legal processes may be ongoing. A Guardian ad Litem (GAL), who represents the best interests of the child, is typically involved. Additionally, the minor(s) may have an independent therapist in the community.

In some instances, the custodial parent has developed an enmeshment with the minor(s). This may manifest inadvertently or overtly through speaking poorly about the estranged parent in front of the child, spreading rumors about the estranged parent, and/or presenting a one-sided narrative to the professionals involved in the case. It is not uncommon for the custodial parent to become defensive when the FRT therapist does not cooperate with their narrative about the estranged parent. Some professionals may have bought fully into the narrative, which can create conflict when the FRT therapist presents an alternative point of view regarding the situation. This may threaten professional alliances.

The estranged parent can also become strongly anchored in their own perspective of the family conflict. They may perceive the system as against them. This can make it difficult for them to reflect on their role in the family conflict or consider how their past actions may have affected the minor(s) or custodial parent. They may have trouble with the pace of the therapy as they want to see quicker results. They may accuse the FRT therapist of being manipulated by the custodial parent. Such dynamics make the role of the FRT therapist tricky to navigate and, if not managed well, can contribute to a less than desired treatment outcome.

An Ineffective Case of FRT

The case was referred to the FRT therapist involving a 10-year-old girl who reported the estranged mother’s boyfriend hugged her inappropriately two years earlier. She said that the now estranged mother did nothing to stop it. Mother and daughter had seen each other twice in the two years following the incident. Each visitation took place in a public setting and occurred without problem. There was no substantiated documentation of the alleged misbehavior and no charges of endangerment or abuse from mother to child. The child welfare system ultimately dismissed the case.

The custodial parent, the father, believed the allegations. He reported an ongoing list of concerns about the mother and her boyfriend to the GAL, the daughter, and the child’s therapist. The therapist had not contacted the estranged mother despite having developed concerns regarding the daughter’s potential safety during visitation with her. The therapist shared her views about the mother with the GAL without ever meeting or hearing from the mother.

The treatment frame was set during the initial phone contacts with each parent, including expectations for treatment and clarification of the FRT therapist’s role. The FRT therapist emphasized that his role was neither that of an investigator nor a child advocate. The mother was quick to note her frustration and pushed to speed things up. After two urgent follow-up phone calls from her, the FRT therapist had to remind her that while he understood her frustration, she needed to respect the process of treatment. Initial phone contact with the father found him wanting to convince the FRT therapist of what actually happened and what a poor parent the mother was. He became frustrated with the FRT therapist’s tone of neutrality. After a few sessions with the child, who wanted her father present, the child’s therapist was contacted by the FRT therapist to talk about a stepwise plan of action. The therapist was resistant to a short meeting between the mother and the child in the FRT therapist’s office. Any new suggestion fell on deaf ears and seemed to reinforce the relationship between the father and the child’s therapist; both of whom developed a disregard for the FRT therapist.

The GAL was objective and open to suggestion, having noted feeling stuck and stressed by the general lack of movement. She contacted each parent and the child’s therapist about a brief therapeutic meeting between the child and the mother. However, this never materialized. The child’s therapist questioned the motivations of the FRT therapist to the GAL, suggesting a possible collusion with the mother.

The father continued to object to any form of “pushing” the daughter to see the mother. He was reluctant to schedule follow-up appointments with the FRT therapist. Under some pressure from the judge, he and the therapist suggested that the girl was open to the process of reunification under the condition of the FRT therapist’s removal. They recorded her in a therapy session stating, “I prefer a female reunification therapist”. The girl also added that she “was not comfortable with a strange man”. Through conversations with the GAL, it was decided that the FRT therapist would make a referral for a female therapist in the community.

This case highlights the various difficulties that can arise for the FRT therapist. Reflecting on his role, he identified that in response to the reactivity he encountered, he should have adopted a motivational approach by meeting both parties within their existing perspectives and facilitating movement from precontemplation to contemplation and, ultimately, action toward reunification. He recognized countertransference reactions that emerged in response to challenging interpersonal dynamics and may have contributed to increased tension among those involved and accelerated the termination of treatment. Relatedly, he realized he may have been responding to a self-imposed need to make something happen. There is often an implicit pressure in this kind of work that needs to be continuously monitored and makes consultation with a colleague an important part of FRT work. This is in addition to an evolving need to satisfy all parties involved, which, if not managed effectively, can negatively impact the case.

An Effective Case of FRT

This case was referred by the estranged parent, the father of a 16-year-old daughter. She refused to see him for 11 months. He and her mother, the custodial parent, divorced when she was five. The divorce was long and bitter. Due to the mother’s alcohol abuse, he was initially awarded custody. However, friction developed when his daughter became an adolescent. She began using substances, and he became involved in a volatile dating relationship. At times, he directed verbal rage toward the daughter, which made her scared and withdrawn. She eventually moved in with her mother, who was now sober. The father felt the mother was speaking poorly about him and influencing the daughter not to speak to him.

After establishing some rapport, the FRT therapist focused on how the father’s behavior affected his relationship with his daughter. He was short-sighted in regard to how the divorce could have contributed to her using substances at an early age. From his perspective, she was just following in the footsteps of her mother. Consistent effort was made to focus not on his presumptions, but on his role in the relationship. He was encouraged to be patient with the process of reunification and refrain from pressuring her to see him.

The FRT therapist met with the daughter at her request. She said she wanted to make things work. However, she was tired of his volatility and the pressure he had been placing on her to visit. She described the effect of growing up with two parents she described as “emotionally immature”.  Her father joined at the end of session, and we discussed a stepwise plan to focus on therapy between the two before visitation. Her therapist was quite receptive and worked collaboratively with the reunification plan, providing valuable suggestions. The therapist and the FRT therapist maintained contact throughout reunification treatment. This information was shared with the GAL, who was on board with the plan.

Things were proceeding well until the father raged about not being included in homecoming photos. The daughter immediately stopped participating in therapy. Treatment focused on managing his frustration and exploring his longstanding feelings of insignificance. This stemmed from his early childhood and contributed to emotional fragmentation and outbursts when he felt overlooked or like he did not count.

The daughter returned after several weeks during which she processed the homecoming episode with her therapist. She was encouraged to resume reunification therapy. Sessions led to lunch dates, followed by spending time at his house. The father was open to the FRT therapist meeting with the mother even though it was he who pursued treatment. Mother stated she was on board with whatever decision her daughter made about seeing him.

This successful reunification was due to the therapist setting the treatment frame early on, encouraging the father to reflect on his role in the relationship, facilitating insight into his childhood dynamics, and allowing the process to unfold at his daughter’s pace. The mother’s cooperation, the GAL’s support, and the establishment of a collaborative working relationship with the daughter’s therapist were pivotal in facilitating effective treatment.

Tips for Working as a Family Reunification Therapist

To avoid the most common pitfalls associated with FRT, the following tips are suggested. First, it is important to get releases of information signed and to contact the GAL and the minor’s therapist as early as possible to develop cooperative and reciprocal working relationships. When working with a system of professionals, remember that, as the FRT therapist, you are entering later in the game. It is important to recognize and give respect to the existing relationships in the system to determine the most effective way to enter and deliver perspective(s) in a manner that circumvents the potential for being ignored or seen as the problem. This may have been the case in the first example, in which the FRT therapist may have entered too quickly with a perspective that challenged the therapist’s conceptualization.

Second, it is important to consistently present feedback in the most objective manner possible. This includes the use of concrete examples that can support any statement you make. This might include examples of a young child using words to describe the estranged parent that are typically not part of a child’s vocabulary. Consider relevant collateral information when developing and communicating clinical impressions, particularly when those impressions differ from an existing conceptualization of either parent. This documentation might be from the GAL, school, mental health therapist, psychiatrist, inpatient program, or protective services.

Third, let the involved parties have their emotional reactions without becoming too engaged. Do not feel the need to overly explain or justify yourself outside of the basic facts. Make sure to thoroughly document any relevant interactions to limit a misrepresentation or false accusation regarding something you said to any party or either parent. Do not engage in any outside conversation with either parent, letting them know that while they may email you, any response will be copied to the GAL, the minor’s therapist, and/or custodial/estranged parent.

Fourth, make sure to do a thorough assessment of the minor’s readiness to participate in treatment. This includes the parents’ level of emotional readiness, which will dictate how sessions are structured.

Fifth, relative to building the most effective treatment alliance, it is imperative that the child/adolescent knows that you are safe and will respect their space. It is important to let them know that you may be making some decisions that may not please them. Ensure them that their voice will be heard and considered in all decision making. For the parents, it is important to listen to their concerns, remind them of your neutrality, and note that while the goal is movement, movement can occur in different forms and at different paces as long as we are moving toward reunification. I let parents know during this process that it is okay if they get angry with me and that I am here to resolve any potential sources of conflict.

Sixth, within the context of a working alliance, it is important to negotiate a set of treatment goals that work with the pace and emotional readiness of each of the involved parties. It is important to define these goals as “working” goals that can always be redefined across the course of treatment.

Seventh, suggestions should be made that are practical and stepwise in nature, as noted in the case that worked. This will make it harder for a GAL, parent, or parents’ attorneys to dispute.

Finally, it is important to remember to maintain the treatment frame. Despite being questioned, accused, met with hostility, or feeling like suggestions are falling on deaf ears, it is important to set and maintain the frame of the treatment. If either or both parents cannot accept or work within this frame, then it is up to them to terminate services and/or ask for a new reunification therapist.