Resources · Guide
Individual, Couples or Family Therapy: Where to Start
One of the first questions people face when looking for therapy is who should come. The good news is that you do not have to get it right on your own. This guide explains how a systemic therapist thinks about the question, and how the answer can change as the work goes on.
The Lens
How a Systemic Therapist Thinks About the Room
Athena Metos, MA, LMFT is a marriage and family therapist, and her training is systemic. That means she understands problems as belonging to patterns between people, not only to the person who happens to be struggling most. A teenager's anxiety, a partner's withdrawal, a parent's exhaustion: each makes more sense when you see the relationships around it.
One consequence of that view is freeing. Because the pattern involves several people, it can be worked on from several places. Sometimes the most useful place is one person on their own. Sometimes it is two partners together. Sometimes it is the whole household. The systemic lens applies in every format, so choosing a format is less about finding the only correct option and more about finding a good place to begin.
Athena's reason for choosing the MFT license speaks to this directly. As her bio explains, change in an individual alone is not always enough, and systemic therapy addresses people in relationship and the patterns between them.
This also means there is no wrong door. Whichever format you begin with, the relationships around the difficulty stay in view, and the work can widen or narrow as it becomes clearer where change is most likely to take hold.
Common Starting Points
When Each Format Tends to Fit
Individual therapy is often the natural place to start when the concern is centered on your own experience: anxiety, depression, burnout, body image, a life transition, or a relationship you are trying to understand before deciding what to do. It is also a good starting point when other people in your life are not ready or willing to come. Individual sessions still look at your relationships; they simply do so with you as the one in the room.
Couples counseling tends to fit when the difficulty lives between two partners: recurring arguments, distance, broken trust, communication that has become defensive, or a major decision the two of you are facing. Athena has Level 2 Gottman training and draws on the Gottman Method in this work. Both partners need to be willing to take part.
Family therapy fits when a pattern involves the household as a whole: conflict between parents and children, tension between siblings, a family adjusting to a big change, or a cycle that no longer serves anyone. For younger people, teen therapy offers one-to-one sessions with parents kept appropriately in the loop, which can be a helpful middle ground.
Over Time
How the Format Can Change
The format you start with is not a commitment for the whole course of therapy. It is common for the shape of the work to shift as the picture becomes clearer. Someone who begins individually might invite a partner to join for a few sessions once it becomes clear the relationship is part of what keeps the difficulty going. A couple might decide, partway through, that each partner would benefit from some individual time. A family might meet together for a stretch and then move to sessions with a parent and teen.
These shifts are not a sign that the first choice was wrong. They reflect a better understanding of the system, which is exactly what the early sessions are for. Each change has practical considerations too, such as scheduling, privacy and fees, so it is discussed openly before anything is decided.
There are also times when a change is not the right idea. If individual work is going well and bringing someone else in would make the room feel less safe, it can stay individual. The point is to choose the format that serves the work, not to follow a fixed sequence.
Practical realities matter as well. Work schedules, childcare, distance and privacy all influence which format is workable, and telehealth anywhere in Utah can make it easier for more than one person to take part. Those considerations are part of the conversation, not an afterthought.
Together
Decided With You, Never for You
Whatever the format, the decision about who is in the room is made together. Athena may suggest that someone join, or that a different format might be worth considering, and she will explain why. But she will not add people to your sessions or change the arrangement unilaterally. You keep a say in how your therapy is structured.
That applies to privacy as well. When people move between formats, questions come up about what is shared and what is kept private. Those questions are worth raising early, and Athena will talk through how she handles them before any change is made.
A useful rule of thumb is that nobody should be surprised by who turns up in a session. Everyone involved knows in advance who will be there, why, and what the session is meant to focus on.
Getting Started
If You Are Still Unsure
You do not need to decide the format before reaching out. In the contact form, a sentence about what is going on and who is involved is enough, and the starting point can be worked out from there. The what to expect page describes how first sessions are structured, and rates and insurance lists the fees for each format. Sessions are available in person in Salt Lake City or by telehealth anywhere in Utah.
Common Questions
Questions About Where to Start
- What if my partner does not want to come to therapy?
- You can start on your own. Individual work still looks at the relationship, and change in one person often shifts the pattern between two. If your partner becomes interested later, adding couples sessions can be discussed.
- Can we switch from individual to couples or family sessions later?
- Yes. The format can change over time as the work develops. Any change is discussed and decided together, never imposed.
- Do the formats cost different amounts?
- Individual sessions are 60 minutes at $200. Couples and family sessions are 60 minutes at $250. Select Health, BCBS, UBH and University of Utah Health Plans are accepted.
Start With the Contact Form
Not sure who should come? Say so in the contact form, and the starting point can be worked out together.