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Family Constellations: The Method, the Trial Evidence, and Its Limits

Setting a family out in space to see how its relationships stand, and what the trials can and cannot show

What is family constellations therapy, and how do family constellations work?

Family constellations is a group method whose originator is Bert Hellinger. A person chooses people from the group to stand in for family members and places them in relation to each other, and the group helps the placements unfold. It is not the Adlerian term of the same name, which means birth order. The first of two randomised trials of the seminar found improvements compared with a wait-list. The second, from 2024, found gains that were small and mostly gone by six months. A 2021 systematic review by Konkolÿ Thege and colleagues reads the data as pointing toward benefit, but judges the quantity and overall quality of the evidence low.

Family constellations is a group method whose originator is Bert Hellinger. Stiefel, Harris and Zollmann (2002) describe it as “a popular yet also controversial form of systemic therapy in the German-speaking therapy community,” and as a one-session approach that addresses family-of-origin issues. Cohen (2006) describes the method as trans-generational and phenomenological. In a seminar, one person, the active participant, describes the family and the problem with a facilitator, then chooses others from the group to stand in for family members and places them in the room (Cápec et al., 2022). A plain word on the name: in Adlerian psychology, “family constellation” means birth order, a different idea, and this page is not about that (Gallagher & La Lima, 2020). The evidence for the seminar format is two randomised trials, one of 208 adults with a three-day seminar and one of 80 adults with a single-day version. The reviews of the method point toward a possible benefit, but judge the quantity and overall quality of the evidence low. The method’s claims about families beyond the people in the room are not what those trials tested.

Practices

How these practices connect

Each practice here uses one move: a family’s relationships are placed in space, so they can be watched from a different position rather than only retold. The seminar supplies that position through a group; the active participant places representatives in the room according to their own image, and the placements are then moved toward a solution arrangement. Stiefel and colleagues describe the process as highly experiential, utilising multiple sensory modalities (2002). None of the trials read for this page tested why that move would change a person’s experience of their family.

What is family constellations therapy, and how does a session work?

In a family constellation seminar, a group of about 20–25 people is led by a trained facilitator. One participant, the active participant, describes the family and the problem, then asks others to stand in for family members and places them in the room according to their own image of the situation. The facilitator interprets reactions, and the representatives change places until a “solution constellation” is reached (Cápec et al., 2022). The sources describe this format and do not give a fuller step-by-step account.

What did the randomised trials of family constellation seminars find?

Two randomised trials have tested the seminar format. The first, with 208 adults from the general population, compared a three-day seminar with a wait-list group. Psychological functioning improved more in the seminar group, with effect sizes of d = 0.45 at two weeks and d = 0.46 at four months (Weinhold et al., 2013). The second, with 80 adults, used a single-day version. Its intervention group improved significantly on overall psychopathology, but the authors report that the gains were small, mostly gone by six months, and not significant in the time-by-group comparison (Konkolÿ Thege & Szabó, 2024).

Did the improvements from the three-day seminar last beyond the first four months?

A follow-up at eight and twelve months (Hunger et al., 2015) included 104 adults, all from the seminar group, with no wait-list comparison. The abstract reports significant improvement in psychological functioning at d = 0.41 at eight months and d = 0.40 at twelve months. Because the follow-up had no control group, it cannot show that the seminar caused those changes over that period.

What do the systematic reviews say about family constellation therapy?

Konkolÿ Thege and colleagues (2021) searched for prospective quantitative studies published up to April 2020. They found 12 studies with 568 participants, and nine of the twelve showed significant improvement after the intervention. A meta-analysis of five studies on general psychopathology found a moderate effect, Hedges’ g = 0.531. Four of the seven studies that looked for harmful effects reported minor or moderate negative effects in 5–8% of participants. The authors read the data as pointing toward benefit, but conclude that the quantity and overall quality of the evidence is low.

Can I do family constellations on my own, without a group or a facilitator?

None of the sources read for this page describes a solo, self-applied version. Each describes a group format led by a facilitator. Cápec et al. (2022) also mention an individual form with figurines, objects or pictures, but that is described as an individual session, which the paper says can also take place by videoconferencing. This page therefore gives no solo exercise. The four practices on this page need a group and a trained facilitator, because placements can bring up overwhelming material.

Is family constellation the same as the Adlerian term of the same name?

No. In Adlerian psychology, family constellation means birth order, the position a child takes within the family, which Alfred Adler introduced as a possible influence on later personality (Gallagher & La Lima, 2020). The Hellinger method on this page is a different practice, and the Adlerian meaning is not studied here.

How does family constellation differ from psychodrama?

The sources read for this page do not compare the two methods in detail, so this page does not say how they differ. Psychodrama has its own concept page, psychodrama-techniques. One article on integrating the two, Carnabucci (2026), The Challenge and Promise for Psychodrama and Family and Systemic Constellations, Journal of Psychodrama, Sociometry, and Group Psychotherapy, 66(1), https://doi.org/10.12926/caaz1g20, describes a growing number of psychodramatists integrating them and notes that some voice skepticism. This page relies on that article’s abstract only.

How do you choose between these?

The sources read here do not give a rule for which role or which format suits which person, so this page does not give one. What they support is narrower: the seminar format is the one with trial evidence, and the active role, the representative role and the solution arrangement are steps within it. The observing role is named in the 2013 trial but not described in detail. Whether to join at all is a decision to take with a trained facilitator, since the review found minor or moderate negative effects in a small share of participants across studies of the method.

What these approaches do not settle

The trial evidence is two randomised trials. The 2013 trial was monocentric; the site of the 2024 trial is not stated in its abstract. The 2013 trial compared a three-day seminar with a wait-list in 208 adults, and its follow-up included only the seminar group. The 2024 trial used a single-day version in 80 adults, pandemic-adjusted, and its authors say its gains were small, mostly gone by six months, and not significant in the time-by-group comparison, and that pandemic deviations from protocol may limit generalisation. Konkolÿ Thege et al. (2021) read the data as pointing toward benefit, but judge the quantity and overall quality of the evidence low. Systemic constellations applied in organisations: a systematic review, Gruppe. Interaktion. Organisation (2021), https://doi.org/10.1007/s11612-021-00592-8, found 79 potentially relevant publications, seven of which were prospective and two of those seven used a controlled design. It concludes that the empirical evidence points toward a potentially effective intervention in organisations, but that it is too early to make firm conclusions as the number of studies was small and quality of the studies was low in general. An ethics critique (Talarczyk, 2011) found the method does not fulfil many rules of the Polish code of ethics for psychotherapists, and questioned whether it is psychotherapy at all. A 2026 critical appraisal (Zhong et al., 2026) reports that a 2026 systematic review and meta-analysis across clinical conditions, which Zhong et al. note is currently a preprint that has not yet undergone peer review, concluded that there is currently “no reliable evidence to support its use for any condition”, and that its included trials were at high risk of bias with very low-certainty evidence and significant concerns regarding potential adverse effects. The method’s own accounts reach further than these studies. Cohen (2006) describes it as trans-generational, with roots that include “the ancestor reverence of the South African Zulus.” None of the trials read here tested claims about influences across generations, or claims about what a placement reveals beyond people’s own reported experience. This page does not quote Hellinger’s own books; the 1998 English edition, Love’s Hidden Symmetry, is cited only for its bibliographic record.

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Frequently asked questions

What is family constellations therapy, and how do family constellations work?

Family constellations is a group method whose originator is Bert Hellinger. A person chooses people from the group to stand in for family members and places them in relation to each other, and the group helps the placements unfold. It is not the Adlerian term of the same name, which means birth order. The first of two randomised trials of the seminar found improvements compared with a wait-list. The second, from 2024, found gains that were small and mostly gone by six months. A 2021 systematic review by Konkolÿ Thege and colleagues reads the data as pointing toward benefit, but judges the quantity and overall quality of the evidence low.

How do you step out of the placement and come back to your body?

A constellation places people in roles that stand for your family, and the feelings in that room can feel very real long after the placements end. Stepping out and orienting to the room (the floor, the faces you can see, your breath) gives the body a break from that intensity and reminds you that your present life is separate from the scene. Grounding first lets you notice what you actually feel, rather than being carried by the group's momentum.

How do you reach a person if the sobbing and guilt keep going?

A group workshop can stir grief and guilt about people you cannot change, and that feeling can run on for days when no one is helping you carry it. Constellations work with the family in the room, which is not a replacement for a clinician who knows you. How long it has lasted, and who is beside you, are the things that tell you it is time for a person to take over.

How do you attend a three-day family constellation seminar?

The trials measured outcomes but did not test why those outcomes occur. The seminar is described as a group, usually of about 20–25 participants, led by a trained facilitator (Cápec et al., 2022), and as a short-term group intervention “aiming to help clients better understand and then change their conflictive experiences within a social system” (Konkolÿ Thege et al., 2021). Those are descriptions of the format, not tested causes of change.

How do you take the active seat and place your family members?

Stiefel and colleagues describe the process as the client’s “physical-emotional positioning and re-positioning of substitute family members in relation to each other, with help of a therapeutic group” (2002). Cápec et al. (2022) state that representatives act on their “subconscious impulses” and depict family behaviour “with reliable accuracy.” Those are the method’s own claims; none of the trials read for this page tested them, and the trials tested the seminar as a whole.

How do you stand in as a representative for someone else’s family member?

In the method, representatives are placed in the room according to the active participant’s internal image, and Zhong et al. (2026) report that representatives “frequently describe embodied sensations, emotions, or impulses.” Cápec et al. (2022) describe representatives as acting on “subconscious impulses.” Whether those reports reflect the family member they stand for is the method’s own claim and was not tested in any trial read for this page.

How do you watch the placements move toward a solution arrangement?

The method describes representatives changing their places after interventions, until an optimal “solution constellation” is reached that “should provide a new, more comfortable pattern of the family relationships for the client” (Cápec et al., 2022). That is the method’s stated aim. No trial read for this page measured the arrangement as a step, and the trials measured questionnaire outcomes for the seminar as a whole.

What is family constellations therapy, and how does a session work?

In a family constellation seminar, a group of about 20–25 people is led by a trained facilitator. One participant, the active participant, describes the family and the problem, then asks others to stand in for family members and places them in the room according to their own image of the situation. The facilitator interprets reactions, and the representatives change places until a “solution constellation” is reached (Cápec et al., 2022). The sources describe this format and do not give a fuller step-by-step account.

What did the randomised trials of family constellation seminars find?

Two randomised trials have tested the seminar format. The first, with 208 adults from the general population, compared a three-day seminar with a wait-list group. Psychological functioning improved more in the seminar group, with effect sizes of d = 0.45 at two weeks and d = 0.46 at four months (Weinhold et al., 2013). The second, with 80 adults, used a single-day version. Its intervention group improved significantly on overall psychopathology, but the authors report that the gains were small, mostly gone by six months, and not significant in the time-by-group comparison (Konkolÿ Thege & Szabó, 2024).

Did the improvements from the three-day seminar last beyond the first four months?

A follow-up at eight and twelve months (Hunger et al., 2015) included 104 adults, all from the seminar group, with no wait-list comparison. The abstract reports significant improvement in psychological functioning at d = 0.41 at eight months and d = 0.40 at twelve months. Because the follow-up had no control group, it cannot show that the seminar caused those changes over that period.

What do the systematic reviews say about family constellation therapy?

Konkolÿ Thege and colleagues (2021) searched for prospective quantitative studies published up to April 2020. They found 12 studies with 568 participants, and nine of the twelve showed significant improvement after the intervention. A meta-analysis of five studies on general psychopathology found a moderate effect, Hedges’ g = 0.531. Four of the seven studies that looked for harmful effects reported minor or moderate negative effects in 5–8% of participants. The authors read the data as pointing toward benefit, but conclude that the quantity and overall quality of the evidence is low.

Can I do family constellations on my own, without a group or a facilitator?

None of the sources read for this page describes a solo, self-applied version. Each describes a group format led by a facilitator. Cápec et al. (2022) also mention an individual form with figurines, objects or pictures, but that is described as an individual session, which the paper says can also take place by videoconferencing. This page therefore gives no solo exercise. The four practices on this page need a group and a trained facilitator, because placements can bring up overwhelming material.

Is family constellation the same as the Adlerian term of the same name?

No. In Adlerian psychology, family constellation means birth order, the position a child takes within the family, which Alfred Adler introduced as a possible influence on later personality (Gallagher & La Lima, 2020). The Hellinger method on this page is a different practice, and the Adlerian meaning is not studied here.

How does family constellation differ from psychodrama?

The sources read for this page do not compare the two methods in detail, so this page does not say how they differ. Psychodrama has its own concept page, psychodrama-techniques. One article on integrating the two, Carnabucci (2026), The Challenge and Promise for Psychodrama and Family and Systemic Constellations, Journal of Psychodrama, Sociometry, and Group Psychotherapy, 66(1), https://doi.org/10.12926/caaz1g20, describes a growing number of psychodramatists integrating them and notes that some voice skepticism. This page relies on that article’s abstract only.

Research

Related concepts