Family constellations: what the research says

A few small studies in the general population found people reported less distress after a family constellation seminar, but the quality of the evidence is low and the most recent trial was mixed. Spain's national health technology agency found the evidence too thin to say it helps anxiety, depression or stress. No studies have looked at sleep, grief, pain or menopause.

What a session is

A family constellation is a group session, often run as a one- to three-day seminar. You briefly describe a family situation, then other participants stand in for members of your family and the facilitator places them in the room to show how the family relates. You may take part actively or watch. In one-to-one sessions, objects or floor markers can stand in for family members. The method, developed by Bert Hellinger, grew out of family therapy and also draws on spiritual and esoteric ideas. Perspectives on Psychological Science, 2023

What the research says

• Worry, stress and low mood: A 2021 review found 12 small studies with 568 people in total. Nine of the 12 found an improvement after a seminar, such as less distress, but the review rated the amount and quality of the evidence as low. One trial of 208 adults in 2013 found a small to moderate improvement in psychological functioning compared with a waiting list, and a follow-up of the people who took part found this was still there at 12 months. A 2022 study of 102 people, without a comparison group, found moderate improvements that mostly lasted 6 months. A 5-year follow-up of the 2013 trial, without a comparison group, found psychological functioning was back to where it started. A 2024 trial of 80 people, run with pandemic changes, found only small gains that mostly faded by 6 months and no clear difference from the control group. Most of these studies were in the general population, not in people with a diagnosed condition, and a 2026 review found a lack of trials in people with depression. In 2025, Spain's national health technology agency reviewed the evidence and concluded it does not allow saying family constellations help anxiety, depression or stress. Limited evidence · Family Process, 2021 · Journal of Counseling Psychology, 2013 · Family Process, 2015 · Journal of Psychiatric Research, 2024 · Psychiatria Danubina, 2022 · Frontiers in Psychiatry, 2026 · Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 2020 · AETS-ISCIII (Spanish Ministry of Health), 2025
• How you feel within your family: One trial of 208 adults in 2014 found that people who took part in a 3-day seminar reported a stronger sense of belonging, autonomy, accord and confidence in their close relationships than people on a waiting list, 2 weeks and 4 months later. A follow-up of the same group found the change was still there at 12 months, and a 5-year follow-up without a comparison group found it was still there after 5 years. This is a single trial using a new questionnaire, so more studies are needed. Limited evidence · Family Process, 2014 · Family Process, 2015 · Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 2020
• Sleep, grief, pain and menopause: No studies found. The 2021 review searched ten databases for studies of family constellations. The outcomes it found were mental health, self-image and family relationships, not sleep, grief, pain or menopause. No good evidence yet · Family Process, 2021

More on each need: Lift your mood · Feel calmer

Is it safe?

Seven of the 12 studies in the 2021 review looked for harm. Four reported minor or moderate negative effects in a small share of people (5 to 8%) that may have been linked to the session. Spain's agency found no sign of serious harm, but said the evidence is too thin to call it safe for people with anxiety, depression or stress. A 2022 study found these were about as common and as serious as in other kinds of talking therapy. Strong feelings can come up during and after a seminar. Choose an experienced facilitator and ask how they support people afterwards. If you are in crisis or have a serious mental health condition, talk to your doctor or therapist first. Family Process, 2021 · Psychiatria Danubina, 2022 · AETS-ISCIII (Spanish Ministry of Health), 2025

Sessions on Sissoo complement medical care and never replace it. Please don’t stop or change any treatment without talking to your doctor. If you feel very low or think about ending your life, call your local emergency number now.

Checked 9 November 2026. Next check by May 2027. How we rate the evidence.