1 Introduction

Systemic practice focuses on relational systems, typically families and couples (Dallos and Draper 2015), often overlooking friendship (Flemke 2001), one of life's most meaningful and enduring connections (Dunbar 2021). Friendships can promote well-being (Christakis and Fowler 2010; Santini et al. 2021) but can also involve dynamics, similar to family patterns, such as possessiveness, inequality, or bullying (Burck and Daniel 2021), and undergo changes in circumstances leading to conflict or grief when friendships end (Flemke 2001). These complexities highlight the utility of recognising friendships as a potential site for systemic intervention (Jenicek and MacIntosh 2023).

It is worth considering how systemic practice has engaged with friendships. Some early models drew on wider relational networks. Speck's (1967) Family Network interventions brought family and friends together in crisis, later refined into smaller Core Network Interventions (Llamas et al. 1981). Haber (1987) invited friends as lay consultants, while Anderson et al. (1986) concept of ‘problem-determined systems’ included anyone involved in the discourse, which extended to friends. Later approaches such as Multi-systemic Therapy, Multidimensional Therapy, and Open Dialogue (Henggeler and Borduin 1990; Kinane et al. 2022; Liddle et al. 1992) also recognised the role of peers and wider networks. Yet in these models, friends typically appear as resources for the client rather than the central focus of therapy. Although anecdotal reports suggest systemic practitioners can work relationally with friendships (Henggeler and Borduin 1990; Kinane et al. 2022; Liddle et al. 1992), they remain a rare focus of intervention.

In this paper, we argue that social changes are elevating the role of friendships in many people's lives, and systemic practice should take note. Economic crises, housing challenges, the feminist movement, shifting marriage norms, globalisation, and the COVID-19 pandemic all contribute to their rising importance (Ayers et al. 2021; Spencer and Pahl 2006).

Marriage has undergone significant shifts. Once a political and economic institution, in which friendships often carried greater emotional weight (Coontz 2006), in the 20th century the nuclear family reframed marriage as both practical and romantic, with emphasis on partnership and unity. Feminist critiques later encouraged fulfilment beyond the family and renewed attention to friendships (Sow and Friedman 2020). However, more recently, economic precarity and rising housing costs have reinforced traditional family values, while also delaying marriage and homeownership (Stone et al. 2011). As a result, many young adults live communally for longer, with friends often taking on family-like roles (Arnett 2007; Bynner 2005).

The COVID-19 pandemic and lockdown-induced isolation further highlighted the value of friendships (Maloy et al. 2022). At the same time, it accelerated the uptake of digital communication, enabling people to live and work across borders (Hermann and Paris 2020). Yet this mobility also fragments traditional structures, as work and education often separate individuals from their families of origin, potentially increasing reliance on friendships (Bauman 2000).

For marginalised communities, friendships have long been vital support structures. In LGBTQIA+ communities, kinship networks—often described as ‘chosen family’—highlights how friendships can assume roles typically associated with families when ties to families of origin are disrupted (Nelson 2013; Weston 1997). Green (2000) critiques systemic therapy for overlooking these relational needs and calls for greater inclusion of chosen families, while others argue that excluding chosen family and privileging the nuclear family reflects white, Western, heteronormative frameworks embedded in systemic practice (Jenicek and MacIntosh 2023). Similar dynamics are proposed for care-experienced and migrant communities, where disconnection or estrangement from biological families often makes friendships central (Francisco-Menchavez 2018; Gill et al. 2023). In these contexts, therapeutic interventions could usefully address the complex dynamics of such bonds (Burck and Daniel 2021).

Therefore, we argue that it is timely and necessary for systemic practitioners to consider including friends as a critical relational focus for therapy. This study explored systemic therapists' perspectives on friend therapy and their readiness to consider friendships as sites for intervention.

We acknowledge that the term friend therapy may provoke discomfort, as it sits outside traditional systemic categories such as family or couple therapy, and participants in this study also expressed ambivalence about it. We use the term deliberately—not to propose a fixed model or potential new manualised approach—but to foreground friendships as meaningful contexts for systemic work and to challenge the assumption that therapy is confined to familial or romantic bonds. Alternatives such as chosen family or logical family were considered but avoided: the former is rooted in queer communities, and we wished to avoid appropriating a concept with specific cultural and political meaning; the latter lacks wider recognition beyond academic or activist circles. In contrast, friend therapy echoes familiar framings like family or couple therapy, making it more accessible to both clients and practitioners. We offer it not as a definitive label but as a provocation—an invitation to reconsider which relationships systemic practice should include, and to better reflect contemporary relational realities.

For this study, we focus on emotionally significant friendships—those that may act as primary sources of support, intimacy, and care that may at times be considered ‘family’. Specifically, we draw on Dunbar's (2021) notion of the ‘inner circle’: friendships marked by high emotional intensity and mutual investment.

2 Method

2.1 Design

This study used a qualitative design to explore systemic practitioners' views on the inclusion of friendships within therapeutic practice. Semi-structured interviews were used to gather rich, in-depth accounts from participants, which were analysed using reflexive thematic analysis (RTA) (Braun and Clarke 2022).

The research question guiding this study was:

What are systemic practitioners' perspectives on working relationally with friends in therapy?

To support this, we also considered the following sub-question:

What benefits and challenges do systemic practitioners identify, both personally and professionally, when considering the inclusion of friends in therapeutic work?

2.2 Researcher Positionality

The authors hold a deep appreciation of friendship. The first author's experience of friendship as a site of both sanctuary and loss, including the death of a close friend, prompted reflection on how systemic practice could create space for these bonds. Over time, curiosity grew about the contrast between systemic theory's relational breadth, alongside practice's narrower focus on families and couples, inspiring the exploration in this study of how therapists engage with friends. While drawn to the possibilities, the authors remained curious and cautious about the risks and challenges of incorporating therapy into relationships that many value precisely for their lack of professional intervention. As a research team, we reflected throughout on language and meaning as applied to friendship and friend therapy.

Only the first author was aware of the participants' identities, and no personal relationships with the participants existed. Recruitment occurred through formal professional structures and shared professional networks, with transparent informed consent procedures used throughout. Journaling and collaborative discussions among the research team supported RTA (Braun and Clarke 2022). As a research team we reflected on research processes throughout, and reflexive conversations often brought forth personal stories and considered its implications both personally and professionally.

2.3 Participants

Recruitment was through systemic networks, including the Family and Systemic Therapy Research Centre email list, the Association of Family Therapy mailing list, and various practice group mailing lists. Overall, 22 individuals expressed interest, of which 18 consented to participate. One participant experienced technical issues and did not proceed, so the final number of participants was 17. Participants had completed one or more of the Year Two Intermediate Postgraduate Diploma in Systemic Practice, the CYP IAPT Systemic Family Practitioner Courses, the Master's in Family and Systemic Psychotherapy, and the Doctorate in Systemic Practice. Participants worked in the UK and were fluent in English. Demographically, most were white-British, female, and aged between 27 and 79 years, with 2–36 years of experience in systemic practice. A summary of participants' demographic information is below (Table 1).

2.4 Ethical Considerations

Ethical approval was granted by University of Hertfordshire (protocol number LMS/PGR/UH/05311). Following British Psychological Society (BPS) guidelines (Oates et al. 2021), informed consent was obtained before interviews and participant anonymity was maintained. Data were securely managed in line with GDPR standards. Guidance was followed for online research (Kaye et al. 2021) and home visits for data collection.

2.5 Data Collection

Interviews were conducted between June 2023 and January 2024 by the first author. Participants received information and consent forms before the interviews. Most were interviewed via MS Teams, with one at a participant's home. The researcher recorded and transcribed all interviews verbatim. A semi-structured schedule guided the interviews, using open-ended prompts to explore how participants understood friendships in relation to other systemic contexts. Questions included: ‘How might systemic friendship therapy be the same or different from family or couple therapy?’, ‘What skills might you draw on when working with friends in therapy?’, and ‘What distinctions do you see between friendship therapy and other forms of systemic work?’ The schedule aimed to elicit both personal and professional perspectives.

Working definition provided to participants: ‘Friend therapy refers to applying systemic ideas and practices to emotionally significant friendships, treating the friendship as a meaningful relational system in which patterns, communication, and contextual influences can be explored. It draws on approaches commonly used in systemic family and couple work but adapts them to support friends to reflect on their relationship, navigate difficulties, or make sense of changes in their lives and connection.’

Appendix A includes the full interview schedule.

2.6 Data Analysis

We analysed the data using RTA (Braun and Clarke 2022), following a flexible, recursive process that allowed movement across the six analytic phases. The first author led the analysis, conducting systematic coding using NVivo 12 and applying both semantic and latent approaches. This was followed by theme generation, clustering codes into patterns, and refining thematic maps. Co-authors were involved in reviewing early codes, supporting the development and naming of themes, and offering critical feedback to ensure coherence with the dataset. Regular discussions fostered reflexivity, enabling us to reflect on our assumptions, consider alternative interpretations, and remain grounded in the principles of RTA throughout the process.

3 Findings

Through the analysis, four themes were constructed, namely ‘Engagement with friend therapy’, ‘Changing social dynamics—implications for the emergence of friend therapy’; ‘Navigating complex relational dynamics through friend therapy’; and ‘Systemic therapists' suitability for friend therapy’. Across all these themes, both factors in support of and those against including friendships in therapy were highlighted. These will now be discussed.

3.1 Engagement With Friend Therapy

Systemic practitioners had varied reactions to the concept of friend therapy that more often drew from personal experiences despite being invited to consider it from a professional standpoint. Some participants were enthusiastic, recognising the significance of friendships:

I really like the idea of friend therapy… I think it makes absolute sense because of the significance of those relationships. [Participant 10]

Others were more tentative, acknowledging the novelty of the concept:

[Friend therapy] feels a bit of a novel request, you'd probably be feeling your way through a little bit and trying to get a sense with [the clients] about, ‘What are we doing here?’. [Participant 04]

Despite interviewing participants in their professional capacity, personal experiences often played a prominent role in shaping their response to friend therapy:

Friends are the new family… I have lifelong friends who are very important to me, and I have many… relatives by blood, who I have absolutely nothing to do with. [Participant 17]

Many who had these profound friendships expressed how these relationships shaped their receptiveness to the idea of friend therapy:

I do think [introducing friend therapy is] incredibly important because like I said, friends as family. And that girl… I've known since we were three… she and her family are like kin to me. [Participant 11]

However, some participants expressed scepticism about the necessity of friend therapy, often citing personal and cultural beliefs that prioritise familial relationships over friendships:

I've been married [many decades], so clearly, I take very seriously being married… you have more motivation to at least try to make things different… because of children or families you know it's much stronger with marriage than with friends. [Participant 09]

Some reflexively considered their positions regarding friends in relation to family:

People will drop a lot for a relative that they barely know when there's a crisis. But would they do the same for a friend?… I really am aware, like, this is perhaps just my own cultural expectations of friends. [Participant 13]

While mostly drawing on personal experiences, some participants also drew on professional experiences when considering friend therapy. Some considered how the clients' identities might inform how they understood their friendship:

I could be organised by my ideas of their friendship simply because of their culture or their religion. [Participant 01]

One participant reflected on how working with families and couples often involves pre-existing assumptions, whereas they felt friend therapy would require a more open, exploratory approach:

With couples and families, I have a little catalogue in my head of what they might want… with friends, I think I would be more likely to explore [my assumptions] in more detail because I don't have a taken-for-granted, built-up over years… idea of what the repertoire of possibilities are. [Participant 07]

Although not central to their practice, in a few instances participants drew on their clinical experiences of friend therapy:

A colleague and I were working with somebody who… her chosen, sort of, family were friends. And she didn't have any contact with her own family… we had a couple of sessions where we, yeah, did something therapeutic, and it was really memorable. [Participant 07]

In summary, participants were generally unfamiliar with the concept of friend therapy, and their initial reactions ranged from enthusiastic support to tentative or ambivalent responses. Personal values and lived experiences often shaped these responses. Those who viewed friendships as central to their own lives tended to be more open to the idea, while others drew on cultural norms that prioritised familial or romantic relationships. However, most reflexively questioned their assumptions and reflected on how identity, background, and professional positioning might shape their views.

3.2 Changing Social Dynamics: Implications for the Emergence of Friend Therapy

Participants reflected on how social dynamics, like economic crises and shifting marriage norms, influence relationships. Despite shifts away from traditional norms, many noted that marriage and the nuclear family remain prioritised in Western society, reinforced by cultural expectations, legal frameworks, and institutions like the NHS. Many participants believed this reinforcement had, so far, resulted in the marginalisation of friendship's role within systemic therapy.

Several participants suggested that friend therapy has not emerged because capitalism reinforces the nuclear family's importance within the economic system:

Why do we focus on family? Because they are a socially, legally, validated unit, domain of production. They look after people they provide for people and that's what the state relies on. [Participant 17]

As one participant stated, it could be argued that systemic therapy has unwittingly aligned itself with this economic system:

It's a capitalist plot… because friends are not part of the means of production… if you look at industrialised society… you're a family. You've produced new workers… But friendship? … I think it's too nebulous for capitalism to focus on. [Participant 11]

Several participants highlighted how legal systems also reinforce family structures over friendships:

There is a legal framework around those type of [family] relationships while there is… very little legal framework around friendships. [Participant 03]

Some saw cultural expectations prioritising romantic relationships and ‘settling down’ as contributing to the marginalisation of friendships. They considered the dialogical ways these priorities can be reinforced:

I'm sitting around talking with my friends, the conversation kind of goes to our children and forming partnerships… I have two children who don't have, and have never had partners… I even feel a little bit marginalised. [Participant 08]

Many participants described ways NHS and social care service design can neglect friendships due to its individualistic focus:

The other barrier would be the NHS generally organises itself primarily around an individual… they wouldn't think about friendships so much as being the presenting difficulty. [Participant 04]

Several reflected on how NHS service models prioritise individualised care and operate within legal and funding constraints that reinforce family-focused interventions. The emphasis on evidence-based practice was seen as a key barrier to the inclusion of friends, particularly given the lack of an established research base. As one participant noted:

I think it would be really important to have a think about the evidence for friendship therapy… I work an NHS job… if there's something new that's being offered to a service, you'd maybe have to justify a business case. [Participant 05]

This was echoed by others, who described the need to demonstrate outcomes and align with economically driven priorities:

Whenever you're doing anything, there's always going to be, you know, ‘Who's this for? What's it for? How are you going to show it's effective? Is this worth our money?’ [Participant 07]

Most participants noted that while society has traditionally reconstituted the importance of the family through multiple systems, there appears to be a shift in Western culture where friendships are gaining importance:

I wonder whether the Western society has moved from extended family to nuclear family, and now our friendship networks are much more important than they used to be. [Participant 03]

This shift was attributed to cultural changes affecting relational dynamics, with some participants linking it to a move away from religious norms and traditional expectations of marriage and parenthood, thereby elevating the role of friendship in social dynamics:

Religion being less of a focal, central context… there's something about those expectations, whether it's marriage, children… that's perhaps shifted… it raises the importance of friendship for people. I think it becomes more central. [Participant 18]

Many participants noted that rising living costs lead to longer cohabitation with friends, especially among young people:

I think for young person… to live on your own is almost impossible if you don't get the parental support. So, the economic… You have to connect with friends. You have to share houses. [Participant 03]

Global mobility was another factor that participants considered, with many noting that physical distance from family of origin affects traditional connections, leading to friendships becoming more significant as they fill the gaps left by family:

Globalisation… people being physically disconnected by thousands of miles from family… that makes a difference because I think that lots of our traditional structures of support are much different to 50 years ago, and that often friendship, kind of, comes into that gap. [Participant 07]

More broadly, many participants reflected on the importance of friendships in communities that are disconnected from their family of origin:

I think the people are relying more on friendships now… There are some situations where young people are not accepted by their own families due to the different paths that they are choosing. And so, if one is not accepted by their family then they will need to, you know, form a community somehow. [Participant 08]

When invited to reflect on these shifts, most participants critically examined the traditional focus of systemic therapy on family relationships:

I never thought of friends in there. I always think ‘family.’ We're organised by that word. [Participant 01]

Others indicated that family therapy might inadvertently impose norms:

All of the theories that we're using have their roots in a fairly heteronormative, traditional way of thinking about relationships… It's sort of like decolonising, isn't it? We're using all of these very Western, Eurocentric ideas, and if we don't attend to the way in which they've grown up, then we are going to thoughtlessly be replicating and imposing the taken for granted assumptions… woven into them. [Participant 07]

After critically assessing the possible limitations of systemic therapy's traditional focus, many participants advocated for expanding the scope of ‘family’ therapy to include friendships:

I think emphasising more of the ‘systemic’ in therapy could be more helpful because it doesn't just give the message that it just applies to a family… It opens up things more for thinking systemically about any group of people, so including friendships. [Participant 04]

In summary, participants reflected that friend therapy may not have emerged due to socio-political, legal, and systemic barriers prioritising family over friendships. However, societal shifts driven by economic, cultural, and relational changes appear to highlight friendships' increasing importance. Participants considered how these changes could suggest a growing relevance for friend therapy, notably as it offers a more inclusive approach to addressing the complexities of modern relationships. As Participant 11 compellingly stated, ‘Systemic friendship therapy is a form of activism… because it's questioning the status quo.’

3.3 Navigating Complex Relational Dynamics Through Friend Therapy

Participants identified contexts where friend therapy could be meaningful, especially for individuals disconnected from traditional family support or those navigating the impact of loss on friendship dynamics. Many participants considered ways gender identity, sexual orientation, migration, and care experience could disrupt traditional familial bonds through disconnection or ostracisation and lead to the creation of alternative support structures.

Some suggested that for migrants, the creation of friendship networks provides a sense of belonging and security in an unfamiliar environment:

Migrants, refugees, they don't have their families here… friendships in that case would be much more important to replace safety and security… Then friendship circles become more important. But then of course, there's also more difficulties. [Participant 03]

Similarly, many participants suggested individuals in the LGBTQIA+ community rely on friendships when faced with societal or familial rejection:

Members of the LGBTQ+ community who have not felt accepted within their families, or maybe society, and then they form a, kind of, friendship family. [Participant 01]

Some suggested friends assume a more prominent role in the lives of individuals in the care system who may not have access to their family of origin:

Friends could be like some of their [people with care experience] most significant relationships. For this then to be an offering in the NHS would be an excellent development. To support the relationships that are the most meaningful. [Participant 07]

Several participants noted the elevated importance of friendships to those ostracised or disconnected from their family of origin potentially introduces new relationship challenges and dynamics:

It's a relationship just like any other relationship… if that's who you're spending the majority of your time with, then there will be relational dynamics just like anywhere else. [Participant 08]

Many participants also considered loss, noting the death of a close friend, especially through suicide, could reverberate through social networks and fundamentally alter friendships:

Suicide… it was just horrific what had happened to them… It made perfect sense why they would have chosen that route. But for someone who doesn't believe in suicide or for somebody who's like, ‘If only she'd talked to me’… All these people will be coming to it going, ‘If only’ or ‘What about?’ or ‘I feel really guilty because I could have…’ now they've got to shape the two of them that are left. And it's like, ‘How do we go on?’ ‘I don't know how to do these friendships now that you're not here’. [Participant 02]

The profound impact of such events led some participants to emphasise the need for greater recognition of the repercussions of suicide and loss on friendships within therapeutic services:

After they left university, this young man took his own life. And I think in history taking, we don't ask enough about repercussions in friendship relationships… we'll always ask about family events, things that impact family life, but the impact of a friend taking their own life, or being lost in an accident, or whatever, is very profound. [Participant 17]

Some participants reflected on how friend therapy could be beneficial in these contexts, providing a framework for navigating the complex emotional landscapes that emerge after loss:

You could lose someone, but it might not be thought about to have therapy with a friend in the context of that. And yet, how helpful could that be? [Participant 18]

Overall, the changes in friendships described by participants following loss or disconnection from traditional family structures suggest that current therapeutic offerings may not address the unique challenges faced by individuals in these situations. According to participants, friend therapy could offer a framework for helping individuals renegotiate expectations within their friendships in the wake of significant life events or in contexts where friendships are elevated in importance due to disconnection from family of origin.

3.4 Systemic Therapists' Suitability for Friend Therapy

In this theme, participants reflected on the potential for systemic therapists to engage effectively in friend therapy. They discussed how systemic therapists' relational expertise, adaptability across various contexts, and ability to incorporate multiple perspectives could make them well suited for addressing the complexities of friendships. Participants also considered how traditional systemic tools, such as the genogram, could be adapted to better capture the nuances of friendships.

All participants expressed that the relational proficiency of systemic therapists in managing family or couple dynamics could be applied to friendships as well, as they are also a form of relationship:

Because it's relationship. Doesn't matter. Relationship is relationship. [Participant 15]

Many noted that the challenges encountered in friendships are likely to mirror those in family relationships:

I think quite a lot of the challenges would be the same: difficulties in relationships or communication. [Participant 12]

Several participants noted systemic therapists had adapted their practice to relational contexts beyond the traditional family and suggested they could effectively address relational dynamics within friendships:

I think [friend therapy is] absolutely as applicable, just like we apply systemic to corporate contexts. Right? We look at co-workers and colleagues experiencing relational dynamics. [Participant 08]

Another strength identified was systemic therapists' ability to hold space for multiple perspectives:

If you have both [friends] in the room, I guess I'm trying to help them think about what that other person might think and feel… which seems to me to be something which is absolutely what we do in systemic work. [Participant 06]

Beyond relational proficiency and a capacity to hold multiple perspectives, participants reflected on systemic practitioners' capacity to consider context in reflecting on ways life transitions can strain friendships:

Friendships are often very threatened when a close friend enters a relationship. I've seen this several times, actually, when a close friend decides to set up home with somebody else, and they think, ‘Oh goodness. Now I'm going to lose that friend’. [Participant 09]

Participants noted the emotional toll such transitions take on friendships:

That friendship changes, and there's a tremendous sense of loss and bereavement, and sadness, and anger. [Participant 10]

Some participants discussed the meanings that individuals attach to their friendships in shaping how they experience these transitions. Such observations indicate how personal expectations, and cultural norms can influence the emotional impact of life changes on friendships:

Friendships change just because of that [life change]! You're stressed at work or have a new partner you're focusing on… the meaning that they have will then shape how they will see what their friend is doing to them. Rather than this is a culturally normal, age-appropriate, you know, part of friendship, changing and developing. So, I think [in friend therapy] you might have that about the meaning side of it. [Participant 02]

All participants discussed the applicability of existing systemic tools to make sense of relational dynamics in friendships. For example, several suggested using the traditional genogram to support friends to think about how they do friendships based on their experiences of family:

I think [a genogram] could be really useful to be thinking, as well, how those friends sit in the context of their other friends and family and other people. [Participant 13]

Other participants proposed adapting the genogram in ways that could capture the broader network of important relationships in a person's life, beyond family:

I'm wondering how we can adapt a genogram to be a ‘networkergram’… Maybe I need to move in a direction where I'm less set on ‘this person's relationship, to this person, in this way,’ to ‘these are the people who are important to me’. [Participant 05]

In summary, participants suggested systemic therapists' relational expertise, adaptability to relational context, and ability to hold multiple perspectives could make them well-suited to incorporate friend therapy into their practice. They highlighted the potential of adjusting existing systemic tools, like the genogram, to capture friendships' nuances better. These insights indicate that systemic practitioners believe that systemic skills, approaches and tools could effectively address the complexities of friendship dynamics, providing a potentially valuable framework for navigating the challenges and transitions that friendships can entail.

4 Discussion

This study was motivated by our belief that friend therapy is a timely and valuable addition to systemic practice. While previous literature suggests systemic therapy often overlooks friendships in favour of family due to cultural biases and traditional norms (Flemke 2001; Jenicek and MacIntosh 2023), no studies have directly examined systemic therapists' perspectives on this possibility.

Most participants were unfamiliar with friend therapy, leading to varied reactions, including enthusiasm, curiosity, ambivalence, and tentativeness. All agreed that systemic skills could be applied to friendships, though opinions differed on whether friend therapy should hold the same weight as family or couple work. These perspectives were influenced by cultural narratives and personal experiences, reflecting broader societal norms, alongside service constraints, familiar service design and a focus on evidence-based practice. The prioritisation of family has historical roots; as Faderman (1985) notes, the rise of companionate marriage and the nuclear family in industrialised societies marginalised friendships in favour of romantic and familial ties. Many participants reflexively considered whether their beliefs were influenced by socially (Greenwald and Banaji 1995) and institutionally (McGeorge and Stone Carlson 2011) reproduced norms that marginalise friendships, noting how law, economics, and social systems reinforce the primacy of family. At the same time, they recognised broader societal shifts that elevate friendships, suggesting a systemic focus on these bonds may now be timely and necessary.

Therefore, the study suggests the incorporation of friendships into systemic training courses, encouraging a more comprehensive view of relational networks. Training programmes could reflexively explore friendships' significant role in people's lives while addressing potential conflicts or ruptures in these relationships. Such programmes could support practitioners in critically examining their assumptions about ‘family’ and ‘social networks’ and ensure that friendships are not overlooked in practice. Additionally, systemic training programmes could provide specialised workshops and continuing education for qualified practitioners, equipping them with the tools and skills to effectively engage with this promising but novel approach. Moreover, offering accreditation in friend therapy could further enhance professional qualifications and support the development of this emerging therapeutic approach.

Participants in this study suggested that systemic practitioners may be well equipped, with their relational skills, to offer friend therapy. However, early reflections indicated that current tools and methods may need adjustment or further development to accommodate friendships better. Specifically, modifying the genogram to include friendship networks was mentioned as one potential adaptation. Notably, participants did not address other important aspects, such as consent, confidentiality, and risk management between friends. This suggests that friend therapy may be a relatively new area for systemic practitioners, requiring further training and reflection on the specific challenges and opportunities it presents and the developments required in current practices.

Several participants emphasised the cultural contexts that shape their relationships with friends and family, noting that these contexts would similarly influence those seeking our services. Currently, there is limited understanding of how people perceive the role of friendships in their lives, how they navigate challenges or ruptures in these relationships, and how acceptable friend therapy would be in addressing such issues. Therefore, understanding public attitudes toward friend therapy could deepen our grasp of its potential in systemic interventions.

Finally, participants highlighted the potential constraints inherent in the term ‘Family Therapy,’ suggesting that it may be timely for the field to reconsider its scope. Therefore, we argue that the Association for Family Therapy (AFT) should revisit and update its definition of ‘family’ to reflect evolving social contexts better, explicitly recognising friendships and chosen families. Such an update would acknowledge these relationships' significant role in contemporary life (Jenicek and MacIntosh 2023).

4.1 Limitations

As with all qualitative research, the accounts produced in this study are shaped by the contexts and positions of those who took part. Most participants were White British, female, and mid- to late-career, and this demographic composition may have influenced how friendship and friend therapy became understood within the interviews. We did not collect information on sexual orientation, so it is unclear whether LGBTQIA+ perspectives were included; this is relevant given the significance of queer kinship and chosen family in the wider literature and in some participants' reflections. Practitioners from different cultural backgrounds or with lived experience of migration may also make sense of friendship in distinctive ways, and the absence of this information limits what can be known from the present study. Generational positioning may have been another influence on meaning-making, particularly as younger adults often navigate housing precarity and delayed milestones such as marriage or home ownership—social conditions that can shape how friendships are experienced (Druta et al. 2021; Levine 2012). Finally, because friend therapy was a novel idea for most participants, many contributions took the form of exploratory or speculative sense-making rather than descriptions of established practice.

4.2 Invitations for Future Research

There are several avenues for future research. Researchers could explore public attitudes toward friend therapy, particularly among groups who may rely more heavily on friendships for support, such as LGBTQIA+ individuals, migrants, and those with care experience. Further studies are needed to examine how friend therapy is implemented, its impact on mental health and relationships, and how systemic therapists might integrate it into practice. Research could also investigate how therapists and clients decide which friends to include—such as those marked by emotional closeness, cohabitation, or long-term connection—and how they make sense of these distinctions. Additionally, studies could investigate how therapists approach conversations about potential risks and benefits, including issues of power, safety, and confidentiality. These inquiries could inform ethical and culturally responsive practice, as well as the development of training that equips therapists to work confidently with friendship dynamics.

5 Conclusion

In conclusion, the study suggests that systemic practitioners believe that systemic practice could benefit from recognising and addressing the complex dynamics of friendships and that systemic therapists might be well placed to offer friend therapy. However, to realise the full potential of friend therapy, further research is needed to build an evidence base, develop training programmes, and address the institutional barriers that may limit its adoption. Ultimately, friend therapy in systemic practice could reflect a broader recognition of the diverse and evolving forms of connection and support that friendships provide in contemporary society.

Appendix A: Interview Schedule

1. Revised Interview Schedule (Friend Therapy Version)

   1. The researcher will introduce themselves and explain the purpose of the interview.
   2. The researcher will explain the informed consent process and ensure that the participant understands and signs the informed consent form.

2. Demographics:

   1. Please tell me a bit about yourself (age, occupation, education level, etc.)
   2. How long have you been working as a therapist?
   3. With what type of clients do you typically work?

3. Friend therapy:

   1. Can you describe your understanding of friend therapy?
   2. The researcher will provide a workable definition of friend therapy on which participants will base their responses.
   3. What are the main distinctions you see between friend therapy and family or couples therapy?
   4. How might you determine if someone is a good candidate for friend therapy?
   5. If you have used friend therapy before, can you describe it?
   6. If you have not used friend therapy, can you describe what a typical therapy session might entail?

   7. Can you describe a specific case where friend therapy was or could have been particularly effective?

      1. What about that client led you to think it might be helpful?
      2. What would it have looked like if you had offered that client friend therapy?

4. Friend Therapy Outcomes

   1. How do you evaluate the progress of the child/person during friend therapy?
   2. How might you measure the success of friend therapy?

5. Systemic practices relevant to friend therapy

   1. How might friend therapy be the same or different from systemic couples or family therapy?
   2. How might the skills you use as a systemic therapist apply to work between friends?
   3. What systemic approach, model, or technique comes to mind when you think about using friend therapy?

6. Barriers and challenges of friend therapy

   1. What are some common challenges you might encounter when using friend therapy?
   2. What might get in the way of introducing friend therapy to the therapeutic community?

7. Friend therapy training

   1. In what ways did your systemic course encourage or discourage you from offering friend therapy during your training?
   2. What, if any, training did you receive about friend therapy? If yes, was there enough teaching out there about it? If not, would you like training in friend therapy?
   3. If you chose to undertake some training in friend therapy, what are the key components you would want to be covered?

8. Improving accessibility of friend therapy

   1. What are systemic therapists' recommendations for improving the accessibility of friend therapy?

9. Context of friend therapy

   1. Why do you think friend therapy has not emerged before?
   2. What do you think about the context that makes friend therapy more or less relevant? (e.g., changes in marriage practices, increases in social media use, the rise of individualism)
   3. What particular client groups might benefit from friend therapy? (e.g., migrants, LGBTQIA+ community, care leavers, men)

10. Conclusion

    1. Are there any other comments or insights you would like to share about friend therapy?
    2. Thank the participant for their time and remind them of the follow-up process.

The researcher will refine this guide based on feedback from peers, field experts, and participants' responses.