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The 1980s saw the emergence of a new type of therapy, family constellations, developed by German psychotherapist Bert Hellinger (1925–2019). Born to Catholic parents who were conscientious objectors in the Hitler regime, Hellinger initially trained as a Jesuit priest, but developed and refined his approach over decades, influenced by a range of spiritual, academic and therapeutic influences. He studied philosophy, theology and education at universities in Germany and South Africa, before leaving the priesthood and training in psychoanalysis, transactional analysis, NLP, hypnosis, primal scream and Gestalt therapy, among other modalities.

Family constellations recreates family systems in the therapy setting and then re-orders those systems, with the aim of interrupting the transmission of guilt, pain and suffering to successive generations. Hellinger developed the systemic practice as a refinement of the techniques and philosophy of family therapy pioneers Virginia Satir and Ivan Boszormenyi-Nagy.^1–3 In her therapeutic work, Satir observed that unbalanced individuals were the product of unbalanced families, and frequently began dialogues between generations of family members to bring about reconciliation.⁴ Boszormenyi-Nagy’s theory about accountability across generations, and his assertions that unconscious rules govern families, also influenced Hellinger.⁵

A cornerstone of Hellinger’s work is the idea that families are governed by ordering forces, sometimes known as the orders of love, and that alignment with these forces brings about peace and strength for all system members. In contrast to Satir and Boszormenyi-Nagy’s approaches, family constellations does not require actual system members to be present; instead, representatives are used. Family constellations are usually conducted in a group setting, in which participants stand in for an issue-holder’s family members, but they can also be successfully carried out one to one, using objects as the representatives. It is not group therapy or family therapy, although it can have a positive effect on the group and on the family of the issue-holder, despite the absence of other actual family members.^4–6

In a group setting, representatives can give accurate information about the perceptions and emotions of the people they are standing in for, through surrogate perception: a process I wrote about in the December 2020 issue of Therapy Today.⁷

This is managed through the skill of the facilitator and adds a dimension to the work not present in most other modalities. Surrogate perception can span the entire range of human experience, from extreme grief to numbness, and is not unfamiliar in the world of Shamanism, as discussed by Dan Van Kampenhout.⁸

The following case studies illustrate the basic principles of setting up, working through and bringing a family constellation to a resolution, along with some observations about Hellinger’s ordering forces at play. The first is carried out in a group setting, the second on a one-to-one basis.

Case study one: David

David, 31, a composite client created for this study, attended a workshop to improve his relationship with his mother, which he described as cold and infused with anger and resentment. He also reported that life felt hard: he had little passion for living. We identified David’s goal for the session to be to find some positive feelings toward his mother and, if possible, ‘recalibrate’ that relationship while reinvigorating his zest for life.

With my help, David assembled the historical facts relevant to his presenting issue – an important prerequisite for setting up a constellation. David’s mother’s parents insisted she marry a man they considered suitable, rather than another man from a different social class whom she preferred, and who became the love of her life. She dutifully obeyed and the marriage produced three children, David being the eldest. When David was 10, she had an affair with the other man. The man died of a heart attack when David was 15. David’s mother then entered a depression lasting two years. David felt his mother was often distracted – ‘not there’ – and saw this as the root of relational difficulties between them. He judged her as ‘a woman who made foolish decisions, someone who could have made a better job of bringing up her children’. He also recounted attempts to ‘talk some sense into her’, but felt they fell flat.

Selecting participants from among the workshop group, David set up a constellation featuring his mother’s parents, the ‘lover’, his mother, his two younger siblings, his father and, finally, himself. He placed his parents together and his two siblings to the side. He placed the ‘lover’ opposite his mother, next to himself. His two siblings were behind him. His father looked lovingly at his two youngest children; this was reciprocated. His mother looked admiringly at her ‘lover’ and David looked at his mother with a scowl. His mother’s parents looked admonishingly at her.

I checked with each representative in turn, who confirmed their places/roles as described above. I then placed another representative in the constellation to represent ‘the grandparents’ moral code’ – note that the components of a constellation do not always need to be individuals; rather they can be any influential element, eg an idea or principle, a group, or the religious or socioeconomic context in which the family system in question operates. Immediately, both grandparents moved their attention away from their daughter and toward this ‘moral code’ and reported feeling relaxed. David’s mother reported relief at being freed from her parents’ gaze. I asked David how he was feeling. He replied, ‘I’m not used to seeing or thinking about my mother as part of something bigger.’ He also said he felt agitation toward her.Ìý

I knew I needed to alleviate the obvious tension between David and his mother’s representative, so I offered him the following to say to her – with instructions to test it and see how it felt: ‘Because you obeyed your parents and tolerated a man who was your second choice for decades, my life was possible. Thank you for my life. I will make the most of it so that what you sacrificed won’t be wasted. A joyful and appropriate life won’t take away what you lost, but it will make what you did worthwhile.’

Speaking these sentences profoundly touched David. He began to sob. For the first time in his life, he had been shown something bigger than his need in relation to his mother. He could view the situation with a wider lens.

When I asked the representative for his mother what she felt on hearing her son say this, she reported being ‘dumbstruck’. I then offered her some words to say to her son: ‘This burden is mine to carry, and mine alone. You can leave it all with me.’ The words instantly shifted her feeling to one of appropriate responsibility. David, too, reported feeling lighter.

The focus of the constellation then turned to the ‘lover’, who looked distressed at the exchange between David and his mother. He felt he didn’t have a right to be there. I asked David to say to him, ‘You have a place in this family as my mother’s first choice for a husband: no more and no less.’ Hearing this, everyone in the constellation breathed a sigh of relief, and the ‘lover’ beamed and moved slightly away from the family.

I then reordered the constellation, placing the three siblings in front of their parents, facing them. Behind the parents, I placed the grandparents, and next to them their moral code. Close to David’s mother, I placed the ‘lover’, near enough to have a place, but not so close that he encroached on the biological family’s territory. He reported feeling honoured to be placed so close to the family and that he felt he belonged, acknowledging that the distance felt appropriate. I then turned David’s and his siblings’ backs to their parents (the past), looking into the future – resourced by both the parents and grandparents behind them. David reported feeling supported and excited about the future, with the past behind him. I checked in with each representative. They each reported feeling complete and in a good place, and I ended the constellation.

Place and belonging

At least two of Hellinger’s orders were seen at play here. The first was the order of place. For love and support to flow, every family member needs to be ‘in the right place’. David had become caught up in the fruitless, frustrating and draining position of parenting his parent – the wrong place for a child – until the constellation showed another position he could take in relation to her. At the resolution of the constellation, we witnessed a spatial metaphor for something better: parents stand behind their children, while children look toward the future (resourced by their parents). It can be humbling if a system member has become over inflated and needs to be ‘resized’, but it brings relief to the children, and returns dignity to the parents.

The other Hellinger order we saw was belonging, which holds that everyone in a family system has an equal right to belong, however detrimental their actions or difficult their fate. When the ‘lover’ was given a place, albeit a limited one, it had a positive effect on every representative. It is worth noting, though, that those who have suffered tragic deaths, including children, are often excluded because it is too painful to fully face their deaths.

David’s constellations gave him a new image around which he could organise his future. The initial image was characterised by judgment, exclusion, confusion, resentment and anger. The new image, expressed through the rearranged constellation, included qualities such as acceptance, inclusion, responsibility, humility and love. A constellation can have an immediate effect, or it can be nurtured and supported over time, eventually becoming our dominant internal image. In any case, at the end of the workshop, David reported feeling ‘revived’ and ready for a new chapter in his life.

Case study two: Maria

Maria, 58, a composite client, arranged an individual session to explore why she was dreading an upcoming family gathering in Greece. Whenever she thought about being with her siblings and mother, her breath shortened, her stomach tensed, and her mind filled with negative expectations. I asked Maria to give me some background details. She was born on a small Greek island in 1962, the youngest of four children. Her parents’ living conditions were desperate and poverty stricken. They lived in a rural, subsistence setting, experiencing frequent periods of hunger. Regular church attendance gave them some solace. Due to their financial hardship, Maria was sent as a baby to her maternal grandparents in Athens, who took her to visit her parents’ island home during school and religious holidays. She moved to the UK at 21 and became successful in her field.

As this was a one-to-one session, I asked Maria to write each of her three siblings’ names on pieces of A4 paper. I then asked her to place these sibling representatives in age order, with the oldest at the far left, about a metre in front of her. Standing facing them, Maria reported feeling distant from them, so I asked her to say out loud to each one, starting with the oldest, ‘You are a full member of this family and so am I.’ I then stood in the position of each sibling and repeated the same sentence back to Maria. This simple intervention, the speaking of an incontrovertible truth by both Maria and her siblings, had a positive effect in that Maria felt compelled to join her three siblings opposite her – and, enthusiastically, she did. I then placed another piece of paper on the floor in front of Maria to represent her mother.

Maria said her mother seemed distant and unavailable. To alleviate this, I placed more pieces of paper on the floor surrounding her mother. These represented the following: absolute economic necessity; the Greek Orthodox Church; women in her female line who thrived; her own mother; and 1960s rural Greece. With these elements resourcing her and placing her in context, Maria reported feeling that, for the first time, her mother was able to see her anguish. I then asked Maria to say to her mother, ‘I thought it was my fault and that you didn’t care.’ Maria reported that saying this – something she had felt all her life – no longer felt true, considering the scene in front of her. I then asked her to say to her mother, ‘Precious though my grandmother has been, I missed you terribly.’ After saying this, Maria cried out, which I encouraged and supported. After several minutes, she told me the sentence had brought relief and helped express a feeling she had held all her life. Finally, I asked her to say to her grandmother, ‘Even though you raised my mother and her siblings, you then took me on – and for this I am eternally grateful. Thank you.’

I asked Maria to slowly take in all the various people and elements in the constellation. I then asked her to register any feelings, thoughts or sensations that arose. She reported surprise at feeling calm while standing among the people who normally caused her anxiety. I invited Maria to internalise the image in front of her and the feeling of calm it engendered and use it to resource herself for the future. She left the session feeling ready for a trip back to her family’s village.

Maria’s constellation used the speaking of an irrefutable truth to ‘reunite’ her with her siblings, who had different upbringings and different life outcomes. Further, it offered a narrative about the past that brought peace and strength – largely accomplished by looking at an old story with adult eyes. We saw place and belonging attended to via the dialogue between the siblings and the spatial reorganisation of the constellation at that juncture. While these processes are even more powerful in the witnessed environment of a group, Maria’s case study demonstrates that they can be highly effective in a one-to-one therapeutic setting using simple (inanimate) representatives for family members and other influencing elements of the system in question.