Family difficulties
Family psychotherapy at the Psychological Help Centre, Karachi — in clinic in DHA and PECHS, or online wherever you are.
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What people describe
People rarely describe one argument. They describe a weather system — something that has been sitting over the house for years, that everybody can feel and nobody names, and that surfaces at dinner over something trivial.
A great deal of it is about space and about roles. Two or three generations under one roof, and nobody entirely sure whose decision anything is. A daughter-in-law who is asked for opinions and then not asked again. A son who is thirty-four and still being told what time to come home. Parents who moved aside for their children and now feel like guests in a house they built.
Some of it arrives with change. A death, and the shape of the family quietly rearranging afterwards. A marriage, and the family recalculating around it. A migration, with half the family on a screen and a time difference. A property or a will, and an old resentment that had been managed for twenty years no longer being managed.
What people find hardest to describe is the ordinary version: nobody is a villain, nobody has done anything unforgivable, and the house is still not a place anyone relaxes in. That is a completely normal reason to speak to someone.
Recognising your family in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess anyone, and there is nothing here for you to score your family against.
When it is worth speaking to someone
Families argue. Argument is not the problem, and a family that never disagrees is usually managing something rather than avoiding it.
What a clinician pays attention to is duration, pattern and cost. Difficulty that has been running for months or years rather than since one incident. The same disagreement in a new form every few weeks, arriving at the same place each time. And a cost that has become visible: someone who has stopped coming home for dinner, a person nobody talks to directly any more, or a household where one person's mood sets everybody else's day.
It is also worth speaking to someone before a decision that cannot be walked back — a separation, a move, a family business split — rather than afterwards.
Only a qualified clinician can tell you what is going on — a website cannot. What a page like this can tell you is that families do come, that coming is not a declaration that the family has failed, and that you do not need everybody's agreement to start.
How PHC approaches it
PHC is an assessment-first practice, and with a family the first question is a practical one: who is the work actually with?
- An initial sessionWe ask what has been going on, for how long, who is involved and what it is costing. This can be one person, a couple or a wider group — whoever can come. Nothing is administered before this conversation.
- Emotional assessment and symptom screeningWhere an individual is carrying more than the situation explains, a structured screening of emotional functioning and presenting symptoms is used, with internationally validated instruments. Its purpose is to decide which further tests, if any, are clinically warranted — you will not be given tests you do not need.
- A psychologist matched to what the assessment foundPsychologists at PHC are not assigned on availability. Assignment is based on speciality, presenting needs and clinical fit — which, for family work, includes whether everyone in the room can speak freely in front of that clinician.
- Therapy, reviewed as it goesWhere the family is the unit of work rather than the individual, PHC uses family psychotherapy, and the sessions are structured rather than a conversation everybody has already had at home. Where the difficulty is really between two spouses, marriage counselling is the better route and we will say so. Sessions are 50 minutes, in clinic at our DHA clinic or in PECHS, or online.
Who you would see
Psychologists at PHC hold a minimum postgraduate qualification in clinical psychology and over 800 supervised clinical hours. The two psychologists below name this area in their own words — Shakir Adam names relationship and family concerns, and Aisha Ahmad names interpersonal relationship difficulties.
Aisha AhmadClinical Psychologist · Workshop Facilitator · 5+ years
Master's in Clinical Psychology. Interpersonal relationship difficulties, attachment issues, self-esteem and self-worth, emotional dysregulation, anxiety, depression, trauma. Client-centred, attachment-informed, psychodynamic-informed and mindfulness-based approaches.Read her profile →Who you see is decided at the initial session, not before it — ask us beforehand and we will tell you.
Questions people ask first
My family will not come. Is there any point coming alone?
Yes, and it is how a good proportion of family work starts. One person can look at their own part in a pattern, at what is and is not theirs to carry, and at how to be in the house differently. Nobody is required to attend for you to be seen.
Will you take sides?
No. A clinician's job is not to decide who is right, and a family session that becomes a hearing has stopped being useful. What is being worked on is the pattern between people rather than the verdict on any one of them.
Is this the same as marriage counselling?
They overlap and they are not the same. Marriage counselling works with two spouses; family therapy takes in a wider group — parents and adult children, siblings, in-laws, a household. If you are unsure which you need, say what is going on when you contact us.
Can elderly parents be seen?
Yes. PHC asks when you book whether the person attending is a minor or elderly, precisely so the match and the session are set up appropriately. Tell us who will be in the room.
Confidentiality, session length, fees and choosing your psychologist are answered in full in questions people ask before booking.
Speaking to someone starts here
PHC is appointment-only. Message or call and a real person answers — Monday to Saturday, 10am to 8pm PKT.
Not sure whether this is us? Contact us anyway. We will tell you directly whether we can help, and refer you elsewhere if we cannot.
Six details, and we can match you
- Name of the person who will attend
- Their age
- What is going on, in your own words
- Whether you would prefer a male or female psychologist
- Online, or in clinic in Karachi
- Whether the person attending is a minor or elderly
If someone else is paying, we will also ask for guardian or payer details. A slot is held once the booking payment is received — half the fee, at least 24 hours ahead.