The role of the family or carer in old age psychiatry is well acknowledged. However, carer interventions are often focused on addressing carer burden alone and are usually individually rather than family based. Interpersonal conflict and family dynamics are rarely addressed. This is not surprising as there is a paucity of literature in family and systems theory applied to the older person, and clinicians are often skeptical about the efficacy of this treatment mode or daunted by the complexity of family and systems theory. Three cases are presented to illustrate the potential benefits of family-based interventions in the setting of commonly encountered clinical situations: (i) the treatment of chronically depressed older people in the community; (ii) the management of behavioral and psychological symptoms of dementia (BPSD) in residential care; and (iii) home-based support and care of the older patient with dementia.