The pharmacologically treatment in approaching gambling seems to have limited effect; better results are obtained using psychotherapy alone or in association with medication. Different psychotherapeutically approaches have been described as efficient. Aims Analysis of published data concerning factors which influence the prognostic in this type of treatment and comparison with practical experience. Material and methods Long term follow up (2 years) prospective study of efficacy of family therapy in 11 cases of patients with gambling for Identification of factors for positive and negative prognostic on long term follow-up. The presentation will underline the specificity of systemic approach. Results The long duration of history of gambling, association with use of alcohol and drugs, cluster B personality traits, low motivation for treatment, co-morbidity with psychotic disorders, disorganised family seems to be associate with poor prognosis and being young, short duration of gambling, recent crises in family life seems to be associate with better prognosis. Limitation: low number of patients retained in study. Conclusions Family therapy with systemic view could offer a new efficient perspective on therapeutically approach of gambling.