Lecture 3: Structural Family Therapy

Systemic Comparative Kevin Standish

Newham College University Centre

http://minuchincenter.org/structural_family_therapy

Salvador Minuchin on Family Therapy Interview

• http://www.youtube.com/watch?v=2evU02UocpQ

• 3 minutesIn all cultures, the family imprints its members with selfhood. Human experience of identity has two elements; a sense of belonging and a sense of being separate. The laboratory in which these ingredients are mixed and dispensed is the family, the matrix of identity.—Salvador Minuchin

Learning Outcomes

1. Describe the core concepts of Structural Family Therapy (SFT)2. Conceptualisation of problems in SFT3. Therapeutic goals in SFT4. Therapist role in SFT5. SFT interventions6. Evaluation of SFT

Origins and Social Context

• Salvador Minuchin• Pediatric physician from Argentina• Psychoanalytic practice• New York State Wiltwyck School for Boys • Work with delinquent boys: poor structure and no

rules/regulation or routine.• Post WWII• Theory applied to non-traditional inner city families• Suitable for families with single parenthood, illness,

acting-out members, drug addiction, crime, and violence

1. UNDERLYING ASSUMPTIONS OF SFT

Underlying Assumptions

• Families (people) are competent and capable of solving their own problems -- an attitude derived from the existential-humanistic tradition• Rigidity of transactional patterns and

boundaries prevents the exploration of alternatives. • Symptoms are a by-product of a structural

system that is failing• The system fails to nurture growth or deal

with crisis of its members.

Underlying Assumptions

• A family system is therefore stabilized by each member’s contribution.

• Subsystems are organized hierarchically : power is distributed appropriately within individuals and between subsystems, making reliance on some members more expected than on others.

• All family systems desire homeostasis: each individual member desires to stabilize the system and contributes their part to balance the system so that they can continue to be satisfied by the system (Minuchin, 1974)

Underlying Assumptions

• Therapists work collaboratively with families, not as experts who can solve problems, but as consultants and coaches who work to bring the family’s dormant capacities to the surface.• Therapists respect the family’s unique

culture. The question should be, not “What’s ideal?” but “Does it work for them?”

2. CORE CONCEPTS OF STRUCTURAL FAMILY THERAPY (SFT)

Core Concepts of Structural Family Therapy (SFT)

• “Family structure is the invisible set of functional demands that organize the ways in which family members interact” (Minuchin, 1974, p. 51).

Core Concepts of SFT• There is an overall organization or structure that maintains a

family’s dysfunctional interactions.– Power and hierarchy– Subsystems and boundaries• Boundaries can be clear or normal, weak or diffuse

(too open), or rigid (too closed)• Restructuring is based on observing and manipulating

interactions within the session– Spontaneous behavior sequences -- form the basis for

hypotheses about family structure– Enactments - interactions are suggested by the therapist

as a way to understand and diagnose the structure, and to provide an opening for restructuring intervention.

Concepts, continued• Structure

– an organized pattern in which families interact, not deterministic or prescriptive, only descriptive

– Can only be seen when a family is in action, because verbal descriptions rarely convey the true structure.

• Subsystems are subgroupings within the family based on age (or generation), gender and interest (or function)– parenting– spousal– sibling

• Boundaries are invisible barriers that regulate contact between members

• Diffuse, too weak, or “enmeshed”• Rigid, too fortified, or “disengaged”

Examples of subsystems

Concepts, continued

• Boundaries are reciprocal– That means that a weak boundary

(enmeshment) in one relationship usually means that the same person is disengaged from someone else.– Example is wife who is enmeshed with child and

disengaged from husband– Example is father who is very close and

enmeshed with older son who hunts with him, and disengaged with daughter who is quietly depressed and doesn’t speak up.

Concepts:Power and Hierarchy

• the person with the most power makes all of the final decisions and takes responsibility for the outcome of the family dynamics.

• Appropriate persons to have power in families are the parents.

• For example, when a father tells his child not to play video games, the child obeys because the father has consistently shown the child that he expects compliance in his child. This interaction defines the relationship between them as well as creates the appropriate hierarchy.

Concepts:Power and Hierarchy

• In dysfunctional families children may be given more attention than the couple gives each other, and the child is therefore given control.

• This leaves the child insecure as they are not mature enough to have such power and cause parents to continue their conflict over the child rather than deal with their own issues. The child acts out as a result.

• The therapist strives to place parents in their proper hierarchical role above the children, helping the children feel safe and secure and creating a natural boundary between parents and children.

A Couple’s Challenge: Forming a Healthy Spousal Subsystem

• Must develop complementary patterns of mutual support, or accommodation (compromise)

• Must develop a boundary that separates couple from children, parents and outsiders.

• Must claim authority in a hierarchical structure

Core concepts: Alignments, Coalitions and triangulations

• Alignment indicates that two or more share reciprocal benefits, and team up. It usually refers to a positive bond between family members. Eg two parents working together, providing a secure life for their children.

• misalignments especially cross-generational can undermine families eg grand parent and acting out child.

• Coalitions refer to an alliance of some family members against other family members. This can be positive or negative. Can result in scapegoating.

Core concepts: triangulations

• Triangulation occurs when one member of a two-member system who are against one another attempts to distract from the conflict by bringing in a third person to focus on.

• For example : two parents who are fighting; one member may attempt to win the child over to his or her “side.”

• puts the child in a no-win position: child allies with one parent, experiences betrayal of the other parent, and the original conflict is never resolved.

3. CONCEPTUALISATION OF PROBLEMS IN SFT

How Problems Develop

• Inflexible response to maturational (or developmental) and environmental challenges leads to conflict avoidance through disengagement or enmeshment• Disengagement and enmeshment tend to be

compensatory (I’m close here to make up for my distance elsewhere.)• This leads to what is called the cross-generational

coalition, which is a triangular structure

The Nature of Problems And Change

• Power Imbalances• Subsystem Boundaries too rigid or too diffuse• Disengaged Members• Enmeshed Members• Pervasive Conflict• Failure of the System to Realign• Member Resistance• Action Precedes Understanding

How change occurs

• SFT believe that when the structure of the family changes, the positions of members in the group change, and vice versa.

• There must be a proper hierarchy in place, with the caretakers or parents in charge, in a healthy coalition.

• In terms of healthy and unhealthy functioning, symptoms in an individual are rooted in the context of family transaction patterns, and family restructuring must occur before an individual’s symptoms are relieved (Minuchin, 1974).

How change occurs

• Structural changes must first occur within the family because how a family functions has a direct effect on how an individual functions within, only then will individual symptoms be limited, reduced, or resolved.

• As family member’s experience changes as the family functions differently, then symptomatic distress will decrease. Therefore, the therapist focuses on changing the experience of family members.

4. THERAPEUTIC GOALS IN SFT

Therapeutic Goals• Therapy is directed at altering the family

structure and Creation of an effective hierarchy• Structural problems are usually viewed

simply as failure to adjust to changes.• Therapist doesn’t solve problems, that’s

the family’s job. • Boundaries must be strengthened in

enmeshed relationships, and weakened (or opened up) in disengaged ones.

Therapeutic Goals• Not a matter of creating new structures, but

reforming existing ones• What distinguishes SFT from other forms of

family therapy is the emphasis on modifying family structure in the immediate context of the therapy setting.• When new patterns are repeated and result

in improvement of family relationships, they will stabilize and replace old patterns and symptoms of dysfunction will be reduced or disappear.

5. THERAPIST ROLE IN SFT“STRUCTURAL FAMILY THERAPY IS A THERAPY OF ACTION” (MINUCHIN, 1974, P. 14).

Therapist’s Role• Structural therapeutic efforts are based on

the principle that action leads to new experiences and insight (Vetere, 2001). • The therapist tries to help the family

create permeable boundaries and subsystems. • Therapist’s task is to break the certainty of

the family of what the problem is or who the “problem” is. This confusion helps family members to rethink their roles and try out new ones.

Therapist role in SFT

• The therapist intervenes with the family actively during sessions by assuming a leadership position.• Maps the family’s underlying structure

(boundaries, hierarchy, subsystems)• Intervenes to transform the structure with

direct requests to the family to change how the members interact with each other

6. SFT INTERVENTIONS

Phases of treatment

• Phase 1: Joining• Phase 2: Understanding the presenting

issue• Phase 3: Assessment of Family

Dynamics• Phase 4: Goals• Phase 5: Amplifying Change• Phase 6: Termination

Therapeutic Interventions• Joining in a position of leadership, and

accommodating– Family is set up to resist you. You are a

stranger, and know nothing about their struggles, and their goodness.

– Important to join with angry and powerful family members

– Important to build an alliance with every family member

– Important to respect hierarchy

Therapeutic Interventions• Working with Interaction by inquiring into the

family’s view of the problem, and tracking the sequences of behaviors that they use to explain it.

• Mapping underlying structure in ways that capture the interrelationship of members -- A structural map is essential!)– Family structure is manifest only with members

interact– By asking everyone for a description of the

problem, the therapist increases the chances for observing and restructuring family dynamics.

– Tracking communication contents and use them in the session.

Therapeutic InterventionsHighlighting and modifying interactionsEnactments -- directed by therapist in which the family performs a conflict scenario, which happens at home during the therapeutic session. Sharf (2004) enactment offers the therapist an opportunity to observe the family rather than simply listening to the family story.

Therapeutic InterventionsRestructuring• Use of reframing to illuminate family structure• Use of circular perspectives, e.g. helping each other

change• Boundary setting• Unbalancing (briefly taking sides)• Challenging unproductive assumptions• Use of intensity to bring about change (not giving up)• Shaping competency• Not doing the family’s work for them refusing to

answer questions, or to step in and take charge when it’s important for the family members to do so.

Therapeutic Interventions• Homework– Should be to increase contact between

disengaged parties, – To reinforce boundaries between individuals

and subsystems that have been enmeshed– Should be something that is not too

ambitious– While Minuchin rarely used strategic

interventions, he did caution family members to expect setbacks, in order to prepare them for a realistic future.

7. EVALUATION

Criticisms Of The Theory

• De-emphasizes emotional lives• Biases on appropriate family structure that is

“western” nuclear family model• Cross Cultural considerations are needed

Evaluation

• Key model in the development of family therapy as a whole

• Core Concepts and interventions have been incorporated into most family therapy: eg Joining and enactment

• Empirically evaluated, validated and refined by research particularly with conduct disorders, anorexia, substance abuse, and psychosomatic illness in children.

Conclusion

• Architecture of a given family considered• Help families with multiple problems• Used for over 40 years and continued today

as society is rapidly changing

8. Readings

• Metcalf, L. ( 2011) Marriage and Family Therapy : A Practice-oriented Approach. Chap 10 Structural Family therapy. On EBSCO.

• Winek, J. (2010) Systemic Family therapy: From Theory to Practice. London. Sage. (Chapter 8 Structural Family Therapy). On order for Flex