1. Salvador Minuchins structural model is the mostinfluential
approach to family therapy throughout theworld
2. Learning Outcomes 1. Describe the principal concepts of
Structural FamilyTherapy (SFT) 2. Conceptualization of problems in
SFT 3. Therapeutic goals in SFT 4. Therapist role in SFT 5. SFT
interventions 6. Evaluation of SFT
3. Leading Figures Minuchin was born and raised in Argentina.
Pediatric physician . He served as a physician in the Israeli army,
Psychoanalytic practice New York State Wiltwyck School for Boys
Work with delinquent boys: poor structure and norules/regulation or
routine. Suitable for families with single parenthood, illness,
acting-outmembers, drug addiction, crime, and violence Self taught,
collaborated with a variety of thinkers,including Jay Haley
(Strategic Family Therapy) in the early60s Became head of the Phil.
Child Guidance Clinic in 1965 Started his own center in NY in 1981
Retired in 1996
4. Theoretical Formulations Structural family therapy offers a
plan for analyzing the processof family interactions. Three
constructs are the essential components of structuralfamily theory:
structure, subsystems,and boundaries Family structure is the
invisible set of functional demands thatorganize the ways in which
family members interact (Minuchin,1974, p. 51). Family structure is
reinforced by the expectations that establish rules in the family.
For example, A rule such as family members should always protect
oneanother If a boy gets into a fight with another boy in
theneighborhood, his mother will go to the neighbors to
complain
5. Structure an organized pattern in which families interact,
not deterministic orprescriptive, only descriptive Can only be seen
when a family is in action, because verbal descriptionsrarely
convey the true structure. Subsystems are subgroupings within the
family based on age (orgeneration), gender and interest (or
function) parenting spousal sibling Boundaries are invisible
barriers that regulate contact betweenmembers Diffuse, too weak, or
enmeshed Rigid, too fortified, or disengaged
6. Normal Family Development What distinguishes a normal family
isnt the absence ofproblems, but a functional structure for dealing
with them. Allcouples must learn to Adjust to each other, rear
their children, if they choose to haveany, deal with their parents,
cope with their jobs, and fit intotheir communities(Minuchin,
1974). Families begin when two people join together to form a
spouse subsystem. Two people in love agree to share theirlives and
futures and expectations; but a period of often difficultadjustment
is required before they can complete the transition from courtship
to a functional spouse subsystem.
7. 1. Underlying assumptions of SFTFamilies are capable of
solving their own problemsTherapists work collaboratively with
families, not as expertswho can solve problems, but as
consultantsTherapists respect the familys unique culture. The
questionshould be, not Whats ideal? but Does it work for them?SFT
is the beginning of the postmodern approaches, butretains some
traditional views concerning the importance ofpower and
hierarchyRigidity of transactional patterns and boundaries
preventsthe exploration of alternatives.
8. An important aspect of structural family problems is
thatsymptoms in one member reflect not only that
personsrelationships with others, but also the fact that
thoserelationships are a function of still other relationships
inthe family. If Johnny, aged sixteen, is depressed, its helpful to
knowthat hes enmeshed with his mother. Discovering that shedemands
absolute obedience from him and refuses to lethim develop his own
thinking or outside relationshipshelps to explain his
depression
9. Why is the mother enmeshed with her son?Perhaps shes
disengaged from her husband.Perhaps shes a widow who hasnt found
newfriends, a job, or other interests. Helping Johnnyresolve his
depression may best be accomplishedby helping his mother satisfy
her need for closenesswith her husband or friends.
10. Boundaries are reciprocal That means that a weak boundary
(enmeshment) inone relationship usually means that the same person
isdisengaged from someone else.Rigid boundaries areoverly
restrictive and permit little contact withoutside subsystems,
resulting in disengagement.Disengaged individuals or subsystems are
independentbut isolated. On the positive side, thisfosters
autonomy
11. Enmeshed subsystems offer a heightened sense ofmutual
support, but at the expense of independenceand autonomy. Enmeshed
parents are loving andconsiderate; they spend a lot of time with
their kidsand do a lot for them. children enmeshed with their
parents becomedependent. Theyre less comfortable bythemselves and
may have trouble relating topeople outside the family
12. Underlying Assumptions A family system is therefore
stabilized by eachmembers contribution. Subsystems are organized
hierarchically : power isdistributed appropriately within
individuals andbetween subsystems, making reliance on somemembers
more expected than on others. All family systems desire
homeostasis: each individualmember desires to stabilize the system
and contributestheir part to balance the system so that they
cancontinue to be satisfied by the system (Minuchin,1974)
13. Every family member plays many roles in severalsubgroups.
Mary may be a wife, a mother, a daughter.In each of these roles she
will be required to behavedifferently and exercise a variety of
interpersonaloptions. If shes mature and flexible, she will be able
to vary herbehavior to fit different subgroups. Enactments -
interactions are suggested by thetherapist as a way to understand
and diagnose thestructure, and to provide an opening for
restructuringintervention
14. Concepts:Power and Hierarchy the person with the most power
makes all of the finaldecisions and takes responsibility for the
outcome ofthe family dynamics. Appropriate persons to have power in
families are theparents. For example, when a father tells his child
not to playvideo games, the child obeys because the father
hasconsistently shown the child that he expectscompliance in his
child. This interaction defines therelationship between them as
well as creates theappropriate hierarchy.
15. Concepts:Power and Hierarchy In dysfunctional families
children may be given moreattention than the couple gives each
other, and thechild is therefore given control. This leaves the
child insecure as they are not matureenough to have such power and
cause parents tocontinue their conflict over the child rather than
dealwith their own issues. The child acts out as a result. The
therapist strives to place parents in their properhierarchical role
above the children, helping thechildren feel safe and secure and
creating a naturalboundary between parents and children.
16. A Couples Challenge: Forming a Healthy SpousalSubsystem
Must develop complementary patterns of mutualsupport, or
accommodation Must develop a boundary that separates couple
fromchildren, parents and outsiders. Must claim authority in a
hierarchical structure
17. Core concepts: Alignments, Coalitions andtriangulations
Alignment indicates that two or more share reciprocalbenefits, and
team up. It usually refers to a positivebond between family
members. Eg two parentsworking together, providing a secure life
for theirchildren. misalignments especially cross-generational
canundermine families Coalitions refer to an alliance of some
family membersagainst other family members. This can be positive
ornegative. Can result in scapegoating.
18. Core concepts:triangulations Triangulation occurs when one
member of a two-membersystem who are against one another attemptsto
distract from the conflict by bringing in a thirdperson to focus
on. For example : two parents who are fighting; onemember may
attempt to win the child over to his orher side. puts the child in
a no-win position: child allies withone parent, experiences
betrayal of the other parent,and the original conflict is never
resolved.
19. Family systems must be stable enough to ensure continuity,
butflexible enough to accommodate to changing
circumstances.Problems arise when inflexible family structures
cannot adjustadequately to maturational or situational
challengesFamily dysfunction results from a combination of stress
andfailure to realign themselves to cope with it (Colapinto,
1991).Stressors may be environmental (a parent is laid off, the
familymoves) or developmental (a child reaches adolescence,
parentsretire) The familys failure to handle adversity may be due
to flawsin their structure or merely to their inability to adjust
to changedcircumstances.
20. How Problems Develop Inflexible response to maturational
(ordevelopmental) and environmental challenges leads toconflict
avoidance through disengagement orenmeshment Disengagement and
enmeshment tend to becompensatory (Im close here to make up for
mydistance elsewhere.) This leads to what is called the
cross-generationalcoalition, which is a triangular structure
21. The Nature ofProblems 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
22. How change occurs SFT believe that when the structure of
the familychanges, the positions of members in the groupchange, and
vice versa. There must be a proper hierarchy in place, with
thecaretakers or parents in charge, in a healthy coalition. In
terms of healthy and unhealthy functioning,symptoms in an
individual are rooted in the context offamily transaction patterns,
and family restructuringmust occur before an individuals symptoms
arerelieved (Minuchin, 1974).
23. How change occurs Structural changes must first occur
within the familybecause how a family functions has a direct effect
onhow an individual functions within, only then willindividual
symptoms be limited, reduced, or resolved. As family members
experience changes as the familyfunctions differently, then
symptomatic distress willdecrease. Therefore, the therapist focuses
on changingthe experience of family members.
24. Therapeutic Goals Therapy is directed at altering the
family structure andCreation of an effective hierarchy Structural
problems are usually viewed simply asfailure to adjust to changes.
Therapist doesnt solve problems, thats the familysjob. Boundaries
must be strengthened in enmeshedrelationships, and weakened (or
opened up) indisengaged ones.
25. The goal of SFT is to facilitate the growth of the systemto
resolve symptoms and encourage growth inindividuals. Short-range
goals may be to alleviate acute problems,especially
life-threatening symptoms such as anorexianervosa (Minuchin,
Rosman, & Baker, 1978). At times,behavioral techniques,
suggestion, or manipulationmay be used to achieve an immediate
effect
26. The goals for each family are dictated by the problemsthey
present and by the nature of their structuraldysfunction. Although
every family is unique Another common goal is to help parents
functiontogether as a cohesive executive subsystem. Whenthere is
only one parent, or when there are severalchildren, one or more of
the oldest children may beencouraged to become a parental
assistant
27. Therapeutic Goals Not a matter of creating new structures,
but reformingexisting ones What distinguishes SFT from other forms
of family therapyis the emphasis on modifying family structure in
theimmediate context of the therapy setting. When new patterns are
repeated and result inimprovement of family relationships, they
will stabilize andreplace old patterns and symptoms of dysfunction
will bereduced or disappear.
28. Therapists Role Structural therapeutic efforts are based on
theprinciple that action leads to new experiences andinsight
(Vetere, 2001). The therapist tries to help the family create
permeableboundaries and subsystems. Therapists task is to break the
certainty of the familyof what the problem is or who the problem
is. Thisconfusion helps family members to rethink their rolesand
try out new ones.
29. Therapist role in SFT The therapist intervenes with the
family activelyduring sessions by assuming a leadership
position.Maps the familys underlying structure(boundaries,
hierarchy, subsystems) Intervenes to transform the structure with
directrequests to the family to change how the membersinteract with
each other
30. 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
31. Therapeutic Interventions Joining in a position of
leadership, andaccommodating Family is set up to resist you. You
are a stranger, andknow nothing about their struggles, and
theirgoodness. Important to join with angry and powerful
familymembers Important to build an alliance with every
familymember Important to respect hierarchy
32. Structural therapists work with what they see going on in
the session, not what family membersdescribe There are two types of
live, in-session materialon which structural family therapy
focusesenactments and spontaneous behavior sequences. An enactment
occurs when the therapist stimulatesthe family to demonstrate how
they handle a particulartype of problem.Enactments commonly begin
when the therapist suggeststhat specific subgroups begin to discuss
a particularproblem
33. Working with enactments requires three operations. First,
the therapist defines or recognizes a sequence.For example, the
therapist observes that when mothertalks to her daughter they talk
as peers, and littlebrother gets left out Second, the therapist
directs an enactment. Forexample, the therapist might say to the
mother, Talkthis over with your kids. Third, and most important,
the therapist must guidethe family to modify the enactment.
34. Assessment Diagnosis implies knowledge: You describe
something andgive it a name Assessment deals with assumptions. A
structuralassessment is based on the assumption that a
familysdifficulties often reflect problems in the way thefamily is
organized ,if change occurs between mother anddaughter, things will
also change between husband and wife.
35. Structural therapists make assessments firstby joining with
the family to build an alliance,and then by setting the family
system in motionthrough the use of enactments, in-session
dialoguesthat permit the therapist to observe howfamily members
actually interactmaking an assessmentis best done by focusing on
the presentingproblem and then exploring the familys responseto
it.
36. In Families and Family Therapy, Minuchin (1974) listedthree
overlapping phases in the process of structuralfamily therapy. The
therapist (1) joins the family in a position of leadership; (2)
maps their underlying structure; and (3) intervenes to transform
this structure
37. The strategy of structural family therapy followsthese
seven steps: 1. Joining and accommodating 2. Working with
interaction 3. Structural mapping 4. Highlighting and modifying
interactions 5. Boundary making 6. Unbalancing 7. Challenging
unproductive assumptions
38. Therapeutic Interventions Working with Interaction by
inquiring into the familys viewof the problem, and tracking the
sequences of behaviors thatthey use to explain it. Mapping
underlying structure in ways that capture theinterrelationship of
members -- A structural map is essential!) Family structure is
manifest only with members interact By asking everyone for a
description aof the problem, thetherapist increases the chances for
observing andrestructuring family dynamics. Tracking communication
contents and use them in thesession.
39. Therapeutic InterventionsHighlighting and modifying
interactionsEnactments -- directed by therapist in which thefamily
performs a conflict scenario, which happensat home during the
therapeutic session. Sharf(2004) enactment offers the therapist
anopportunity to observe the family rather than simplylistening to
the family story.
40. Therapeutic InterventionsRestructuring Use of reframing to
illuminate family structure Use of circular perspectives, e.g.
helping each otherchange Boundary setting Unbalancing (briefly
taking sides) Challenging unproductive assumptions Use of intensity
to bring about change (not givingup) Shaping competency Not doing
the familys work for them refusing toanswer questions, or to step
in and take charge whenits important for the family members to do
so.
41. Therapeutic Interventions Homework Should be to increase
contact between disengagedparties, To reinforce boundaries between
individuals andsubsystems that have been enmeshed Should be
something that is not too ambitious While Minuchin rarely used
strategic interventions, hedid caution family members to expect
setbacks, inorder to prepare them for a realistic future.
42. Evaluation Key model in the development of family therapy
as awhole Core Concepts and interventions have beenincorporated
into most family therapy: eg Joining andenactment Empirically
evaluated, validated and refined byresearch particularly with
conduct disorders, anorexia,substance abuse, and psychosomatic
illness inchildren.