Structural Family Therapy

By Isabel Brasil and Melissa Ruiz

Background of Structural Family Therapy

Some prominent theorists in structural family therapy, include Braulio Montalvo, Bernice Rosman, Harry Aponte, and Charles Fishman. The best known is the founder of the theory, Salvador Minuchin.

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Salvador Minuchin’s Background Born in 1921 to Russian Jewish emigrants in

Argentina In 1948 he joined the Israeli army as a doctor In 1950, Minuchin came to United States with the

intention of studying with Bruno Bettleheim in Chicago

    1. Met Nathan Ackerman in New York andchose to stay there

    2. In 1954 Minuchin began studying psychoanalysis and a few years later took the  position of medical director of the Wiltwyck School, a residential facility in New York for inner-city delinquents

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Minuchin Became a Systems Therapist Along with Dick Auerswald and Charles King in 1959,

began developing a 3 stage approach to working with low-socioeconomic-level black families

1. Treatment created out of necessity due to long-term, passive approaches to these families proving

unsuccessful 2. Minuchin discovered that dramatic and active

interventions were necessary to be  effective 3. Minuchin discovered two common patterns in

dysfunctional families: enmeshed, chaotic and tightly interconnected, or disengaged, isolated and seemingly unrelated

Minuchin gained widespread attention for his work at Wiltwyck

The method used was published in Families of the Slums in1967

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Minuchin Became Director of Philadelphia Child Guidance Clinic (1967)

He transformed the clinic into a family therapy center Gained a reputation as a tough and demanding

administrator Developed many innovative ideas at the Clinic Example: Institute for Family Counseling, a training

program for community paraprofessionals that was effective in providing mental health services to

the poor Minuchin published Families and Family Therapy in1974 Most clearly written and popular books in field of family

therapy In 1975 Minuchin stepped down as director of clinic, but

remained head of training until 1981

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Minuchin since 1981 Has studied normal families, written several

plays and books and commented on the overall field of family therapy

He set up the Family Studies Institute in New York City

Continues to do workshops and trains therapists from all over the world

Passionately committed to social justice and is involved in foster care system in New

York

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Key Concepts of Structural Family Therapy

Focus is on family interactions to understand the structure/organization of the family

Symptoms/presenting problem viewed as by-product of structural failings

Structural changes must occur in a family before an individual’s symptoms can be reduced

Structural Family Therapist’s Function

The therapeutic task is to help move family from a dysfunctional stage to a new stage (evolved different structures have more stable levels of functioning)

Actively engage family unit to initiate structural change by joining and accommodating

Challenge rigid transactional patterns

Family Structure

invisible set of functional demands or rules that organize way family members relate to one another

Family Subsystems

Spousal: wife & husband Parental: mother & father Sibling: children Extended: grandparents, other relatives Family member play a different role in each

of the subsystems they belong Structural difficulty when one subsystem

takes over or intrude another

Boundaries Emotional/physical barriers that define amount

and kind of contact allowable between members Extremes of boundaries may lead to dysfunction Disengagement-rigid-little

commitment/closeness to family Enmeshment-diffuse-very involved as one-

fosters dependency on parents/other members Clear healthy boundaries-attain sense of

personal identity yet allow sense of belongingness within family system

Understanding the ProblemThe therapist determines the issues around

which to explore and intervene in the session.

Joining the family in a position of leadership entering their reality and becoming part of that

family’s patterns of relating/structure

Collecting Data

The therapist tracks content and learns about the family issue and draws together all data relevant to the issue as gathered from prior information and the in-session experience leading up to the moment when the therapist is to intervene.

Mapping family’s underlying structure observe family to see structure, focusing on the how,

when, and to whom family members relate who says what to whom in what way with what result

Formulating Hypotheses

On the basis of the data, the therapist commits to hypotheses about the significance of the current transactional sequence of the nature of the problem, its locus, and sustaining structure.

Conducts experiments through probes and challenges to assess the flexibility of family patterns

Structural Goals

To the extent permitted by the hypotheses, the therapist determines immediate goals for the intervention that is to follow

Reduce symptoms of dysfunction

Bring about structural change because it is assumed that faulty family structures have:

Boundaries that are rigid or diffuse Subsystems that have inappropriate tasks and

functions

Intervening Intervening in ways designed to transform an ineffective

structure

The therapist: (a) to facilitates change in patterns of transactional sequences among family members and/or between self and family members(b) to controls for variables in the transaction so that the effects of the intervention can be assessed

Challenging family rules, fostering boundary reorganization, prompting conflict resolution, creating an effective hierarchical structure, increasing degree of flexibility in family interactions, modifying dysfunctional family structures, and supporting greater individuation of family members.

Feedback On the basis of the reactions of the family members to the

intervention, the therapist restarts the cycle from the second step.

Structural Techniques

Joining Imparting a Systemic

View Restructuring Making Rules/Relationships/

Structure Known Intensity Circular questioning Unbalancing

Triangulation/Detriangulation

Enactment Boundary-making Reframing/Relabeling Paradoxical Techniques

Restraining Prescribing the symptom

Therapist Awareness

Your Role/Position/Function in the Family

Your Family of Origin Issues

GeneralUnresolved

Cultural Factors (yours and theirs)

Possible Therapist Interventions in the Problem of Mrs. N.’s Daughter

STRUCTURAL INTERVENTION: “Mrs. N., would you tell

your husband to remind Becky that you are fine, that this is an old story of yours, and you don’t need any help with it. That you know exactly what to do. Ask your husband to do that for you.”

Mother Father

― ― ― ― ― ― ― ―

Daughter

PROBLEM:

How to stop the daughter from interrupting and

clinging to her mother.

ALTERNATIVE INTERVENTION:

“It would be good to stop her from that because, see, she is identifying with you, acting inadequate right now, just like you feel yourself. So, she wants to be like you, to cling to inadequacy.”

Mother Ξ Daughter | Father

Possible Therapist Responses to the Scapegoating Problem in the Fletcher Family

STRUCTURAL THERAPIST:

“Only Irving has said nothing so far. Who can get his side of the story?”

PROBLEM:

A system stuck with the completion of a

scapegoating sequence.

OTHER THERAPIST:

“Irving, you must be really upset by all this.”

OR

“Irving, I am really interested in your side of this.”

Possible Therapist Interventions in Fletcher Family ACCOMMODATION

“Mrs. Fletcher, I wonder if you could get Irving’s side of the story?”

ALLIANCE RESTRUCTURING“Mr. Fletcher, perhaps you and Irving could

discuss his side of the story.” HIERARCHY RESTRUCTURING

“Mr. Fletcher, perhaps you could get your wife to find out more about her son’s view of this matter.”

Role Play

Strategies for Approaching the California Marriage and Family Therapy Licensing

Exam

Q – You have been seeing a couple in therapy for four months. One of the goals of your treatment plan was to improve dysfunctional interaction patterns and your treatment included restraining and repositioning strategies. This is representative of:

a. Humanistic-existential theoryb. Structural theoryc. Strategic theory

d. Psychodynamic theory

Q – Common sense solutions to problems rarely work. What theoretical orientation supports this belief:

a. Experimental family therapy

b. Structural family therapy

c. Strategic family therapy

d. Extended family therapy

Q – Client: “I think my wife says mean things to me to make me feel guilty.” Therapist: “How do you feel when your wife says mean things to you?” Client: “I feel that she is mean.” Therapist: “You say you think your wife is mean when she says these things to you. Now, how do you feel when this happens?” Client: “I feel bad about myself.” What is this therapist attempting to do:

a. Help the client in the process of differentiationb. Get the client to “unwrap” his projections

c. Learn this family’s rules about arguingd. Analyze the function of the couple’s behavior

Q – For Minuchin, scapegoating and overprotection of a child by the child’s mother and father are both forms of:

a. Triangulation

b. Detouring

c. A stable coalition

d. Marital skew

Q – A 45-year-old client was sexually abused as a child by her father. She says she’s not angry with him and, in fact, has kept a close relationship with him over the years. She sees him often and says she intends to continue doing so. This is an example of:

a. Blurred boundariesb. Enmeshment

c. Disengagementd. Pseudohostility

Q – From a systems perspective, which of the following is MOST true about treating a family with an alcoholic member:

a. The first step in restructuring the family involves getting the alcoholic’s relatives to

admit they are codependent b. The aim of therapy is to restructure the family’s

homeostatic mechanismsc. Therapy should focus on identifying and

correcting faulty communication patternsd. The family should be trained in ways of

reinforcing non-drinking behaviors and extinguishing drinking behaviors

Q- When working with an intellectually-oriented family, the therapist “joins” the family by adopting a cognitive, intellectual style. This technique is referred to as:

a. Tracking

b. Modeling

c. Mimesis

d. Enactment

Q- A father and mother bring their 13-year-old son into therapy. At the beginning of treatment, the father states that the boy has been behaving disrespectful toward parents and teachers, and that all he cares about is his “damn skateboard.” The mother confirms non-verbally what her husband is saying by nodding and frowning. The son is sitting silently, with his eyes down, and refusing to talk. Which of the following techniques would a structural family therapist employ:

a. Sending the parents out to talk to the boy aloneb. Asking each family member to share their feelings

about what is going onc. Pointing out to the family that the father seems to be

doing all the talkingd. Engaging the family in conversation by using family

members’ mannerisms and communication styles

Q – In an enmeshed family in which an overcontrolling father constantly nags and yells at his 18- and 15-year-old sons, a structural therapist is MOST likely to do which of the following:

a. Manipulate the family’s mood by nagging even more and yelling even louder

b. Help the father understand that his nagging and yelling elicit oppositional behaviors from the boys

c. Construct a genogram of the father’s family

d. Create a therapeutic double-bind by telling the father to set aside an hour a day during which he will nag and yell at his sons

Q- When working with a family, Minuchin creates rapport by:

a. Joining and accommodating

b. Accommodating and restructuring

c. Restructuring and detriangling

d. Forming coalitions with subsystems

Q- For Salvador Minuchin, “psychosomatic families” – e.g., those in which asthma, diabetes, or anorexia threaten the life of one child – are MOST likely to be characterized by which of the following:

a. Frequent intense open conflicts between family members

b. Weak boundaries between family members and limited opportunities for individual autonomy

c. Family roles that are inflexible and stereotypedd. Marked emotional distance between the

husband and the wife, who are both emotionally immature

Q- You are currently treating a large family that presented with communication and discipline problems. You assess the family as having an enmeshed style and a weak executive subsystem. Your overall goal is to define clearer boundaries within the system. Given this context, it is likely that you would agree with all of the following EXCEPT:

a. Both the family’s present and its past will be examined in therapy

b. The focus of the treatment should be on changing the family’s maladaptive transactional patterns

c. Dysfunctional patterns in the family can be altered through the use of directive techniques

d. The focus should be each family member and on how family members feel about and interact with each other

Q- A family therapist instructs a family member to continue performing the target behavior and to do so in an exaggerated way. This technique id referred to a:

a. Reframing

b. Prescribing

c. Positioning

d. Cryptic message

Q- You are working with a family from a structural perspective. The family keeps telling you that one of the sons is the problem. The boy is sitting quietly, not defending himself. You go over to him and sit quietly, while the family’s conversation continues. This is an example of:

a. Unbalancingb. Enactment

c. Mimesisd. Manipulation

Q- From the perspective of structural family therapy, triangulation, parent-child coalition and detouring are:

a. Methods for establishing clearer boundaries

b. Methods for maintaining homeostasis

c. Types of positive feedback

d. Attempts to increase intimacy

Q- “Change, through therapy, is accompanied by stress, and the therapeutic system must be capable of dealing with it.” This statement was made by:

a. Glasser

b. Bower

c. Adler

d. Minuchin

Q- What does a structuralist do in the initial phase of therapy:

a. Join and accommodate

b. Highlight and join

c. Accommodate and restructure

d. Evaluate and restructure

Q- Mr. and Mrs. Smith, in their mid-thirties, have a three-year-old adopted daughter. The adoption occurred when the girl was an infant. They report that, since the adoption, they have quarreled frequently and no longer feel intimate. Mr. Smith is particularly disturbed because he feels that his wife directing all of her energies and attention to the child. The couple also mentions that their daughter may have developmental problems – their pediatrician is concerned about delays in her language development. Mrs. Smith is defensive and minimizes the girl’s problems. Both parents acknowledge feeling frustrated and unable to control their daughter’s behavior at times.

a. All of the following would be appropriate to do with this family EXCEPT:

b. Family-of-origin work to identify messages Mr. and Mrs. Smith got about parenthood and adoption

c. Role-playing to help the parents say good-bye to the perfect daughter they thought they had and hello to the one they actually have

d. Behavioral assignments to increase intimacy between Mr. and Mrs. Smith

e. Structural techniques to strengthen the mother-daughter dyad

References

Minuchin, Salvador. (1971). Families and family therapy. Harvard University Printing Press.

Minuchin, Salvador. (1984). Family therapy techniques. Harvard University Printing Press.

http://www.mariemontschools.org/parr/therapy_backgr.htm Sysemtic Interventions (Power Point) http://www.psyc.csustan.edu/kbaker/5790/.com Family Systems Therapy (Power Point) by James J. Messina,

Ph.D. www.coping.org/write/C6444/Family%20Therapy.ppt Gurman, A. S. & Kniskern, D. P. (1981). Handbook of Family

Therapy. New York: Brunner/Mazel Publishers. Umbarger, C.C. (1983). Structural Family Therapy. New York:

Grune & Stratton, Inc.