Structural Family Therapy Quiz

Collection Data and Mapping the family's underlying structure

Therapist tracks the content, the themes that the family is naming and how they are behaving with one another to see where they need to intervene inseission Observe the family structure by seeing how, when and whom the family members relate to through non-verbal and verbal communication; observe transactional communication patterns and see what expectations are there

Three main strategies towards making change: Challenge symptom (2), Challenge family structure (3) and challenge family realities (3)

1) Challenge the symptom and idea that the problems in family are being caused by the IP Techniques to do this: enactment, focusing (on person or relationship dynamic) and increasing intensity (repeating words and phrases) 2) Challenging the family structure by repositioning people based on where they currently are located within their subsystem by changing the context Techniques: Mapping (take children out of parental subsystem), unbalancing (saying that parents liked being talked over and ultimately getting the parents to challenge the therapist so that the parents can form an alliance) and boundary making (saying to someone that they can talk more or less) 3) Challenging the family reality by saying that the current transactional patterns in the family are not working and having them create a new homeostasis Techniques: Cognitive constructs (challenge people's unproductive thought patterns such as that coparenting can exist even if the parents aren't together anymore), paradoxical interventions (prescribing the symptom such as don't have sex for a week) and emphasize the family's strengths and resources

Role of Therapist (5)

1) Changes from leader, observer and expert all the time 2) Provides family members with their insights about the dynamics so family members can adjust the meanings they form about the family 3) Actively making interventions to modify and change family structure, reality and symptoms 4) Be encouraging and remind them that change is gradual 5) Do inseission techniques and take home tasks

Who will be seen in therapy

Everyone who is directly involved with current presenting problems

Process of Change (4)

1) Change is relational 2) Gradual and steady 3) Help the family interact in new ways by challenging them to engage in different action patterns so that they can create new rules that align with their current reality 4) Emphasize patterns of communication rather than the content in the communication

Self of the Therapist

1) Be aware of your role/position and function in the family- whether you are a leader, expert or observer or none; need to know when to maintain distance or not from the family and become comfortable with having the family challenge you 2) Recognize and work unresolved FOO that come up in seission that make you reactive with clients; be aware of general FOO issues that may trigger you; be aware of dysfunctional familial patterns within own family and how they can transform them 3) Be aware of cultural factors that may impact how the conversation is occurring between the family and clients; recognize areas of privilege and marginalization; also recognize how families have been fractured by societal challenges

What does the therapist do when they are intervening and How (5) and Feedback

1) Facilitate change in the transnational patterns among family member and 2) Controls for variables in the transactions so that the effects of the interventions can be assessed How: 1) Challenging family rules that center around how the family relates to one another (naming that the mom is the child's alarm clock if they refuse to get up), 2) Boundary reorganization, 3) Prompt conflict resolution and have vulnerable conversation around it (bring up lack of trust between family members), 4) Hierarchical functioning (talk about how parental subsystem lacks control over children), 5) Increase flexibility: Make certain boundaries more permeable if they are rigid Feedback: See how the family reacts and restart the cycle of tracking, hypothesizing and intervening

Techniques for the therapy room: Joining and Accomodating, Enactment, structural mapping, highlighting and modifying interactions, boundary making, unbalancing and challenging unproductive assumptions

1) Talking about commonalities and using their language while maintaining distance to become part of family (joining; Do this by greeting, asking about problem and validating each person's statements); create trust with the family members so they can challenge them in the future (accomodating) 2) Direct members to engage in dialogues and remain silent. Do this as to challenge or change transaction patterns between the family members; offer alternative behavioral patterns EX: Saying that someone is too strict and to answer her response 3) Observing and tracking the behavior patterns of subsystems so that the therapist can guide the family in changing the transactional paterns of family members; can make this by drawing it out on paper 4) Change the direction of conversations and addressing when the family does something correct; keep them uncertain though 5) Reinforcing clear boundaries and challenging unhealthy rigid or diffused boundaries. Do this by moving people around the therapy room and preventing individuals from blocking a confrontation between two people. In an enmeshed subsystem can do this by having people speak for themselves without interuption and acknowledging kids mature behaviors. Disengaged requires people to not avoid conflict and talk about problems fairly. 6) Unbalancing: Support one family member and interfere with the familial homeostasis for others by creating stress; Can do this by removing the child from the conversations and forcing the parents to talk to one another; family will create new homeostasis and subsystem dynamic to try to address discomfort 7) Challenging unproductive assumptions: Questioning the family's solutions and opinions about the problem and framing the problem as being relational; reframing the daughter's misbehavior is stemming from being labelled as "nervous" and being interacted with to encourage that kind of behavior; use humor and metaphorical language to do so; stroke and kick

Goals of structural therapy (3)

1) Therapist determines immediate goals for the intervention 2) Reduce the symptoms of dysfunction 3) Bring structural changes because the family has a faulty structure due to rigid or diffused boundaries and inappropriote tasks and functions of the subsystems

Three Phases of Change

1) Therapist joins the family and assumes a leadership position; therapist needs to respect hierarchy by asking parents what is going on first 2) Therapist discovers family underlying structure and after doing this they are allowed to intervene 3) Therapist transforms the family structure

Structural Techniques: Joining, imparting a systemic view, restructuring, making rules and relationships overt, intensity, circular questioning, unbalancing, Triangulation, Enactment, Boundary making, reframing/relabeling, paradoxical techniques (restraining and prescribing the symptom)

1) Using the same language and finding commonalities with family 2) Seeing problems relationally rather than having an IP 3) Helping the family to challenge and change structure, reality and symptoms; do this through hierarchal restructing and boundary making 4) Naming rules and relationship dynamics 5) Intensity: Making a request and using a particular voice that challenges family members to extend a relational transaction or repeating the same phrase over again 6) Circular questioning: Reveal patterns of causality between the relational behaviors between actors 7) Unbalancing: Supporting one family member and interfering with the family's homeostasis 8) Triangulation: Observing when one family member is pulled in to diffuse conflict in a subsystem 9) Enactment: Have two people act out a conversation that is usually had at home, do this to get them to recognize and change transactional patterns and expectation; get family to see alternative ways of behaving 10) Boundary Making: establishing or deestablishing physical and emotional rules between family members 11) Reframe the problem so that it focuses on relatonal rather than individual dynamics 12) Tell the family to try not to change so that they feel pressure to eventually change

Key Concepts of Structural Family Therapy (3)

1. Focus on familial interactions to understand the structure/organization and hierarchies of the family 2. Symptoms/presenting problem is viewed as a byproduct of structural failings 3. Structural changes must occur before the individual's symptoms can be decreased

Function of Therapist (3)

1. Help families move from a dysfunctional stage to a functional stage by processing the familial dynamics 2. Actively engage with the family by joining (talk about commanlities that are shared with family) and accomodating (use their language while maintaining distance) 3. Challenge rigid transaction processes

Formulating hypotheses

Based on the data collected the therapist forms hypotheses based on the significance of the transactional sequence, nature of the problem, its locus and sustaining structure Conducts experiments through probes and challenges that assess the flexibility of family patterns

Structural mapping: Boundaries, alliances, detouring/triangulating, Coalition and relationships of the parts

Emotional and physical contact rules that maintain the structure of the system (lines drawn above or below actors based on hierarchy and depending on boundaries) Alliance: The quality of actions between two family members (clear, enmeshed, weak or conflicted) Detouring: Two members decrease their conflict by placing it onto a third person Coalition: Two family members team join together to team up against a third; can happen between generations as a way to establish control or balance another coalition See how the family structure is mapped and how each person interacts with another

Family Subsystems

Groups that are formed within the family system 1) Spousal subsystem 2) Parental subsystem 3) Extended family subsystem 4) Sibling subsystem Important that the parental and sibling subsystem is separate from one another; extended familial subsystem can participate with parental subsystem only if they do not overpower it Bad if one system takes over another Each subsystem has a structure Remind people that their roles vary depending on which subsystem they are in and allowing them to understand their roles in it to facilitate change

Family Structure

Invisible rules (FUNCTIONAL DEMANDS) that organize how each individual understands their role and relationship to others Formed by the accomodation of the couple's FOO values that guide their behaviors as a couple and/or parents with subsystems Look at communication and connection through transactional patterns to identify areas of intervention and change EX: Be attentive for the person who will tell everyone else in the family about what is going on

Boundaries

Physical and emotional contact rules that separate family members in order to protect the system structure 3 types of boundaries: 1) Rigid: Restrictive rules that permit minimal physical and emotional contact with other subsystems that lead members to develop a sense of independence. 2) Diffused boundaries: Flexible rules that permit great physical and emotional contact between subsystems. These boundaries lead family members to be affectionate with each other however they struggle to form a sense of independence. 3) Clear: Generational and hierarchical rules that allow family members to maintain their designated rules and transactional patterns Dysfunction can be created through extreme boundaries: (a) disengagement: facilitated by rigid boundaries and they have little contact or commitment to one another and (b) enmeshment: facilitated by diffused boundaries, individuals are very involved, dependent on one another and forced to conform Goal: Create clear and healthy boundaries that allow for individual and familial well being; modelled by cohesion in couple and spousal subsystem that have power over sibling subsystem

What additional information would be helpful

Seeing who else is very involved with the family and what types of adverse societal problems is the family undergoing Observe the contextual problems that are currently occurring that the family structure is not willing to accomodate to create a new homeostasis

Understanding the presenting problem

The first thing a therapist needs to do is join the family and they can do this by being empathetic, respectful and show they are committed to helping the family heal; join in a leadership positon and make alliances with every family member; make sure family trusts you as a therapist Need to remember that families come in with a limited view about their problems and they are wrong in their assumptions about the situation Therapist holds the power and determines the course of therapy; they are the expert an explore problems and intervene; they will frame the therapy to address problematic relational transactions rather than focus on symptoms from the IP Need to make sure that the client remains open to viewing the problem in different ways and remains uncertain about the exact problem that is occurring