Structural Family Therapy (Salvador Minuchin)

How a structural therapist produces change

By joining the family, probing for areas of flexibility, and then activating dormant structural alternatives.

Boundaries in a healthy family are...

Clear enough to protect independence and permeable enough to allow mutual support.

Enmeshment

Closeness at the expense of independence. Too much closeness cripples initiative. In enmeshed families, boundaries are diffuse and family members become dependent on one another.

A "Normal" Family

Does not have an absence of problems, but rather has a functional structure for dealing with problems.

The 3 Overlapping Stages in Structural Family Therapy

The therapist (1) joints the family in a position of leadership, (2) maps the family's underlying structure, and (3) intervenes to transform this structure.

Subsystems

Units of the family based on function. (Ex. If the leadership of a family is taken over by a father and daughter, then they, not the husband and wife, are the executive subsystem). Subsystems are circumscribed and regulated by interpersonal boundaries.

Cross-generational Coalition

ex. The enmeshed mother responds to the child's needs with excessive concern. The disengaged father may not respond at all. Both are critical of each other's way, but they perpetuate each other's behavior with their own.

Enactments

family members are encouraged to deal directly with each other in sessions, permitting the therapist to observe and modify their interactions. Note: Structural therapists work with what they see, not with what family members describe.

Steps of Structural Family Therapy

1. Joining and accomodating (In family therapy, the members come in defensive and expecting to be told that they are doing something wrong. Thus, the therapist must first disarm defenses and ease anxiety, which is done by building an alliance of understanding with each member of the family). 2. Enactment (Family structure is seen in the way family members interact. Their descriptions cannot always be trusted, and families tend to describe themselves more as they think they should be than as they are. Thus, the therapist wants them to enact something. Ex. "She says you're too strict, can you answer her?" Picking a specific issue is more effective than vague requests, such as "Why don't you talk this over?") Enactment require three operations: the therapist notices a problematic sequence, the therapist initiates an enactment, and the therapist guides the family to modify the enactment. 3. Structural mapping (Families quickly induct therapists into their culture. Ex. the family that initially appeared to be chaotic and enmeshed soon comes to be jus the familiar Jones family. For this reason, It is critical to develop provisional hypotheses relatively early in the process). 4. Highlighting and modifying interactions (focus on process, not content. Ex. The problem is not that he doesn't talk or she nags too much, but rather the problem is that the more she nags, the more he withdraws, and the more he withdraws, the more she nags). 5. Boundary making (Where the therapist aims to realign relationships between subsystems. Ex. Parental boundaries from children) 6. Unbalancing (The goal is to change relationships within a subsystem. What often keeps families stuck in stalemate is that members in conflict are balanced in opposition and, as a result, remain frozen in inaction. In unbalancing, the therapist joins and supports one individual or subsystem (basically taking sides). The therapist does this to purposefully unbalance and realign the system. The therapist eventually sides with other members of the family). 7. Challenging unproductive assumptions

Structural Therapy's 3 Essential Components

1. Structure (refers to the way a family is organized into subsystems whose interactions are regulated by boundaries. The PROCESS of family interactions is like the patterns of conversations at the dinner table. The STRUCTURE of the family is where family members sit in relation to one another. 2. Subsystems (demarcated by interpersonal boundaries) 3. Boundaries (invisible barriers that regulate contact with others).

Shaping competence

A method of modifying interactions. It is like altering the direction of flow. By reinforcing positives, structural therapists help family members use functional alternatives that are already in their repertoire.

Disengagement

A result of rigid boundaries that are restrictive and permit little contact with outside subsystems. They are independent but isolated. On the positive side, this fosters autonomy. On the negative, disengagement limits affection and support.

Hierarchical Structure

Adults and children have different amounts of authority.

Empathy

An alternative strategy to "intensity" used to help family members get beneath the surface of their defensive wrangling.

Important tenant of Structural Therapy

Every family has a structure, and this structure is revealed only when the family is in action. According to this view, therapists who fail to consider the entire family's structure and intervene in only one subsystem are unlikely to effect lasting change.

Intensity

Forceful intervening using a selective regulation of affect, repetition, and duration. Used to block the stream of interactions. Tone, volume, pacing, and choice of words can be used to raise affective intensity. Ex. "It's your fault."

"Joining" a family

Gets the therapist into the family. To join, a therapist conveys acceptance of family members and respect for their ways of doing things. (Ex. If parents come for help with a child's problems, the therapist doesn't begin by asking for the child's opinion. This would convey lack of respect for the parents). Therapists must first join a family before it will be fruitful to attempt restructuring.

Restructuring a family

Is done after a therapist has "joined." It is the often dramatic confrontations that challenge families and encourage them to change.