Structural Family Therapy

Structural Family Therapy Regarded as one of the most influential and widely used therapies used in the field Founded by Salvador Minuchin Born and raised in Argentina Psychoanalytically trained child psychiatrist Worked with inner city families Developed an approach to work with chaotic family structures Directed the Philadelphia Child Guidance Clinic during 1960s Started his own center in NY in 1981 Retired in 1996 Copyright © 2010 Pearson Education, Inc. All rights reserved.

Assumptions There is an overall organization or structure that maintains a family’s dysfunctional interactions. Structural Family Therapy is comprised of various components and themes including: Family Structure Family Subsystems Family Boundaries

Concepts: Structure An organized pattern in which families interact Not deterministic or prescriptive, only descriptive Partly universal, partly idiosyncratic Universal ex.? Idiosyncratic ex.? Can only be seen when a family is in action, because verbal descriptions rarely convey the true structure

Concepts: Structure Once patterns are established, family members use a small range of behaviors available to them Once patterns are set, this leads to predictability and limitations Structures typically have some form of hierarchical structure and also tend to have reciprocal and complementary functions parental involvement with children: over vs. under involved

Concepts: Structure Family transactions are repeated  foster expectations  limit the range of behaviors The first time the baby cries…. “who is going to..?”  “she’ll probably…”  “she always…” Rules “A good mom always takes care of her baby” Any problems with this?

Concepts: Subsystems Subsystems are based on: age (or generation) gender interest (or function) Power and hierarchy Subsystems are often formed based on the patterns of interaction in a family Covert coalitions are often more significant than obvious groupings

Concepts: Boundaries Boundaries are invisible barriers that regulate contact between subsystems and serve to protect the separateness and autonomy of the family Rigid boundaries -Disengagement promotes independence but limits warmth and affection Diffuse boundaries – Enmeshment promotes dependence and limits contact with others outside the family system

Concepts: Boundaries Diffuse  too open . . . . . Rigid too closed ________ Normal boundaries: - - - - - - Rigid boundaries disengagement Diffuse boundaries  enmeshment Boundaries are defined by rules “no phone calls after 10pm” “not allowed to interrupt parents”

Boundaries Boundaries are reciprocal A weak boundary (enmeshment) in one relationship usually means that the same person is disengaged from someone else. Ex: A wife who is enmeshed with child and disengaged from husband Ex: A father who is very close and enmeshed with older son who hunts with him, and disengaged with daughter who is quietly depressed

Normal Family Development Healthy families are not defined by the absence of problems, but rather by a functional family structure Healthy families can modify their structure to accommodate changing circumstances Unhealthy families increase rigidity of structures that are no longer functional Copyright © 2010 Pearson Education, Inc. All rights reserved.

Normal Family Development New couple: Accommodation and boundary making New baby: A new subsystem Mom vs. Dad Growing pains vs. pathology

Why do problems occur? Inflexible response to developmental and environmental challenges Weak hierarchies Conflict avoidance Poor boundaries Disengagement and enmeshment tend to be compensatory “I’m close here to make up for my distance elsewhere” Cross-generational coalitions: similar to…?

Goals of Therapy The ultimate goal of therapy is structural changes to the family (roles, rules, hierarchy, behavior patterns) Alter the family structure so that the family can solve its own problems General goal: create or strengthen executive subsystem Enmeshed families: create more appropriate boundaries (strengthen boundaries) between individuals and subsystems Disengaged families: increase interaction by making boundaries more permeable (weaken boundaries)

Therapy: Phase I Opening Phase: Joining and accommodating Effective therapy requires challenge and confrontation Enactment Mapping structural patterns Copyright © 2010 Pearson Education, Inc. All rights reserved.

Joining & Accomodating Maintenance: validation Tracking: “let me see if I understand you” Mimesis: “tuning in”

Joining & Accomodation Family is set up to resist you. You are a stranger, and know nothing about their struggles Obtaining acceptance from the family in order to disarm defenses and create an environment for change Important to build an alliance with every family member Especially with the angry and powerful family members Important to respect hierarchy I see you don’t want to talk right now, it’s ok, maybe you will have something to say later”

While joining: Focus on understanding the family structure Enactment: Ask the family to manifest their interactions “She says you are too strict, can you show me how?” Therapist pays attention to the dynamics of the family: Who interrupts who? Who is speaking for who? Etc. What are the signs of enmeshment vs. disengagement?

While joining: Focus on understanding the family structure Structural Mapping Working with interaction Observing enmeshment and disengagement Ways that capture the interrelationship of members Family structure manifests itself only when members interact

Therapy: Phase II Focus on the underlying family structure Highlight and modify interactions Intensity (interrupt rigid and difficult patterns) Help people do things themselves Therapists can invite family members to participate and interact in ways that will help them function more effectively Copyright © 2010 Pearson Education, Inc. All rights reserved.

Therapeutic Interventions Highlighting and Modifying Interactions Your wife says you don’t communicate with her. Can you please respond to that? Increase INTENSITY How come you are ok with this? How come little Johnny is this tall? Whose shoulders is he standing on? Shaping competence Alter the direction of the flow by highlighting and reinforcing other behaviors in their repertoire. She nags He withdraws

Therapy: Phase III Transformation of Family Structure Boundary Making Loosen boundaries in disengaged families Strengthen boundaries in enmeshed families Unbalancing change the relationship of family members within a subsystem by joining a subsystem or individual at the expense of another – taking sides Reframing adding cognitive constructions Copyright © 2010 Pearson Education, Inc. All rights reserved.

Therapeutic Interventions Boundary making: In enmeshed families: Family members are encouraged to speak for themselves The Kleenex Box Some of the sessions can be held with individuals or subgroups In disengaged families: Increase positive interactions between subsystems that are disengaged

Boundaries: Individual Individual boundaries include: each family member is allowed to talk for themselves each family member needs to be listened to by other members each family member need to ask a question or answer a question directed to them each family member needs to respect the rights of each family member each family member needs to be treated equally relative to their age and level of responsibility

Boundaries: Subsystems Most common: the boundary between the parental subsystem and the children subsystem Where there is triangulation between a child and one of the parents that weakens the parental subsystem, the therapist needs strengthen the boundaries here to re- establish a better functioning parental bond that does not stray into involving one of the children.

Disengaged families “We have a communication problem, he won’t tell me what he is feeling. All he cares about is his damn job” Our sex life is lousy, my wife is a frigid, who can talk to her? All she can do is complain about the kids?”

Therapeutic Interventions Homework Increase contact between disengaged parties Should be something that is not too ambitious While Minuchin rarely used strategic interventions, he cautioned family members to expect setbacks, in order to prepare them for a realistic future.

Role of the therapist Families are competent and capable of solving their own problems Therapist doesn’t solve problems; that’s the family’s job Therapists are collaborators and not experts Therapists respect the family’s unique culture. The question should be, not “What’s ideal?” but “Does it work for them?” Encourage positive interactions

Therapy Session Example http://www.youtube.com/watch?v=mPW0UZd 9gQ4