1. Structural Family Therapy

2. 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
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3. 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

4. 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

5. 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

6. 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?

7. 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

8. 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

9. 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”

10. 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

11. 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
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12. Normal Family Development
New couple: Accommodation and boundary making
New baby: A new subsystem
Mom vs. Dad
Growing pains vs. pathology

13. 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…?

14. 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)

15. Therapy: Phase I Opening Phase: Joining and accommodating
Effective therapy requires challenge and confrontation
Enactment
Mapping structural patterns
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16. Joining & Accomodating
Maintenance: validation
Tracking: “let me see if I understand you”
Mimesis: “tuning in”

17. 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”

18. 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?

19. 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

20. 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
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21. 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

22. 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
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23. 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

24. 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

25. 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.

26. 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?”

27. 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.

28. 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

29. Therapy Session Example
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