1. 1. Salvador Minuchins structural model is the mostinfluential approach to family therapy throughout theworld
2. 2. Learning Outcomes 1. Describe the principal concepts of Structural FamilyTherapy (SFT) 2. Conceptualization of problems in SFT 3. Therapeutic goals in SFT 4. Therapist role in SFT 5. SFT interventions 6. Evaluation of SFT
3. 3. Leading Figures Minuchin was born and raised in Argentina. Pediatric physician . He served as a physician in the Israeli army, Psychoanalytic practice New York State Wiltwyck School for Boys Work with delinquent boys: poor structure and norules/regulation or routine. Suitable for families with single parenthood, illness, acting-outmembers, drug addiction, crime, and violence Self taught, collaborated with a variety of thinkers,including Jay Haley (Strategic Family Therapy) in the early60s Became head of the Phil. Child Guidance Clinic in 1965 Started his own center in NY in 1981 Retired in 1996
4. 4. Theoretical Formulations Structural family therapy offers a plan for analyzing the processof family interactions. Three constructs are the essential components of structuralfamily theory: structure, subsystems,and boundaries Family structure is the invisible set of functional demands thatorganize the ways in which family members interact (Minuchin,1974, p. 51). Family structure is reinforced by the expectations that establish rules in the family. For example, A rule such as family members should always protect oneanother If a boy gets into a fight with another boy in theneighborhood, his mother will go to the neighbors to complain
5. 5. Structure an organized pattern in which families interact, not deterministic orprescriptive, only descriptive Can only be seen when a family is in action, because verbal descriptionsrarely convey the true structure. Subsystems are subgroupings within the family based on age (orgeneration), gender and interest (or function) parenting spousal sibling Boundaries are invisible barriers that regulate contact betweenmembers Diffuse, too weak, or enmeshed Rigid, too fortified, or disengaged
6. 6. Normal Family Development What distinguishes a normal family isnt the absence ofproblems, but a functional structure for dealing with them. Allcouples must learn to Adjust to each other, rear their children, if they choose to haveany, deal with their parents, cope with their jobs, and fit intotheir communities(Minuchin, 1974). Families begin when two people join together to form a spouse subsystem. Two people in love agree to share theirlives and futures and expectations; but a period of often difficultadjustment is required before they can complete the transition from courtship to a functional spouse subsystem.
7. 7. 1. Underlying assumptions of SFTFamilies are capable of solving their own problemsTherapists work collaboratively with families, not as expertswho can solve problems, but as consultantsTherapists respect the familys unique culture. The questionshould be, not Whats ideal? but Does it work for them?SFT is the beginning of the postmodern approaches, butretains some traditional views concerning the importance ofpower and hierarchyRigidity of transactional patterns and boundaries preventsthe exploration of alternatives.
8. 8. An important aspect of structural family problems is thatsymptoms in one member reflect not only that personsrelationships with others, but also the fact that thoserelationships are a function of still other relationships inthe family. If Johnny, aged sixteen, is depressed, its helpful to knowthat hes enmeshed with his mother. Discovering that shedemands absolute obedience from him and refuses to lethim develop his own thinking or outside relationshipshelps to explain his depression
9. 9. Why is the mother enmeshed with her son?Perhaps shes disengaged from her husband.Perhaps shes a widow who hasnt found newfriends, a job, or other interests. Helping Johnnyresolve his depression may best be accomplishedby helping his mother satisfy her need for closenesswith her husband or friends.
10. 10. Boundaries are reciprocal That means that a weak boundary (enmeshment) inone relationship usually means that the same person isdisengaged from someone else.Rigid boundaries areoverly restrictive and permit little contact withoutside subsystems, resulting in disengagement.Disengaged individuals or subsystems are independentbut isolated. On the positive side, thisfosters autonomy
11. 11. Enmeshed subsystems offer a heightened sense ofmutual support, but at the expense of independenceand autonomy. Enmeshed parents are loving andconsiderate; they spend a lot of time with their kidsand do a lot for them. children enmeshed with their parents becomedependent. Theyre less comfortable bythemselves and may have trouble relating topeople outside the family
12. 12. Underlying Assumptions A family system is therefore stabilized by eachmembers contribution. Subsystems are organized hierarchically : power isdistributed appropriately within individuals andbetween subsystems, making reliance on somemembers more expected than on others. All family systems desire homeostasis: each individualmember desires to stabilize the system and contributestheir part to balance the system so that they cancontinue to be satisfied by the system (Minuchin,1974)
13. 13. Every family member plays many roles in severalsubgroups. Mary may be a wife, a mother, a daughter.In each of these roles she will be required to behavedifferently and exercise a variety of interpersonaloptions. If shes mature and flexible, she will be able to vary herbehavior to fit different subgroups. Enactments - interactions are suggested by thetherapist as a way to understand and diagnose thestructure, and to provide an opening for restructuringintervention
14. 14. Concepts:Power and Hierarchy the person with the most power makes all of the finaldecisions and takes responsibility for the outcome ofthe family dynamics. Appropriate persons to have power in families are theparents. For example, when a father tells his child not to playvideo games, the child obeys because the father hasconsistently shown the child that he expectscompliance in his child. This interaction defines therelationship between them as well as creates theappropriate hierarchy.
15. 15. Concepts:Power and Hierarchy In dysfunctional families children may be given moreattention than the couple gives each other, and thechild is therefore given control. This leaves the child insecure as they are not matureenough to have such power and cause parents tocontinue their conflict over the child rather than dealwith their own issues. The child acts out as a result. The therapist strives to place parents in their properhierarchical role above the children, helping thechildren feel safe and secure and creating a naturalboundary between parents and children.
16. 16. A Couples Challenge: Forming a Healthy SpousalSubsystem Must develop complementary patterns of mutualsupport, or accommodation Must develop a boundary that separates couple fromchildren, parents and outsiders. Must claim authority in a hierarchical structure
17. 17. Core concepts: Alignments, Coalitions andtriangulations Alignment indicates that two or more share reciprocalbenefits, and team up. It usually refers to a positivebond between family members. Eg two parentsworking together, providing a secure life for theirchildren. misalignments especially cross-generational canundermine families Coalitions refer to an alliance of some family membersagainst other family members. This can be positive ornegative. Can result in scapegoating.
18. 18. Core concepts:triangulations Triangulation occurs when one member of a two-membersystem who are against one another attemptsto distract from the conflict by bringing in a thirdperson to focus on. For example : two parents who are fighting; onemember may attempt to win the child over to his orher side. puts the child in a no-win position: child allies withone parent, experiences betrayal of the other parent,and the original conflict is never resolved.
19. 19. Family systems must be stable enough to ensure continuity, butflexible enough to accommodate to changing circumstances.Problems arise when inflexible family structures cannot adjustadequately to maturational or situational challengesFamily dysfunction results from a combination of stress andfailure to realign themselves to cope with it (Colapinto, 1991).Stressors may be environmental (a parent is laid off, the familymoves) or developmental (a child reaches adolescence, parentsretire) The familys failure to handle adversity may be due to flawsin their structure or merely to their inability to adjust to changedcircumstances.
20. 20. How Problems Develop Inflexible response to maturational (ordevelopmental) and environmental challenges leads toconflict avoidance through disengagement orenmeshment Disengagement and enmeshment tend to becompensatory (Im close here to make up for mydistance elsewhere.) This leads to what is called the cross-generationalcoalition, which is a triangular structure
21. 21. The Nature ofProblems And Change Power Imbalances Subsystem Boundaries too rigid or too diffuse Disengaged Members Enmeshed Members Pervasive Conflict Failure of the System to Realign Member Resistance Action Precedes Understanding
22. 22. How change occurs SFT believe that when the structure of the familychanges, the positions of members in the groupchange, and vice versa. There must be a proper hierarchy in place, with thecaretakers or parents in charge, in a healthy coalition. In terms of healthy and unhealthy functioning,symptoms in an individual are rooted in the context offamily transaction patterns, and family restructuringmust occur before an individuals symptoms arerelieved (Minuchin, 1974).
23. 23. How change occurs Structural changes must first occur within the familybecause how a family functions has a direct effect onhow an individual functions within, only then willindividual symptoms be limited, reduced, or resolved. As family members experience changes as the familyfunctions differently, then symptomatic distress willdecrease. Therefore, the therapist focuses on changingthe experience of family members.
24. 24. Therapeutic Goals Therapy is directed at altering the family structure andCreation of an effective hierarchy Structural problems are usually viewed simply asfailure to adjust to changes. Therapist doesnt solve problems, thats the familysjob. Boundaries must be strengthened in enmeshedrelationships, and weakened (or opened up) indisengaged ones.
25. 25. The goal of SFT is to facilitate the growth of the systemto resolve symptoms and encourage growth inindividuals. Short-range goals may be to alleviate acute problems,especially life-threatening symptoms such as anorexianervosa (Minuchin, Rosman, & Baker, 1978). At times,behavioral techniques, suggestion, or manipulationmay be used to achieve an immediate effect
26. 26. The goals for each family are dictated by the problemsthey present and by the nature of their structuraldysfunction. Although every family is unique Another common goal is to help parents functiontogether as a cohesive executive subsystem. Whenthere is only one parent, or when there are severalchildren, one or more of the oldest children may beencouraged to become a parental assistant
27. 27. Therapeutic Goals Not a matter of creating new structures, but reformingexisting ones What distinguishes SFT from other forms of family therapyis the emphasis on modifying family structure in theimmediate context of the therapy setting. When new patterns are repeated and result inimprovement of family relationships, they will stabilize andreplace old patterns and symptoms of dysfunction will bereduced or disappear.
28. 28. Therapists Role Structural therapeutic efforts are based on theprinciple that action leads to new experiences andinsight (Vetere, 2001). The therapist tries to help the family create permeableboundaries and subsystems. Therapists task is to break the certainty of the familyof what the problem is or who the problem is. Thisconfusion helps family members to rethink their rolesand try out new ones.
29. 29. Therapist role in SFT The therapist intervenes with the family activelyduring sessions by assuming a leadership position.Maps the familys underlying structure(boundaries, hierarchy, subsystems) Intervenes to transform the structure with directrequests to the family to change how the membersinteract with each other
30. 30. Phases of treatment Phase 1: Joining Phase 2: Understanding the presenting issue Phase 3: Assessment of Family Dynamics Phase 4: Goals Phase 5: Amplifying Change Phase 6: Termination
31. 31. Therapeutic Interventions Joining in a position of leadership, andaccommodating Family is set up to resist you. You are a stranger, andknow nothing about their struggles, and theirgoodness. Important to join with angry and powerful familymembers Important to build an alliance with every familymember Important to respect hierarchy
32. 32. Structural therapists work with what they see going on in the session, not what family membersdescribe There are two types of live, in-session materialon which structural family therapy focusesenactments and spontaneous behavior sequences. An enactment occurs when the therapist stimulatesthe family to demonstrate how they handle a particulartype of problem.Enactments commonly begin when the therapist suggeststhat specific subgroups begin to discuss a particularproblem
33. 33. Working with enactments requires three operations. First, the therapist defines or recognizes a sequence.For example, the therapist observes that when mothertalks to her daughter they talk as peers, and littlebrother gets left out Second, the therapist directs an enactment. Forexample, the therapist might say to the mother, Talkthis over with your kids. Third, and most important, the therapist must guidethe family to modify the enactment.
34. 34. Assessment Diagnosis implies knowledge: You describe something andgive it a name Assessment deals with assumptions. A structuralassessment is based on the assumption that a familysdifficulties often reflect problems in the way thefamily is organized ,if change occurs between mother anddaughter, things will also change between husband and wife.
35. 35. Structural therapists make assessments firstby joining with the family to build an alliance,and then by setting the family system in motionthrough the use of enactments, in-session dialoguesthat permit the therapist to observe howfamily members actually interactmaking an assessmentis best done by focusing on the presentingproblem and then exploring the familys responseto it.
36. 36. In Families and Family Therapy, Minuchin (1974) listedthree overlapping phases in the process of structuralfamily therapy. The therapist (1) joins the family in a position of leadership; (2) maps their underlying structure; and (3) intervenes to transform this structure
37. 37. The strategy of structural family therapy followsthese seven steps: 1. Joining and accommodating 2. Working with interaction 3. Structural mapping 4. Highlighting and modifying interactions 5. Boundary making 6. Unbalancing 7. Challenging unproductive assumptions
38. 38. Therapeutic Interventions Working with Interaction by inquiring into the familys viewof the problem, and tracking the sequences of behaviors thatthey use to explain it. Mapping underlying structure in ways that capture theinterrelationship of members -- A structural map is essential!) Family structure is manifest only with members interact By asking everyone for a description aof the problem, thetherapist increases the chances for observing andrestructuring family dynamics. Tracking communication contents and use them in thesession.
39. 39. Therapeutic InterventionsHighlighting and modifying interactionsEnactments -- directed by therapist in which thefamily performs a conflict scenario, which happensat home during the therapeutic session. Sharf(2004) enactment offers the therapist anopportunity to observe the family rather than simplylistening to the family story.
40. 40. Therapeutic InterventionsRestructuring Use of reframing to illuminate family structure Use of circular perspectives, e.g. helping each otherchange Boundary setting Unbalancing (briefly taking sides) Challenging unproductive assumptions Use of intensity to bring about change (not givingup) Shaping competency Not doing the familys work for them refusing toanswer questions, or to step in and take charge whenits important for the family members to do so.
41. 41. Therapeutic Interventions Homework Should be to increase contact between disengagedparties, To reinforce boundaries between individuals andsubsystems that have been enmeshed Should be something that is not too ambitious While Minuchin rarely used strategic interventions, hedid caution family members to expect setbacks, inorder to prepare them for a realistic future.
42. 42. Evaluation Key model in the development of family therapy as awhole Core Concepts and interventions have beenincorporated into most family therapy: eg Joining andenactment Empirically evaluated, validated and refined byresearch particularly with conduct disorders, anorexia,substance abuse, and psychosomatic illness inchildren.