Structural Family Therapy Sarah Fender Emily Hornung Leslie Hall

History & Evolution Founded by Salvado Minuchin Worked with boys at a school where all boys came from poverty The boys frequently had no father figures Put emphasis on family structure, subsystems, and boundaries Originated in the 1970’s Expanded in early 1990’s by Aponte to include values and spirituality

Structural Family Therapy: 6 Tenets Families are organized with structural patterns which are important to the dynamic of the family. Symptoms within families are signs of a family under stress. Understanding the organizational patterns of families as they relate to the problem at hand is essential to the assessment and treatment process. There are 3 basic structural dimensions of families: Boundaries Alignment Power The interaction pattern demonstrated by the family in the family session is a critical source of information and more reliable than a family members in alternative behaviors. Change occurs through active involvement of family members in alternative behaviors. The family session is used to enact new behaviors and family change.

Goal of Structural Family Therapy To restructure the family Allow the family to alleviate stress, resolve conflict, and cope more effectively and efficiently Role of the therapist = Stage Manager

Treatment Principles Focus on concrete issues Locate in the present Mediate interventions through the client’s experience in the session Reorganize the structure of relationships Build on client strengths Aim at palpable outcomes Intervene through the active involvement of the practitioner with the family Initiate, facilitate, and close the enactment

Assessment of Family Dysfunction: overaffiliation or underaffiliation Therapist maps out the family structure: Leadership Alignments/Triangles Boundaries Power dynamics Coalitions, conflicts, roles (Ex. nurturers, healers; mother, father, problem child) Dysfunction: overaffiliation or underaffiliation Members speak for each other in session, inadequate boundaries Body language, lack of knowledge of other family members, separateness in lives Who sits where, who listens to whom about sitting where Flexibility vs. Rigidity: Roles and Coping

Treatment: Challenging Symptoms Observe structure of family Reframe the initial problem to reduce blame placed on one family member The problem is not the one identified; it lies in the interaction patterns Challenge behavioral, cognitive, and affective responses Reframe their understandings of the problem(s)

Challenge Structure: Enactment/Focus/Intensity Enact the family patterns while in session Ask for further explanations in this safe context Is this always the way it works? What comes first; what comes after? Who steps in, what do they do? Use members’ reactions to identify and transform patterns Intervene using new structural patterns and behaviors Focus session on one particular theme, pattern, or behavior Help family reach a goal in session rather than give up Persistence

Interventions Addressing parents first and more formally by role Moving around the structure of family seating Telling permissive parents that they need to LEAD Providing a new pattern of parenting Enactment, boundary-making Reframing, punctuation, unbalancing

Treatment: Challenging Reality The family’s reality will change Therapist must emphasize the strengths of this new structure Build security, self-efficacy, skill and confidence Emphasize or PUNCTUATE positive actions for positive meaning Increase power through repetition of new patterns Build boundaries Unbalancing Complementarity

With Families: Lack of effective leadership Look at subsystems Building the self-efficacy of parents to parent effectively Setting ground rules for what will go on in the house Restructuring the seating arrangements to reduce buffering Look at subsystems parental subsystem/couple subsystem sibling subsystem

Some Interventions in Action https://www.youtube.com/watch?v=bOrnOcHWXgA Boundary-making: We see that the father is kept out of the son/daughter interaction because that is for them to negotiate Chairs are moved so that brother and sister sit side by side, without father as a buffer Enactment: Therapist has brother and sister enact their morning argument, without father interceding, so therapist can locate the problem behavior

Theory in Practice Leslie “Les”: Dad (38) Cecile “Cessa”: Mom (36) Note: in actual practice (as of 1982) this therapy was applied in a case where the son/daughter was the identified target of change Leslie “Les”: Dad (38) Cecile “Cessa”: Mom (36) Jackson “Jack”: Son (11) John: Son (9)

DEMO

Some ‘Punctuations’ Reframing: “Is this how you all live your lives everyday?” Makes it a family-wide problem than just a one-child problem Enactment Allowing the two boys to run around to see how the parents react Enact the mother taking the “make it happen” role Experience of success for mother, successful mother for the family Boundary-making: movement of seating Les and Cessa usually talk with the boys fighting in the background, by getting these two together without the boys the pattern can change

Ethical Implications Trying to change the structure of a family could result on it falling in on itself Families may try to increase rigidity of dysfunctional family structures

BINGO

References Colapinto, J. (1982). Structural family therapy. Received from minuchincenter.org/yahoo.../SFT.65163124.doc Corcoran, J. (2003). Clinical applications of evidence-based family interventions. New York, NY: Oxford University Press. Nichols, M. (2009). Family structure therapy. In The essentials of family therapy (4th ed.). Boston, Ma.: Pearson /Allyn and Bacon. Van Hook, M. P. (2014). Social work practice with families: A resiliency-based approach. 2nd Ed. Chicago, IL: Lyceum Books, Inc.