Chapter 12 - Structured Family Therapy Flashcards
Structural Family Therapy
notes that an individual’s symptoms are best understood when examined in the CONTEXT OF FAMILY INTERACTIONAL PATTERNS
notes every family has a FAMILY STRUCTURE, an “invisible set of functional demands that organizes the ways in which family members interact. This structure is revealed ONLY when the family is in ACTION.
A CHANGE in the family’s organization or structure must take place before symptoms can be relieved.
The structural approach as a theory is quite PRAGMATIC
COALITION
ALLIANCE between specific family members against a THIRD member. There are three types of coalitions:
- STABLE COALITION: a fixed and inflexible union (such as a mother and son) that becomes a dominant part of the family’s everyday functioning.
- DETOURING COALITION: one in which the pair holds a third family member responsible for their difficulties or conflicts with one another, thus decreasing the stress on themselves or their relationship.
- CROSS-GENERATIONAL: contains members of two different generations within it. If a parent and child collude to obtain certain objectives or needs, such as love or power, they are in a cross-generational alliance.
sibling subsystem (hint: Brady Bunch)
a unit within the family whose members are of the same generation.
For example, brothers and sisters are considered to be a sibling subsystem.
In some families, the sibling subsystem is composed of those born of the same parents. In other families, such as in blended arrangements (i.e., stepfamilies), the sibling subsystem is made up of unre lated children.
BOUNDARIES (3 Types)
physical and psychological factors that separate people from one another and organize them. There are several boundaries:
CLEAR BOUNDARIES consist of rules and habits. In families with clear boundaries, members freely exchange information and give and receive corrective feedback.
RIGID BOUNDARIES: inflexible and are characterized by power struggles. They keep people separated from each other. Families with rigid boundaries experience difficulty relating in an intimate way to one another
DIFFUSED BOUNDARIES: there is not enough separation between family members. In this arrangement, some family members are said to be “fused.”
triangulation
system process in which children becomes involved in parents’ conflictual interactions by taking sides, distracting parents, and carrying messages to avoid or minimize conflict between the parents
Parentified children
are given privileges that exceed what would be considered developmentally consistent with their age
Structural Family Therapy also based on
(1) roles
(2) rules
(3) power
ROLES:
RULES: may be adhered to regardless of the changes that have occurred in the family’s lifestyle or outside circumstances.
POWER: ability to get something done. In families, power is related to both authority and responsibility Structural family therapists observe that, in dysfunctional families, power is vested in only a few members.
Dysfunctional sets
In response to stress, family reactions that are repeated without whenever there is family conflict.
structural family therapy approach
treatment technique: Joining
the backbone of structural family therapy; the process of ‘coupling’ that occurs between the therapist and the family, leading to the development of the therapeutic system.
1, TRACKING, the therapist follows the content of the family. information is gathered by means of open-ended questions to inquire about the interests and concerns of family members.
2. MIMESIS: the therapist becomes like the family “in the manner or content of their communications,
3. CONFIRMATION: involves using an affective word to reflect an expressed or unexpressed feeling of that family member.
4. ACCOMMODATION: the therapist makes personal adjustments in order to achieve a therapeutic alliance
Disequilibrium Techniques of Structural Family Therapy 1. Reframing 2. Punctuation 3. Unbalancing 4. Enactment 5. Working with spontaneous interaction 6. Boundary making 7. Intensity 8. Restructuring 9. Shaping competence 10. Diagnosing 11. Adding cognitive constructions constructions
interventions that are aimed at changing a system.
- REFRAMING involves changing perception by explaining a situation from a different context.
- PUNCTUATION is the way a person describes a situation,
- UNBALANCING (or allying with a subsystem) is a procedure by which the therapist supports an individual or subsystem against the rest of the family. the therapist may sit next to a daughter who is being accused of not living up to the family’s tradition.
- ENACTMENT: occurs when the therapist “invites client-system members to interact directly with each other”. It consists of families bringing problematic behavioral sequences into treatment by showing them to the therapist in a demonstrative transaction. Such a process redirects communication between the therapist and the family so that communications and resulting changes in behaviors occur “among family members
- WORKING WITH SPONTANEOUS INTERACTION - It occurs whenever families display actions in sessions that are disruptive or dysfunctional and the therapists can see first hand the dynamics within a family’s interactions. Therapists can point out the dynamics and sequencing of behaviors.
- BOUNDARY: invisible line that separates people or subsystems from each other psychologically. To function effectively, families need different types of boundaries at distinct times of stage development.
- INTENSITY: method of changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure. The tone, volume, pacing, and choice of words used by a therapist can raise the affective intensity of statements.
- RESTRUCTURING: altering the existing hierarchy and interaction patterns so that problems are not maintained.
- SHAPING COMPETENCE - highlighting positive behaviors.
- DIAGNOSING is done early in the therapeutic process. By diagnosing, therapists become proactive, instead of reactive, in promoting structural interventions
- ADDING COGNITIVE CONSTRUCTIONS includes advice, information, pragmatic fictions, and paradox
a. ADVICE AND INFORMATION are derived from experience and knowledge of families in therapy
b. PRAGMATIC FICTIONS are pronouncements that help families and family members change
c. PARADOX - a confusing message meant to frustrate or confuse families and motivate them to search for alternatives
Role of the Therapist
observer
expert
theater director
therapist’s role over the course of therapy:
- PHASE THREE: the therapist joins the family and takes a leadership position
- PHASE TWO: the therapist mentally maps out the family’s underlying structure
- PHASE THREE: the therapist helps transform the family structure
5 Aspects of Structural Family Therapy and 5 Comparisons
- VERSATILITY: successful in treating families experiencing difficulties with juvenile delinquency, alcoholism, adolescent drug use, obesity, serious emotional disturbance in children, pornography addiction, intimacy, and sexual desire issues in couples, coping with human immunodeficiency virus (HIV), parental alienation syndrome, adolescent eating disorders, children with chronic illness, bullying, bipolar disorder, autism, and schizophrenia
- TERMINOLOGY: Structural family therapy has clearly defined terms and procedures.
- ATTRIBUTES of structural therapy that helped make family therapy acceptable to medicine and psychiatry.
- emphasis on SYMPTOM REMOVAL and reorganization of the family.
- PRAGMATIC, PROBLEM-SOLVING emphasis. Therapists are active in bringing about change
Comparisons:
A. XXXX
B. REINFORCES SEXISM: Minuchin encourages husbands to take on executive roles and wives to take on expressive roles in the family so that everyone does not suffer
C. FOCUSED ON PRESENT. Structural family therapy basically ignores historical data.
D. HARD TO DISTINGUISH FROM STRATEGIC FAMILY THERAPY. In both approaches, there is a pragmatic emphasis on identifying and blocking present behaviors that are destructive and repetitive.
E. FAMILY EMPOWERMENT: families may not become as empowered, because the therapist is active and in control of the process
