Gladding Ch. 13 - Structural Family Therapy Flashcards
Prominent Theorists
● Salvador Minuchin (Founder of Structural Family Therapy) ● Braulio Montavlo ● Bernice Rosman ● Harry Aponte ● Charles Fishman
Family Structure
○ “an invisible set of functional demands that organizes the ways in which family members interact” (Minuchin, 1974, p.51).
Coalition
● Coalition: an alliance between specific family members against a third member
○ Stable coalition is a union that becomes a dominant part of the family’s everyday functioning
○ Detouring coalition is when the pair holds a third member responsible for their difficulties and conflicts
subsystems
● Subsystems are smaller units of the system as a whole.
○ Spousal subsystem – husband and wife work as a team.
○ Parental subsystem – is considered healthy if it does not function in a cross-generational way.
○ Siblings subsystem – members of the same generation
Boundaries
● Boundaries are the physical and psychological factors that separate people from one another and organize them.
○ Clear, rigid, diffuse
Treatment Techniques
● Joining ● Reframing ● Punctuation ● Unbalancing ● Enactment ● Working with spontaneous interaction ● Boundary making ● Intensity ● Restructuring ● Shaping competence ● Diagnosing ● Adding cognitive constructions
Role of Therapist
● Observer and Expert
○ Actively adjusting treatment to change underlying structure of family
○ Timing is everything: allow a new family organization to transpire
● Roles change throughout phases
○ Phase One: join the family as a leader
○ Phase Two: maps out family underlying structure
○ Phase Three (Final): helps transform family structure
● Techniques initiate change
○ Unbalancing, praise, challenge, direct orders, judgments
● Therapist is the ONE who truly understands the family structure
● Therapist seen is seen a critic when things slow or return to old patterns
Course, Process, Outcome
● Process is gradual and steady
○ Focus on family cultural context
● Outcome of symptom resolution and structural changes
○ Key factor for techniques is breaking patterns of dysfunction
● Action above insight
Comparison to other approaches
● Just as well-developed, articulated, and action-oriented as any other FT approach
○ Issue with possible inability to encompass all family life
● Feminists see it promoting gender stereotypes
○ Encourages husbands to take executive roles, whereas women in more of expressive roles
● With focus being on change, little explanation is given to family dynamics and development
○ Focus on here and now takes away from no discussion of prior information
● Difficult to distinguish between Strategic FT
○ Causes issues with appropriate use and appreciation of the individual theory
● Issue with no family empowerment
○ Actively controlling the process, but could be helpful to families who find it difficult to initiate within the session
Multicultural Implications
● Implications
○ Coparenting with One Incarcerated Parent (Tadros, 2018, pp. 253-261)
■ Communication, parent-child subsystem strengthened, restructuring of parental hierarchy, boundaries, family expectations
○ Asian Americans (Kim, 2003, pp. 388-392)
■ Acculturation conflicts, single member is issue, authority, generational boundaries
■ Use of treatment interventions, specifically joining, enactment, restructuring, and reframement
○ Eating disorders and Female Adolescents (Tadros, 2018, pp. 9-15)
■ Focus on improving symptoms
■ Empower parents to be director of family feeding habits
■ Boundaries for a healthy body image and weight
Multicultural Limitations
● Limitations
○ There is no updated research on limitations of structural family therapy, this can be considered a limitation
History
- developed by minuch & colleagues at Wiltwyck School.
- initially for inner-city delinquents.
- treatment created from necessity for dramatic and active intervention.
major thesis
invididual’s symptoms are best understood when examined in the context of family interactional patterns. a change in the family’s organization or structure must occur befor symptoms can be relieved.
basic understanding
family dysfunction perpetuates individual problems. family doesn’t necessarily cause symptom. problems that exist will be maintained and possibly prolonged by the structure of the family system
Salvaador Minuchin
- helped develop a 3-stage approach to working with low-socioeconomic–level black families.
- focused on boundaries, disengagement, enmeshment
- director of Philadelphia Child Guidance Clnic.
- founded Institute for Family Counseling to provide mental health services to the poor.
- Must lauded achievement was development of treatmenent techniques with psychosomatic families.
- passionately committed to social justice.
Premises
- pragmatic
- influenced by philosophy of Jose Ortega y Gasset.
- every family has a structure
stable coaltion
fixed and inflexible union that becomes a dominant part of family’s everyday functioning
detouring coalition
a pair holds a 3rd family member responsible for difficulty or conflict
family transaction patterns
best context for understanding person’s systems. family is seen as the client
Complementarity
spousal substems work best when there is a complementarity of functions, or reciprocal role rlationships that typically constitute an important element in family organization
boundaries
physical and psychological factors that separate people from one another and organize them
diffuse boundaries
not enough separration between family members. instead of creating independence and autonomy, they encourage dependence
alignments
the ways family members join together or oppose one another in carrying out a famliy activity
structural fam therapy based on
roles
rules
power
trianguation
a system process in which child becomes involved in parents’ conflictual interactions by taking sides, distracting parents, and carrying messages to avoid or minimize conflict between parents
power
ability to get something done
dysfunctional sets
family reactions developed in response to stress that are repeated without modification whenever there is conflict
joining
backbown of structural approach. process of coupling between therapist and family
tracking
therapist follows content of family
mimesis
therapist becomes like family
confirmation of familly member
use affective word to reflect an expressed or unexpressed feeling of family member
accomodation
therapist makes personal adjustments in order to achieve a therapeutic alliance
4 methods of joining
tracking
mimesis
confirmation of a family member
accomodation
punctuation
the way a person describes a sutation, that is, begins and ends a sentence, due to a selective perspective or emotional involvement in an event. the selective description of a transaction in accordance with a therapist’s goals.
unbalancing
allying w/ a subsystem. therapist supports individual or subsystem against the rest of the family. usually to support and underdog in the family
working w/ spontaneous interaction
therapist points out dynamics and sequencing of behaviors when family displays actions in session that are disruptive or dysfunctional
intensity
the structural method of changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure.
pragmatic fictions
pronouncements that help families and family members change.
disequilibrium techniques
interventions aimed at changing a system. create different sequences of events, or foster different perceptions of reality
disequilibrium techniques
reframing punctuation unbalancing enactment working w/ spontaneous interaction boundary making intensity restructuring shaping competence diagnosing adding cognitive constructions
role of the therapist
- observer and expert; theater director.
- high energy; precise timing
- role changes over course of therapy
3 phases
- joining. therapist takes leader role
- therapist mentally maps out family’s underlying structure
- therapist helps transform family structure
therapist watches “the family dance,” then enters (joins) then lieaves the interactional field at will in order to transform it therapeutically.
process and outcome
- gradual and steady.
- geared to cultural context of family
- symptom resolution and structural changes
- homework
- if therapy is successful, overal structur of family is altered and reorganized
unique aspects of structural family therapy
- versatility
- appropriate for low-SES families as well as for high-income families.
- adaptable for minority and cross-cultural populations
- hierarchy and advocy
- helped make family therapy as a whole acceptable to medicine in general and psychiatry in particular
- symptom removal and reorganization of family
- pragmatic problem-solving emphasis
- structural family therapy was born out of necessity and has not deviated from its origins
