Gladding Ch. 13 - Structural Family Therapy

Question 1

Prominent Theorists

Answer 1

●	Salvador Minuchin (Founder of Structural Family Therapy) 
●	Braulio Montavlo
●	Bernice Rosman
●	Harry Aponte
●	Charles Fishman

Question 2

Family Structure

Answer 2

○ “an invisible set of functional demands that organizes the ways in which family members interact” (Minuchin, 1974, p.51).

Question 3

Coalition

Answer 3

● 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

Question 4

subsystems

Answer 4

● 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

Question 5

Boundaries

Answer 5

● Boundaries are the physical and psychological factors that separate people from one another and organize them.
○ Clear, rigid, diffuse

Question 6

Treatment Techniques

Answer 6

●	Joining
●	Reframing
●	Punctuation
●	Unbalancing
●	Enactment
●	Working with spontaneous interaction
●	Boundary making
●	Intensity
●	Restructuring
●	Shaping competence
●	Diagnosing
●	Adding cognitive constructions

Question 7

Role of Therapist

Answer 7

● 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

Question 8

Course, Process, Outcome

Answer 8

● 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

Question 9

Comparison to other approaches

Answer 9

● 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

Question 10

Multicultural Implications

Answer 10

● 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

Question 11

Multicultural Limitations

Answer 11

● Limitations

○ There is no updated research on limitations of structural family therapy, this can be considered a limitation

Question 12

History

Answer 12

• developed by minuch & colleagues at Wiltwyck School.
• initially for inner-city delinquents.
• treatment created from necessity for dramatic and active intervention.

Question 13

major thesis

Answer 13

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.

Question 14

basic understanding

Answer 14

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

Question 15

Salvaador Minuchin

Answer 15

• 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.

Question 16

Premises

Answer 16

• pragmatic
• influenced by philosophy of Jose Ortega y Gasset.
• every family has a structure

Question 17

stable coaltion

Answer 17

fixed and inflexible union that becomes a dominant part of family’s everyday functioning

Question 18

detouring coalition

Answer 18

a pair holds a 3rd family member responsible for difficulty or conflict

Question 19

family transaction patterns

Answer 19

best context for understanding person’s systems. family is seen as the client

Question 20

Complementarity

Answer 20

spousal substems work best when there is a complementarity of functions, or reciprocal role rlationships that typically constitute an important element in family organization

Question 21

boundaries

Answer 21

physical and psychological factors that separate people from one another and organize them

Question 22

diffuse boundaries

Answer 22

not enough separration between family members. instead of creating independence and autonomy, they encourage dependence

Question 23

alignments

Answer 23

the ways family members join together or oppose one another in carrying out a famliy activity

Question 24

structural fam therapy based on

Answer 24

roles
rules
power

Question 25

trianguation

Answer 25

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

Question 26

power

Answer 26

ability to get something done

Question 27

dysfunctional sets

Answer 27

family reactions developed in response to stress that are repeated without modification whenever there is conflict

Question 28

joining

Answer 28

backbown of structural approach. process of coupling between therapist and family

Question 29

tracking

Answer 29

therapist follows content of family

Question 30

mimesis

Answer 30

therapist becomes like family

Question 31

confirmation of familly member

Answer 31

use affective word to reflect an expressed or unexpressed feeling of family member

Question 32

accomodation

Answer 32

therapist makes personal adjustments in order to achieve a therapeutic alliance

Question 33

4 methods of joining

Answer 33

tracking
mimesis
confirmation of a family member
accomodation

Question 34

punctuation

Answer 34

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.

Question 35

unbalancing

Answer 35

allying w/ a subsystem. therapist supports individual or subsystem against the rest of the family. usually to support and underdog in the family

Question 36

working w/ spontaneous interaction

Answer 36

therapist points out dynamics and sequencing of behaviors when family displays actions in session that are disruptive or dysfunctional

Question 37

intensity

Answer 37

the structural method of changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure.

Question 38

pragmatic fictions

Answer 38

pronouncements that help families and family members change.

Question 39

disequilibrium techniques

Answer 39

interventions aimed at changing a system. create different sequences of events, or foster different perceptions of reality

Question 40

disequilibrium techniques

Answer 40

reframing
punctuation
unbalancing
enactment
working w/ spontaneous interaction
boundary making
intensity
restructuring
shaping competence
diagnosing
adding cognitive constructions

Question 41

role of the therapist

Answer 41

• observer and expert; theater director.
• high energy; precise timing
• role changes over course of therapy

Question 42

3 phases

Answer 42

1. joining. therapist takes leader role
2. therapist mentally maps out family’s underlying structure
3. 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.

Question 43

process and outcome

Answer 43

• 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

Question 44

unique aspects of structural family therapy

Answer 44

• 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