Structural

Question 1

What makes Structural Family Therapy different from Strategic therapy and other modalities?

Answer 1

Rather than focus on the individual’s pathology, SFT considers problems in the family’s structure – a dysfunction in the way the family interacts or operates. Unlike Strategic Therapy, SFT does not maintain that the family’s interactions, or “transactions” cause the pathology, but rather that the family’s transactions support or encourage the symptoms.

Through its transactions, a family establishes a set of rules for its daily functioning, and these rules form its “structure.” A marriage and family therapist employing SFT must first assess the family’s interactions, figuring out the family’s hierarchy, alliances within the family, such as a mother and son against a father, or siblings against another sibling or siblings. The therapist composes a map or flow chart describing the process that a family unconsciously follows.

Question 2

What is the goal of Structural Family Therapy?

Answer 2

Goals are:
- To establish healthy boundaries within the family and sub-systems. - To establish an appropriate hierarchical structure where the children do not control the parents, and outer circles are not intruding.

Question 3

What is a transaction, in structural therapy?

Answer 3

Transactions are simply patterns of how family members routinely interact with each other. For example, a mother’s transaction with her daughter could be controlling and overprotective, or an older brother’s transaction with a younger brother could be one of bullying and overpowering.

Question 4

What are important elements to consider in a family’s structure?

Answer 4

• Roles
• Subsystems
• Hierarchies
• Alliances (coalitions)
• Rules
• Boundaries
• Whether relationships are enmeshed, balanced, or disengaged
• Triangulation

Question 5

What is the therapist’s role in structural therapy?

Answer 5

The therapist metaphorically becomes a member of the family.

In this unique role, and in the context of the therapeutic setting, the therapist will provoke the family members to interact and speak about the problem or issue. The therapist asks questions, points out harmful transactions, and uncovers not only dysfunctional patterns, but positive behaviors or personal qualities that are ignored or overlooked by the family.

Question 6

What is the stance of the therapist in Structural Family Therapy?

Answer 6

• Active in sessions
• Views families as resilient
• Views families/people as NOT fundamentally flawed, but instead needing key adjustments to flourish
• Pays attention to both content and process of relational interactions
• Oscillates between first and second order cybernetic stances

Question 7

What are the core assumptions of Structural Family Therapy?

Answer 7

• Families engage in consistent and predictable ways (patterns)
• These patterns indicate they have a certain structure
• Identifying this structure allows therapists to effect change in families in systemic and organized
  ways

Question 8

What is Family Structure, in Structural Family Therapy?

Answer 8

Family Structure is the way a family is organized into subsystems and how the interaction among those subsystems is regulated by boundaries.

Family structure manifests in the way family members interact:
* The process of a family’s interaction is like the patterns of conversation at the dinner table
* The structure of the family is like where family members sit in relation to one another

Question 9

What is Structure, in Structural Family Therapy?

Answer 9

The relative positioning and alignment of family members within a family.

Families are differentiated into subsystems based on generation, gender, and function, which are demarcated by interpersonal boundaries, which are invisible barriers that regulate contact with others.

Question 10

What is a Boundary, in Structural Family Therapy?

Answer 10

Boundaries are invisible barriers that regulate contact with
others

Question 11

What makes a boundary rigid?

Answer 11

Rigid boundaries are restrictive and limiting. They allow for minimal contact from those that are outside of the sub-system, resulting in isolation and disengagement (but can also be safer in some situations).
A person with rigid boundaries prioritizes independence and autonomy, over closeness and intimacy.

Question 12

What makes a boundary diffuse?

Answer 12

Diffuse boundaries are permeable and promote too much contact with other systems, resulting in enmeshment. A person with diffuse boundaries prioritizes intimacy and closeness over independence and autonomy.

(Think of “diffuse” as having dissolved or diffused – so the boundary is invisible and not even there anymore.)

When boundaries are diffused, they may be unclear. The sub-system in the family may lack limits that lead to unhealthy behaviors. A lack of boundaries could allow others to intrude on the system and become over-involved.

Question 13

What is Boundary Making/Setting, in Structural Family Therapy?

Answer 13

In Boundary Making or Boundary Setting, the therapist defines areas of interaction that he rules open to certain members but closed to others, or prescribes physical positions or movements.

Question 14

What is a subsystem in Structural Family Therapy?

Answer 14

Subsystems are groupings of family members based on generation, gender, and function, which are demarcated by interpersonal boundaries (invisible barriers that regulate contact with
others).

Question 15

What are key strategies used in Structural Family Therapy?

Answer 15

Modifying structure (creating disequilibrium):
* Structural mapping
* Boundary setting
* Systemic reframing (including punctuation)
* Crisis Induction
* Unbalancing
* Intensity
*Enactments – i.e. realigning/restructuring family interactions by having family members enact or re-enact interactions, and then shaping competence by highlighting and modifying interactions

Joining and Accommodating:
* Compliments
* Expanding family truths
* Challenging the family’s worldview & unproductive assumptions

Question 16

What is “punctuation” in Structural Family Therapy?

Answer 16

Punctuation is the selective description or reframing of an interaction, in accordance with the therapist’s goals – to emphasize successfully meeting a goal, for example.

Question 17

What is viewed as healthy development, within Structural Family Therapy?

Answer 17

• All families have structure that is
  developed through repetition and
  through influence of external context
• Healthy families are able to be flexible and adapt when the situation calls for it
• Developmental phases are
  particularly difficult for families

Question 18

What is the source of problems, in Structural Family Therapy?

Answer 18

Family Systems function poorly when…
* Subsystems, boundaries and roles do not adapt to changing needs (circumstances, developmental stages)
* Subsystems, boundaries and roles do not support a healthy balance of closeness AND autonomy between members
* The usual way of responding has become rigid without adaptation.
* Poor structural experiences happen, which often lead to symptoms

Question 19

Why does Structural Family Therapy value spontaneity?

Answer 19

If a therapists’ interventions are to
be effective, they cannot be preplanned or rehearsed.

Question 20

What are the three overlapping phases or steps in Structural Family Therapy?

Answer 20

1) Join with the family (alliance building) in a position of leadership
2) Map their underlying family
structure – including boundaries, hierarchies, and interactional
patterns (can be done observing spontaneous interactions & using
structural maps)
3) Intervene to transform this structure and reduce symptoms

***May have to repeat phases 2 and 3 until goals are accomplished

Alternate steps:
1. The therapist joins and accommodates the group. Trust between the family and the therapist should develop for the process to work.
2. The therapist then observes how the family behaves together. During this process, they watch for which person is leading the family, which is defensive, and which may be most likely to cause conflict.
3. Next, the therapist maps the underlying structures of the family.
4. The family then completes role-playing exercises, so the therapist can watch and intervene to teach appropriate behavior.
5. Work on restructuring to create new boundaries is often necessary for the family to strengthen their bonds. The therapist may assist in this process.
6. When needed, the therapist may go through an unbalancing process where they join with a sub-system or individual to help break an impasse in the system to support the relationship.

Question 21

What is joining, in Structural Family Therapy?

Answer 21

Joining is the empathic connection which opens the way for family members to begin listening to each other and establish a bond with the therapist; allowing them to accept challenges to come.

The family therapist is an unwelcome outsider. After all, why did he or she want to see the
entire family? Family members expect to be told they are doing something wrong. The therapist
must disarm these defenses and ease anxiety.

Question 22

What is mimesis, in Structural Family Therapy?

Answer 22

Mimesis refers to the therapist’s attempts to mirror and match the family’s attitudes, behavior, and
posture to further communicate that they are temporarily a part of the system. (Think: mim from mimic or mimeograph, and “sis” for family – the therapist is copying the family)

Question 23

What is tracking in Structural Family Therapy?

Answer 23

Tracking refers to the therapists’ observation of the family’s patterns of communication, behavior, and attitudes/values.

Question 24

How are enactments useful in Structural Family Therapy?

Answer 24

Enactments are used early and often in SFT. Family structure manifests in the way family members interact. Families often describe themselves more as they think they should be than as they are. So, using enactments to get family members to interact among themselves runs counter to their expectations.
* Pick a specific issue for response!
* Families demonstrate enmeshment by frequently interrupting, speaking for each other, doing things for children that they can do for themselves, or constantly arguing.
* In disengaged families, one partner may sit passively while the other partner cries.

Question 25

What is the value of asking for each family member’s perspective of the problem, in Structural Family Therapy?

Answer 25

• By asking everyone for a description of the problem, the
  therapist increases the changes for observing and restructuring family dynamics

Question 26

Why is Structural Mapping done, in Structural Family Therapy?

Answer 26

• Maps a family’s underlying structure in ways that capture the
  interrelationship of members
• Maps hypothetical family structures
• Helps to determine goals

Family structure only manifests in members’ interaction. Once families begin to interact, problematic transactions emerge. Recognizing their structural implications demands focus on process, not content.

Question 27

What is the role of intensity in Structural Family Therapy?

Answer 27

The purpose of intensity is to spark change to patterns of interaction when family seems stuck in old established ways of interacting.
The trick to changing a cyclical negative interaction is to modify the pattern. This may require
forceful intervening, or what SFT call “intensity”/”affective intensity.” The therapist turns up the “emotional heat.” Selective regulation of affect, repetition, duration, tone, volume, pacing, and choice of words are used to raise the affective intensity of statements.

Examples:
- Asking the same question many many times
- Exaggerating the worst possible outcome
- Confronting or challenging someone in the system

• Intensity requires clarity of purpose, a knowledge of family
  structure, and a commitment to help families change.
• Affective intensity isn’t simply a matter of clever phrasing. You have to know how and when to be
  provocative.
• Intensity may strike some as overly aggressive and may not be a good fit for all therapists. An alternative strategy for stalemated interactions is the use of empathy to help family members get beneath the surface of
  their defensive wrangling.

Question 28

What is Shaping Competence in Structural Family Therapy?

Answer 28

Shaping Competence is another way you can modify interactions. It involves picking out something
that families are doing successfully.

Question 29

How do therapists modify a family’s boundaries in Structural Family Therapy?

Answer 29

In enmeshed families, interventions are designed to strengthen boundaries:
* Family members are urged to speak for themselves
* Interruptions are
blocked
* Dyads are helped to finish conversations without intrusion

In Disengaged families, interventions are designed to challenge conflict avoidance and improve closeness. The therapist…
* Encourages quiet members to interact or be curious
* Intervenes to challenge conflict avoidance
* Points out or blocks detouring, to help disengaged members break down the walls between them

Question 30

What is the importance of complementarity in Structural Family Therapy?

Answer 30

In complementarity, the therapist reframes behavior such that any given individual’s behavior is presented as contingent
on somebody else’s behavior.
The therapist moves family discussions from linear to circular perspectives by stressing complementarity.
SFT therapists emphasize complementarity by asking family members to help each other to change.

Question 31

How is unbalancing used as an intervention in Structural Family Therapy?

Answer 31

Unbalancing is used to alter the system into changing, by supporting one family member and taking sides (only briefly). This interferes with homeostasis.
* Not meant to be blaming, but
nudges the system to change from current structural impasses
* Usually used when one member is being blamed for everything (i.e.
the identified patient) or when there are extreme difficulties in hierarchy
* What may seem like antagonism from the therapist is actually a
challenge for the clients to confront their fear of change
* Only done when necessary and with specific realignment
goal(s) in mind

Question 32

How are unbalancing and boundary making different, in Structural Family Therapy?

Answer 32

In boundary making, the therapist aims to realign relationships between subsystems. In unbalancing, the goal is to change the relationship within a
subsystem.
* What often keeps families stuck in stalemate is that members in conflict are balanced in opposition and, as a result, remain frozen in inaction.
* Differences are normal, but they can become detrimental, such as when one parent undermines the other’s handling of the children.

Question 33

What is the role of challenging unproductive assumptions in Structural Family Therapy?

Answer 33

Changing the way family members view their situation enables them to change the way they interact.

Question 34

How are crisis inductions used in Structural Family Therapy?

Answer 34

Purpose: Used with families who chronically avoid the problem.
How: Therapist introduces a crisis to help family deal with the
problem (problem patterns & interactions).
* What may seem like antagonism from the therapist is actually a
challenge for the clients to confront their fear of change
* Only done when necessary and with specific realignment
goal(s) in mind

Question 35

Who created Structural Family Therapy?

Answer 35

Salvador Minuchin - born 1921, Argentina. Saw change in his own family hierarchy & dynamics after his father lost his business & uncle became head of household. Spent time in Israel and NYC. Child psychiatrist/MD conceptualized SFT in the 1960’s while working at the Wiltwyck School for delinquent boys in New York. It was formally developed primarily at the Philadelphia Child Guidance Clinic.

Question 36

Who contributed to Structural Family Therapy, besides Minuchin?

Answer 36

Many other influential thinkers have worked in association with the development of the ideas, such as:
Charles Fishman - coauthor
Jay Haley - early Minuchin colleague
Braulio Montalvo - coauthor
Lynn Hoffman
Marianne Walters
George Simon
Jorge Colapinto?
Harry Aponte?

Question 37

What is parentification in Structural Family Therapy?

Answer 37

Parentification is a process where children or adolescents assume adult roles before they are emotionally or developmentally ready which, in turn, disrupts the development of healthy, secure attachment in childhood.

Question 38

When does termination happen in Structural Family Therapy?

Answer 38

• When the problem is gone (1st order or 2nd order change - change of family structure is not strictly necessary)

Question 39

For which kinds of issues has Structural Family Therapy been shown to be effective?

Answer 39

Anorexia, psychosomatic children, adult substance abusers