structural family therapy

Question 1

how did structural family therapy help some of the issues that existed in family therapy at the time

Answer 1

-When it came out, sense from the field that there were a lot of intelligent leaders conducting family therapy in the field, these models you can understand conceptually, but actually doing the therapy and how to do the therapy seems unclear
-Then came Minuchin, modeled the work of Ackerman, and he made his kind of therapy very understandable and clear and people viewed family therapy as less mysterious and it became easier to practice it and train others in it
-Some will say structural is the most common family therapy being practiced, most therapists combine structural and strategic ideas

Question 2

reason structural family therapy was created

Answer 2

Beginners were looking for a framework to make sense of transactions

Question 3

three essential components of the theory

Answer 3

1) Structure

2) Subsystems
-Can go from single individual, up to the entire family
-Typically parent subsystem, children subsystem, parent-child subsystem

3) Boundaries
-How do we establish issues of hierarchy

All three families have these three components and if we want success in therapy, focus on these three issues

Question 4

what is meant by the “structure” of family

Answer 4

Description of predictable behavior patterns
-“Who relates to whom?”
-Certain people will always relate to certain people in some way
-Ex. Father might be forceful when talking to children, but deals different when talking to wife

Set of rules govern transactions
-E.g. “member must protect one another”
-Changes one rule, the system shifts (changes with the rule)

Are there cross-generational coalitions?
-He was always interested in this, was saying they exist and can be healthy or pathological
-Ex. Grandparent is mad at own child, and recruits the grandchild to be angry at the parent with them, erode the parent authority

Question 5

what is meant by “subsystems”

Answer 5

Each individual is a subsystem, and groups make up other subsystems.

Every member plays many roles in several subsystems.
-E.g. okay to discipline as a father, but not as a husband or son.
-People act different in the different subsystems
-Is someone stuck in a transactional pattern? Cross subsystems and cannot shift style they get into

Question 6

what is meant by “boundaries”

Answer 6

Those rules that regulate contact with others.

Rigid -> diffuse (exists on a spectrum)
-Rigid: would look like a family that does not let anyone in, ex. Family does not let school know what is happening at home
-Diffuse: people are in and out of the home, the family group is not set and changes a lot, chaotic, very limited rules

Disengaged -> Enmeshed
-Minuchin believed that families have a little bit of both, have a preferred style of being

Therapist looks at how systems and boundaries exist in the family

Question 7

family development in structural family therapy

Answer 7

Couple must establish new boundary and accommodations.
-People must establish a sense of self
-History from family of origin
-How does that influence the current home?
-How development can be a healthy or unhealthy process

Question 8

explain symbols in structural family therapy

Answer 8

-Having a method to track structure made the model more accessible
-Used diagrams, not genograms, to give himself a better idea of family structure

Straight solid line, rigid boundary; dotted line, more diffuse boundary
-Minuchin was interested in the present rather than the early days
-Rigid boundary between mom and dad, have to get them to become a team, cannot have mom being the leader of the home and dad being buddy-buddy with the kids, have to work to get mother and father to be a collaborative team

Case conceptualization: who am I going to see, why am I going to see them, what are my goals in working with them

Question 9

what is joining in structural family therapy

Answer 9

-Not just the beginning, joining supports change.

It is a mistake to become wedded to a theory ahead of one’s data. Planning treatment is fine, but remain open.

Only by joining the family can you learn the information you need. (ex. Rules and roles)
-Can be kind of like pre-therapy, gathering information about the family and how it is moving along

Initial hypothesis can be invaluable to a therapist
-So, think about possible functions of the symptom, but don’t get locked in
-You are all going to walk in with a hypothesis, you are going to see intake and think about what is at play, do not let hypothesis blind you to other things that are happening

Question 10

explain divorced parents, child and how it can be resolved

Answer 10

People who are damaged during divorce are typically those who are caught in the middle of parental arguments, divorced parents need to have a coalition and view their role as parenting the kids together

Question 11

how does the structural therapist see the family and what can be done to change it

Answer 11

Structural FT sees the family as an organism: a complex system that is under-functioning. Thus the structural approach has elements of existential/experiential (Whitaker) and strategic (goal oriented via Haley).
-Trying to realign the organization
-Usually, the kid has a problem in therapy, so this therapy is mainly about children and family work that deals with children, less about couples work,

Like the strategic therapist, the structuralist realigns significant organizations to produce change in the entire system.

Like Whitaker, the structuralists challenges the family’s accepted reality combining a growth based orientation, with a Strategic emphasis on goals.
-We have to work based off the assumption that the problem is the child, we have to work with the idea that it is coming from the family

Question 12

main idea of how structural change works

Answer 12

The techniques of structural work lead to family reorganization by :
-Challenging the family organization

Question 13

three main strategies that lead to change

Answer 13

-Challenging the symptom
-Challenging the family structure
-Challenging the family reality

Question 14

explain challenging the symptom

Answer 14

-Therapist enters viewing the family as wrong. The family’s view that there is one identified patient (IP) and nothing works, is mistaken.
-The problem is not the IP, but certain family interactional patterns. “Transactional biopsy”
-What is actually happening, if I set a camera up on the wall what is happening at dinner or when people are doing homework
-In terms of our thinking, the identified patient language is problematic and it is really a systems issue

The structuralist sees this response by the family as not helpful, but instead, a reaction to a system under stress.

All family members are equally symptomatic
-More like “all are symptomatic” rather than equally

Challenge definition of the problem

Question 15

summary of goal of challenging the symptom

Answer 15

change or reframe family’s view of the problem

Question 16

techniques used to challenge the symptom

Answer 16

enactment, focusing and achieving intensity. (to view symptom from another perspective)

Question 17

what is enactment

Answer 17

-The technique by which the therapist asks the family to dance in his/her presence.

Play out the transactions

The act of enacting offer a challenge to this reality offers people a context for experimentation in concrete situations (benefits listed below)
-Therapist observes
-Therapist organizes scenarios
-Therapist suggests alternatives to pattern

“help me understand what happens when you become frustrated with X, can you show me what normally happens in these situations”

Question 18

what is focusing

Answer 18

Do not always “follow the plot”
-Have to make decisions, is this really important
-When are tangents important or when are they taking you off topic because on-topic is too stressful or they just want to talk to you more casually

Learn to explore one area in depth
-What area should you explore in depth, what area gives you a lot of transactional information about what is going on
-Redirect if things are being discussed that are not beneficial

Be aware of tunnel vision
-Some of us have areas that we are so quick to hone in on
-Try to not have a bias that gets you involved in something that is not really productive

The fact that therapist takes one area to focus on indicates its importance.

Question 19

explain intensity

Answer 19

Family members will be deaf to some messages.
-People’s comments might get lost in therapy, you as a therapist have to say that this comment is too important to let go
-People usually bring important messages up again, definitely grab it if it comes up the second time because the third time is not guaranteed

Therapist style

Drama
-Make certain things more dramatic if you believe they are important
-E.g. behavior happening now, will this happen again in 5 years, what will this mean

Repetition of message
-Can make things more dramatic by doing this
-Can also repeat a message that is a lovely message, like someone stating their feelings for other people

Speaking quietly
-Use variety of tones to manage the intensity of the room

Making it concrete
-“Are these your hands?”, “Are these your muscles?”, “Are you sure it is not your mother’s arm?”
-Trying to determine how your mother is controlling you, trying to figure out that it is mom constantly critiquing child that controls them

Continue the transaction past the time when the system usually turns on the yellow/red light.

Question 20

techniques to challenge the family structure

Answer 20

-Boundary making
-Unbalancing
-Teach complementarity

Question 21

explain boundary making

Answer 21

Boundary making techniques regulate the permeability of boundaries.
-Where they sit in a session
-Do not want to overuse this, moving where people sit does change the dynamics of the room
-It is very powerful
-Shifts the boundaries

One can use
-Cognitive constructs
-Might be is there someone else that might be an authority for this person right now, anyone willing to help out and guide them through school and whatever it is that they’re doing

Concrete maneuvers
-Would you two be willing to do something on Saturday together and then come back and talk about it

Question 22

what are cognitive constructs

Answer 22

-Someone is too helpful
-“you’re helpful, you take Jane’s memory.” (iow separation is desirable)

Reframing
-Intrusions–=concern
-Strictness–=support
-Depression–=confusion

Using them to have a person imagine a situation in a different perspective

Question 23

what are concrete spatial maneuvers

Answer 23

-Use of therapist arms or body

Move chairs
-Boundaries around dyads

Homework which supports people interacting longer than normal
-Increase contact

Question 24

what is unbalancing

Answer 24

Goal: to change the hierarchical relationship.
-One may empower someone low in the order
-Empowering children, good to do when you are seeing something where parents cannot see concern and how they are contributing to the problem
-Ignores the family switchboard
-Joins coalitions against a family member

Problems:
-Questions of ethics
-Difficult

Types:
-Affiliation with family members
-Alternating affiliation - new ways of relating
-Coalition against family members

Question 25

what is teaching complementary

Answer 25

-Interdependence
-The degree to which needs and abilities dove-tail help to provide a key factor in harmonious family functioning.
-Good child-bad child/tender mother-tough father

Maintains equilibrium – represents teamwork in well functioning families
-Not as intense as homeostasis

Question 26

explain challenging the family reality

Answer 26

Transactional patterns depend on and contain the way people experience reality. Must develop new ways of interacting.

Techniques:
-Cognitive constructs
-Paradoxical interventions
-Emphasizing strengths

Alternative Ways of Seeing Things
-Tradition (age of child) “Is she 4?”
-Dr. Browning’s example of a child who is large sitting on her mom’s lap, behavior of a 4 year old even though they are biologically 7
-Common sense “Well, everyone knows that children attend school.”
-Things that “everybody knows”

Question 27

what are family truths in challenging the family reality

Answer 27

use their world view to expand their functioning (mad or bad)
-Ex. What a family might be seeing as “bad behavior” we might be seeing mental health issue, a good intervention for this is assessment

Question 28

what is expert advice in challenging the family reality

Answer 28

at times families will want this
-Ex. The family that did not process your grief
-Ambiguous loss: anything where they are physically absent but psychologically present or psychologically absent and physically present, (ex. Drug addict or person in the military)
-We are experts on this, if we are talking to someone whose spouse is deployed we have to use our expertise on ambiguous loss in this situation

Question 29

what is paradox and the two types

Answer 29

-Redefining – behavior is seen as benignly motivated to stabilize the system. (anger is caring; suffering is self-sacrificing)
-Prescribing – having been defined in a positive way, the symptom-producing cycle is then prescribed as inevitable conclusion of family logic. Family is confronted by itself.
-Restrain from change to follow through on the logic of your diagnosis of the system.
-Help families see the strength in their natural or culturally based system.
-Direct and non-direct

Question 30

what is a direct paradox

Answer 30

mother who is protecting her son, being overprotective; I see that you are worried about your child being sick, in addition to wearing a jacket, should they also wear bags over their hands
-Allow the person to see the absurdity of what they are doing

Question 31

non-direct example

Answer 31

recognize both sides of an issue can be seen as correct, have the couple where the husband is taking care of his mother constantly and the wife is complaining about how much time the husband is spending with his mother
-Both sides are right, have the other recognize that they are both right and the other is not necessarily wrong; understand the others positions

Question 32

therapists role in paradox

Answer 32

Element of Paradox:
-support while challenging
-Attach while encouraging
-Sustain while undermining

The therapist is for the people who need help, against the system of transactions that cripple them.

First, establish a working relationship. Accommodate enough to not be rejected, but not so much that you are inducted.

Find the right balance of probing, advancing/withdrawing

“Little room for neutral listening or floating attention.”

Question 33

explain the active therapist

Answer 33

-Hypotheses are: tested, expended, corrected
-Therapist is: selectively oriented toward process and away from content.
-How they relate increases, what they say decreases – language used for metaphor

Question 34

explain what the map has in structural therapy

Answer 34

-Positions,
-alliances,
-hierarchies,
-complementary patterns

Question 35

-explain therapist evolution in structural family therapy

Answer 35

Dancer -> stage director -> film director
-Start as a dancer, move back and forth and try to hear everything; then you move into a stage director; then close in on people as the film director
-Deciding to get a close-up
-“Air” the close up

Thinking of the next scene
-Where would I be moving to next clinically

Scenarios are created to: uncover hidden resources or confirm suggested limitations
-Looking for specific situations to help understand

always remember whole picture

Question 36

squestion in your mind as a therapist about homeostatic maintainer

Answer 36

How is this family keeping its homeostasis? Once determined, can I disrupt to form a new, more complex equilibrium?

someone is often called the HM (homeostasis maintainer), there is someone or multiple someones who has desire to keep things the way they are
-Not necessarily the identified patient, but it is someone who seems more investment in the family not make change
-Ex. Child with behavior problem and the dad always says “boys will be boys” about it

Question 37

what is the therapist doing in essence

Answer 37

-Moving around the system – blocking stereotyped interactions.
-Fostering the development of new ones.
-Enough empathy to understand and keep distance
-Joining is not just being accepted, but rather, being accepted with a quota of leadership.

Question 38

explain maintenance in therapy

Answer 38

The therapist lets him/herself be organized by the same rules that regulate the transactional process
-E.g. 4 generations – approval of grandmother.)

But the therapist does not perform maintenance that leave him/her powerless
-E.g. therapist does not follow the rules to verbally abuse Kathy about her misdeeds.

Question 39

explain how disequilibrium is done in therapy (changing the system)

Answer 39

Reframe: change the definitions of the original complaint from a problem of one to a problem of many.
-Anything we can do that offers an alternative perspective
-E.g. Is this how you run your lives together? Vs. Is this how she behaves usually?

She is uncontrollable
-Mom – “We try to make her do it.”
-Dad – “I make her do it!”
-More complex – Mom is ineffective, Dad is authoritarian, child is undisciplined.

Question 40

7 categories of restructuring

Answer 40

1) Actualize family transaction patterns
-Ex. Have dad talk to child instead of mom, literally shift how they are transactioning

2) Mark boundaries
-Shifting chairs or moving people around

3) Escalate stress
-Ex. Project 5 years in the future, if things continue like this I do not think this marriage will make it

4) Assign tasks

5) Utilize symptoms
-I wonder if X’s depression is leading to the family rallying and supporting him or if it is bringing the family farther apart

6) Manipulate mood
-I think there is a lot more happening here in terms of people supporting each other than you are giving credit

7) Support/Educate/ Guide
-Do not take over the process completely, but it is important to educate
-Always allow window for them to disagree with you