Structural Family Therapy

Question 1

What is the theory of Structural Family Therapy?

Answer 1

• Behavior problems reflect inadequate family structure, usually resulting from a nonhierarchical arrangement of the parent and child subsystems.
• Inadequate family hierarchy occurs when the family members fail to recognize alternative patterns of engaging each other or when there is conflict between the parents.

Question 2

What is the goal of Structural Family Therapy?

Answer 2

The goal of therapy is to change boundaries and hierarchies sufficiently to remove or reduce the presenting problem.

Question 3

What does the therapist do in the session?

Answer 3

• The therapist assesses where in the system the structure fails to carry out its function.
• The therapist then tries to disrupt the existing inadequate structure by forcing new interactions to occur during the session.
• The therapist alters the existing patterns by giving directives and demanding participation by the family members.

Question 4

Who is the founder of Structural Family Therapy?

Answer 4

Salvador Minuchin
Minuchin’s thinking shifted from a traditional psychodynamic view of human behavior to one reflecting a sociological perspective. This shift occurred contemporaneous to two ideas forwarded by Parsons and Bales (1955). First, the behavior of each family member influences and reflects family structure. Second, these behaviors also maintain the division of labor in the family; in turn, the division of labor maintains the structure. In short, the behavior of any family member serves to maintain structure.
The assumption that the presenting problem has a homeostatic function is still a cornerstone of the model.

Question 5

Key Terms-Structure

Answer 5

behavior patterns organized to fulfill the functions of the family. SFT uses diagrams to illustrate family organization.

Question 6

Key terms-subsystems

Answer 6

one or more family members organized to carry out family roles. Subsystems are defined by redundant patterns organized across three dimensions: time, proximity, behavioral activity. There are three primary subsystems: spousal, parental, child.

Question 7

Key terms-boundaries

Answer 7

metaphorical barriers that surround subsystems. These boundaries, categorized by their level of permeability, regulate the amount of contact with other subsystems.

Question 8

What is diffuse boundary?

Answer 8

the boundary is too permeable, resulting in minimum autonomy and individuation. Individuals within these subsystems perceive a sense of emotional and psychological support but often fail to develop a sense of autonomy. Diffuse boundaries are associated with the concept enmeshment.

Question 9

What is clear boundary?

Answer 9

regulated and optimal amount of permeability.

Question 10

What is rigid boundary?

Answer 10

restrains contact with other subsystems. Rigid boundaries produce disengaged subsystems; these individuals are characterized by autonomy and independence but lack a sense of emotional and psychological support.

Question 11

What is hierarchy?

Answer 11

the preferred ranking of subsystems; the parental subsystem should be above the child and sibling subsystems.

Question 12

What is power?

Answer 12

the relative influence each family member has on the outcome of a system activity. Family members form coalitions to affect power.

Question 13

What is triangulation?

Answer 13

the child’s alliance with one parent against the other parent. This latter parent perceives the alliance as betrayal.

Question 14

What is coalition?

Answer 14

two family members regularly join against a third. Triangulation always involves a child; a coalition may not.
o Stable coalition-Inflexibility characterizes a stable coalition; the coalition does not vary across most family functions.
o Detouring coalition-Interpersonal conflict characterizes a detouring coalition; a third party is blamed for the discord. Detouring coalitions have been suggested as a possible mechanism underlying psychosomatic illness.

Question 15

What are rules?

Answer 15

o	Generic (universal)- interaction patterns assumed to apply to all families. Families arrange themselves hierarchically, and parents show complementarity and reciprocity. 
o	Idiosyncratic (individualized)- interaction patterns within a specific family. Patterns evolve over time, and, although not explicit, everyone knows they exist and can anticipate the consequences for a pattern violation. 
Rule flexibility- Flexibility in rules allows the system to accommodate normal transitions and unexpected transitions.

Question 16

Technique-Enactment

Answer 16

• Enactment-forcing the family to engage in behavioral patterns associated with the presenting problem. An enactment achieves the following outcome:
o Raises in-session intensity.
o Destabilizes the system
o Provides the therapist with information about the family structure; an opportunity to demonstrate that the current patterns are inadequate, and an opportunity for reframe.

Question 17

Technique-Joining

Answer 17

• Joining-therapist acts to increase family comfort by using the family’s behaviors, language, and communication style. The therapist uses three primary techniques to join the family.
o Accommodating- becoming part of the family system by using the family’s thinking patterns, symbols, and organizational structure.
o Tracking- using simple verbal and nonverbal behaviors that convey that the therapist is engaged and listening.
o Mimesis-subtle mimicking of the family’s affective and communication style.

Question 18

Technique-Raising intensity

Answer 18

The therapist manipulates affect intensity to destabilize patterned transactions within the family; only after the entrenched patterns are disrupted can new patterns be put in place consistent with the premises of this model.
o Enactments
o Adding or subtracting subsystems
o Forming new cross-generational coalitions
o Altering the symptoms-exaggerating the symptom; deemphasizing the symptom; moving to a new symptom; relabeling the symptom.
o Reinforcing spontaneous behavior sequences
o Using temporal or physical distance to reinforce boundaries (e.g., moving chairs or family members).
o Using goal-specific tasks that force new transactions.

Question 19

How Do Problems Arise?

Answer 19

Dysfunctional behavior arises from inadequate family structure. At least two mechanisms produce this inadequacy:
• Lack of appropriate reconfiguration concomitant with life stage developmental changes; unexpected major changes in family composition; major environmental changes.
• Evolving conflict in the parental relationship.

Structural therapy assumes that the symptom
• Signals a structural deficit.
• Deflects intrasubsystem conflict onto a scapegoat thereby stabilizing an unstable situation by focusing attention away from the subsystem, and
• Retards normal developmental maturation.

Question 20

How Do Problems Persist?

Answer 20

The identified patient in this model represents the system-aberrant behavior reflects inadequate structure. The continued expression of problem behavior, or even psychosomatic illness, represents the fulfillment of actions consistent with the faulty structure.

Question 21

What is the Objective of Therapy?

Answer 21

Removing the symptoms is the goal of therapy. This occurs when the faulty family structure changes sufficiently to stop dysfunctional transactions.

Question 22

What Produces Change?

Answer 22

Change occurs by introducing transactional patterns that reinforce appropriate hierarchies and strengthen boundaries. These structural changes alter the assumed or assessed structural deficit.

Question 23

How Does Change Occur?

Answer 23

Change occurs when the therapist uses in-session techniques to alter the way family members interact. Theory assumes that in-session transaction pattern deviations will force structural reorganization and that these changes will generalize to the home environment.

Question 24

How Does Treatment Proceed?

Answer 24

Initial Sessions
• Join the family-accommodation, tracking, mimesis.
• Assess family structure
o Asking questions
o Using enactments
o Watching interactions for cross-generational coalitions, interparental conflict, and inadequate boundaries between subsystems.
• Attend to the presenting problem
• Assume that the family has available but unused alternative methods of interacting.
• Raise intensity strategically
• Give directives that restructure the family system by
o Reinforcing good transactions
o Expanding the repertoire of transactional patterns available to the family
o Challenging behavioral patterns, not individuals
o Challenging the family’s perception of the problem.
o Using reframes
Subsequent Sessions
• Create objectives:
o Small changes in interactions are accepted as progress
o Therapy attempts to develop an effective hierarchy with an executive coalition, and clear boundaries.
o Devise system level structures that are appropriate for the family’s developmental stage, and allow age-appropriate individuation.
• Termination of treatment is appropriate when:
o The presenting problem is gone;
o The structure supporting the symptom has changed
o Structural flexibility allows future adaptation to changes.

Question 25

What is the Role of the Therapist?

Answer 25

The therapist is responsible for forcing the family to change their interaction patterns. To induce this change, the therapist is active, gives directives, quick to give positive reinforcement, uses humor, infrequently uses self, giving advice only if strategically useful.
Family structure is manipulated at two levels, the overt and the covert. The therapist
• Overtly manipulates the family structure by
o Raising intensity
o Use of enactments
o Moving people and furniture
o Commenting on and altering process
• Covertly manipulates the family structure by
o Posing questions that focus on structure and the desired structural change,
o Challenging attributional sets.