Structural Therapy Flashcards
1
Q
Structural Family Therapy
A
Salvador Minuchin
- Medical training: pediatrics and child psychiatry
- Wiltwyck School for Boys
- Mutual influence with Jay Haley (strategic)
2
Q
Tenets of Structural Family Therapy
A
- Core Assumptions:
- 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
- Essential Concepts to Understand:
- Structure
- Subsystems
- Boundaries
- Structural Family Therapy is a way to conceptualize what occurs in
families and it includes some techniques
3
Q
Structural Terminology
A
- Family Structure: the way a family is organized into subsystems and
how the interaction among those subsystems is regulated by
boundaries- 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
- The process of a family’s interaction is like the patterns of
- Families are differentiated into subsystems based on generation,
gender, and function, which are demarcated by interpersonal
boundaries, invisible barriers that regulate contact with others - Rigid boundaries are restrictive and permit little contact with outside
subsystems, resulting in disengagement- Independence over intimacy
- Diffuse boundaries are permeable and promote too much contact
with other systems, resulting in enmeshment- Intimacy over independence
4
Q
Stance of the Structural therapist
A
- Active in sessions
- Views families as resilient
- Not fundamentally flawed, but instead needing key adjustments to
flourish
- Not fundamentally flawed, but instead needing key adjustments to
- Pays attention to both content and process of relational interactions
- Oscillates b/w first and second order cybernetic stance
Employs these Key strategies:
* Enactments
* Realignment/Restructuring family interactions
* Boundary setting
* Systemic reframing
* Intensity
* Compliments
* Shaping Competence
* Challenging Family Worldview
* Expanding Family Truths
* To a lesser extent these:
- Unbalancing
- Crisis Induction
5
Q
Structural view of clinical problems
A
Healthy Development
* All families have structure that is developed through repetition and
through influence of external context
* Families are able to be flexible/adapt when the situation calls for it
- Developmental phases are particularly difficult for families
Problems
* Family Systems function poorly when subsystems, boundaries and
roles:
- do not adapt to changing needs (developmentally) and/or
- do not support healthy balance of closeness AND autonomy
between members
* Usual way of responding has become rigid without adaptation.
Symptoms develop from poor structural experiences
6
Q
Overlapping Phases
A
- There are three overlapping phases in the process of structural
family therapy. - The therapist:
1) Joins with the family in a position of leadership
2) Maps their underlying structure and
3) Intervenes to transform this structure. If a therapists’
interventions are to be effective, they cannot be preplanned or
rehearsed. - In general, SFT follows these steps:
- Joining and Accommodating
- Enactment
- Structural Mapping
- Highlighting and modifying interactions
- Boundary Making
- Unbalancing
- Challenging unproductive assumptions
7
Q
Joining & Accommodating
A
- 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. Therapist must disarm these
defense and ease anxiety. - 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.- Tracking refers to the therapists’ observation of the family’s
patterns of communication, behavior, and attitudes/values. - 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
- Tracking refers to the therapists’ observation of the family’s
8
Q
Enactment
A
- Family structure manifests in the way family members interact.
Families often describe themselves more as they think they should
be than as they are. Getting family members to talk among
themselves run 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 may see one partner sitting passively
while the other partner cries.
9
Q
Structural Mapping
A
- Mapping underlying structure in ways that capture the
interrelationship of members - Map of hypothetical family structures
- Helps to determine goals
- Family structure manifests only with members interaction
- By asking everyone for a description of the problem, the therapist
increases the changes for observing and restructuring family
dynamics
10
Q
Highlighting and modifying interactions
A
- Once families begin to interact, problematic transactions emerge.
Recognizing their structural implications demands focus on process,
not content. - The trick to change cyclical negative interaction is to modify the
pattern. This may require forceful intervening, or what SFT call
intensity. - Intensity isn’t a function of personality; it reflects clarity of purpose.
Knowledge of family structure and a commitment to help families
change make powerful interventions possible. - Structural family therapists achieve intensity by selective regulation
of affect, repetition, and duration. Tone, volume, pacing, and choice
of words can be used to raise the affective intensity of statements.
11
Q
Intensity
A
- Therapists don’t need to make speeches, but they do occasionally
have to speak forcefully to get the point across. - Affective intensity isn’t simply a matter of clever phrasing. You have
to know how and when to be provocative. - What I am calling intensity may strike some as overly aggressive. An
alternative strategy for stalemated interactions is the use of
empathy to help family members get beneath the surface of their
defensive wrangling. - Shaping Competence is another way you can modify interactions
and involves picking out something that families are doing
successfully.
12
Q
Boundary Making
A
- In enmeshed families, interventions are designed to strengthen
boundaries.- Family members are urged to speak for themselves, interruptions
are blocked, and dyads are helped to finish conversations without
intrusion.
- Family members are urged to speak for themselves, interruptions
- Disengaged families tend to avoid conflict and thus minimize
interaction.- The structural therapists intervenes to challenge conflict avoidance
and to block detouring in order to help disengaged members
break down the walls between them.
- The structural therapists intervenes to challenge conflict avoidance
- SFT therapists move family discussions from linear to circular
perspectives by stressing complementarity.- The mother who complains that her son is a trouble-maker is
taught to consider what she’s doing to trigger or maintain his
behavior. The person who asks for change must learn to change
his or her way of trying to get it.
- The mother who complains that her son is a trouble-maker is
- SFT emphasize complementarity by asking family members to help
each other to change.
13
Q
Intervention - Unbalancing
A
- An intervention that supports one family member and interferes
with homeostasis: Taking sides (only briefly)- Not meant to be blaming, but is used to alter the system into
changing from current structural impasses - Usually used when one member is being blamed for everything
(i.e. identified patient) or when there are extreme difficulties in
hierarchy
- Not meant to be blaming, but is used to alter the system into
- 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 - 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.
- What often keeps families stuck in stalemate is that members in
- Differences are normal, but they become detrimental when one
parent undermines the other’s handling of the children.
14
Q
Challenging unproductive assumptions
A
- Although SFT is not primarily a cognitive approach, its practitioners
do challenge unproductive assumptions that support structural
problems. - Changing the way family members interact offers alternative views
of their situation. The converse is also true: Changing the way family
members view their situation enables them to change the way they
interact.
15
Q
Intervention - Intensity
A
- Therapist turns up the “emotional heat” using tone of voice, pacing,
and word choice - Achieved in varying degrees, not always as dramatic as it sounds
- Can help solidify the utility of enactments
- Purpose: to spark change to patterns of interaction when family
seems stuck in old established ways of interacting
