Therapist

Examples of structural family therapy interventions


What Is Structural Family Therapy?

Structural family therapy (SFT) is a type of family therapy that looks at the structure of a family unit and improves the interactions between family members. This approach to therapy was originally developed by Salvador Minuchin and has become one of the dominant forms of family intervention.

It suggests that dysfunctional family relationships can create stress and mental health problems for members of that family. 

By addressing how members of the family relate to one another, the goal is to improve communication and relationships to create positive changes for both individual family members and the family unit as a whole.

Techniques

Structural family therapy relies on a technique known as family mapping to uncover and understand patterns of behavior and family interactions. During this process, the therapist creates a visual representation that identifies the family’s problems and how those issues are maintained through family dynamics.

This map diagrams the basic structure of the family, including the members of the family unit, their ages, genders, and relationships to one another. Aspects of the family observed during this process include:

  • Family rules
  • Patterns of behavior
  • Family structure/hierarchies

This process frequently involves having family members themselves make their own maps describing their family. This not only boosts engagement in the therapeutic process but also gives a therapist a better understanding of how individual family members view their place within the family.

“Inviting family members to place the people and write their names inside a circle promotes a recognition of their mutual belongingness, an awareness that ‘these are us,'” explained Salvador Minuchin and his colleagues in Working With Families of the Poor.

After this initial process, the therapist observes the family during therapy sessions and in the home environment to track interactions and develop a hypothesis about the nature of the family’s relationships and interaction patterns.

Other techniques that may be used during SFT include:

  • Joining: This technique involves the therapist developing a sharing and empathetic relationship to “join” the family.
  • Boundary-making: The therapist will help the family identify, explore, and adopt clear boundaries and hierarchies within the family.
  • Role-play: This involves acting out scenarios with the therapist’s guidance to look at certain patterns of behavior, identify dysfunction, and practice enacting alternatives.
  • Reframing: In cognitive reframing, the therapist helps family members think about situations in different ways or see things from a different perspective. This can help people see experiences more positively.

What Structural Family Therapy Can Help With

Structural family therapy can be helpful for many families, but it is often recommended in situations or life events that involve:

  • Families affected by trauma
  • Divorce, separation, or remarriage 
  • Blended families
  • Intergenerational families
  • Single-parent families
  • When one family member is affected by a mental health condition such as depression, anxiety, substance use, or post-traumatic stress disorder (PTSD)
  • Families affected by chronic illness or disability
  • Significant life changes such as changing careers, coming out, or moving

Any family that is coping with tension or conflict can potentially benefit from structural family therapy.

Vulnerable families faced with readjustments caused by shifting roles, changed norms, and new demands may benefit from this type of therapy, which has been shown to help empower and strengthen the entire family system.

Benefits of Structural Family Therapy

Families struggling with conflict can benefit from this type of therapy for many reasons. Some of the ways it may help include:

  • Corrects imbalances within a family
  • Establishes healthy boundaries
  • Helps individuals improve their reactions to changing demands
  • Improves communication
  • Improves hierarchies within the family system
  • Increases parental competence and satisfaction
  • Improves relationship dynamics
  • Reduces anger and resentment

SFT recognizes that many aspects of a family’s structure—including behavior patterns, routines, habits, and communication—can contribute to dysfunction. However, this approach to therapy can help families become more stable and improve support to individual family members who may need extra help by working to address these issues.

It can be beneficial for families that have dealt with some significant change in their lives. For example, this might involve the death of a family member, a change in the family structure through a divorce, or some trauma such as interpersonal violence or an accident. 

Effectiveness

Structural family therapy has been shown to be effective at helping to address problems within families. Studies have also demonstrated the efficacy of this type of therapy. 

  • A 2019 study looking at the impact of family therapy on adolescents with mental health problems and their families found that therapy incorporating SFT offered several benefits. For example, the results indicated that after treatment, teens exhibited fewer externalizing and internalizing symptoms. In terms of other improvements, parents also reported increased family cohesion, better parental practices, and greater perceived efficacy as a parent.
  • A small 2020 case study found that structural family therapy was an effective approach for improving marital mediation and reducing marital distress. However, the study authors noted that follow-up was needed to evaluate the long-term effects of treatment better.

Since its initial development in the 1960s, SFT has become one of the predominant family counseling theories.

Things to Consider

The amount of time needed for treatment to be successful often depends on the dynamics of the family and the situation they are facing. Some families may require relatively short-term treatment lasting a few weeks, while others may need more sessions lasting several months. 

Participation and cooperation play an important role in the success of this type of treatment. However, some family members may be less cooperative or may refuse to participate altogether.

How to Get Started

If you think that structural family therapy may be helpful, ask your doctor if they can refer you to a professional who practices this type of treatment. You may also search an online directory to locate professionals in your area who specialize in SFT. 

Some questions you might ask before you begin treatment include:

  • How much experience does the therapist have with SFT?
  • How long treatment is expected to take?
  • How will progress be measured?
  • What happens if some family members miss therapy sessions?

During your first appointment, your therapist will ask you questions to learn more about the problems you are facing and how your family currently functions. They may ask you to create a family diagram to describe relationships between members of the family and work to get a better view of the dynamic between individuals in the family.

After your initial session, your therapist will then be able to provide a fuller view of your family’s treatment plan and what else you can expect during treatment.

Salvador Minuchin developed structural family therapy in the 1960s after working as a pediatrician in Argentina. After spending time exclusively working with children, he began to realize that treating them alone didn’t inherently solve their problems. 

His model of structural family therapy began as a way of identifying and treating problems within family systems. He believed that problems were not individually-based; instead, they were a function of the family’s homeostasis.

This therapy can help families struggling with various issues, such as trauma. It may also treat different high-risk situations, like single-parent households, families struggling with severe marital problems, or families with special-needs children. 

Basic Assumptions of Family

Structural family therapists tend to assume the following:

  • Families are capable and competent in solving their issues.
  • Rigid or enmeshed boundaries can prevent closeness and growth.
  • Individual symptoms are often a result of the entire family system.
  • Each family has subsystems, which hold onto different levels of power.
  • All family systems want homeostasis (a sense of stability and balance).

Structural family therapists aim to be equal and collaborative in their work. They perceive families as unique and special, and they don’t try to enforce rules on them that don’t work. Instead, they aim to present viable suggestions for change. 

Understanding Family Structure

It should come as no surprise that structural family therapists focus on the structure within each family. The structure refers to what builds, maintains, and even destroys individual families.

Hierarchy of Power

All families have a hierarchy of power. In healthy systems, the parents or caregiver(s) hold the authority. They decide what’s best for their children, and they work as a united team to instil boundaries. 

But as we know, this hierarchy isn’t the case for all families. In some systems, children seem to run the house. They call the shots and make the rules, and parents may fall helpless to their demands.

In other households, only one parent has all the power. The other parent may become subservient to them, which can result in a lopsided structure. Children may feel afraid of the powerful parent. The powerful parent may use threats, hostility, or even violence to maintain their role. 

Whoever holds power makes the decisions. If the power consistently fluctuates, it leaves family members feeling confused and untethered. This is especially true for children. Without consistency, they don’t understand which rules they need to follow. They may rebel or defy their parents if this pattern persists.

Subsystems

Family subsystems refer to the specific subgroupings within a family. These groupings happen based on gender, age, or interest. Common subsystems include:

  • Parental: can include any caregiver taking care of the children
  • Spousal: may include a single parent or couple
  • Sibling: includes any biological, adopted, or step-sibling pairs 

Subsystems can be measured based on the boundaries maintained between each member.

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Boundaries 

Structural family therapists measure dysfunction based on boundaries and how family members adapt to different stressors. In functional families, family members are flexible and fairly easygoing. 

They have clear boundaries, but they can adjust these limits as needed. Dysfunctional families, on the other hand, tend to have rigid or enmeshed boundaries. 

Rigid boundaries are strict and inflexible. In these households, members are expected to follow certain beliefs without question. These beliefs can include anything from religious affiliation to food preferences to what kind of occupation the children should aspire to have. 

Rigid family systems rarely support individual thought. Instead, members are accepted by their willingness to conform to the status quo. 

Enmeshed boundaries refer to blurred, nonexistent, or loose boundaries between family members. Some signs of enmeshment include:

  • Family members taking on the emotions of other family members
  • Feeling like you’re not allowed to be close to people outside of the family
  • Spending all your free time with one another
  • Having no sense of privacy 
  • Parents seeking their child’s approval, friendship, or emotional support
  • Becoming overinvolved in each other’s lives

Enmeshed families tend to present as “very close” to the outside world. Therefore, it can be challenging to discern that problems exist. But many times, enmeshment can lead to struggles with identity, decisiveness, and assertiveness. 

Boundaries are reciprocal, and they have ongoing ripple effects. For example, a mother who is extremely close with her daughter may withdraw from her husband. If a father favors his oldest son, the younger son may become anxious, depressed, and angry.

Triangulation 

Triangulation happens when one family member tries to use something or someone else to pit against another family member. 

For example, two arguing parents may ask their child to play referee. Or, a parent may always step in when two siblings disagree, which means they never have the chance to resolve their conflicts together. At times, clients may even attempt to triangulate the therapist to avoid talking to one another directly.

Parentified Children

Parentified children may result from dysfunctional families. In these cases, the parents often rely on the child to provide ongoing emotional or physical support. For instance, a parent may share their marital problems with her small child. Or, they might expect their child to start working in the family business while in elementary school.

These parentified children often grow up seeming overly mature and wise. They may get along very well with other adults because they seem like small adults themselves. 

Unfortunately, even though they present as responsible, they tend to feel misunderstood and insecure. Having been robbed of their childhood, they’re often used to taking care of other people- rather than the other way around. 

Structural Family Therapy Goals

The main goals include establishing clear boundaries and shifting the hierarchical structure. Structural family therapists work to improve the separation between couples, children, parents, and other family members. They also aim to strengthen subsystems.

Making slight changes to the structure can improve happiness and functioning. As family members learn to adapt to new boundaries, they gain more respect for one another. 

Getting Started 

Just like with any professional therapy, the first steps include intake and consent. The intake consists of learning about the family, reviewing goals, and assessing for mental health concerns. Families may fill out a written questionnaire or respond to a series of questions. 

This intake information helps the therapist establish a working treatment plan. The treatment plan entails goals, objectives, and expectations for therapy.

Consent is an essential part of any therapy process. Consent means consenting to therapy- which refers to agreeing to the terms, limitations, and expectations of the process. The therapist will review the limits of confidentiality and also discuss administrative concerns like payment, scheduling, and frequency of sessions. 

Confidentiality is one of the most important factors in family therapy, and this is especially true if the therapist is meeting with any of the members individually. It’s essential that each person thoroughly understands their right to privacy.  

Joining The Family

Structural family therapists don’t assume they are experts on the families they treat. Instead, they aim to join the family. This joining requires building rapport, providing validation, and having a genuine interest in each member.

By becoming a part of the system, they learn the rules, hierarchies, and subsystems between members. Joining happens at the beginning of therapy. However, it isn’t just a one-time event. The therapist must continue to maintain their position as a stand-in family member for the duration of therapy. 

Many structural family therapists join through mimesis. In this method, they take on the family’s style of communication and mannerisms. If the family is overly sarcastic, they will make witty jokes. This isn’t disingenuous- it’s meant to show respect for how the family acts and behaves.

The Typical Session

In structural family therapy, the therapist first spends time observing the family interact with one another. It’s not uncommon for families to present on their best behavior when they first arrive at the office. This usually happens due to a combination of nerves and people-pleasing tendencies. They may also want to impress the therapist.

But family therapists are skilled in making careful analyses of human behavior. They notice small discrepancies and patterns. Let’s discuss some common interventions used in this model.

Mapping

Family therapists use structural maps to present how family members interact with one another. 

They achieve this task by asking each family member to thoroughly describe the family problems. There is no interrupting or shaming allowed- families have full freedom to speak what’s on their mind.

Reframing

Reframing is a way to provide an alternate perspective to a certain thought. 

For example, a therapist may reframe a father’s strict protectiveness over his daughter as he loves her and feels concerned about her safety. They may reframe a child who continues to talk back to his teacher as wanting to learn how to express themselves and have a voice.

Reframing aims to create more solutions for fixed problems. It’s a way of softening the discomfort. When families can believe that each member has good intentions, the system tends to feel safer. As a result, people become less hostile, judgmental, and self-serving. 

Enactment

Enactment refers to families engaging and interacting with one another, rather than to the therapist directly. This exercise allows the clients to become more aware of their patterns. It also enables the therapist to observe them more closely.

Enactments offer many insights, including:

  • How couples relate and interact with one another
  • How children feel talking to their parents and vice versa
  • How different boundaries or triangles affect relationship satisfaction

The therapist may direct the family to enact a specific conflict. During the enactment, the therapist can watch how families talk, respond, and react. 

Restructuring 

Along with reframing, restructuring includes different techniques to disrupt the family’s homeostasis. It will include exercises like setting boundaries, unbalancing (temporarily taking one person’s side), and heightening emotion to evoke change.

Heightening emotion helps families recognize the severity of their behaviors. It’s not uncommon for families to run on auto-pilot for many years. They may not recognize how much damage they are inflicting until someone points it out. Subsequently, since the therapist has already joined the family, they are more likely to listen to the therapist’s observations. 

Boundary marking refers to having families identify the limits needed between subsystems. Therapists will work with families to discuss the appropriate boundaries to consider setting. At this point, they have made astute observations, which can be incredibly helpful in supporting family members to navigate this uncharted territory.

Therapists do not attempt to solve the family’s problems. They encourage family members to take ownership over making change. The goals should not be so far-fetching that they feel unrealistic. Instead, structural family therapy aims to be realistic and feasible.

Shaping Competence 

Shaping competence refers to acknowledging and praising positive behaviors. In a sense, it’s a form of positive reinforcement. Therefore, a therapist may reinforce a parent who supports their child to follow a specific rule. This reinforcement ideally encourages them to continue making that choice. It reinforces that they are capable of doing the right thing.

Finding a Structural Family Therapist

If you think structural family therapy sounds like a good option for your family, start looking for professionals in your local area. In some cases, insurance may cover some or all of your co-pay. Contact your insurance provider to determine your eligibility. They may also have a referral list of in-network providers.

You will want to seek someone who has a background in family therapy with specific structural family therapy training. It’s reasonable to ask clarifying questions. Consider asking potential candidates: 

  • How long have you been practicing therapy?
  • What kind of expertise or training do you have in structural family therapy?
  • What outcomes do you anticipate for my family?
  • How often do you think we will meet?

Finding the right therapist may require some trial-and-error. You might need to meet with a few different providers before finding the right fit. This is normal. Just like with any relationship, it’s important that you feel respected, heard, and appreciated.

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