Structural family therapy


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A presentation on SFT

Published in: Education, Health & Medicine

Structural family therapy

  1. 1. Structural Family Therapy <ul><li>Marriage and Family Counseling </li></ul><ul><li>Dr. Sparrow </li></ul>
  2. 2. Founder <ul><li>Salvador Minuchin, born and raised in Argentina </li></ul><ul><ul><li>Child psychiatry, psychoanalytically trained </li></ul></ul><ul><ul><li>Started seeing families at a school for delinquent boys in the 50s </li></ul></ul><ul><ul><li>Self taught, collaborated with a variety of thinkers, including Jay Haley (Strategic Family Therapy) in the early 60s </li></ul></ul><ul><ul><li>Became head of the Phil. Child Guidance Clinic in 1965 </li></ul></ul><ul><ul><li>Started his own center in NY in 1981 </li></ul></ul><ul><ul><li>Retired in 1996 </li></ul></ul>
  3. 3. Underlying Assumptions <ul><li>Families (people) are competent and capable of solving their own problems -- an attitude derived from the existential-humanistic tradition </li></ul><ul><li>Therapists work collaboratively with families, not as experts who can solve problems, but as consultants and coaches who can work to bring the family’s dormant capacities to the surface. </li></ul><ul><li>Therapists respect the family’s unique culture. The question should be, not “What’s ideal?” but “Does it work for them?” </li></ul><ul><li>SFT is the beginning of the postmodern approaches, but retains some traditional views concerning the importance of power and hierarchy </li></ul>
  4. 4. SFT Principles <ul><li>There is an overall organization or structure that maintains a family’s dysfunctional interactions. </li></ul><ul><ul><li>Power and hierarchy </li></ul></ul><ul><ul><li>Subsystems and boundaries </li></ul></ul><ul><ul><ul><li>Boundaries can be clear or normal, weak or diffuse (too open), or rigid (too closed) </li></ul></ul></ul><ul><li>Restructuring is based on observing and manipulating interactions within the session </li></ul><ul><ul><li>Spontaneous behavior sequences -- form the basis for hypotheses about family structure </li></ul></ul><ul><ul><li>Enactments -- interactions suggested by the therapist as a way to diagnose structure, and to provide an opening for restructuring intervention. </li></ul></ul>
  5. 5. Concepts and Definitions <ul><li>Structure </li></ul><ul><ul><li>an organized pattern in which families interact, not deterministic or prescriptive, only descriptive </li></ul></ul><ul><ul><li>Partly universal, partly idiosyncratic </li></ul></ul><ul><ul><li>Can only be seen when a family is in action, because verbal descriptions rarely convey the true structure. (Haley once said that if you ask a family member what the problem is, what they describe is not the problem.) </li></ul></ul>
  6. 6. Concepts, continued <ul><li>Subsystems are subgroupings within the family based on age (or generation), gender and interest (or function) </li></ul><ul><ul><li>parenting </li></ul></ul><ul><ul><li>spousal </li></ul></ul><ul><ul><li>sibling </li></ul></ul><ul><li>Boundaries are invisible barriers that regulate contact between members </li></ul><ul><ul><ul><li>Diffuse, too weak, or “enmeshed” </li></ul></ul></ul><ul><ul><ul><li>Rigid, too fortified, or “disengaged” </li></ul></ul></ul>
  7. 7. Concepts, continued <ul><li>Boundaries are reciprocal </li></ul><ul><ul><li>That means that a weak boundary (enmeshment) in one relationship usually means that the same person is disengaged from someone else. </li></ul></ul><ul><ul><li>Example is wife who is enmeshed with child and disengaged from husband </li></ul></ul><ul><ul><li>Example is father who is very close and enmeshed with older son who hunts with him, and disengaged with daughter who is quietly depressed and cutting herself. </li></ul></ul>
  8. 8. A Couple’s Challenge: Forming a Healthy Spousal Subsystem <ul><li>Must develop complementary patterns of mutual support, or accommodation (compromise) </li></ul><ul><li>Must develop a boundary that separates couple from children, parents and outsiders. </li></ul><ul><li>Must claim authority in a hierarchical structure </li></ul>
  9. 9. How Problems Develop <ul><li>Inflexible response to maturational (or developmental) and environmental challenges leads to conflict avoidance through disengagement or enmeshment </li></ul><ul><li>Disengagement and enmeshment tend to be compensatory (I’m close here to make up for my distance elsewhere.) </li></ul><ul><li>This leads to what is called the cross-generational coalition, which is a triangular structure </li></ul>
  10. 10. Therapeutic Goals <ul><li>Therapy is directed at altering family structure. </li></ul><ul><ul><li>General goals of family are important, but not as important as creating an effective structure. </li></ul></ul><ul><ul><li>Creation of </li></ul></ul><ul><ul><ul><li>effective hierarchy </li></ul></ul></ul><ul><ul><ul><li>executive subsystem </li></ul></ul></ul><ul><li>Structural problems are usually viewed simply as failure to adjust to changes. </li></ul><ul><li>Therapist doesn’t solve problems, that’s the family’s job. </li></ul><ul><li>Boundaries must be strengthened in enmeshed relationships, and weakened (or opened up) in disengaged ones. </li></ul>
  11. 11. Therapist’s Role <ul><li>Joins the family in a position of leadership </li></ul><ul><li>Maps the family’s underlying structure (boundaries, hierarchy, subsystems) </li></ul><ul><li>Intervenes to transform the structure </li></ul>
  12. 12. Therapeutic Goals <ul><li>Not a matter of creating new structures, but activating dormant ones </li></ul><ul><li>What distinguishes SFT from other forms of family therapy is the emphasis on modifying family structure in the immediate context of the therapy setting. </li></ul><ul><li>When new patterns are repeated, and result in improvement of family relationships, they will stabilize and replace old patterns without having to keep supporting them. (Similar to the behavioristic notion of reinforcement.) </li></ul>
  13. 13. Therapeutic Interventions <ul><li>Joining in a position of leadership, and accommodating </li></ul><ul><ul><li>Family is set up to resist you. You are a stranger, and know nothing about their struggles, and their goodness. </li></ul></ul><ul><ul><li>Important to join with angry and powerful family members </li></ul></ul><ul><ul><li>Important to build an alliance with every family member </li></ul></ul><ul><ul><li>Important to respect hierarchy </li></ul></ul>
  14. 14. Therapeutic Interventions <ul><li>Working with Interaction by inquiring into the family’s view of the problem, and tracking the sequences of behaviors that they use to explain it. </li></ul><ul><li>Mapping underlying structure in ways that capture the interrelationship of members -- A structural map is essential!) </li></ul><ul><ul><li>Family structure is manifest only with members interact </li></ul></ul><ul><ul><li>By asking everyone for a description of the problem, the therapist increases the chances for observing and restructuring family dynamics. </li></ul></ul>
  15. 15. Therapeutic Interventions <ul><li>Highlighting and modifying interactions </li></ul><ul><ul><li>Spontaneous behavior sequences </li></ul></ul><ul><ul><li>Enactments -- directed by therapist </li></ul></ul><ul><li>Restructuring </li></ul><ul><ul><li>Use of reframing to illuminate family structure </li></ul></ul><ul><ul><li>Use of circular perspectives, e.g. helping each other change </li></ul></ul><ul><ul><li>Boundary setting </li></ul></ul><ul><ul><li>Unbalancing (briefly taking sides) </li></ul></ul><ul><ul><li>Challenging unproductive assumptions </li></ul></ul><ul><ul><li>Use of intensity to bring about change (not giving up) </li></ul></ul><ul><ul><li>Shaping competency </li></ul></ul><ul><ul><li>Not doing the family’s work for them (refusing to answer questions, or to step in and take charge when it’s important for the family members to do so. </li></ul></ul>
  16. 16. Therapeutic Interventions <ul><li>Homework </li></ul><ul><ul><li>Should be to increase contact between disengaged parties, </li></ul></ul><ul><ul><li>To reinforce boundaries between individuals and subsystems that have been enmeshed </li></ul></ul><ul><ul><li>Should be something that is not too ambitious </li></ul></ul><ul><ul><li>While Minuchin rarely used strategic interventions, he did caution family members to expect setbacks, in order to prepare them for a realistic future. </li></ul></ul>