Structural-strategic couple and family therapy focuses on how family structures define roles, rules, and boundaries. Symptoms originate when the executive subsystem is ineffective in managing stress or responding to life changes. Therapists challenge symptoms by assessing their purpose within the family system and prescribing tasks to practice new interaction patterns without the problematic behavior. The life cycle model outlines developmental stages and tasks that can create stress if the family is inflexible in adapting to needed changes.

1. Structural-Strategic Couple and Family Therapy
Demetrios Peratsakis, LPC, ACS

2. Presenter's Notes
1. Slide Notes: This PowerPoint provides information that will not be covered during the presentation, so please review
the material at your convenience and contact me directly for further clarification.
2. Role-Play Demonstration: A structural-strategic family therapy session will be demonstrated; while styles vary broadly,
it will punctuate some common, simple rules that can advantage family practice.
3. F/C Specialization (1980-1995): This was a very active period in my own practice of marriage and family therapy;
while we benefit from our work with many, I am particularly indebted to
- AAMFT Supervisor Robert Sherman, co-founder of Adlerian Family Therapy and developer of the Marriage and
Family Therapy programs at Queens College. From 1980 until 1992 he supervised my training, adjunct faculty work,
and involvement in the department’s annual MFT Founder Series, sponsoring such notable theorists as M. Andolphi,
J. Framo, M. McGoldrick, C. Whitaker, M. Bowen, J. Haley, and the Minuchins;
- AAMFT Supervisor Neil Rothberg for our work together at the ASPECTS Family Counseling Center (1982 to 1992);
- Richard Belson, Director, for a 2-year intensive at the Family Therapy Institute of Long Island in live-supervision and
strategic family therapy (1990 to 1992). Richard collaborated with Jay Haley and Cloe Madanes as faculty at the
Family Therapy Institute of Washington, D.C. from 1980 to 1990 and served on the editorial board of the Journal of
Strategic and Systemic Therapies, from 1981 to 1993;
- Strategic Impact (1992-1995), a professional cooperative for advanced training methods in couple and family therapy.
- Demetrios Peratsakis, LPC, ACS

3. A New Understanding of Human Nature and How to Treat its Problems

4. Rubin Vase
Family Systems Therapy forced a new insight into our customary
view of the individual and their relationship systems.

5. Family Systems Therapy expanded on the belief
that psychological symptoms were the creation of the
individual in service to their family.
IP: Lightning Rod? Scape-goat? Sacrificial Lamb?

6. IMHO, there are three (3) very significant perspectives
that have reshaped our understanding of the purposiveness of human behavior:
1. Psychological symptoms are the creation of the individual in service to their family
2. Thought creates feelings which drive behavior; all reaffirm one’s world-view
3. Psychological symptoms are an excuse, a pretext, for avoiding responsibility

8. 1. Families have Purpose
Individuals in trust relationships acting alone and in concert to accomplish and obtain individual and collective
purposes and needs:
 Basic Needs
1) Safety: food; drink; shelter, warmth and protection from the elements; safety and security and freedom from fears
2) Belongingness: nurturance, intimacy, friendship, affection and love; sex. Meaningful connection with community
3) Esteem and Self-Actualization: achievement, mastery, independence, status, dominance, prestige, self-respect,
respect from others; realizing personal potential, self-fulfillment, seeking personal growth and peak experiences
 Life Tasks
a) larger processes that the family, as a group, must accomplish (Life-cycle Tasks); and
b) those each individual must master (Developmental Tasks) and reconcile (Adler Life Tasks/Existential Anxiety)
Structural Family Therapy
8

9. 2. Families have Structures - they define Who does What, When, How, and with Whom
 These define the operational organization and atmosphere of the family system
 They define the manner in which transactions occur around tasks, functions and responsibilities.
 They are partly universal (cultural) and partly idiosyncratic (intergenerational): information (rules and myths) on how to
accomplish tasks and assume responsibility; how gender, roles, and functions are defined; how power and emotion is
expressed; how loyalty, intimacy and trust are conveyed; and so on.
Structures
a. Sub-systems: Temporary or enduring subgroupings within the family based on age or generation, gender, and interest or
function:
1) Executive Subsystem;
2) Couple or Marital;
3) Sibling;
4) Grandparental;
5) Extended (cousins, uncles and aunts; 6) Friends/Neighbors/Work
b. Roles: Who does what? What are the established assignments for performing specific functions and tasks?
c. Rules: What is done and how? What are the routine procedures and interactional patterns (transactions) --and their
accompanying rules, which define behavior surrounding functions and tasks of importance?
d. Relationship Boundaries: the degree of reactivity, communication and emotional exchange between
members, subsystems and the system as a whole with the outside world

10. 3. Family Structures have Power - the ability to influence the outcome of events
Members have power based on status and prestige and authority to fulfill or direct assignments for performing specific functions
and tasks. Power must accompany responsibilities otherwise failure and conflict occur.
Executive Subsystem
No matter the configuration, is the recognized authority responsible for the decision-making and problem-solving capacity of
the family. Core responsibilities include
 to effectively manage stress and conflict as individual members and the group adapts to change.
 define the relationship between the family and the community
 parenting / child rearing
Specialized Individual Family Member Roles
 Family Spokesperson: family member elected to serve as the representative of the family to the outside world. Often most
controlling or member ascribed the most authority/power
 “Enabler”, “Family Hero”, “Mascot”, “Lost Child” (from Addiction theories): roles adopted to mediate stress and help
bind the family cohesion
 Identified Patient (I.P.) or Symptom Bearer: member that controls (and organizes) the family’s behavior by virtue of their
own problems or behaviors

11. Problems arise as faulty attempts to adapt to change -the solution becomes the problem
1. Symptoms (excluding organic illness) are purposive; they are voluntary and under the control of the individual
2. While the Identified Patient (IP) may be appear helpless to change, the helplessness is actually a source of power over others
whose lives and actions are restricted and even ruled by the demands, fears, and needs of the symptom bearer (Madanes, 1991)
3. Symptoms are metaphors for the family disturbance and may express the problem(s) of another, non-IP, family member
(example: child IP with school failure expresses mom’s rage against father)
4. Benevolence drives family interaction; interactions must be described in terms of love
5. Problems arise when the family hierarchy, or power allocation is incongruous; re-aligning power remedies the problem
6. Conflicts arise when the intent of the interaction is at cross-purposes; personal gain versus benefit to the group
 if a person is hostile, he or she is being motivated by personal gain or power
 if the person is concerned with helping others or receiving more affection, he or she is being motivated by love
The motivation helps define the treatment strategy or intervention: the therapist targets the same outcome or the identical
pattern of interaction (sequence) without the problematic symptom; when either occur without the symptom occurring the
problem behavior should abate. (Madanes, 1991).

12. Structural-Strategic Therapy Synthesis
Therapy involves disengaging power-struggles that occur in relationships and structures due to
power imbalances and redirecting them through decision-making and the problem-solving process
Structural: structures are organized constructions of power
 change the Structure in order to change the System
in order to change the Symptom
Strategic: processes are methods by which power is employed
 change the Symptom in order to change the System
in order to change the Structure

14. Overview of
1. Symptoms: how they originate and how to challenge them
2. Life-cycle: its role in family development and problem origination
3. Family Constellation and Atmosphere
4. Triangulation: role in stress reduction and problem origination
5. Boundaries: how to define them and how to manipulate them

16.  Symptoms are the Result of Problems with Power
1. inappropriate alliances, such as cross-generational alliances;
2. inappropriate hierarchies, such as parents ceding excess authority to children; or
3. inappropriate boundaries, such as marked enmeshment or disengagement between members
 Symptoms Originate when the Executive Subsystem is Ineffectual -excessive rigidity or diffuseness
1. difficulty reconciling stress and mending trauma or severe impairment in one of its members
2. difficulty responding to maturational, developmental (life-cycle) and environmental challenges
3. difficulty mediating conflict in the couple or partner relationship resulting in power-struggles and their aftermath
Note:
o unresolved, problems become symptoms characterized by power-struggles and improper methods of resolving them; this includes
betrayal, domestic violence, emotional cut-off or expulsion, infidelity, incest, and severe passive-aggressive acts such as eating
disorders, catastrophic failure, depression and suicide
o when the identified patient (IP) is a child, the problem is a failure of the Executive Subcommittee to effectively parent
1. Triangulation of the child due to marital or couple conflict, including parents who are separated and estranged;
2. Triangulation of the child in a cross-generational coalition (child enlisted to take sides in a in loyalty dispute, ie. parent against parent;
grand-parent (s) against parent(s); in-law(s) against parent(s)
 Symptoms are Maintained by Faulty Convictions and Concretized Sequences of Thoughts and Behaviors
 Interrupting these will necessarily disrupt their power and meaning
16

17. 17
1. Create a new symptom (ie. “I am also concerned about
________; when did you first start noticing it?”)
2. Move to a more manageable symptom (one that is
behavioral and can be scaled; ie. chores vs attitude)
3. I.P. another family member (create a new symptom-
bearer or sub-group; ie. “the kids”, “the boys”)
4. I.P. a relationship (ie. “the marriage/relationship makes
her depressed”)
5. Push for recoil through paradoxical intention
6. “Spitting in the Soup” –make the covert intent, overt
7. Add, remove or reverse the order of the steps (having the
symptom come first);
8. Remove or add a new member to the loop
9. Inflate/deflate the intensity of the symptom or pattern
10. Change the frequency or rate of the symptom or pattern
11. Change the duration of the symptom or pattern
12. Change the time (hour/time of day/week/month/year) of the
symptom or pattern
13. Change the location (in the world or body) of the
symptom/pattern
14. Change some quality of the symptom or pattern
15. Perform the symptom without the pattern; short-circuiting
16. Perform the pattern without the symptom
17. Change the sequence of the elements in the pattern
18. Interrupt or otherwise prevent the pattern from occurring
19. Add (at least) one new element to the pattern
20. Break up any previously whole elements into smaller
elements
21. Link the symptoms or pattern to another pattern or goal
22. Reframe or re-label the meaning of the symptom
23. Point to disparities and create cognitive dissonance
Note: 1-4, Minuchin/Fishman; 5-6, 22, 23, Adler; 7-21, O’Hanlon.
Pattern or element may represent a concrete behavior, emotion, or family member
Challenge the Meaning and Power of the Symptom

18. The Process of Challenging
Three Key Concepts
A. “Functional Value” -operational purpose of symptomatic behaviors and conditions
Irrespective of etiology, symptoms aquire purpose: A condition acquires meaning and power to the individual and the relationship
system when it aides in the ability to function and operate (“functional value”). This rigidifies over time and becomes a preferred
transaction pattern that re-defines the rules and roles of interaction.
1. The History of the Presenting Problem, who participates and is affected by it, and how, will clue you in as to the meaning and
significance of the symptom. “Why now?” “Why that particular symptom?” “Why her?”
2. The sequence and pattern of interaction clues you in to how the symptom is maintained and what triggers it.
3. Ask yourself: “If this was NOT the problem, what would be?”
Symptoms have Purpose
1. Symptoms are purposive; moreover, they are metaphors for the family’s disturbance or failure to adequately adapt to change
2. Symptoms are stop-gap measures that preserve a level of safety between the imperative to change and the desire to remain the same
3. Symptoms are maintained by a rigid pattern of convictions and their corresponding feelings and behaviors
4. Symptom recurrence, or substitution, is due to replication of the same pattern of convictions and behaviors
B. Tracking or Sequencing -degree of effectiveness, 1, 2, 3; from lesser to greater 
1. Interviewing client about experience “A” (self-report)
2. Interviewing (family) members about their respective perspective about experience “A” (group report)
3. Enactment or role-play of experience “A”: directive to re-enact problem transaction in session

19. C. Prescribing or Giving Directives
Prescribing or assigning tasks provide practice in new ways of thinking and behaving. It includes simple tasks or assignments as
well as complex sequences of behavioral interactions designed to foster change, such as Re-enactments (repeating pattern with
modifications), Ordeals (patterns designed to be burdensome), and Rituals (ceremonies). In this regard, therapy is nothing more
than a long series of creating deliberate opportunities for change!
1. Give task
Simple introductions include: “Let’s try something…”; “Most/Some people find this helpful…”; “Let’s do an
experiment”; “I’m going to have you do something that may be very difficult/uncomfortable… ”
2. Encourage work by not rescuing
Once a task has been assigned, the therapist's job is to continually redirect straying or direct back to task, while working on
their own anxiety, impatience and need to rescue
3. Work through power-struggles and challenges to therapeutic alliance
Resistance to a task should be expected, but NOT tolerated (see “notes” on client-therapist power struggles)
4. Recap and button-up
a) Explore experience: “Was this worst than you thought it would be?” If the task was not completed, explore a) what would
happen had the task been accomplished? and b) what was going on for the person while struggling with the task?
b) Examine therapeutic alliance for possible back-lash, anger, resentment or fear
c) Predict residual anger
d) Predict back-sliding due to difficulty of change
e) Assign homework
 must be “safe”
 Must anticipate failure or sabotage
 Client must be free to abandon task, unless it is a specific “test” of client’s investment in change

20. The natural, developmental change process of all family systems and their members

21. Life-cycle
Life-cycle is the context within which developmental change occurs. Stress develops into symptoms at points of intersection when
family of origin rules (Vertical stressors) are too rigid and insufficiently flexible to adapt smoothly to trauma or normative
developmental change. This is illustrated in the diagram below which denotes the concentric context we are each embedded within
(Systems Levels) and the merging pressure to remain the same (Vertical Stressors) and the imperative to change (Horizontal
stressors):
Carter and McGoldrick identify six family life cycle stages and their respective processes and tasks, somewhat modified herein.
Because the processes are universal, understanding the Stages helps identify and predict inherent in the developmental changes each
family undergoes.
Factors that decrease adaptabilityto change
Change Events

22. Stage 1: Launching the Young Adult/Differentiation of Self in Relation to the Family of Origin
Each member is born into a uniquely formed inter-generational social group (family of origin) that defines their identity and
remains an integral part of their life until death. The challenge is for each member to retain the benefits of remaining an integral
part of their birth family while sufficiently separating to form one’s own adult life and new social unit, a process that the entire
family contributes to and supports and paves the way for how other siblings may “graduate”. While a culminating event,
separation occurs incrementally through childhood and accelerates through adolescents. Most problems intensify if not wholly
originate, from difficulties encountered during this stage (and adolescents). Barring childhood trauma from sexual abuse or
catastrophe, this period is prone to trauma as power struggles intensify between the executive subsystem and the young adult.
Tasks:
 due to greater autonomy and independence, parents can no longer require compliance or obedience; power must be
renegotiated; threat and shame are less effective, requiring greater mutual agreement the young adult must separate
without becoming cut-off, fleeing or getting themselves ejected
 the young adult must accept emotional responsibility for self and clarify own values & belief system
 the young adult must develop intimate peer relationships with the prospects of pair-bonding and sex
 the young adult must establish self in work/higher education and a path to financial independence
 family members provide support by accommodating to change in roles, functions, and chores
 family members provide flexibility to allow movement in and out of the family
 parents (executive subsystem) must provide continued support without enabling
Problems occur when young adults fail to differentiate themselves from their family of origin and recreate similar, typically
flawed emotional transaction patterns in their own adult social relationships and in their family of formation. While work,
school and adult peer relations can provide an opportunity to reconcile unresolved issues these also provide a venue in which to
reaffirm them. Serious problems occur when families do not let go of their adult children encouraging dependence, defiance or
rebellion.
Stage 2: Developing the Couple Relationship: Vulnerability, Trust and Intimacy
 The task of this stage is to accept new members into the system and form a new family separate and distinct from the couple’s
families of origin.
 Couples may experience difficulties in intimacy and commitment. The development of trust and mutual support is critical
 Negotiation of the sexual component of the relationship system
 Negotiation of Power, boundaries and rules of the marriage; identifying/protecting against threats
 Problems consist of enmeshment (failure to separate from a family of origin) or distancing (failure to stay connected)

23. Stage 3: Parenting (Establishing the Executive Subsystem)/Families with Young Children
 Child-rearing and the task of becoming caretakers to the next generation
 Adjusting marital system to make space for child (ren)
 Joining in childrearing, financial, and household tasks
 Realignment of relationships with extended family to include parenting and grand-parenting roles
 Couples must work out a division of labor, a method of making decisions, and must balance work with family obligations and leisure pursuits.
 Problems at this stage involve couple and parenting issues, as well as maintaining appropriate boundaries with both sets of grandparents.
Stage 4: Families with Adolescents: Transition of Power
 In stage four, families must establish qualitatively different boundaries for adolescents than for younger children. Individuation
accelerates and movement in and out of the family increases.
 Problems during this period are typically associated with adolescent exploration, friendships, substance use, sexual activity and school;
peer relations take a primary place as does self-absorption
 Parents may face a mid-life crisis as they begin to regard their own life accomplishments and foresee the promise of an empty
nest or diminishment of the parenting role; refocus on midlife marital and career issues
 Increasing flexibility of family boundaries to include children's independence and grandparent's frailties; joint caring for older generation
Stage 5: Launching Children and Moving On
 The primary task of stage five is to adapt to the numerous exits and entries to the family
 Renegotiation of marital system as a dyad
 Development of adult to adult relationships between grown children and their parents
 Realignment of relationships to include in-laws and grandchildren
 Dealing with disabilities and death of parents (grandparents)
 Problems may arise when families hold on to the last child or parents become depressed at the empty nest or due to loss. Ease of
separation tied to contentment in the marriage/adult life and future plans
 Problems can occur when parents decide to divorce or adult children return home
Stage 6: Families in Later Life
 The primary task of stage six is adjustment to aging and physical frailty, Life review and integration
 Maintaining own and/or couple functioning and interests in face of physiological decline; exploration of new familial and social role options
 Making room in the system for the wisdom and experience of the elderly, supporting the older generation without over-functioning for them
 Dealing with loss of spouse, siblings, and other peers and preparation for own death
 Problems consist of difficulties with retirement, financial insecurity, declining health, dependence on others, loss of a spouse and others

24. The natural temperament of the family as defined by its flexibility, rules and customary set of convictions

25. Use of the Genogram
1. Places the Individual in a Family Context
2. Tracks Familial Trends and Characteristics
3. Makes the Client a Co-therapist
How to Use
 Intergenerational Issues and Trends; display Information; for at least three generations show:
o the client's name, age, gender , occupation, spouse/partner, children, parents and siblings
o the wider family such as grandparents, uncles, aunties, and their pairings and children (include names, birth dates, a
occupation , highest level of education, dates of marriage, divorce, death, etc)
o how persons are related and the relationship between family members (adoptions, marriages, sources of str
alliances/collusions, etc)
o Clinical and health issues such as child/partner abuse, drug and alcohol dependency, anxiety, depression, heart conditic
diabetes, etc.
o ethnic and cultural history of the family
o socioeconomic status of the family
o major nodal events and recent trigger issues, such as pregnancies, illnesses, relocations, or separations
 Tracking and Interpreting
o post the client's symptoms/concerns and trace similar patterns across member relationships
o look at roles and rules that may have bearing on the presenting problem (s); post myths, legends and value statements
o look at life-cycle, nodal events and triggers for timing surrounding the presenting problem(s)
o demarcate, by dotted inclusion lines, members who participates/in the presenting problem
o client(s) and therapist (s) share observations and interpretations from the genogram

26. Patterns of interaction that reduce conflict and duress within the dyad

27. Triangles: Problem Solvers and Creators
Triangle Theory
1. Conflict is a continuous condition of human interaction
2. Triangulation is a pattern of interaction that reduces conflict and distress; it is a process whereby anxiety is decreased and
tension dissipated through emotional interaction with others
“The (Bowen) theory states that the triangle, a three-person emotional configuration, is the molecule or the basic building block of
any emotional system, whether it is in the family or any other group. The triangle is the smallest stable relationship system. A two-
person system may be stable as long as it is calm, but when anxiety increases, it immediately involves the most vulnerable other
person to become a triangle. When tension in the triangle is too great for the threesome, it involves others to become a series of
interlocking triangles.” M. Bowen. “Family Therapy in Clinical Practice.” Aronson New York. 1976. P373
3. Unmediated, conflict results in chronic tension expressed as “physiological symptoms, emotional dysfunction, social illness
or social misbehavior” - M. Bowen
4. The resulting conditions are characterized by “1) marital (or partner) discord; 2) dysfunction in a partner; 3) impairment
in one or more of the children; or 4) severe emotional “cut-off”, including isolation, abandonment, betrayal, or expulsion
5. Triangulation may also result in preferred patterns of interaction that avoid responsibility for change –Alfred Adler
27

28. dyad
third person or subject of mutual, concern or interest
anxiety
closeness may increase as
anxiety is reduced
28

29. dyad
third person or subject of mutual, concern or interest
Anxiety decreases in dyad
 Third party helps mediate conflict or remedy problem in the two-person relationship (dyad). For example:
 siblings cease their disagreement over chores to actively chide their younger brother
 co-workers are unclear on best approach to an issue and seek guidance from their supervisor
29
1. Greater anxiety = more closeness or distance

30. dyad
third person or subject of mutual,
concern or interest
Alliance
increases trust
and intimacy
 Two members (or all three) are drawn closer in alliance or
support. For example:
 Separated or divorced husband and wife come together as parents
for their child in need
 sisters share greater intimacy after one has been the victim of a
crime (the triangulated my be a person or an issue, such as “work”,
the “neighbors” or in this example, the “crime”)
closeness may increase as
anxiety is reduced
30

31. Conflict in the dyad goes
unresolved as attention is drawn
away from important issues
AdultAdult
child
# 2. Collusion and Cross-generational Coalitions
# 1. Detouring or “Scapegoating”
 Collusion: Two members ally against a third, such as when a friend serves as a confidant
with one of the partners during couple discord or siblings ally against another. The third
member feels pressured or manipulated or gets isolated, feels ignored, excluded, or rejected
as a result of being brought into the conflict
 Cross-generational Coalition: The third party is a child pulled into an inappropriate role
(cross-generational coalition) such as mediator in the conflict between two parents. This
could include parent-child-parent and parent-child-grandparent triangles.
31
# 1
# 2

32. Over time
 Triangulation begins as a normative response due to stress or anxiety
caused by developmental transition, change or conflict
 The pattern habituates, then rigidifies as a preferred transactional
pattern for avoiding stress in the dyad
 The IP begins to actively participate in maintaining the role due to
primary and secondary gains
 The “problem”, which then serves the purpose of refocusing attention
onto the IP and away from tension within the dyad, becomes an
organizational node around which behaviors repeat, thereby governing
some part of the family system’s communication and function
 Over time, this interactional sequence acquires identity, history and
functional value (Power), much like any role, and we call it a
“symptom” and the symptom-bearer, “dysfunctional”
 A key component in symptom development is that the evolving
pattern of interaction avoids more painful conflict
 This places the IP at risk of remaining the “lightning rod” and
accelerating behaviors in order to maintain the same net effect
 When this occurs, it negates the need to achieve a more effective
solution to some other important change (adaptive response) and
growth is thwarted. The ensuing condition is called “dysfunction”.
- d. peratsakis
32

33. The physical and psychological factors that separate members from one another and organize them.
The rules which define "who participates and how much"

34. Boundaries
Invisible barriers that regulate a) contact between members and b) flow of information in and out of the system.
Boundaries pertain to adaptability, the degree of openness and flexibility to change in relationships.
 Enmeshment: exceedingly porous boundary between members resulting in hypersensitivity to each other’s thoughts and feelings
 Disengagement: exceedingly rigid boundary between members resulting in inadequate support and indifference to each other’s
thoughts and feelings
The “Goldilocks” Principle -problems arise when boundaries are too rigid or too diffuse
 Diffuse, too weak, too open, or “enmeshed”; mapped as “ .........................”
 Rigid, too fortified, too closed, or “disengaged”; mapped as “________________”
 Appropriate boundaries; mapped as “ ___ ___ ___ ___ ___ ___ “
Key: ………………..……….……. ___ ___ ___ ___ ___ ___ ___ ______________________________
Enmeshed Clear Boundaries Disengaged
(inappropriately diffuse boundaries) (normal range) (inappropriately tight boundaries)

36. Boundaries are Reciprocal and Complimentary
 Enmeshment in one relationship usually means disengaged from someone else
Example: parents disengaged from one another and enmeshed with child
Mapped as: M F
..................
C
Process
1. Mark boundaries between partners, subsystems, or entire groups; examine skewed boundaries
2. Give directives and assign tasks that push individuals with diffuse boundaries closer, enmeshed further
apart. Firm up individual or relational identities and point to disparities or similarities
3. Partner enmeshed persons with others in and members outside the nucleus; partner peripheral or
disengaged persons through teamwork, alliances and collusions
Rule of Thumb: to restructure a boundary create tasks that push it to the opposite extreme
For example:
M F t a s k M F
K i d s p u s h t o o p p o s i t e K i d s

37. Sample Mapping Directives for Nudging Boundaries
Problem Boundary Pattern: Dad is very peripheral; Mom is over-enmeshed with Daughter and Son
M F
……… ______
Kids (D & S)
M F
………………
D S
“The Girls versus the Boys”
- Relatively “safe”; keeps Mom attached
M F
______ .............
Kids (D & S)
“Mom’s is on vacation from doing laundry” “ Us” versus “Them”
Riskier task; removes Mom M F - Riskiest; mirrors the Marital
_________________
Kids
37
# 1
# 2
# 3

39. 39
1. Join Executive Subsystem as Coach; Assume Leadership
 Important to join with angry and powerful family members; determine the source of power and who can mobilize the family to
action (and to bring them back to session)
 Examine the interactions around the Presenting Problem: “who does what?” Note the history and pattern of the Presenting problem
(PP); this will define the sequence of interactions that uphold the symptom and give it purpose to the individual and to the family.
Immediately challenge assumptions; broaden narrow problems/narrow broad problems
 Need to build an alliance with all, especially the Identified Patient, accommodate to family’s temperature, style and current
hierarchy. Accept current world-view, question workability and suggest alternatives to modify world-view
 Need to foster intimacy through use of self, own history, family bragging, praise, celebrations, rituals and story-telling
 Continually monitor impact of tasks and directives for possible collusion against therapy or the therapist
 Continually reaffirm family’s power; take one-down and reframe progress as family’s love/commitment to each other
 Continually expresses appreciation for sharing their pain, secrets and shame
2. Force Enactment
 Examine family’s view of the problem; track the sequences of behaviors; ie. “...and then what happens? Who does what next?’
 Re-create the presenting problem in session; role-play a typical scenario or the most recent argument or frustration
 Examine how it works and how it fails
 Explore new possibilities and direct new transactions
 Practice new behavior patterns and new forms of expression (behavior rehearsal is critical to solidify new ways
Methods
o Use of reframing to illuminate family structure
o Use of circular perspectives, e.g. helping each other change
o Boundary setting
o Unbalancing (briefly taking sides)
o Challenging unproductive assumptions
o Use of intensity to bring about change
o Shaping competencies
o Not rescuing: refusing to answer questions or to step in and take charge when it’s important for the family members to do so

40. 3. Build Up the Executive Subsystem, Address Power Inequities and Realign the Power
 Get Adults to Accept Responsibility and Authority, Problem Solve and Remedy Power Inequities
o Partners must be equal; may need to address how each expresses power or controls the outcome of decisions. Must develop a
boundary that separates parent(s)/couple (executive subsystem) from children, in-laws and outsiders.
o Must clarify Roles, Rules and Responsibilities: Who has the power to do what with whom? Authority and responsibility must
match; tasks must be hierarchy and age appropriate. Disengage power-plays, alliances, collusions and triangles that interfere with
functions.
o Must Balance Boundaries: Boundaries must be strengthened in enmeshed relationships, and weakened (or opened up) in
disengaged ones. Address trust, loyalty and betrayal issues; look to affection, tenderness and mutual support. Bridge disengaged
members and cut-offs and create breathing room and independence for enmeshed members.
 Get Parents to Parent
o The therapist must assume that the parents are capable of effectively parenting unless they are abdicating their authority;
accordingly, the role of the therapist is to reconcile the existing family-of-origin concerns; work through trauma, hurt, betrayal
and trust issues; and remedy personal and interpersonal barriers to effective governance and growth
o Makes kids age appropriate; throw them out of spousal alliances; match authority, responsibilities and benefits by age; promote
(or demote) older teens and young adults with “parental” responsibilities
o Resolving differences in temperature and parenting styles; developing team-work as core to problem-solving and decision-making
o Agreeing on family goals and aspirations
 Get Family to Address Individuation Issues with Teens and Young Adults. New power alignments and readiness to launch
 Get Family to Examine and Confront Ghosts (family myths, cut-offs, or other legacy issues) that interfere or are used as road-
blocks to effective problem-solving or growth.
4. Assign Homework for Practice
o Should be practice of newly explored changes in sequence, roles or responsibilities
o Should be crafted to increase contact between disengaged parties and to reinforce boundaries that have grown enmeshed
o Should be something that is not too ambitious, “dooming” the members to success
o Caution family members to expect setbacks in order to prepare them for a realistic future

42. Simple Genogram of a Blended Family
Presenting Problem: Don took Ben (17 yo) on a drinking spree; when stopped, police found two open
bottles and a bag of pot in the car. Step-dad wants Don to leave the house; mom (Katal) claims that Don is
depressed and upset about the anniversary of his father’s death
Assignment:
1. What Questions jump out at you? Form some initial hypothesis that should be tested.
2. Who should participate in session and why?
3. List some of the more significant issues that may be concerns
Reminder:
1. Always track who participates in the problem and how
2. Look for themes and patterns, such as roles, boundaries and conflicts
3. Examine cut-offs
Drug Use;
Depression;
Attempted
suicide;
multiple
hospitalizations
Alcoholism;
Depression;
Suicide
22 yo
Drug Use
Bad Temper
Recent crime: petty
theft; assault
D.= Overdose
Alcoholism
Domestic Violence
Local Pastor; got
custody of
children while
mom is in rehab
16 yo; straight
“A” student;
model child

43. “There is no coming to consciousness without pain”
- C. Jung