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Key concepts of structural family therapy

Salvador Minuchin’s work proved to be interesting and very insightful. The information presented allowed me to see family therapy through a systematic lens. Minuchin’s most lasting contribution to the field of family therapy involved a theory of family structure and a set of guidelines to organize therapeutic techniques. I would like to give a brief summary of Minuchin’s life, in addition to some key concepts and interventions that made his journey unique. Minuchun (2010) was originally born in Argentina and served in the Israeli army. He traveled to the United States and trained in child psychiatry (Nichols, 2010). In 1954, Minuchin began psychoanalytic training at the William Alanson White Institute where he studied the interpersonal psychiatry of Harry Stack Sullivan. After leaving the White Institute, Minuchin (2010) took a job at the Wiltwyck School for delinquent boys, where he suggested to his staff that they start seeing families. According to Nichols (2010), the success of Minuchin’s work with families at Wiltwyck led to a groundbreaking book, Families of the Sums (1967), which first outlined the structural model. Minuchin’s (2010) reputation as a virtuoso therapist grew, and he became the director of the Philadelphia Child Guidance Clinic in 1965. By the 1970s, structural family therapy had become the most widely practiced of all systems of family therapy. Minuchin (2010) stepped down as director of the Philadelphia Child Guidance Clinic in 1976 and started his own center in New York, where he practiced until 1996.

Key Concepts

There are many key concepts to be explained or defined in Structural Family Therapy. In

2010, Nichols defines family structure as a way the 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 (Nichols, 2010). The structure of the family is where the members sit in relation to one another. Within families, boundaries are established. Boundaries are invisible barriers that regulate contact with others and can be rigid, clear, or diffused. According to Nichols (2010), diffuse boundaries exist between a couple if they call each other at work frequently, neither has their own friends or independent activities and they view themselves only as a pair rather than as two separate personalities. In retrospect, they’ve established a rigid boundary if they spend little time together, have separate bedrooms, take separate vacations, have different checking accounts, and are more invested in careers or outside relationships than in their relationship (Nichols, 2010). Boundary making is negotiating the boundaries between members of a relationship, the actual relationship and the outside world (Nichols, 2010). Nichols (2010) defines another form of a relationship as the concept of cross-generational coalition. This is an inappropriate alliance between a parent and a child, who side together against a third member of the family (Nichols, 2010). The concept of accommodation is when elements of a system automatically adjust to coordinate their functioning. Some people may need to work at this.

In Structural Therapy, the therapists attempt to join the family. The concept of “joining is accepting and accommodating to families to win their confidence and circumvent resistance” (Nichols, 2010 p. 462). The key structural term of enactments is an interaction stimulated in structural therapy in order to observe and then change transactions that make up family structure (Nichols, 2010). According to Nichols (2010), empathy is used in structural family therapy to show understanding of the families’ beliefs and feelings.

How Problems Arise and are Maintained

According to Nichols (2010), what distinguishes normal families isn’t the absence of

a problem. The true origin of the problem derives within the Functional structure for dealing organization” (Nichols, 2010 p. 176). They also believe that modifications in structure are required with them. Structural family therapists believe that “problems are maintained by a dysfunctional family when a family or one of its members encounters external pressures (a parent is laid off, the family moves) and when developmental transitions are reached (a child reaches adolescence, parents retire). Healthy families accommodate to changed circumstances. According to Nichols (2010), less-adaptive families increase the rigidity of structures that are no longer functional. Structural therapists believe that in disengaged families, boundaries are rigid and the family fails to mobilize support when needed. Whereas in enmeshed families, boundaries are diffused and family members become dependent on one another (Nichols, 2010).

What Needs to Happen for Change to Occur

According to Nichols (2010), Structural Therapy changes behavior by opening alternative

patterns of interaction that can modify family structures. It isn’t necessarily a matter of creating

new structures, but of activating dormant ones (Nichols, 2010). Structural family therapists “produce change by joining the family, probing for areas of flexibility, and then activating dormant structural alternatives” (Nichols, 2010 p. 177). According to Nichols (2010), the first task is to understand the family’s view of their problems. The structural therapist will use enactments and spontaneous behavior sequences to better understand the families structure (Nichols, 2010). Nichols states (2010); the therapist first defines or recognizes a problematic sequence. Second, the therapist directs an enactment. Third, and most important, the therapist must guide the family to modify the enactments (Nichols, 2010). All of the therapist’s strategies should create new options for the family and options for productive interaction (Nichols, 2010). Interventions/Techniques

According to Nichols (2010), Minuchin used three overlapping phases in the process of Structural Family therapy. The therapist joins the family in position of leadership; maps their underlying structure; and intervenes to transform this structure. The structural therapist believes that the strategy of therapy must be organized. Within this organization, the structural therapist uses seven steps that could be considered interventions or techniques. The first step is joining and accommodating. In this step, the therapist “attempts to disarm defenses by building an alliance of understanding within each member of the family” (Nichols, 2010 p. 180). In the second step the therapist provokes family members to talk among the selves to produce enactments. Enactments help the therapist discover many things about a family’s structure (Nichols, 2010). According the Nichols (2010), structural family therapists try to assess the interrelationship of all family members by the third step of structural mapping. In the fourth step, structural therapists highlight and modify interactions. In this step the therapist may use the technique of intensity which is facilitated by using “strong affect repeated intervention or prolonged pressure” (Nichols, 2010 p.464). Shaping competence is another method of modifying interactions by highlighting and reinforcing the positive (Nichols, 2010). The fifth step distinguishes boundary making or the negotiation of boundaries between members of a relationship and between members of the outside world (Nichols, 2010). The sixth step consists of unbalancing. In this step the therapist “aims to change the relationship within a subsystem” (Nichols, 2010 p. 186). Finally, in the seventh step the therapist challenges unproductive assumptions that support structural problems (Nichols, 2010).

The Goal of Therapy

Structural Family therapists “direct therapy at altering family structure so that the family can solve its problems” (Nichols, 2010 p. 176). Structural problems are viewed as a failure to adjust to changing circumstances. Therefore, structural therapists see their work as “activating latent adaptive structures that are already in client families’ repertoires” (Simon, 1995 p. 176). First, the structural family therapist joins the family system to help its members change their structure. By altering boundaries and realigning subsystems, the therapist is able to change the behavior and experience of each family member (Nichols, 2010). For a structural therapist, one of the most important goals of therapy is the creation of an effective hierarchy (Nichols, 2010). According to Nichols (2010), another common goal of a structural therapist is to help parents function together as an executive subsystem. In contrast, the goal within enmeshed families is to differentiate individuals and subsystems by strengthening the boundaries around them. The goal with disengaged families is to make boundaries more permeable (Nichols, 2010 p. 177).

How the Therapeutic Alliance is or Can be Addressed (Task, Bond, Goals)

Structural Family therapists would like for clients to be in agreement with them on the tasks that they require clients to do in therapy. For example, if clients are now willing to engage in enactments, the therapist will not be able to gain an understanding of the families’ structural make up. Also, if clients are unwilling to do tasks like changing seating arraignments, then it could be difficult for the therapist to attempt to restructure the family boundaries. In Structure Family therapy, the therapeutic bond between the client and therapist is very important. The therapeutic bond is the foundation of structural family therapy because it helps the family trust the therapist. According to Nichols (2010), the therapist must first disarm defenses and ease anxiety. This is done by building an alliance of understanding with each member of the family. Joining, as the empathic connection is called, “opens the way for family members to begin listening to each other while establishing a bond with the therapist that enables them to accept the challenges to come” (Nichols, 2010 p. 181). Without this therapeutic bond it would be hard to get families to agree upon or complete tasks given. When the therapist does not effectively join the family, a therapeutic bond is not created. Therefore, challenging of any kind could be met with resistance. Although it doesn’t appear to be much goal setting in structural family therapy, it is important that the client and therapist agree on what needs to be accomplished as an end result. There needs to be some sort of ultimate goal in order for the family and therapist to know when the therapy has been successful. It is important that this is agreed upon by the therapist and family. Today’s structural family therapists place more of an “emphasis on helping families understand their organization” (Nichols, 2010 p. 180).

How Gender and Diversity/Culture Can Be Incorporated Into the Theory

Since Salvador Minuchin began work on his therapeutic model of structural family therapy times have changed. More awareness has since been given to understanding diversity, culture and gender issues. It is apparent that Minuchin has been very aware of the impact of socioeconomic and cultural environment on family and individual functioning. It is important for structural therapists to understand and consider that not all family structures will look the same. Some families may have single parent families. Therefore, the power in the hierarchy may look different from a traditional two parent family. Different ethnic groups may appear to have a closeness that is very normal for that group or culture, but could appear to be enmeshed from the perspective of a therapist who was raised in a more individualistic society. It is imperative that the therapist understands his or her own cultural constructs about what a family structure should look like and be careful not to apply it to clients of other cultural back grounds.

The structural model offers the conceptual framework and the vocabulary for addressing organizational patterns, boundaries, and subsystems. It has yet to apply the framework to the “dimension of gender—either to the gender—based on arrangements in the construction of marital/parental subsystem” (Scheikman, 1988 p. 27), or to the gendered coalitions across generations amongst sister or brothers. According to Goldner, the generational distinction is a major focus of attention without notice taken of the distinction between genders (1985). Husbands and wives have been conceptualized as a marital or parental unit, with the most salient distinguishing feature between them ignored, perhaps to avoid falling back into an individualistic view in noting sex differences. In fact, structural family therapy diagrams, until recently, made no gender distinctions (Goldner, 1985).

It is important for structural family therapists to be constantly aware and sensitive to different diversity, cultural, and gender issues that may relate to clients when doing therapy. We all come from different backgrounds and receive information differently. After summarizing structural therapy, I am now able to understand the different subsystems and boundaries from a structural point of view. Considering Minuchin’s structural therapy when working with diverse relationships can be a useful framework when working with today’s families.

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