Exploration Of Structural Family Therapy

Structural Family Therapy is a therapeutic approach that recognizes that families possess many strengths and it attempts to move family’s beyond dysfunctional patterns of interactions. Structural Family Therapy method was developed by Salvador Minuchin in the 1960’s and is the leading model in family therapy and is one of the most widely used models for family therapy (Powell & Dosser,1992). Its focus is on family structure; subsystems; boundaries. Its goal is to focus on problem presented and structures displayed and improve or restructure the family structure then realign the family subsystems.

The established family patterns is described by family structure and it is these patterns that determine how, why, who and when family members respond to and react with one another. The traditional family structure in the United States is considered a family support system involving two-parent household that provides provisions for their children. However, the two-parent, family has become less customary, and the unconventional family system has become more common. The family is formed at birth and generations are formed. Those generations are known as the extended family or subsystems; aunts, uncles, grandparents, and cousins, and of these family members anyone can hold major emotional and financial roles for the family. Minuchin is a follower of the communication theory, which is the discipline that studies the principles of transmitting information and the methods by which it is delivered. An important attribute of Structural Family Therapy is that the family system is used as a facilitator for positive transformation.

Every family has a structure. A family’s structure is the invisible or covert set of functional demands that dictate or organize the way family members interact (Minuchin, 1974). Family dynamics is the term used for the way that families communicate and exist together. Every family has a distinct pattern of relating to one another, which can be positive or negative. Family structure influences the dynamics of the family. For example, the cultural background and personalities of each member in the household, the number of children in the family, if the family is made up of two parents and children or a single parent and children. These are all examples of contributions that influence family dynamics. Minuchin believes families that have an open and appropriate structure recovers more quickly and functions better in the long term.

Structural Family Therapy outlines three basic subsystems and is often organized by gender or generation: The marital subsystem in which the couple relationship, the parental subsystem, and the sibling subsystem. Each subsystem is identifiable by the members who make up that subsystem along with the task that they are assigned.

In Structural Family Therapy, family rules are defined as an invisible set of functional demands that persistently organizes the interaction of the family. Coalitions, boundaries, and power hierarchies between subsystems are important rules for a counselor to study (Minuchin, S. 1974). Ann Hartman (1979) has defined the boundary of a family as “that invisible line that separates what is ‘inside’ the family and what is ‘outside’ the family.” This outside boundary is what delineates the whole family in relation to other systems such as schools, churches, or other families, and outside individuals. The subsystems could involve, for instance, of those members who belong to the same generation (such as the children) or the same sex (the women of the family) or those who have the same interests or functions. Individuals may belong to more than one subsystem. Over a period of time, rules are developed about how the subsystems interact with each other, and who is included in the subsystems, and how each participates. In other words, the kind of boundary that exists defines the relationship between and among the subsystems (Hartman, 1978).

According to Minuchin, “understanding a family requires identifying the processes and boundaries that operate the subsystems and coalitions in that family. Minuchin defined three types of interpersonal boundaries (clear, rigid, or diffuse) that determine the overall ability of the family to adapt successfully to change”: Clear boundaries define the authority of the parents while allowing the children to develop as appropriate for their age. Rigid boundaries imply disengagement between family members or subsystems and they are found in families where the members are isolated from one another and communication has broken down. The prevailing non-communicative hinders support and confines effective adaptation. A diffuse boundary implies enmeshment where each individual is interested in everyone else’s business. These boundaries are found in overly involved families. In these families, there’s a blurring of the line between parents and children. Parents act like their children’s friends and children run the risk of becoming too involved with their parents. In this case, no one person is in charge and effective guidance during times of change is incapable of occurring (Minuchin, 1974). In addition to structure, substructures and external and internal boundaries, Structural Family Therapy is also based on roles, rules and power. A family is organized in terms of roles. Every family has to decide who will care for the child, who does certain household task, who will be the decision maker, and who will be responsible for paying the bills. To function well, a family must be on one accord with these rules. Nevertheless, roles cannot be so firm and closely defined that they cannot be modified. Each member of a family plays a significant role in the family dynamics, and if a death or divorce occurs, the family structure is upset, which upsets family dynamics. People might blame one another or rely on a different family member more than before, which shifts the structure. The guidelines of a members role is influenced by factors such as culture, ethnic background, experience in the family in which one grew up, life style, and family size and composition.

Rules are developed over a period of time, which dictates who will make decisions, how problems are solved and how people are expected to act feel and think. The rules are monotonous, expected, and unwavering. All families must have ways to resolve conflict and make decisions. In most families each member wants and/or needs to have a certain amount of power or influences. Families develop distinguishing ways to make decisions and to resolve conflict. All families must have ways to make decisions and to resolve conflict. In most families all members have, and need to have, a certain amount of power and influence in some areas. As Aponte (1976) has pointed out, “Family members must have enough power in the family to be able to protect their personal interests in the family at all times, while keeping the well-being of the other members, and of the family as a whole, in mind.” Most people think that power and decision-making is vested primarily in adult members of the family. However, there can be a great variation in how power is distributed and used in families.

There are many types of boundary problems – as many problems as there are families. Family systems therapists assess families for boundary problems along a spectrum, placing boundary problems between the following two extremes: Enmeshed families are entangled and it is difficult to be extricated or separated the boundaries. In enmeshed families, boundaries do not allow for individuation; they are too relaxed, and have become overlapped and often misleading. Boundaries are constantly crossed in numerous ways. Disengaged which means to mentally separate yourself or somebody else from a situation or difficulty. Detached describes the individual that stands on its own and is not joined to another system. Families that share little to nothing, typically overly rigid families, are described as detached. There’s little to no communication – and no flexibility in family patterns to accommodate effective support and guidance (Gladding, 1998).

Alignment refers to the way in which “family members as individuals and as parts of subsystems relate to each other relative to other family members and subsystems” (Nelson & Utesch, 1990. P. 237). Alignments can include either joining or opposing one member or subsystem over another (Aponte & Van Deusen, 1981). A Coalition is an alignment between two people in a system which excludes a third person. According to Minuchin coalitions are short-lived.

The structural family therapy has many therapeutic interventions such as Boundary making, Unbalancing, Joining, Enactments, Accommodating, Raising Intensity, and Reframing. Boundary making involves restructuring the family because it changes the rules within which the family functions (Colapinta, 1982). Boundary making is a restructuring maneuver because it changes the rules of the game. Unbalancing is to make something lose its balance or equilibrium. It is used create disequilibrium in the family structure which helps the systems to see their dysfunctional patterns and to be open to restructuring and/or change. Joining means to put or bring together so as to make continuous or form a unit. It is necessary for the therapist to establish this bond (Minuchin, 1974). Enactments are the act or process of enacting something. According to Minuchin and Fishman enactment “constructs an interpersonal scenario in the session in which dysfunctional transactions among family members are played out”. This technique allows the therapist to observe how family members control their actions, and to determine the problematic behavior within the sequence of transactions (Colapinta, 1982). Accommodating is a willing to please or to be helpful. Intensity is the structural method of changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure. Intensity works best if done in a direct, unapologetic manner that is goal specific. The procedure of restructuring is at the heart of the structural approach. The goal of structural family therapy is to make the family more functional by altering the existing hierarchy and interaction patterns so that problems are not maintained. It is accomplished through the use of enactment, unbalancing, and boundary formation.

Cognitive Behavioral Therapy

Cognitive-behavioral and psychodynamic therapy are the most commonly used psychotherapeutic treatments of mental disorders in adults (Goisman et al., 1999). Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT) was developed by Dr. Aaron T. Beck, in the mid-1960s, and is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems conditions. Cognitive Behavioral Therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. Indeed, much of what the patient does is solve current problems. The goals of cognitive therapy are to help individuals gain control a better understanding and to solve current problems. Cognitive Behavioral Therapy uses a wide variety of techniques to help patients change their thoughts, actions, attitudes, and make-up. Its focus is on the way we perceive situations influences how we feel emotionally. Techniques may be cognitive, behavioral, environmental, biological, supportive, interpersonal, or experiential. Cognitive behavior therapy has been demonstrated to be an effective treatment for a wide variety of disorders. To name just a few, it has been found useful for: psychiatric disorders such as depression, the full range of anxiety disorders, eating disorders, substance abuse, personality disorders, and (along with medication) bipolar disorder and schizophrenia; medical disorders with a psychological component, including several conditions involving chronic or acute pain, chronic fatigue syndrome, pre-menstrual syndrome, colitis, sleep disorders, obesity, Gulf War syndrome, and somatoform disorders; and Psychological problems such as anger, relationship difficulties, and compulsive gambling (Beck,2012).

In Cognitive Behavioral Therapy clients learn certain skills that they can use throughout their lives. These skills involve relating to others in different ways, and changing behaviors, identifying distorted thinking, and modifying beliefs distorted thinking or Cognitive distortions are exaggerated and irrational thoughts. There are many types of Cognitive distortion: Emotional reasoning – is Feelings are facts; Anticipating negative outcomes -The worst will happen; All-or-nothing thinking-All good or all bad; Mind-reading – Knowing what others are thinking; Personalization – Excess responsibility; and Mental filter – Ignoring the positive. The cognitive distortions theory was presented by David Burns in The Feeling Good Handbook in 1989. He studied under Aaron T. Beck. According to Beck eliminating these distortions and negative thoughts will improve mood and discourage disorders such as depression and chronic anxiety. The process of learning to refute these distortions is called “cognitive restructuring”. Modifying Beliefs is a huge step and begins with pinpointing and acknowledging these beliefs exist. However, in order to improve your attitude or behavior, you must begin to change these beliefs and adopt new healthy ones. If you have held to certain beliefs all your life, the task will be challenging. For you to change any belief system, you must begin by questioning yourself about these beliefs – sort of a personal rebuttal to your own ineffective beliefs. When it comes to relating to others, most people have been conditioned to think one way, the win-lose way. Relating to others simply means interacting effectively with a wide range of people in a many different situations. Clients who relate well to others are open to new learning and able to take different roles in different situations. They are aware of how their words and actions affect others. They know when it is appropriate to compete and when it is appropriate to co-operate. By working effectively together, they can come up with new approaches, ideas, and ways of thinking. Behavior change can refer to any transformation or modification of human behavior and is a rapid and involuntary when associated with mental disorders.

Ivan Pavlov, B.F. skinner, Joseph Wolpe, Albert Bandura, Arnold Lazarus, Albert Ellis and Aaron Beck are the contributors to the development of Cognitive Behavior therapy. There are three main theoretical approaches Cognitive behavior therapy. The first approach is Behavior therapy which is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B. F. Skinner. Classical conditioning is a reflexive or automatic type of learning in which a stimulus acquires the capacity to evoke a response that was originally evoked by another stimulus. The traditional example of classical conditioning is Pavlov’s classic experiment with dogs, the neutral signal was the sound of a tone and the naturally occurring reflex was salivating in response to food. By associating the neutral stimulus with the environmental stimulus (the presentation of food), the sound of the tone alone could produce the salivation response. Operant conditioning is a method of learning that occurs through rewards and punishments for behavior. Through operant conditioning, an association is made between a behavior and a consequence for that behavior. The traditional example of operant conditioning uses the Skinner box, the subject, a rat, is kept in the box and becomes conditioned to press a bar by being rewarded with food pellets each time its early random movements caused it to press against the bar. The second theoretical approach is social learning theory is the view that people learn from observation, imitation and modeling. The social theory was coined by Albert Bandura’s in the 1960s, and explains how people learn new behaviors, values, and attitudes. Arnold Lazarus is a pioneer in behavior therapy, cognitive-behavior therapy, and multimodal therapy. He originated the term “Behavior Therapy” in the professional literature and went on to develop Multimodal Therapy which has been recognized as one of the most effective forms of cognitive-behavior therapy. Arnold Lazarus expanded the scope of CBT to include physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors. The third theoretical approach is cognitive therapy. Cognitive therapy seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses. It was developed by Aaron Beck in the 1960’s (Lazarus, 2010).

In summary Structural family therapy is the leading and most widely used model in family therapy and it places emphasis on the family structure as to how the structure of the family relates to families being dysfunctional. Its assumptions is a family’s structure is the invisible or covert set of functional authoritatively mandates that dictate or organize the way family members interact and demeanor problems reflect inadequate family structure. The Goal of Structural family therapy is to change boundaries and hierarchies to make the family more functional. It is accomplished through the use of enactment, unbalancing, and boundary formation. Whereas Cognitive behavioral therapy is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures.

The name refers to behavior therapy, cognitive therapy, and to therapy based upon a combination of basic behavioral and cognitive principles and research. Cognitive behavior therapy simply attempts to alleviate suffering as quickly as possible by training your mind to replace dysfunctional thought patterns, perceptions, and behavior (without asking more about them) with more realistic or helpful ones in order to alter behavior and emotions. It is relatively brief and time-limited (twelve weeks to six months. It is highly structured and directed with the therapist setting the agenda for each session (based on mutually set goals) and its focuses on the here-and-now only and not a person’s history.

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Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved