Structural Family Therapy: Core Concepts

Lecture 3: Structural Family
Therapy
Systemic Comparative
Kevin Standish
Newham College University Centre
http://minuchincenter.org/structural_family_therapy

Salvador Minuchin on Family Therapy
Interview
• http://www.youtube.com/watch?v=2evU02
UocpQ
In all cultures, the family imprints
its members with selfhood.
• 3 minutes

Human experience of identity
has two elements; a sense of
belonging and a sense of being
separate. The laboratory in
which these ingredients are mixed
and dispensed is the family, the
matrix of identity.
—Salvador Minuchin

Learning Outcomes
1. Describe the core concepts of Structural
Family Therapy (SFT)
2. Conceptualisation of problems in SFT
3. Therapeutic goals in SFT
4. Therapist role in SFT
5. SFT interventions
6. Evaluation of SFT

Origins and Social Context
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Salvador Minuchin
Pediatric physician from Argentina
Psychoanalytic practice
New York State Wiltwyck School for Boys
Work with delinquent boys: poor structure and no
rules/regulation or routine.
• Post WWII
• Theory applied to non-traditional inner city families
• Suitable for families with single parenthood, illness,
acting-out members, drug addiction, crime, and
violence

1. UNDERLYING ASSUMPTIONS OF
SFT

Underlying Assumptions
• Families (people) are competent and capable
of solving their own problems -- an attitude
derived from the existential-humanistic
tradition
• Rigidity of transactional patterns and
boundaries prevents the exploration of
alternatives.
• Symptoms are a by-product of a structural
system that is failing
• The system fails to nurture growth or deal
with crisis of its members.

• A family system is therefore stabilized by each
member’s contribution.
• Subsystems are organized hierarchically : power
is distributed appropriately within individuals
and between subsystems, making reliance on
some members more expected than on others.
• All family systems desire homeostasis: each
individual member desires to stabilize the
system and contributes their part to balance the
system so that they can continue to be satisfied
by the system (Minuchin, 1974)

• Therapists work collaboratively with families,
not as experts who can solve problems, but as
consultants and coaches who work to bring
the family’s dormant capacities to the
surface.
• Therapists respect the family’s unique
culture. The question should be, not “What’s
ideal?” but “Does it work for them?”

2. CORE CONCEPTS OF STRUCTURAL
FAMILY THERAPY (SFT)

Core Concepts of Structural Family
Therapy (SFT)

• “Family structure is the
invisible set of functional
demands that organize the
ways in which family
members interact” (Minuchin,
1974, p. 51).

Core Concepts of SFT
• There is an overall organization or structure that maintains a
family’s dysfunctional interactions.
– Power and hierarchy
– Subsystems and boundaries
• Boundaries can be clear or normal, weak or diffuse
(too open), or rigid (too closed)
• Restructuring is based on observing and manipulating
interactions within the session
– Spontaneous behavior sequences -- form the basis for
hypotheses about family structure
– Enactments - interactions are suggested by the therapist
as a way to understand and diagnose the structure, and
to provide an opening for restructuring intervention.

Concepts, continued
• Structure
– an organized pattern in which families interact, not
deterministic or prescriptive, only descriptive
– Can only be seen when a family is in action, because
verbal descriptions rarely convey the true structure.

• Subsystems are subgroupings within the family based
on age (or generation), gender and interest (or
function)
– parenting
– spousal
– sibling

• Boundaries are invisible barriers that regulate contact
between members
• Diffuse, too weak, or “enmeshed”
• Rigid, too fortified, or “disengaged”

Concepts, continued
• Boundaries are reciprocal
– That means that a weak boundary
(enmeshment) in one relationship usually means
that the same person is disengaged from
someone else.
– Example is wife who is enmeshed with child and
disengaged from husband
– 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 doesn’t speak up.

Concepts:
Power and Hierarchy
• the person with the most power makes all of the
final decisions and takes responsibility for the
outcome of the family dynamics.
• Appropriate persons to have power in families
are the parents.
• For example, when a father tells his child not to
play video games, the child obeys because the
father has consistently shown the child that he
expects compliance in his child. This interaction
defines the relationship between them as well
as creates the appropriate hierarchy.

Concepts:
Power and Hierarchy
• In dysfunctional families children may be given more
attention than the couple gives each other, and the
child is therefore given control.
• This leaves the child insecure as they are not mature
enough to have such power and cause parents to
continue their conflict over the child rather than deal
with their own issues. The child acts out as a result.
• The therapist strives to place parents in their proper
hierarchical role above the children, helping the
children feel safe and secure and creating a natural
boundary between parents and children.

A Couple’s Challenge: Forming a
Healthy Spousal Subsystem
• Must develop complementary patterns of
mutual support, or accommodation
(compromise)
• Must develop a boundary that separates
couple from children, parents and outsiders.
• Must claim authority in a hierarchical
structure

Core concepts: Alignments, Coalitions
and triangulations
• Alignment indicates that two or more share reciprocal
benefits, and team up. It usually refers to a positive
bond between family members. Eg two parents
working together, providing a secure life for their
children.
• misalignments especially cross-generational can
undermine families eg grand parent and acting out
child.
• Coalitions refer to an alliance of some family
members against other family members. This can be
positive or negative. Can result in scapegoating.

Core concepts:
triangulations
• Triangulation occurs when one member of a
two-member system who are against one
another attempts to distract from the conflict by
bringing in a third person to focus on.
• For example : two parents who are fighting; one
member may attempt to win the child over to
his or her “side.”
• puts the child in a no-win position: child allies
with one parent, experiences betrayal of the
other parent, and the original conflict is never
resolved.

3. CONCEPTUALISATION OF
PROBLEMS IN SFT

How Problems Develop
• Inflexible response to maturational (or
developmental) and environmental challenges leads
to conflict avoidance through disengagement or
enmeshment
• Disengagement and enmeshment tend to be
compensatory (I’m close here to make up for my
distance elsewhere.)
• This leads to what is called the cross-generational
coalition, which is a triangular structure

The Nature of
Problems And Change
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Power Imbalances
Subsystem Boundaries too rigid or too diffuse
Disengaged Members
Enmeshed Members
Pervasive Conflict
Failure of the System to Realign
Member Resistance
Action Precedes Understanding

How change occurs
• SFT believe that when the structure of the family
changes, the positions of members in the group
change, and vice versa.
• There must be a proper hierarchy in place, with the
caretakers or parents in charge, in a healthy
coalition.
• In terms of healthy and unhealthy functioning,
symptoms in an individual are rooted in the
context of family transaction patterns, and family
restructuring must occur before an individual’s
symptoms are relieved (Minuchin, 1974).

How change occurs
• Structural changes must first occur within the
family because how a family functions has a
direct effect on how an individual functions
within, only then will individual symptoms be
limited, reduced, or resolved.
• As family member’s experience changes as the
family functions differently, then symptomatic
distress will decrease. Therefore, the therapist
focuses on changing the experience of family
members.

Therapeutic Goals
• Therapy is directed at altering the family
structure and Creation of an effective
hierarchy
• Structural problems are usually viewed
simply as failure to adjust to changes.
• Therapist doesn’t solve problems, that’s
the family’s job.
• Boundaries must be strengthened in
enmeshed relationships, and weakened (or
opened up) in disengaged ones.

Therapeutic Goals
• Not a matter of creating new structures, but
reforming existing ones
• What distinguishes SFT from other forms of
family therapy is the emphasis on modifying
family structure in the immediate context of
the therapy setting.
• When new patterns are repeated and result
in improvement of family relationships, they
will stabilize and replace old patterns and
symptoms of dysfunction will be reduced or
disappear.

5. THERAPIST ROLE IN SFT
“STRUCTURAL FAMILY THERAPY IS
A THERAPY OF ACTION”
(MINUCHIN, 1974, P. 14).

Therapist’s Role

• Structural therapeutic efforts are based on
the principle that action leads to new
experiences and insight (Vetere, 2001).
• The therapist tries to help the family
create permeable boundaries and
subsystems.
• Therapist’s task is to break the certainty of
the family of what the problem is or who
the “problem” is. This confusion helps
family members to rethink their roles and
try out new ones.

Therapist role in SFT
• The therapist intervenes with the family
actively during sessions by assuming a
leadership position.
• Maps the family’s underlying structure
(boundaries, hierarchy, subsystems)
• Intervenes to transform the structure with
direct requests to the family to change how
the members interact with each other

Phases of treatment
• Phase 1: Joining
• Phase 2: Understanding the presenting
issue
• Phase 3: Assessment of Family
Dynamics
• Phase 4: Goals
• Phase 5: Amplifying Change
• Phase 6: Termination

Therapeutic Interventions
• Joining in a position of leadership, and
accommodating
– Family is set up to resist you. You are a
stranger, and know nothing about their
struggles, and their goodness.
– Important to join with angry and powerful
family members
– Important to build an alliance with every
family member
– Important to respect hierarchy

• 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.
• Mapping underlying structure in ways that capture
the interrelationship of members -- A structural map
is essential!)
– Family structure is manifest only with members
interact
– By asking everyone for a description of the
problem, the therapist increases the chances for
observing and restructuring family dynamics.
– Tracking communication contents and use them
in the session.

Highlighting and modifying interactions
Enactments -- directed by therapist in
which the family performs a conflict
scenario, which happens at home during
the therapeutic session. Sharf (2004)
enactment offers the therapist an
opportunity to observe the family rather
than simply listening to the family story.

Restructuring
• Use of reframing to illuminate family structure
• Use of circular perspectives, e.g. helping each
other change
• Boundary setting
• Unbalancing (briefly taking sides)
• Challenging unproductive assumptions
• Use of intensity to bring about change (not
giving up)
• Shaping competency
• 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.

• Homework
– Should be to increase contact between
disengaged parties,
– To reinforce boundaries between individuals
and subsystems that have been enmeshed
– Should be something that is not too
ambitious
– While Minuchin rarely used strategic
interventions, he did caution family members
to expect setbacks, in order to prepare them
for a realistic future.

Criticisms Of The Theory
• De-emphasizes emotional lives
• Biases on appropriate family structure that is
“western” nuclear family model
• Cross Cultural considerations are needed

Evaluation
• Key model in the development of family
therapy as a whole
• Core Concepts and interventions have been
incorporated into most family therapy: eg
Joining and enactment
• Empirically evaluated, validated and refined
by research particularly with conduct
disorders, anorexia, substance abuse, and
psychosomatic illness in children.

Conclusion
• Architecture of a given family considered
• Help families with multiple problems
• Used for over 40 years and continued today
as society is rapidly changing

8. Readings
• Metcalf, L. ( 2011) Marriage and Family
Therapy : A Practice-oriented Approach.
Chap 10 Structural Family therapy. On
EBSCO.
• Winek, J. (2010) Systemic Family
therapy: From Theory to Practice.
London. Sage. (Chapter 8 Structural
Family Therapy). On order for Flex

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Structural Family Therapy: Core Concepts

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