Structural Family Therapy

Underlying Assumptions
Families (people) are competent and capable of solving their own problems -- an attitude derived from the existential-humanistic tradition Symptoms are a bi-product of a structural system that is failing Therapists work collaboratively with families, not as experts who can solve problems, but as consultants and coaches who can work to bring the familys dormant capacities to the surface. Therapists respect the familys unique culture. The question should be, not Whats ideal? but Does it work for them?

SFT Principles

There is an overall organization or structure that maintains a familys 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

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 doesnt speak up.

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 (Im close here to make up for my distance elsewhere.) This leads to what is called the crossgenerational coalition, which is a triangular structure

Therapeutic Goals

Therapy is directed at altering the family structure.

General goals of family are important, but not as important as creating an effective structure. Creation of an effective hierarchy

Structural problems are usually viewed simply as failure to adjust to changes. Therapist doesnt solve problems, thats the familys job. Boundaries must be strengthened in enmeshed relationships, and weakened (or opened up) in disengaged ones.

Therapists Role

Joins the family in a position of leadership Maps the familys underlying structure (boundaries, hierarchy, subsystems) Intervenes to transform the structure

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 without having to keep supporting them and symptoms of dysfunction will be reduced or disappear. (Similar to the idea of behavioral reinforcement)

Therapeutic Interventions

Joining in a position of leadership, and accommodating other members of the family The family may resist, its important to join with angry family members Important to build an alliance with every family member Important to respect the hierarchy

Therapeutic Interventions
Working with Interaction by inquiring into the familys 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.

Therapeutic Interventions

Highlighting and modifying interactions

Spontaneous behavior sequences Enactments that the therapist directs Restructuring Use of reframing to illuminate family structure Use of circular perspectives, helping each other change Boundary setting Unbalancing (briefly taking sides) Challenging unproductive assumptions Shaping competency Not doing the familys work for them (refusing to answer questions, or to step in and take charge when its important for the family members to do so.

Therapeutic Interventions

Homework Should be used to: increase contact between disengaged parties To reinforce boundaries between individuals and subsystems that have been enmeshed Increase contact between disengaged parties Should be something that is realistic and not too ambitious Expect setbacks in preparation for a realistic future

The technique that we will be using during the therapy session is where the children draw out a family map. This technique is very beneficial for younger children since it allows them to express how they view and feel about the familys structure. This is very similar to the technique that we saw in the video during class, in which each family member physically moves and arranges the family; however, drawing the family map can be easier for younger children, as it is similar to play therapy. Also, it is less likely that other family members will influence them when performing the exercise by speaking to them or even through body language or facial expressions.