Structural Family Structural Family TherapyTherapy

Families (people) are competent and Families (people) are competent and capable of solving their own problems -- capable of solving their own problems -- an attitude derived from the existential-an attitude derived from the existential-humanistic traditionhumanistic tradition

Symptoms are a bi-product of a structural Symptoms are a bi-product of a structural system that is failingsystem that is failing

Therapists work collaboratively with Therapists work collaboratively with families, not as experts who can solve families, not as experts who can solve problems, but as consultants and coaches problems, but as consultants and coaches who can work to bring the family’s who can work to bring the family’s dormant capacities to the surface.dormant capacities to the surface.

Therapists respect the family’s unique Therapists respect the family’s unique culture. The question should be, not culture. The question should be, not “What’s ideal?” but “Does it work for “What’s ideal?” but “Does it work for them?”them?”

Underlying Underlying AssumptionsAssumptions

There is an overall organization or There is an overall organization or structure that maintains a family’s structure that maintains a family’s dysfunctional interactions.dysfunctional interactions.

Power and hierarchyPower and hierarchy Subsystems and boundariesSubsystems and boundaries

Boundaries can be clear or normal, weak or diffuse (too Boundaries can be clear or normal, weak or diffuse (too open), or rigid (too closed)open), or rigid (too closed)

Restructuring is based on observing and Restructuring is based on observing and manipulating interactions within the manipulating interactions within the sessionsession

Spontaneous behavior sequences -- form the Spontaneous behavior sequences -- form the basis for hypotheses about family structurebasis for hypotheses about family structure

Enactments - interactions are suggested by Enactments - interactions are suggested by the therapist as a way to understand and the therapist as a way to understand and diagnose the structure, and to provide an diagnose the structure, and to provide an opening for restructuring intervention.opening for restructuring intervention.

SFT PrinciplesSFT Principles

StructureStructure an organized pattern in which families interact, not an organized pattern in which families interact, not

deterministic or prescriptive, only descriptivedeterministic or prescriptive, only descriptive Can only be seen when a family is in action, because Can only be seen when a family is in action, because

verbal descriptions rarely convey the true structure. verbal descriptions rarely convey the true structure. Subsystems Subsystems are subgroupings within the family based are subgroupings within the family based

on age (or generation), gender and interest (or on age (or generation), gender and interest (or function)function)

parentingparenting spousalspousal siblingsibling

BoundariesBoundaries are invisible barriers that regulate are invisible barriers that regulate contact between memberscontact between members

Diffuse, too weak, or “enmeshed”Diffuse, too weak, or “enmeshed” Rigid, too fortified, or “disengaged”Rigid, too fortified, or “disengaged”

ConceptsConcepts

Boundaries are reciprocalBoundaries are reciprocal That means that a weak boundary That means that a weak boundary

(enmeshment) in one relationship usually (enmeshment) in one relationship usually means that the same person is disengaged means that the same person is disengaged from someone else.from someone else.

Example is wife who is enmeshed with Example is wife who is enmeshed with child and disengaged from husbandchild and disengaged from husband

Example is father who is very close and Example is father who is very close and enmeshed with older son who hunts with enmeshed with older son who hunts with him, and disengaged with daughter who is him, and disengaged with daughter who is quietly depressed and doesn’t speak up.quietly depressed and doesn’t speak up.

Concepts, continuedConcepts, continued

Inflexible response to maturational Inflexible response to maturational (or developmental) and environmental (or developmental) and environmental challenges leads to conflict avoidance challenges leads to conflict avoidance through disengagement or through disengagement or enmeshmentenmeshment

Disengagement and enmeshment tend Disengagement and enmeshment tend to be compensatory (I’m close here to to be compensatory (I’m close here to make up for my distance elsewhere.)make up for my distance elsewhere.)

This leads to what is called the cross-This leads to what is called the cross-generational coalition, which is a generational coalition, which is a triangular structuretriangular structure

How Problems How Problems DevelopDevelop

Therapy is directed at altering the Therapy is directed at altering the family structure.family structure.

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

Creation of an effective hierarchyCreation of an effective hierarchy Structural problems are usually viewed Structural problems are usually viewed

simply as failure to adjust to changes.simply as failure to adjust to changes. Therapist doesn’t solve problems, that’s Therapist doesn’t solve problems, that’s

the family’s job. the family’s job. Boundaries must be strengthened in Boundaries must be strengthened in

enmeshed relationships, and weakened enmeshed relationships, and weakened (or opened up) in disengaged ones.(or opened up) in disengaged ones.

Therapeutic GoalsTherapeutic Goals

Joins the family in a position of Joins the family in a position of leadershipleadership

Maps the family’s underlying structure Maps the family’s underlying structure (boundaries, hierarchy, subsystems)(boundaries, hierarchy, subsystems)

Intervenes to transform the structureIntervenes to transform the structure

Therapist’s RoleTherapist’s Role

Not a matter of creating new structures, Not a matter of creating new structures, but reforming existing onesbut reforming existing ones

What distinguishes SFT from other forms What distinguishes SFT from other forms of family therapy is the emphasis on of family therapy is the emphasis on modifying family structure modifying family structure in the in the immediate context of the therapy setting.immediate context of the therapy setting.

When new patterns are repeated and When new patterns are repeated and result in improvement of family result in improvement of family relationships, they will stabilize and relationships, they will stabilize and replace old patterns without having to replace old patterns without having to keep supporting them and symptoms of keep supporting them and symptoms of dysfunction will be reduced or disappear. dysfunction will be reduced or disappear. (Similar to the idea of behavioral (Similar to the idea of behavioral reinforcement)reinforcement)

Therapeutic GoalsTherapeutic Goals

JoiningJoining in a position of leadership, and in a position of leadership, and accommodating other members of the accommodating other members of the familyfamily

The family may resist, it’s important The family may resist, it’s important to join with angry family membersto join with angry family members

Important to build an alliance with Important to build an alliance with every family memberevery family member

Important to respect the hierarchyImportant to respect the hierarchy

Therapeutic Therapeutic InterventionsInterventions

Working with Interaction Working with Interaction by by inquiring into the family’s view of the inquiring into the family’s view of the problem, and tracking the sequences of problem, and tracking the sequences of behaviors that they use to explain it. behaviors that they use to explain it.

Mapping underlying structure Mapping underlying structure in in ways that capture the interrelationship ways that capture the interrelationship of members -- A structural map is of members -- A structural map is essential!)essential!)

Family structure is manifest only with members Family structure is manifest only with members interactinteract

By asking everyone for a description of the problem, By asking everyone for a description of the problem, the therapist increases the chances for observing and the therapist increases the chances for observing and restructuring family dynamics.restructuring family dynamics.

Therapeutic Therapeutic InterventionsInterventions

Highlighting and modifying Highlighting and modifying interactionsinteractions

Spontaneous behavior sequencesSpontaneous behavior sequences Enactments that the therapist directsEnactments that the therapist directs

RestructuringRestructuring Use of reframing to illuminate family Use of reframing to illuminate family

structurestructure Use of circular perspectives, helping each Use of circular perspectives, helping each

other changeother change Boundary settingBoundary setting Unbalancing (briefly taking sides)Unbalancing (briefly taking sides) Challenging unproductive assumptionsChallenging unproductive assumptions Shaping competencyShaping competency Not doing the family’s work for them Not doing the family’s work for them

(refusing to answer questions, or to step in (refusing to answer questions, or to step in and take charge when it’s important for the and take charge when it’s important for the family members to do so.family members to do so.

Therapeutic Therapeutic InterventionsInterventions

HomeworkHomework

Should be used to:Should be used to:

increase contact between disengaged increase contact between disengaged partiespartiesTo reinforce boundaries between To reinforce boundaries between individuals and subsystems that have individuals and subsystems that have been enmeshedbeen enmeshedIncrease contact between disengaged Increase contact between disengaged partiespartiesShould be something that is realistic Should be something that is realistic and not too ambitiousand not too ambitiousExpect setbacks in preparation for a Expect setbacks in preparation for a realistic futurerealistic future

Therapeutic Therapeutic InterventionsInterventions

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