Structural Family Therapy

1. Structural Family Therapy By Isabel Brasil and Melissa Ruiz

2. Background of Structural Family Therapy http://www.mariemontschools.org/parr/therapy_backgr.htm

3. Salvador Minuchin’s Background http://www.mariemontschools.org/parr/therapy_backgr.htm • Born in 1921 to Russian Jewish emigrants in Argentina • In 1948 he joined the Israeli army as a doctor • In 1950, Minuchin came to United States with the intention of studying with Bruno Bettleheim in Chicago     1. Met Nathan Ackerman in New York and chose to stay there     2. In 1954 Minuchin began studying psychoanalysis and a few years later took the  position of medical director of the Wiltwyck School, a residential facility in New York for inner-city delinquents

4. Minuchin Became a Systems Therapist • Along with Dick Auerswald and Charles King in 1959, began developing a 3 stage approach to working with low-socioeconomic-level black families • 1. Treatment created out of necessity due to long-term, passive approaches to these families proving unsuccessful • 2. Minuchin discovered that dramatic and active interventions were necessary to be  effective • 3. Minuchin discovered two common patterns in dysfunctional families: enmeshed, chaotic and tightly interconnected, or disengaged, isolated and seemingly unrelated • Minuchin gained widespread attention for his work at Wiltwyck • The method used was published in Families of the Slums in1967 http://www.mariemontschools.org/parr/therapy_backgr.htm

5. Minuchin Became Director of Philadelphia Child Guidance Clinic (1967) • He transformed the clinic into a family therapy center • Gained a reputation as a tough and demanding administrator • Developed many innovative ideas at the Clinic • Example: Institute for Family Counseling, a training program for community paraprofessionals that was effective in providing mental health services to the poor • Minuchin published Families and Family Therapy in1974 • Most clearly written and popular books in field of family therapy • In 1975 Minuchin stepped down as director of clinic, but remained head of training until 1981 http://www.mariemontschools.org/parr/therapy_backgr.htm

6. Minuchin since 1981 http://www.mariemontschools.org/parr/therapy_backgr.htm • Has studied normal families, written several plays and books and commented on the overall field of family therapy • He set up the Family Studies Institute in New York City • Continues to do workshops and trains therapists from all over the world • Passionately committed to social justice and is involved in foster care system in New York

7. Key Concepts of Structural Family Therapy Focus is on family interactions to understand the structure/organization of the family Symptoms/presenting problem viewed as by-product of structural failings Structural changes must occur in a family before an individual’s symptoms can be reduced

8. Structural Family Therapist’s Function The therapeutic task is to help move family from a dysfunctional stage to a newstage (evolved different structures have more stable levels of functioning) Actively engage family unit to initiate structural change by joining and accommodating Challenge rigid transactional patterns

9. Family Structure • invisible set of functional demands or rules that organize way family members relate to one another

10. Family Subsystems Spousal: wife & husband Parental: mother & father Sibling: children Extended: grandparents, other relatives Family member play a different role in each of the subsystems they belong Structural difficulty when one subsystem takes over or intrude another

11. Boundaries Emotional/physical barriers that define amount and kind of contact allowable between members Extremes of boundaries may lead to dysfunction Disengagement-rigid-little commitment/closeness to family Enmeshment-diffuse-very involved as one-fosters dependency on parents/other members Clear healthy boundaries-attain sense of personal identity yet allow sense of belongingness within family system

12. Understanding the Problem The therapist determines the issues around which to explore and intervene in the session. • Joining the family in a position of leadership • entering their reality and becoming part of that family’s patterns of relating/structure

13. Collecting Data The therapist tracks content and learns about the family issue and draws together all data relevant to the issue as gathered from prior information and the in-session experience leading up to the moment when the therapist is to intervene. • Mapping family’s underlying structure • observe family to see structure, focusing on the how, when, and to whom family members relate • who says what to whom • in what way • with what result

14. Formulating Hypotheses On the basis of the data, the therapist commits to hypotheses about the significance of the current transactional sequence of the nature of the problem, its locus, and sustaining structure. • Conducts experiments through probes and challenges to assess the flexibility of family patterns

15. Structural Goals • To the extent permitted by the hypotheses, the therapist determines immediate goals for the intervention that is to follow • Reduce symptoms of dysfunction • Bring about structural change because it is assumed that faulty family structures have: • Boundaries that are rigid or diffuse • Subsystems that have inappropriate tasks and functions

16. Intervening • Intervening in ways designed to transform an ineffective structure • The therapist: (a) to facilitates change in patterns of transactional sequences among family members and/or between self and family members (b) to controls for variables in the transaction so that the effects of the intervention can be assessed • Challenging family rules, fostering boundary reorganization, prompting conflict resolution, creating an effective hierarchical structure,increasing degree of flexibility in family interactions, modifying dysfunctional family structures, and supporting greater individuation of family members. Feedback • On the basis of the reactions of the family members to the intervention, the therapist restarts the cycle from the second step.

17. Structural Techniques Joining Imparting a Systemic View Restructuring Making Rules/Relationships/Structure Known Intensity Circular questioning Unbalancing Triangulation/Detriangulation Enactment Boundary-making Reframing/Relabeling Paradoxical Techniques Restraining Prescribing the symptom

18. Therapist Awareness Your Role/Position/Function in the Family Your Family of Origin Issues General Unresolved Cultural Factors (yours and theirs)

19. Possible Therapist Interventions in the Problem of Mrs. N.’s Daughter PROBLEM: How to stop the daughter from interrupting and clinging to her mother. ALTERNATIVE INTERVENTION: “It would be good to stop her from that because, see, she is identifying with you, acting inadequate right now, just like you feel yourself. So, she wants to be like you, to cling to inadequacy.” Mother Ξ Daughter | Father • STRUCTURAL INTERVENTION: • “Mrs. N., would you tell your husband to remind Becky that you are fine, that this is an old story of yours, and you don’t need any help with it. That you know exactly what to do. Ask your husband to do that for you.” Mother Father ― ― ― ― ― ― ― ― Daughter

20. Possible Therapist Responses to the Scapegoating Problem in the Fletcher Family PROBLEM: A system stuck with the completion of a scapegoating sequence. OTHER THERAPIST: “Irving, you must be really upset by all this.” OR “Irving, I am really interested in your side of this.” STRUCTURAL THERAPIST: “Only Irving has said nothing so far. Who can get his side of the story?”

21. Possible Therapist Interventions in Fletcher Family • ACCOMMODATION • “Mrs. Fletcher, I wonder if you could get Irving’s side of the story?” • ALLIANCE RESTRUCTURING • “Mr. Fletcher, perhaps you and Irving could discuss his side of the story.” • HIERARCHY RESTRUCTURING • “Mr. Fletcher, perhaps you could get your wife to find out more about her son’s view of this matter.”

22. Role Play

23. Strategies for Approaching the California Marriage and Family Therapy Licensing Exam

24. Q – You have been seeing a couple in therapy for four months. One of the goals of your treatment plan was to improve dysfunctional interaction patterns and your treatment included restraining and repositioning strategies. This is representative of: Humanistic-existential theory Structural theory Strategic theory Psychodynamic theory

25. Q – Common sense solutions to problems rarely work. What theoretical orientation supports this belief: Experimental family therapy Structural family therapy Strategic family therapy Extended family therapy

26. Q – Client: “I think my wife says mean things to me to make me feel guilty.” Therapist: “How do you feel when your wife says mean things to you?” Client: “I feel that she is mean.” Therapist: “You say you think your wife is mean when she says these things to you. Now, how do you feel when this happens?” Client: “I feel bad about myself.” What is this therapist attempting to do: Help the client in the process of differentiation Get the client to “unwrap” his projections Learn this family’s rules about arguing Analyze the function of the couple’s behavior

27. Q – For Minuchin, scapegoating and overprotection of a child by the child’s mother and father are both forms of: Triangulation Detouring A stable coalition Marital skew

28. Q – A 45-year-old client was sexually abused as a child by her father. She says she’s not angry with him and, in fact, has kept a close relationship with him over the years. She sees him often and says she intends to continue doing so. This is an example of: Blurred boundaries Enmeshment Disengagement Pseudohostility

29. Q – From a systems perspective, which of the following is MOST true about treating a family with an alcoholic member: The first step in restructuring the family involves getting the alcoholic’s relatives to admit they are codependent The aim of therapy is to restructure the family’s homeostatic mechanisms Therapy should focus on identifying and correcting faulty communication patterns The family should be trained in ways of reinforcing non-drinking behaviors and extinguishing drinking behaviors

30. Q- When working with an intellectually-oriented family, the therapist “joins” the family by adopting a cognitive, intellectual style. This technique is referred to as: Tracking Modeling Mimesis Enactment

31. Q- A father and mother bring their 13-year-old son into therapy. At the beginning of treatment, the father states that the boy has been behaving disrespectful toward parents and teachers, and that all he cares about is his “damn skateboard.” The mother confirms non-verbally what her husband is saying by nodding and frowning. The son is sitting silently, with his eyes down, and refusing to talk. Which of the following techniques would a structural family therapist employ: Sending the parents out to talk to the boy alone Asking each family member to share their feelings about what is going on Pointing out to the family that the father seems to be doing all the talking Engaging the family in conversation by using family members’ mannerisms and communication styles

32. Q – In an enmeshed family in which an overcontrolling father constantly nags and yells at his 18- and 15-year-old sons, a structural therapist is MOST likely to do which of the following: Manipulate the family’s mood by nagging even more and yelling even louder Help the father understand that his nagging and yelling elicit oppositional behaviors from the boys Construct a genogram of the father’s family Create a therapeutic double-bind by telling the father to set aside an hour a day during which he will nag and yell at his sons

33. Q- When working with a family, Minuchin creates rapport by: Joining and accommodating Accommodating and restructuring Restructuring and detriangling Forming coalitions with subsystems

34. Q- For Salvador Minuchin, “psychosomatic families” – e.g., those in which asthma, diabetes, or anorexia threaten the life of one child – are MOST likely to be characterized by which of the following: Frequent intense open conflicts between family members Weak boundaries between family members and limited opportunities for individual autonomy Family roles that are inflexible and stereotyped Marked emotional distance between the husband and the wife, who are both emotionally immature

35. Q- You are currently treating a large family that presented with communication and discipline problems. You assess the family as having an enmeshed style and a weak executive subsystem. Your overall goal is to define clearer boundaries within the system. Given this context, it is likely that you would agree with all of the following EXCEPT: Both the family’s present and its past will be examined in therapy The focus of the treatment should be on changing the family’s maladaptive transactional patterns Dysfunctional patterns in the family can be altered through the use of directive techniques The focus should be each family member and on how family members feel about and interact with each other

36. Q- A family therapist instructs a family member to continue performing the target behavior and to do so in an exaggerated way. This technique id referred to a: Reframing Prescribing Positioning Cryptic message

37. Q- You are working with a family from a structural perspective. The family keeps telling you that one of the sons is the problem. The boy is sitting quietly, not defending himself. You go over to him and sit quietly, while the family’s conversation continues. This is an example of: Unbalancing Enactment Mimesis Manipulation

38. Q- From the perspective of structural family therapy, triangulation, parent-child coalition and detouring are: Methods for establishing clearer boundaries Methods for maintaining homeostasis Types of positive feedback Attempts to increase intimacy

39. Q- “Change, through therapy, is accompanied by stress, and the therapeutic system must be capable of dealing with it.” This statement was made by: Glasser Bower Adler Minuchin

40. Q- What does a structuralist do in the initial phase of therapy: Join and accommodate Highlight and join Accommodate and restructure Evaluate and restructure

41. Q- Mr. and Mrs. Smith, in their mid-thirties, have a three-year-old adopted daughter. The adoption occurred when the girl was an infant. They report that, since the adoption, they have quarreled frequently and no longer feel intimate. Mr. Smith is particularly disturbed because he feels that his wife directing all of her energies and attention to the child. The couple also mentions that their daughter may have developmental problems – their pediatrician is concerned about delays in her language development. Mrs. Smith is defensive and minimizes the girl’s problems. Both parents acknowledge feeling frustrated and unable to control their daughter’s behavior at times. All of the following would be appropriate to do with this family EXCEPT: Family-of-origin work to identify messages Mr. and Mrs. Smith got about parenthood and adoption Role-playing to help the parents say good-bye to the perfect daughter they thought they had and hello to the one they actually have Behavioral assignments to increase intimacy between Mr. and Mrs. Smith Structural techniques to strengthen the mother-daughter dyad

42. References Minuchin, Salvador. (1971). Families and family therapy. Harvard University Printing Press. Minuchin, Salvador. (1984). Family therapy techniques. Harvard University Printing Press. http://www.mariemontschools.org/parr/therapy_backgr.htm Sysemtic Interventions (Power Point) http://www.psyc.csustan.edu/kbaker/5790/.com Family Systems Therapy (Power Point) by James J. Messina, Ph.D. www.coping.org/write/C6444/Family%20Therapy.ppt Gurman, A. S. & Kniskern, D. P. (1981). Handbook of Family Therapy. New York: Brunner/Mazel Publishers. Umbarger, C.C. (1983). Structural Family Therapy. New York: Grune & Stratton, Inc.