COUN 601 – Marriage and Family Counseling
Understanding the Development and Techniques of Structural Family Therapy
When structural family therapy was developed by Salvador Minuchin in the 1970s, it was among the most influential family therapy models in the field. Now, in applying this model, the structural family the rapist focuses on the family’s structure, their subsystems, and the boundaries that separate and protect the system and its subsystems. The objective with this form of therapy is to establish a family hierarchy and to strengthen the boundaries that exist between the familyâ€™s subsystems. The therapist uses techniques like joining and accommodating, diagnosing, family mapping, enacting, intensity, changing boundaries, reframing, and challenging the family’s assumptions to accomplish these objectives. Since its beginning, structural family therapy has been used successfully in a wide number of instances.
Formal marriage counseling first became available in the 1930s (Sharf, 2000). Some years later, structural family therapy, which began in the 1970s, came along and was among the most influencial family therapy models in the field (Nichols & Schwartz, 1998).
To discover and understand more about this particular model for family therapy, a number of topics will be discussed, including the early leaders of structural family therapy, the theoretical formulations of structural family therapy, the normal family development as it has been described by this approach, the development of behavior disorders, the goals of structural family therapy, the conditions for behavior change, and the techniques that are often used in structural family therapy. Following those discussions, an evaluation of this approach to marriage and family counseling will be presented, along with some closing summary remarks.
The leading counselor and founder of structural family therapy was Argentian-born Salvador Minuchin. He understood that individuals need group support in order to survive the ordeals of life, to have the benefits of socialization, and to feel a measure of emotional stability. He also understood that the family was a primary source for this kind of support and that, from other family members, the individual could gain a sense of belonging and autonomy (Clark & Standard, 1996).
Other counselors that became involved with this style of therapy were Dick Auerswald, Charlie King, Braulio Montalvo, Clara Rabinowitz, Jay Haley, Bernice Rosman, Harry Aponte, Carter Umbarger, Marianne Walters, Charles Fishman, Cloe Madanes, and Stephen Greenstein (Nichols & Schwartz, 1998). The current leaders in the field, as well as the teachers at the Minuchin Center in Philadelphia, are Ema Genijovich, George Greenan, Richard Holm, Wai-Yung Lee, and George Simon (Nichols & Schwartz, 1998).
In developing the structural family therapy model, Minuchin focused on individuals in the family and on their interactions within the family. He knew that beginning counselors would have difficulty working with the overall complexity of family dynamics, so one of his early design considerations was that the counselor had to be able to see all the familyâ€™s interactions. Once those interactions were clear, he believed that the therapist could look for effective ways to help his or her clients. To gain this needed insight, the structural family therapist focuses on the family’s structure, their subsystems, and the boundaries that separate and protect the system and its subsystems.
The family’s structure pertains to the rules that are developed over time within the family. This structure also determines with whom and how each member of the family will interact (Sharf, 2000). According to Minuchin, the family’s structure will have the parents at the top with most of the power. Beneath them will be the children. Then, within the childrenâ€™s part of the hierarchy, older siblings will be understood to have more responsibility than the younger. Through family interactions and relationships, subsystems will develop, and over time, everyone in the family will learn their role in the family as well as how to live by the family’s rules. This part of the process shows the familyâ€™s hierarchy and how they are organized.
Next, the familyâ€™s subsystems describe all the relationships that exist within the family. For example, the husband and wife have a relationship with each other that is called the marital subsystem. As parents to their children, the parental subsystem describes the roles of those who oversee the children. It should be noted, however, that the parental subsystem does not have to be the mother and father of the children. This subsystem is simply defined based on those who provide the actual parenting role. Sibling subsystems can also exist, and they describe how the children relate to each other (Clark & Standard, 1996). In the extended family, subsystems can even exist for grandparents and other family members if they interact with each other and the rest of the family.
In the matter of boundaries, structural family therapy theory maintains that boundaries exist between outside forces and the family system and also between the subsystems within the family system. According to Minuchin, these boundaries will either be clear, too rigid, too loose, or somewhere in between. Clear boundaries are a sign of healthy interaction, and they mean that the family will probably be able to deal with most of the important issues that come up. “With clear boundaries, theÂ familyÂ has the potential to function adaptively to stress and to grow in relation to normal developmental stages” (Greif, 1996, p.Â 5). Boundaries that are too rigid or too loose do not fare so well.
According to Geoffrey Greif, families with loose boundaries are characterized by blurred roles and a lack of family or individual identity, while families with rigid boundaries usually indicate poor communications within the family system and do not allow for easy movement between roles. “A highly permeable boundary would be found in enmeshed families, whereas nonpermeable or rigid boundaries would be found in disengaged families” (Sharf, 2000, p.Â 513). Minuchin saw enmeshed families as chaotic and tightly interconnected. He saw disengaged families as isolated and seemingly unrelated.
Normal Family Development
A healthy family will have a structure in place that can efficiently handle family problems. But when a man and woman marry and are just getting started, the structure of their family is only beginning to form. First, the couple must learn to live together, and this usually requires some major adjustments. By accommodating each other and establishing some clear boundaries, the couple and their relationship mature, and their small family can begin to develop its own structure. Then, when or if children are born as a result of their union, even greater levels of complexity are added.
Clark and Standard write that the family goes through eight developmental stages (Clark & Standard, 1996). The first stage is being married without children. Second is when the oldest child in the family is between birth and two-and-a-half years old. Third is the family with the oldest child being between two-and-a-half and six years old. Fourth is the family with school-aged children, with the oldest child being between six and thirteen. Fifth is the family with teenagers, where the oldest child is between thirteen and twenty. Sixth is called the family launching adults stage, which means that the first child has left home and the youngest child is preparing to leave. Seventh is when the parents are middle-aged and approaching retirement, and eighth is when the parents are retired and approaching death.
Understanding these stages and their significance to the family is important to the therapist when he or she is trying to assess the familyâ€™s overall developmental progress. They are also important when the therapist is trying to determine where the family is in life. Has the family adapted well as it has gone through the various stages of normal family development? Has the family successfully moved from one stage to the next, or are they still hung up on an earlier stage? Where is this family right now in the family development stage, and how well are they dealing with it? These are just some of the questions that a therapist might ask relative to the familyâ€™s development.
Development of Behavior Disorders
Behavior disorders occur within the family when its structure and boundaries do not allow the family to respond favorably to changing circumstances. Structural difficulties often suggest a family hierarchy that is weak and ineffective or one that is rigid and arbitrary. The structural family therapist must be aware of the family’s structure and rules in order to best help the dysfunctional family (Sharf, 2000). He or she must also be able to identify the alliances and coalitions within the family because these may many times need to be neutralized or done away with completely.
Likewise, boundaries are a factor in determining behavior disorders, too.. Loose boundaries are associated with enmeshment and mean that the family members are too closely connected. As was stated above, this can lead to blurred roles and a lack of family or individual identity. Rigid boundaries, on the other hand, are consistent with being disengaged, and they mean that the family is too distant and probably has poor communications patterns. Enmeshed families try to take everything in, while disengaged families try to keep everything out. Both extremes are signals for trouble, so the therapist should be looking for ways to establish a balance between the two.
Goals of Therapy
Being able to deal with changing circumstances requires that the family be able to adapt and change with those changing circumstances. To do that, the family might have to alter its power structure and/or role relationships to properly position itself for the given environmental situation (Coco & Courtney, 1998). As one might expect, analyzing and changing boundaries is also an important part of this process.
Using the principles of structural family therapy, the therapist should try to understand the structure of the family and the external influences that might be acting on that structure. As Jones and Butner write, “A very direct and often manipulative approach, [structural family therapy] focuses on establishing more adaptive patterns of interactions by creating clear, flexible boundaries between family members and strengthening the parental hierarchy” (Jones & Butman, 1991, p. 356). Andrew G. Weinstein makes a similar statement by saying that the objective of structural family therapy is to establish a family hierarchy and to strengthen the boundaries that exist between the familyâ€™s subsystems (Papp, 1983).
Conditions for Behavior Change
The family comes to the therapist with their problems, and one of the first keys to their successful change is for them to have a willingness to change. Too often, a patient will choose the certainties of a known pathology over having to deal with the uncertainties of a new course. Undergoing change can be very scary. However, most of the time, change is the very thing that is most needed.
Another factor relative to undergoing change is that the family must be able to accept their therapist and have confidence in him or her. Having confidence in the therapist and in the therapeutic process might be the important elements that will make the family more willing to change. The therapist might also be able to create the right environment for change by using some or all of the techniques discussed below.
Family relational problems have been linked to the alliances and coalitions of the family, the permeability of family boundaries, and the organization of power (Mash & Johnston, 1996). Structural family therapy requires a close observation of the family’s interactions (Clark & Standard, 1996). To deal with these issues and to satisfy the need to observe the family, the therapist can use some of the following therapeutic techniques: joining and accommodating, diagnosing, family mapping, enacting, intensity, changing boundaries, reframing, and challenging the family’s assumptions. These techniques will be discussed below.
Joining and Accommodating
To enhance success during the therapy process, the therapist should join and accommodate his clients. Joining, in a sense, is like taking sides with one of the key members of the family, such as a member who is powerful, angry, or depressed, and showing acceptance to that particular family member. In a similar sense, accommodating involves acceptance, too, because the therapist actually takes on the familyâ€™s style of interacting. The purpose of joining and of accommodating is to gain the family’s confidence so that they will listen to the therapist and follow his or her recommendations. “Joining and accommodating are considered prerequisite to restructuring” (Nichols & Schwartz, 1998, p. 254).
One method of joining is mimesis, where the therapist might imitate the familyâ€™s manner and/or content of communication. He may joke around with an unusally happy family, or he might be somber with a family that is deeply depressed and glum. When trying to join with the family, however, the counselor must set personal boundaries and exercise extreme caution because this tactic can also backfire.
In another example of joining, the therapist might join to a specific family member in an attempt to unlock a stalemated family that is not getting anywhere. This is referred to as unbalancing, and Nichols and Schwartz compare this type of joining as combat for the purpose of change (Nichols & Schwartz, 1998). When properly done, joining to unbalance can lead to a desired change in the family system, and that will strengthen the overall family. The authors point out that the therapist should join with different family members during the life of the therapy sessions, though, so that none of the family members will feel left out or unduly picked on.
Many times, a family will initiate visits to the therapist because of problems being experienced with a particular family member, and of course, that usually means that there is a problem with one of the children. However, this troubled family member, who is called the identified patient, is very rarely the reason for the actual problem. By watching how the family interacts during the first session, the therapist should be able to begin diagnosing their real problem (Greif, 1996).
For example, if one of the children is exhibiting extremely negative behavior, then it is most likely because of some other part of the family that is out of balance. For example, a child will be bad if he or she thinks that the bad behavior will keep the parents together. But in that case, the childâ€™s insecurity about the parentsâ€™ relationship is the motivating force behind the bad behavior, not the childâ€™s badness. A 1974 study by Minuchin found that family relational problems usually come from families with weak marital alliances (Mash & Johnston, 1996).
When the therapist can pick up on an out of balance situation within the family, then solutions can often be worked out and quickly applied. However, when the therapist fails to quickly diagnose the problem, particularly in an early session, then the sessions that follow will many times have him helping the family through isolated problems and incidences but not actually leading them to a good, workable solution.
Murray Bowen created the genogram so that he could track all the relationships in the family and also so that he could keep up with all the members of the family. Minuchin developed a family map to accomplish essentially the same purpose, only he was more concerned about boundaries and how the family was relating. With a family map, Minuchin and other structural therapists can see which subsystems are most vulnerable, which ones are most likely to be causing the problem, which, if any, boundaries are either too loose or too rigid, plus which repeated behaviors need to be modified or eliminated.
In the map itself, boundaries are shown by different line types, where a dashed line represents a clear, healthy boundary. A solid line represents a rigid boundary, and a dotted line, with a wide space between each dot, represents a loose or diffuse boundary.
To fix family problems, the structural family therapist needs to observe the family and see how they interact together. By having them enact or act out a particular conflict, he or she can often gain this kind of valuable information. The therapist can watch how the family behaves with each other and see them firsthand in a conflict situation rather than having them just tell him about their behavior in such situations.
Intensity means that the therapist places extra emphasis on a particular behavior or family situation. For example, the therapist can show emphasis by repeating a statement or by how he expresses a thought and, by so doing, bring about change within the family. In an enmeshed parent-child relationship, for instance, the counselor can encourage the parents to loosen up a little. He can, then, follow that remark up by encouraging them to give their child more freedom and more responsibility. In a disengaged family situation, the counselor can encourage more open communications among all family members. He can, then, reinforce that idea by having the family enact a particular conflict situation.
In structural family therapy, the therapist tries to understand the familyâ€™s structure, their subsystems, their interactions, and their boundaries so that he can identify the source or sources of their problem. Where a boundary is too rigid or too loose, the therapist will suggest changes that might make the boundary more clear. Rigid boundaries suggest bad communication patterns within the family, and loose boundaries suggest blurred family member roles and poor family or individual identity. The purpose of structural family therapy is to fix these dysfunctional characteristics. However, the therapist needs to be mindful of the fact that, many times, family boundaries are based on culture or ethnicity (Greif, 1996).
Reframing pertains to changing how the patient sees a particular behavior so that the familyâ€™s structure, subsystems, and boundaries can be changed to fix the problem. In one of his more famous cases, Minuchin told a girl with anorexia that she was really just stubborn, rather than sick, and his remark brought the whole family into the problem (Sharf, 2000). When the child had been considered sick, the rest of the family could remain detached and uninvolved. But when Minuchin diagnosed her as being stubborn, then both she and her family had to deal with the problem and take responsibility for her condition.
Challenging the Family’s Assumptions
Challenging the familyâ€™s assumptions can be an effective way to bring about change in a family because many of their assumptions will probably involve the familyâ€™s rules about interaction. If the therapist can successfully challenge one or more assumptions and cause the family to see a part of reality differently, then the family structure, subsystems, and boundaries might be changed, and this would accomplish the primary goal of structural family therapy.
Evaluating Therapy Theory and Results
Structural family therapy has enjoyed a good success record since its inception in the 1970s. Minuchin developed this technique and successfully used it on severely ill psychosomatic children. This approach to family therapy has also been used with success on drug addicts, families that live in slum areas, people with anorexia, and in families that are experiencing other types of relational problems. Clark and Standard even suggest that the principles of structural family therapy apply to being an effective caregiver (Clark & Standard, 1996).
In developing the structural family therapy model, Minuchin focused on the individuals in a family and how they interacted with the rest of the family. The key constructs for this model are the family structure, their subsystems, and their boundaries. Boundaries that are too rigid or too loose are indicators of a family relational problem, while clear boundaries enable the family to adapt well to changing, stressful situations.
The structural family therapist examines the family for alliances and coalitions. He or she tries to join with the family and accommodate himself or herself to their style of interacting. The goals of therapy are to establish more adaptive patterns of interactions, to create clear, flexible boundaries between family members, and to strengthen the parental hierarchy. The therapist also seeks to strengthen the marital, parental, and sibling subsystems and to help each family member understand their place and role within the family. Since its beginning, structural family therapy has been used successfully in a wide number of instances.