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Structural Family Therapy

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Background of Structural Family Therapy ... He transformed the clinic into a family therapy center ... written and popular books in field of family therapy ... – PowerPoint PPT presentation

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Title: 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_backg
r.htm
3
Salvador Minuchins Background
  • 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

http//www.mariemontschools.org/parr/therapy_backg
r.htm
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_backg
r.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_backg
r.htm
6
Minuchin since 1981
  • 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

http//www.mariemontschools.org/parr/therapy_backg
r.htm
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 individuals symptoms can be reduced

8
Structural Family Therapists Function
  • The therapeutic task is to help move family from
    a dysfunctional stage to a new stage (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
    familys 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 familys 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
  • 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 dont need any help with
    it. That you know exactly what to do. Ask your
    husband to do that for you.
  • Mother Father
  • ? ? ? ? ? ? ? ?
  • 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 ? Daughter Father

20
Possible Therapist Responses to the Scapegoating
Problem in the Fletcher Family
  • STRUCTURAL THERAPIST
  • Only Irving has said nothing so far. Who can
    get his side of the story?
  • 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.

21
Possible Therapist Interventions in Fletcher
Family
  • ACCOMMODATION
  • Mrs. Fletcher, I wonder if you could get
    Irvings 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 sons 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 familys rules about arguing
  • Analyze the function of the couples behavior

27
  • Q For Minuchin, scapegoating and overprotection
    of a child by the childs 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 shes 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 alcoholics relatives to
    admit they are codependent
  • The aim of therapy is to restructure the familys
    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 familys 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 fathers 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 familys present and its past will be
    examined in therapy
  • The focus of the treatment should be on changing
    the familys 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
    familys 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 girls problems. Both parents
    acknowledge feeling frustrated and unable to
    control their daughters 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_backg
    r.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/Family2
    0Therapy.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.
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