January 14, 2021

What Is Structural Family Therapy?

by | Jan 14, 2021 | Treatment & Medication

Salvador Minuchin developed structural family therapy in the 1960s after working as a pediatrician in Argentina. After spending time exclusively working with children, he began to realize that treating them alone didn’t inherently solve their problems. 

His model of structural family therapy began as a way of identifying and treating problems within family systems. He believed that problems were not individually-based; instead, they were a function of the family’s homeostasis.

This therapy can help families struggling with various issues, such as trauma. It may also treat different high-risk situations, like single-parent households, families struggling with severe marital problems, or families with special-needs children. 

Basic Assumptions of Family

Structural family therapists tend to assume the following:

  • Families are capable and competent in solving their issues.
  • Rigid or enmeshed boundaries can prevent closeness and growth.
  • Individual symptoms are often a result of the entire family system.
  • Each family has subsystems, which hold onto different levels of power.
  • All family systems want homeostasis (a sense of stability and balance).

Structural family therapists aim to be equal and collaborative in their work. They perceive families as unique and special, and they don’t try to enforce rules on them that don’t work. Instead, they aim to present viable suggestions for change. 

Understanding Family Structure

It should come as no surprise that structural family therapists focus on the structure within each family. The structure refers to what builds, maintains, and even destroys individual families.

Hierarchy of Power

All families have a hierarchy of power. In healthy systems, the parents or caregiver(s) hold the authority. They decide what’s best for their children, and they work as a united team to instil boundaries. 

But as we know, this hierarchy isn’t the case for all families. In some systems, children seem to run the house. They call the shots and make the rules, and parents may fall helpless to their demands.

In other households, only one parent has all the power. The other parent may become subservient to them, which can result in a lopsided structure. Children may feel afraid of the powerful parent. The powerful parent may use threats, hostility, or even violence to maintain their role. 

Whoever holds power makes the decisions. If the power consistently fluctuates, it leaves family members feeling confused and untethered. This is especially true for children. Without consistency, they don’t understand which rules they need to follow. They may rebel or defy their parents if this pattern persists.

Subsystems

Family subsystems refer to the specific subgroupings within a family. These groupings happen based on gender, age, or interest. Common subsystems include:

  • Parental: can include any caregiver taking care of the children
  • Spousal: may include a single parent or couple
  • Sibling: includes any biological, adopted, or step-sibling pairs 

Subsystems can be measured based on the boundaries maintained between each member.

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Boundaries 

Structural family therapists measure dysfunction based on boundaries and how family members adapt to different stressors. In functional families, family members are flexible and fairly easygoing. 

They have clear boundaries, but they can adjust these limits as needed. Dysfunctional families, on the other hand, tend to have rigid or enmeshed boundaries. 

Rigid boundaries are strict and inflexible. In these households, members are expected to follow certain beliefs without question. These beliefs can include anything from religious affiliation to food preferences to what kind of occupation the children should aspire to have. 

Rigid family systems rarely support individual thought. Instead, members are accepted by their willingness to conform to the status quo. 

Enmeshed boundaries refer to blurred, nonexistent, or loose boundaries between family members. Some signs of enmeshment include:

  • Family members taking on the emotions of other family members
  • Feeling like you’re not allowed to be close to people outside of the family
  • Spending all your free time with one another
  • Having no sense of privacy 
  • Parents seeking their child’s approval, friendship, or emotional support
  • Becoming overinvolved in each other’s lives

Enmeshed families tend to present as “very close” to the outside world. Therefore, it can be challenging to discern that problems exist. But many times, enmeshment can lead to struggles with identity, decisiveness, and assertiveness. 

Boundaries are reciprocal, and they have ongoing ripple effects. For example, a mother who is extremely close with her daughter may withdraw from her husband. If a father favors his oldest son, the younger son may become anxious, depressed, and angry.

Triangulation 

Triangulation happens when one family member tries to use something or someone else to pit against another family member. 

For example, two arguing parents may ask their child to play referee. Or, a parent may always step in when two siblings disagree, which means they never have the chance to resolve their conflicts together. At times, clients may even attempt to triangulate the therapist to avoid talking to one another directly.

Parentified Children

Parentified children may result from dysfunctional families. In these cases, the parents often rely on the child to provide ongoing emotional or physical support. For instance, a parent may share their marital problems with her small child. Or, they might expect their child to start working in the family business while in elementary school.

These parentified children often grow up seeming overly mature and wise. They may get along very well with other adults because they seem like small adults themselves. 

Unfortunately, even though they present as responsible, they tend to feel misunderstood and insecure. Having been robbed of their childhood, they’re often used to taking care of other people- rather than the other way around. 

Attachment theory is grounded in how we relate to others based on our childhood relationship with our parents.

Structural Family Therapy Goals

The main goals include establishing clear boundaries and shifting the hierarchical structure. Structural family therapists work to improve the separation between couples, children, parents, and other family members. They also aim to strengthen subsystems.

Making slight changes to the structure can improve happiness and functioning. As family members learn to adapt to new boundaries, they gain more respect for one another. 

Getting Started 

Just like with any professional therapy, the first steps include intake and consent. The intake consists of learning about the family, reviewing goals, and assessing for mental health concerns. Families may fill out a written questionnaire or respond to a series of questions. 

This intake information helps the therapist establish a working treatment plan. The treatment plan entails goals, objectives, and expectations for therapy.

Consent is an essential part of any therapy process. Consent means consenting to therapy- which refers to agreeing to the terms, limitations, and expectations of the process. The therapist will review the limits of confidentiality and also discuss administrative concerns like payment, scheduling, and frequency of sessions. 

Confidentiality is one of the most important factors in family therapy, and this is especially true if the therapist is meeting with any of the members individually. It’s essential that each person thoroughly understands their right to privacy.  

Joining The Family

Structural family therapists don’t assume they are experts on the families they treat. Instead, they aim to join the family. This joining requires building rapport, providing validation, and having a genuine interest in each member.

By becoming a part of the system, they learn the rules, hierarchies, and subsystems between members. Joining happens at the beginning of therapy. However, it isn’t just a one-time event. The therapist must continue to maintain their position as a stand-in family member for the duration of therapy. 

Many structural family therapists join through mimesis. In this method, they take on the family’s style of communication and mannerisms. If the family is overly sarcastic, they will make witty jokes. This isn’t disingenuous- it’s meant to show respect for how the family acts and behaves.

The Typical Session

In structural family therapy, the therapist first spends time observing the family interact with one another. It’s not uncommon for families to present on their best behavior when they first arrive at the office. This usually happens due to a combination of nerves and people-pleasing tendencies. They may also want to impress the therapist.

But family therapists are skilled in making careful analyses of human behavior. They notice small discrepancies and patterns. Let’s discuss some common interventions used in this model.

Mapping

Family therapists use structural maps to present how family members interact with one another. 

They achieve this task by asking each family member to thoroughly describe the family problems. There is no interrupting or shaming allowed- families have full freedom to speak what’s on their mind.

Reframing

Reframing is a way to provide an alternate perspective to a certain thought. 

For example, a therapist may reframe a father’s strict protectiveness over his daughter as he loves her and feels concerned about her safety. They may reframe a child who continues to talk back to his teacher as wanting to learn how to express themselves and have a voice.

Reframing aims to create more solutions for fixed problems. It’s a way of softening the discomfort. When families can believe that each member has good intentions, the system tends to feel safer. As a result, people become less hostile, judgmental, and self-serving. 

Enactment

Enactment refers to families engaging and interacting with one another, rather than to the therapist directly. This exercise allows the clients to become more aware of their patterns. It also enables the therapist to observe them more closely.

Enactments offer many insights, including:

  • How couples relate and interact with one another
  • How children feel talking to their parents and vice versa
  • How different boundaries or triangles affect relationship satisfaction

The therapist may direct the family to enact a specific conflict. During the enactment, the therapist can watch how families talk, respond, and react. 

Restructuring 

Along with reframing, restructuring includes different techniques to disrupt the family’s homeostasis. It will include exercises like setting boundaries, unbalancing (temporarily taking one person’s side), and heightening emotion to evoke change.

Heightening emotion helps families recognize the severity of their behaviors. It’s not uncommon for families to run on auto-pilot for many years. They may not recognize how much damage they are inflicting until someone points it out. Subsequently, since the therapist has already joined the family, they are more likely to listen to the therapist’s observations. 

Boundary marking refers to having families identify the limits needed between subsystems. Therapists will work with families to discuss the appropriate boundaries to consider setting. At this point, they have made astute observations, which can be incredibly helpful in supporting family members to navigate this uncharted territory.

Therapists do not attempt to solve the family’s problems. They encourage family members to take ownership over making change. The goals should not be so far-fetching that they feel unrealistic. Instead, structural family therapy aims to be realistic and feasible.

Shaping Competence 

Shaping competence refers to acknowledging and praising positive behaviors. In a sense, it’s a form of positive reinforcement. Therefore, a therapist may reinforce a parent who supports their child to follow a specific rule. This reinforcement ideally encourages them to continue making that choice. It reinforces that they are capable of doing the right thing.

Finding a Structural Family Therapist

If you think structural family therapy sounds like a good option for your family, start looking for professionals in your local area. In some cases, insurance may cover some or all of your co-pay. Contact your insurance provider to determine your eligibility. They may also have a referral list of in-network providers.

You will want to seek someone who has a background in family therapy with specific structural family therapy training. It’s reasonable to ask clarifying questions. Consider asking potential candidates: 

  • How long have you been practicing therapy?
  • What kind of expertise or training do you have in structural family therapy?
  • What outcomes do you anticipate for my family?
  • How often do you think we will meet?

Finding the right therapist may require some trial-and-error. You might need to meet with a few different providers before finding the right fit. This is normal. Just like with any relationship, it’s important that you feel respected, heard, and appreciated.

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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