Structural Family Therapy
...ions about families. “Families are conservative, constraining social systems that organize their members toward certain predictable functioning with each other”(Lee, Minuchin, & Simon, 1996, p. 68). Biological changes and family members’ development through different stages of life result in either a family growing or getting stuck (Lee, Minuchin & Simon, 1996). Another assumption is with “the self is inside the individual”(Minuchin & Nicholson, 1993, p. 19). This concept, based on “the realization that the self is fluid and includes interaction with other people is acquired rather that self-evident knowledge” (Minuchin & Nicholson, 1993, p. 19). The philosophy of structural family therapy also recognizes that families develop static ways of interacting, and that the diagnosis for a maladaptive family is both within and outside of the family (Lee, Minuchin, & Simon, 1996). Diagnosis of a family requires surface and deep knowledge of the functioning, as well as experiences before explanations (Lee, Minuchin, & Simon, 1996). In other words the family therapist can only work with what is presented in session and present alternatives in that setting. This paper will review some of the basic definitions that promote the systems approach in structural family therapy. The specific terms such as boundaries, subsystems, affiliations and coalitions will be explored in relation to structural family therapy. Boundaries are a way of describing “where one person or group of persons ends and where the next begins” (Szapocznik & COSSMHO, 1993). Boundaries can be defined as impenetrable or extremely flexible, either extreme results in problems for the family(Szapocznik & COSSMHO, 1993, p. 52). Subsystems within a family “can thus be thought of as being surrounded by boundaries of varying permeability” (Lee, Minuchin, & Simon, 1996, p. 31). Several factors create subsystems, which define boundaries, such as age factors, and gender roles (Lee, Minuchin, & Simon, 1996, p. 31). Subsystems then develop into coalitions within the family. Coalitions are interpreted as the power inherent in certain relationships between two members in a family that occasionally is opposed to a third member (Franklin & Jordan, 1999). There are several types of such coalitions like triangulation, detouring, or complementarity (Franklin & Jordan, 1999). Triangulation is when two members side together against a third, detouring is when the frustrations of two are channeled through another, and complementarity is when family members develop complementary traits to accommodate each other (Franklin & Jordan, 1999). While describing these concepts, one can look at any family for a short time and notice these patterns of interaction. It is almost as if to a certain degree that the description of the family structures identifies families in a universal way. One can understand why this model is so easily adaptable to a multiplicity of ethnic groups. The techniques for structural family therapy involve joining the family. The term joining refers to “the process of approaching a family in a way that the family finds acceptable” (Szapocznick & COSSMHO, 1993, p. 56). Supporting this idea, Hardy, Karrer, & Hardy (1989) suggest that “to share a certain way of viewing the world is often the first step in inventing appropriate therapeutic interventions”(p. 42). Holland & Kilpatrick (1999) cite Minuchin (1974) as stressing the importance of accommodation when the therapist must make readjustments for himself in order to facilitate joining the family (p.111). The therapist must be cognizant of both verbal and nonverbal messages that might be communicated to the family when attempting to join a family (Holland & Kilpatrick, 1999). Lastly, in order for this process to be successful, joining and accommodating must be “done with the family as a whole, with each individual, and with each subsystem” (Holland & Kilpatrick, 1999, p. 112). “Joining has nothing to do with pretending to be what you are not. It means tuning into people and responding to the way they move you” (Minuchin & Nichols, 1993, p. 42). After joining a family, the family therapist will track the “repetitive patterns of family interaction the we call ‘family structure’” (Szapocznick & COSSMHO, 1993, p. 60). Two types of structure that contribute to family interaction, they are the generic and idiosyncratic structures within a family (Holland & Kilpatrick, 1999). The generic structure is the power hierarchy in the family, and the idiosyncratic structure according to Minuchin (1974) is quoted in Holland & Kilpatrick (1998)“involves the mutual expectations of the family members”(p. 107). While family structure does not prescribe how people interact, “it does set limits and it organizes the way they prefer to function" (Minuchin & Nichols, 1993, p. 40). However, it must be recognized that “the goal of therapy is to increase the flexibility of these underlying structures” (Minuchin & Nichols, 1993, p. 41). Assuming the family therapist joins and tracks the family accurately, the next step is time to do the restructuring of the family system. The restructuring technique involves a vast scope of techniques. The main four are “1. Working in the present; 2. Reframing; 3. Working with the boundaries and alliances; and, 4. Tasks” (Szapocznick & COSSMHO, 1993, p. 62). Working in the present can be described as working on relationship patterns as they are being presented in the session (Szapocznick & COSSMHO, 1993). Reframing is when the family therapists rephrase a situation to give a new perspective on it (Szapocznick & COSSMHO, 1993). Working within the boundaries and alliances refers to shifting maladaptive boundaries within the family system. Lastly tasks “are the basic tool for orchestrating change” (Szapocznick & COSSMHO, 1993, p. 70). In general, the task should be small enough to be easily accomplished, and should be done in the session before it is assigned to do out of session (Szapocznick & COSSMHO, 1993). These techniques appear to be eclectic in the sense that some of them are used in different frameworks and even other disciplines. For example, the idea of “joining” is very similar to what anthropologists and ethnographers do when studying various peoples around the world. In order for the anthropologist and ethnographer to research the specific group, ideally they would work on establishing positive relationships with the people to be accepted in that society. The technique identified as assigning tasks are also used by behavior therapist. Cognitive therapists use the technique of reframing with the client, to develop positive self-talk and to readjust negative thinking. The fact that there are similarities in the therapeutic techniques of structural family therapy, and other frameworks, as well as other disciplines, reflects on the versatility and usefulness of this model in working with a variety of populations. Evidence of the effectiveness of this model has been illustrated in various studies with a myriad of populations. A few groups this model has been effective for are Hispanic families, families with juvenile offenders, single child families, and families that have mentally ill members. Structural family therapy is “a viable clinical model that defines, acknowledges, and strengthens each subsystem within a family”(Ryan, 1997, p. 132). Studies on the efficacy of family therapy in general show that “family therapy interventions appear to decrease adolescent conduct problems and delinquent behavior when compared to individual therapy, treatment as usual, or no therapy” (Chamberlain & Gilbert, 1995, p. 443). Additionally, the adaptability to different ethnic groups was cited by Sykes (1987) when he studied working with black youth in cross-cultural therapy. A meta-analysis of family therapy by Shadish, Ragsdale, Glaser, & Montogomery (1995) showed that those in family therapy did “significantly better than control clients for child conduct disorders (n=18, d=.53), child aggression (n=5, d=.61), global family problems (n=14, d=.60), schizophrenic symptoms (d=.48), and global psychiatric symptoms (d=.50)” (p. 345). It can be concluded that structural family therapy is effective treatment for many different types of families in a variety of contexts. However, it must be noted that there have been some indications that families that are enmeshed respond better to this form of therapy than families that are disengaged (Franklin & Jordan, 1999). Enmeshment refers to the degree in which family members are involved with each other, and disengagement implies the opposite (Franklin & Jordan, 1999). This model would be very useful in working with traditional hierarchical family groups. Many immigrant families from eastern backgrounds have a structure that would respond well to this type of therapy. The idea of joining the family would be very important when dealing with this group in order to develop trust so as to effect change. Additionally, one would need to take into account one’s own preconceived ideas of family and be careful on how religion and culture shape the family. For instance, to truly understand differences “the therapist must keep in mind that a culture’s influence is not evenly distributed among all family members” (Hardy, Karrer, & Saba, 1990,p. 36). Therefore, during the process of joining a family of eastern background, part of the challenge would be gauging to what degree acculturation has occurred. There certainly might be issues for many eastern women expressing themselves within the therapeutic setting. Many women from the east are taught that shyness is a feminine characteristic that has value. In this case, it would be a challenge for the therapist to obtain cooperation from the females in therapy. According to Hardy, Karrer, & Saba (1990) a technique to use when it may be considered rude or hostile to approach the woman directly is to “request permission before intervening”(p. 47). Using this tactic, one would respect the hierarchy, but more importantly the cultural mores that are in that the family feels comfortable. Another consideration is that since therapy sought when there is a crisis of some sort, the clients would probably be more apt to participate and voice their concerns. In many eastern cultures, the husband plays the dominant power role in the family, establishing a governing coalition with the husband would be a culturally respectful approach. In general, the husband is pivotal in the family even continuing treatment in m...