structural family therapy Flashcards
(40 cards)
how did structural family therapy help some of the issues that existed in family therapy at the time
-When it came out, sense from the field that there were a lot of intelligent leaders conducting family therapy in the field, these models you can understand conceptually, but actually doing the therapy and how to do the therapy seems unclear
-Then came Minuchin, modeled the work of Ackerman, and he made his kind of therapy very understandable and clear and people viewed family therapy as less mysterious and it became easier to practice it and train others in it
-Some will say structural is the most common family therapy being practiced, most therapists combine structural and strategic ideas
reason structural family therapy was created
Beginners were looking for a framework to make sense of transactions
three essential components of the theory
1) Structure
2) Subsystems
-Can go from single individual, up to the entire family
-Typically parent subsystem, children subsystem, parent-child subsystem
3) Boundaries
-How do we establish issues of hierarchy
All three families have these three components and if we want success in therapy, focus on these three issues
what is meant by the “structure” of family
Description of predictable behavior patterns
-“Who relates to whom?”
-Certain people will always relate to certain people in some way
-Ex. Father might be forceful when talking to children, but deals different when talking to wife
Set of rules govern transactions
-E.g. “member must protect one another”
-Changes one rule, the system shifts (changes with the rule)
Are there cross-generational coalitions?
-He was always interested in this, was saying they exist and can be healthy or pathological
-Ex. Grandparent is mad at own child, and recruits the grandchild to be angry at the parent with them, erode the parent authority
what is meant by “subsystems”
Each individual is a subsystem, and groups make up other subsystems.
Every member plays many roles in several subsystems.
-E.g. okay to discipline as a father, but not as a husband or son.
-People act different in the different subsystems
-Is someone stuck in a transactional pattern? Cross subsystems and cannot shift style they get into
what is meant by “boundaries”
Those rules that regulate contact with others.
Rigid -> diffuse (exists on a spectrum)
-Rigid: would look like a family that does not let anyone in, ex. Family does not let school know what is happening at home
-Diffuse: people are in and out of the home, the family group is not set and changes a lot, chaotic, very limited rules
Disengaged -> Enmeshed
-Minuchin believed that families have a little bit of both, have a preferred style of being
Therapist looks at how systems and boundaries exist in the family
family development in structural family therapy
Couple must establish new boundary and accommodations.
-People must establish a sense of self
-History from family of origin
-How does that influence the current home?
-How development can be a healthy or unhealthy process
explain symbols in structural family therapy
-Having a method to track structure made the model more accessible
-Used diagrams, not genograms, to give himself a better idea of family structure
Straight solid line, rigid boundary; dotted line, more diffuse boundary
-Minuchin was interested in the present rather than the early days
-Rigid boundary between mom and dad, have to get them to become a team, cannot have mom being the leader of the home and dad being buddy-buddy with the kids, have to work to get mother and father to be a collaborative team
Case conceptualization: who am I going to see, why am I going to see them, what are my goals in working with them
what is joining in structural family therapy
-Not just the beginning, joining supports change.
It is a mistake to become wedded to a theory ahead of one’s data. Planning treatment is fine, but remain open.
Only by joining the family can you learn the information you need. (ex. Rules and roles)
-Can be kind of like pre-therapy, gathering information about the family and how it is moving along
Initial hypothesis can be invaluable to a therapist
-So, think about possible functions of the symptom, but don’t get locked in
-You are all going to walk in with a hypothesis, you are going to see intake and think about what is at play, do not let hypothesis blind you to other things that are happening
explain divorced parents, child and how it can be resolved
People who are damaged during divorce are typically those who are caught in the middle of parental arguments, divorced parents need to have a coalition and view their role as parenting the kids together
how does the structural therapist see the family and what can be done to change it
Structural FT sees the family as an organism: a complex system that is under-functioning. Thus the structural approach has elements of existential/experiential (Whitaker) and strategic (goal oriented via Haley).
-Trying to realign the organization
-Usually, the kid has a problem in therapy, so this therapy is mainly about children and family work that deals with children, less about couples work,
Like the strategic therapist, the structuralist realigns significant organizations to produce change in the entire system.
Like Whitaker, the structuralists challenges the family’s accepted reality combining a growth based orientation, with a Strategic emphasis on goals.
-We have to work based off the assumption that the problem is the child, we have to work with the idea that it is coming from the family
main idea of how structural change works
The techniques of structural work lead to family reorganization by :
-Challenging the family organization
three main strategies that lead to change
-Challenging the symptom
-Challenging the family structure
-Challenging the family reality
explain challenging the symptom
-Therapist enters viewing the family as wrong. The family’s view that there is one identified patient (IP) and nothing works, is mistaken.
-The problem is not the IP, but certain family interactional patterns. “Transactional biopsy”
-What is actually happening, if I set a camera up on the wall what is happening at dinner or when people are doing homework
-In terms of our thinking, the identified patient language is problematic and it is really a systems issue
The structuralist sees this response by the family as not helpful, but instead, a reaction to a system under stress.
All family members are equally symptomatic
-More like “all are symptomatic” rather than equally
Challenge definition of the problem
summary of goal of challenging the symptom
change or reframe family’s view of the problem
techniques used to challenge the symptom
enactment, focusing and achieving intensity. (to view symptom from another perspective)
what is enactment
-The technique by which the therapist asks the family to dance in his/her presence.
Play out the transactions
The act of enacting offer a challenge to this reality offers people a context for experimentation in concrete situations (benefits listed below)
-Therapist observes
-Therapist organizes scenarios
-Therapist suggests alternatives to pattern
“help me understand what happens when you become frustrated with X, can you show me what normally happens in these situations”
what is focusing
Do not always “follow the plot”
-Have to make decisions, is this really important
-When are tangents important or when are they taking you off topic because on-topic is too stressful or they just want to talk to you more casually
Learn to explore one area in depth
-What area should you explore in depth, what area gives you a lot of transactional information about what is going on
-Redirect if things are being discussed that are not beneficial
Be aware of tunnel vision
-Some of us have areas that we are so quick to hone in on
-Try to not have a bias that gets you involved in something that is not really productive
The fact that therapist takes one area to focus on indicates its importance.
explain intensity
Family members will be deaf to some messages.
-People’s comments might get lost in therapy, you as a therapist have to say that this comment is too important to let go
-People usually bring important messages up again, definitely grab it if it comes up the second time because the third time is not guaranteed
Therapist style
Drama
-Make certain things more dramatic if you believe they are important
-E.g. behavior happening now, will this happen again in 5 years, what will this mean
Repetition of message
-Can make things more dramatic by doing this
-Can also repeat a message that is a lovely message, like someone stating their feelings for other people
Speaking quietly
-Use variety of tones to manage the intensity of the room
Making it concrete
-“Are these your hands?”, “Are these your muscles?”, “Are you sure it is not your mother’s arm?”
-Trying to determine how your mother is controlling you, trying to figure out that it is mom constantly critiquing child that controls them
Continue the transaction past the time when the system usually turns on the yellow/red light.
techniques to challenge the family structure
-Boundary making
-Unbalancing
-Teach complementarity
explain boundary making
Boundary making techniques regulate the permeability of boundaries.
-Where they sit in a session
-Do not want to overuse this, moving where people sit does change the dynamics of the room
-It is very powerful
-Shifts the boundaries
One can use
-Cognitive constructs
-Might be is there someone else that might be an authority for this person right now, anyone willing to help out and guide them through school and whatever it is that they’re doing
Concrete maneuvers
-Would you two be willing to do something on Saturday together and then come back and talk about it
what are cognitive constructs
-Someone is too helpful
-“you’re helpful, you take Jane’s memory.” (iow separation is desirable)
Reframing
-Intrusions–=concern
-Strictness–=support
-Depression–=confusion
Using them to have a person imagine a situation in a different perspective
what are concrete spatial maneuvers
-Use of therapist arms or body
Move chairs
-Boundaries around dyads
Homework which supports people interacting longer than normal
-Increase contact
what is unbalancing
Goal: to change the hierarchical relationship.
-One may empower someone low in the order
-Empowering children, good to do when you are seeing something where parents cannot see concern and how they are contributing to the problem
-Ignores the family switchboard
-Joins coalitions against a family member
Problems:
-Questions of ethics
-Difficult
Types:
-Affiliation with family members
-Alternating affiliation - new ways of relating
-Coalition against family members
