Transcript Slides from the Internet - Psychology and Child Development

Structural Family
Therapy
By Isabel Brasil and Melissa
Ruiz
Background of Structural Family
Therapy
Some prominent theorists in
structural family therapy,
include Braulio Montalvo,
Bernice Rosman, Harry Aponte,
and Charles Fishman. The
best known is the founder of
the theory, Salvador Minuchin.
http://www.mariemontschools.org/parr/therapy_backgr.htm
Salvador Minuchin’s Background
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Born in 1921 to Russian Jewish emigrants in
Argentina
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In 1948 he joined the Israeli army as a doctor
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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_backgr.htm
Minuchin Became a Systems Therapist
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Along with Dick Auerswald and Charles King in 1959,
began developing a 3 stage approach to working with lowsocioeconomic-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_backgr.htm
Minuchin Became Director of
Philadelphia Child Guidance Clinic (1967)
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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_backgr.htm
Minuchin since 1981
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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_backgr.htm
Key Concepts of Structural Family
Therapy
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Focus is on family interactions to understand the
structure/organization of the family
Symptoms/presenting problem viewed as byproduct of structural failings
Structural changes must occur in a family before
an individual’s symptoms can be reduced
Structural Family Therapist’s Function
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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
Family Structure
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invisible set of functional demands or
rules that organize way family members
relate to one another
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
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Boundaries
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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 onefosters dependency on parents/other members
Clear healthy boundaries-attain sense of
personal identity yet allow sense of
belongingness within family system
Understanding the Problem
The therapist determines the issues around
which to explore and intervene in the
session.
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Joining the family in a position of
leadership
 entering
their reality and becoming part of that
family’s patterns of relating/structure
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 family’s 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
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
Structural Goals
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To the extent permitted by the hypotheses, the therapist
determines immediate goals for the intervention that is to
follow
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Reduce symptoms of dysfunction
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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
Intervening
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Intervening in ways designed to transform an ineffective
structure
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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.
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Feedback
 On the basis of the reactions of the family members to the
intervention, the therapist restarts the cycle from the second
step.
Structural Techniques
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Joining
Imparting a Systemic
View
Restructuring
Making Rules/Relationships/
Structure Known
Intensity
Circular questioning
Unbalancing
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Triangulation/
Detriangulation
Enactment
Boundary-making
Reframing/Relabeling
Paradoxical Techniques
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Restraining
Prescribing the symptom
Therapist Awareness
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Your Role/Position/Function in the Family
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Your Family of Origin Issues
 General
 Unresolved
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Cultural Factors (yours and theirs)
Possible Therapist
Interventions in the
Problem of Mrs. N.’s
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 Ξ Daughter | Father
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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 don’t
need any help with it.
That you know exactly
what to do. Ask your
husband to do that for
you.”
Mother
Father
――――――――
Daughter
Possible Therapist
Responses to the
Scapegoating
Problem in the
Fletcher Family
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.”
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STRUCTURAL
THERAPIST:
“Only Irving has said
nothing so far. Who
can get his side of the
story?”
Possible Therapist Interventions in
Fletcher Family
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ACCOMMODATION
 “Mrs.
Fletcher, I wonder if you could get
Irving’s side of the story?”
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ALLIANCE RESTRUCTURING
 “Mr.
Fletcher, perhaps you and Irving could
discuss his side of the story.”
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HIERARCHY RESTRUCTURING
 “Mr.
Fletcher, perhaps you could get your wife
to find out more about her son’s view of this
matter.”
Role Play
Strategies for Approaching
the California Marriage and
Family Therapy Licensing
Exam
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:
a. Humanistic-existential
theory
b. Structural theory
c. Strategic theory
d. Psychodynamic theory
Q – Common sense solutions to problems
rarely work. What theoretical orientation
supports this belief:
a. Experimental
family therapy
b. Structural family therapy
c. Strategic family therapy
d. Extended family therapy
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
b. Get the client to “unwrap” his projections
c. Learn this family’s rules about arguing
d. Analyze the function of the couple’s behavior
a.
Q – For Minuchin, scapegoating and
overprotection of a child by the child’s
mother and father are both forms of:
a. Triangulation
b. Detouring
c.
A stable coalition
d. Marital skew
Q – A 45-year-old client was sexually
abused as a child by her father. She says
she’s 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:
a. Blurred
boundaries
b. Enmeshment
c. Disengagement
d. Pseudohostility
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 alcoholic’s relatives to
admit they are codependent
b. The aim of therapy is to restructure the family’s
homeostatic mechanisms
c. Therapy should focus on identifying and
correcting faulty communication patterns
d. The family should be trained in ways of
reinforcing non-drinking behaviors and
extinguishing drinking behaviors
a.
Q- When working with an intellectuallyoriented family, the therapist “joins” the
family by adopting a cognitive, intellectual
style. This technique is referred to as:
a. Tracking
b. Modeling
Mimesis
d. Enactment
c.
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:
a.
b.
c.
d.
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
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:
a.
Manipulate the family’s mood by nagging even more and
yelling even louder
b.
Help the father understand that his nagging and yelling
elicit oppositional behaviors from the boys
c.
Construct a genogram of the father’s family
d.
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
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Q- When working with a family, Minuchin
creates rapport by:
a. Joining
and accommodating
b. Accommodating and restructuring
c. Restructuring and detriangling
d. Forming coalitions with subsystems
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:
a.
b.
c.
d.
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
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:
a.
b.
c.
d.
Both the family’s present and its past will be examined
in therapy
The focus of the treatment should be on changing the
family’s 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
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:
a. Reframing
b. Prescribing
Positioning
d. Cryptic message
c.
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 family’s conversation
continues. This is an example of:
a. Unbalancing
b. Enactment
c. Mimesis
d. Manipulation
Q- From the perspective of structural family
therapy, triangulation, parent-child
coalition and detouring are:
a. Methods
for establishing clearer
boundaries
b. Methods for maintaining homeostasis
c. Types of positive feedback
d. Attempts to increase intimacy
Q- “Change, through therapy, is
accompanied by stress, and the
therapeutic system must be capable of
dealing with it.” This statement was made
by:
a. Glasser
b. Bower
Adler
d. Minuchin
c.
Q- What does a structuralist do in the initial
phase of therapy:
a. Join
and accommodate
b. Highlight and join
c. Accommodate and restructure
d. Evaluate and restructure
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 girl’s problems. Both parents acknowledge feeling frustrated and
unable to control their daughter’s behavior at times.
All of the following would be appropriate to do with this family
EXCEPT:
b. Family-of-origin work to identify messages Mr. and Mrs. Smith got
about parenthood and adoption
c. 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
d. Behavioral assignments to increase intimacy between Mr. and Mrs.
Smith
e. Structural techniques to strengthen the mother-daughter dyad
a.
References
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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_backgr.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/Family%20Therapy.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.