Since the mid-20th century, family therapy has assumed systems thinking as a new model of understanding how to help families to understand their problems and resolve them (Sawyer, 2003). Rather than directing the energies of therapy on the individual with the problem, the symptom bearer, family therapists examine the family as a whole, or as a social unit, with complex interactions and patterns of communication. Rather than focusing on the problems in a family system, family therapists assumed that families have within them a basic goal toward health. They are created and sustained for the purpose of helping individual family members do well.
In this paper, structural family therapy concepts and practices will be discussed, as well as the complex interactions and patterns of communication involved in structural family therapy.
The model of structural family therapy is "a therapy of action." When first developed by psychologist Salvador Minuchin in the mid-20th century, its unique goal was to modify the present and forget about the past. Basically, structural family therapy targets families. Minuchin stated, "Structural family therapy as dealing with the process of feedback between circumstances and the person involved - the changes imposed by a person on his circumstances and the way in which feedback to these changes affects his next move. A shift in the position of a person vis -- a -vis his circumstances constitutes a shift of his experience (Minuchin, 1974, p.13)."
Structural family therapy involves a great deal of direction by the therapist, and is very action oriented. The goal is to change the behavior of the family by enactment and creation of alternative realities. The goal of therapy is not symptom relief but rather for the family to transform and reinvent itself around a symptom, so that they can apply these structural changes to other areas of their lives.
Strategic Family Theory and Therapy
Structural family therapy has been greatly modified since its creation, and has been influenced by Bateson's cybernetics model, which focuses on changing behavior rather than insight. There are three basic models in this theory (Niolan, 1999):
The Mental Research Institute (MRI)
The Haley and Madanes
The Milan Model
According to the MRI model, families make logical but misguided attempts to solve their problems, and the solution selection, as well as its success, is governed by system rules. When these attempts are unsuccessful, the result is a positive feedback loop that worsens the problem. Therefore the MRI model encourages therapists to take three steps in family therapy. First, identify the feedback loop. Next, find the rules governing it. Finally, change the loop and the rules. This model does not focus on long-term change, insight, or what function the symptom serves in the family. Its main area of concern is problem focused behavioral change.
Haley and Madanes' model is based on the same ideas, but some significant changes are made. Haley and Madanes placed a greater deal of emphasis on the function a symptom served, as it revealed a payoff in the system that was the direct result of the structure of the system. Haley and Madanes researched triadic interaction over long periods of time. According to Niolon (1999), "Haley was particularly concerned with power struggles, and often prescribed the symptom such that the cost of keeping it up outweighed the gains. Madanes was concerned with incongruous hierarchies, where a child uses symptoms to change the behavior of the parent."
In addition, Haley and Madanes determined that rules followed a hierarchical order. Therefore, improving the hierarchical and boundary problems would prevent dysfunctional feedback loops from starting, so that problems would be eliminated before they even developed. Haley and Madanes believe that all families must go through dysfunctional stages to get to functional ones.
Finally, this model describes four categories of problems resulting from (Niolon, 1999):
desire to control and dominate; desire to be loved; desire to love and protect others; and desire to repent and forgive.
In conclusion, like the MRI model, Haley and Madanes' model is more concerned with short sequences, but also concentrates on long ones that last months or years and reflect chronic structural problems.
The Milan Group studies the works of MRI and Haley and Madanes, worked with the power struggles and boundaries described in these models, and focused on long time spans spanning even multiple generations. This model concentrated mainly on anorexic and schizophrenic families.
When looking at normal family development, the MRI group believes that concepts of "normality" should be tossed aside (Niolon, 1999). Instead, this group believes that families should be able to change solutions when are not successful, in an attempt to prevent an unsuccessful positive feedback loop. Haley and Madanes concentrated more on clear generational boundaries, as did the Milan group, but assumed a concept of normality and believed structural family therapy should change the dysfunctional structure and create an improved, functional structure.
The Milan group, like the MRI group, did not believe in concepts of "normality." In addition, like Haley and Madanes, the Milan groups held that families should have clear generational boundaries. However, this group felt that family therapy should be "neutral" and not expect anything of families. Therefore, the therapist's role is to help the family by "simply examining the family, asking questions to help them examine their own family structure, and exposing games after which they can redesign their family into a better structure on their own."
When looking at family development, there are three basic models for problem development: cybernetic (runaway positive feedback loops); structural (flawed family hierarchies); and functional (an individual develops symptoms to control the whole family) (Niolon, 1999).
The MRI uses only the cybernetic model; Haley and Madanes use all three, with Haley stressing the structural and Madanes the functional; and the Milan group uses both structural and functional (Niolon, 1999). For example, if a 16-year-old boy suddenly refuses to leave the house, the MRI model would concentrate on getting the boy to leave the house, believing the parents attempted solutions kept him home. Haley and Madanes would examine the triadic relationship between the boy and his parents. Haley would look at the parents' unresolved conflicts and marital struggles; Madanes would examine how the boy staying home helped one or both of his parents. Milan would concentrate on the family's history and hidden power struggles, or family games, in which the boy is embedded and has to stay home to help a family member "win."
All three models assume that there are certain conditions for change. "MRI believed that by attempting first order change, or change in the behavior, second order change, or change in the system's structure, could be achieved. They don't need insight as to why they have problems, nor do they need to understand why the change in behavior is needed. They simply need to act differently and see for themselves that the family's rules for problem solving can be more flexible. They try to keep resistance low and motivation high (Niolon, 1999)."
Haley and Madanes tried to keep resistance low, and focused on behavioral change, stating that before the family can think or feel differently, they must first act differently. The Milan model also wanted to keep resistance low and motivation high. "They also try to find the "customer" or the most motivated family member and work with them. While they may not have the "problem," they may be the most motivated for change, and since one person can change a system, they may be the most successful level to use in producing change (Niolon, 1999)."
Basically, structural family therapy aims to induce "more adequate family organisation by restructuring the system, creating clear and flexible boundaries, so that family members can carry out age appropriate life tasks. The aim is to change structure believed to perpetuate the problem behaviour. Dysfunctional transactions are blocked and new or unused repertoires of transactions are mobilized (Fattah, 2003)." To accomplish this goal, there are many techniques used by family therapists, including the following (Fattah, 2003):
Joining-- A non-judgmental and continuous activity used by therapists to accommodate to family's language and styles of communication by forming a partnership.
Focusing -- A deliberate activity of exploring a small area in great depth.
Enactment -- A therapist attempts to study a family's rules by encouraging the family to enact a transaction in the session.
Intensification -- This process involves "putting the heat on," by "increasing affective component of a transaction, by repetition, prolonging length of transaction, altering spatial arrangements, boundary making, blocking family 'pull, disrupting a transaction pattern, etc."
Unbalancing -- A deliberate attempt to forge a coalition with one member against another, or supporting one member at the expense of another. This disassembles family organization and sets the stage for structural change.
For several decades, psychologists have been using structural family therapy to reveal the emotional life and problems of families as a whole. Even if only family member has a problem, therapists often find that looking at family structure one…