Structural Family Therapy Counseling Approach

“Over the past twenty years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders” (Breulin, D.C., Pinsof, W., Russell, W.P., & Lebow, J., 2001. p. 293). (Breulin et al., 2001) suggest that psychotherapist will ultimately require to integrating empirical data and multicultural competence into their practice. Rather than specific models of therapy, elements common across models of therapy and common to the process itself are responsible for therapeutic change. According to the text, Minuchin describes structural approach to families based on the concept that a family is more than the individual biopsychodynamics of its members.

Like most structuralist are interested in how the components of system interact. “The idea of looking at behavior in the context began sometime in the late 1940s and early 1950s” (Goldenberg and Goldenberg, 2013). This movement stemmed from those who were frustrated by the limitations of traditional psychiatry, the families, and the problems with juvenile delinquency (Goldenberg and Goldenberg, 2013).

During the 1950s and the early 1960s, therapist came across individuals who repelled against traditional methods of counseling.

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Minuchin found that he needed a model of change where he saw inner-city delinquent children who roamed their school hallways and were troublesome. Structural therapy was birthed through three factors: the difficult population that Minuchin was working with; timing; and the collaboration with other colleagues. Structural Family Therapy or SFT was researched with the help of the Children’s Hospital of Philadelphia. Goldenberg and Goldenberg (2013) describes that the children who had diabetes had an unusual high number of stress-related condition were not improving by traditional forms of therapy.

“Minuchin and his team begin to correlation between certain family characteristics” (Goldenberg and Goldenberg, 2013).

As the theory grew in popularity, so did the Child Guidance Clinic which stretched the boundaries of traditional outpatient and inpatient work by incorporating the structural approach? SFT is based on Murray Bowen’s family systems therapy, which holds individuals separate from the network of relationships (Brown, 2008). Traditional individual therapy addresses the individual’s psyche in order to influence change in his or her relationships (Brown, 2008). SFT is similar to other therapies under the psychological framework of family systems therapy. These types of therapies view the family system as a unit that operates within culture, community and organizations.

Goldenberg and Goldenberg (2013) report the therapeutic efforts of structuralist as follows: joining and accommodating, assessing family interactions, monitoring family dysfunctional sets, and restricting transactional patterns. “As a therapist, Minuchin (2013) describes himself as acting like a distant relative, joining a family system and respectfully accommodating to its style” (Goldenberg and Goldenberg, 2013 p. 286,). Joining is a technique that is used which helps the family to understand that the therapist is a concerned member working with them in a common search for alternative ways of dealing with family problems. It is important to acknowledge the pain or stress; the therapist will verbalize to the family members to know that he or she will respond to them with sensitivity in which their environment is safe to confront distressing issue. “Affiliating with the family, the therapist might make confirming statements regarding what is positive about each member” (Goldenberg and Goldenberg, 2013).

SFT views a family’s issues as a structural problem which is the dysfunction in the way the family interacts or operates instead of an individual’s pathology. “The major therapeutic thrust of structural family therapy is to actively and directly challenge the family’s patterns of interactions, forcing them members to look beyond the symptoms of the identified patient in order to view all of their behavior within the context of family structures” (Goldenberg and Goldenberg, 2013). An SFT therapist must assess the families’ interactions, exploring families’ hierarchy, alliances within the family. “Structuralists are interested in how the flexibility the family adapts to developmental changes as well as unexpected situational crises and how well the family members join together to resolve conflict” (Goldenberg and Goldenberg, 2013. p. 287).

Goldenberg and Goldenberg (2013) reported moving forward from the initial session to show the family’s ability to change obsolete or no longer workable patterns into ones that are more consistent with continuous family development. “Having joined the family, structuralists are likely to want to learn about coalitions, affiliations, the nature of family conflict, and the ways in which this family resolves conflict” (Goldenberg and Goldenberg, 2013. p. 289). “Hierarchical relationships where the parents customarily exercise authority may be more flexible in some cases and reinforced in others” (Goldenberg & Goldenberg, 2013). Once the assessment is complete the SFT therapist will create a flow chart describing the process of the family. The ultimate goal is to change or modify the family map or structure. Structural therapist’s offers the family leadership, direction, and encouragement to examine and discard rigid structures that no longer are functional and to make adaptive changes in structure as family developmental stages change (Goldenberg & Goldenberg, 2013).

“Strucutalists make use of a simple device called a structural map to formulate hypotheses about those areas where the family functions well and other areas where dysfunction may occur” (Goldenberg and Goldenberg, 2013) Using the technique of mapping offers an endless number of possible combinations for picturing family boundaries, alliances, affiliations, coalitions, and detouring strategies. “Family mapping has to useful purposes; it geographically describes how the family is organized, and it helps the therapist detect the family subunit requiring restructuring. SFT theorists have coined the term “transactions” referring to the simple patterns of how the family members interact with each other. A major goal to a structural therapist is to monitor and help modify troubled or problematic transaction patterns is crucial part of structural intervention process (Goldenberg and Goldenberg, 2013). For example, “the therapist may observe for diagnostic purposes how the family enters the therapy room, when the therapist ask what the problem is the mother answers” (Goldenberg and Goldenberg, 2013. p 291).

“Therapeutically, therapist actively challenge the rigid, repetitive transactional patterns by which some families unsuccessfully attempt to organize themselves and cope with stress and then “unfreezing” these patterns and unbalancing the system, create an opportunity for the family to structurally reorganize” (Goldenberg and Goldenberg, 2013. p. 293). Generally, with this approach it suggest to the family to stretch their comfort box to push for clearer boundaries, increased flexibility in family interactions, and modification of the dysfunctional structure. According to Nichols & Schwartz (2004) what distinguishes a normal family is not the absence of problems, but a functional structure that is more equip to handle them. It’s important that the couple must adjust to one another to provide support to rear the children, deal with their parents, cope with their jobs, and fit within their communities (Nichols & Schwartz, 2004).

Nicholas and Schwartz (2004) describes accommodating each other as a couple it is necessary to negotiate the boundary between them and the boundary separating them from the outside. Research shows the importance of the couple to have their own friends or independent activities. As a result, the couple may view themselves not only as a pair but with two separate personalities. Nichols & Schwartz (2004) reports the addition of children transform the new family into a parental subsystem and a child subsystem. Becoming a mother begins at pregnancy however a father may not feel like one until the child is born (Nichols & Schwartz, 2004). Post-pregnancy the mother’s life is radically changed as she stays home with the baby and the father returns back to work; as a result she sacrifices many things while needing added support from the husband (Nichols & Schwartz, 2004). Understand that children require different styles of parents at different stages.

Normal parents adjust to these developmental challenges and respond appropriately. Nicholas & Schwartz (2004) explains that the family modifies its structure to adapt to new changes which may involve children’s growth and development and the external environment. “Structuralists assume that any family seeking treatment is experiencing some stress that had overloaded the system’s adaptive and coping mechanisms, handicapping the optimum functioning of its members in the process” (Goldenberg and Goldenberg, 2013. p. 294). Nicholas & Schwartz (2004) found that if a family is unable to be flexible to accommodate changes than behavioral disorders may ensue. It is important for the family to become stable and flexible enough to adapt to changes when the family or one of its members faces external stress and when transitional points of growth are reached. “Family dysfunction results for a combination of stress and failure to realign themselves to cope with it” (Nicholas and Schwartz, 2004 p.182).

“The family’s failure to handle adversity may be due to flaws in their structure or their inability to adjust to changed circumstances” (Nicholas and Schwartz, 2004. p. 182). Restructuring involves changes to family rules, changes in patterns that support undesirable behaviors, changes in the sequences of interaction. “Structural interventions frequently increase the stress on the family system, perhaps even creating a family crisis that unbalance family homeostasis, however they also open the way for transformation of the family structure” (Goldenberg and Goldenberg, 2013 p. 295). A useful technique called reframing allows the therapist to change the original meaning of an event or situation by replacing it in a new context. It serves a purpose by relabeling what occurs in order to provide a more constructive perspective, thereby altering the way the event or situation is viewed. In conclusion, SFT identifies the strengths of family members and identifies concrete skills to develop both inside and outside of sessions.

Integrating Faith into the Structural Approach to Family Therapy Throughout this entire course I have learned not only more about myself in regards to counseling but also how my faith influences my counseling with my clients and providing effective family therapy. I enjoyed learning about the code of ethics and how it relates to Christian counseling, couples therapy, confidentiality, informed consent, privileged communication, and maintaining professional competence. Working in the field I am able to relate to certain situations in which I questioned what to do in regards to what was ethical or not. For example, I had a client who was being raised by her grandmother since she was 3 years old. Before I went to her grandmothers’ house for our initial session I received a phone call from the client’s father. He was unsure the reasons for her receiving treatment however I was not sure if I was speaking to the biological father or not.

As a result, I contacted the office and the grandmothers to validate his identity and made sure a release of information was signed to speak with him. Another aspect that I enjoyed was learning about different theories and how it relates to family counseling. Before this class, I was unaware of how many different theories and techniques are being researched and utilized to provide effective family counseling. As I read more about each theory, it seemed as if I would use an integrative/eclectic approach when working with families. I believe each family is unique in nature and one particular theory along with other techniques could be beneficial than just sticking to one approach. Some of the theories that interested me were the experiential, structural, and Freudian. Experiential model explained how it is a multigenerational approach that uses therapy to address both individual and family relational patterns.

Goldenberg and Goldenberg (2013) stated it is oriented toward personal growth and family connectedness, the therapist assumes the role to help the family members discover flexible ways of accepting and dealing with their impulses. In the paper above, I spoke about Structural Family Therapy. In my household I run a tight ship and I believe structure is very important. This theory spoke volumes to me because it used structure as a theory to assist families in the need of restoring function in their homes. I enjoyed that structural therapist focus on the dysfunction of how the family is interacting with each other instead of the pathology of the individual seeking treatment with the family. It is imperative for the family to look at each other and understand how they all communicate amongst themselves and how that could be a potential issue that causes the family to be unable to function normally. I believe Freud does have a place in psychotherapy when learning about childhood and how some behaviors were learned. It is important to see how individuals were raised to notice unwarranted behaviors that are causing stress.

“Psychodynamic models emphasize insight, motivation, unconscious conflict, early infant-caregiver attachments, unconscious intra-psychic object relations and, more recently, actual relationships and their impact on inner experience” (Goldenberg and Goldenberg, 2013. p.167). There weren’t many things I didn’t like about this class however the research was a bit unnerving. I found research in reference to blended families and the therapeutic process. I was a bit offended since I have a blended family how the research generalized that children from blended homes are less likely to succeed in their education. I understand that the research comes from a sample size and used to generalize a certain group of people however I don’t believe that overall children from a blended family will fail. I also was offended from how it broke statistics into races showing that minorities are less likely to succeed because of a blended family unit.

Other than the research I found was the only issue that I ran across during this class, however it was helpful to know that there can be an issue with children and their educational success and how it is important to catch the warning signs before it becomes too late. I learned how to work with families by using an approach that fits my counseling style and how to utilize different techniques that deem appropriate. Working with blended families and families has helped me reflect upon my past practices in working with families. It helps tremendously to learn about how different cultures and their families receive therapeutic services and how to work with them in a culturally sensitive way. What I am going to take away from this class is the Structural Family Therapy and how I can utilize this approach and techniques to provide effective counseling to my families. I believe most of my families suffer from a lack of structure and this could be of most beneficial for them. Techniques that I learned that were of interest to me were reframing and family mapping.

“Reframing changes the original meaning of an event or situation by placing it in a new context in which an equally plausible explanation is possible.” (Goldenberg and Goldenberg, 2013. p.294). I find myself having to reframe majority of my client’s issues to provide them another perspective, especially on negative events that can be used to turn their situation into a positive. This has also helped me learn how to reframe some personal issues that I have so I may adequately teach my clients that this technique is useful if used appropriately. Family mapping was another interesting technique, this will allow me as a therapist to learn the family system and dynamics that go on within the household.

“Family mapping often helps provide an organizing schema for understanding complex family interactive patterns, especially when a subsystem is having a problem. I have had both positive and negative experiences working with families that consider themselves Christian or non-Christian. My clients have never forced their religion upon me nor have I. I leave it up to the client to disclose their religious or spiritual preference before I deem appropriate to share mine. I must be mindful of self-disclosure because if my religious or spiritual views are not for the benefit of my client then there is no need to self-disclose. Overall, I think this was a wonderful class not only learning professional but how to improve my personal family needs.

References
Bjorck, J. P. (2007). A christian application of multimodal therapy. Journal
of Psychology and Christianity. 26(2), 140-150 Breunlin, Pinsof, Russell, & Lebow. (2011). Integrative problem-centered metaframeworks therapy I: Core concepts and hypothesizing. Family Process, Vol. 50, 299-301 Burbee, Sparks, Pau, & Arnzen. (2011). Integrative marital intensive therapy: A strategy for marriages in severe distress. Journal of Psychology and Christianity, Vol. 30, No. 1, 37-50. Christensen, A., Johnson, S., Lebow, J., and Chambers, A. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, Vol. 38, No. 1, pp. 145–168. Brown, Jenny. (2008, September). Is Bowen theory still relevant in the family therapy field? Journal of the Counsellors and Psychotherapists Association of NSW Inc 3. Retrieved from http://www.familysystemstraining.com/papers/is-bowen-theory-still-relevant.html Goldenberg. (2008). Family therapy: An overview (7th Edition). Belmont, CA: Brooks/Cole Goldenberg, Herbert & Goldenberg, Irene. (2013). Family therapy: an overview. (8th ed.). Belmont, CA: Brooks/Cole. Hatchett, G. T. (2008). A one-size relationship stance does not fit all: Customization of the counseling relationship. Australian Journal of Guidance & Counseling, 18(2), 210-218. Hoffman, L. (2006). Understanding psychology's diversity in a postmodern perspective theoretical orientations, specialties and the role of dialogue. Postmodernism & Psychology's Diversity. Accessed from http://www.postmodernpsychology.com/Topics/Postmodernism_Psychologys_Diversity.html Nichols, M. P., & Schwartz, R. C. (2004). Family therapy: Concepts and methods. Boston: Pearson. Worthington Jr, Everett. (1991). Hope - focused marriage counseling. Downers Grove, Il: Intervarsity Press.