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Structural and Strategic revision
Structural Family Therapy
Salvador Minuchin is a family therapy pioneer who wrote several books:
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The families of the Slums (1967) – this pioneered his theory
Psychosomatic Families (1967)
Families and Family Therapy (1976)

The task of the structural family therapist is to restructure the family & eco-system in a way that
allows the family & individual members to function 'better'
...

Families who feel powerless in society might sometimes feel overwhelmed by this & find it
more difficult to feel empowered at home
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Underlying Assumptions:
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Alterations in a family’s beliefs is fundamental to change
Alterations to the organisational structure will change symptomatic behaviour
Assumptions of ‘healthy family functioning’ Families have an objective structure
Families (people) are competent and capable of solving their own problems
Rigidity of transactional patterns and boundaries prevents the exploration of alternatives
Symptoms are a by-product of a structural system that is failing
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All family systems desire homeostasis: to stabilise the system (Minuchin, 1974)

Key ideas:
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Families are regarded as evolving and capable of change
Focus on organisational patterns in families and hierarchies
Concepts of triangulation (for example: when you get a child stuck in a relationship with
parents) and clear boundaries between family members and between subsystems
Notion of boundaries: too close (over-involved or enmeshed)/too distant (disengaged,
detached and over-rigid)
Family subsystems = Parenting/executive, Spousal, Siblings

o
o

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Hierarchy (notion of executive power in decision making processes; power to decide
might be related to strengths, knowledge, age, gender, status, etc
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g
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Children are not mature enough to handle such power and cause the parents to conflict over
the child rather than their own issues and the child acts out as a result
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Patterns in relationships:
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Behavioural connectedness
o Complementary (teacher/pupil – one-up/one-down position)
o Symmetrical (competing in the one-up position)
o Reciprocal (able and allowed to adopt either position)
Emotional connectedness
o Enmeshment (react very quickly to small amount of distress; differences between
people seem to be mistrusted and discouraged)
o Disengagement (distance and under involvement)
Boundaries (can add these to a genogram)
o Diffuse ……
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g
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How problems develop:
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Inflexible response to maturational (or developmental) and environmental challenges
leading to conflict avoidance through disengagement or enmeshment
Disengagement and enmeshment tend to be compensatory
This leads to cross-generational coalitions – a triangular structure
The nature of problems come from power imbalances, rigid or too diffuse subsystem
boundaries, disengaged members, enmeshed members,

Techniques include:
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Challenging absent or over-rigid boundaries, enmeshment or under-involvement
'Unbalancing' the family equilibrium by briefly joining with one family member against
others
Physically moving family members about to restore more 'appropriate' hierarchies

The therapist sees themselves as a 'distant relative' of the family – giving them a fluidity to join
different subsystems to put certain point of view’s across
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Other techniques include:
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The family sculpt: where you allow the family to position themselves as to how they feel the
power lies
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Enactments: role play a problem
Intensification of a problem
Joining with one person or subsystem in a family temporarily

Evidence base:
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Minuchin's first examination of structural family therapy occurred in the 1960s when he was
working with delinquent boys and their families
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They compared structural family therapy with
two other conditions
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Specifically, these researchers found that posttreatment addict families displayed better boundaries between subsystems
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Strengths
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It is a model with “relative simplicity, concreteness and directness” (Figley and Nelson, 1990,
p
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Simon (1995) states that structural family therapy is a very teachable model in that it takes
something as abstract as the family and organizes it using concepts like boundaries and
hierarchy
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Further, this approach is versatile, and to this end
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e
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Again, concepts such as "enmeshment" and "disengagement" fail to consider
the different parenting techniques utilized by people in different cultures
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As well, the concept of healthy boundaries may be problematic for cultures that have a less
distinct delineation of the boundaries within the family and between generations
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Also because they have drawn attention to power dynamics, structures and subsystems within
families which may be influencing the beliefs and behaviours of its members
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In a popular clinical sense, being strategic means that you might not be transparent with the family
or the patient about the intervention you’re making
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Strategic Family Therapy pioneers: Erickson, Satir, Haley & Madanes
Milton Erickson (1901 – 1980):
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Believed in harnessing the power of the unconscious mind of the patient through trance or
hypnosis (persuasion)
And that the unconscious mind used a metaphorical language which could be useful in
treatment
In the early 1950s, anthropologist Gregory Bateson involved Erickson as a consultant as part
of his research on communication
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Erickson influenced the first generation of family therapy founders in the USA: Haley,
Weakland & Jackson
In particular, Jay Haley (1923-2007), who went on to write books about Erickson
Haley (1963) Strategies of Psychotherapy & (1976) Problem Solving Therapy
Jackson, Erickson & Haley belong to the 'maverick' tradition in family therapy
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Hypnosis was influential
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Core concepts:
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Family members’ behaviour can only be understood within the family context
Feedback loops maintain the solution as the problem
Symptoms result from misguided attempts at changing an existing difficulty
Normal families are flexible enough to modify solutions that do not work and are flexible
enough to adjust to development
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Symptoms are a homeostatic mechanism regulating marital or family transactions
The feedback loop uses positive feedback: problem  attempted solutions  more
problems  more (greater) attempted solutions
To interrupt this cycle a new solution is required
Family rules govern much of the families behaviour (Jackson, 1965) and restrict which
solutions can be tried
Change in these cases is required in the problem behaviour and in the underlying rule
First order change – change in the system according to the rules of the system
Second order change – change in the rules of a system

Strategic family therapists’ initial focus is on 'removing the symptom'
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The contemporary meaning of 'strategic' in the context of family therapy is when the therapist
makes an intervention for its effect rather than its face value
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e
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o Symptom prescription: request to continue to perform or even expand the
symptom
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This is used when families are ambivalent about
changing
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Strengths:
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Many of the core ideas have been influential in developing Milan Family therapy and
Solution focused therapy (this is based on the idea of reframing)
Allows the clinician to take a variety of positions

Limitations:
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Ethical problems with paradoxical techniques – however not necessarily unethical as it is
done in a group setting
There is little research into strategic approaches



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