2.  Salvador Minuchin’s structural model is the most
influential approach to family therapy throughout the
world

3. Learning Outcomes
 1. Describe the principal concepts of Structural Family
Therapy (SFT)
 2. Conceptualization of problems in SFT
 3. Therapeutic goals in SFT
 4. Therapist role in SFT
 5. SFT interventions
 6. Evaluation of SFT

4. Leading Figures
 Minuchin was born and raised in Argentina.
 Pediatric physician .
 He served as a physician in the Israeli army,
 Psychoanalytic practice
 New York State Wiltwyck School for Boys
 Work with delinquent boys: poor structure and no
rules/regulation or routine.
 Suitable for families with single parenthood, illness, acting-out
members, drug addiction, crime, and violence
 Self taught, collaborated with a variety of thinkers,
including Jay Haley (Strategic Family Therapy) in the early
60s
 Became head of the Phil. Child Guidance Clinic in 1965
 Started his own center in NY in 1981
 Retired in 1996

5. Theoretical Formulations
 Structural family therapy offers a plan for analyzing the process
of family interactions.
 Three constructs are the essential components of structural
family theory: structure, subsystems,
and boundaries
 “Family structure is the invisible set of functional demands that
organize the ways in which family members interact” (Minuchin,
1974, p. 51).
 Family structure is reinforced by the expectations
 that establish rules in the family. For example,
 A rule such as “family members should always protect one
another If a boy gets into a fight with another boy in the
neighborhood, his mother will go to the neighbors to complain

6.  Structure
 an organized pattern in which families interact, not deterministic or
prescriptive, only descriptive
 Can only be seen when a family is in action, because verbal descriptions
rarely convey the true structure.
 Subsystems are subgroupings within the family based on age (or
generation), gender and interest (or function)
 parenting
 spousal
 sibling
 Boundaries are invisible barriers that regulate contact between
members
 Diffuse, too weak, or “enmeshed”
 Rigid, too fortified, or “disengaged”

7. Normal Family Development
 What distinguishes a normal family isn’t the absence of
problems, but a functional structure for dealing with them. All
couples must learn to
 Adjust to each other, rear their children, if they choose to have
any, deal with their parents, cope with their jobs, and fit into
their communities
(Minuchin, 1974).
 Families begin when two people join together to
 form a spouse subsystem. Two people in love agree to share their
lives and futures and expectations; but a period of often difficult
adjustment is required before they can complete the
 transition from courtship to a functional spouse subsystem.

8. 1. Underlying assumptions of SFT
Families are capable of solving their own problems
Therapists work collaboratively with families, not as experts
who can solve problems, but as consultants
Therapists respect the family’s unique culture. The question
should be, not “What’s ideal?” but “Does it work for them?”
SFT is the beginning of the postmodern approaches, but
retains some traditional views concerning the importance of
power and hierarchy
Rigidity of transactional patterns and boundaries prevents
the exploration of alternatives.

9.  An important aspect of structural family problems is that
symptoms in one member reflect not only that person’s
relationships with others, but also the fact that those
relationships are a function of still other relationships in
the family.
 If Johnny, aged sixteen, is depressed, it’s helpful to know
that he’s enmeshed with his mother. Discovering that she
demands absolute obedience from him and refuses to let
him develop his own thinking or outside relationships
helps to explain his depression

10. Why is the mother enmeshed with her son?
Perhaps she’s disengaged from her husband.
Perhaps she’s a widow who hasn’t found new
friends, a job, or other interests. Helping Johnny
resolve his depression may best be accomplished
by helping his mother satisfy her need for closeness
with her husband or friends.

11.  Boundaries are reciprocal
 That means that a weak boundary (enmeshment) in
one relationship usually means that the same person is
disengaged from someone else.
Rigid boundaries are
overly restrictive and permit little contact with
outside subsystems, resulting in disengagement.
Disengaged individuals or subsystems are independent
but isolated. On the positive side, this
fosters autonomy

12.  Enmeshed subsystems offer a heightened sense of
mutual support, but at the expense of independence
and autonomy. Enmeshed parents are loving and
considerate; they spend a lot of time with their kids
and do a lot for them.
 children enmeshed with their parents become
dependent. They’re less comfortable by
themselves and may have trouble relating to
people outside the family

13. Underlying Assumptions
 A family system is therefore stabilized by each
member’s contribution.
 Subsystems are organized hierarchically : power is
distributed appropriately within individuals and
between subsystems, making reliance on some
members more expected than on others.
 All family systems desire homeostasis: each individual
member desires to stabilize the system and contributes
their part to balance the system so that they can
continue to be satisfied by the system (Minuchin,
1974)

14.  Every family member plays many roles in several
subgroups. Mary may be a wife, a mother, a daughter.
In each of these roles she will be required to behave
differently and exercise a variety of interpersonal
options.
 If she’s mature and flexible, she will be able to vary her
behavior to fit different subgroups.
 Enactments - interactions are suggested by the
therapist as a way to understand and diagnose the
structure, and to provide an opening for restructuring
intervention

15. Concepts:
Power and Hierarchy
 the person with the most power makes all of the final
decisions and takes responsibility for the outcome of
the family dynamics.
 Appropriate persons to have power in families are the
parents.
 For example, when a father tells his child not to play
video games, the child obeys because the father has
consistently shown the child that he expects
compliance in his child. This interaction defines the
relationship between them as well as creates the
appropriate hierarchy.

16. Concepts:
Power and Hierarchy
 In dysfunctional families children may be given more
attention than the couple gives each other, and the
child is therefore given control.
 This leaves the child insecure as they are not mature
enough to have such power and cause parents to
continue their conflict over the child rather than deal
with their own issues. The child acts out as a result.
 The therapist strives to place parents in their proper
hierarchical role above the children, helping the
children feel safe and secure and creating a natural
boundary between parents and children.

17. A Couple’s Challenge: Forming a Healthy Spousal
Subsystem
 Must develop complementary patterns of mutual
support, or accommodation
 Must develop a boundary that separates couple from
children, parents and outsiders.
 Must claim authority in a hierarchical structure

18. Core concepts: Alignments, Coalitions and
triangulations
 Alignment indicates that two or more share reciprocal
benefits, and team up. It usually refers to a positive
bond between family members. Eg two parents
working together, providing a secure life for their
children.
 misalignments especially cross-generational can
undermine families
 Coalitions refer to an alliance of some family members
against other family members. This can be positive or
negative. Can result in scapegoating.

19. Core concepts:
triangulations
 Triangulation occurs when one member of a two-member
system who are against one another attempts
to distract from the conflict by bringing in a third
person to focus on.
 For example : two parents who are fighting; one
member may attempt to win the child over to his or
her “side.”
 puts the child in a no-win position: child allies with
one parent, experiences betrayal of the other parent,
and the original conflict is never resolved.

20. Family systems must be stable enough to ensure continuity, but
flexible enough to accommodate to changing circumstances.
Problems arise when inflexible family structures cannot adjust
adequately to maturational or situational challenges
Family dysfunction results from a combination of stress and
failure to realign themselves to cope with it (Colapinto, 1991).
Stressors may be environmental (a parent is laid off, the family
moves) or developmental (a child reaches adolescence, parents
retire) The family’s failure to handle adversity may be due to flaws
in their structure or merely to their inability to adjust to changed
circumstances.

21. How Problems Develop
 Inflexible response to maturational (or
developmental) and environmental challenges leads to
conflict avoidance through disengagement or
enmeshment
 Disengagement and enmeshment tend to be
compensatory (I’m close here to make up for my
distance elsewhere.)
 This leads to what is called the cross-generational
coalition, which is a triangular structure

22. The Nature of
Problems And Change
 Power Imbalances
 Subsystem Boundaries too rigid or too diffuse
 Disengaged Members
 Enmeshed Members
 Pervasive Conflict
 Failure of the System to Realign
 Member Resistance
 Action Precedes Understanding

23. How change occurs
 SFT believe that when the structure of the family
changes, the positions of members in the group
change, and vice versa.
 There must be a proper hierarchy in place, with the
caretakers or parents in charge, in a healthy coalition.
 In terms of healthy and unhealthy functioning,
symptoms in an individual are rooted in the context of
family transaction patterns, and family restructuring
must occur before an individual’s symptoms are
relieved (Minuchin, 1974).

24. How change occurs
 Structural changes must first occur within the family
because how a family functions has a direct effect on
how an individual functions within, only then will
individual symptoms be limited, reduced, or resolved.
 As family member’s experience changes as the family
functions differently, then symptomatic distress will
decrease. Therefore, the therapist focuses on changing
the experience of family members.

25. Therapeutic Goals
 Therapy is directed at altering the family structure and
Creation of an effective hierarchy
 Structural problems are usually viewed simply as
failure to adjust to changes.
 Therapist doesn’t solve problems, that’s the family’s
job.
 Boundaries must be strengthened in enmeshed
relationships, and weakened (or opened up) in
disengaged ones.

26.  The goal of SFT is to facilitate the growth of the system
to resolve symptoms and encourage growth in
individuals.
 Short-range goals may be to alleviate acute problems,
especially life-threatening symptoms such as anorexia
nervosa (Minuchin, Rosman, & Baker, 1978). At times,
behavioral techniques, suggestion, or manipulation
may be used to achieve an immediate effect

27.  The goals for each family are dictated by the problems
they present and by the nature of their structural
dysfunction. Although every family is unique
 Another common goal is to help parents function
together as a cohesive executive subsystem. When
there is only one parent, or when there are several
children, one or more of the oldest children may be
encouraged to become a parental assistant

28. Therapeutic Goals
 Not a matter of creating new structures, but reforming
existing ones
 What distinguishes SFT from other forms of family therapy
is the emphasis on modifying family structure in the
immediate context of the therapy setting.
 When new patterns are repeated and result in
improvement of family relationships, they will stabilize and
replace old patterns and symptoms of dysfunction will be
reduced or disappear.

29. Therapist’s Role
 Structural therapeutic efforts are based on the
principle that action leads to new experiences and
insight (Vetere, 2001).
 The therapist tries to help the family create permeable
boundaries and subsystems.
 Therapist’s task is to break the certainty of the family
of what the problem is or who the “problem” is. This
confusion helps family members to rethink their roles
and try out new ones.

30. Therapist role in SFT
 The therapist intervenes with the family actively
during sessions by assuming a leadership position.
Maps the family’s underlying structure
(boundaries, hierarchy, subsystems)
 Intervenes to transform the structure with direct
requests to the family to change how the members
interact with each other

31. Phases of treatment
 Phase 1: Joining
 Phase 2: Understanding the presenting issue
 Phase 3: Assessment of Family Dynamics
 Phase 4: Goals
 Phase 5: Amplifying Change
 Phase 6: Termination

32. Therapeutic Interventions
 Joining in a position of leadership, and
accommodating
 Family is set up to resist you. You are a stranger, and
know nothing about their struggles, and their
goodness.
 Important to join with angry and powerful family
members
 Important to build an alliance with every family
member
 Important to respect hierarchy

33. Structural therapists work with what
 they see going on in the session, not what family members
describe
 There are two types of live, in-session material
on which structural family therapy focuses—
enactments and spontaneous behavior sequences.
 An enactment occurs when the therapist stimulates
the family to demonstrate how they handle a particular
type of problem.
Enactments commonly begin when the therapist suggests
that specific subgroups begin to discuss a particular
problem

34. Working with enactments requires three operations.
 First, the therapist defines or recognizes a sequence.
For example, the therapist observes that when mother
talks to her daughter they talk as peers, and little
brother gets left out
• Second, the therapist directs an enactment. For
example, the therapist might say to the mother, “Talk
this over with your kids.
• ” Third, and most important, the therapist must guide
the family to modify the enactment.

35. Assessment
 Diagnosis implies knowledge: You describe something and
give it a name
 Assessment deals with assumptions. A structural
assessment is based on the assumption that a family’s
difficulties often reflect problems in the way the
family is organized ,if change occurs between mother and
daughter, things will also change between husband and wife.

36. Structural therapists make assessments first
by joining with the family to build an alliance,
and then by setting the family system in motion
through the use of enactments, in-session dialogues
that permit the therapist to observe how
family members actually interact
making an assessment
is best done by focusing on the presenting
problem and then exploring the family’s response
to it.

37.  In Families and Family Therapy, Minuchin (1974) listed
three overlapping phases in the process of structural
family therapy. The therapist
 (1) joins the family in a position of leadership;
 (2) maps their underlying structure; and
 (3) intervenes to transform this structure

38.  The strategy of structural family therapy follows
these seven steps:
 1. Joining and accommodating
 2. Working with interaction
 3. Structural mapping
 4. Highlighting and modifying interactions
 5. Boundary making
 6. Unbalancing
 7. Challenging unproductive assumptions

39. Therapeutic Interventions
 Working with Interaction by inquiring into the family’s view
of the problem, and tracking the sequences of behaviors that
they use to explain it.
 Mapping underlying structure in ways that capture the
interrelationship of members -- A structural map is essential!)
 Family structure is manifest only with members interact
 By asking everyone for a description aof the problem, the
therapist increases the chances for observing and
restructuring family dynamics.
 Tracking communication contents and use them in the
session.

40. Therapeutic Interventions
Highlighting and modifying interactions
Enactments -- directed by therapist in which the
family performs a conflict scenario, which happens
at home during the therapeutic session. Sharf
(2004) enactment offers the therapist an
opportunity to observe the family rather than simply
listening to the family story.

41. Therapeutic Interventions
Restructuring
 Use of reframing to illuminate family structure
 Use of circular perspectives, e.g. helping each other
change
 Boundary setting
 Unbalancing (briefly taking sides)
 Challenging unproductive assumptions
 Use of intensity to bring about change (not giving
up)
 Shaping competency
 Not doing the family’s work for them refusing to
answer questions, or to step in and take charge when
it’s important for the family members to do so.

42. Therapeutic Interventions
 Homework
 Should be to increase contact between disengaged
parties,
 To reinforce boundaries between individuals and
subsystems that have been enmeshed
 Should be something that is not too ambitious
 While Minuchin rarely used strategic interventions, he
did caution family members to expect setbacks, in
order to prepare them for a realistic future.

43. Evaluation
 Key model in the development of family therapy as a
whole
 Core Concepts and interventions have been
incorporated into most family therapy: eg Joining and
enactment
 Empirically evaluated, validated and refined by
research particularly with conduct disorders, anorexia,
substance abuse, and psychosomatic illness in
children.