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Underlying Theory and Concepts
Structural Family Therapy
Therapist's Role
Systems Theory
Establish a working relationship.
Concepts
Mapping the family system
* Identify problems from different perspective.
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Challenge problem to create new equilibrium between systems.
Identify strengths and limitations from each family member in the system.
History has already occurred and cannot be undone.
“There is no such thing as an individual; there are only fragments of families.” --- Carl Whitaker
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Analyze the family structure through different perspectives.
*Identify unused strenghts.
Minuchin: What is the problem?... So who wants to start?
Mr. Smith: I think it's my problem. Im the one that has the problem...
Re-enact emotional moments as a process to gain awareness.
Minuchin: Don't be so sure. Never be so sure.
Structural Family Therapy
-An accommodation technique in which the therapist provides planned support of the family structure while he/she analyzes it.
-Therapist must respect where the family stands at the moment.
-Maintenance involves modesty and patience, specially when the therapist is trying to understand the family system .
-Validates, accepts and supports the family as it is now.
Concepts cont'd
The basic goal of structural family therapy is the re-structuralization of the family's transactional rules.
-Establish a closer relation with a member through verbal interventions or mimesis.
- Paralleling the family’s mood or behavior.
- Slow talk with a slow talking family or be animated with animated family.
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Re-structuralization enables the system to mobilize its underutilized resources and to improve its ability to cope with stress and conflict.
-Help reveal the patterns that make a family function the way it does.
-Ask clarifying questions, make approving comments, elicit amplification of a point.
-Let's the therapist check that he/she is understanding correctly.
-Allows the family to be more clear and explicit.
-Putting presenting problem in a perspective different from what the family brings into a more workable one.
- Changing the definition of complaint from a problem of one to a problem of many.
-Clear boundaries is an optimum balance between dependance and independence .
-Each family member is allowed to talk for themselves
-Be listened to by other members
-Ask questions or answer questions directed at them.
-involves respecting the rights of all members.
-Name give to all techniques that destabilize the system.
-Changes hierarchical relations.
-Goal is to create crisis therefore a lot of therapist’s involvement is needed.
-To challenge prevailing family structure, therapist supports one member more than the other.
-Family crisis is purposefully precipitated.
-Helps family reach a new level of organization.
-Spontaneous or planned.-serves as dual process of diagnosis and restructuring.
- 1st movement: therapist watches interactions allowing unfolding of sequences that suggest structural hypotheses.
-2nd movement- eliciting transactions- therapist decides which aspects to highlight. Possible clues to dysfunctional sequence and tests hypotheses.
-3rd movement: suggestion of alternatives. Ideally adopted by family, not always the case.
-Either case, feedback yields additional diagnostic data.
- The more resistant to change, the more precise and impactful interventions.
Why Structural Family Therapy
Family Therapy and Homo Sexuality
-Hierarchical structure
power driven
-Male Dominated
-Neglects abuse
1980 APA established committee to address under represented Gay/Lesbian community
-Neglected in Family therapy
-Family developmental guidelines
Inappropriate premises in relating to
homosexual families
-Role misinterpretation
Salvador Minuchin developed Structural Family Therapy in the early 1960's
He was influenced by working with
-Aggressive/ Confrontational
-Non-Collaborative with families
-Directive and manipulative
-Cultural Bias
-Potentially Dis-empowering
for familaies
Evidence-Based Theory: Proven To Be Factual
The diabetic group was in therapy for periods ranging from 3 to 15 months, with a median of 8 months, and was followed up for 2 to 9 years, with a median of 4 years.
20 cases of labile diabetes,
88% of the subjects (aged 10 to 18 years)
recovered
12% showed moderate improvement:
Role of Social Worker
"As a Profession, we are committed to the pursuit of social justice for the poor, disadvantaged, disenfranchised, and oppressed people".
Evidence-Based Theory: Proven To Be Factual
To facilitate organizational changes in the dysfuncional family with individual changes, and symptom reduction, naturally following changes from the overall structure
Treatment lasted between 2 and 16 months—with a median of 6—and follow up was done between 1½ and 7 years, with a median of 2½ years.
53 cases of anorexia
(aged 9 to 21 and with a median weight loss of 30°lo),
86%achieved normal eating patterns and a body weight stabilized within normal limits;
4% gained weight but continued suffering of the effects of the illness (borderline weight, obesity, occasional vomiting),
10% showed little or no change or relapsed.
Psychotherapy
Treatment contracted between therapist/client
-Aimed to increase sense of his/her own well
being
-Techniques based on experimental
relationships, dialogues, communication,
and behavioral change
-Used to improve family relationships
and mental health of the client
A family's structure is the covert set of functional demands or codes that organizes the way family members interact with one another (Minuchin, 1974)
SFT Influence on Hispanic Families
Family Systems
Families organized into subsystems
-Based on gender, generation, common
interest, functions
-Family member's (sub systems) can belong
to multiple subsystems
-Spousal Systems
-Parental Systems
-Sibling Systems
Idea of Machismo
Must respect family view of roles
Father is head of house hold
Mother is caregiver
ex. Joining
Look at situation of family
Clearly defined roles
Express Concerns
“Never forget that you are one of a kind. Never forget that if there weren't any need for you in all your uniqueness to be on this earth, you wouldn't be here in the first place. And never forget, no matter how overwhelming life's challenges and problems seem to be, that one person can make a difference in the world. In fact, it is always because of one person that all the changes that matter in the world come about. So be that one person.” R. Buckminster Fuller
According to SFT, a functional family:
Facilitates individual growth while preventing intrusion and has clear boundaries between individuals and subsystems.
Feminist
Social Context accounts overall not gender
Position of woman and children
Exertion of Power and Hierarchy
Post Modernist
Aggressive confrontational
non collaboration with families
Directive and manipulative
Cultural biases
Nonflowering for families
Families are Dependent and Independent
Dependent because rely on outside systems
Independent because assist in shaping
society
What is Family?
The definition of family is subjective based on cultural view on the individual
Anglo- Nuclear family (parent/children)
Afro-Americans-kinship/communities
Hispanic- Extended family
Asian-ancestors and descendants
Duration of treatment was between 2 and 22 months with a median of 8, and follow up was done between 1 and 7 years later, with a median of 3.
17 asthmatics (suffering severe attacks with regular steroid ther¬apy, or an intractable condition with steroid dependency), aged 7 to 17 years,
82% achieved recovery (little or no school days lost, moderate attacks with occasional or regular use of bronchodilator only)
12% improved moderately (weeks of school lost, prolonged and severe attacks and some use of steroids but with symptomatic im¬provement), and the remaining
6% stayed unimproved (more than 50% school loss with need for special schooling, persistent symptoms and dependency on regular steroid therapy).
How does culture dictate the structure of each family?
What is the level of each family member's acculturation?
What is additional cultural consideration must be addressed to be effective and culturally sensitive to the family?
What change needs to occur for greater functionality?
Structural Family Therapy has been applied to treatment settings for: