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Underlying Theory and Concepts

Structural Family Therapy

Therapist's Role

Systems Theory

Problems can only be understood and treated in context.

Establish a working relationship.

Concepts

Mapping the family system

* Identify problems from different perspective.

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Techniques

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.

Salvador Minuchin

Families and Family Therapy

Joining. (Assessment)

  • coupling between family & therapist; leads to therapeutic system.
  • therapist is accepted and remains accepted.
  • Maintenance of working relationship.
  • Listening, empathy. genuine interest and feedback.
  • Empathy must be disciplined to keep distance and promote change.
  • Acceptance of therapist as leader.
  • Excessive accommodation should be prevented.

Maintenance (technique used in joining)

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

Mimesis (Assessment)

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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Tracking (Assessment)

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.

Reframing (Planning)

-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.

Boundary Making (Intervention)

-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.

Unbalancing (Intervention)

Enactment (Planning)

-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

Feminist

-Hierarchical structure

power driven

-Male Dominated

-Neglects abuse

Criticisms

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

History cont'd...

Salvador Minuchin developed Structural Family Therapy in the early 1960's

Postmodernist

He was influenced by working with

  • Inner-city troubled youth
  • Diabetic children with acidosis
  • Children and adolescents with eating disorders

The Angry Family...

A little dysfunctional...

-Aggressive/ Confrontational

-Non-Collaborative with families

-Directive and manipulative

-Cultural Bias

-Potentially Dis-empowering

for familaies

SFT Influence on African Americans Families (affected by poverty)

-Explore nature of relationship

-Develop Trust

-Joining

-Learning family language

-Metaphorically become a part of the

family

-Accommodation

-Reframing

Evidence-Based Theory: Proven To Be Factual

Other leading figures...

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:

 

SFT is based on ecosystemic principles:

  • Charles Fishman, PhD in Psychology
  • Harry Aponte, PhD in Psychology
  • Marion Lindblad, PhD in Psychology
  • Marianne Walters, PhD in Psychology and Psychotherapy
  • Jorge Colapinto, PhD in Psychology and Pychotherapy

Role of Social Worker

SFT Goal

"As a Profession, we are committed to the pursuit of social justice for the poor, disadvantaged, disenfranchised, and oppressed people".

  • Context organizes us
  • The family is the primary context
  • A well functioning family
  • The job of the structural family therapist

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

Hepworth 2006

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.

SFT Influence on Asian Families

Well suited

Filial Piety-based on core value

-Respect

-Obedience

Collective Society

Techniques

-Joining

-Reframing

-Enactment

Foundation

Family structure

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

Definitions & Descriptions...

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

Quote

The History

  • Structural Family Therapy - a strength-based outcome oriented treatment. A theory and therapeutic model which focuses on family organization, boundaries, and the ways in which these structures govern interactional patterns.

“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

Salvador Minuchin

The Man Behind the Theory

According to SFT, a functional family:

Facilitates individual growth while preventing intrusion and has clear boundaries between individuals and subsystems.

Questions

  • Minuchin was born and raised in Argentina
  • Graduated from Medical School
  • He served as a doctor in the war with the Arab nations
  • In 1952 while in Israel he worked with children displaced by the Holocaust

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

  • He returned to the United States in 1954 and began Psychanalytic training

Family As A Systems

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

Evidence-Based Theory: Proven To Be Factual

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).

SFT Applications

Questions to Consider in over coming biases

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:

  • Addiction
  • School problems
  • Depression
  • Eating disorders
  • Mental retardation
  • Delinquency in minors

Structural Family Therapy

Brunella Caro

Kamilah Cross

Oscar Polanco

Daniela Riveros

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