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Structural Family Therapy

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Brunella Caro

on 18 April 2013

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Transcript of Structural Family Therapy

Structural Family Therapy Underlying Theory and Concepts Systems Theory “There is no such thing as an individual; there are only fragments of families.” --- Carl Whitaker Structural Family Therapy Concepts *

*

* History has already occurred and cannot be undone. Analyze the family structure through different perspectives.
*Identify unused strenghts. Re-enact emotional moments as a process to gain awareness. Structural Family Therapy Concepts cont'd *


* The basic goal of structural family therapy is the re-structuralization of the family's transactional rules. Re-structuralization enables the system to mobilize its underutilized resources and to improve its ability to cope with stress and conflict. Structural Family Therapy Therapist's Role *
*


*

* Establish a working relationship. Mapping the family system
* Identify problems from different perspective. Challenge problem to create new equilibrium between systems. Identify strengths and limitations from each family member in the system. Salvador Minuchin The Man Behind the Theory 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 He returned to the United States in 1954 and began Psychanalytic training 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 Why Structural Family Therapy "As a Profession, we are committed to the pursuit of social justice for the poor, disadvantaged, disenfranchised, and oppressed people". Role of Social Worker 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:

  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. 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). Evidence-Based Theory: Proven To Be Factual History cont'd... The History Salvador Minuchin developed Structural Family Therapy in the early 1960's He was influenced by working with
Inner-city troubled youth
Diabetic children with acidosis
Children and adolescents with eating disorders Definitions & Descriptions... 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. According to SFT, a functional family:
Facilitates individual growth while preventing intrusion and has clear boundaries between individuals and subsystems. SFT is based on ecosystemic principles: Context organizes us
The family is the primary context
A well functioning family
The job of the structural family therapist Family structure 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 Goal To facilitate organizational changes in the dysfuncional family with individual changes, and symptom reduction, naturally following changes from the overall structure SFT Applications Structural Family Therapy has been applied to treatment settings for: Eating disorders
Mental retardation
Delinquency in minors Addiction
School problems
Depression Techniques 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 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) -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. Tracking (Assessment) -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. Mimesis (Assessment) -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. Enactment (Planning) -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. 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) -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. Problems can only be understood and treated in context. Family Therapy and Homo Sexuality 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? Family As A Systems SFT Influence on Asian Families

Well suited
Filial Piety-based on core value
-Respect
-Obedience
Collective Society

Techniques

-Joining
-Reframing
-Enactment 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 Foundation 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 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 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 Questions to Consider in over coming biases Hepworth 2006 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 Criticisms Feminist Postmodernist -Hierarchical structure
power driven
-Male Dominated
-Neglects abuse -Aggressive/ Confrontational
-Non-Collaborative with families
-Directive and manipulative
-Cultural Bias
-Potentially Dis-empowering
for familaies Other leading figures... 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... Minuchin: Don't be so sure. Never be so sure. Salvador Minuchin Families and Family Therapy A little dysfunctional... The Angry Family... Brunella Caro
Kamilah Cross
Oscar Polanco
Daniela Riveros 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
SFT Influence on Hispanic Families Quote Questions “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
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