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Identify three key concepts of Structural Family by Arlene Vetere.

Identify three key concepts of Structural Family by Arlene Vetere.

 Identify three key concepts of Structural Family by Arlene Vetere.

1. Identify three key concepts of Structural Family by Arlene Vetere. 1 Page

2.  SYSTEMS THEORIES – Identify four pieces of new information that would be useful to you as a family professional. Discuss why they are important. 1 page

Therapy Matters : Structural Family Therapy

Structural Family Therapy

Arlene Vetere

Structural Family Therapy was developed by Salvador Minuchin and

colleagues during the 1960s as part of the growing interest in systemic

ways of conceptualising human distress and relationship dilemmas, and in

working therapeutically with those natural systems and relationships,

thought to give rise to distress. Structural family therapy is underpinned by

a clearly articulated model of family functioning, and has been developed

and used most consistently in services for children and families. A growing

body of empirical evidence attests to the efficacy of structural family

therapy. As an approach it was extensively critiqued during the 1980s by

feminist writers and during the 1990s by those interested in the

implications of a social constructionist position. Structural family therapy

continues to evolve in response to challenges mounted from within and

outwith the systemic field, and as part of integrative practice and multi-

systemic approaches, with practitioners ever mindful of the need for

regular feedback from family members themselves.

Keywords : Structural family therapy


Structural family therapy is a body of theory and

techniques that approaches individuals in their social and

relational contexts. It was developed in the context of

therapeutic work with families and young people. It is

predicated on family systems theory, and brings with it

many of the strengths and weaknesses associated with the

appropriation of general system theory (von Bertalanffy,

1968) into the realm of social behaviour. This article

reflects my interpretation of structural family theory and

therapy, modified by my longstanding and continuing use

of the ideas and methods. For me, the central creative

thesis of structural family therapy is embodied within the

paradigm shift of the relational therapies, that distress can

be understood not only in the context of the relationships

within which it arises and is maintained, but also in seeing

the potential for relationships to be the cause of distress.

The excitement and challenge of structural family therapy

is in the focus on family members’ interaction and in the

broad definition of communication to be more than what

we say and the way in which we say it.

Structural family therapy is an approach mainly identified

with the work and writing of Salvador Minuchin, although

many other influential thinkers have worked in association

with the development of the ideas, such as Jay Haley,

Braulio Montalvo, Lynn Hoffman, Marianne Walters,

Charles Fishman and George Simon. Many of the

concepts are familiar, such as family rules, roles, co-

alitions, triangulation of conflict, subsystems and bound-

aries, organisation, feedback, stability and change. How-

ever, the thinking and practice of a structural family

therapist will likely be characterised by formulation of

family members’ difficulties in terms of family structure

and dynamic organisation and a preference for working in

the here and now. At this point, I wish to note that in my

experience in the UK, few working family therapists

adhere rigidly to one school of thought ; rather an

integrated pragmatic approach to conceptualisation and

practice is more likely, with a consideration of the fit

between family members’ style and preferences, therapist

style and the nature of the difficulties driving the domi-

nance of one family therapy model over another. Nor

would I want this article to reflect the view that family

therapy, of whatever approach, is always the treatment of

choice when confronted with human distress. It may be

the treatment of choice, or it may be part of an integrated

package of care.

Model of change

The term structure refers to the organisational charac-

teristics of the family at any point in time, the family

subsystems, and the overt and covert rules that are said to

Arlene Vetere

Child and Family


The Tavistock Centre,

120 Belsize Lane,

London NW3 5BA

Child Psychology & Psychiatry Review Volume 6, No. 3, 2001 133

Therapy Matters : Structural Family Therapy

influence interpersonal choices and behaviours in the

family. Thus an aim of this therapy is to alter the

organisational patterns, particularly where the modes of

communication are thought to be unhelpful and where

behaviours are considered to be abusive and neglectful or

to have the potential to be so. When the structure of the

relational group changes, the positions of members in the

group changes. Thus it is said, each individual’s experience

changes and therein lies the potential to alleviate symp-

tomatic distress. Structural family therapy works with the

processes of feedback between circumstances and the

people involved, tracking how changes made to our

circumstances feedback into choices and decisions about

further change.

This is a competence model, encouraging people to explore

the edges of their known repertoires of responding,

assuming that family members have the ability to innovate

and draw on less tapped interpersonal and intrapersonal

resources. Enactment as a structural family therapy

technique is seen as central to this model of change

(Simon, 1995) i.e., encouraging family members to prob-

lem solve and generate alternative responses to each other

in the relative safety of the therapeutic relationship. Thus

intervention is promoted at three levels : challenging

symptomatic behaviour, challenging the family structure,

and challenging family belief systems. The therapy is

based on the tenet of action preceding understanding, and

vice versa, with the use of cognitive techniques such as

reframing. Family members are encouraged to think

beyond symptomatic behaviours and current complaints

and see their behaviour and choices in the context of

family structures and process and in the relationships

between the family group and other societal systems. The

structural family therapy model of change does not

exclude other models of change and structural therapists

can work alongside other therapeutic approaches to

change as part of a co-ordinated package of care.

Principal features of structural family theory

The theory is based on the clinical experience of Minuchin

and his associates with families in distress. The devel-

opment of the theory can be traced through their major

publications : Families of the slums (1967), which focused

on issues of parental authority and leadership in Black

American women who headed lone parent families where

children were in trouble with the law ; Families and family

therapy (1974), which outlined the key constructs, such as

enmeshment and disengagement ; Psychosomatic families

(1978), where conflict, its avoidance and resolution, and

styles of parent-child interaction are described ; Family

therapy techniques (1981), which detailed the different

techniques of structural family therapy ; Family kaleido-

scope (1984), which brought family systems thinking to a

general readership ; and Mastering family therapy (1996),

which provided a revision of some of the earlier principles

and methods of the approach.

The key features of the approach can be summarised thus :

E The family is seen as a psychosocial system, embedded

within wider social systems, which functions through

transactional patterns : these transactions establish

patterns of how, when and to whom to relate, and they

underpin the system;

E The family tasks are carried out within bounded

subsystems ;

E Such subsystems are made up of individuals on a

temporary or more permanent basis, and members can

be part of one or more subsystems, within which their

roles will differ ;

E Subsystems are organised hierarchically in a way that

regulates power within and between subsystems ;

E Cohesiveness and adaptability are key characteristics

of the family group, within which the balance between

emotional connectedness and developing autonomy is

seen to change as family members mature and live

through life cycle transitions.

Minuchin writes about family structure metaphorically, as

a device for describing family interaction in the here and

now. His writing is less concerned with how family

members evolve their interactional style and negotiate

their interpersonal tasks and expectations. The boundaries

of a subsystem are said to be the rules defining who

participates and how. The function of boundaries is to

protect the differentiation of the subsystem. Every family

subsystem is said to have specific tasks and make specific

demands on its members ; and the development of inter-

personal skills achieved in these subsystems is predicated

on the subsystem’s freedom from interference by other

subsystems, as might be seen with a diffuse subsystem

boundary. According to this approach, proper func-

tioning within subsystems implies clear boundaries. Clar-

ity is seen as more important than composition, for

example, the responsibility for proper supervision and

care of the children needs to be identified with person}s able to sustain and discharge such responsibilities. Family

subsystems might include : parental, couple, parent-child,

grandparent, male}female, organised by history, power, hobbies, interests and so on. Relationships between and

within subsystems can be described as affiliations, co-

alitions, with patterns of conflict resolution, detouring,

enmeshment and disengagement.

The notion of a couple subsystem straddles different

modes of family household composition and recognises

the needs of adults for affection, confiding relationships,

shared decision making and is seen as the primary

mediator between the household group and the outside

world. The parental or executive subsystem is vested with

the authority for the care and safety of the children and

fulfils major socialisation requirements within the family.

If more than one person is responsible for caring for the

children, this approach stresses the importance of team-

work and the ability to negotiate conflicting interests.

Adaptability is seen as necessary because of developmental

changes in the children and pressures of age related

expectations from societal institutions. The parent}child

Child Psychology & Psychiatry Review Volume 6, No. 3, 2001134

Therapy Matters : Structural Family Therapy

subsystem is the context for affectional bonding, gender

identification and modelling, and where children learn to

develop a degree of autonomy within unequal power

relationships. The sibling subsystem was highlighted as an

important social group early in the writings of Minuchin

and colleagues, long before it attracted the interest of

current researchers (see Brody, 1996). This is seen as the

social context within which children learn to co-operate,

compete, resolve conflict, cope with jealousy, and prepare

for peer related activities and friendships as they mature.

The structural approach assumes families and family

members are subject to inner pressures coming from

developmental changes in its own members and sub-

systems, and to outer pressures coming from demands to

accommodate to the significant social institutions that

have an impact on family members. Inherent in this

process of change and continuity are the stresses of

accommodating to new situations. The strength of the

family system depends on the abilities of family members

to mobilise alternative transactional patterns when inter-

nal and}or external conditions of the family demand restructuring. A family is said to adapt to stress in a way

that maintains family continuity while making restruc-

turing possible. If family members respond to stress with

rigidity, for example, by reapplying ‘ old ’ solutions,

unhelpful transactions may ensue. Symptomatic behav-

iour is seen as a maladaptive reaction to changing

environmental and developmental requirements, and thus

the presence or absence of problems does not define


Thus we can see that the ‘ as if ’ notion of structure is

helpful in providing a framework for thinking about

belonging and loyalty, proximity, exclusion and aban-

donment, power, aggression (as reflected in subsystem

formation), the relative permeability of boundaries, work-

ing alliances and coalitions. In the 1996 publication

Mastering family therapy, Minuchin and colleagues made

a commitment to the original formulation of family

functioning, with a shift in perspective in the following

areas of therapist functioning :

E Modified intensity of therapeutic encounters ;

E A more fluid commitment to a key ‘ alphabet of

therapist skills ’ ;

E An increased use of the self of the therapist in therapy,

with a greater emphasis on feedback to family members

of the effects of interaction on the therapist, aimed at

offering more information about their interactions with

one another ;

E An increased interest in supervision, aimed at develop-

ing the therapist’s under-utilised skills ;

E Admission of his own impatience and speed in reading

non-verbal cues ;

E The recognition of relative perspectives, with the

structural frame as an organiser of therapists’ per-

ceptions rather than universal truths ;

E The role of the therapist in activating the family

members’ own alternative ways of relating : ‘ While the

therapist has ideas and biases about family norms, and

about the best family fit, she can only go in the direction

that the family indicates when they enact their drama

and show possible alternatives’ (Minuchin, Lee, &

Simon, 1996).

Assessment for therapy

Structural therapy posits that for therapy to be effective,

the therapist needs to form a new system with the family

group (family plus therapist system). In order to do this,

the therapist relies on techniques of accommodation and

joining. Accommodation is said to be the process of

adjustment of the therapist to the family members, which

includes : a) planned support for the family structure i.e.,

offering support for what is going well, and helping to

create changes in structures that will work ; b) carefully

tracking the content and process of family interaction ;

and c) accommodating to the family members’ style and

range of affect through mirroring. Joining refers to those

actions of the therapist aimed directly at relating to family

members. The therapist must therefore be aware of taking

sides, and must offer support at times when being

confrontational. This emphasis on the importance of the

therapeutic relationship recognises its potential as a

vehicle for therapeutic change.

Structural therapists assess and explore the family’s

structure (for example, subsystems, boundaries, functions,

relationships, external relationships and social support) to

identify areas of strength and resilience, possible flexibility

and change. Assessment includes : a) family members’

preferred transactional patterns and available alterna-

tives ; b) flexibility and the capacity to change, often based

on responses to earlier demands for change within the

family group ; c) family members’ sensitivity to members’

needs, behaviours, attitudes, and so on ; d) developmental

issues, tasks and requirements ; e) the meaning and

relational significance of symptomatic behaviour ; and f )

the context of family life, with specific reference to sources

of social support and sources of stress. Pitfalls within the

assessment process can include : a) ignoring the devel-

opmental processes of family members and changing

family subsystems ; b) ignoring some family subsystems ;

and c) joining and supporting only one family subsystem.

Therapeutic change is seen to be a delicate process,

whereby too little involvement by the therapist will lead to

maintenance of the status quo and too much involvement

and directiveness might lead to panic and premature

ending of therapy by the family members. Change is

thought to occur through the trusting relationship with

the therapist, within which a context is created to actualise

family transactional patterns through enactment and re-

enactments, to recreate communication channels, to help

members manage psychological distance and space, to

delineate and reinforce individual and subsystem bound-

aries, such as helping a lone mother regain her parental

authority with her children, to create therapeutic intensity

by emphasising differences and exploring conflicts and

Child Psychology & Psychiatry Review Volume 6, No. 3, 2001 135

Therapy Matters : Structural Family Therapy

their resolution, to offer support, education and guidance,

and to assign agreed tasks and opportunities to try out

new solutions developed within the session between


Fish and Piercy (1987) used a Delphi procedure to examine

the similarities and differences in the theory and practice

of structural family therapy and strategic family therapy

in the United States with the help of a panel of knowl-

edgeable and well known structural and strategic thera-

pists (which included practitioners of Milan family ther-

apy). Of interest here are the findings that : a) structural

panellists endorsed differently those theoretical assump-

tions that pertain to subsystems, hierarchy, boundaries,

and families as organisations ; b) structural panellists

endorsed different goals of therapy, which included

reorganisation of the family structure, the lessening of

rules}roles constrained by narrow bounds of transactions, and resolution of the presenting problems through struc-

tural reorganisation

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