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
Introduction
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
Department,
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
normality.
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
sessions.
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
