Salvador Minuchin is a family therapist born and raised in Argentina. Salvador Minuchin developed his own form of family therapy, known as structural family therapy (SFT). Structural Family Therapy addresses problems within a family by charting the relationships between family members, or between subsets of family. These charts represent power dynamics as well as the boundaries between different subsystems. The therapist tries to disrupt dysfunctional relationships within the family, and cause them to settle back into a healthier pattern. Some prominent theorists in structural family therapy, include Braulio Montalvo, Bernice Rosman, Harry Aponte, and Charles Fishman.In 2007, a survey of 2,600 psychology practitioners named Minuchin as one of the ten most influential therapists of all time.
SFT utilizes, not only a unique systems terminology, but also a means of depicting key family parameters diagrammatically. Minuchin's focus is on the structure of the family, including its various substructures. In this regard, he is a follower of systems and communication theory, since his structures are defined by transactions among interrelated systems within the family. Minuchin subscribes to the systems notions of wholeness and equifinality, both of which are critical to his notion of change. An essential trait of SFT is that the therapist actually enters, or joins with the family system as a catalyst for positive change. Joining with a family is a goal of the structural family therapist early on in their therapeutic relationship with the family.
According to Minuchin, a family is functional or dysfunctional based upon its ability to adapt to various stressors (extra-familial, idiosyncratic, developmental); which, in turn rests upon the clarity and appropriateness of its subsystem boundaries.
Boundaries are characterized along a continuum from enmeshment through semi-diffuse permeability to rigidity. In addition, family subsystems are characterized by a hierarchy of power, typically with the parental subsystem “on top” vis-à-vis the offspring subsystem.
In healthy families, parent-children boundaries are both clear and semi-diffuse, allowing the parents to interact together with some degree of authority in negotiating between themselves the methods and goals of parenting; from the children’s side the parents are sufficiently unmeshed from the children to allow for the degree of autonomous sibling and peer interactions that produce socialization, yet not so rigid or aloof as to ignore childhood needs for support, nurturance and guidance. Dysfunctional families exhibit mixed subsystems (i.e, coalitions) and improper power hierarchies, as for example when an older child is brought in to the parental subsystem to replace a physically or emotionally absent spouse.
Minuchin’s goal is to promote a restructuring of the family system along more healthy lines, which he does by entering the various family subsystems, “continually causing upheavals by intervening in ways that will produce unstable situations which require change and the restructuring of family organization….
Therapeutic change cannot occur unless some pre-existing frames of reference are modified, flexibility introduced and new ways of functioning developed”. To accelerate such change, Minuchin manipulates the format of the therapy sessions, structuring desired subsystems by isolating them from the remainder of the family, either by the use of space and positioning (seating) within the room, or by having non-members of the desired substructure leave the room (but stay involved by viewing from behind a one-way mirror).
The aim of such interventions is often to cause the unbalancing of the family system, in order to help them to see the dysfunctional patterns and be open to restructuring. He believes that change must be gradual and taken in digestible steps for it to be useful and lasting. Because structures tend to self-perpetuate, especially when there is positive feedback, Minuchin asserts that therapeutic change is likely to be maintained beyond the limits of the therapy session.
One variant or extension of his methodology can be said to move from manipulation of experience toward fostering understanding. When working with families who are not introspective and are oriented toward concrete thinking, Minuchin will use the subsystem isolation—one-way mirror technique to teach those family members on the viewing side of the mirror to move from being an enmeshed participant to being an evaluation observer. He does this by joining them in the viewing room and pointing out the patterns of transaction occurring on the other side of the mirror. While Minuchin doesn’t formally integrate this extension into his view of therapeutic change, it seems that he is requiring a minimal level of insight or understanding for his subsystem restructuring efforts to “take” and to allow for the resultant positive feedback among the subsystems to induce stability and resistance to change.
Change, then, occurs in the subsystem level and is the result of manipulations by the therapist of the existing subsystems, and is maintained by its greater functionality and resulting changed frames of reference and positive feedback. He is one of the greatest child and family psychologists. He introduced the Minuchin effect which talks about the idealism of the children inside them.
Key Concepts of Structural Family Therapy 1.Every family has a structure
Revealed when family is in action
Structure influences for better of worse
Families that have an open and appropriate structure recover more quickly and function better in the long term
Structural approach emphasizes the family as a whole as well as between subunits
2.A person’s symptoms are best understood as rooted in the context of family transaction patterns
3. Family seen as client
The hope is through structuring or restructuring the system, all members of the family and the family itself will become stronger
Lasting change is dependent on altering the balance and alliances in the family
4. Subsystems
Smaller units of the system as a whole
Formed when members join together to perform various functions
Family would not function without them
5. Types of Subsystems
Spousal
Parental
Sibling
6. Boundaries - Physical and psychological factors that separate people from one another and organize them.
Types of Boundaries
Clear
Rigid
Diffuse
7. In addition to structure, subsystems, and boundaries, Structural Family Therapy is also based on: 1.Roles 2.Rules 3.Power
8. Process and Outcome
Process of change is gradual but steady - Significant changes occur in a few sessions because of specific techniques to help the family interact in new ways
Overlap techniques
Emphasize action over insight
Overall structure is altered and reorganized
Dated and outgrown rules are replaced with those more to family’s current realities
9. Unique Aspects
A..Strongest is versatility
Successful treating juvenile delinquents, alcoholics and anorexics
Appropriate for low socioeconomic level families
B.Emphasis on terminology and ease of application
Clearly defined terms and procedures
Novice therapist can easily conceptualize what they are to do and when to do it
C.Helps make family therapy as a whole acceptable to medicine in general and psychiatry in particular. Without this recognition and implicit endorsement, family therapy would be more of an intellectual exercise and a mystery
D.Emphasis on symptom removal and reorganization of family
Changes in structure contribute to changes in behavior
Families have a different emphasis as a result of treatment and better able to cope
E.Pragmatic problem-solving emphasis
Therapists are active in bringing change
Depressive rather than hopeless
10. Role of Marriage and Family Therapist in Structural Therapy
A. Goal is to change the family structure so family members can unite in a healthy and productive ways.
Marriage and Family Therapist is an observer and implicitly and an expert in the sessions
Marriage and Family Therapist is active in making interventions to modify and change structure of family
Marriage and Family Therapist possesses high energy and precise timing implementing techniques
B. Marriage and Family Therapist role changes throughout therapy.
Phase 1: Marriage and Family Therapist joins family and takes leadership position
Phase 2: Marriage and Family Therapist mentally maps out underlying family structure
Phase 3: Marriage and Family Therapist helps transform family structure
Marriage and Family Therapist watches family "dance" and then "joins" and leaves the interaction in order to transform it therapeutically.
C, Marriage and Family Therapist uses a wide variety of techniques to foster change.
Assumption is the Marriage and Family Therapist has a "correct" interpretation of family structure and interactions
Marriage and Family Therapist must be precise in timing when using techniques Example: being dramatic or passive.
STRUCTURAL FAMILY THERAPY THERAPEUTIC TECHNIQUES
Structural family therapy is sometimes referred to as a way of looking at families.There are several techniques and procedures associated with structural family therapy described below.
DIAGNOSING Diagnosing is done early in the therapeutic process.The goal is to describe the systematic interrelationships of all family members to see what needs to be changed or modified for the family to improve.By diagnosing interactions, therapists become proactive, instead of reactive.
JOINING This is the process of coupling that occurs between the therapist and the family, leading to the development of therapeutic system.In this process the therapist allies with family members by expressing interest in understanding them as individuals and working with and for them.Joining is considered one of the most important prerequisites to restructuring.It is a contextual process that is continuous.There are four ways of joining in structural family therapy.
Tracking: In tracking, the therapist follows the content of the family that is the facts.Getting information through using open-ended questions.Tracking is best exemplified when the therapist gives a family feedback on what he or she has observed or heard.
Mimesis: The therapist becomes like the family in the manner or content of their communications.
Confirmation of a family member: Using an affective word to reflect an expressed or unexpressed feeling of that family member.
Accommodation: The therapist makes personal adjustments in order to achieve a therapeutic alliance.
DISEQUILIBRIUM TECHNIQUES The following techniques are used to create a different perception of reality.
REFRAMING The technique of reframing is a process in which a perception is changed by explaining a situation in terms of a different context.For example, the therapist can reframe a disruptive behavior as being naughty instead of incorrigible allowing family members to modify their attitudes toward the individual and even help him or her makes changes.
PUNCTUATION Punctuation is “the selective description of a transaction in accordance with a therapist’s goals”.Therefore it is verbalizing appropriate behavior when it happens.
UNBALANCING This is a procedure wherein the therapist supports an individual or subsystem against the rest of the family.When this technique is used to support an underdog in the family system, a chance for change within the total hierarchical relationship is fostered.
The following techniques can be used to create a different sequence of events:.
RESTRUCTURING The procedure of restructuring is at the heart of the structural approach.The goal is to make the family more functional by altering the existing hierarchy and interaction patterns so that problems are not maintained.It is accomplished through the use of enactment, unbalancing, and boundary formation.
ENACTMENT The process of enactment consists of families bringing problematic behavioral sequences into treatment by showing them to the therapist a demonstrative transaction.This method is to help family members to gain control over behaviors they insist are beyond their control.The result is that family members experience their own transactions with heightened awareness.In examining their roles, members often adapt new, more functional ways of acting.
BOUNDARY FORMATION Part of the therapeutic task is to help the family define, or change the boundaries within the family. The therapist also helps the family to either strengthen or loosen boundaries, depending upon the family’s situation.
WORKING WITH SPONTANEOUS INTERACTION In addition to enactment, structural family therapists concentrate on spontaneous behaviors in sessions. It occurs whenever families display behaviors in sessions that are disruptive or dysfunctional, such as members yelling at one another or parents withdrawing from their children. The focus is on process not content.It is important that therapists help families recognize patterns of interaction and what changes they might make to bring about modification.
INTENSITY Intensity is the structural method of changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure. Intensity works best if done in a direct, unapologetic manner that is goal specific.
SHAPING COMPETENCE The family therapists help families and individuals in becoming more functional by highlighting positive behaviors.
ADDING COGNITIVE CONSTRUCTIONS
Advice & Information are derived from experience and knowledge of the family in therapy. They are used to calm down anxious members of families or reassure these individuals and families about certain actions.
Pragmatic fictions are formal expressions of opinion to help families and their members change.
Paradox is an apparently sound argument leading to a contradiction.It is used to motivate family members to search or alternatives. Family members may defy the therapists and become better or they may explore reasons why their behaviors are as they are and make changes in the ways members interact.
STRUCTURAL FAMILY THERAPY RESEARCH
Structural Family Therapy’s strength is in its versatility.It may be utilized with families experiencing several different types of problems.
Structural Family Therapy’s approach is sensitive to the effect of culture on families.
Structural Family Therapy’s interventions employ clearly defined terms and procedures and has aided in promoting the credibility of family therapy in the medical community.
Structural Family Therapy emphasizes symptom removal and reorganization of the family.It proposes a pragmatic and problem-solving emphasis.
Salvatore Minuchin, MD
I. Founder Salvador Minuchin’s Background A. Born in 1921 to Russian Jewish emigrants in Argentina B. In 1948 he joined the Israeli army as a doctor C. In 1950, Minuchin came to United States with the intention of studying with Bruno Bettleheim in Chicago 1. Met Nathan Ackerman in New York and chose to stay there 2. In 1954 Minuchin began studying psychoanalysis and a few years later took theposition of medical director of the Wiltwyck School, a residential facility in New York for inner-city delinquents
II. Minuchin Became a Systems Therapist A. Along with Dick Auerswald and Charles King in 1959, began developing a 3 stage approach to working with low-socioeconomic-level black families 1. treatment created out of necessity due to long-term, passive approaches to these families proving unsuccessful 2. Minuchin discovered that dramatic and active interventions were necessary to beeffective 3. Minuchin discovered two common patterns in dysfunctional families: enmeshed, chaotic and tightly interconnected,or disengaged, isolated and seemingly unrelated B. Minuchin gained widespread attention for his work at Wiltwyck C. The method used was published in Families of the Slums in 1967
III. Minuchin Became Director of Philadelphia Child Guidance Clinic (1967) A. He transformed the clinic into a family therapy center B. Gained a reputation as a tough and demanding administrator C. Developed many innovative ideas at the Clinic - Example: Institute for Family Counseling, a training program for community paraprofessionals that was effective in providing mental health services to the poor D. Minuchin published Families and Family Therapy in 1974 - Most clearly written and popular books in field of family therapy E. In 1975 Minuchin stepped down as director of clinic, but remained head of training until 1981
IV. Minuchin since 1981 A. Has studied normal families, written several plays and books and commented on the overall field of family therapy B. He set up the Family Studies Institute in New York City C. Continues to do workshops and trains therapists from all over the world
D. Passionately committed to social justice and is involved in foster care system in New York
E. Currently Minuchin is working with the judicial system.He is advocating for a more effective approach to juvenile justice.
F. The Minuchin Center for the Family is also exploring the role of a structural approach in the organizational setting.
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