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Chapter: Essentials of Psychiatry: Family Therapy

Structural Family Therapy

Structural family therapy considers problems involving a particu-lar family member to be inextricably linked to the organizational context of the entire family.

Structural Family Therapy


Structural family therapy considers problems involving a particu-lar family member to be inextricably linked to the organizational context of the entire family. It solves problems by changing the family’s organizational context. Structural family therapy thus emphasizes an understanding of a family in terms of the family rules and roles that shape its members’ actions.


Family structure is the internal organization of the fam-ily that dictates how, when and to whom family members relate while carrying out the various functions of the family (Aponte and VanDeusen, 1981; Colapinto, 1991). Some important ele-ments of family structure for clinical work are boundaries, hier-archy, alliances and coalitions:


·  Boundaries Rules defining who participates and how, in particular moments of family life. For example, a boundary around the parental couple means that the children are in-cluded in discussions of certain topics but not in others;


·  Hierarchy Relative influence of each family member upon the outcome of an activity. For example, all family members may have opinions about spending money, but the parents as a couple typically have the final say;


·  Alliances Family members joining together to support an-other family member. For example, older children may join the well-parent in organizing to parent younger children if the other parent were to become seriously ill;


·  Coalitions Family members joining together in opposition to another family member. For example, a grandchild and grandmother might quietly ally together for the child to stay up late at night against the mother’s wishes when the child is at grandmother’s house.


The family structure should provide cohesive and flexible re-sponses to life stresses so that important family functions – parenting, providing income, marital intimacy, recreation and other activities – can be carried out successfully, and family members can grow and mature in their individual lives.


What to Look For


A structural family therapist observes closely the flow of fam-ily structures as family members talk about and interact together around the presenting problem of the therapy. The therapist wishes to witness how sequences of family behaviors are enacted during interactions in the sessions, particularly the occurrence of a symp-tom as it is embedded within different configurations of organ-ized family interactions. The therapist observes how boundaries, hierarchy, alliances and coalitions are associated with the pre-senting symptom, as well as any repetitive-behavioral sequences (verbal or nonverbal) that involve symptomatic behavior.


What to Think About


The structural family therapist considers the problem to be sustained by the current family structure and its community eco-system. Important questions to answer in assessing these rela-tionships include:


·              To what elements of family structure – boundaries, hierarchy, alliances, coalitions – do occurrences of the presenting prob-lem appear linked?


·              What family functions are blocked by the problem? If not for the problem, what would be happening that is not happening now?


·              For whom is the problem a concern? Who is most affected? Who would need to change for the symptom to disappear


What to Do


Structural family therapists ameliorate symptoms by shifting family structure. Boundaries can be strengthened or weakened by behavioral assignments that exclude a particular family mem-ber from certain moments of family life (e.g., an assignment for parents to leave children with a baby sitter to go on a date alone) or include a particular family member where that person had been absent (e.g., involving both parents in collaborative disciplining of a misbehaving child when the father had been only peripher-ally involved). Alliances are encouraged when they support the individual development of family members and strengthen the family as a whole. Secret coalitions, particularly when they cross generational boundaries, are targeted for therapeutic disruption as when one parent covertly supports a child’s oppositional be-havior with the other parent.


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