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Structural Family Therapy. By Isabel Brasil and Melissa Ruiz. Background of Structural Family Therapy. http://www.mariemontschools.org/parr/therapy_backgr.htm. Salvador Minuchin’s Background. http://www.mariemontschools.org/parr/therapy_backgr.htm.

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structural family therapy

Structural Family Therapy

By Isabel Brasil and Melissa Ruiz

background of structural family therapy
Background of Structural Family Therapy

http://www.mariemontschools.org/parr/therapy_backgr.htm

salvador minuchin s background
Salvador Minuchin’s Background

http://www.mariemontschools.org/parr/therapy_backgr.htm

  • Born in 1921 to Russian Jewish emigrants in Argentina
  • In 1948 he joined the Israeli army as a doctor
  • 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 the  position of medical director of the Wiltwyck School, a residential facility in New York for inner-city delinquents

minuchin became a systems therapist
Minuchin Became a Systems Therapist
  • 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 be  effective
  • 3. Minuchin discovered two common patterns in dysfunctional families: enmeshed, chaotic and tightly interconnected, or disengaged, isolated and seemingly unrelated
  • Minuchin gained widespread attention for his work at Wiltwyck
  • The method used was published in Families of the Slums in1967

http://www.mariemontschools.org/parr/therapy_backgr.htm

minuchin became director of philadelphia child guidance clinic 1967
Minuchin Became Director of Philadelphia Child Guidance Clinic (1967)
  • He transformed the clinic into a family therapy center
  • Gained a reputation as a tough and demanding administrator
  • 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
  • Minuchin published Families and Family Therapy in1974
  • Most clearly written and popular books in field of family therapy
  • In 1975 Minuchin stepped down as director of clinic, but remained head of training until 1981

http://www.mariemontschools.org/parr/therapy_backgr.htm

minuchin since 1981
Minuchin since 1981

http://www.mariemontschools.org/parr/therapy_backgr.htm

  • Has studied normal families, written several plays and books and commented on the overall field of family therapy
  • He set up the Family Studies Institute in New York City
  • Continues to do workshops and trains therapists from all over the world
  • Passionately committed to social justice and is involved in foster care system in New York
key concepts of structural family therapy
Key Concepts of Structural Family Therapy

Focus is on family interactions to understand the structure/organization of the family

Symptoms/presenting problem viewed as by-product of structural failings

Structural changes must occur in a family before an individual’s symptoms can be reduced

structural family therapist s function
Structural Family Therapist’s Function

The therapeutic task is to help move family from a dysfunctional stage to a newstage (evolved different structures have more stable levels of functioning)

Actively engage family unit to initiate structural change by joining and accommodating

Challenge rigid transactional patterns

family structure
Family Structure
  • invisible set of functional demands or rules that organize way family members relate to one another
family subsystems
Family Subsystems

Spousal: wife & husband

Parental: mother & father

Sibling: children

Extended: grandparents, other relatives

Family member play a different role in each of the subsystems they belong

Structural difficulty when one subsystem takes over or intrude another

boundaries
Boundaries

Emotional/physical barriers that define amount and kind of contact allowable between members

Extremes of boundaries may lead to dysfunction

Disengagement-rigid-little commitment/closeness to family

Enmeshment-diffuse-very involved as one-fosters dependency on parents/other members

Clear healthy boundaries-attain sense of personal identity yet allow sense of belongingness within family system

understanding the problem
Understanding the Problem

The therapist determines the issues around which to explore and intervene in the session.

  • Joining the family in a position of leadership
    • entering their reality and becoming part of that family’s patterns of relating/structure
collecting data
Collecting Data

The therapist tracks content and learns about the family issue and draws together all data relevant to the issue as gathered from prior information and the in-session experience leading up to the moment when the therapist is to intervene.

  • Mapping family’s underlying structure
  • observe family to see structure, focusing on the how, when, and to whom family members relate
  • who says what to whom
  • in what way
  • with what result
formulating hypotheses
Formulating Hypotheses

On the basis of the data, the therapist commits to hypotheses about the significance of the current transactional sequence of the nature of the problem, its locus, and sustaining structure.

  • Conducts experiments through probes and challenges to assess the flexibility of family patterns
structural goals
Structural Goals
    • To the extent permitted by the hypotheses, the therapist determines immediate goals for the intervention that is to follow
  • Reduce symptoms of dysfunction
  • Bring about structural change because it is assumed that faulty family structures have:
        • Boundaries that are rigid or diffuse
        • Subsystems that have inappropriate tasks and functions
intervening
Intervening
  • Intervening in ways designed to transform an ineffective structure
  • The therapist:

(a) to facilitates change in patterns of transactional sequences among family members and/or between self and family members

(b) to controls for variables in the transaction so that the effects of the intervention can be assessed

  • Challenging family rules, fostering boundary reorganization, prompting conflict resolution, creating an effective hierarchical structure,increasing degree of flexibility in family interactions, modifying dysfunctional family structures, and supporting greater individuation of family members.

Feedback

  • On the basis of the reactions of the family members to the intervention, the therapist restarts the cycle from the second step.
structural techniques
Structural Techniques

Joining

Imparting a Systemic View

Restructuring

Making Rules/Relationships/Structure Known

Intensity

Circular questioning

Unbalancing

Triangulation/Detriangulation

Enactment

Boundary-making

Reframing/Relabeling

Paradoxical Techniques

Restraining

Prescribing the symptom

therapist awareness
Therapist Awareness

Your Role/Position/Function in the Family

Your Family of Origin Issues

General

Unresolved

Cultural Factors (yours and theirs)

possible therapist interventions in the problem of mrs n s daughter
Possible Therapist Interventions in the Problem of Mrs. N.’s Daughter

PROBLEM:

How to stop the daughter from interrupting and clinging to her mother.

ALTERNATIVE INTERVENTION:

“It would be good to stop her from that because, see, she is identifying with you, acting inadequate right now, just like you feel yourself. So, she wants to be like you, to cling to inadequacy.”

Mother Ξ Daughter | Father

  • STRUCTURAL INTERVENTION:
    • “Mrs. N., would you tell your husband to remind Becky that you are fine, that this is an old story of yours, and you don’t need any help with it. That you know exactly what to do. Ask your husband to do that for you.”

Mother Father

― ― ― ― ― ― ― ―

Daughter

possible therapist responses to the scapegoating problem in the fletcher family
Possible Therapist Responses to the Scapegoating Problem in the Fletcher Family

PROBLEM:

A system stuck with the completion of a scapegoating sequence.

OTHER THERAPIST:

“Irving, you must be really upset by all this.”

OR

“Irving, I am really interested in your side of this.”

STRUCTURAL THERAPIST:

“Only Irving has said nothing so far. Who can get his side of the story?”

possible therapist interventions in fletcher family
Possible Therapist Interventions in Fletcher Family
  • ACCOMMODATION
    • “Mrs. Fletcher, I wonder if you could get Irving’s side of the story?”
  • ALLIANCE RESTRUCTURING
    • “Mr. Fletcher, perhaps you and Irving could discuss his side of the story.”
  • HIERARCHY RESTRUCTURING
    • “Mr. Fletcher, perhaps you could get your wife to find out more about her son’s view of this matter.”
slide24

Q – You have been seeing a couple in therapy for four months. One of the goals of your treatment plan was to improve dysfunctional interaction patterns and your treatment included restraining and repositioning strategies. This is representative of:

Humanistic-existential theory

Structural theory

Strategic theory

Psychodynamic theory

slide25

Q – Common sense solutions to problems rarely work. What theoretical orientation supports this belief:

Experimental family therapy

Structural family therapy

Strategic family therapy

Extended family therapy

slide26

Q – Client: “I think my wife says mean things to me to make me feel guilty.” Therapist: “How do you feel when your wife says mean things to you?” Client: “I feel that she is mean.” Therapist: “You say you think your wife is mean when she says these things to you. Now, how do you feel when this happens?” Client: “I feel bad about myself.” What is this therapist attempting to do:

Help the client in the process of differentiation

Get the client to “unwrap” his projections

Learn this family’s rules about arguing

Analyze the function of the couple’s behavior

slide27

Q – For Minuchin, scapegoating and overprotection of a child by the child’s mother and father are both forms of:

Triangulation

Detouring

A stable coalition

Marital skew

slide28

Q – A 45-year-old client was sexually abused as a child by her father. She says she’s not angry with him and, in fact, has kept a close relationship with him over the years. She sees him often and says she intends to continue doing so. This is an example of:

Blurred boundaries

Enmeshment

Disengagement

Pseudohostility

slide29

Q – From a systems perspective, which of the following is MOST true about treating a family with an alcoholic member:

The first step in restructuring the family involves getting the alcoholic’s relatives to admit they are codependent

The aim of therapy is to restructure the family’s homeostatic mechanisms

Therapy should focus on identifying and correcting faulty communication patterns

The family should be trained in ways of reinforcing non-drinking behaviors and extinguishing drinking behaviors

slide30

Q- When working with an intellectually-oriented family, the therapist “joins” the family by adopting a cognitive, intellectual style. This technique is referred to as:

Tracking

Modeling

Mimesis

Enactment

slide31

Q- A father and mother bring their 13-year-old son into therapy. At the beginning of treatment, the father states that the boy has been behaving disrespectful toward parents and teachers, and that all he cares about is his “damn skateboard.” The mother confirms non-verbally what her husband is saying by nodding and frowning. The son is sitting silently, with his eyes down, and refusing to talk. Which of the following techniques would a structural family therapist employ:

Sending the parents out to talk to the boy alone

Asking each family member to share their feelings about what is going on

Pointing out to the family that the father seems to be doing all the talking

Engaging the family in conversation by using family members’ mannerisms and communication styles

slide32

Q – In an enmeshed family in which an overcontrolling father constantly nags and yells at his 18- and 15-year-old sons, a structural therapist is MOST likely to do which of the following:

Manipulate the family’s mood by nagging even more and yelling even louder

Help the father understand that his nagging and yelling elicit oppositional behaviors from the boys

Construct a genogram of the father’s family

Create a therapeutic double-bind by telling the father to set aside an hour a day during which he will nag and yell at his sons

slide33

Q- When working with a family, Minuchin creates rapport by:

Joining and accommodating

Accommodating and restructuring

Restructuring and detriangling

Forming coalitions with subsystems

slide34

Q- For Salvador Minuchin, “psychosomatic families” – e.g., those in which asthma, diabetes, or anorexia threaten the life of one child – are MOST likely to be characterized by which of the following:

Frequent intense open conflicts between family members

Weak boundaries between family members and limited opportunities for individual autonomy

Family roles that are inflexible and stereotyped

Marked emotional distance between the husband and the wife, who are both emotionally immature

slide35

Q- You are currently treating a large family that presented with communication and discipline problems. You assess the family as having an enmeshed style and a weak executive subsystem. Your overall goal is to define clearer boundaries within the system. Given this context, it is likely that you would agree with all of the following EXCEPT:

Both the family’s present and its past will be examined in therapy

The focus of the treatment should be on changing the family’s maladaptive transactional patterns

Dysfunctional patterns in the family can be altered through the use of directive techniques

The focus should be each family member and on how family members feel about and interact with each other

slide36

Q- A family therapist instructs a family member to continue performing the target behavior and to do so in an exaggerated way. This technique id referred to a:

Reframing

Prescribing

Positioning

Cryptic message

slide37

Q- You are working with a family from a structural perspective. The family keeps telling you that one of the sons is the problem. The boy is sitting quietly, not defending himself. You go over to him and sit quietly, while the family’s conversation continues. This is an example of:

Unbalancing

Enactment

Mimesis

Manipulation

slide38

Q- From the perspective of structural family therapy, triangulation, parent-child coalition and detouring are:

Methods for establishing clearer boundaries

Methods for maintaining homeostasis

Types of positive feedback

Attempts to increase intimacy

slide39

Q- “Change, through therapy, is accompanied by stress, and the therapeutic system must be capable of dealing with it.” This statement was made by:

Glasser

Bower

Adler

Minuchin

slide40

Q- What does a structuralist do in the initial phase of therapy:

Join and accommodate

Highlight and join

Accommodate and restructure

Evaluate and restructure

slide41

Q- Mr. and Mrs. Smith, in their mid-thirties, have a three-year-old adopted daughter. The adoption occurred when the girl was an infant. They report that, since the adoption, they have quarreled frequently and no longer feel intimate. Mr. Smith is particularly disturbed because he feels that his wife directing all of her energies and attention to the child. The couple also mentions that their daughter may have developmental problems – their pediatrician is concerned about delays in her language development. Mrs. Smith is defensive and minimizes the girl’s problems. Both parents acknowledge feeling frustrated and unable to control their daughter’s behavior at times.

All of the following would be appropriate to do with this family EXCEPT:

Family-of-origin work to identify messages Mr. and Mrs. Smith got about parenthood and adoption

Role-playing to help the parents say good-bye to the perfect daughter they thought they had and hello to the one they actually have

Behavioral assignments to increase intimacy between Mr. and Mrs. Smith

Structural techniques to strengthen the mother-daughter dyad

references
References

Minuchin, Salvador. (1971). Families and family therapy. Harvard University Printing Press.

Minuchin, Salvador. (1984). Family therapy techniques. Harvard University Printing Press.

http://www.mariemontschools.org/parr/therapy_backgr.htm

Sysemtic Interventions (Power Point)

http://www.psyc.csustan.edu/kbaker/5790/.com

Family Systems Therapy (Power Point) by James J. Messina, Ph.D. www.coping.org/write/C6444/Family%20Therapy.ppt

Gurman, A. S. & Kniskern, D. P. (1981). Handbook of Family Therapy. New York: Brunner/Mazel Publishers.

Umbarger, C.C. (1983). Structural Family Therapy. New York: Grune & Stratton, Inc.