Structural Family Therapy

Structural Family Therapy (SFT) is a method of psychotherapy developed by Salvador Minuchin which addresses problems in functioning within a family. Structural Family Therapists strive to enter, or "join", the family system in therapy in order to understand the invisible rules which govern its functioning, map the relationships between family members or between subsets of the family, and ultimately disrupt dysfunctional relationships within the family, causing it to stabilize into healthier patterns. Minuchin contends that pathology rests, not in the individual, but within the family system.

SFT utilizes, not only a unique systems terminology, but also a means of depicting key family parameters diagrammatically. Its focus is on the structure of the family, including its various substructures. In this regard, Minuchin is a follower of systems and communication theory, since his structures are defined by transactions among interrelated systems within the family. He 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 (also called positive feedback). Joining with a family is a goal of the therapist early on in his or her therapeutic relationship with the family.

Family Rules
In SFT, family rules are defined as an invisible set of functional demands that persistently organizes the interaction of the family. Important rules for a therapist to study include coalitions, boundaries, and power hierarchies between subsystems.

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. Additionally, 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 not enmeshed with the children, allowing for the degree of autonomous sibling and peer interactions that produce socialization, yet not so disengaged, rigid, or aloof, ignoring childhood needs for support, nurturance, and guidance. Dysfunctional families exhibit mixed subsystems (i.e., coalitions) and improper power hierarchies, as in the example of an older child being brought in to the parental subsystem to replace a physically or emotionally absent spouse.

Therapeutic Goals and Techniques
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 remain 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.