Structural Family total 2 Full Pages

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

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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

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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 ; c) all panellists endorsed relabelling

and reframing as a shared therapeutic technique, whereas

structural therapists did not endorse any indirect tech-

niques, only direct methods of working ; d) all panellists

endorsed a view of therapeutic change occurring when

unhelpful sequences of interaction were altered, through a

change in both family members’ behaviours and percep-

tions. This study provides an interesting glimpse into the

panellists’ perceptions of family therapy practice in the

mid 1980s, at a time when all schools of family therapy

were reorganising to take account of the recent major

critiques of thinking and practice.

Challenges to structural family therapy

Like most schools of family therapy, structural therapy

was critiqued during the 1980s by feminist commentators

(Hare Mustin, 1987), and by those concerned with issues

of race and culture (Holland, 1990). The thrust of the

feminist informed critiques was that family theorists and

therapists had paid attention to issues of power and the

effect on relatedness between the generations, i.e., the

politics of growing up, but had systematically failed to

address the issue of power within same generational

relationships, such as couple relationships. Although it

should be said that a power skew in either direction of the

couple’s relationship was seen as more likely associated

with widespread distress and general problems within the

family. The gender informed critique coincided with a

growing body of demographic data that identified high

rates of physical violence from men to their women

partners (Straus & Gelles, 1990). This was a serious

omission within the field, that has been addressed recently.

See the work by Goldner (1998) and that of Vetere and

Cooper (2000), which privileges the issues of responsibility

and safety, when working with abuses of power in family

relationships, and seeks to find ways of giving voice to

women as they regain their parental authority with their

children, and to redress relative power inequalities within

couple relationships.

The challenges to structural family therapy have come

from different quarters. The approach to assessment has

been criticised as located solely within the household

family group, ignoring the roles of extended family,

neighbourhood and other social institutions and leading

to an incomplete picture of the presenting difficulties. The

problem here, in my view, lies more in the local application

of the ideas, as there is nothing in the theoretical language

and model that constrains assessment of wider systemic

issues in the therapist ’s formulation (Vetere, 1992).

The direct and involved therapeutic style of the structural

therapist does not find favour within the UK, amidst

concerns of therapist burnout. Earlier excesses of en-

thusiasm around the therapist as leader and director of the

therapy have led to moderation in the description and

promotion of structural therapist style. Research by

Hampson and Beavers (1996) has highlighted the im-

portance of the fit between family members’ emotional

style and that of the therapist. The influence of con-

structivism and social constructionism have been pro-

found, in that the focus on issues of therapist reflexivity

have led to profound changes in how we think about our

own a priori assumptions about families and cultural

norms and in our increased search for integration of

theory. However, an overemphasis on the value of

uncertainty and uniqueness, often associated with post-

modern critiques, runs the risk of injustice by assuming

that abuse and issues of structural inequality can be seen

as one narrative amongst others (Minuchin, 1991).

Arguably, many family therapists are interested in in-

tegrative practice, both within the field of family therapy

and across the major psychotherapeutic domains (see

Larner, 2000). Thus the structural focus on the here and

now, in the description and attempted alleviation of

symptoms, limits the ability to explain and predict

symptomatic behaviour and possibly leads the therapist to

search for other models that address these issues. In the

absence of well articulated attempts to integrate theory at

the conceptual level, this criticism remains a problem of

application and practice. Therapists seem more interested

in seeking multi-dimensional views of family members’

behaviour and general functioning and tailoring their

approaches to families rather than slavishly following

‘ schools ’. There is no doubt in my mind that theory can be

used narrowly and prescriptively ; the challenge lies in

using theory in an elaborated and sceptical way, such that

we can be held accountable ethically for the connections

between our thinking and our practice.

Another set of challenges have revolved around the

structural view of problem maintenance and the purported

function of symptomatic behaviour. The notion that the

system is maintained by the problem has been popular

within structural thinking, with a recognition that symp-

tomatic behaviour is often the ironic consequence of

attempts to solve problems and adapt. The punctuation of

this thinking has been criticised for failing to acknowledge

Child Psychology & Psychiatry Review Volume 6, No. 3, 2001136

Therapy Matters : Structural Family Therapy

that symptomatic behaviour may take on functional

significance within the family group, or that a structural

therapist may see dysfunction where none exists i.e., a

family group is temporarily off track, so to speak. The

structural focus on competence and strengths within the

family is likely to temper this criticism, although Gorell

Barnes (1998) highlights that an assumption of resilience

may not be born out in practice, particularly with more

fragile family forms, such as some newly formed step-

family arrangements.

It is of interest to me that Minuchin has always been

interested in his writing in the social and economic

conditions that support family members’ functioning. In

particular, his awareness of the unrelenting and numerous

external pressures on poor inner city families, that lead to

problems in family functioning, and the legal context of

the Courts and social policy changes around substitute

care that serve to undermine the functioning of}and break up poor families (Minuchin, 1992). Structural therapists

have always advocated cultural relativity in their practice,

asking, does this family’s structure, at this time, in this

particular cultural and social grouping, sufficiently meet

the needs of family members? However, recent critiques

have questioned the extent to which any notion of

structure, with its associated implications of norms and

normality, can be helpful when addressing issues of

cultural diversity.

An illustration of structural family therapy

The following excerpt is from an early therapy session

with a family, self referred over their concern for Caro-

line’s drinking problem. It is preceded by some infor-

mation about the family to help the reader put the therapy

session into context.

The household members are the mother and father and

their adult younger daughter, Caroline, 22 years old. Jean,

her older sister by two years, moved to live in independent

lodgings over a year ago. Jean has a successful career in a

software company. Caroline misses her sister. Caroline

cannot help but compare herself adversely with her older

sister. Caroline struggled with a college course in art and

design and, since leaving, has not been able to find

employment. Both parents are employed in a professional

capacity. Caroline describes her drinking problem as a

direct result of believing she has nothing to get up for in

the morning.

The family therapy complements Caroline’s individual

work with her alcohol keyworker. The family work was

requested by all family members as they wished to think

together about the consequences of Caroline’s drinking

for family relationships and to understand how best to

support her in her recovery. Initially tacitly, and then

subsequently, overtly, the parents wished to understand

whether their relationships with their daughter had

somehow made it more likely she would turn to alcohol

for solace in the face of distress and disappointment. The

alcohol keyworker made the referral to the family therapy

team when Caroline had been abstinent from alcohol for

a period of 2 months.

The family therapy team uses an integrative approach ;

however, this excerpt, which occurred in the third meeting

with the family, is chosen to emphasise the structural

aspects of the team’s thinking and practice. In the early

stages of the work, the team focused on family members’

roles, relationships and expectations of each other, both in

the context of their recent life cycle changes and the

iterative, problem maintaining effects of drinking. Early in

the third session Caroline said that she did not know how

any of her family felt about anything any more, what they

felt about their jobs, their lives, about each other, about

her. Caroline’s mother replied in a hesitant way that

talking to her these past few years had been like walking

on egg shells, unpredictable, uncertain and never knowing

what would upset her, leading her mother to believe it was

safest and prudent not to discuss anything of a potentially

sensitive nature. Caroline listened to her mother intently,

and then expressed deep regret at the loss of contact and

personal understanding of each other that seemed to have

crept up on them all. Jean looked at Caroline, seemed to

take a deep breath, and said directly and clearly, that she

wanted to talk to Caroline, not Caroline plus the bottle.

At this point, the therapist asked the two sisters if they

wanted to continue this discussion without having to talk

over their parents, who were seated between them. Jean

moved with alacrity to sit next to Caroline, and in what

seemed like a gesture of support and intimacy, held each

other’s arms. They continued to talk further to each other

about the importance of their relationship as sisters, their

wish to confide in each other, their wish to support each

other, thus reclaiming some of their past sense of closeness.

In recognising how alcohol had come between them, as

Caroline had seemed to form a primary relationship with

alcohol, which she now wanted to challenge in her wish to

reconnect with her sister, Caroline drew on the support of

the therapist and the team as a bridging relationship to her

family members.

Further on in this session, the father produced a set of

house rules that he and his wife had agreed and then given

to Caroline in an attempt to help her maintain her

abstinence and to continue to live with them. The therapist

asked about the rules, whose ideas were they, and what did

Caroline think? Caroline said she had agreed to the list of

rules and that she respected them. In our view this seemed

to be linked to Caroline’s attempt to reclaim her own sense

of self-respect and to develop a different voice in her own

family. Caroline took the list from her father and read out

the first few rules to the therapist. The first one was ‘ To

behave like an adult ’. The therapist asked what this

meant. Caroline paused and seemed very thoughtful. She

raised her head and looked at everyone, ‘ It means to take

more responsibility for my behaviour ’. This generated

much discussion, and afforded an opportunity for Caro-

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Therapy Matters : Structural Family Therapy

line’s father to praise her definition, saying it was much

better than his, previously offered one. Caroline thought

her father’s praise was important, as she had previously

described her father to the team as overly critical of her as

a growing young woman. This interaction led the team to

speculate that perhaps Caroline’s father had an uncertain

sense of his importance to his developing and now adult

daughter. This theme was explored in subsequent meetings

where we learned that Caroline’s father had been raised as

an only child, with an authoritarian father, as he saw it,

with whom he had only made a more adult relationship in

his mid-thirties. Caroline’s father told us he had left home

to get married to Caroline’s mother. Thus connections

between the generations and their remembrance and

understanding of developmental transitions and relation-

ship changes formed another bridge between Caroline and

her mother and father.

This small excerpt can only offer a flavour of the

complexity of the family work. The team’s thinking

complemented the family’s focus on roles, communication

and relationships, and how the transition into adulthood

for Caroline had challenged family members’ expectations

of her and each other. Much that was hurtful had been

said during periods of intoxication, and communication

withdrawal had characterised periods of sobriety, creating

an equilibrium within which nothing seemed to change or

could seem to change. In our view, Caroline’s commitment

to working with her keyworker formed the first step in re-

orienting her to relationships with people, thus paving the

way for the family work to create a context for coping and

support that facilitated forgiveness, reconciliation and

hopefulness for the future.

Applications and efficacy

A recent survey of family therapists’ practice in the UK

identified that 21 % of respondents identified themselves

with structural family therapy (Bor, Mallandain, & Vetere,

1998). Jonathan Dare (1996) lamented what he saw as the

decline in structural family therapy practice in the UK and

his perception of common misunderstandings about such

practice, such as the belief that structural therapists

imposed Eurocentric middle class beliefs on everyone else.

However, a significant minority of UK family therapists

and systemic practitioners identify a primary loyalty to

this modality, alongside a growing body of empirical

research that attests to the efficacy of structural and

behavioural based approaches to working with families.

The field of outcome research does not differentiate

between the earlier schools of family therapy, such that

reviews include structural, strategic and some Milan based

therapies with both families and couples.

According to Bergin and Garfield (1994), the marital and

family approaches have been subjected to rigorous re-

search scrutiny, with only a few forms of psychotherapy

studied as often. Studies report the use of controlled and

uncontrolled group comparison designs, single case de-

signs, and a few studies comparing the relative efficacy of

the different family therapy approaches. The overwhelm-

ing findings from the research reviews and the meta-

analytic studies is that family therapy works compared to

untreated control groups, with some demonstrated su-

periority to standard and individual treatments for certain

disorders and populations. Meta-analysis demonstrates

moderate, statistically and clinically significant effects

(Markus, Lange, & Pettigrew, 1990 ; Shadish et al., 1995 ;

Goldstein & Miklowitz, 1995). The following list of people

and problems is found to benefit both clinically and

significantly from the marital and family therapies com-

pared to no psychotherapy : marital}couple distress and conflict ; outpatient depressed women in unsatisfactory

marriages ; adult drinking problems and drug misuse ;

adolescent drug misuse ; adult schizophrenia ; adolescent

conduct disorder ; child conduct disorders ; aggression and

non-compliance in children with a diagnosis of ADHD ;

chronic physical illness in children ; obesity in children and

cardiovascular risk factors in children. Marital and family

therapy appears not to be harmful, in that no RCT study

has reported poorer outcomes for treated clients than for

untreated control family members (Pinsof & Wynne,

1995).

In my view, the structural model is attractive because it is

parent-friendly, with its emphasis on team working and

practical problem solving. It is a contractual and time

limited model, it emphasises the importance of giving

clear feedback and responding to the presenting problems,

it is a consciousness raising model for families and

organisations, and avoids using covert methods of in-

tervention. It meets many of the criteria identified by

Reimers and Treacher for ‘ user friendly approaches ’

(Reimers & Treacher, 1995). As Minuchin (1998) argues,

it focuses on family interaction and multi-channel com-

munication processes and keeps alive the value of family

process for therapists in these days of the narrative

therapies. Its applications have been wider than its original

formulation within the field of child and family mental

health, including the services and problems listed above

and, in my experience, in services for people with learning

disabilities (Vetere, 1993). Family therapy in the 90s, edited

by John Carpenter and Andy Treacher, identifies further

applications of the approach for the interested reader.

Sigurd Reimers, writing in the first number of the 2000

edition of the Journal of Family Therapy, comments that

practitioners should never forget family therapists’ exces-

ses of certainty that preceded the postmodern challenges.

In his view, collaboration with family members will be the

most treasured contribution offered by recent advances,

alongside the more explicit recognition of the ‘ as if ’

quality of our ideas about families and family members

(Reimers, 2000).

Whilst agreeing with Sigurd Reimers, I would add to his

reflections an enduring belief in the helpfulness of the

notion of scepticism, born out of my training as a social

Child Psychology & Psychiatry Review Volume 6, No. 3, 2001138

Therapy Matters : Structural Family Therapy

scientist within the tradition of British empiricism. It

seems to me that amongst the clinical competencies we

seek in ourselves, and in those whom we train as family

therapists, are the abilities to be curious about what we do,

to ask questions, to refine those questions in the light of

observation and experience, to evaluate and re-evaluate

our understandings, constantly checking with all partici-

pants as we go along. This list, for me, also describes a

structural family therapist.

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