Module 5
Structural
a. The Structural Outlook
The family’s underlying organizational structure and its flexibility in responding
to changing conditions throughout the family life cycle help govern the appearance of
functional or dysfunctional patterns. Minuchin (1984) views families as going through
their life cycles seeking to maintain a delicate balance between stability and change. The
more functional the family, Minuchin suggests, the more open to change and structure
modification during periods of family transition, as new conditions demand.
The primary role of structural therapists is the facilitation of organizational
changes in the dysfunctional family, assuming that individual behavioral changes and
symptom reduction will follow as the context for the family’s transactions changes.
When the family’s structure is transformed, the positions of its members are altered, and
each person experiences change.
As a proactive agent of change, the therapist employs a dynamic and inclusive
approach that actively engages the entire family system in the therapeutic process. Rather
than focusing solely on individual clients, the therapist recognizes the interconnectedness
of family dynamics and the role that each member plays in shaping relational patterns and
behaviors. By introducing carefully crafted challenges that prompt adaptive changes, the
therapist creates opportunities for growth, learning, and transformation within the family
unit.
The introduction of challenges serves as a catalyst for change, prompting family
members to confront existing patterns of interaction and communication that may
contribute to relational distress or dysfunction. These challenges may take various forms,
such as structured exercises, role-playing scenarios, or experiential activities designed to
stimulate reflection, insight, and behavioral experimentation. By presenting challenges in
a supportive and non-threatening manner, the therapist empowers family members to
explore new ways of relating to one another and to confront underlying issues that may
be contributing to conflict or dissatisfaction within the family system.
Throughout the therapeutic process, the therapist serves as a supportive guide and
coach, providing encouragement, feedback, and guidance to family members as they
navigate the complexities of change. This coaching role involves fostering a collaborative
and empowering environment in which family members feel empowered to take
ownership of their own growth and development. The therapist offers validation and
affirmation of each family member's strengths and contributions, while also gently
challenging unhelpful patterns of behavior and communication.
Moreover, the therapist adopts a strengths-based approach that highlights the
resilience and resourcefulness of the family system, even in the face of adversity or
conflict. By emphasizing the inherent strengths and capabilities of each family member,
the therapist fosters a sense of hope and optimism that change is possible. This strengths-
based perspective encourages family members to draw upon their own internal resources
and external supports as they navigate the challenges and opportunities presented in
therapy.
In addition to supporting individual family members, the therapist also facilitates
collective problem-solving and collaboration within the family system. By fostering open
dialogue, active listening, and empathy, the therapist creates a space for family members
to express their thoughts, feelings, and needs in a constructive and non-judgmental
manner. Through collaborative problem-solving, family members can identify shared
goals, develop action plans, and implement strategies for addressing challenges and
achieving desired outcomes.
In summary, as an instrument of change, the therapist actively engages the whole
family in the therapeutic process, introducing challenges that prompt adaptive changes
and supporting and coaching family members as they navigate the complexities of
change. By fostering a collaborative and strengths-based approach, the therapist
empowers family members to confront issues, build resilience, and cultivate healthier
patterns of interaction and communication within the family system. Through this
collaborative and empowering process, families can achieve greater cohesion, resilience,
and well-being.
Raised in Argentina of European immigrant parents, Salvador Minuchin practiced
pediatrics following his medical training. When Israel declared itself a state in 1948,
Minuchin, guided by his sense of social purpose, volunteered his services to Israel as an
army doctor for 18/months. After subsequent training as a child psychiatrist in the United
States, partly under the tutelage of Nathan Ackerman, Minuchin returned to Israel in
1952 to work with children displaced from the Holocaust and with Jewish immigrants to
Israel.
In 1954 Minuchin returned to the United States to begin psychoanalytic training at
the William Alanson White Institute (where Sullivan’s interpersonal psychiatry ideas
held sway), eventually becoming the intake psychiatrist at the Wiltwyck School, a
residential school for delinquent adolescents outside New York City. Inspired by an
article by Don Jackson in 1959, Minuchin began to look beyond the individual children
to examine and analyze their family predicaments. He worked primarily with low-income
African-American and Puerto Rican adolescents from New York’s inner city. Minuchin
and his therapeutic team began developing a theory and a special set of intervention
techniques in response to the multiple problems arising from the disconnected and
underorganized structures of the families they encountered. Increasingly, he turned to a
sociological analysis of social context—how the experience of living in poverty affected
family functioning.
Minuchin and his colleagues revolutionized the field of family therapy by
pioneering therapeutic approaches that focused on transforming the family context, rather
than solely addressing individual personality traits or behavioral problems. Their
innovative techniques and interventions emphasized the interconnectedness of family
systems and the profound influence of family dynamics on individual well-being and
functioning. By targeting the underlying structures and patterns of interaction within the
family unit, Minuchin and his coworkers sought to bring about meaningful and lasting
change that would promote healthier relationships and more adaptive ways of
functioning.
Central to Minuchin's approach was the concept of family structure, which refers
to the organization of roles, boundaries, and power dynamics within the family system.
Minuchin observed that dysfunctional family structures often contributed to the
development and maintenance of psychological symptoms and interpersonal conflicts
among family members. Rather than viewing these symptoms as isolated problems to be
treated individually, Minuchin recognized them as manifestations of underlying systemic
issues that needed to be addressed within the context of the family as a whole.
To address these systemic issues, Minuchin and his colleagues developed a range
of therapeutic techniques and interventions designed to restructure dysfunctional family
patterns and promote healthier modes of interaction. These techniques included boundary
setting, reframing, enactment, and sculpting, among others. Through these interventions,
therapists were able to challenge rigid boundaries, clarify roles and responsibilities, and
facilitate open communication and problem-solving within the family system. By actively
engaging family members in the therapeutic process and encouraging their participation
and collaboration, therapists were able to foster greater self-awareness, empathy, and
understanding among family members, leading to more harmonious and adaptive
relationships.
In addition to restructuring family dynamics, Minuchin emphasized the
importance of creating a therapeutic alliance characterized by warmth, empathy, and
collaboration. He believed that the therapist's role was not to impose solutions or dictate
outcomes, but rather to facilitate a process of exploration and discovery in which families
could uncover their own strengths, resources, and solutions to their problems. By
adopting a non-pathologizing stance and reframing problems as opportunities for growth
and change, therapists were able to empower families to take ownership of their own
healing journey and to develop greater resilience and self-efficacy.
Furthermore, Minuchin's approach was informed by a deep appreciation for
cultural diversity and the unique strengths and challenges faced by families from different
cultural backgrounds. He recognized that cultural factors, such as values, beliefs, and
traditions, profoundly shape family dynamics and influence the therapeutic process. As
such, Minuchin advocated for a culturally sensitive and responsive approach to therapy
that honored and respected the cultural identities and experiences of all clients.
In summary, Minuchin and his coworkers revolutionized the field of family
therapy by developing therapeutic approaches that focused on changing the family
context rather than individual personality or behavioral problems. Their innovative
techniques and interventions emphasized the interconnectedness of family systems and
the importance of restructuring dysfunctional patterns of interaction. By fostering a
collaborative and culturally sensitive therapeutic environment, Minuchin's approach
empowered families to create positive change and cultivate healthier relationships that
would endure beyond the therapy room.
Finding that long-term, interpretive psychoanalytic techniques were ineffective
with this population, Minuchin and associates devised many brief, direct, concrete,
action-oriented, and problem-solving interventions to effect context change by
restructuring the family. (Nathan Ackerman’s influences regarding interlocking
pathology and his provocative, charismatic presence with families are clear here.)
Minuchin’s 8 years at Wiltwyck, during which he developed many highly original and
action-oriented techniques for working with disadvantaged families, were described in
Families of the Slums and earned Minuchin widespread recognition (Simon, 1984).
The groundbreaking work of Wiltwyck School for Boys laid the cornerstone for
the development of structural family therapy by emphasizing the importance of family
reorganization and establishing effective hierarchies among family members. Wiltwyck's
pioneering approach recognized that the dynamics within a family system played a
crucial role in shaping the behavior and well-being of individual family members,
particularly children and adolescents. By focusing on restructuring family interactions
and establishing clear boundaries and roles, Wiltwyck sought to address underlying
systemic issues and promote healthier patterns of functioning within the family unit.
At the heart of Wiltwyck's approach was the concept of family hierarchy, which
refers to the distribution of power, authority, and responsibility among family members.
Wiltwyck observed that dysfunctional families often lacked clear hierarchies, leading to
confusion, conflict, and power struggles among family members. To address this issue,
Wiltwyck therapists worked collaboratively with families to establish clear roles and
boundaries, ensuring that parents assumed their rightful roles as leaders and decision-
makers within the family system, while children were encouraged to respect parental
authority and contribute to the family in age-appropriate ways.
In addition to establishing effective hierarchies, Wiltwyck focused on
reorganizing family dynamics to promote cohesion, communication, and mutual support
among family members. This involved identifying and addressing maladaptive patterns
of interaction, such as enmeshment, disengagement, or triangulation, that contributed to
relational difficulties and emotional distress within the family system. Through a process
of exploration, insight, and intervention, Wiltwyck therapists helped families develop
more adaptive ways of relating to one another, fostering greater empathy, understanding,
and connection.
Furthermore, Wiltwyck's approach to family therapy was characterized by a
strengths-based perspective that recognized the resilience and resourcefulness of families,
even in the face of adversity. Rather than pathologizing individual family members or
blaming parents for their children's problems, Wiltwyck therapists adopted a non-blaming
stance that emphasized the importance of collaboration, empathy, and empowerment
within the therapeutic relationship. By acknowledging families' inherent strengths and
capabilities, Wiltwyck therapists were able to create a supportive and affirming
environment that facilitated positive change and growth.
Moreover, Wiltwyck's work was instrumental in highlighting the systemic nature
of family dysfunction and the need for comprehensive interventions that address the
underlying dynamics within the family system. By focusing on family reorganization and
hierarchy, Wiltwyck paved the way for the development of structural family therapy,
which builds upon these foundational principles to promote systemic change and enhance
family functioning. Today, structural family therapy remains an influential approach to
family therapy, providing a framework for understanding and addressing the complex
interplay of relationships, roles, and boundaries within families.
In summary, the Wiltwyck School for Boys played a pivotal role in shaping the
field of family therapy by emphasizing the importance of family reorganization and
effective hierarchy among family members. Their innovative approach laid the
groundwork for the development of structural family therapy, which continues to inform
contemporary therapeutic practice and contribute to positive outcomes for families facing
a wide range of challenges.
In 1965, wanting to test his techniques with a wider cross-section of families,
including both working-class and middle-class populations, Minuchin took on the
directorship of the Philadelphia Child Guidance Center. To assist with training, he
brought along social worker Braulio Montalvo from Wiltwyck and recruited Jay Haley
from Palo Alto. Originally a small clinic with a staff of 10 serving the African-American
population, the Philadelphia Child Guidance Clinic blossomed under Minuchin’s boldly
imaginative leadership as it grew into the largest facility of its kind ever established, with
an elaborate modern complex, close to 300/people on its staff, and affiliation with
Children’s Hospital on the campus of the University of Pennsylvania.
The establishment of the Wiltwyck School for Boys marked a significant
milestone in the field of family therapy as it became the first clinic in the United States to
predominantly serve poor urban families. This groundbreaking initiative recognized the
need for accessible mental health services tailored to the unique needs and challenges
faced by underserved communities, particularly those living in urban areas. By
prioritizing the well-being of low-income families, Wiltwyck sought to address systemic
inequalities and promote social justice within the mental health field.
Throughout its history, Wiltwyck played a pioneering role in advancing the field
of family therapy, thanks in part to the contributions of Salvador Minuchin. In 1974,
Minuchin published the influential book "Families and Family Therapy," which served as
a seminal text in the field of structural family therapy. This comprehensive work
provided an in-depth exploration of Minuchin's ideas and techniques for promoting
change within families through a structural lens.
Minuchin's approach to family therapy emphasized the importance of
understanding and addressing the underlying structure of family dynamics, rather than
focusing solely on individual symptoms or behaviors. Drawing on principles from
systems theory and cybernetics, Minuchin conceptualized families as complex,
interconnected systems characterized by patterns of interaction, communication, and
power dynamics. By identifying and restructuring these patterns, therapists could
facilitate positive change and promote healthier functioning within the family unit.
In "Families and Family Therapy," Minuchin elaborated on a range of therapeutic
techniques and interventions designed to reorganize family structures and promote more
adaptive ways of relating. These techniques included boundary setting, reframing,
enactments, and sculpting, among others. Through a combination of education,
exploration, and intervention, therapists could help families develop greater clarity,
cohesion, and resilience in the face of challenges.
Moreover, Minuchin's work underscored the importance of cultural sensitivity
and responsiveness in family therapy, recognizing the diverse backgrounds and
experiences of clients served by Wiltwyck and other clinics. He advocated for an
inclusive approach to therapy that honored and respected the cultural identities and values
of all families, while also challenging oppressive or dysfunctional patterns that may exist
within cultural contexts.
In addition to his contributions to clinical practice, Minuchin played a pivotal role
in shaping the training and education of future family therapists through his work as a
teacher, supervisor, and mentor. His influence extended beyond the walls of Wiltwyck to
impact the broader field of family therapy, inspiring generations of clinicians to adopt a
systemic perspective and embrace the principles of structural family therapy in their
work.
In summary, the establishment of the Wiltwyck School for Boys and the
publication of "Families and Family Therapy" by Salvador Minuchin represented
significant milestones in the evolution of family therapy. Through their innovative
approaches and groundbreaking contributions, Wiltwyck and Minuchin helped to
redefine the field of family therapy and advance the cause of social justice within mental
health care. Their legacies continue to inspire and inform contemporary approaches to
working with families, particularly those from underserved communities.
After stepping down as director of the Philadelphia Child Guidance Center in
1975 and as director of training there in 1981, Minuchin spent most of his professional
time teaching, consulting, supervising, writing, and demonstrating his dramatic
techniques in front of professional audiences around the world. In 1981, he founded and,
until 1996, led a small institute called Family Studies (now renamed the Minuchin Center
for the Family) in New York City, offering consultative services to community
organizations, particularly those dealing with poor families (Minuchin, Colapinto, &
Minuchin, 2007). Minuchin has now retired to Florida but continues to lecture around the
world.
Over the years, Minuchin surrounded himself with clinicians from various
disciplines who themselves have contributed significantly to shaping structural family
theory and therapy. Psychiatrist Charles Fishman (1993), social worker Harry Aponte
(2009), and psychologist Marion Lindblad-Goldberg (Lindblad-Goldberg, Dore, & Stern,
1998), all of Philadelphia, have contributed to advancing the structural viewpoint through
offering family therapy training, typically with economically needy families.
Marianne Walters, a social worker in Washington, DC, is best known for the
groundbreaking work she and her associates (Walters, Carter, Papp, & Silverstein, 1988)
produced as part of the long-running Women’s Project, employing the lens of gender to
examine family relationships. Psychiatrist Jorge Colapinto (2000) is Coordinator of
Training and Consultation at the Minuchin Center. The original Philadelphia Child
Guidance Center, having trained thousands of family therapists, closed a decade ago and
has been replaced by a more modest Philadelphia Child and Family Guidance Training
Center, still structurally oriented, under Lindblad-Goldberg’s direction.
At the Philadelphia Child Guidance Clinic, Minuchin turned his attention to the
role of family context in psychosomatic conditions, especially such urgent medical
problems as diabetes and anorexia. More specifically, no medical explanations could be
found for the unusually large number of diabetic children who required emergency
hospitalization for acidosis (a depletion of alkali in the body), nor would they respond to
individual psychotherapy directed at helping them deal with stress. As Minuchin and his
coworkers began to accumulate research and clinical data and to redefine the problem in
family terms, successful interventions involving the entire family became possible.
As Salvador Minuchin's pioneering work in family therapy continued to evolve,
he expanded his research to include a broader range of clinical populations, shedding
light on the intricate interplay between family dynamics and individual pathology.
Building upon his earlier insights, Minuchin sought to explore how family systems
influenced the manifestation and maintenance of various health conditions, including
severe asthma and anorexia nervosa.
The inclusion of asthmatic children with severe, recurrent attacks and anorectic
children in Minuchin's research represented a significant expansion of his clinical focus,
reflecting his commitment to understanding the systemic nature of psychological and
physiological health. By examining these diverse clinical populations, Minuchin aimed to
elucidate the underlying patterns and dynamics within family systems that contributed to
the development and exacerbation of illness.
Through rigorous observation, assessment, and intervention, Minuchin and his
colleagues uncovered compelling evidence that supported their hypothesis: the locus of
pathology was not solely within the afflicted individual but was intricately intertwined
with the family context. In the case of asthmatic children, for example, Minuchin
observed how patterns of overprotection, enmeshment, and parental conflict could
contribute to heightened stress and anxiety in the child, exacerbating the frequency and
severity of asthma attacks. Similarly, in families with anorectic children, Minuchin
identified maladaptive patterns of communication, control, and boundary disturbances
that perpetuated disordered eating behaviors and undermined the child's sense of
autonomy and agency.
These findings underscored the fundamental principle of systemic family therapy:
that individual symptoms and behaviors are often manifestations of underlying relational
dynamics within the family system. Rather than viewing illness as solely a product of
biological or psychological factors, Minuchin advocated for a holistic approach that
considered the family as a dynamic, interconnected unit. By addressing dysfunctional
patterns and promoting healthier modes of interaction within the family, therapists could
alleviate symptoms, restore balance, and facilitate healing for the individual and the
family as a whole.
Moreover, Minuchin's research highlighted the importance of a multidisciplinary
approach to understanding and treating complex health conditions. By collaborating with
medical professionals, psychologists, and other experts, Minuchin was able to integrate
insights from multiple disciplines and develop comprehensive treatment plans that
addressed the biopsychosocial needs of the individual and their family. This
interdisciplinary approach underscored the interconnectedness of physical, emotional,
and relational health and underscored the importance of addressing all aspects of the
individual's well-being in the therapeutic process.
In summary, Minuchin's research with asthmatic and anorectic children
exemplified his commitment to understanding the systemic nature of illness and the
pivotal role of family dynamics in shaping individual health outcomes. By expanding his
clinical focus and collaborating across disciplines, Minuchin advanced our understanding
of the complex interplay between family systems and pathology, laying the groundwork
for more holistic and effective approaches to treatment in family therapy and beyond.
As noted in Psychosomatic Families (Minuchin, Rosman, & Baker, 1978),
families of children who manifest severe psychosomatic symptoms are characterized by
transactional problems that encourage somatization. Enmeshment is common, subsystems
function poorly, and boundaries between family members are too diffuse to allow
individual autonomy. A/psychosomatic family was found to be overprotective, inhibiting
the child from developing a sense of independence, competence, or interest in activities
outside the safety of the family. The physiologically vulnerable child, in turn, feels great
responsibility for protecting the family. The manifestation of symptoms typically occurs
when stress overloads the family’s already dysfunctional coping mechanisms.
In Salvador Minuchin's systemic approach to family therapy, symptoms are
viewed not only as individual expressions of distress but also as indicators of underlying
dynamics within the family system. According to this perspective, symptoms serve a
regulatory function within the family, often arising in response to unresolved conflicts or
dysfunctional patterns of interaction. The sick child, for example, may inadvertently
become a focal point for family attention, diverting attention away from more deeply
rooted but less easily addressed conflicts among family members.
By examining the role of symptoms within the family system, therapists can gain
valuable insights into the relational dynamics that contribute to the maintenance of illness
and dysfunction. In the case of the sick child, for instance, symptoms such as asthma
attacks or anorexic behaviors may serve as a means of expressing distress or seeking
validation within the family context. By drawing attention to the child's illness, the family
may temporarily unite in their efforts to care for and support the sick child, thereby
avoiding or minimizing conflict in other areas of their relationships.
However, while symptoms may serve a temporary function in regulating family
dynamics, they often perpetuate a cycle of dysfunction and exacerbate underlying issues
over time. For example, the sick child may become trapped in a role of perpetual
victimhood, receiving attention and validation only when they are unwell, while the
underlying conflicts within the family remain unaddressed. Similarly, the family may
become enmeshed in a pattern of overprotection or codependency, sacrificing individual
autonomy and healthy boundaries in their efforts to care for the sick child.
In therapy, the goal is to help families recognize and address the underlying
dynamics that contribute to the maintenance of symptoms and dysfunction. Therapists
work collaboratively with families to identify maladaptive patterns of interaction,
challenge rigid roles and boundaries, and promote healthier modes of communication and
problem-solving. By fostering greater awareness and insight into the relational dynamics
at play, therapists empower families to break free from dysfunctional patterns and
cultivate more adaptive ways of relating.
Moreover, therapists may also work with families to develop strategies for
managing symptoms and promoting the individual well-being of the sick child. This may
involve implementing practical interventions to alleviate symptoms, such as medication
management or lifestyle changes, as well as providing emotional support and validation
to the child within the context of the family system. By addressing both the symptoms
and the underlying relational dynamics, therapists can facilitate holistic healing and
promote greater harmony and resilience within the family unit.
In summary, Minuchin's systemic approach to family therapy highlights the
intricate interplay between symptoms and family dynamics, with symptoms often serving
as a means of regulating relational tensions within the family system. By recognizing the
underlying function of symptoms and addressing the relational dynamics that contribute
to their maintenance, therapists can help families break free from dysfunctional patterns
and cultivate healthier, more adaptive ways of relating and coping.
Unlike the underorganized, often single-parent, family population at Wiltwyck, at
the Philadelphia Child Guidance Center, there were primarily middle-class, intact
families that often appeared to be too tightly organized. Interventions had to be modified
to first destructure the family’s rigid patterns and then restructure them to permit greater
flexibility. Therapeutic efforts were directed at changing the structure of relationships
within the family, helping the family develop clearer boundaries, learning to negotiate for
desired changes, and dealing more directly with hidden, underlying conflicts.
Colapinto's (1991) observation regarding the success of the Minuchin team in
treating anorexia nervosa underscores the profound impact of their structural family
therapy approach on the field of family therapy. Unlike physical ailments such as
diabetes or asthma, which have clear physiological bases, anorexia nervosa is a complex
and multifaceted disorder with psychological, social, and cultural dimensions. The fact
that the Minuchin team achieved significant success in treating anorexia nervosa through
their family-focused approach challenged conventional wisdom and drew widespread
attention to the potential efficacy of the structural model in addressing a wide range of
mental health issues.
The success of the Minuchin team in treating anorexia nervosa can be attributed
to several key factors inherent in the structural family therapy approach. Firstly, by
conceptualizing anorexia nervosa as a family system issue rather than solely an individual
problem, therapists were able to target underlying relational dynamics and interpersonal
patterns that contributed to the maintenance of the disorder. This systemic perspective
enabled therapists to identify and address dysfunctional family interactions, boundaries,
and power dynamics that perpetuated the illness and hindered recovery.
Secondly, the structural model's emphasis on restructuring family systems and
establishing clear roles and boundaries proved particularly effective in challenging the
maladaptive patterns of interaction often observed in families of individuals with
anorexia nervosa. Therapists worked collaboratively with families to promote healthy
communication, cooperation, and problem-solving, thereby fostering greater cohesion
and resilience within the family unit. By empowering families to adopt more adaptive
ways of relating, therapists facilitated lasting change and recovery for individuals
struggling with anorexia nervosa.
Furthermore, the success of the Minuchin team in treating anorexia nervosa
highlighted the importance of a multidisciplinary approach to mental health care. In
addition to family therapy, individuals with anorexia nervosa often require
comprehensive treatment that may include nutritional counseling, medical monitoring,
individual therapy, and support from a multidisciplinary team of healthcare professionals.
By collaborating with other specialists, such as dietitians, physicians, and psychiatrists,
therapists were able to address the diverse needs of individuals with anorexia nervosa and
provide holistic, integrated care that supported their recovery journey.
The impact of the Minuchin team's success in treating anorexia nervosa extended
far beyond the realm of family therapy, drawing many practitioners to the structural
model and inspiring further research and innovation in the field. Therapists were
intrigued by the model's ability to achieve meaningful outcomes in the treatment of a
notoriously challenging disorder, and they sought to incorporate its principles and
techniques into their own clinical practice. As a result, the structural model gained
widespread recognition and acceptance within the field of family therapy, cementing its
status as a leading approach to addressing complex family issues and mental health
concerns.
In summary, Colapinto's (1991) observations underscore the transformative
impact of the Minuchin team's success in treating anorexia nervosa on the field of family
therapy. By demonstrating the efficacy of the structural model in addressing a range of
mental health issues, including those with no clear physiological basis, the Minuchin
team inspired a new wave of interest and enthusiasm for the systemic approach to family
therapy, paving the way for further advancements and innovation in the field.
b. Structural Family Theory
Like most systems theorists, structuralists are interested in how the components of
a system interact, how balance or homeostasis is achieved, how family feedback
mechanisms operate, how dysfunctional communication patterns develop, and so forth.
Consistent with Minuchin’s background in child psychiatry, he influenced his associates
to observe too how families cope with developmental tasks and make adaptive changes
during periods of transition. Structuralists pay attention to family transactional patterns
because these offer clues to the family’s structure, the permeability of the family’s
subsystem boundaries, and the existence of alignments or coalitions—all of which
ultimately affect the family’s ability to achieve a delicate balance between stability and
change. Before an individual’s symptoms can be reduced or extinguished, according to
this model, structural changes must first occur within the family.
Families need some form of internal organization that dictates how, when, and to
whom to relate. The subsequent transactional patterns make up the structure of the family
(Colapinto, 1991). Put another way, a family’s structure is the covert set of functional
demands or codes that organizes the way family members interact with one another
(Minuchin, 1974). The structure represents the sum of the operational rules the family has
evolved for carrying out its important functions. It provides a framework for
understanding those consistent, repetitive, and enduring patterns that reveal how a
particular family organizes itself in order to maintain its stability or, under new
conditions, to seek adaptive alternatives. Once established, such patterns are self-
perpetuating and resistant to change until changing circumstances cause tensions and
imbalance within the system.
The example provided illustrates a common pattern within family dynamics
wherein certain roles and power dynamics become established over time through
repeated interactions and reinforcement. This interactive routine involving the young
son's compliance with his father's requests but defiance towards his mother's pleading can
have far-reaching implications for the overall family structure and relational dynamics.
As this pattern persists and recurs across various situations, it can contribute to the
emergence of a basic family structure wherein the father is perceived as the ultimate
authority figure, while the mother's authority or influence is diminished or undermined.
This dynamic may not only impact the parent-child relationship but can also influence
how other family members perceive and interact with each other.
In addition to the direct impact on family relationships, this pattern may also have
broader implications for the individual development and well-being of family members.
For example, the young son's consistent obedience to his father's requests while
disregarding his mother's pleas may shape his understanding of gender roles and power
dynamics within relationships. He may internalize the belief that authority and respect are
inherently tied to masculinity, while femininity is associated with weakness or
ineffectiveness.
Furthermore, this dynamic can perpetuate unequal distribution of power and
responsibility within the family, reinforcing traditional gender roles and expectations.
The mother may feel marginalized or disempowered, leading to feelings of frustration,
resentment, or inadequacy. Meanwhile, the father may inadvertently assume a
disproportionate share of authority and decision-making, potentially contributing to
feelings of pressure or isolation.
Addressing and modifying entrenched family dynamics such as these requires a
systematic and collaborative approach that involves all family members. Family therapy
provides a valuable space for exploring underlying beliefs, communication patterns, and
relational dynamics that contribute to the maintenance of these patterns. By fostering
open dialogue, empathy, and understanding, therapists can help family members identify
and challenge unhelpful patterns of interaction, and develop more balanced and mutually
respectful relationships.
Moreover, interventions aimed at redistributing power and fostering equitable
relationships within the family can promote greater harmony, cohesion, and well-being
for all family members. This may involve setting clear boundaries, encouraging open
communication, and promoting shared decision-making and responsibility. Through a
process of exploration, reflection, and change, families can work towards creating a
healthier and more supportive family environment that nurtures the growth and
development of all its members.
In summary, the example provided offers valuable insights into the ways in which
interactive routines within families can shape relational dynamics and family structures
over time. By understanding and addressing these patterns, families can cultivate more
balanced, respectful, and fulfilling relationships that support the well-being and
development of all family members.
Subsequent transactional patterns are likely to reflect this now-established
blueprint, combining into more or less constant relationships (Umbarger, 1983) and
regulating the family’s day-to-day functioning. However, structure is not static or fixed.
On the contrary, certain temporary structures (a mother–son coalition in which the father
is kept in the dark, say, about erratic school attendance or a bad grade) may occur but not
persist beyond a brief arrangement and thus must be considered to be dynamic. The
structural therapist watches for repeatable family processes in action during therapy
sessions in order to detect problematic or ineffective patterns that need restructuring.
Family therapists, drawing from the insights of Salvador Minuchin (1974),
recognize that a family's transactional patterns play a crucial role in shaping the behavior
and interactions of its members. These patterns are governed by a complex interplay of
generic or universal rules, which are shared across cultures and societies, and
idiosyncratic or individualized rules, which are specific to each family's unique dynamics
and history.
Universal rules represent overarching principles or norms that are commonly
accepted across societies and cultures. For example, one such universal rule identified by
structural family therapists is the hierarchical organization of well-functioning families.
According to this rule, parents typically exercise greater authority and power within the
family unit, while children are expected to defer to parental guidance and direction.
Moreover, within sibling relationships, older children often assume greater
responsibilities and enjoy additional privileges compared to their younger siblings. This
hierarchical structure serves as a foundation for maintaining order, stability, and cohesion
within the family system, providing a framework for decision-making, conflict
resolution, and socialization.
However, alongside these universal rules, families also operate according to
idiosyncratic rules that reflect their unique history, values, and dynamics. These
idiosyncratic rules may emerge in response to specific family experiences, challenges, or
cultural influences, and they shape the ways in which family members interact and relate
to one another. For example, a family may develop rules or norms around
communication, conflict resolution, or emotional expression that are distinct from those
of other families. These idiosyncratic rules contribute to the family's identity and
functioning, influencing patterns of behavior, roles, and relationships among family
members.
In addition to these sets of rules, family therapists also recognize the role of
boundaries in regulating family transactions. Boundaries define the limits and distinctions
between individual family members, subsystems within the family, and the family system
and its external environment. Healthy boundaries promote autonomy, self-expression,
and individuation, while also facilitating connection, intimacy, and mutual support within
the family. However, dysfunctional boundaries, such as enmeshment or disengagement,
can lead to relational difficulties, emotional distress, and conflict within the family
system.
In therapy, the exploration of family transactional patterns, rules, and boundaries
provides valuable insights into the underlying dynamics that contribute to family
functioning and dysfunction. Therapists work collaboratively with families to identify
and challenge unhelpful patterns, promote healthier modes of interaction, and strengthen
relational bonds. By fostering greater awareness and understanding of these dynamics,
families can cultivate more adaptive ways of relating and navigate challenges with
greater resilience and cohesion.
In addition, complementarity of functions is universal—the husband and wife, for
example, operate as a team and accept their interdependency. The degree to which the
needs and abilities of both spouses dovetail and reciprocal role relations provide
satisfaction are key factors in harmonious family functioning. In some cases, family
balance is achieved by family members being assigned complementary roles or functions
(good child–bad child; tender mother–tough father). Complementarity takes the form of
teamwork in wellfunctioning families. Idiosyncratic constraints apply to specific families
and involve mutual presumptions regarding family member behavior toward one another.
While the origin of certain expectations may no longer be clear, buried in years of
implicit and explicit negotiations, their pattern of mutual accommodation and functional
effectiveness is maintained.
Some feminists take exception to Minuchin’s insistence on family hierarchies,
claiming that they run the risk of reinforcing sex-role stereotypes. Luepnitz (1988) argues
that Minuchin bases many of his ideas regarding family organization on the work of the
influential functional sociologist Talcott Parsons (Parsons & Bales, 1955), who saw
normal family life neatly organized according to gender roles, family functions, and
hierarchical power. Parsons maintained that adaptation to society requires that husbands
perform an “instrumental” role (e.g., making managerial decisions) in the family and that
wives perform “expressive” roles (caring for the family’s emotional needs). Hare-Mustin,
as quoted by Simon (1984), believes Minuchin himself models the male executive
functions while working with families, in effect demanding that the father resume control
of the family and exert leadership much as Minuchin leads and directs the therapeutic
session.
Colapinto (1991) contends that Minuchin does not hold the stereotypic division of
instrumental versus expressive as an ideal but rather believes all families need some kind
of structure, some form of hierarchy, and some differentiation between subsystems. A
family will try to maintain preferred patterns—its present structure—as long as possible.
While alternate patterns may be considered, any deviation from established rules that
goes too far too fast will be met with resistance as the family seeks to reestablish
equilibrium. On the other hand, the family must be able to adapt to changing
circumstances (a child grows into a young adult; mother goes to work outside the home;
grandmother comes to live with them). It must have a sufficient range of patterns
(including alternatives to call upon whenever necessary) and must be flexible enough to
mobilize these new patterns in the face of impending change if members are to continue
as a family.
As we pointed, families organize themselves into coexisting subsystems, often
arranged in hierarchical order. Typically, subsystem divisions are made according to
gender (male/female), generation (parents/children), common interests
(intellectual/social), or function (who is responsible for what chores). Other possibilities
(older children vs. younger; parents vs. teenagers) spring up in most families. All families
contain a number of coexisting but separate subsystems. Subsystems are components of a
family’s structure. They exist to carry out various family tasks necessary for the
functioning of the overall family system. Each member may belong to several subgroups
at the same time, and families are capable of organizing themselves into a limitless
number of such units. Each person may have a differing level of power within different
subgroups, may play different roles, may exercise different skills, and may engage in
different interactions with members of other subsystems within the family.
Complementarity of roles (Ackerman’s influence again) is a key here—as Minuchin
(1974) points out, a child has to act like a son so his father can act like a father, but he
may take on executive powers when he is alone with his younger brother.
Subsystems are defined by interpersonal boundaries and rules for membership; in
effect, they regulate the amount of contact with other subsystems. Such boundaries
determine who participates and what roles those participants will have in dealing with
one another and with outsiders who are not included in the subsystem. They may be
temporary alliances (mother and daughter go shopping together on Saturday afternoon)
and may have rules concerning exclusion (fathers and brothers are unwelcome). Or they
may be more enduring (based on generational differences in roles and interests between
parents and children), with clearly defined boundaries separating the two generations
(one watches public television documentaries, the other spends hours on Facebook and
Twitter). Subsystem organization within a family provides valuable training in
developing a sense of self in the process of honing interpersonal skills at different levels.
The spousal, parental, and sibling subsystems are the most prominent and important
subsystems in the family. The strength and durability of the spousal subsystem in
particular offers a key regarding family stability. How spouses learn to negotiate
differences and accommodate to one another’s needs and develop complementary roles
impacts the likelihood of family stability and flexibility to adapt to changing
circumstances.
While the arrival of children forces the couple to transform their system to
become a parental subsystem grappling with new responsibilities, complementarity of
roles remains essential as the couple negotiates differences in parenting attitudes and
styles. Accommodations to one another’s perspectives are apt to be renegotiated as
children grow and require different parental responses at different stages of their lives. It
is crucial that, whatever the demands of child rearing and the evolution of an effective
parental subsystem, the parents work to maintain and strengthen their spousal subsystem,
which is fundamental to family well-being. The sibling subsystem offers the first
experience of being part of a peer group and learning to support, cooperate, and protect
(as well as compete, fight, and negotiate differences).
The sibling subsystem deals with the parental subsystem to work out relationship
changes commensurate with the developmental changes they are going through. In a
well-functioning family, all three subsystems operate in an integrated way to protect the
differentiation and integrity of the family system. When the integrated family structure is
flexible enough to meet ongoing family developmental challenges, we may consider the
family functional. When the family cannot adjust to changing circumstances, we consider
it dysfunctional. From the structural perspective, family dysfunction generally involves
boundary issues such as enmeshment, disengagement, alignments, power, and coalitions.
Rosenberg (1983) summarizes the structural position: “when a family runs into
difficulty, one can assume that it is operating within a dysfunctional structure” (p. 160).
This may happen when the family hits a snag entering a life cycle stage, such as the birth
of a child, children leaving for college, or retirement. Perhaps the family members have
become enmeshed, or, at the other end of the continuum, perhaps they are disengaged.
Dysfunction suggests that the covert rules that govern family transactions have become,
if only temporarily, ineffective and require renegotiation.
In the Wiltwyck families (Minuchin et al., 1967), typically burdened by severe
external stressors brought about by poverty, five dysfunctional family structures were
differentiated: (a) enmeshed families, (b) disengaged families, (c) families with a
peripheral male, (d) families with noninvolved parents, and (e) families with juvenile
parents. A sense of feeling overwhelmed and helpless was common to these families,
often led by single mothers, who struggled to control or guide their delinquent children.
Just as the social context as stressor was apparent in the Wiltwyck population, so
the inadequate internal responses to stress—the other component of the dysfunctional
equation— played a key role for the Philadelphia working-class and middle-class
families suffering from psychosomatic disorders (Colapinto, 1991). Here the problem
stemmed from inflexibility, particularly the family’s inability to modify those
transactional patterns that had ceased to satisfy the needs of family members. For
example, a couple that negotiated a complementary relationship before the arrival of
children that did not allow for much open conflict failed to adapt readily to becoming
parents because there was conflict regarding the new roles of mother and father. Or
parents accustomed to dealing with young children were unable to adapt to growing
teenagers who now demanded more autonomy. Fear of departing from established
patterns led to rigid repetition of failed patterns.
Disengagement or enmeshment—avoiding contact with one another or continuous
bickering—are both directed at circumventing change, thus failing to achieve conflict
resolution. Overprotection of the sick child by the entire family helped cover up
underlying family conflicts and tended to discourage the development of a sense of
competence, maturity, or self-reliance on the part of the symptomatic child. Minuchin
(1974) reserves the label of pathological for those families who, when faced with a
stressful situation, increase the rigidity of their transactional patterns and boundaries, thus
preventing any further exploration of alternatives. Normal families, in contrast, preserve
family continuity and permit family restructuring.
The specific composition of a subsystem is not as important as the clarity of its
boundaries. Boundaries in a family vary in their permeability, and that degree of
accessibility helps determine the nature and frequency of contact between family
members. Clearly defined boundaries between subsystems help maintain separateness
and at the same time emphasize belongingness to the overall family system. In an ideal
arrangement, the clarity enhances the family’s overall well-being by providing support
and easy access for communication and negotiation between subsystems while
simultaneously encouraging independence and the freedom to experiment by the
members of the separate subsystems.
Excessively rigid or inflexible boundaries lead to impermeable barriers between
subsystems. In this case, the parents and children—the generational hierarchy—are
separate and distinct; the members of neither subsystem are willing or able to enter into
the other’s world. With parents and children unable to alter or cross subsystem
boundaries when necessary, autonomy may be maintained, but nurturance, involvement,
and the easy exchange of affection with one another are typically missing. While the
child in such a family may gain a sense of independence, it may come at the price of
feeling isolated from others and unsupported during critical times.
Diffuse boundaries are excessively blurred and indistinct, so easily intruded upon
by other family members. Here, parents are too accessible, and contact with their children
may take the form of hovering and the invasion of privacy. Children run the risk of
becoming too involved with their parents, in the process failing to develop independence
or to learn the skills for developing relationships outside the family. Because there is no
clear generational hierarchy, adults and children may exchange roles easily, and a
member’s sense of self or personal identity becomes hard to establish for later adulthood.
Here children may feel supported and cared for by parents, but it is often at the expense
of feeling free to take independent (and possibly disapproved-of) actions. In a well-
functioning family, clear boundaries give each member a sense of “I-ness” along with a
group sense of “we” or “us.”
Each member retains his or her individuality but not at the expense of losing the
feeling of belonging to a family. Most family systems fall somewhere along the
continuum between enmeshment (diffuse boundaries) and disengagement (rigid
boundaries; Minuchin et al., 1967), although they may contain enmeshed or disengaged
subsystems. Minuchin and Nichols (1993) describe a familiar if troubled family pattern in
which a disengaged father is preoccupied with work and neglectful of his wife and
children, and an enmeshed mother is overinvolved with her children, her closeness to
them serving as a substitute for closeness in the marriage.
Enmeshment refers to an extreme form of proximity and intensity in family
interactions in which members are overconcerned and overinvolved in each other’s lives.
The family’s lack of differentiation between subsystems makes separation from the
family an act of betrayal. Belonging to the family dominates all experiences at the
expense of each member’s self-development. Whatever is happening to one family
member reverberates throughout the system: a child sneezes, his sister runs for the
tissues, his mother reaches for the thermometer, and his father becomes anxious about
sickness in the family. Subsystem boundaries in enmeshed families are poorly
differentiated, weak, and easily crossed. Children may act like parents, and parental
control may be ineffective. Excessive togetherness leads to a lack of separateness;
members, overly alert and responsive to signs of distress, intrude on each other’s
thoughts and feelings. Members of enmeshed families place too high a value on family
cohesiveness, so they yield autonomy and have little inclination to explore and master
problems outside the safety of the family. As we indicated earlier, enmeshment is
common in psychosomatic families.
While boundaries are defined by how a family is organized, alignments are
defined by the way family members unite or oppose one another in carrying out a family
activity. Power in a family has to do with both authority (who is the decision maker) and
responsibility (who carries out the decision). Thus, alignments refer to the emotional or
psychological connections family members make with one another. Power, on the other
hand, speaks to the relative influence of each family member on an operation’s outcome.
Aponte and Van Deusin (1981) believe that every instance of a family transaction makes
a statement about boundaries, alignments, and power. As noted, the boundaries of a
subsystem are the rules defining who participates and what roles they will play in the
transactions or operations necessary to carry out a particular function. (For example,
should the sex education of young children be carried out by father, mother, older
siblings, or be a shared responsibility? Or should the task be left to the schools?)
Alignments refer to how supportive or unsupportive of one another the players are in
carrying out an operation. (For example, does father agree or disagree with his wife’s
disciplinary actions with the children?) Power is seldom absolute but is related to the
context or situation. (For example, the mother may have considerable influence on her
adolescent daughter’s behavior at home but minimal influence over the daughter’s social
contacts outside the home.) Power is also related to the way family members actively or
passively combine forces.
c. Structural Family Therapy
The structural approach has made two particularly noteworthy contributions to
family therapy practice, according to Aponte and DiCesare (2000): (a) demonstrating that
poor families, including those living in chaotic environments, can benefit from family
therapy, and (b) examining a family’s structure, including those families that have
become fragmented or underorganized, can be a powerful means for treating family
dysfunction. The model recognizes the influence of social factors in family functioning
and in working within the community’s larger systems.
Because structuralists view symptoms in a family member as emerging from and
being maintained by a family structure unable to adapt to changing environmental or
developmental demands, they reach their therapeutic goal when the family has
restructured itself and freed its members to relate to one another in nonpathological
patterns. Changing a family’s structure calls for changing its rules for dealing with one
another, and that in turn involves changing the system’s rigid or diffuse boundaries to
achieve greater boundary clarity.
Structural therapeutic efforts are geared to the present and are based on the
principle of action preceding understanding. The major therapeutic thrust of structural
family therapy is to actively and directly challenge the family’s patterns of interaction,
forcing the members to look beyond the symptoms of the identified patient to view all
their behavior in the context of family structures. They aim to help the family change its
stereotyped interactive patterns and redefine its relationships, aiding members to better
deal with the stresses in their lives (Colapinto, 2000). In a marital relationship, for
example, one partner’s behavior might be yoked to the other’s (Minuchin & Nichols,
1998). Their actions are codetermined and subject to reciprocal forces that support or
polarize the relationship. The structural therapist’s task is to disentangle the pair from
their automatic yoked reactions, helping each partner discover his or her individuality,
power, and responsibility. For example, changes in the relative positions of family
members may be in order, such as more proximity between husband and wife or more
distance between mother and son.
Hierarchical relationships in which the parents customarily exercise authority may
be redefined and made more flexible in some cases and reinforced in others. Alignments
and coalitions may be explored, embedded conflicts acknowledged, alternative rules
considered. To use an example offered by Colapinto (1982), a mother may be urged to
abstain from intervening automatically whenever the interaction between her husband
and son reaches a certain pitch, while father and son may be encouraged not to
automatically abort an argument just because it upsets Mom. For structuralists, the most
effective way to alter dysfunctional behavior and eliminate symptoms is to change the
family’s transactional patterns that maintain them.
In an attempt to help family members who may be suspicious or fearful of being
challenged or blamed to feel more comfortable, structuralists typically begin by adjusting
to the family’s affective style. With a constricted family, the therapist tries not to be too
demonstrative; with an expansive family, he or she is more open and uses expressive
movements. The therapist greets each member by name and encourages him or her to
participate but does not insist on a response or confront silent or resistant members. The
therapist shows respect for the family hierarchy by asking first for the parents’
observations. (If the children are addressed first, the parents may feel the therapist is
blaming them for family problems, and they will likely reject future therapist efforts as
biased.) Nonthreatening, friendly, ready to help without being pushy, the structural
therapist is at the same time adapting to the family organization, assimilating the family’s
language patterns, interactive style, and commonly used terms—and gaining a sense of
family patterns and structures.
As a therapist, Minuchin (1974) describes himself as acting like a distant relative,
joining a family system and respectfully accommodating to its style. As the therapist
begins to understand family themes and family myths, to sense a member’s pain at being
excluded or scapegoated, to distinguish which persons have open communication
pathways between them and which closed, he or she is beginning to obtain a picture of
the family hierarchical structure, subsystems operations, boundaries, coalitions, and so
on. Mimesis (Greek for “copy”) refers to the process of joining the family by imitating
the manner, style, affective range, or content of its communications in order to solidify
the therapeutic alliance with them. The therapist might tell of personal experiences (“I
have an uncle like that”) or mimic a family member’s behavior (taking off his coat,
sitting in a particular position, playing with the baby). These efforts are sometimes
spontaneous, sometimes planned; whatever the case, they often have the effect of
increasing kinship with the family and building trust as the therapist becomes part of the
system.
Joining lets the family know that the therapist, a nonpermanent but concerned
member, understands and is working with them in a common search for alternate ways of
dealing with family problems. In the process, the structural therapist is encouraging the
family to feel secure enough to explore other, more effective ways of interacting and
solving problems together. Acknowledging their areas of pain or stress, the therapist lets
family members know that he or she will respond to them with sensitivity and that it is
safe for them to confront the distressing previously avoided issues.
Assessment overlaps with joining the family. From the start, structuralists assess a
family by attending to its organizational structure and ongoing transaction patterns and by
noting the social context in which any dysfunctional behavior has manifested itself. Their
ultimate concerns in any family appraisal are the family’s hierarchical organization, the
ability of its subsystems to carry out their functions, the family’s possible alignments and
coalitions, the permeability of its current boundaries, and its pliability or rigidity in
meeting the needs of individual members as circumstances command. Structuralists focus
on how flexibly the family adapts to developmental changes as well as unexpected
situational crises and how readily and effectively family members join together to resolve
conflict.
The overall thrust of assessment, from the initial session onward, is to evaluate
the family’s ability to change obsolete or no-longer-workable interactive patterns into
ones more consistent with ongoing family development. But the major purpose of the
early assessment is to develop a road map for entering the family—adjusting to its
customary style of dealing with problems—and once inside, planning restructuring
interventions. Immediately—sometimes before meeting the family, based on intake form
information— the therapist forms hypotheses about the family’s structural arrangement.
One technique is to direct the family’s attention to the their current organization,
which they diagram in graphic form in order to map out relationship patterns within the
family. Just as Bowenian family systems therapists utilize genograms to chart family
relationships over generations, structuralists use family diagramming to depict a family’s
current transactional patterns. Structuralists use a simple pictorial device called a
structural map to formulate hypotheses about those areas in which the family functions
well and other areas in which dysfunction may be occurring. Family mapping helps
provide an organizing schema for understanding complex family interactive patterns—
especially which particular subsystem is involved in perpetuating a problem—and as
such may be invaluable in therapeutic planning.
Monitoring and helping modify troubled or problematic transaction patterns is the
crux of the structural intervention process. Once structuralists join the family, they begin
to probe the family structure, looking for areas of flexibility and possible change. For
example, a family has come for therapy because the teenage daughter is shy, withdrawn,
and has difficulties in her social life. The therapist may observe how the family enters the
therapy room: the girl sits next to her mother, and they move their two chairs close
together. When the therapist asks what the problem is, the mother answers, ignoring her
daughter’s attempts to add her thoughts on the matter. The mother makes comments that
suggest she has too intimate a knowledge of her adolescent daughter’s personal life—
more knowledge than is usual. Soon, the structural therapist makes the first intervention,
asking the mother and father to change chairs. Structural therapy has begun: As the father
is brought into the picture, the family flexibility is being tested; implying pathology in the
mother–daughter dyad, the family’s reason for seeking therapy for the teenager is already
being reframed or relabeled as a problem with a larger focus.
Two structural techniques are operating in this example. Boundary making
represents an effort to create greater psychological distance between the enmeshed
mother and daughter, and, by bringing the marginalized father closer, begins to modify
the family’s customary transactional patterns. The daughter, in turn, gains a greater
chance of developing more independence as the diffuse boundary with her mother begins
to be clarified. The strengthened parental subsystem increases the likelihood of greater
differentiation between parents and children in the family. At the same time, the therapist
is using the technique of unbalancing— attempting to change the hierarchical relationship
between members of the parental subsystem by having the father take on an expanded
role in the family. By seeming to side with the father, the therapist is upsetting the family
homeostasis and making an initial move to change preexisting family patterns by first
unbalancing and then realigning the system. In boundary making, then, the therapist tries
to change the distance between subsystems; in unbalancing, the goal is to change the
hierarchical relationships of the members of a subsystem.
Through tracking, the structural therapist adopts symbols of the family’s life
gathered from members’ communication (such as life themes, values, significant family
events) and deliberately uses them in conversation with the family. The therapist’s effort
to confirm that he or she values what family members say, without soliciting the
information, is also a way of influencing their later transactional patterns. Minuchin
(1974) calls this technique “leading by following.” Tracking a particular family theme
may also reveal clues to the family structure. For example, in working with an enmeshed
family, Minuchin noted the father’s statement that he disliked closed doors. Minuchin
discovered that the children were not permitted to close the doors of their rooms, that a
brother slept in his older sister’s room, and that the sex lives of the parents were curtailed
because their own bedroom door remained open. Later, Minuchin used the metaphor of
the doors to help the family clarify its boundaries. So tracking can be a restructuring
strategy.
An enactment is a staged effort by the therapist to bring an outside family conflict
into the session so that family members can demonstrate how they deal with it. The
therapist can observe the conflict sequence and begin mapping a way to modify the
members’ interaction and create structural changes. Using this technique, the therapist
has the players act out their dysfunctional transactions rather than simply describe them
(Colapinto, 2000). For example, Rosenberg (1983) recounts a mother complaining that
her 2-year-old daughter had tantrums and embarrassed her in front of grandparents, on
buses, and in other situations. The daughter remained well behaved during the early
sessions despite (or maybe because of) her mother’s insistence that she engaged in this
awful behavior away from the therapist. During the third or fourth session, when the child
asked for gum, Rosenberg saw his chance: He asked the mother not to give her daughter
the gum, because lunchtime was approaching.
As the child’s whimper turned to crying, to begging, and finally to falling on the
floor and undressing herself—and as the mother considered giving in—Rosenberg
encouraged the mother to hold firm despite the by-now deafening noise. More than a half
hour later, the child came to a whimpering stop. She seemed fine, although both mother
and therapist were exhausted. However, the mother had asserted her control during the
enactment, thus learning she could be competent and more resolute than she had
previously thought. From a structural viewpoint, the child’s problematic behavior was
redefined in transactional terms; the generational boundaries were reestablished; effective
alternative transactional patterns were introduced; the proper hierarchical order was put
into place (mother was again in charge); and the daughter, whose tantrums at home
ceased shortly thereafter, was comfortable in knowing that her mother could handle her.
Nichols and Fellenberg (2000) identified three phases of an enactment: initiation,
facilitation, and closing, each with numerous possible interventions. Further, they ask two
clinical questions: (1) what do therapists do to promote the effective use of enactments,
and (2) what do they do or fail to do that makes enactments ineffective? Their research
indicates that during a successful initiation phase, therapists direct the participants to talk;
therapists lean back in their chairs to “remove” themselves from the dialogue; they
specify the topic of conversation and physically position participants’ chairs to face each
other. Successful facilitation includes not interrupting the family members; encouraging
participants to talk with each other rather than to the therapist, and, when conversation
bogs down, to push the members to explain themselves more fully or to speak more about
what they are feeling. The therapist’s task during the closing phase is to help the clients
gain insight on how to profit from the experience. Their research indicates that successful
closings include explaining the problematic dynamic that took place, advising clients how
to continue to improve their communication, praising clients for expressing feelings and
listening well, and emphasizing the need for continued dialogue.
