Structural versus Strategic Family Therapy PDF

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Systems perspective on family counseling - structural versus strategic family therapy nuances...

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Structural Family Therapy- Minuchin A structural therapist strives to enter and join a family system to understand the invisible rules that govern functioning and to help the family as a catalyst for positive change Structural therapy works on altering the dysfunctional structure by promoting growth and encouragement in individuals for the building of family support. The structural theory asserts that changing the structure of a dysfunctional family will enable the family to interact in a positive manner and overcome the pressing issues. Structural family therapy assumes that problems and solutions develop on a series of hierarchal, subsystem, and architectural influences within the household that affect the behaviors of individual family members (Israelstam, 1988). A further assumption is that people interpret issues like social interactions as patterns of interaction that occur on a repetitive basis (McAdams et al., 2016). The dynamics of a family network or structure ranges from dysfunctional to supportive and based on the level of cohesiveness will either promote negative or positive household interactions (McAdams et al., 2016). The structural interpretation of problems versus solutions provides a systemic comprehension of the family unit as an operational network and provides insight into the routine functionality of both the family system and individual components. If the therapist determines a dysfunction in family operations, he or she assists the family in changing the issues to encourage more positive interactions (Israelstam, 1988; McAdams et al., 2016). The fundamental concepts of structural family therapy emphasize a systemic and organizational process where the therapist analyzes the family structure to determine how the household interactions maintain the dysfunction without identifying the solution (McAdams et al., 2016). A primary assumption of Minuchin is that a family network core function centers on functional expectations that establish individual interactions and affect household homeostasis (Issitt, 2013; Lindstrom, Filges, & Jorgensen, 2015). Besides the inner workings of the family itself, the therapist also reviews external social influences that potentially affect the dysfunctional behaviors in a negative manner. Another area of focus is subsystems intertwined with the primary system and hierarchal processes identified as potentially harmful influences, hence allowing the therapist to aid in modifying how individuals relate to one another and create a positive rebalance of the primary system (Issitt, 2013; McAdams et al., 2016). Minuchin’s goal is to promote a restructuring of the family system along more healthy lines, which he does by entering the various family subsystems, continually causing upheavals by intervening in ways that will produce unstable situations which require change and the restructuring of family organization. Applying unbalancing techniques, aiding individual family members to reframe perceptions, family mapping, joining with the family during sessions, and presenting the dysfunction as a metaphor are core intervention methods employed in structural family therapy (Nichols &

Tafuri, 2013). Applying these techniques, a therapist can diagnose the dysfunction and aid the family in restructuring, which allows the process to develop structure and improved esteem within both the individuals and family network (Nichols & Tafuri, 2013). For example, if a therapist is working with a family that has an addiction problem, he or she may choose to use a family structure map to analyze various coalitions to interpret the underlying cause of the addiction (McAdams et al., 2016; Nichols & Tafuri, 2013). The therapist, in this case, objectifies the addiction to detach it from the affected family member and realigns the spousal coalition to strengthen the family’s center of power to combat the influence of the dependency (Nichols & Tafuri, 2013). Therapeutic change cannot occur unless some pre-existing frames of reference are modified, flexibility introduced, and new ways of functioning developed. Goals of family structure are to alter the dynamics and provide new alternative ways in solving problems and interactions. This includes subsystems that influence the way each member interacts with each other. Members that have trouble in solving family problems require a change in structure, implementing some order and organization. This includes realignment or the altering of behaviors in the family structure by working with each member finding ways to improve interaction Minuchin manipulates the format of the therapy sessions, structuring desired subsystems by isolating them from the remainder of the family, either by the use of space and positioning (seating) within the room, or by having non-members of the desired substructure leave the room (but stay involved by viewing from behind a one-way mirror). The aim of such interventions is often to cause the unbalancing of the family system, in order to help them to see the dysfunctional patterns and remain open to restructuring. He believes that change must be gradual and taken in digestible steps for it to be useful and lasting When working with families who are not introspective and are oriented toward concrete thinking, Minuchin will use the subsystem isolation—one-way mirror technique to teach those family members on the viewing side of the mirror to move from being an enmeshed participant to being an evaluation observer. He does this by joining them in the viewing room and pointing out the patterns of transaction occurring on the other side of the mirror. Working with interaction – inquiring into the family’s view of the problem and tracking the sequences of behaviors they use to explain it Family Mapping, map underlying structure – capture the interrelationships of members with a structural map. Ask everyone for a description of the problem to observe and potentially restructure family dynamics

Map the relationships between family members or between subsets of family and ultimately disrupt dysfunctional relationships within the family causing it to stabilize in healthier patterns. family rules, patterns, and structure family rules are defined as an invisible set of functional demands that persistently organizes the interaction of the family. Important rules for a therapist to study include coalitions, boundaries, and power hierarchies between subsystems Six areas of observation that are identified in the family structure: transactional patterns, flexibility, resonance, context, family development stage, and maintaining family interactions. In reference, intervention methods are based on directives that feed the symptom by giving a set of instructions to emphasize communication Boundaries are characterized along a continuum from enmeshment through semi-diffuse permeability to rigidity. Additionally, family subsystems are characterized by a hierarchy of power, typically with the parental subsystem "on top" vis-à-vis the offspring subsystem. In healthy families, parent-children boundaries are both clear and semi-diffuse, allowing the parents to interact together with some degree of authority in negotiating between themselves the methods and goals of parenting. From the children’s side, the parents are not enmeshed with the children, allowing for the degree of autonomous sibling and peer interactions that produce socialization, yet not so disengaged, rigid, or aloof, ignoring childhood needs for support, nurturance, and guidance. Dysfunctional families exhibit mixed subsystems (i.e., coalitions) and improper power hierarchies, Tracking – track communication and the content and use this in session Homework- used to increase contact between disengaged parties Reinformce boundaries between individuals and subsystems that have been enmeshed Should be something that is doable and not too ambitions Highlighting and modifying interactions with Enactments Directed by therapist in which the family performs a conflict scenario, which happens at home but during their therapeutic session. The enactment offers the therapist an opportunity to observe the family rather than simply listen to the family story

Strategic Family Therapy – Haley Therapists used concepts from feedback loops. Family members behavior can only be understood in context

1. Find Solvable Problems The therapist will listen to the client's problems and look for doable solutions to those problems. Some issues will take longer to solve than others, but some of the issues can be solved easily. The therapists will look for the best solution that can be accomplished with ease. 2. Create Goals Perhaps the best motivator is the concept of a goal. You reach the end of the goal, and you feel so great. Imagining your accomplishments as a race is perhaps the best way to win, and your therapist will know that. They'll create short and long-term goals. 3. Make A Plan To Accomplish Goals As we said, a strategic therapist is like a coach, and they'll work with you to formulate the best plan to accomplish the goals. They'll try to tailor the goals according to how the person works. Some people work better with groups, some alone, and others work better with a little help all the time. It all depends. 4. See How They Accomplish Their Goals A good therapist won't just set goals and push their clients on their merry way. They're going to follow up with their clients and see how they accomplish the goals, or if they're even doing so at all. If there are any hurdles to the goals, the therapists will intervene and figure out a new strategy to accomplish the goals. 5. Success Once everyone has accomplished their goals, the therapist will then get everyone together and talk about how well they did, and also teach them how they can accomplish any future goals.

Feedback loops maintain the solution as the problem. Loop = problem, attempted solution, more problems, grater attempted solutions etc. Positive feedback loops keep going in the same direction Negative feedback loop is the solution because it entails restraint of any of the points in the system (or 180 degree change You want to interrupt the cycle. Family rules govern a lot of the family’s behaviors and restrict what solutions can be tried Change is required in the problem behavior but also the underlying rule (first order change and second order change) A strategic family therapist sees all symptoms of the problem as voluntary and under the control of the individual Helplessness vs Power – The symptom bearer can appear helpless if he or she presents unfortunate or involuntary behavior that she can’t control or change even though she wants to. The helplessness can actually be a source of power over the other family members whose lives

and actions are restricted and even ruled by the demands, fears, and needs of the symptom bearer Hierarchies – address the problem by changing the structure Therapists prefer to think of people as benevolently motivated, motivated by positive characteristics of love versus hostility. The therapist attributes meaning to the motivations of people involved. The therapist initiates what happens during therapy and designs a particular approach for each problem Therapist plans a strategy.The problem has to be put in some solvable form. It must be something that is agreed upon so everyone can assess the outcome Paradoxical interventions (restraining change or go slow messages and prescribing the symptom are typical techniques used in strategic therapy and can be directed toward the whole family or to certain members The therapist works to substitute new behaviors for the vicious positive feedback loop that circles and exists. The goal is to change the dysfunctional sequences of behavior. Positive interpretations of the client’s symptoms or motives. Turn the familie’s involvement into positive use. Sets clear goals that lead to solving the presenting problem Designs interventions appropriate for the client’s social situation Uses metaphors created specifically for each client and his or her presenting problem Is a person hostile and motivated by personal gain or power or are they concerned with helping others or receiving more affection? 1st order change – change that occurs within system according to the rules of that system (ex: compliance is a logical change to a problem). Occurs when a family member attempts to solve a problem repeatedly with the same solution, only by increasing the level of intensity (ex: shouting more loudly at a teen) 2nd order change – change in the rules of the system so the change is within the system and the operating principles are changed. Allows the system to shift into a new level of homeostasis that allows for permanent rather than temporary change. This is achieved by changing the existing rules within the family system to create new behavioral responses to the identified problem Symptoms are the result of misguided attempts at changing an existing difficulty Therapist initiates what happens in therapy and the plan for solving each problem

Flexibility is key in that a family needs to be able to adjust to develop and modify solutions that do not work Utilization – using person’s strengths to effect change One up vs one down – utilizing hierarchy as a means of changing patterns Rituals – forcing changes in patterns through “ordeals” Reframing negative behavior into functional behavior Homework – directives Positive connotations – no one can change when the system has a negative connotation of them Address problems in hierarchy and structure – members try to protect and control others Therapist focuses on the problem through motivating families to change signature behavioral patterns associated with the identified problem through 2nd order change The underlying assumptions about problems in strategic family therapy focus on the family system and how it interacts with a problem instead of identifying the problem itself (Gardner, Burr, & Wiedower, 2006; McAdams et al., 2016). Strategic family therapists attempt to change the household interactional processes by focusing on individual communication patterns and developing strategies designed to aid the family to recognize and change actions and interactions associated with the dysfunction (Horigan, Anderson, & Szapocznik, 2016). Strategic family therapists believe that this manner of intervention will aid in the restoration of active family function and the dysfunction will cease (Lindstrom, Filges, & Jorgensen, 2015). The fundamental concepts of strategic family therapy emphasize systemic process, hierarchal structure, and understanding the intricacies of individual and family communication patterns (Horrigan, Anderson, & Szapocknik, 2016; Sheehan & Friedlander, 2015). The process includes analyzing invisible and visible family guidelines [rules], family function, and repetitive behavioral patterns that appear to reoccur within the family (Israelstam, 1988). Emphasizing that problems are inherent to dysfunctional hierarchies in the family structure; therapists seek to aid families to correct the problems by modifying personal interactions to change the family structure. Other concepts of strategic family therapy include the household’s behavioral sequences and the processes that potentially exacerbate or maintain the dysfunction (Szapocznik, Schwartz, Muir, & Brown, 2012). Strategic family therapy focuses on a set of planned, practical, and problem-focused strategies to address dysfunctional behaviors and familial structures that are associated with or contribute to the underlying problems (Lindstrom, Filges, & Jorgensen, 2015; Szapocznik, Schwartz, Muir, & Brown, 2012). The unique or core fundamental approaches of strategic family therapy include providing directives, assessing ordeals, and therapeutic paradoxes during interventions. A

Therapeutic paradox is a tactic used to engage family members to evaluate unfavorable interactions and to redirect efforts into different interactions or behaviors (Lindstrom, Filges, & Jorgensen, 2015). Directives serve as precise instructions for the family members to enact to facilitate change, whereas ordeals are behavioral prescriptions that direct the family to engage in pernicious behaviors when maladaptive interactions return (Lindstrom, Filges, & Jorgensen, 2015; Szapocznik, Schwartz, Muir, & Brown, 2012)....