Structural Family Therapy Case Study

Model Description

Among the existing variety of therapies for a family, it is hard to define the most appropriate or the less effective because every family is unique, and its members face different problems and misunderstandings. In the current paper, one of the family therapy models, the structural family therapy by Salvador Minuchin, will be discussed. Its historical background, some facts from the developer’s life, and different aspects of the theory will be analyzed to make the evaluation of the case study within the frames of the chosen model possible.

Historical Background

Structural family therapy (SFT) is one of the available models of treatment offered to all members of a family on the basis of the possible structural change and communication within a family. It was developed in the middle of the 1970s by one of the brightest representatives of the Philadelphian Child Guidance Clinic, Salvador Minuchin.

His physician experience in the army in Israel and the work with children in New York helped to understand that personal problems are based on a family and the philosophies inherent to it. The Israel families turned out to be a good example for Minuchin on how a variety of cultures and interests may be gathered in one certain community that has to follow the order and mind the traditions around.

Another historical perspective from Minuchin’s like comes from his childhood. As a son in a Jewish family during the 1920s, who had to live in a unique Argentina, Minuchin faced the necessity to learn different rules and truths and add them to the life of his own (Prochaska & Norcross, 2013). In fact, his life was not only about the challenges.

The existed cultural diversity helped Minuchin to realize that every person has to perform his/her own role and be ready to change it in accordance with the demands set by society. His practice at the Wiltwyck School for Boys opened a number of perspectives with the help of which Minuchin (in a company of several colleagues) started to develop some new approaches to family therapy and offered problematic boys the ideas of how to improve their lives (Miller, 2011).

A chance to work with children and their families proved the idea that family therapy had to be based on trust and loyalty to the ideas; and the role of a therapist should not be only as a mentor or teacher but be a good advisor, a coach, who could implement the changes and participate in the process at the same time.

Salvador Minuchin

In fact, the life of Salvador Minuchin may serve as a good explanation of his structural family therapy and general intentions to help people around through the work with a whole family. Minuchin raised in a Russian-Jewish family in Argentina. The necessity to combine different traditions and perform the roles according to the expectations of the others was obvious (Miller, 2011).

Being deeply impressed by the works of Jean-Jacque Rousseau about the delinquents and their place in society, he made a decision to connect his life with psychology in some way. He entered the medical university and united his education with politics opposing the ideas of Juan Peron, the head of the majority of Argentina’s institutions.

With time, he moved to Israel and worked with oppressed children using his own experience in combining rules and traditions. The American practice in the sphere of psychiatry provided him with the necessary amount of knowledge. The works by Harry Stack Sullivan made Minuchin pay more attention to family therapy on the basis the troubled youth (Miller, 2011).

Within a short period of time, he was ready to introduce a new theory of how to help families and divide their functions in a proper way. It was structural family therapy.

Therapist’s Role

In family therapy, a therapist can perform a number of roles from being a leader in the relations to guide every action properly to stay a third-party observant making notes and conclusions (Simon, 2012). One of the peculiar features of SFT is the attention to the therapist and his/her role in the process.

According to this theory, the therapist remains to be an active participant as he/she is responsible for the implementation of the changes in a family and the process of restructuring itself. Due to his own experience, Minuchin underlines the fact that any therapist has to respect each family’s culture and underline its uniqueness; this is why it is an obligatory task for the therapist to gather some information before therapy takes place (Minuchin & Fishman, 2009).

It is necessary to clear up what each member find the best for a family and how it is possible to unite their interests within one community that is called a family. The therapist has to help every family member and explain how they can establish healthy relations and consider their own skills and interests.

It is possible for the therapist to use some physical objects and moves to achieve better results of a therapeutic process (Jones-Smith, 2014). In general, SFT presupposes the role of the therapist being important indeed, and Minuchin makes everything possible to explain what and when a professional counselor has to do.

Essence of the Theory of Change

One of the primary SFT characteristics is the possibility to describe family problems and offer solutions with the help of “spatial and organizational metaphors” (Goldenberg & Goldenberg, 2012). These techniques promote the required portion of a change in any family organization and structure.

The only important requirement that has to be considered is that the change should take place before all symptoms are relieved because the way of how a whole family can function defines the way of how every member functions within. According to the theory, the structure of a family changes as soon as the positions of the family members undergo some changes and vice versa.

Each new function is the possibility to define and analyze the same problem from a new perspective. The therapist, who is going to offer a change, has to check whether the experience of a family is appropriate for the chosen intervention. Every hierarchy created depends on the functions performed by every member.

There has to be a leader, who should be an example for the rest and an advisor. At the same time, whose, who perform the supplementary roles, should not consider themselves diminished or misjudged. The therapist has to explain that any family therapy should be organized according to such order.

Target of Intervention

When the therapist starts working with a family, he/she has to identify the targets of the therapy interventions in a proper way. A goal for change has to be established (Jones-Smith, 2014). The target of intervention is the change that happens when the therapist try to help each family member to create the necessary boundaries within a family that are “neither too rigid nor too diffuse” (Jones-Smith, 2014).

The intervention results in the change in the frames of which it becomes easier to make decisions and distribute the issue of power in different ways to choose the most appropriate one. It is expected that dysfunctional family structures are improved, and a family gets the required portion of explanations and suggestions on how they have to behave and react to each other’s activities.

Assessment from the Approach

SFT provides the therapist with a chance to evaluate the conditions under which a family lives, define misunderstanding and challenges that take place, and offer several appropriate solutions for a situation to be improved. The following assessment of a family is possible from the therapy offered by Minuchin:

1. Family hierarchy according to the powers gained (proper, improper, in need of improvements);
2. Boundaries between each member of a family (proper, improper, in need of improvements);
3. Subsystems of a family (present, absent, necessary);
4. Therapist’s role (active, passive, leading, minimized).

As soon as this kind of family evaluation takes place, the therapist is able to continue working and making the necessary implementations gradually.

Normalcy, Health, and Pathology within the Model

Normalcy, health, and pathology are the assumptions that help to identify the necessity and essence of assessment and interventions in a family. Family normalcy is usually characterized by the presence of absence of symptoms that can disturbed or destroy a family (Walsh, 2012). In the Minuchin’s therapy, a normal family is defined as “nonstressful, living in constant harmony and cooperation” (Walsh, 2012, p. 30).

This is why when parents or other grown-ups of a family face the problems related to bringing up children, sexual life, or the outside world, they are bothered and require some professional help. It is normal for a family to struggle with some problems in case all struggles can be ended with some compromises.

In terms of health, Walsh (2012) explains a healthy family as the parents of which know a lot and can solve intrapsychic conflicts and meet the needs to promote their children’s development.

Finally, SFT defines pathology as the situation when families face with stress or other challenges and suffer from increasing “the rigidity of their transactional patterns and boundaries” and inabilities to “avoid or resist any exploration of alternatives” (Walsh, 2012, p. 31).

Cultural and Diversity Factors within the Model

SFT is the model that is too sensitive to cultural and diversity factors because it is based on the way of how the therapist, as well as a family, can define cultural priorities and survive the diversities around. Minuchin underlines that the therapist has to respect cultural preferences of a family and do not try to change them or diminish their role in a family’s life.

In fact, both, cultural and diversity, factors play an important role in family therapy as it helps to show the family how unique and special their family life actually is. Children are in need of an explanation of how their own cultures have to be introduced to society the most.

They should feel respect to their diversity and a chance to share this uniqueness with a family but not feel sorry or disappointment. Parents are responsible for the way of how children understand their cultural needs in regards to their family hierarchy, and the therapist should explain all aspects accordingly.

Type of a Model (Strength-Based or Deficit-Based)

Therapy models may be of two types, strengths-based and deficit based. Deficit-based models aim at addressing the patient’s needs and problems, and strengths-based models focus on people’s attributes that can promote health. The latter approach differs from the former by the possibility to use the already given features and work them out to avoid the development of possible pathologies (Xie, 2013).

The therapy offered by Minuchin is of a strengths-based type as it focuses on the outcomes, considers family as the primary concept that has to be used, and defines the possibility to structure a family as one of the ways to help people and use their strengths avoiding weaknesses and deficits.

Intervention Examples

SFT may have a number of interventions. Still, the most crucial are as follows:

1. Join a family in a friendly-formal way;
2. Analyze the situation and evaluate family;
3. Set the goals;
4. Identify the rules that have to be followed;
5. Define the roles according to the family hierarchy;
6. Change the roles and observe the results;
7. Support communication;
8. Do not try to give the directions (but explain that these are just pieces of advice).

All these steps help the therapist realize whether it is possible to help a family and identify the root of the existing and potential problems and overcome the majority of them.

Model Application

Role of the Counselor for the Case in Specific Aspects

In the case under consideration, the role of the therapist remains to be crucial as he takes responsibility for the organization of communication between all members of a family. The therapist has to analyze each member separately and tries to define the aspects that can bother them.

It is necessary not to become a friend for them because Jimmy is one of the most vulnerable members of the family, who want to gain more someone’s attention. The therapist should not provide Jimmy with empty hopes and clearly define his role as a counselor, who is going to understand and suggest the options that can change the situation within the family.

Possible Changes within the Family

Among the variety of possible changes for the family under consideration, the following suggestions may be considered. For example:

• Jane is bothered by her inability to raise her little daughter Sunny (she may be offered to ask for a part-time job);
• Paul wants his wife paying more attention to him as a man (he may use his free time to amaze Jane with his own works and achievements);
• Jimmy is jealous of his father spending more time with Sunny than with him (he can think about some hobbies and the activities to be involved in together with his father).

Aspects that Undergo Changes

The therapist has to focus on the next aspects with the family and be ready to promote some changes in:

1. Communication between the family members;
2. Occupation of the family members;
3. Identification of the family culture as the thing that can unite all of them;
4. Social norms and rules that have to be followed by all family members as equal members of society;
5. Obligations to each other.

All these aspects have to be changed in some way, and every change has to be explained.

Understanding of the Case within the Model’s Framework

The Duncan’s is almost an ordinary American family that has to face some challenges because of the economic conditions of the country and the obligations that have to be followed. Jane and Paul Duncan have to understand that their new duties should not influence their relations, and they have to take some steps to develop the duties according to the hierarchy that has been developed earlier.

The wife has to demonstrate her respect to the husband even in spite of the fact that it is she, who earns money. The husband has to remember that he has a son, who needs more attention. At the same time, e new-born daughter can take much time as well. The therapist should discuss all these points and advise how to improve the current weak situation.

Model’s Assumptions around Normalcy, Health, and Pathology

In general, the evaluation of the case from the normalcy, health, and pathology shows the following picture:

1. The family’s level of normalcy is medium because of the evident stresses that take place from time to time.
2. It is a health family because of the absence of bad habits and the necessity to feed properly.
3. There are no evident pathologies, just the inability to communicate directly and speak out loud about personal discontents and desires.

The family has all changes to be changed and “healed” because the cooperation is still possible, harmony can be achieved, and several alternatives can be offered by the therapist and accepted by the family as a result of open communications and discussions.

Cultural and Diversity Aspects of the Case

The case under analysis does not touch upon some cultural and diversity aspects of society. The family consists of the White Americans, who live under the traditions accepted by the United States. The family likes different thematic holidays and tries to participate in all parties to entertain children and show them how the majority of people can live.

At the same time, the family can use its cultural preferences as the thing that can unite them and offer a common hobby (for the father and the son) or a captivating holiday (for the husband and the wife). The family should get a strong basis that cannot be postponed, or moved, or neglected. The family has to have something to believe in. The cultural issue is one of the most available suggestions for the family under consideration.

Model’s Status and the Case

SFT, as the strength-based type of model, is applied to the case as the members of the family expect to achieve successful outcomes. They have a number of strengths and positive intentions to benefit from the changed offered by a professional.

Interventions Applied in the Case

The possible interventions in the case are:

1. Private talks with every member of a family;
2. Promotion of open communication between all members;
3. Distribution of the roles and mutual exchange of the roles so that every member of the family can understand the pros and cons of each other’s position;
4. Identification of one common interest can unite a family and make its members spend together sometime.

Assessment of the Model of the Hypothetical Case Study

The success of SFT is the possibility to implement it in a variety of cases. The therapist has to be mature enough to be close to each family member but never cross the line and become a friend. Still, it is necessary to remember that Minuchin’s therapy is more applicable for large families so that their structures, boundaries, and functions can be changed.

References

Goldenberg, H. & Goldenberg, I. (2012). Family therapy: An overview. Belmont, CA:Cengage Learning.

Jones-Smith, E. (2014). Theories of counseling and psychotherapy: An integrative approach. Thousand Oaks, CA: SAGE Publications.

Miller, A. (2011). Instructor’s manual for Salvador Minuchin on family therapy. Mill Valley, CA: Psychhotherapy.net.

Minuchin, S. & Fishman, C. (2009). Family therapy techniques. Cambridge, MA: Harvard University Press.

Prochaska, J. & Norcross, J. (2013). Systems of psychotherapy: A transtheoretical analysis. Stamford, CT: Cengage Learning.

Simon, G. (2012). The role of the therapist: What effective therapists do. Journal of Marital and Family Therapy, 38(1), 8-12.

Walsh, F. (2012). Normal family processes: Growing diversity and complexity. New York: Guilford Press.

Xie, H. (2013). Strengths-based approach for mental health recovery. Iranian Journal of Psychiatry and Behavioral Sciences, 7(2), 5-10.