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MFT Structural


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A. Salvador Minuchin
created new ways of helping families (with poor, disorganized, multi-problems) that didn’t do well with his training in analytical skills/approach in therapy. Rather they conceptualized family members as responding to one another and to others according to a hypothetical structure. Minuchin conceptualizes families as operating according to consistent, learned, underlying structures.
A. When do problems occur and how are strutural and strategic therapists alike?
When problems occur, it is because their usual way of responding has become stuck for lack of alternatives; therapy is designed to unfreeze them from rigid habits, creating the opportunity for new structures to emerge. Thus the structural practitioners, like the strategic therapists are interested in behavioral sequences, the rules that govern interactions, and the contexts that influence the rules. In both structural and strategic models, therapists are directive, attend more to process than content, observe reactions to current interventions in order to plan future interventions, and use techniques such as joining, reframing and paradox. Further, the structuralists alter behavioral sequences that occur in the session rather than assign out of session homework, as is typically done in strategic work.
A. Goal and central idea of structural
Goals of structural are to correct dysfunctional hierarchies by putting parents in charge of their children and differentiate between subsystems within families. Central idea of structural-is to change the family structure by changing the interactional patterns so that the improvements the family makes in the session will persist. Therapists believe in inherent ability of families to find solutions and alternate ways of interacting once they are unstuck from their old habits. Solving problems, per se, is not a goal, though it is often a result of treatment.
B. What is family structure? How does family structure develop?
Family structure-every family has a specific structure that determines how members interact with one another and with outsiders and with other systems. Structure develops partly through repetition and partly through the influence of the external context. The interrelated processes of accommodation and boundary-setting bind them into a spousal unit or subsystem. When children are born, the couple forms a parental subsystem---which works out a new pattern of interactions with the child subsystem. These processes, then result in a family structure or ‘covert set of rules that govern transactions in the family…rules that are self-perpetuating and resistant to change’. Ex. Mom initially responds to her baby during the night, she is likely to continue to do so, not only with this child, but also with subsequent children. The external context—culture, education, experiences in the family of origin—influences such features of the new family as the nature of sex roles or the preferences for child discipline practices.
At what times are families vulnerable to the development of problems?
Every developmental stage or change in the external environment presents challenges to which the family structure must accommodate; these times are particularly vulnerable to the development of problems as families experience disruption and anxiety.
B. What are subsystem? How are they determined? Give example of subsystem.
Subsystems—Individuals, dyads, triads, and groups form subsystems or units within the family that perform certain functions. Subsystems may be determined by generations, role gender, age, or interest. Example: Woman may be a mom, daughter, sibling, and/or aunt.
B. What are boundaries? What does a healthy family with clear boundaries look like in relation to autonomy and separateness?
Boundaries—separate individuals, subsystems, and families; boundary is a hypothetical line of demarcation that ‘serves to protect the autonomy of a family and its subsystems by managing proximity and hierarchy’. Boundaries range from rigid to diffuse. In healthy families boundaries are clear enough to protect the separateness and autonomy, and permeable enough to ensure mutual support and affection. A Clear boundary between the parental subsystem and the children establishes the parents in leadership positions. Allows parents and children to interact but also supports couple in separate relationship. Healthy families—clear generational, hierarchical boundaries that ‘allow parents to maintain parental roles and children to maintain child roles’.
B. How do structural therapists define families facing problems? Give an example of dysfunctional structure.
Structural therapists do not pathologize the families they treat; rather, they define dysfunction as a failure to adjust to changing circumstances. One dysfunctional structure that demands particular attention from the structural therapist is the situation in which parents are not in charge of their children.
B. What are rigid boundaries and what can it result in? How is the family affected with rigid boundaries and disengagement. How does the relate to whether family will seek treatment?
Rigid boundaries—are overly restrictive and permit little contact with outside subsystems, resulting in disengagement. Family members in disengaged systems with rigid boundaries tend to be independent but they may be isolated; children learn to be self-sufficient and resourceful; however, in the extreme the families aren’t warm or nurturing; they don’t seek treatment until they face exceedingly stressful problems.
B. What are diffuse boundaries and what can it result in for families? How does diffuse boundaries and enmeshment relate to autonomy and relating to others?
Diffuse boundaries are permeable and permit easy contact with other subsystems, but can result in enmeshment. Disengage or enmeshed doesn’t automatically mean the requirement of therapy and they can function well in a variety of circumstances. Children from enmeshed families (diffuse boundaries) receive affection and nurturance, but it can be at the expense of autonomy and the ability to relate to others outside the family.
B. Give example of inflexible family structure and family unable to accommodate to the demands of development or change, the dysfunction and behavioral problems result.
Example of inflexible family structure and family unable to accommodate to the demands of development or change, the dysfunction and behavioral problems result. The example: in enmeshed family if child is not taught to respect rules and authority or are overly dependent on their parents, they may not negotiate the developmental stages that require increasing independence. Lead to example of a child develop school phobia, and if parents repeatedly let child stay at home, then behavior becomes problematic family interactional pattern.
B. How do families manage conflict? How can a disengaged family manage conflict? How may an enmeshed family manage conflict?
Example : If a family member has a problem this can lead to anxiety and conflict arising. Families manage conflict according to their rules of their structure. Ex Disengaged family may avoid contact with another when experiencing a problem; the parents may not notice child is experiencing difficulty at school and fail to provide the help and support. Ex. Enmeshed families tend to deny and suppress differences; if child has a minor problem, the parents may intervene excessively, not allowing the child to learn to find his/her own solutions.
B. example of how enmeshment and disengagement may be reciprocal within a family? When can the skewed arrangment within the example become problematic under certain circumstances? What is a cross generational coalition? What is coalition? Stable coalit
Ex the enmeshed mom with her children and the disengaged father; the relationship is somewhat skewed but structural therapists don’t automatically judge the arrangement….only suggest families need some kind of structure, some parental teamwork, and some degree of differentiation between subsystems. This skewed arrangement can become problematic in certain circumstances. For example spousal subunit experiences problems and may divert their attention away from their problem and onto the children, or parents may argue through the children, in this case skewed relationship becomes dysfunctional. Cross generational coalition—enmeshed mom forming bond with child, and the father becomes more disengaged. Coalition—covert alliance between two family members against a third. Stable coalition—one parent joins a child in a rigidly bounded cross-generational coalition. Structural therapist would make changing this structure a target of therapy.
C. What does structural therapist need in order to interevene? How does therapist access family patterns of interaction? How does accommodation relate?
In Structural family therapy, assessment and tx are closely intertwined. In order for therapist to intervene, therapist needs to get complete picture of existing structure. Family members cannot articulate the structure directly, but the therapist discerns it by observing the patterns of their interactions. The therapists earns family’s trust through the accommodation process in order to observe unguarded interactions among family members. Observation is facilitated by enactments
C. Accommodation? Types of accommodation and define: Joining, Mimesis,
Accommodation—adjustments a therapist may make to a family in order to achieve a therapeutic alliance with them. Initial interactions—critical. Structural therapy requires strong, often confrontational challenges to the family, but the challenges won’t be tolerated unless each family member feels accepted and understood by the therapist. First session. Joining—accommodation maneuver in which the therapist establishes rapport..and temporarily becomes part of the family. This makes it easier for the therapist to bring about change. Therapist will greet each person, ask each person to describe problem, and acknowledges each person’s views. Mimesis—fostering accommodation by matching the mood/behaviors of the family members. Ex-therapist act solemn with a serious member, silly with a light-hearted member, or sit on floor with a child.
C. Enactment? How would therapist develop enactment with parent says the other is too strict? What does therapist look for in enactment?
Enactment—Therapist asks the family members to talk among themselves and enact the dysfunctional transactional patterns, picking a particular point for dialogue. Ex. If one parent says the other is too strict, the therapist can develop an enactment by saying: ‘She says you’re too strict, can you answer her?’ Therapist attends to primarily the process, not the content of the enactment conversation.
C. What would therapist look for with a family who has brought in school phobic daughter who is enmeshed with mom? What are the daughter's symptoms a reflection of?
Ex. Family brings a school phobic daughter to tx, and the therapists observes that the mom and daughter are enmeshed; critical for therapist to observe the interactions of the parents; symptoms of the daughter are assumed to be a reflection of a stuck structure in the family; if parents are disengaged, the intervention directed at engaging and improving the parental subsystem, rather than strengthening the boundary between mom and daughter; altering the parental unit for overall interactional pattern to change.
C. Mapping the system? Family map? Minuchin devised symbols to depict what? What assumption is structural therapy based?
Mapping the System—Structural therapist makes a map of hypothetical structures as the family enacts their interactions. Family map—powerful simplification device allowing the therapist to organize diverse materials about family, helps formulate hypotheses about other dysfunctional areas, and helps determine therapeutic goals. Minuchin devised symbols that depict the quality of the boundaries and coalitions. Therapy is guided by assumption that family is competent and their processes and structures should be respected.
C. Part of structural therapist's job is to activate what?
Therapist’s job is to activate latent adaptive structures that are already in the client family’s repertoires…or create effective hierarchal structures by helping parents function together as a cohesive executive subsystem.
C. Primary goal of tx for structural is to change family structure so that the family can problem solve themselves. What does help and changing family structure look like for enmeshed vs. disengaged families? Purpose of structural therapist's interventio
c.Primary goal of treatment—change the family structure—altering boundaries and realigning subsystems so that the family can solve its own problems. 1.Enmeshed families are helped to strengthen the diffuse boundaries around them, and disengaged families are helped to make their rigid boundaries more permeable. 2.Therapist’s interventions are for the purpose of creating more options for the family, not to criticize what’s wrong. Therapist joins the family in a position of leadership, maps the structure, and helps the family to transform it.
C. Common structural techniques?
Common techniques of structural: intensity, shaping competence, boundary-making unbalancing, and challenging assumptions.
C. A structural technique called intensity? How does therapist achieve intensity? Pacing tools of intensity? How would therapist increase intensity with parents having prob controlling child's tantrum?
Intensity—degree of impact regulated by therapist. Therapist can achieve intensity by increasing the affective component of an interaction by increasing the length of a transaction or by repeating the same message in different transactions. Tone, volume, and pacing are the tools of intensity. Ex of increasing the length of a transaction would be to ask the parents to control a child’s temper tantrum longer after they typically would have given up. Intensity exceeds the family threshold… for not hearing challenges to the way they perceive reality…and it blocks the stream of interactions.
C. A structural technique called shaping competence?
Shaping competence—changes the direction of interactions. Therapists avoid telling families what they are doing wrong; rather, they point out what they are doing right an d express confidence in the family’s competence.
C. A structural technique, boundary making? What is improved with parents who have formed cross-generational coalitions? Therapist dealing with boundaries of enmeshed families versus disengaged families? Methods of establishing clearer boundaries?
Boundary Making—therapist reinforces appropriate boundaries and diffuses inappropriate boundaries by modifying transactional patterns. Parents who have formed cross-generational coalitions are helped to improve executive functioning by restructuring the boundary between the executive subsystem and the child subsystem. In enmeshed families-boundary between subsystems may need to be established or reestablished. Method of establishing clearer boundaries is getting people to speak for themselves, encouraging individuals to express ideas without interruption, urging parents to take time away from their children, and acknowledging children for increasingly mature behaviors. Disengaged families have rigid boundaries and goal is to help family members loosen their boundaries and increase access to subsystems but first need to get out grievances because members avoid one another on discussing these issues. Therapist must block their escape and give opportunity for family to discuss honestly, safely, and fairly.
C. A structural technique, unbalancing? Therapist used unbalancing with parents who have given up on child prob behs by asking dad when he divorced wife and married his golf clubs
Unbalancing—supports one family member and interferes with homeostasis. Unlike many other therapies that strive to maintain neutrality, structural therapists often appear to take sides. Ex. Parents giving up on child’s behavior problems; the therapist might exclude child from session and throw the system off balance by asking the father when he divorced his wife and married his golf clubs—this is not inherently blaming but a means to jolt the stuck structure; goal is to get couple talking about unexpressed conflicts/pain that drove them apart and help them be both a couple and a more effective parental subsystem.
C. A structural techn, challenging assumptions? Parents have labeled daughter nervous coming from inherent characteristics versus willful beh leading to what parental responses?
Challenging assumptions—offers the family alternative views of reality by changing the way they relate to one another. Family’s perceived reality becomes its ‘truth’ or narrative hx (part accurate, part construction) which guides family interactions sometimes to their detriment. Ex Daughter labeled nervous leading parents to see her behavior coming from inherent characteristics rather than simply as willful misbehavior; the label they assign determines parental responses to the behavior. Misbehavior calls for greater parental control whereas a nervous character leaves parents in more helpless position. Challenge these assumption thru education and new experiences can help them choose more effective responses. Study-research conducted on children with psychosomatic illness, supports the validity of the structural approach.
D. Family map symbols. Boundaries divide what and set by what? What is open or clear boundary symbol around family system? Closed or rigid? Diffuse? page 112-116
Boundaries—range from rigid to flexible—abstract dividers between systems and subsystems and set by implicit rules defining who participates in which subsystems and how. Boundary lines may be drawn around the entire family system (circle around entire family). Open/Clear boundary (dash line) designating open boundary with systems or subsystems. Closed or rigid boundary (line) indicates closed from systems or among subsystem. Diffuse boundary (dotted line) indicates boundaries that are not clearly defined or maintained, resulting in blurred generational roles/responsibility leading to enmeshed relationships often. Boundary lines are also drawn between subsystems within family unit ex from parents and child (in middle of circle.)
D. Family map symbols, alliance or affiliation? Types of alliances or affliations; what are the symbols for those types.
Alliances/Affiliations—symbols used to depict the quality of the typical transactions between two family members. Clear affiliation or normal bond –two lines Enmeshed or over-involved affiliation—four lines (ex cross-generational bond between mom and son) iii. Weak or unknown affiliation—dotted line. (ex btw dad and daughter means little is known about the affiliation or that it is weak.) Conflicted affiliation—two side t’s (mary’s cut-off symbol). Ex between bro and sis meaning sibling conflict
D. Family maps symbols, detouring? Give example of parents detouring on child.
Detouring— two arrows point down at 3rd person as the problem; two family members preserve harmony in their relationship by detouring the conflict onto a third person. Ex In this circumstance, the parents often define the child as a problem but actually reinforce their child’s deviant behavior.
D. Family maps symbols, coalitions? What do power blocks which are created by coalitons do?
Coalitions— (side bird symbol) two family members join together against a third usually across generational boundaries. Coalitions create power blocks in families that serve to either balance another coalition or establish control.
D. Family Maps, symbols. Two main uses for mapping? Draw couple maps in answer.
The relationships of the parts—two main uses for mapping: describe the way the entire family is organized or it describes the family unit’s involvement in a problem. Pg 114 Draw a family that shows family unit with diffuse boundaries with an over-involved mother and son forming a parental subunit and a rigid boundary between them and the other children. The whole family is in a coalition against the father who is not a part of the family household. Draw a family that shows open family unit boundary, enclosing a parental subsystem characterized by mom’s over-involvement with her own mother, who is in conflict with mom’s husband. A normal affiliations exists between the two spouses, and a diffuse boundary between the parental and child subsystems.
D. Family maps, symbols. Transitions? Draw couple family maps with transitions.
Transitions—transitional pictures or stages in the treatment. Pg 115 Draw a family enters treatment in which conflict has been chronically deflected onto one of the children. The boundary between the parental subsystem and children is diffuse and the boundary around the parents-child triad, which should be diffuse, becomes rigid—called rigid triad. The therapist joined the child locked into the rigid triangle with the parents, blocking the child from this usual position in the conflict. Page116---Draw the parents begin discussing the difficulties between them and working together as parents, forming a stronger parental subsystem.
D. Parentified child? How does parentified child differ from non-parentified child? why do some become symptomatic?
From Minuchin's structural model, a role set of behaviors, and placement in a family sequence which stems from the functional removal of a child from the sibling subsystem. Parentified child differs from child with healthy responsibilities when child's parental responsibilities are poorly defined and therefore, unlimited and are beyond the child's developmental capabilities. Children become syptomatic when given responsibilites they cannot handle or are not given the authority to perform a responsibility they are given. Example: 17 year old girl functions as head household when mom sits uninvolved in the corner of the room.

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