You are on page 1of 29

FAMILY THERAPY

Concepts and Methods, 6/E


© 2004

Michael P. Nichols
Richard C. Schwartz

0-205-35905-1 Bookstore ISBN

Visit www.ablongman.com/replocator to contact your local Allyn & Bacon/Longman representative.

s a m p l e c h a p t e r
The pages of this Sample Chapter may have
slight variations in final published form.

Allyn & Bacon


75 Arlington St., Suite 300
Boston, MA 02116
www.ablongman.com
7
Structural Family Therapy
The Underlying Organization of Family Life

O ne of the reasons family therapy


can be difficult is that families often
appear as collections of individuals
who affect each other in powerful but unpre-
dictable ways. Structural family therapy offers
a framework that brings order and meaning to
those transactions. The consistent patterns of
What structural family therapy adds to the
equation is a recognition of the overall organi-
zation that supports and maintains those inter-
actions. The “parents who scold” might turn
out to be two partners who undermine each
other because one is wrapped up in the child
while the other is an angry outsider. If so, at-
family behavior are what allow us to consider tempts to encourage effective discipline are
that they have a structure, although, of course, likely to fail unless the structural problem is ad-
only in a functional sense. The boundaries and dressed and the parents develop a real partner-
coalitions that make up a family’s structure are ship. Similarly a couple who don’t get along
abstractions; nevertheless, using the concept of may not be able to improve their relationship
family structure enables therapists to intervene until they create a boundary between them-
in a systematic and organized way. selves and intrusive children or in-laws.
Families who seek help are usually con- The discovery that families are organized
cerned about a particular problem. It might be into subsystems with boundaries regulat-
a child who misbehaves or a couple who don’t ing the contact family members have with
get along. Family therapists typically look be- each other turned out to be one of the de-
yond the specifics of those problems to the fam- fining insights of family therapy. Perhaps
ily’s attempts to solve them. This leads them to equally important, though, was the introduc-
the dynamics of interaction. The misbehaving tion of the technique of enactment, in
child might have parents who scold but never which family members are encouraged to deal
reward him. The couple may be caught up in a directly with each other in sessions, permit-
pursuer–distancer dynamic, or they might be ting the therapist to observe and modify their
unable to talk without arguing. interactions.

176
CHAPTER 7 ● Structural Family Therapy 177
When he first burst onto the scene, Salvador At Wiltwyck, Minuchin and his colleagues—
Minuchin’s galvanizing impact was as an in- Dick Auerswald, Charlie King, Braulio Montalvo,
comparable master of technique. His most last- and Clara Rabinowitz—taught themselves to do
ing contribution, however, was a theory of family therapy, inventing it as they went along.
family structure and a set of guidelines to orga- To do so, they built a one-way mirror and took
nize therapeutic techniques. This structural ap- turns observing each other work. In 1962 Min-
proach was so successful that it captivated the uchin made a hajj to what was then the mecca
field in the 1970s, and Minuchin built the of family therapy, Palo Alto. There he met Jay
Philadelphia Child Guidance Clinic into a Haley and began a friendship that was to bear
world-famous complex, where thousands of fruit in an extraordinarily fertile collaboration.
family therapists have been trained in struc- The success of Minuchin’s work with fam-
tural family therapy. ilies at Wiltwyck led to a groundbreaking

S
book, Families of the Slums, written with Mon-
talvo, Guerney, Rosman, and Schumer. Min-
ketches of Leading Figures uchin’s reputation as a practitioner of family
therapy grew, and he became the Director of
Minuchin was born and raised in Argentina. the Philadelphia Child Guidance Clinic in
He served as a physician in the Israeli army, 1965. The clinic then consisted of less than a
then came to the United States, where he dozen staff members. From this modest begin-
trained in child psychiatry with Nathan Acker- ning Minuchin created one of the largest and
man in New York. After completing his studies most prestigious child guidance clinics in the
Minuchin returned to Israel in 1952 to work world.
with displaced children—and became ab- Among Minuchin’s colleagues in Philadel-
solutely committed to the importance of fami- phia were Braulio Montalvo, Jay Haley, Bernice
lies. He moved back to the United States in Rosman, Harry Aponte, Carter Umbarger, Mar-
1954 to begin psychoanalytic training at the ianne Walters, Charles Fishman, Cloe Madanes,
William Alanson White Institute, where he and Stephen Greenstein, all of whom had a role
studied the interpersonal psychiatry of Harry in shaping structural family therapy. By the
Stack Sullivan. After leaving the White Insti- 1970s structural family therapy had become
tute, Minuchin took a job at the Wiltwyck the most influential and widely practiced of all
School for delinquent boys, where he suggested systems of family therapy.
to his colleagues that they start seeing families. In 1976 Minuchin stepped down as Direc-
tor of the Philadelphia Child Guidance Clinic,
but stayed on as head of training until 1981.
S alvador Minuchin’s After leaving Philadelphia, Minuchin started
his own center in New York, where he contin-
structural model is the
most influential ap- ued to practice and teach family therapy until
proach to family 1996, when he retired and moved to Boston.
therapy throughout Long committed to addressing problems of
the world. poverty and social justice, Minuchin is now
consulting with the Massachusetts Depart-
ment of Mental Health on home-based ther-
apy programs. In 1996 he completed his ninth
book, Mastering Family Therapy: Journeys of
Growth and Transformation, coauthored with
178 PART TWO ● The Classic Schools of Family Therapy

nine of his supervisees, which explains his obviates the need to have a specific technique—
views on the state of the art in family therapy usually someone else’s—for every occasion.
and training. Three constructs are the essential components
Like good players on the same team with a of structural family theory: structure, subsys-
superstar, some of Minuchin’s colleagues are tems, and boundaries.
not as well known as they might be. Foremost Family structure, the organized pattern in
among these is Braulio Montalvo, one of the which family members interact, is a determin-
underrated geniuses of family therapy. Born istic concept, but it doesn’t prescribe or legislate
and raised in Puerto Rico, Montalvo, like Min- behavior; it describes sequences that are pre-
uchin, has always been committed to treating dictable. As family transactions are repeated
minority families. Like Minuchin, he is also a they foster expectations that establish enduring
brilliant therapist, though he favors a gentler, patterns. Once patterns are established, family
more supportive approach. Montalvo was in- members use only a small fraction of the full
strumental in building the Philadelphia Child range of behavior available to them. The first
Guidance Clinic, but his contributions are less time the baby cries, or a teenager misses the
well known because he is a quiet man who school bus, it’s not clear who will do what. Will
prefers to work behind the scenes. the load be shared? Will there be a quarrel? Will
Following Minuchin’s retirement the center one person get stuck with most of the work?
in New York was renamed the Minuchin Center Soon, however, patterns are set, roles assigned,
for the Family in his honor, and the torch has and things take on a sameness and predictabil-
been passed to a new generation. The staff of ity. “Who’s going to . . . ?” becomes “She’ll
leading teachers at the Minuchin Center now probably . . . ” and then “She always.”
includes Ema Genijovich, David Greenan, Family structure is reinforced by the expec-
Richard Holm, and Wai-Yung Lee. Their task is tations that establish rules in the family. For ex-
to keep the leading center of structural family ample, a rule such as “family members should
therapy in the forefront of the field without the always protect one another” will be manifest in
charismatic leadership of its progenitor. various ways depending on the context and
Among Minuchin’s other prominent stu- who is involved. If a boy gets into a fight with
dents are Jorge Colapinto, now at the Acker- another boy in the neighborhood, his mother
man Institute in New York; Michael Nichols, will go to the neighbors to complain. If a
who teaches at the College of William and teenager has to wake up early for school,
Mary; Jay Lappin who works with child welfare mother wakes her. If a husband is too hung
for the state of Delaware; and Charles Fishman, over to get to work in the morning, his wife calls
in private practice in Philadelphia. in to say he has the flu. If the parents have an

T
argument, their kids interrupt. The parents are
so preoccupied with the doings of their children
heoretical Formulations that it keeps them from spending time alone to-
gether. These sequences are isomorphic: They’re
Beginners tend to get bogged down in the con- structured. Changing any of them may not af-
tent of family problems because they don’t fect the basic structure, but altering the under-
have a theory to help them see the patterns of lying structure will have ripple effects on all
family dynamics. Structural family therapy of- family transactions.
fers a blueprint for analyzing the process of Family structure is shaped partly by univer-
family interactions. As such, it provides a basis sal and partly by idiosyncratic constraints. For
for consistent strategies of treatment, which example, all families have some kind of hierar-
CHAPTER 7 ● Structural Family Therapy 179
chical structure, with adults and children hav- from his mother. This spontaneous bickering
ing different amounts of authority. Family between mother and son reveals an intense
members also tend to have reciprocal and com- involvement between them—a mutual preoc-
plementary functions. Often these become so cupation no less intense simply because it’s
ingrained that their origin is forgotten and they conflictual. This sequence doesn’t tell the
are presumed necessary rather than optional. If whole story, however, because it doesn’t in-
a young mother, burdened by the demands of clude the father or the other children. They
her infant, gets upset and complains to her hus- must be engaged to observe their role in the
band, he may respond in various ways. Perhaps family structure. If the father sides with his wife
he’ll move closer and share the demands of but seems unconcerned, then it may be that the
childrearing. This creates a united parental mother’s preoccupation with her son is related
team. On the other hand, if he decides that his to her husband’s lack of involvement. If the
wife is “depressed,” she may end up in psy- younger children tend to agree with their
chotherapy to get the emotional support she mother and describe their brother as bad, then
needs. This creates a structure where the it becomes clear that all the children are close
mother remains distant from her husband, and to the mother—close and obedient up to a
learns to turn outside the family for sympathy. point, then close and disobedient.
Whatever the chosen pattern, it tends to be self- Families are differentiated into subsystems
perpetuating. Although alternatives are avail- based on generation, gender, and common in-
able, families are unlikely to consider them terests. Obvious groupings such as the parents
until changing circumstances produce stress in or the teenagers are sometimes less significant
the system. than covert coalitions. A mother and her
Families don’t walk in and hand you their youngest child may form such a tightly bonded
structural patterns as if they were bringing an subsystem that others are excluded. Another
apple to the teacher. What they bring is chaos family may be split into two camps, with mom
and confusion. You have to discover the and the boys on one side, and dad and the girls
subtext—and you have to be careful that it’s on the other. Though certain patterns are
accurate—not imposed but discovered. Two common, the possibilities for subgrouping are
things are necessary: a theoretical system that endless.
explains structure, and seeing the family in Every family member plays many roles in
action. Knowing that a family is a single- several subgroups. Mary may be a wife, a
parent family with three children, or that two mother, a daughter, and a niece. In each of
parents are having trouble with a middle child these roles she will be required to behave differ-
doesn’t tell you what their structure is. ently and exercise a variety of interpersonal op-
Structure becomes evident only when you ob- tions. If she’s mature and flexible, she will be
serve the actual interactions among family able to vary her behavior to fit different sub-
members. groups. Scolding may be okay from a mother,
Consider the following. A mother calls to but it can cause problems from a wife or a
complain of misbehavior in her seventeen- daughter.
year-old son. She is asked to bring her husband, Individuals, subsystems, and whole families
son, and their three other children to the first are demarcated by interpersonal boundaries, in-
session. When they arrive, the mother begins to visible barriers that regulate contact with oth-
describe a series of minor ways in which the ers. A rule forbidding phone calls at dinner
son is disobedient. He interrupts to say that establishes a boundary that protects the family
she’s always on his case, he never gets a break from outside intrusion. When small children
180 PART TWO ● The Classic Schools of Family Therapy

are permitted to freely interrupt their parents’ and gets. He learns to accommodate her wish
conversations, the boundary separating the to be kissed hello and goodbye. She learns to
generations is eroded. Subsystems that aren’t leave him alone with his paper and morning
adequately protected by boundaries limit the coffee. These little arrangements, multiplied a
development of interpersonal skills achievable thousand times, may be accomplished easily or
in these subsystems. If parents always step in to only after intense struggle. Whatever the case,
settle arguments between their children, the this process of accommodation cements the
children won’t learn to fight their own battles. couple into a unit.
Interpersonal boundaries vary from rigid to The couple must also develop complementary
diffuse (see Figure 7.1). Rigid boundaries are patterns of mutual support. Some patterns are
overly restrictive and permit little contact with transitory and may later be reversed—perhaps,
outside subsystems, resulting in disengagement. for instance, one works while the other com-
Disengaged individuals or subsystems are inde- pletes school. Other patterns are more stable and
pendent but isolated. On the positive side, this lasting. Exaggerated complementary roles can
fosters autonomy. On the other hand, disen- detract from individual growth; moderate com-
gagement limits affection and assistance. Dis- plementarity enables spouses to divide functions,
engaged families must come under extreme to support and enrich each other. When one has
stress before they mobilize mutual support. the flu and feels lousy, the other takes over. One’s
Enmeshed subsystems offer a heightened permissiveness with children may be balanced
sense of mutual support, but at the expense of by the other’s strictness. One’s fiery disposition
independence and autonomy. Enmeshed par- may help to melt the other’s reserve. Comple-
ents are loving and considerate; they spend a mentary patterns exist in most couples. They be-
lot of time with their kids and do a lot for them. come problematic when they are so exaggerated
However, children enmeshed with their parents that they create a dysfunctional subsystem.
become dependent. They’re less comfortable by Therapists must learn to accept those structural
themselves and may have trouble relating to patterns that work and challenge only those that
people outside the family. do not.
Minuchin described some of the features of The spouse subsystem must also develop a
family subsystems in his most accessible work, boundary that separates it from parents, chil-
Families and Family Therapy (Minuchin, 1974). dren, and other outsiders. All too often, husband
Families begin when two people join together to and wife give up the space they need for support-
form a spouse subsystem. Two people in love ing each other when children are born. Too rigid
agree to share their lives and futures and ex- a boundary around the couple can deprive the
pectations; but a period of often difficult adjust- children of the care they need; but in our child-
ment is required before they can complete the centered culture, the boundary between parents
transition from courtship to a functional and children is often ambiguous at best.
spouse subsystem. They must learn to accom- The birth of a child instantly transforms the
modate each other’s needs and preferred styles family structure; the pattern of interaction be-
of interaction. In a healthy couple, each gives tween the parental and child subsystems must

Rigid Boundary Clear Boundary Diffuse Boundary

F
Disengagement Normal Range Enmeshment

IGURE 7.1 Boundaries


CHAPTER 7 ● Structural Family Therapy 181
be worked out and then modified to fit chang- with developmental stages and situational
ing circumstances. A clear boundary enables crises.
children to interact with their parents but ex- When two people join to form a couple, the
cludes them from the spouse subsystem. Par- structural requirements for the new union are
ents and children eat together, play together, accommodation and boundary making. The first
and share much of each others’ lives. But there priority is mutual accommodation to manage
are some spouse functions that need not be the myriad details of everyday living. Each
shared. Husband and wife are sustained as a partner tries to organize the relationship along
loving couple, and enhanced as parents, if they familiar lines and pressures the other to comply.
have time to be alone together—to talk, to go Each must adjust to the other’s expectations
out to dinner occasionally, to fight, and to make and wants. They must agree on major issues,
love. Unhappily, the clamorous demands of such as where to live and if and when to have
small children often make parents lose sight of children; less obvious, but equally important,
their need to maintain a boundary around they must coordinate daily rituals, like what to
their relationship. watch on television, what to eat for supper,
In addition to maintaining privacy for the when to go to bed, and what to do there.
couple, a clear boundary establishes a hierar- In accommodating to each other, a couple
chical structure in which parents exercise a po- must also negotiate the nature of the bound-
sition of leadership. All too often this hierarchy ary between them, as well as the boundary
is disrupted by a child-centered ethos, which in- separating them from the outside. A diffuse
fluences helping professionals as well as par- boundary exists between the couple if they call
ents. Parents enmeshed with their children each other at work frequently, if neither has
tend to argue with them about who’s in charge, their own friends or independent activities,
and misguidedly share—or shirk—the respon- and if they come to view themselves only as a
sibility for making parental decisions. pair rather than as two separate personalities.
In Institutionalizing Madness (Elizur & Min- On the other hand, they’ve established a rigid
uchin, 1989), Minuchin makes a compelling boundary if they spend little time together,
case for a systems view of family problems that have separate bedrooms, take separate vaca-
extends beyond the family to encompass the en- tions, have different checking accounts, and
tire community. As Minuchin points out, unless each is considerably more invested in careers
therapists learn to look beyond the limited slice or outside relationships than in the marriage.
of ecology where they work to the larger social Each partner tends to be more comfortable
structures within which their work is embed- with the sort of proximity that existed in their
ded, their efforts may amount to little more own family. Since these expectations differ, a
than spinning wheels. struggle ensues that may be the most difficult

N
aspect of a new union. He wants to play golf
with the boys; she feels deserted. She wants to
ormal Family Development talk; he wants to watch ESPN. His focus is on
his career; her focus is on the relationship. Each
What distinguishes a normal family isn’t the thinks the other is unreasonable.
absence of problems, but a functional structure Couples must also define a boundary sepa-
for dealing with them. All couples must learn to rating them from their original families. Rather
adjust to each other, rear their children, if they suddenly the families that each grew up in
choose to have any, deal with their parents, must take second place to the new marriage.
cope with their jobs, and fit into their commu- This, too, is a difficult adjustment, both for
nities. The nature of these struggles changes newlyweds and for their parents. Families vary
182 PART TWO ● The Classic Schools of Family Therapy

in the ease with which they accept and support tween healthy and unhealthy families, we can
these new unions. say that healthy families modify their structure
The addition of children transforms the to accommodate to changed circumstances;
structure of the new family into a parental sub- dysfunctional families increase the rigidity of
system and a child subsystem. It’s typical for structures that are no longer effective.
spouses to have different patterns of commit-
ment to the babies. A woman’s commitment to
a unit of three is likely to begin with pregnancy,
since the child inside her womb is an unavoid-
able reality. Her husband, on the other hand,
D evelopment of
Behavior Disorders
may only begin to feel like a father when the Family systems must be stable enough to en-
child is born. Many men don’t accept the role of sure continuity, but flexible enough to accom-
father until their infants are old enough to re- modate to changing circumstances. Problems
spond to them. Thus, even in normal families, arise when inflexible family structures cannot
children bring with them great potential for adjust adequately to maturational or situa-
stress and conflict. A mother’s life is usually tional challenges. Adaptive changes in struc-
more radically transformed than a father’s. She ture are required when the family or one of its
sacrifices a great deal and typically needs more members faces external stress and when tran-
support from her husband. The husband, sitional points of growth are reached.
meanwhile, continues his job, and the new Family dysfunction results from a combina-
baby is far less of a disruption. Though he may tion of stress and failure to realign themselves
try to support his wife, he’s likely to resent some to cope with it (Colapinto, 1991). Stressors may
of her demands as inordinate. be environmental (a parent is laid off, the fam-
Children require different styles of parenting ily moves) or developmental (a child reaches
at different ages. Infants primarily need nurture adolescence, parents retire). The family’s fail-
and support. Children need guidance and con- ure to handle adversity may be due to flaws in
trol; and adolescents need independence and re- their structure or merely to their inability to ad-
sponsibility. Good parenting for a two-year-old just to changed circumstances.
may be totally inadequate for a five-year-old or In disengaged families, boundaries are rigid
a fourteen-year-old. Normal parents adjust to and the family fails to mobilize support when
these developmental challenges. The family it’s needed. Disengaged parents may be un-
modifies its structure to adapt to new additions, aware that a child is depressed or experiencing
to the children’s growth and development, and difficulties at school until the problem is far ad-
to changes in the external environment. vanced. In enmeshed families, on the other
Minuchin (1974) warns family therapists hand, boundaries are diffuse and family mem-
not to mistake growing pains for pathology. The bers overreact and become intrusively involved
normal family experiences anxiety and disrup- with one another. Enmeshed parents create dif-
tion as its members adapt to growth and ficulties by hindering the development of more
change. Many families seek help at transitional mature forms of behavior in their children and
stages, and therapists should keep in mind that by interfering with their ability to solve their
they may simply be in the process of modifying own problems.
their structure to accommodate to new cir- In their book of case studies, Family Healing,
cumstances. Minuchin and Nichols (1993) describe a com-
All families face situations that stress the sys- mon example of enmeshment as a father jumps
tem. Although no clear dividing line exists be- in to settle minor arguments between his two
CHAPTER 7 ● Structural Family Therapy 183
boys—“as though the siblings were Cain and ensue. Just as a functional hierarchy is neces-
Abel, and fraternal jealousy might lead to mur- sary for a healthy family’s stability, flexibility is
der” (p. 149). The problem, of course, is that if necessary for them to adapt to change.
parents always interrupt their children’s quar- The most common expression of fear of
rels, the children won’t learn to fight their own change is conflict avoidance, when family mem-
battles. bers shy away from addressing their disagree-
Although we may speak of enmeshed and ments to protect themselves from the pain of
disengaged families, it is more accurate to speak facing each other with hard truths. Disengaged
of particular subsystems as being enmeshed or families avert conflict by avoiding contact; en-
disengaged. In fact, enmeshment and disen- meshed families avoid conflict by denying dif-
gagement tend to be reciprocal, so that, for ex- ferences or by constant bickering, which allows
ample, a father who’s overly involved with his them to vent feelings without pressing for
work is likely to be less involved with his family. change or resolving conflict.
A frequently encountered pattern is the en- Structural family therapists use a few sim-
meshed mother/disengaged father syndrome— ple symbols to diagram structural problems
“the signature arrangement of the troubled and these diagrams usually make it clear
middle-class family: a mother’s closeness to her what changes are required. Figure 7.2 shows
children substituting for closeness in the mar- some of the symbols used to diagram family
riage” (Minuchin & Nichols, 1993, p. 121). structure.
Feminists have criticized the notion of an One problem often seen by family therapists
enmeshed mother/disengaged father syn- arises when parents who are unable to resolve
drome because they reject the stereotypical di- conflicts between them divert the focus of con-
vision of labor (instrumental role for the cern onto a child. Instead of worrying about
father, expressive role for the mother) that
they think Minuchin’s belief in hierarchy im-
plies, and because they worry about blaming
mothers for an arrangement that is culturally Rigid Boundary
sanctioned. Both concerns are valid. But prej-
udice and blaming are due to insensitive ap- Clear Boundary
plication of these ideas, not inherent in the
ideas themselves. Skewed relationships, what- Diffuse Boundary
ever the reason for them, can be problematic,
though no single family member should be Coalition
blamed or expected to unilaterally redress im-
balances. Likewise, the need for hierarchy Conflict
doesn’t imply any particular division of roles;
it only implies that families need some kind of
structure, some parental teamwork, and some Detouring
degree of differentiation between subsystems.
Hierarchies can be weak and ineffective, or Involvement
rigid and arbitrary. In the first case, younger
members of the family may find themselves un-
protected because of a lack of guidance; in the
F
Overinvolvement
second, their growth as autonomous individu-
als may be impaired, or power struggles may IGURE 7.2 Symbols of Family Structure
184 PART TWO ● The Classic Schools of Family Therapy

each other, they worry about the child (see Fig- M F


ure 7.3). Although this reduces the strain on
father (F) and mother (M), it victimizes the F
child (C) and is therefore dysfunctional. Becomes
An alternate but equally common pattern is M C
for the parents to continue to argue through the
children. Father says mother is too permissive;
she says he’s too strict. He may withdraw, caus- F IGURE 7.4 Mother–Child Coalition
ing her to criticize his lack of concern, which in
turn causes further withdrawal. The enmeshed
mother responds to the child’s needs with exces- forced by “understanding” parents who permit
sive concern. The disengaged father tends not to them to remain at home (Figure 7.6). Such a
respond even when a response is necessary. case may be labeled as school phobia, and may
Both may be critical of the other’s way, but both become entrenched if the parents permit the
perpetuate the other’s behavior with their own. children to remain at home for more than a few
The result is a cross-generational coalition days.
between mother and child, which excludes the Alternatively, the children of such a family
father (Figure 7.4). may go to school, but since they haven’t
Some families function well when the chil- learned to accommodate to others, they may be
dren are small but are unable to adjust to a grow- rejected by their schoolmates. Such children
ing child’s need for discipline and control. Young often become depressed and withdrawn. In
children in enmeshed families (Figure 7.5) re- other cases, children enmeshed with their par-
ceive wonderful care: Their parents hug them, ents become discipline problems at school, and
love them, and give them lots of attention. Al- the school authorities may initiate counseling.
though such parents may be too tired from car- A major change in family composition that
ing for the children to have much time for each requires structural adjustment occurs when di-
other, the system may be moderately success- vorced or widowed spouses remarry. Such
ful. However, if these doting parents don’t “blended families” either readjust their bound-
teach their children to obey rules and respect aries or soon experience transitional conflicts.
authority, the children may be unprepared to When a woman divorces, she and the children
negotiate their entrance into school. Used to
getting their own way, they may be unruly and
disruptive. Several possible consequences of
this situation may bring the family into treat- F M
ment. The children may be reluctant to go to
school, and their fears may be covertly rein-
F
Children
IGURE 7.5 Parents Enmeshed with Children
F M
M F

F
C

F
School
IGURE 7.3 Scapegoating as a Means
of Detouring Conflict IGURE 7.6 School Phobia
CHAPTER 7 ● Structural Family Therapy 185
must first learn to readjust to a structure that M Step F
establishes a clear boundary separating the
divorced spouses but still permits contact
F
Children
between father and children; then if she remar-
ries, the family must readjust to functioning with IGURE 7.8 Failure to Accept a Stepparent
a new husband and stepfather (Figure 7.7).
Sometimes it’s hard for a mother and children
to allow a stepfather to participate as an equal An important aspect of structural family
partner in the new parental subsystem. problems is that symptoms in one member re-
Mother and children have long since estab- flect not only that person’s relationships with
lished transactional rules and learned to ac- others, but also the fact that those relationships
commodate to each other. The new parent are a function of still other relationships in the
may be treated as an outsider who’s supposed family. If Johnny, aged sixteen, is depressed, it’s
to learn the “right” (accustomed) way of doing helpful to know that he’s enmeshed with his
things, rather than as a new partner who will mother. Discovering that she demands absolute
give as well as receive ideas about childrearing obedience from him and refuses to let him de-
(Figure 7.8). The more mother and children velop his own thinking or outside relationships
insist on maintaining their familiar patterns helps to explain his depression (Figure 7.9). But
without modifications required to absorb the that’s only a partial view of the family system.
stepfather, the more frustrated and angry he’ll Why is the mother enmeshed with her son?
become. The result may lead to child abuse or Perhaps she’s disengaged from her husband.
chronic arguing between the parents. The Perhaps she’s a widow who hasn’t found new
sooner such families enter treatment, the eas- friends, a job, or other interests. Helping Johnny
ier it is to help them adjust to the transition. resolve his depression may best be accomplished
The longer they wait, the more entrenched by helping his mother satisfy her need for close-
structural problems become. ness with her husband or friends.
Because problems are a function of the en-
tire family structure, it’s important to include
the whole group for assessment. For example, if
M F
a father complains of a child’s misbehavior, see-
Children
ing the child alone won’t help the father to state

M F M F
Becomes
Children Johnny

or

M Step F
Becomes M Outside
Interests
Children

F
F Johnny

F IGURE 7.7 Divorce and Remarriage


IGURE 7.9 Johnny’s Enmeshment with His
Mother and Disengagement with Outside Interests
186 PART TWO ● The Classic Schools of Family Therapy

rules clearly or enforce them effectively. Nor has trouble in school, there’s a problem in the
will seeing the father and child together do any- family or school context. Usually, but not
thing to stop the mother from undercutting the always.

G
father’s authority. Only by seeing the whole
family interacting is it possible to get a complete
picture of their structure. oals of Therapy
Sometimes even seeing the whole family
isn’t enough. Structural family therapy is based Structural family therapists believe that prob-
on recognition of the importance of the con- lems are maintained by dysfunctional family
text of the social system. The family may not al- organization. Therefore therapy is directed at
ways be the complete or most relevant context. altering family structure so that the family can
If one of the parents is having an affair, that re- solve its problems. The goal of therapy is struc-
lationship is a crucial part of the family’s con- tural change; problem-solving is a by-product
text. It may not be advisable to invite the lover of this systemic goal.
to family sessions, but it is crucial to recognize The idea that family problems are embed-
the structural implications of the extramarital ded in dysfunctional family structures has led
relationship. to the criticism of structural family therapy as
In some cases, the family may not be the pathologizing. Critics see structural maps of
context most relevant to the presenting prob- dysfunctional organization as portraying a
lem. A mother’s depression might be due more pathological core in client families. This isn’t
to her relationships at work than at home. A true. Structural problems are generally viewed
son’s problems at school might be due more to as a simple failure to adjust to changing cir-
the structural context at school than to the one cumstances. Far from seeing families as inher-
in the family. In such instances, structural fam- ently flawed, structural therapists see their
ily therapists work with the most relevant con- work as activating latent adaptive structures
text to alleviate the presenting problems. that are already in client families’ repertoires
Finally, some problems may be treated as (Simon, 1995).
problems of the individual. As Minuchin The structural family therapist joins the
(1974) has written, “Pathology may be inside family system to help its members change their
the patient, in his social context, or in the feed- structure. By altering boundaries and realign-
back between them” (p. 9). Elsewhere Min- ing subsystems, the therapist changes the be-
uchin (Minuchin, Rosman, & Baker, 1978) havior and experience of each family member.
referred to the danger of “denying the individ- The therapist doesn’t solve problems; that’s
ual while enthroning the system” (p. 91). Fam- the family’s job. The therapist helps modify
ily therapists shouldn’t overlook the possibility the family’s functioning so that family mem-
that some problems may be most appropriately bers can solve their own problems. In this
dealt with on an individual basis. The therapist way, structural family therapy is like dynamic
must not neglect the experience of individuals, psychotherapy—symptom resolution is sought
although this is easy to do, especially with not as an end in itself, but as a result of lasting
young children. While interviewing a family to structural change. The analyst modifies the
see how the parents deal with their children, a structure of the patient’s mind; the structural
careful clinician may notice that one child has family therapist modifies the structure of the
a neurological problem or a learning disability. patient’s family.
These problems need to be identified and ap- The most effective way to change symptoms
propriate referrals made. Usually when a child is to change the family patterns that maintain
CHAPTER 7 ● Structural Family Therapy 187
them. The goal of structural family therapy is to to become a parental assistant. But this child’s
facilitate the growth of the system to resolve needs must not be neglected, either.
symptoms and encourage growth in individu- With enmeshed families the goal is to differ-
als, while also preserving the mutual support of entiate individuals and subsystems by strength-
the family. ening the boundaries around them. With dis-
Short-range goals may be to alleviate acute engaged families the goal is to increase interac-
problems, especially life-threatening symptoms tion by making boundaries more permeable.

C
such as anorexia nervosa (Minuchin, Rosman,
& Baker, 1978). At times, behavioral tech-
niques, suggestion, or manipulation may be onditions for
used to achieve an immediate effect. However, Behavior Change
unless structural change in the family system is
achieved, short-term symptom resolution may Structural therapy changes behavior by open-
collapse. ing alternative patterns of interaction that can
The goals for each family are dictated by the modify family structure. It’s not a matter of cre-
problems they present and by the nature of ating new structures, but of activating dor-
their structural dysfunction. Although every mant ones. When new transactional patterns
family is unique, there are common problems become regularly repeated and predictably ef-
and typical structural goals. Most important of fective, they will stabilize the new and more
the general goals for families is the creation of functional structure.
an effective hierarchical structure. Parents are The therapist produces change by joining
expected to be in charge, not to relate as equals the family, probing for areas of flexibility, and
to their children. Another common goal is to then activating dormant structural alterna-
help parents function together as a cohesive ex- tives. Joining gets the therapist into the family;
ecutive subsystem. When there is only one par- accommodating to their style gives him or her
ent, or when there are several children, one or leverage; and restructuring maneuvers trans-
more of the oldest children may be encouraged form the family structure. If the therapist

Structural therapists use


enactments to observe
and modify problematic
family patterns.
188 PART TWO ● The Classic Schools of Family Therapy

remains an outsider or uses interventions ing and modifying the structure of family
that are too dystonic, the family will reject transactions in the immediate context of the
him or her. If the therapist becomes too much session. Structural therapists work with what
a part of the family or uses interventions that they see going on in the session, not what fam-
are too syntonic, the family will assimilate the ily members describe. Action in the session,
interventions into previous transactional pat- family dynamics in process, is what structural
terns. In either case there will be no struc- family therapists deal with.
tural change. There are two types of live, in-session mater-
Joining and accommodating are considered ial on which structural family therapy focuses—
prerequisite to restructuring. To join the family enactments and spontaneous behavior sequences.
the therapist must convey acceptance of family An enactment occurs when the therapist stim-
members and respect for their way of doing ulates the family to demonstrate how they han-
things. Minuchin (1974) likened the family dle a particular type of problem. Enactments
therapist to an anthropologist who must first commonly begin when the therapist suggests
join a culture before being able to study it. that specific subgroups begin to discuss a par-
To join a family’s culture the therapist makes ticular problem. As they do so, the therapist
accommodating overtures—the sort of thing observes the family process. Working with en-
we usually do unthinkingly, although not al- actments requires three operations. First, the
ways successfully. If parents come for help with therapist defines or recognizes a sequence. For
a child’s problems, the therapist doesn’t begin example, the therapist observes that when
by asking for the child’s views. This conveys a mother talks to her daughter they talk as peers,
lack of respect for the parents and may lead and little brother gets left out. Second, the ther-
them to reject the therapist. Only after the ther- apist directs an enactment. For example, the
apist has successfully joined with a family is it therapist might say to the mother, “Talk this
fruitful to attempt restructuring—the often over with your kids.” Third, and most impor-
dramatic confrontations that challenge fami- tant, the therapist must guide the family to
lies and force them to change. modify the enactment. If mother talks to her
The first task is to understand the family’s children in such a way that she doesn’t take re-
view of their problems. The therapist does this sponsibility for major decisions, the therapist
by tracking their formulation in the content must guide her to do so as the family continues
they use to explain it and in the sequences with the enactment. All the therapist’s moves should
which they demonstrate it. Then the family create new options for the family, options for
therapist reframes their formulation into one more productive interactions.
based on an understanding of family structure. Once an enactment breaks down, the thera-
In fact, all psychotherapies use reframing. pist intervenes in one of two ways: comment-
Patients, whether individuals or families, come ing on what went wrong, or simply pushing
with their own views as to the cause of their them to keep going. For example, if a father re-
problems—views that usually haven’t helped sponds to the suggestion to talk with his twelve-
them solve the problems—and the therapist of- year-old daughter about how she’s feeling by
fers them a new and potentially more con- berating her, the therapist could say to the fa-
structive view of these same problems. What ther: “Congratulations.” Father: “What do you
makes structural family therapy unique is that mean?” Therapist: “Congratulations; you win,
it uses enactments within therapy sessions to she loses.” Or the therapist could simply nudge
make the reframing happen. This is the sine the transaction by saying to the father: “Good,
qua non of structural family therapy: observ- keep talking, but help her express her feelings
CHAPTER 7 ● Structural Family Therapy 189
more. She’s still a little girl; she needs your
help.”
In addition to working with enacted se-
quences, structural therapists are alert to spon-
T herapy
Assessment
taneous sequences that illustrate family
structure. Creating enactments is like directing Diagnosis implies knowledge: You describe
plays; working with spontaneous sequences is something and give it a name. Assessment
like focusing a spotlight on action that occurs deals with assumptions. A structural assess-
without direction. By observing and modifying ment is based on the assumption that a family’s
such sequences early in therapy the therapist difficulties often reflect problems in the way the
avoids getting bogged down in a family’s usual family is organized. It is assumed that if the or-
nonproductive ways of doing business. Dealing ganization shifts, the problem will shift. Per-
with problematic behavior as soon as it occurs haps it’s important to add, that difficulties often
enables the therapist to organize the session, to reflect problems in the way the whole family is
underscore the process, and to modify it. organized. Thus, it is assumed that if change
An experienced therapist develops hunches occurs between mother and daughter, things
about family structure even before the first in- will also change between husband and wife.
terview. For example, if a family is coming to Structural therapists make assessments first
the clinic because of a “hyperactive” child, it’s by joining with the family to build an alliance,
possible to guess something about the family and then by setting the family system in motion
structure and something about sequences that through the use of enactments, in-session dia-
may occur as the session begins, since “hyper- logues that permit the therapist to observe how
active” behavior is often a function of a child’s family members actually interact.
enmeshment with the mother. Mother’s rela- Suppose, for example, a young woman com-
tionship with the child may be a product of a plains of obsessional indecisiveness. In re-
lack of hierarchical differentiation within the sponding to the therapist’s questions during an
family; that is, parents and children relate to initial meeting with the family, a young woman
each other as peers, not as members of different becomes indecisive and glances at her father.
generations. Furthermore, mother’s overin- He speaks up to clarify what she was having
volvement with the “hyperactive” child is likely trouble explaining. Now the daughter’s indeci-
to be both a result and a cause of emotional dis- siveness could be linked to the father’s helpful-
tance from her husband. Knowing that this is a ness, suggesting a pattern of enmeshment.
common pattern, the therapist can anticipate When the therapist asks the parents to discuss
that early in the first session the “hyperactive” their opinions about their daughter’s problems,
child will begin to misbehave, and that the they have trouble talking without becoming re-
mother will be ineffective in dealing with this active and the discussion doesn’t last long. This
misbehavior. Armed with this informed guess suggests disengagement between the parents,
the therapist can spotlight (rather than enact) which may be related (as cause and effect) to
such a sequence as soon as it occurs. If the “hy- enmeshment between parent a child.
peractive” child begins to run around the room, Notice how the structural assessment ex-
and the mother protests but does nothing effec- tends beyond the presenting problem to include
tive, the therapist might say, “I see that your the whole family, and—let’s be frank—to the
child feels free to ignore you.” This challenge assumption that families with problems often
may push the mother to behave in a more com- have some kind of underlying structural prob-
petent manner. lem. However, it is important to note that
190 PART TWO ● The Classic Schools of Family Therapy

structural therapists make no assumptions ents about growing up in their own families in
about how families should be organized. Single- order to explore how their pasts helped make
parent families can be perfectly functional, as them the way that they are.

T
can families with two mommies (or daddies), or
indeed any other family variation. It is the fact
that a family seeks therapy for a problem they herapeutic Techniques
have been unable to solve that gives a therapist
license to assume that something about the In Families and Family Therapy, Minuchin
way this particular family is organized may not (1974) taught family therapists to see what
be working for them. they were looking at. Through the lens of struc-
Although structural assessments are fairly tural family theory, previously puzzling family
global—that is, they involve the basic organiza- interactions suddenly swam into focus. Where
tion of the whole family—making an assess- others saw only chaos and cruelty, Minuchin
ment is best done by focusing on the presenting saw structure: families organized into subsys-
problem and then exploring the family’s re- tems with boundaries. This enormously suc-
sponse to it. Consider the case of a thirteen- cessful book (over 200,000 copies in print) not
year-old girl whose parents complain that she only taught us to see enmeshment and disen-
lies. The first question might be, “Who is she gagement, but also let us hope that changing
lying to?” Let’s say the answer is both parents. them was just a matter of joining, enactment,
(Families rarely walk in and hand you their and unbalancing. Minuchin made changing
structure the way a student brings an apple to families look simple. It isn’t.
the teacher.) The next question would be, “How Anyone who watched Minuchin at work ten
good are the parents at detecting when the or twenty years after the publication of Families
daughter is lying?” And then, less innocently, and Family Therapy would see a creative thera-
“Which parent is better at detecting the daugh- pist still evolving, not someone frozen in time
ter’s lies?” Perhaps it turns out to be the mother. back in 1974. There would still be the patented
In fact, let’s say the mother is obsessed with de- confrontations (“Who’s the sheriff in this fam-
tecting the daughter’s lies—most of which ily?”) but there would be fewer enactments, less
have to do with seeking independence in ways stage-directed dialogue. We would also hear
that raise the mother’s anxiety. Thus a worried bits and pieces borrowed from Carl Whitaker
mother and a disobedient daughter are locked (“When did you divorce your wife and marry
in struggle over growing up that excludes the your job?”), Maurizio Andolfi (“Why don’t you
father. piss on the rug, too?”), and others. Minuchin
To carry this assessment further, a struc- combines many things in his work. To those fa-
tural therapist would explore the relationship miliar with his earlier work, all of this raises the
between the parents. The assumption would question: Is Minuchin still a structural family
not, however, be that the child’s problems are therapist? The question is, of course, absurd; we
the result of marital problems, but simply that raise it to make one point: Structural family
the mother–daughter relationship might be re- therapy isn’t a set of techniques; it’s a way of
lated to the relationship between the parents. looking at families.
Perhaps the parents got along famously until In the remainder of this section, we will pre-
their first child approached adolescence, and sent the classic outlines of structural family tech-
then the mother began to worry much more nique, with the caveat that once therapists
than the father. Whatever the case, the assess- master the basics of structural theory, they must
ment would also involve talking with the par- learn to translate the approach in a way that
CHAPTER 7 ● Structural Family Therapy 191
suits their own personal style. Implementing in- efforts to change them by people they feel don’t
terventions is an art; therapists must discover understand and accept them.
and create techniques that fit each family’s Individual patients generally enter treatment
transactional style and the therapist’s personal- already predisposed to accept the therapist’s au-
ity. Because every therapeutic session has idio- thority. By seeking therapy, an individual tacitly
syncratic features, there can be no immediacy if acknowledges a need for help and a willingness
the context is ignored. Imitating someone else’s to trust the therapist. Not so with families.
technique is stifling and ineffective—stifling be- The family therapist is an unwelcome out-
cause it doesn’t fit the therapist, ineffective be- sider. After all, why did she insist on seeing the
cause it doesn’t fit the family. whole family rather than just the official pa-
In Families and Family Therapy, Minuchin tient? Family members expect to be told that
(1974) listed three overlapping phases in the they’re doing something wrong, and they’re
process of structural family therapy. The thera- prepared to defend themselves. The family is
pist (1) joins the family in a position of leader- thus a group of nonpatients who feel anxious
ship; (2) maps their underlying structure; and and exposed; they’re set is to resist, not to
(3) intervenes to transform this structure. This cooperate.
program is simple, in the sense that it follows a First the therapist must disarm defenses and
clear plan, but immensely complicated because ease anxiety. This is done by building an al-
there are an endless variety of family patterns. liance of understanding with every single
Observed in practice, structural family ther- member of the family. The therapist greets each
apy is an organic whole, created out of the person by name and makes some kind of
very real human interaction of therapist and friendly contact.
family. To be genuine and effective, a therapist’s These initial greetings convey respect, not
moves cannot be preplanned or rehearsed. only for the individuals in the family, but also
Good therapists are more than technicians. for their hierarchical structure and organiza-
The strategy of therapy, on the other hand, tion. The therapist shows respect for parents by
must be thoughtfully planned. In general, the taking their authority for granted. They, not
strategy of structural family therapy follows their children, are asked first to describe the
these seven steps: problems. If a family elects one person to speak
1. Joining and accommodating for the others, the therapist notes this but does
2. Working with interaction not initially challenge it.
3. Structural mapping Children also have special concerns and ca-
4. Highlighting and modifying interactions pacities. They should be greeted gently and
5. Boundary making asked simple, concrete questions, “Hi, I’m so-
6. Unbalancing and-so; what’s your name? Oh, Shelly, that’s a
7. Challenging unproductive assumptions nice name. Where do you go to school, Shelly?”
With older children, try to avoid the usual sanc-
timonious grown-up questions (“And what do
Joining and Accommodating. Because you want to be when you grow up?”). Try some-
families have firmly established homeostatic thing a little fresher (like “What do you hate
patterns, effective family therapy requires chal- most about school?”). Those who wish to re-
lenge and confrontation. But assaults on a fam- main silent should be “allowed” to do so. They
ily’s habitual style will be dismissed unless will anyway, but the therapist who accepts their
they’re made from a position of acceptance and reticence will have made a valuable step toward
understanding. Families, like you and me, resist keeping them involved. “And what’s your view
192 PART TWO ● The Classic Schools of Family Therapy

of the problem?” (Grim silence.) “I see, you any good, he (or she) doesn’t listen”; or “But
don’t feel like saying anything right now? you’re supposed to be the expert.”
That’s fine; perhaps you’ll have something to If the therapist begins by giving each person
say later.” a chance to speak, usually one will say some-
Failure to join and accommodate produces thing about another that can be a springboard
resistance, which is often blamed on the family. for an enactment. When, for example, one par-
It may be comforting to blame others when ent says that the other is too strict, the therapist
things don’t go well, but it doesn’t improve mat- can develop an enactment by saying: “She says
ters. Family members can be called “negative,” you’re too strict; can you answer her?” Picking
“rebellious,” “resistant,” or “defiant,” and seen a specific point for response is more effective
as “unmotivated”; but it’s more useful to make than a vague request, such as “Why don’t you
an extra effort to connect with them. two talk this over?”
It’s particularly important to join powerful Once an enactment is begun, the therapist
family members, as well as angry ones. Special can discover many things about a family’s
pains must be taken to accept the point of view structure. How long can two people talk with-
of the father who thinks therapy is hooey or the out being interrupted—that is, how clear is the
angry teenager who feels like an accused crim- boundary? Does one attack, the other defend?
inal. It’s also important to reconnect with such Who is central, who peripheral? Do parents
people at frequent intervals, particularly as bring children into their discussions—that is,
things begin to heat up. are they enmeshed?
A useful beginning is to greet the family and Families demonstrate enmeshment by fre-
then ask for each person’s view of the prob- quently interrupting each other, speaking for
lems. Listen carefully and acknowledge each other family members, doing things for chil-
person’s position by reflecting what you hear. dren that they can do for themselves, or by con-
“I see, Mrs. Jones, you think Sally must be de- stantly arguing. In disengaged families one
pressed about something that happened at may see a husband sitting impassively while his
school.” “So Mr. Jones, you see some of the wife cries; a total absence of conflict; a surpris-
same things your wife sees, but you’re not con- ing ignorance of important information about
vinced it’s that serious a problem. Is that the children; a lack of concern for each other’s
right?” interests.
If, as soon as the first session starts, the kids
Working with Interaction. Family struc- begin running around the room while the par-
ture is manifest in the way family members in- ents protest ineffectually, the therapist doesn’t
teract. It can’t always be inferred from their need to hear descriptions of what goes on at
descriptions. Therefore, asking questions such home to see the executive incompetence. If a
as “Who’s in charge?” or “Do you two agree?” mother and daughter rant and rave at each
tends to be unproductive. Families generally de- other while the father sits silently in the corner,
scribe themselves more as they think they it isn’t necessary to ask how involved he is at
should be than as they are. home. In fact, asking may yield a less accurate
Getting family members to talk among picture than the one revealed spontaneously.
themselves runs counter to their expectations.
They expect to present their case to an expert Structural Mapping. Families usually con-
and then be told what to do. If asked to discuss ceive of problems as located in the identified
something in the session, they’ll say: “We’ve patient and as determined by events from the
talked about this many times”; or “It won’t do past. They hope the therapist will change the
CHAPTER 7 ● Structural Family Therapy 193
identified patient—with as little disruption to What do you imagine the structure might be,
the family as possible. Family therapists regard and how would you test your hypothesis? A
the identified patient’s symptoms as an expres- good guess might be that mother and daughter
sion of dysfunctional patterns affecting the are enmeshed, excluding the stepfather. This
whole family. A structural assessment broad- can be tested by seeing if mother and daughter
ens the problem beyond individuals to the fam- tend to talk mostly about each other in the
ily system, and moves the focus from discrete session—whether positively or negatively. The
events in the past to ongoing transactions in stepfather’s disengagement would be con-
the present. firmed if he and his wife were unable to con-
Even family therapists often categorize fam- verse without the daughter’s intrusion.
ilies with constructs that apply more to individ- Structural assessments take into account
uals than to systems. “The problem in this both the problem the family presents and the
family is that the mother is smothering the structural dynamics they display. And they in-
kids,” or “These kids are defiant,” or “He’s un- clude all family members. In this instance,
involved.” Structural family therapists diag- knowing that the mother and daughter are en-
nose so as to describe the interrelationship of meshed isn’t enough; you also have to know
all family members. Using the concepts of what role the stepfather plays. If he’s reason-
boundaries and subsystems, the structure ably close with his wife but distant from the
of the whole system is described in a way that daughter, finding mutually enjoyable activities
points to desired changes. for stepfather and stepdaughter will help in-
Preliminary assessments are based on ob- crease the girl’s independence from her mother.
served interactions in the first session. In later On the other hand, if the mother’s proximity to
sessions these formulations are refined and re- her daughter appears to be a function of her
vised. Although there is some danger of bend- distance from her husband, then the marital
ing families to fit categories when they’re pair may be the most productive focus.
applied early, the greater danger is waiting too Without a structural formulation and a
long. We see people with the greatest clarity plan, a therapist is defensive and passive. In-
and freshness during the initial contact. Later, stead of knowing where to go and moving de-
as we come to know them better, we get used to liberately, the therapist lays back and tries to
their idiosyncrasies and soon no longer notice cope with the family, to put out brush fires, and
them. to help them through a succession of incidents.
Families quickly induct therapists into their Consistent awareness of the family’s structure
culture. A family that initially appears to be and focus on one or two structural changes
chaotic and enmeshed soon comes to be just helps the therapist see behind the various con-
the familiar Jones family. For this reason, it’s tent issues that family members bring up.
critical to develop structural hypotheses as
quickly as possible. Highlighting and Modifying Interactions.
In fact, it’s helpful to make some guesses Once families begin to interact, problematic
about family structure even before the first ses- transactions emerge. Recognizing their struc-
sion. This starts a process of active thinking tural implications demands focus on process,
and sets the stage for observing the family. For not content. Nothing about structure is re-
example, suppose you’re about to see a family vealed by hearing who is in favor of punish-
consisting of a mother, a sixteen-year-old ment or who says nice things about whom.
daughter, and a stepfather. The mother called Family structure is revealed by who says what
to complain of her daughter’s misbehavior. to whom, and in what way.
194 PART TWO ● The Classic Schools of Family Therapy

Perhaps a wife complains, “We have a com- therapists don’t need to make speeches, but
munication problem. My husband won’t talk to they do occasionally have to speak forcefully to
me; he never expresses his feelings.” The thera- get the point across.
pist then stimulates an interaction to see what Affective intensity isn’t simply a matter of
actually does happen. “Your wife says you have crisp phrasing. You have to know how and
a communication problem; can you respond to when to be provocative. For example, Mike
that? Talk with her.” If, when they talk, the wife Nichols worked with a family in which a
becomes domineering and critical while the twenty-nine-year-old woman with anorexia
husband grows increasingly silent, then the nervosa was the identified patient. Although
therapist sees what’s wrong: The problem isn’t the family maintained a facade of togetherness,
that he doesn’t talk, which is a linear explana- it was rigidly structured; the mother and her
tion. Nor is the problem that she nags, also a anorexic daughter were enmeshed, while the
linear explanation. The problem is that the father was excluded. In this family, the father
more she nags, the more he withdraws, and the was the only one to express anger openly, and
more he withdraws, the more she nags. this was part of the official rationale for why he
The trick is to modify this pattern. This may was excluded. His daughter was afraid of his
require forceful intervening, or what structural anger, which she freely admitted. What was less
therapists call intensity. clear, however, was that the mother had
Minuchin speaks to families with dramatic covertly taught the daughter to avoid him, be-
and forceful impact. He regulates the intensity cause she, the mother, couldn’t deal with his
of his messages to exceed the threshold family anger. Consequently, the daughter grew up
members have for not hearing challenges to the afraid of her father, and of men in general.
way they perceive reality. When Minuchin At one point the father described how iso-
speaks, families listen. lated he felt from his daughter; he said he
Minuchin is forceful, but his intensity isn’t thought it was because she feared his anger.
merely a function of personality; it reflects clar- The daughter agreed, “It’s his fault, all right.”
ity of purpose. Knowledge of family structure The therapist asked the mother what she
and a commitment to help families change thought, and she replied, “It isn’t his fault.” The
makes powerful interventions possible. therapist said, “You’re right.” She went on,
Structural therapists achieve intensity by se- denying her real feelings to avoid conflict, “It’s
lective regulation of affect, repetition, and du- no one’s fault.” The therapist answered in a
ration. Tone, volume, pacing, and choice of way that got her attention, “That’s not true.”
words can be used to raise the affective inten- Startled, she asked what he meant. “It’s your
sity of statements. It helps if you know what fault,” he said.
you want to say. Here’s an example of a limp This level of intensity was necessary to in-
statement: “People are always concerned with terrupt a rigid pattern of conflict avoidance
themselves, kind of seeing themselves as the that sustained a destructive alliance between
center of attention and just looking for what- mother and daughter. The content—who really
ever they can get. Wouldn’t it be nice, for a is afraid of anger—is less important than the
change, if everybody started thinking about structural goal: freeing the daughter from her
what they could do for others?” Compare that position of overinvolvement with her mother.
with, “Ask not what your country can do for Therapists too often dilute their interven-
you—ask what you can do for your country.” tions by overqualifying, apologizing, or ram-
John Kennedy’s words had impact because they bling. This is less of a problem in individual
were carefully chosen and clearly put. Family therapy, where it’s often best to elicit interpreta-
CHAPTER 7 ● Structural Family Therapy 195
tions from the patient. Families are more like the suggesting they do something different has the
farmer’s proverbial mule—you sometimes have effect of criticizing their competence. However
to hit them over the head to get their attention. well-intentioned, it’s still a put-down. While
Intensity can also be achieved by extending this kind of intervention cannot be completely
the duration of a sequence beyond the point avoided, a more effective approach is to point
where the dysfunctional homeostasis is rein- out what they’re doing right.
stated. A common example is the management Even when people do most things ineffec-
of temper tantrums. Temper tantrums are tively, it’s usually possible to pick out something
maintained by parents who give in. Most par- that they’re doing successfully. A sense of timing
ents try not to give in; they just don’t try long helps. For example, in a large chaotic family the
enough. Recently a four-year-old girl began to parents were extremely ineffective at controlling
scream bloody murder when her sister left the the children. At one point the therapist turned to
room. She wanted to go with her sister. Her the mother and said, “It’s too noisy in here;
screaming was almost unbearable, and the par- would you quiet the kids?” Knowing how much
ents were soon ready to back down. However, difficulty the woman had controlling her chil-
the therapist urged that they not allow them- dren, the therapist was poised to comment im-
selves to be defeated, and suggested that they mediately on any step in the direction of effective
hold her “to show her who’s in charge” until management. The mother had to yell “Quiet!” a
she calmed down. She screamed for thirty min- couple of times before the children momentarily
utes! Everyone in the room was frazzled. But the stopped what they were doing. Quickly—before
little girl finally realized that this time she was the children resumed their misbehavior—the
not going to get her way, and so she calmed therapist complimented the mother for “loving
down. Subsequently, the parents were able to her kids enough to be firm with them.” Thus the
use the same intensity of duration to break her message delivered was “You’re a competent per-
of this highly destructive habit. son, you know how to be firm.” If the therapist
Sometimes intensity requires repetition of had waited until the chaos resumed before tell-
one theme in a variety of contexts. Infantilizing ing the mother she should be firm, the message
parents may have to be told not to hang up would be “You’re incompetent.”
their child’s coat, not to speak for her, not to Wherever possible, structural therapists avoid
take her to the bathroom, and not to do many doing things for family members that they’re ca-
other things that she’s able to do for herself. pable of doing themselves. Here, too, the mes-
Shaping competence is another method of sage is “You are competent, you can do it.” Some
modifying interactions, and it’s a hallmark of therapists justify taking over family functions by
structural family therapy. Intensity is generally calling it “modeling.” Whatever it’s called it has
used to block the stream of interactions. Shap- the impact of telling family members that they’re
ing competence is like nudging the direction of inadequate. Recently a young mother confessed
the flow. By highlighting and shaping the pos- she hadn’t known how to tell her children that
itive, structural therapists help family members they were coming to see a family therapist and so
use functional alternatives that are already in had simply said she was taking them for a ride.
their repertoire. Thinking to be helpful, the therapist then ex-
A common mistake made by beginning ther- plained to the children that “Mommy told me
apists is to attempt to foster competent perfor- there were some problems in the family, so we’re
mance by pointing out mistakes. This focuses all here to talk things over to see if we can im-
on content without regard for process. Telling prove things.” This lovely explanation tells the
parents that they’re doing something wrong or kids why they came, but confirms the mother as
196 PART TWO ● The Classic Schools of Family Therapy

incompetent to do so. If instead the therapist move closer toward each other. This was done in
had suggested to the mother, “Would you like to stages. First the therapist joined the oldest child,
tell them now?” Then the mother, not the ther- a sixteen-year-old girl, and supported her com-
apist, would have had to perform as an effective petence as a potential helper for her mother.
parent. Once this was done, the girl was able to assume
a good deal of responsibility for her younger sib-
Boundary Making. Dysfunctional family dy- lings, both in sessions and at home.
namics are a product of overly rigid or diffuse Freed from preoccupation with the chil-
boundaries. Structural therapists intervene to dren, the parents now had the opportunity to
realign boundaries, increasing either proximity talk more with each other. They had little to
or distance between family subsystems. say, however. This wasn’t the result of hidden
In enmeshed families the therapist’s inter- conflict but instead reflected the marriage of
ventions are designed to strengthen boundaries two relatively nonverbal people. After several
between subsystems and increase the indepen- sessions of trying to get the pair talking, the
dence of individuals. Family members are therapist realized that while talking may be
urged to speak for themselves, interruptions are fun for some people, it might not be for others.
blocked, and dyads are helped to finish conver- So to support the bond between the couple the
sations without intrusion from others. A ther- therapist asked them to plan a special trip to-
apist who wishes to support the sibling system gether. They chose a boat ride on a nearby lake.
and protect it from unnecessary parental intru- When they returned for the next session, they
sion may say, “Susie and Sean, talk this over, were beaming. They had a wonderful time,
and everyone else will listen carefully.” If chil- being apart from the kids and enjoying each
dren frequently interrupt their parents, a ther- other’s company. Subsequently they decided to
apist might challenge the parents to strengthen spend a little time out together each week.
the hierarchical boundary by saying, “Why Disengaged families tend to avoid conflict,
don’t you get them to butt out so that you two and thus minimize interaction. The structural
grown-ups can settle this.” therapist intervenes to challenge conflict avoid-
Although structural family therapy is begun ance, and to block detouring in order to help
with the total family group, subsequent sessions disengaged members increase contact with
may be held with individuals or subgroups to each other. Without acting as judge or referee,
strengthen the boundaries surrounding them. the structural therapist encourages family
A teenager who is overprotected by her mother members to face each other squarely and strug-
is supported as a separate person by participat- gle with the difficulties between them. When
ing in some individual sessions. Parents so en- beginners see disengagement, they tend to
meshed with their children that they never have think of ways to increase positive interaction.
private conversations may begin to learn how if In fact, disengagement is usually a way of
they meet separately with the therapist. avoiding arguments. Therefore, spouses iso-
When a forty-year-old woman called the lated from each other typically need to fight be-
clinic for help with depression, she was asked to fore they can become more loving.
come in with the rest of the family. It soon be- Most people underestimate the degree to
came apparent that this woman was overbur- which their own behavior influences the behav-
dened by her four children and received little ior of those around them. This is particularly
support from her husband. The therapist’s strat- true in disengaged families. Problems are usu-
egy was to strengthen the boundary between ally seen as the result of what someone else is
the mother and children and help the parents doing, and solutions are thought to require that
CHAPTER 7 ● Structural Family Therapy 197
the others change. The following complaints are Taking sides—let’s call it what it is—seems
typical: “We have a communication problem; he like a violation of therapy’s sacred canon of
won’t tell me what he’s feeling.” “He just doesn’t neutrality. However, the therapist takes sides to
care about us. All he cares about is that damn job unbalance and realign the system, not because
of his.” “Our sex life is lousy—my wife’s frigid.” she is the judge of who’s right and wrong. Ulti-
“Who can talk to her? All she does is complain mately, balance and fairness are achieved be-
about the kids.” Each of these statements sug- cause the therapist sides in turn with various
gests that the power to change rests solely with members of the family.

Case Study
the other person. This is the almost universally
perceived view of linear causality.
Whereas most people see things this way,

F
family therapists see the inherent circularity in or example, when the MacLean family sought help for
systems interaction. He doesn’t tell his wife an “unmanageable” child, a terror who’d been expelled
what he’s feeling, because she nags and criti- from two schools, Dr. Minuchin uncovered a covert split be-
cizes; and she nags and criticizes because he tween the parents, held in balance by not being talked
doesn’t tell her what he’s feeling. about. The ten-year-old boy’s misbehavior was dramatically
Structural therapists move family discus- visible; his father had to drag him kicking and screaming
sions from linear to circular perspectives by into the consulting room. Meanwhile, his seven-year-old
stressing complementarity. The mother who brother sat quietly, smiling engagingly. The good boy.
complains that her son is naughty is taught to To broaden the focus from an “impossible child” to is-
consider what she’s doing to trigger or main- sues of parental control and cooperation, Minuchin asked
tain his behavior. The one who asks for change about seven-year-old Kevin, who misbehaved invisibly. He
must learn to change his or her way of trying peed on the floor in the bathroom. According to his father,
to get it. The wife who nags her husband to Kevin’s peeing on the floor was due to “inattentiveness.”
spend more time with her must learn to make The mother laughed when Minuchin said “nobody could
increased involvement more attractive. The have such poor aim.”
husband who complains that his wife never lis- Minuchin talked with the boy about how wolves mark
tens to him may have to listen to her more, be- their territory, and suggested that he expand his territory
fore she’s willing to reciprocate. by peeing in all four corners of the family room.
Minuchin emphasizes complementarity by
asking family members to help each other Minuchin: “Do you have a dog?”
change. When positive changes are reported, Kevin: “No.”
he’s liable to congratulate others, underscoring Minuchin: “Oh, so you are the family dog.”
family interrelatedness. In the process of discussing the boy who peed—and
his parents’ response—Minuchin dramatized how the par-
Unbalancing. In boundary making the ther- ents polarized each other.
apist aims to realign relationships between sub-
systems. In unbalancing, the goal is to change Minuchin: “Why would he do such a thing?”
the relationship of members within a subsys- Father: “I don’t know if he did it on purpose.”
tem. What often keeps families stuck in stale- Minuchin: “Maybe he was in a trance?”
“No, I think it was carelessness.”
mate is that members in conflict check and Father:

“His aim must be terrible.”


balance each other and, as a result, remain Minuchin:

frozen in inaction. In unbalancing, the thera- The father described the boy’s behavior as accidental;
pist joins and supports one individual or sub- the mother considered it defiance. One of the reasons par-
system at the expense of others. ents fall under the control of their young children is that
198 PART TWO ● The Classic Schools of Family Therapy

they avoid confronting their differences. Differences are combat. When a therapist says to a father that
normal, but they become toxic when one parent under- he’s not doing enough or to a mother that she’s
cuts the other’s handling of the children. (It’s cowardly re- unwittingly excluding her husband, it may
venge for unaddressed grievances.) seem that the combat is between the therapist
Minuchin’s gentle but insistent pressure on the couple and the family, that he or she is attacking them.
to talk about how they respond, without switching to focus But the real combat is between them and fear—
on how the children behave, led to their bringing up long- fear of change.
held but seldom-voiced resentments.
“Bob makes excuses for the children’s behavior Challenging Unproductive Assumptions.
Mother:

because he doesn’t want to get in there and help me find Although structural family therapy is not pri-
a solution for the problem.” marily a cognitive treatment, its practitioners
Father: “Yes, but when I did try to help, you’d always criti- sometimes challenge the way family members
cize me. So after a while I gave up.” see things. Changing the way family members
relate to each other offers alternative views of
Like a photographic print in a developing tray, the their situation. The converse is also true:
spouses’ conflict had become visible. Minuchin protected Changing the way family members view their
the parents from embarrassment (and the children from situation enables them to change the way they
being burdened) by asking the children to leave the room. relate to each other.
Without the preoccupation of parenting, the spouses could When six-year-old Cassie’s parents com-
face each other, man and woman—and talk about their plain about her behavior, they say she’s
hurts and grievances. It turned out to be a sad story of “hyper,” “sensitive,” a “nervous child.” Such la-
lonely disengagement. bels convey how parents respond to their chil-
Minuchin: “Do you two have areas of agreement?” dren and have a tremendous controlling power.
He said yes; she said no. He was a minimizer; she was
Is a child’s behavior “misbehavior,” or is it a
a critic.
symptom of “nervousness?” Is it “naughty,” or
is it a “cry for help?” Is the child mad or bad,
Minuchin: “When did you divorce Bob and marry the and who is in charge? What’s in a name?
children?” Plenty.
She turned quiet; he looked off into space. She said, Sometimes the structural family therapist
softly: “Probably ten years ago.” acts as teacher, offering information and ad-
What followed was a painful but familiar story of how a vice, often about structural matters. Doing so is
marriage can drown in parenting and its conflicts. The con- likely to be a restructuring maneuver and must
flict was never resolved because it never surfaced. And so be done in a way that minimizes resistance. A
the rift never healed; it just expanded. therapist does this by delivering first a “stroke,”
With Minuchin’s help, the couple took turns talking then a “kick.” If the therapist were dealing with
about their pain—and learning to listen. By unbalancing, a family in which the mother speaks for her
Minuchin brought enormous pressure to bear to help this children, he might say to her, “You are very
couple break through their differences, open up to each helpful” (stroke). But to the child, “Mommy
other, fight for what they want, and, finally, begin to come takes away your voice. You can speak for your-
together—as husband and wife, and as parents. self” (kick). Thus mother is defined as helpful
but intrusive (a stroke and a kick).
Structural therapists also use pragmatic fic-
tions to provide family members with a differ-
Unbalancing is part of a struggle for change ent frame for experiencing. The aim isn’t to
that sometimes takes on the appearance of educate or deceive, but to offer a pronounce-
CHAPTER 7 ● Structural Family Therapy 199
ment that will help the family change. For in- their results favorably to the usual 50 percent
stance, telling children that they’re behaving rate of successful treatment at Wiltwyck. The
younger than they are is a very effective means authors also noted that none of the families
of getting them to change. “How old are you?” rated as disengaged improved.
“Seven.” “Oh, I thought you were younger; By far the strongest empirical support for
most seven-year-olds don’t need Mommy to structural family therapy comes from a series of
take them to school anymore.” studies with psychosomatic children and adult
Paradoxes are cognitive constructions that drug addicts. Studies demonstrating the effec-
frustrate or confuse family members into a tiveness of therapy with severely ill psychoso-
search for alternatives. Minuchin makes little matic children are convincing because of the
use of paradox, but sometimes it’s helpful to ex- physiological measures employed, and dra-
press skepticism about people changing. Al- matic because of the life-threatening nature of
though this can have the paradoxical effect of the problems. Minuchin, Rosman, and Baker
challenging them to prove you wrong, it isn’t so (1978) reported one study that clearly demon-
much a clever stratagem as it is a benign state- strated how family conflict can precipitate ke-
ment of the truth. Most people don’t change— toacidosis crises in psychosomatic-type diabetic
they wait for others to do so. children. In baseline interviews parents dis-

E valuating Therapy
Theory and Results
cussed family problems with their children ab-
sent. Normal spouses showed the highest levels
of confrontation, while psychosomatic spouses
exhibited a wide range of conflict-avoidance
maneuvers. Next, a therapist pressed the par-
While he was Director of the Philadelphia Child ents to increase the level of their conflict, while
Guidance Clinic, Minuchin developed a highly their children observed behind a one-way mir-
pragmatic commitment to research. As an ad- ror. As the parents argued, only the psychoso-
ministrator he learned that research demon- matic children seemed really upset. Moreover,
strating effective outcomes is the best argument these children’s manifest distress was accom-
for the legitimacy of family therapy. Both his panied by dramatic increases in free fatty acid
studies of psychosomatic children and Stan- levels of the blood, a measure related to ke-
ton’s studies of drug addicts show very clearly toacidosis. In the third stage of these inter-
how effective structural family therapy can be. views, the patients joined their parents. Normal
In Families of the Slums, Minuchin and his and behavior-disorder parents continued as be-
colleagues (1967) described the structural fore, but the psychosomatic parents detoured
characteristics of low socioeconomic families their conflict, either by drawing their children
and demonstrated the effectiveness of family into their discussions or by switching the sub-
therapy with this population. Prior to treat- ject from themselves to the children. When this
ment, mothers in patient families were found to happened, the free fatty acid levels of the par-
be either over- or undercontrolling; either way ents fell, while the children’s levels continued to
their children were more disruptive than those rise. This study provided strong confirmation of
in control families. After treatment mothers the clinical observations that psychosomatic
used less coercive control, yet were clearer and children are used (and let themselves be used)
more firm. In this study, seven of eleven fami- to regulate the stress between their parents.
lies were judged to be improved after six months Minuchin, Rosman, and Baker (1978) sum-
to a year of family therapy. Although no con- marized the results of treating fifty-three cases
trol group was used, the authors compared of anorexia nervosa with structural family
200 PART TWO ● The Classic Schools of Family Therapy

therapy. After a course of treatment that in- ily therapy with a family placebo condition and
cluded hospitalization followed by family ther- individual therapy. Symptom reduction was
apy on an outpatient basis, forty-three anorexic significant with structural family therapy; the
children were “greatly improved,” two were level of positive change was more than double
“improved,” three showed “no change,” two that achieved in the other conditions, and these
were “worse,” and three had dropped out. Al- positive effects persisted at follow-up of six and
though ethical considerations precluded a con- twelve months.
trol treatment with these seriously ill children, More recently, structural family therapy has
the 90 percent improvement rate is impressive, been successfully applied to establish more
especially compared with the 30 percent mor- adaptive parenting roles in heroin addicts (Grief
tality rate for this disorder. Moreover, the posi- & Dreschler, 1993) and as a means to reduce
tive results at termination were maintained at the likelihood that African American and
follow-up intervals of several years. Structural Latino youths would initiate drug use (Santise-
family therapy has also been shown to be effec- ban, Coatsworth, Perez-Vidal, Mitrani, Jean-
tive in treating psychosomatic asthmatics and Gilles, & Szapocznik, 1997). Other studies
psychosomatically complicated cases of dia- indicate that structural family therapy is equal
betes (Minuchin, Baker, Rosman, Liebman, Mil- in effectiveness to communication training and
man, & Todd, 1975). behavioral management training in reducing
While no body of empirical evidence has es- negative communication, conflicts, and ex-
tablished that any one psychotherapeutic ap- pressed anger between adolescents diagnosed
proach is consistently better than the others, with attention deficit hyperactivity disorder
structural family therapy has proven to be ef- (ADHD) and their parents (Barkley, Guevre-
fective in a variety of studies, including many mont, Anastopoulos, & Fletcher, 1992). Struc-
that involved what are usually considered very tural family therapy has also been effective for
difficult cases. Duke Stanton showed that struc- treating adolescent disorders, such as conduct
tural family therapy can be effective for drug disorders (Szapocznik et al., 1989; Chamber-
addicts and their families. In a well-controlled lain & Rosicky, 1995), and anorexia nervosa
study, Stanton and Todd (1979) compared fam- (Campbell & Patterson, 1995).

Summary
Minuchin may be best known for the artistry they provide a clear organizing framework for
of his clinical technique, yet his structural understanding and treating families.
family theory has become one of the most The single most important tenet of this ap-
widely used conceptual models in the field. proach is that every family has a structure, and
The reason structural theory is so popular that this structure is revealed only when the
is that it’s simple, inclusive, and practical. family is in action. According to this view, ther-
The basic concepts—boundaries, subsystems, apists who fail to consider the entire family’s
alignments, and complementarity—are easily structure, and intervene in only one subsys-
grasped and applied. They take into account tem, are unlikely to effect lasting change. If a
the individual, family, and social context, and mother’s overinvolvement with her son is part
CHAPTER 7 ● Structural Family Therapy 201
of a structure that includes distance from her activate dormant structures using techniques
husband, no amount of therapy for the mother that alter alignments and shift power within
and son is likely to bring about basic change in and between subsystems. These restructuring
the family. techniques are concrete, forceful, and some-
Subsystems are units of the family based on times dramatic. However, their success depends
function. If the leadership of a family is taken as much on the joining and assessment as on
over by a father and daughter, then they, not the the power of the techniques themselves.
husband and wife, are the executive subsystem. Structural family therapy’s popularity is
Subsystems are circumscribed and regulated by based on its theory and techniques of treat-
interpersonal boundaries. In healthy families ment; its central position in the field has been
boundaries are clear enough to protect indepen- augmented by its research and training pro-
dence and autonomy, and permeable enough to grams. There is now a substantial body of re-
allow mutual support and affection. Enmeshed search that lends considerable empirical
families are characterized by diffuse boundaries; support to this school’s approach. Moreover,
disengaged families by rigid boundaries. the training programs at the Philadelphia Child
Structural family therapy is designed to re- Guidance Clinic and Minuchin Center in New
solve presenting problems by reorganizing York have influenced an enormous number of
family structure. Assessment, therefore, re- family therapy practitioners throughout the
quires the presence of the whole family, so that world.
the therapist can observe the structure under- Although structural family therapy is so
lying the family’s interactions. In the process, closely identified with Salvador Minuchin that
therapists should distinguish between dys- they once were synonymous, it may be a good
functional and functional structures. Families idea to differentiate the man from the method.
with growing pains shouldn’t be treated as When we think of structural family therapy, we
pathological. Where structural problems do tend to remember the approach as described in
exist, the goal is to create an effective hierar- Families and Family Therapy, published in 1974.
chical structure. This means activating dor- That book adequately represents structural
mant structures, not creating new ones. theory, but emphasizes only the techniques
Structural family therapists work quickly to Minuchin favored at the time. Minuchin, the
avoid being inducted as members of the families thinker, has always thought of families in orga-
they work with. They begin by making con- nizational terms. He read Talcott Parsons and
certed efforts to accommodate to the family’s Robert Bales and George Herbert Mead; and in
accustomed ways of behaving, in order to cir- Israel he saw how children from unstructured
cumvent resistance. Once they’ve gained a fam- Moroccan families often became delinquents,
ily’s trust, therapists promote family interaction, while those from organized Yemenite families
while they assume a decentralized role. From did not. Minuchin the therapist has always
this position they can watch what goes on in the been an opportunist, using whatever works. In
family and make a structural assessment, which the 1990s, you can see Carl Whitaker and
includes the problem and the organization that constructivism in Minuchin’s work. From
supports it. These assessments are framed in Whitaker, he took the idea of challenging fam-
terms of boundaries and subsystems, easily con- ilies’ myths and engaging with them from a po-
ceptualized as two-dimensional maps used to sition of passionate involvement. The young
suggest avenues for change. Minuchin followed families and watched them
Once they have successfully joined and as- in action; that’s why he made such use of en-
sessed a family, structural therapists proceed to actments. The older Minuchin, who has seen
202 PART TWO ● The Classic Schools of Family Therapy

thousands of families, now sees things faster; perhaps he likes the doctrine of constructivism
he uses enactment less and is likely to confront simply because it legitimizes his storytelling.
one family on the basis of what he has seen in But, he cautions, when constructivism isn’t
hundreds of similar cases. Should we follow grounded in structural understanding or when
him in this? Yes, as soon as we have the same it neglects the emotional side of human beings,
experience. it can become arid intellectualism. Minuchin
Minuchin has always been a constructivist, has moved toward eclecticism in technique, but
though he comes by it intuitively, not from not in theory. Although Minuchin the therapist
reading books. He challenges families, telling has changed since 1974, his basic perspective
them, essentially, that they are wrong; their on families, described in structural family the-
stories are too narrow. And he helps them ory, still stands, and continues to be the most
rewrite stories that work. Minuchin has always widely used way of understanding what goes
been interested in literature and storytelling; on in the nuclear family.

Recommended Readings
Colapinto J. 1991. Structural family therapy. In Hand- Minuchin, S., and Nichols, M. P. 1993. Family healing:
book of family therapy, vol. II, A. S. Gurman and Tales of hope and renewal from family therapy. New
D. P. Kniskern, eds. New York: Brunner/Mazel. York: Free Press.
Minuchin, S. 1974. Families and family therapy. Cam- Minuchin, S., Rosman, B. L., and Baker, L. 1978. Psy-
bridge, MA: Harvard University Press. chosomatic families: Anorexia nervosa in context.
Minuchin, S., and Fishman, H. C. 1981. Family ther- Cambridge, MA: Harvard University Press.
apy techniques. Cambridge, MA: Harvard Univer- Nichols, M. P. 1999. Inside family therapy. Boston:
sity Press. Allyn & Bacon.
Minuchin, S., Lee, W-Y., and Simon, G. M. 1996. Nichols, M. P. and Minuchin, S. 1999. Short-term
Mastering family therapy: Journeys of growth and structural family therapy with couples. In Short-
transformation. New York: Wiley. term couple therapy, J. M. Donovad, ed. New York:
Minuchin, S., Montalvo, B., Guerney, B., Rosman, B., Guilford Press.
and Schumer, F. 1967. Families of the slums. New
York: Basic Books.

References
Barkley, R., Guevremont, D., Anastopoulos, A., and Chamberlain, P., and Rosicky, J. 1995. The effective-
Fletcher, K. 1992. A comparison of three family ness of family therapy in the treatment of adoles-
therapy programs for treating family conflicts in cents with conduct disorders and delinquency.
adolescents with attention-deficit hyperactivity Journal of Marital and Family Therapy. 21:441–459.
disorder. Journal of Consulting and Clinical Psychol- Colapinto, J. 1991. Structural family therapy. In Hand-
ogy. 60:450–463. book of family therapy, vol. II. A. S. Gurman and
Campbell, T., and Patterson, J. 1995. The effective- D. P. Kniskern, eds. New York: Brunner/Mazel.
ness of family interventions in the treatment of Elizur, J., and Minuchin, S. 1989. Institutionalizing
physical illness. Journal of Marital and Family Ther- madness: Families, therapy, and society. New York:
apy. 21:545–584. Basic Books.
CHAPTER 7 ● Structural Family Therapy 203
Grief, G., and Dreschler, L. 1993. Common issues for Minuchin, S., Rosman, B., and Baker, L. 1978. Psy-
parents in a methadone maintenance group. Jour- chosomatic families: Anorexia nervosa in context.
nal of Substance Abuse Treatment. 10: 335–339. Cambridge, MA: Harvard University Press.
Minuchin, S. 1974. Families and family therapy. Cam- Santiseban, D., Coatsworth, J., Perez-Vidal, A., Mi-
bridge, MA: Harvard University Press. trani, V., Jean-Gilles, M., and Szapocznik, J. 1997.
Minuchin, S., Baker, L., Rosman, B., Liebman, R., Mil- Brief structural/strategic family therapy with
man, L., and Todd, T. C. 1975. A conceptual African American and Hispanic high-risk youth.
model of psychosomatic illness in children. Journal of Community Psychology. 25:453–471.
Archives of General Psychiatry. 32:1031–1038. Simon, G. M. 1995. A revisionist rendering of struc-
Minuchin, S., and Fishman, H. C. 1981. Family ther- tural family therapy. Journal of Marital and Family
apy techniques. Cambridge, MA: Harvard Univer- Therapy. 21:17–26.
sity Press. Stanton, M. D., and Todd, T. C. 1979. Structural fam-
Minuchin, S., Lee, W-Y., and Simon, G. M. 1996. ily therapy with drug addicts. In The family therapy
Mastering family therapy: Journeys of growth and of drug and alcohol abuse, E. Kaufman and P. Kauf-
transformation. New York: Wiley. mann, eds. New York: Gardner Press.
Minuchin, S., Montalvo, B., Guerney, B., Rosman, B., Szapocznik, J., Rio, A., Murray, E., Cohen, R., Scopetta,
and Schumer, F. 1967. Families of the slums. New M., Rivas-Vazquez, A., Hervis, O., Posada, V., and
York: Basic Books. Kurtines, W. 1989. Structural family versus psy-
Minuchin, S., and Nichols, M. P. 1993. Family healing: chodynamic child therapy for problematic His-
Tales of hope and renewal from family therapy. New panic boys. Journal of Consulting and Clinical
York: Free Press. Psychology. 57:571–578.