Article

The Family Journal: Counseling and

Therapy for Couples and Families
Structural Family Therapy With 2018, Vol. 26(2) 253-261
ª The Author(s) 2018
Article reuse guidelines:
Incarcerated Families: A Clinical sagepub.com/journals-permissions
DOI: 10.1177/1066480718777409
Case Study journals.sagepub.com/home/tfj

Eman Tadros1 and Natasha Finney1

Abstract
“Research has shown that close and supportive family relationships are a key ingredient of successful offender rehabilitation and
that intimate partners and minor children may play a critical role in the process” (Datchi & Sexton, 2013, p. 280). Those affected
by incarceration are underserved, specifically in the realm of mental health. There is a need for a better understanding of how
systemic theories, such as structural family therapy (SFT) can be utilized with the incarcerated population. SFT is an evidence-
based systemic model and defines a problem in terms of family structures, boundaries, hierarchies, roles, rules, and patterns of
interaction and coalitions. Thus, the current case study examines family therapy utilizing the SFT model with a family, in which a
father was incarcerated. The implication of the current case study is to explore the effectiveness of using the SFT model as the
primary approach to treating the incarcerated population.

Keywords
structural family therapy, family therapy, incarceration, case study

Theoretical and Research Basis for
Treatment
According to the U.S. Department of Justice—Bureau of Jus-
tice Statistics, by the end of 2014, an estimated 6,851,000 adult
individuals were in the U.S. correctional system (Kaeble,
Glaze, Tsoutis, & Minton, 2015). Incarcerated individuals are
an underserved population, specifically in the realm of mental
health and family therapy. When reviewing existing literature
on incarcerated populations, some of the treatment approaches
that have been utilized include cognitive behavioral therapy
(CBT), filial therapy, and more recently experiential therapy.
CBT has ample support in effectiveness with this particular
population, specifically in reducing recidivism (Mpofu, Atha-
nasou, Rafe, & Belshaw, 2018). In a study by Landreth and
Lobaugh (1998), results showed that filial therapy aided in skill
building for parents and reconnecting the family. More
recently, researchers have explored how experiential-
existential therapy can be used with prisoners. Utilizing a case
study application, Vanhooren, Leigssen, and Dezutter (2018)
explored how this mode of therapy can “foster meaning making
and posttraumatic growth in prisoners” (p. 144).
The entire family faces a multitude of struggles due to the
changes in family, roles, rules, hierarchy, and structure. To
understand the effects of parental incarceration on the family
system, one must begin to comprehend the story of those who
have experienced these effects (Arditti, 2012). There is a pos-
itive correlation between longer sentences and rate of children
growing up without parents in the home (Chesa, 2011). Chil-
dren of incarcerated parents have a constitutional right to a
family relationship (Chesa, 2011). However, children are not
the only members of the family affected by the repercussions of
incarceration.
Despite the incarcerated population facing a multitude of
special issues, specialized training for clinicians have been
limited. “Research on incarceration, reentry, and the family has
produced evidence that relatives play a critical role in prison-
ers’ successful return to the community” (Datchi, Barretti, &
Thompson, 2016, p. 89). For example, Fontaine, Gilchrist-
Scott, Denver, and Rossman (2012) identified that families
serve as the primary source of emotional support. In addition,
researchers, such as Martinez and Christian (2009), report fam-
ilies assist inmates in reentry by assisting their family member
in obtaining food, housing, transportation, and employment
after their release. Other researchers have highlighted the
importance of the quality of the parent–child subsystem, family
connectedness, support, and acceptance in successful reentry
(Datchi & Sexton, 2013). Incorporating families into the con-
text of therapy with offenders will assist them in fostering
1
The University of Akron, Akron, OH, USA
Corresponding Author:
Eman Tadros, The University of Akron, 344 Village Pointe Dr. #D, Akron, OH
44313, USA.
Email: emantadros@gmail.com
254 The Family Journal: Counseling and Therapy for Couples and Families 26(2)
connectedness and improving the quality of their relationships
to assist in successful reentry into their communities. However,
there is a lack of evidenced-based research on utilizing family
systems theories with families whose members are incarcer-
ated. Clinicians have “observed that many adult offenders are
capable of being caring parents and partners and of fulfilling
the primary functions of the family, namely, nurturing and
protecting” (Datchi & Sexton, 2013, p. 280).
In her book, The New Jim Crow: Mass Incarceration in the
Age of Colorblindness, Alexander (2010) discussed former
president Barack Obama’s speech on Father’s Day in 2008.
The former president spoke out about the lack of presence of
Black fathers and how Black men need to be better fathers.
Alexander (2010) explained that the premise of the speech is
nothing new and that many have addressed this same message.
She further challenged that no one has asked the question—
where are these missing fathers? It appears that with the astro-
nomical number of incarcerated individuals, especially of
minority populations, that many of these families are missing
fathers from the home. To incorporate fathers back into their
family’s hierarchy and structure, family services are vital in
incarcerated facilities.
Empirical anecdotal evidence suggest that children are important
to many incarcerated fathers. Father-child relationships can anchor
a desistance from crime after confinement and serve as the basis of
“a new start” for men, based on a decision to break from the past
and construct a new way of life. (Arditti, 2012, p. 93)
A clinical case study using structural family therapy (SFT)
with a father and son is evidenced to display the effectiveness
of this model and advocate for mental health/family services
for incarcerated populations. The following case study will also
enhance the knowledge and skills of clinicians working with
the incarcerated population.
SFT
SFT (Minuchin, 1974) is one of the most widely used systemic
theories. Using a structural lens, a presenting problem can be
seen in relational terms. Aligning with systems theory, an
SFT’s focus is to highlight to a family how a problem is rela-
tional (Winek, 2010). There are three main strategies to SFT:
(1) challenge a symptom, (2) challenge a family’s structure,
and (3) challenge a family’s reality (Minuchin, 1974). SFT
enables a therapist to define a problem in terms of boundaries,
hierarchies, role of symptoms in a family, subsystems, cross-
generational coalitions, complementarity, developmental pro-
cesses, and a family’s life cycle (Minuchin, 1974). SFT does
not have a set length or number of sessions in treatment. A
therapist and family collaborate to establish the length of treat-
ment. Setting clear, healthy rules, and boundaries within a
system reinforces the overall theme of SFT. “[ . . . ] flexibly
implementing interventions is beneficial for the clinician and
client” (Gordon & Cooper, 2016, p. 128). SFTs view flexibility
as a primary predictor of healthy change and must be flexible in
negotiating with a family as well (Minuchin, 1974).
The goal of SFT is to restructure a family’s organization,
reducing symptoms, and creating flexible boundaries (Minuchin,
1974). SFT strives to understand rules and functions of family
members. It aims to decrease dysfunctional relationships within
a family by implementing more positive patterns for the future
(Minuchin & Fishman, 1981). One main concept of this theory is
to focus on the present and how to change aspects of one’s
current and future life to enhance circumstances rather than
explore and understand the past. Another major theme of SFT
is the continuous feedback and communication that occurs
among family members. Subsystems are always changing; thus,
families are always changing their roles, rules, dynamics, and
functioning. A family is organized by subsystems in a hierarchy
in which an individual’s roles and rules in the family depend
upon their placement within the hierarchy. A family’s rules
create each member’s roles, which are placed in a hierarchy
(Minuchin & Fishman, 1981). A family’s structure is assembled
by their family of origin and traditions as well as their multi-
faceted parts of intersectionality. Depending on the multiple
parts of intersectionality (such as gender, race, culture, ethnicity,
sexual orientation, religion, and socioeconomic status/class), the
family’s roles, rules, hierarchies, and boundaries are formed.
The Pathological Processes of SFT
In SFT, dysfunctions in a family are what maintains a problem
(Minuchin, 1974). Dysfunction in a family’s structure can be
explained by two types of families: enmeshed and disengaged.
Enmeshed families are typically very close, have similar opi-
nions, spend a lot of time together, and have low levels of
individuality (Colapinto, 1979). Boundaries in enmeshed fam-
ilies are diffuse. In disengaged families, there is a distance
between members both physically and emotionally and the
boundaries are rigid (Colapinto, 1979). There may be specific
members within the same family who are enmeshed, while
others are disengaged from each other. The interactions
between family members are what maintain and perpetuate
dysfunction. The goal is to construct more clear boundaries
among family members with a distinction in subsystems and
hierarchy of power. A family’s hierarchy “is expressed by rules
that prescribe differential degrees of decision-making power
for various individuals and subsystems” (Colapinto, 1979, p.
424). In these subsystems, such as in parental or sibling sub-
systems, there may be alliances or what Minuchin calls cross-
generational coalitions. An alliance is between members of a
family in the same subsystem. Cross-generational coalitions
are a type of alliance between a parent and child; they align
together against another member of a family. These alliances
can serve as a dysfunction in the system (Colapinto, 1979).
Etiology
In SFT, a problem is caused by dysfunction in family structures
(Colapinto, 1979). A family’s history is “largely irrelevant for
Tadros and Finney 255

the process of therapeutic change” as the theory focuses on How Change Occurs
current and present functioning and interactions (Colapinto,
One common component among family therapy models is that
1979, p. 427). SFT works under the assumption that “the iden-
they agree on a “need to change the dysfunctional aspects of the
tified patient is only the symptom bearer, the cause of the
family homeostasis” (Minuchin & Fishman, 1981, p. 64).
problem is the dysfunctional family transactions and the pro-
Change happens by a therapist entering a therapeutic system
cess of healing will involve changing those dysfunctional fam-
to first challenge a symptom, then challenge a family’s struc-
ily transactions” (Minuchin & Fishman, 1981, p. 28). In
ture, and finally challenge a family’s reality (Minuchin & Fish-
essence, the symptoms are a consequence of an ineffective
man, 1981). Change in family structure is considered a vital
family structure.
process in eliminating or improving symptoms. Behaviors are
Problems in a family, as explained by SFT, are caused by
not stand-alone; they are usually connected to a larger issue
disturbances to a system (Minuchin, 1974). If a family is inflex-
(Winek, 2010).
ible to change, environmental, developmental, and/or psycho-
A therapist’s primary goal is to change family functioning to
logical conflict may arise. When this conflict arises, family
enhance performance on activities and relations. A therapist
members may develop different relationships with its members
must first understand the position and function of a problem
(disengaged or enmeshed), create power struggles, and/or
behavior, whom a behavior affects, and perceptions of a beha-
change the type of boundaries in place between subsystems
vior (Winek, 2010). SFT relies on a therapist entering a family
(rigid or diffuse). With clear boundaries and hierarchies in
system and promoting positive structural changes, and actions
place between subsystems, change can occur within a family
are valued more greatly than insight (Nichols, 2013). In SFT,
system.
therapists are encouraged to join a family in a way by becoming
entangled with its methods. A therapist joins a family by
Treatment Interventions “letting the family know that the therapist understands them
and is working with and for them” (Minuchin & Fishman,
SFT is made up of many different techniques and interventions
1981, p. 32).
that are employed to eliminate or reduce dysfunction and
symptoms in a family (Nichols, 2013). Some of these tech-
niques include family mapping, joining, enactment, punctua-
tion, unbalancing, and restructuring (Minuchin & Fishman, Case Introduction
1981). Demographic Data and Referring Information
The structural technique joining is essentially the therapist’s
The following case conceptualization has been changed to pro-
overall attitude. By joining with a family, therapists are able to
tect the participants; therefore, their identities have been dis-
understand a family’s structure and change its dynamic, to
guised. In addition, all ethical standards of sound research have
apply these concepts effectively, an individual should be able
been followed. Jay is a 34-year-old heterosexual, African
to function on their own as an individual while still being
American, Christian, upper middle-class male currently incar-
connected to a collective family system (Minuchin & Fishman,
cerated. Sheldon, Jay’s son, is a 13-year-old, African Ameri-
1981). Minuchin (1974) focuses on the social context of a
can, Christian male.
problem by asking questions to reveal one’s role within their
own family. “Man is not an isolate. He is an acting and reacting
member of social groups” (p. 41). Presenting Problem
The structural technique, restructuring, empowers families Jay presented with a desire to be “a better father to his son.” Jay
to set boundaries while also organizing a family’s hierarchy. explained that his son Sheldon is a “good” kid which Jay
Family mapping is an excellent intervention that helps identify defines as a kid with no criminal record, above average grades,
and shed light on types of boundaries (rigid, diffuse, or clear), and extremely helpful at home. Jay expressed that he does not
interactional cycles, hierarchy, alliances, and collations (Min- know how to interact with and discipline his son. Jay reported
uchin & Fishman, 1981). For example, reconstructing family that he has been detached from his son’s life due to his incar-
structure can prevent future conflicts and strengthen overall ceration. In addition, he reported he no longer wants to be “out
family dynamics. The structural technique enactment has been of sight and out of mind.” Jay indicated he and his father do not
effective with clients because at times it is difficult to express have an “emotional bond,” one he wishes to create and main-
emotions to another family member, but reenacting a specific tain with his son.
conflict in therapy can be an alternative productive tool in
expressing how one feels by showing rather than telling. The
empty chair technique is a type of enactment that enables a History
client practice (enact) what one family member wants to do or Jay grew up with his parents and two siblings and described
say to another before the interaction is actually had with the himself as a “stereotypical middle child.” He reported his par-
individual (Minuchin & Fishman, 1981). Therefore, a therapist ents were hardworking and very strict. Jay described himself as
can reconstruct an action proactively or offer suggestions on an “outcast” in his family and that he has always felt out of
how to conduct conversations. place within his family of origin. Jay described his parents and
256 The Family Journal: Counseling and Therapy for Couples and Families 26(2)
siblings to the therapist as law-abiding, upper middle-class,
Christians.
Per client report, since Jay was 16, he was skipping school,
drinking alcohol, selling drugs, and stealing cars. Jay describes
himself as a “black Charlie Sheen.” He said to the therapist, “I
was a wild kid.” Jay expressed his fear of his son becoming like
him. He further reported he would like to form a stronger bond
with his son and divert him from becoming incarcerated or
addicted to “the fast life.”
Assessment
First Session Conceptualization
When conducting an initial intake with a family, it is vital to
inquire about a family’s history of suicide, domestic violence,
child abuse, substance/alcohol use, and mental health. These
factors can have an effect on a family’s structure and home-
ostasis. In this family, Jay has a history of alcohol abuse in his
younger years, but there has been no history of domestic vio-
lence, suicidal ideation, or child abuse. In particular to this
facility, one must screen for incarceration history, Jay is the
only one in his family to have ever been incarcerated.
During the intake session, the therapist met with Jay (incar-
cerated individual who the facility deems as the only client).
Based on the information provided by Jay, the therapist began
to understand the cycle of events between Jay and his father, a
reverend, and how it led to his recurring incarceration. In
reviewing Jay’s cycle of incarceration, it can be understood
that Jay first commits an illegal crime that causes him to feel
a “rush.” Jay later gets caught by a figure of authority such as
his parents, police, or school administrator. This lead to conflict
between Jay and his father. They argue and then his father bails
him out. Jay begins to feel guilty for his actions that lead him to
get his “life on track” (in terms of his father’s wishes). His
father pushes his religious faith on Jay while also pressuring
him to “conform to family norms”; this causes Jay to feel
conflicted between his faith and “love of the fast life.” The
cycle repeats continuously over the course of his life. Jay
reported he recounted interactions with his father because he
felt that the therapist should understand the kind of parent he
did not want to be in hopes that the therapist could help him
become the parent he did want to be.
How the Presenting Problem Is Explored
A family’s style of communication and interactional patterns is
assessed by observing and joining with a family. The technique
of enactment is best for determining styles of communication
and observing a family’s interactional patterns. This is specif-
ically useful for families with children in different develop-
mental stages as well as for families that have distinct
cultural backgrounds to a therapist (Minuchin & Fishman,
1981).
Exploring a presenting problem is done by a clients’ defi-
nition of a problem. A therapist acts as a director in session yet
encourages them to determine their own goals for therapy.
Using a tracking technique is beneficial to “shift from content
to process and to the process concretely to content” (Minuchin,
1974, p. 38). Clients typically want to discuss one particular
situation or explain that they’re coming into therapy to work on
something extremely vague such as “communication.” A thera-
pist’s goal is to join with clients; therefore, they are constantly
shifting from content to process. A therapist juggles between
the balance of validating their clients’ concerns and aiding
them in coming to the realization that the content is not nearly
as important as the process.
Schematic Map of Systemic Functioning
Although a structural map is more commonly used by a struc-
tural family therapist, the therapist preferred to use a genogram
(Kerr & Bowen, 1988). The purpose of a genogram is to assess
systemic functioning and highlight generational patterns such
as alcohol and drug use, abuse, and relational cutoffs (Kerr &
Bowen, 1988). As per the therapist’s experience, most clients
reported they were visual learners, thus having a genogram laid
out in front of them helped them notice repeated interactional
patterns. For example, a genogram can be utilized to point out
the structural concept of cross-generational coalitions in order
to bring insight to restructuring and reorganizing the family
system. Genograms also enable a therapist to gain insight into
a family as well as opening up discussions on family members
that are not present but may have had an impact on current
family structure.
Diagnostic and Statistical Manual of Mental Disorders,
5th Edition (DSM-V) Differential Diagnosis
To formulate a DSM-V diagnosis, the therapist assessed Jay
and Sheldon’s signs, presenting symptoms, and associated risk
factors. Jay appeared to display good hygiene insightfulness,
calmness, and an advanced vocabulary. Jay reported anxious
and nervous symptoms. Jay’s risk factors include his history
alcohol abuse and criminal history. Sheldon’s signs are good
hygiene, well-mannered, quiet, and frequently does not make
eye contact. Sheldon has not reported any symptoms other than
being tired. Risk factors for Sheldon include lacking social
support and being overworked and the son of an incarcerated
father.
Initially, post-traumatic stress disorder (PTSD) 309.81 was
considered because Jay was diagnosed with PTSD at his pre-
vious incarcerated facility but currently does not meet the cri-
teria. The triggering incident was 12 years ago, and Jay no
longer experiences the symptoms necessary for this diagnosis.
In Criteria B, an individual is to have the presence of one or
more of the following symptoms listed after a traumatic event:
recurrent, involuntary, and intrusive memories, recurrent
dreams, dissociative reactions, intense or prolonged psycholo-
gical distress, and/or physiological reactions (American Psy-
chiatric Association, 2013). Jay reports that he has experienced
these symptoms but has not experienced these symptoms in at
Tadros and Finney
least 10 years. Therefore, Jay no longer meets the criteria for
PTSD.
Adjustment disorder was also considered based on the
“emotional or behavior symptoms in response to an identifiable
stressor” (American Psychiatric Association, 2013, p. 286).
The identifiable stressor would be Jay’s incarceration. The
family did not meet the DSM-V Criteria A for adjustment
disorder based on symptoms needing to occur within 3 months
of the onset (Jay was incarcerated Sheldon’s whole life). They
do not meet Criteria B “the distress experienced by the family
may not have necessarily been considered out of proportion to
the severity or intensity of the stressors they were experi-
encing” (American Psychiatric Association, 2013, p. 286).
There was also not a “significant impairment in other important
areas of functioning” (American Psychiatric Association, 2013,
p. 286). Sheldon successfully continued going to school, main-
taining his grades, playing football, and taking care of his
brothers. Jay, despite incarceration, participated in all required
groups and meetings and has not been written up for miscon-
duct at the facility. Therefore, the family does not meet the
criteria necessary for adjustment disorder.
The therapist would diagnose both Jay and Sheldon with the
v code: problems related to imprisonment or incarceration
(V62.5) due to Jay’s incarceration, which is considered a major
contributor to the presenting problem. Due to Jay’s incarcera-
tion, Sheldon does not have his father as a primary support
system—emotionally, physically, or financially. Jay believes
that there is “nothing he can do” while he is incarcerated to
connect with or discipline Sheldon.
The therapist is mindful not to pathologize behaviors, espe-
cially if the behavior makes sense within the context of the
client’s life. For example, the clients are incarcerated, and
therefore, their behavior at times can be a product of their
current living situation. Thus, it is important to do a proper
differential diagnosis only after collecting data and observing
a family and/or using a formal assessment contextually.
Assessment of the Therapeutic Alliance
To assess the strength of the therapeutic relationship, the Sys-
tem of Observing Family Therapy Alliances (SOFTA) was
utilized. SOFTA is an assessment to further explore the ther-
apeutic alliance and identify needed changes or modifications
to the approach to therapy and treatment (Escudero, Friedlan-
der, & Heatherington, 2011). The utilization of SOFTA aligns
with SFT because of the value that is placed upon the joining
process. If the therapist has joined well with the client, it is
assumed that their therapeutic alliance will be stronger; thus,
assessing for the alliance is crucial to the success of treatment.
The use of the structural technique of joining assisted in devel-
oping a strong therapeutic alliance between therapist and fam-
ily. The strong alliance was evidenced in the family’s
willingness to share extensive details of their experiences
throughout therapy despite the limited amount of session
allotted. The strength of the alliance is also demonstrated by
the family’s willingness to be open and responsive to being
257
challenged by the therapist’s efforts to promote positive
change.
The therapist administered the SOFTA to both Jay and his
father. Jay’s SOFTA results depicted a strong therapeutic alli-
ance between the therapist and family. For Sheldon, the
SOFTA also displayed a strong therapeutic alliance and
showed areas the therapist can modify to progress treatment.
Theory-Based Case Conceptualization
Prior to making a treatment plan for a family, it is primarily
important to develop a strong therapeutic alliance with each
client which can be done via the process of joining. Minuchin
explains that a therapist cannot formulate a treatment plan
without joining and getting to know a family’s specific inter-
actional patterns and structure (Minuchin & Fishman, 1981).
After joining with a family, a therapist can assess structure by
assessing interactions between members. Assessment is an
ongoing process in SFT; therefore, the therapist is to observe
family interactions and then point the process out to a family
when useful throughout the course of therapy. A therapist and
family are to negotiate treatment goals to formulate a treatment
plan.
A “therapist enters a therapeutic situation with the assump-
tion that a family is wrong (about the problem). A problem is
not an identified patient, but certain family interactional
patterns” (Minuchin & Fishman, 1981, p. 67). Eliminating the
notion of an identified patient allows the family together, to
work collaboratively on the problem while reducing the blame
from the incarcerated individual. Problems in a family are due
to dysfunction in a system, dysfunction is not maintained by
solely one individual (Minuchin, 1974).
Jay reported having had no experience or skills in parenting.
Jay’s permissive parenting style allowed for a disengagement.
Sheldon who is in the stage of adolescence is in a critical period
for forming and strengthening the attachment with his father
(Dempster, Rogers, Pope, Snow, & Stoltz, 2015). Therefore,
providing psychoeducational parenting skills was necessary for
the advancement of Jay’s treatment. SFT states there should be
clear rules and boundaries within a family system, such as what
behaviors and actions are deemed acceptable or not by parents
or caregivers (Vetere, 2001). Jay expressed that he has never
learned how to be a parent, because although his parents are
“hard working, nice people,” they did not give him choices or
negotiate rules with him. Minuchin argued, when someone
within the system has a role of power, people work more effi-
ciently; as such, a structured environment may work best
within a family system. The therapist believes it is her duty
to ensure the client’s understanding of the division of power.
The constructs of power and control were fundamental in Jay’s
upbringing as evidenced by his parents’ authoritarian parenting
style. Parents having an abundance of power over their children
does not always constitute positive functioning, Jay’s criminal
history affirms this notion.
Dysfunction in this family is due to the family’s structure
and diffuse boundaries between each other. This family lacks
258 The Family Journal: Counseling and Therapy for Couples and Families 26(2)
organization and needs balance between stability and change.
Jay is incarcerated, thus is no longer perceived to be in a posi-
tion of power. Jay needs to be placed at the top of a hierarchy
alongside his father (Sheldon’s grandfather) and Sheldon’s
mother. Sheldon needs to take more of a child’s role and give
some of his “parental” responsibilities back to his mother and
father. The structural intervention of restructuring would help
the family to set boundaries while also organizing the family’s
hierarchy.
Jay and Sheldon are in a family life cycle stage of “families
with adolescents.” However, Jay and Sheldon have not yet
mastered the previous stage “families with young children.”
Jay has been incarcerated for the majority of Sheldon’s life and
has “accepted new members into the system.” However, they
have never mastered the second-order changes in family status,
such as “collaboration in child rearing, financial, and house-
keeping tasks” and “realignment of relationships with extended
family, to include parenting and grandparenting roles.”
Now that Sheldon is aged 13 and an adolescent, Jay and
Sheldon are to work on the developmental task of “shifting
parent/child relationships to permit adolescent to move in and
out of system.” Sheldon is not in a position to move in and out
of the system as he is a parentified child. Sheldon’s mother
relies on Sheldon to take care of his younger siblings. As a
result, he is not given ample opportunity to focus on his per-
sonal growth.
Course of Treatment and Assessment of
Progress
The clinician is able to formulate a treatment plan by joining
with the family and observing this cycle of events and interac-
tional patterns between Jay and Sheldon. The goals for this
family are to establish clear boundaries between subsystems,
to have clear distinctions between the sibling/child subsystem
and parental subsystem, and to reorganize to place Jay on the
parental hierarchy.
The first problem encountered is Jay and Sheldon’s poor
communication with one another. The outcome goal is that Jay
and Sheldon will be able to communicate more positively. The
process goal is to strengthen problem-solving skills and reso-
lution techniques. The intervention to be used in this context is
an enactment. The rationale for using an enactment is to be able
to observe Jay and Sheldon’s interactional patterns and how
they discuss issues. By observing their interaction patterns in
session, the therapist will be able to point out what they are
already doing well and what they can do to improve their
communication skills. The second problem explored is Jay’s
lack of parental involvement in Sheldon’s life.
Parental incarceration is a traumatic event that has a profound
emotional impact on the children of prisoners. In the absence of
information, it can be experienced as a form of rejection, weaken
the children’s sense of stability and safety, and intensify their dis-
tress. (Datchi et al., 2016, p. 92)
The outcome goal is that Jay will be able to interact with his
son with reported increased relational satisfaction. The first
process goal is that Jay will be able to move up to the parental
subsystem alongside his father and mother of his son. The
interventions to be used are restructuring and boundary form-
ing. The therapist’s rationale for using restructuring and bound-
ary forming is due to Jay’s feelings surrounding not being able
discipline to his son. Jay reports he lacks the skills and access to
discipline his son due to being incarcerated most of his life.
Restructuring the hierarchy places Jay in the parental subsys-
tem and through boundary forming, Jay and Sheldon will be
able negotiate more clear boundaries. The second process goal
is that Sheldon will be able to express emotions and concerns to
his father in both a healthy and appropriate manner. The solu-
tion focused technique, miracle questioning is an effective
intervention to further explore and implement how best to
express emotions and concerns among members of the family.
The rationale for using miracle questioning is due to Jay report-
edly feeling that Sheldon refuses to express his emotions and
concerns to him. Jay believes that as a father, it is his duty to
take care of Sheldon and he does not know how to assess
Sheldon’s mood or feelings if he is not expressing them. Thera-
pist observed, Sheldon is not very talkative in sessions, as
evidenced by only speaking when spoken to or when he is
asked a specific question. Asking a miracle question will
enable Sheldon to further explore his feelings and express his
emotions to his father, such as what he wishes the family sys-
tem and their emotional parent–child bond would look like.
Complicating Factors
Cultural Factors
Clinicians are advised to be mindful of the various diverse
populations within the incarcerated population. It is vital to use
culturally appropriate intervention strategies which must be
sensitive to what their client’s culture allows. For example, the
family’s rules might be governed by a religious concept. There-
fore, pathologizing that interaction would be detrimental to the
family system and overall treatment. It may be helpful for a
clinician to take on a curious stance when working with incar-
cerated individuals and their families, while demonstrating
basic counseling skills, such as unconditional positive regard
and empathy.
Many of Minchin, Montalvo, Guerney, Rosman, and Schu-
mer’s (1967) seminal works such as Families of the Slums: An
Exploration of Their Structure and Treatment and Techniques
for Working with Disorganized Low Socioeconomic Families
support the therapy’s effectiveness with multicultural and
underserved populations. Minuchin’s SFT has multicultural
contexts embedded within its framework as its principles have
been evidenced in his work with varying diverse populations.
With the current case, there are significant differences between
the therapist and the family, such as differences in race, ethni-
city, socioeconomic status, religious views, and gender.
Despite these intersectional differences between the therapist
Tadros and Finney
and family, a strong therapeutic alliance between the family
and therapist prevailed evidence by the SOFTA.
Religious Factors
The role of religion was significant in both the lives of Jay and
Sheldon, especially with Jay being raised by a reverend. Their
religious beliefs influenced treatment as evidenced by Jay fre-
quently explaining his actions in terms of religion. This proved
to be problematic during treatment because Jay at times wasn’t
willing to acknowledge his actions. For example, he would
frequently refer to his actions as it was “God’s will” and it was
“the path God has paved for him.” Jay reported that his father
forced Christianity upon him as a child and he did not believe
he should be forced to that way. However, this statement con-
tradicts Jay’s perspective on his actions. For example, when he
was found doing something illegal or was enduring a hard time,
Jay would state “Christ chose this life for me.”
Furthermore, the therapist had difficulty understanding
Jay’s contradicting religious views. Due to Jay’s strong views
on religious values, it was difficult to challenge him because he
attributed his actions as God’s will. Instead of continuing to
challenge Jay’s contradictions, the therapist redirected her
efforts by attempting to understand Jay’s religious values in
context to raising his son. This redirection facilitated a conver-
sation on how Jay would give his son the freedom of religion
choice. Jay and the therapist further explored his religious
beliefs to gain a better understanding of how Christianity has
affected his own life. After further assessment, the therapist
was able to see that this contradiction seems to be deeply
embedded from his upbringing in his family of origin. There
has been a constant battle for Jay to abide by his religion but to
also to be able to live the life he wants to live. Therefore, the
therapist focused on highlighting strengths from his religious
upbringing while also discussing how Jay’s religious values
would affect raising Sheldon and his choices in the future.
Access and Barriers to Care
In this particular private facility, the clients did not pay for their
treatment directly and do not have to have medical insurance.
Every offender in the facility is eligible for family services and
is not discriminated for services based on crime committed,
type of therapy requested, diagnosis, or presenting problem.
Datchi, Barretti, and Thompson (2016) states that despite pro-
viding couple and family community-based services, these ser-
vice professionals seldomly work within adult criminal justice
settings. This notion supports the idea that the lack of helping
professionals in criminal justice settings, specializing in cou-
ples and families work, inhibit incarcerated persons from
receiving adequate access to care.
One significant barrier to treatment was the minimal amount
of sessions allotted. This lack of time is due to the frequency of
the unknown offender release dates. Due to this, a decision was
made to select one goal to work on while in treatment. The goal
chosen was “to be able to express feelings to each other.” A
259
treatment plan was made based upon the amount of time Jay
was predicted to have left at the facility. Therefore, it was
estimated that he would receive about six sessions of treatment,
which is considered brief therapy.
Another presenting barrier to treatment, within the context
of SFT, is that the client was incarcerated for the entirety of the
treatment.
Behind bars, men cannot provide financially or participate fully in
making parenting decisions; they rely on others outside the prison
or jail to maintain contact with their children, to give or read their
letters, to accept phone calls, and to bring the children to the
correctional facility. (Datchi et al., 2016, p. 92)
As discussed previously, Jay does not consider himself to be
a part of the parental subsystem due to his incarceration. Jay’s
incarceration has prevented him from engaging in typical par-
enting activities and responsibilities, contributing to his overall
feeling of being disengaged from the parental and parent–child
subsystems, creating a complex barrier to treatment and care.
Jay’s and Sheldon’s conflicting schedules proved to be bar-
riers to treatment. Jay had work release while incarcerated,
which means he could be scheduled to work at any time and
the schedule may change daily. As a result, it is difficult to
schedule sessions with individuals who are on work releases
because they often do not know what time they will be return-
ing to the facility. Sheldon was extremely busy as well, he had
school during the day followed by football practice until 8:00
p.m. each night. The therapist took into consideration the dif-
ficulty for Sheldon to get to the facility due to school, extra-
curricular activities, and the distance between his home and the
facility. The therapist understood the client was unable to drive
to the facility due to being underage and was reliant on his
grandfather for transportation. Sheldon’s grandfather and the
therapist would communicate frequently in order to coordinate
schedules for sessions.
Further accommodation made was by the therapist. The
therapist agreed to come to the facility on her days off or stay
later, sometimes beginning at 8:30 or 9:00 p.m. It is important
to note that a therapist working with the incarcerated popula-
tion must be flexible, while also maintaining clear boundaries.
The family and therapist made appropriate accommodations to
be able to make treatment possible.
Follow-Up
Modifications Necessary in the Course of Treatment
Despite a strong therapeutic alliance between the therapist and
family, the therapist decided to modify treatment due to the
results of the SOFTA. On the assessment, Sheldon marked a
score of “2” for the statement that read, “I understand what is
being done in therapy.” This response gave the therapist insight
and modified treatment by slowing down the process and
encouraging Sheldon to ask any questions he had about treat-
ment or what was going on treatment. Following the session of
the administered SOFTA, the therapist checked-in with
260 The Family Journal: Counseling and Therapy for Couples and Families 26(2)
Sheldon more often to ensure he understood what was going on
throughout the session. Although Sheldon is very insightful, the
therapist had to be careful not to expect more of Sheldon than
he is capable of due to his age and stage of development. The
therapist must be cognizant of this because she does not want to
mirror the exact processes that are going on between his mother
and grandfather, giving Sheldon more responsibilities than is
appropriate for his age and developmental level.
Treatment Implications
When reviewing existing literature, it was observed that there is
a lack of literature, demonstrating research support of the use of
family systems theories with families whose members are
incarcerated. Due to the complexities of the incarcerated pop-
ulation and associated lack of research, there is an urgency for
clinical case conceptualizations focused on utilizing systemic
treatment models with incarcerated populations, valuing non-
pathologizing attitudes, and addressing the role intersectional-
ity plays within a family. The current case study aims to begin
addressing this gap in literature.
The current case study provides support for the utilization of
SFT with the incarcerated population as evidenced by observed
and reported changes per clients and therapist. For example, by
the end of treatment, Jay reached his first treatment goal of
communicating more positively with his son Sheldon. Per
therapist observation, the parent–child subsystem was able to
strengthen their problem-solving skills and resolution tech-
niques as evidenced by collaborating and negotiating in ses-
sion, in ways that were both appropriate for Sheldon’s age and
level of development.
Additionally, the SFT approach served as the vehicle in
exploring Jay’s second reported problem of lack of parental
involvement. Through a structural lens, Jay was able to move
up to the parental subsystem alongside his father and the
mother of his son thereby restructuring the hierarchical struc-
ture of the family. By restructuring and placing Jay in the role
of parent and disciplinarian, Sheldon can step down into the
role of a child, releasing him of his parentified responsibilities.
Jay’s commitment to becoming more involved in Sheldon’s life
was demonstrated by making a commitment to go to Sheldon’s
weekly football games following his release.
After restructuring the family hierarchy, the therapist and
family worked to construct clear boundaries. Creating clear
boundaries is a main premise of SFT. Jay’s parenting style
before treatment was permissive and the boundaries between
him and Sheldon were diffuse. The family formulated clear
boundaries on topics surrounding new roles and rules. Forming
these boundaries was beneficial in defining expectation for
their relationship. For example, as these boundaries were estab-
lished, Sheldon was able to trust his father’s word. Jay would
set a date and time to call Sheldon and he proved to be reliable
as per report of Sheldon in the following sessions.
Collaboration, restructuring, and boundary forming are pri-
mary goals in SFT. Jay and Sheldon reported favorable out-
comes in these areas during termination. The therapist and
family assembled a plan to continue their success following
Jay’s release. This case serves as an effective example in uti-
lizing SFT in an incarcerated setting with a father and son.
Recommendations to Clinicians and Students
Incarcerated individuals are considered an underserved popu-
lation, especially in regard to family therapy. Moreover, the
incarcerated population is considered a special population;
thus, a clinician needs to be well-informed and knowledgeable
on unique differences, needs, challenges, and obstacles expe-
rienced by this population. When working with individuals of
the incarcerated population, it is important for the clinician to
be conscious of differences among them, specifically labels
that society has placed upon them. Being imprisoned regardless
of crime committed has a negative connotation in society, but
does that warrant the lack of family services offered within the
system? SFT has an abundance of support in working with
diverse cultures and specialized populations (i.e., foster care
and people living in poverty) as well as a distinguished adapt-
ability to families in modern day society (Vetere, 2001).
A limitation of this case is the very limited number of ses-
sions the therapist had with the family and there were also
issues regarding scheduling and facility accessibility. Lastly,
there are associated uncertainties of working with individuals
involved with the criminal justice system. Jay was not given a
release date for most of his duration at the facility; thus, the
therapist could not plan for termination more than 2 weeks
prior. These limitations affect treatment planning and the over-
all structure of the sessions. SFT values flexibility and does not
have a set number of sessions or steps; therefore, it fits well
with the incarcerated setting.
A recommendation for future researchers would be to
explore SFT’s effectiveness with incarcerated men versus
incarcerated women. The underlined case study explored how
SFT can be utilized with incarcerated men. However, identify-
ing how this approach to treatment can be applied with women
in corrections would provide further support of the model’s
overall utilization with individuals who are incarcerated,
regardless of gender. In addition, further research is needed
on other variables that may impact the model’s effectiveness,
such as one’s length of imprisonment, their age, where their
family is in the family life cycle, and pertinent medical condi-
tions. Conducting further research on these variables among
others would begin to address the gap in existing literature
on this underserved population and further identify the needs
of those incarcerated and further inform their mental health
treatment.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Tadros and Finney
ORCID iD
Eman Tadros http://orcid.org/0000-0001-8224-5391
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