Urban Social Work, Volume 3, Number 1, 2019

Black Family Resilience: An Introduction

to Enriched Structural Family Therapy
W. Henry Gregory,a Jannette Meriweather Gregory,b
Gillian Gregory,c Maisha Davis,d Jerrod Lewis,e and Elias
Gregoryf

Culture and racial or ethnic background are important variables to consider when
conceptualizing families and resilience. Working effectively with Black families requires
culturally competent interventions that honor and build upon their strengths and give
attention to the intricate dynamics of relationships. This paper offers an examination of the
unique stressors and adversity experienced by Black families as well as factors influencing
their adaptive functioning. Enriched structural family therapy (ESFT), a versatile, skill-
based, systems approach, is introduced as a viable model to promote resilience in Black
families. Through ESFT interventions, Black families are able to successfully manage and
cope with stressors while improving overall functioning.

Keywords: resilience; Black families; family therapy; structural family therapy; enriched
structural family therapy; ESFT; family resiliency

“Successful family interventions depend more on tapping into family resources than on
therapist techniques.”
Walsh (2002)

T he purpose of this paper is to introduce enriched structural family therapy (ESFT)

to the greater social work community as a viable framework to support families in
the strengthening of resilience factors. Resilience is the ability to rebound from
adversity strengthened by the experience. It refers to manifest competence in the
context of significant challenges to adaptation or development (Masten & Coatsworth,
1999). To identify resilience, two judgments are required: first, there has been a significant
threat to the individual (or system) typically indexed

a
University of Maryland, School of Nursing, Baltimore, MD, USA bRafiki
Consortium, Woodstock, MD, USA
c
Towson University, Family Studies & Community Development, Towson, MD, USA dChase
Brexton Health Care, Baltimore, MD, USA
e
Sarah’s House Mental Health Services, Baltimore, MD, USA
f
Pdf_ Folio:1 Pdf_Fol io:51 St. Vincent’s Villa-Catholic Charities, Timonium, MD, USA
52
© 2019 Springer Publishing Company 51 http://dx.doi.org/10.1891/2474-8684.3.1.51
Gregory et al.

by high-risk status or exposure to severe adversity or trauma; and second, the quality of
adaptation or development is healthy (Masten & Coatsworth, 1999). Resilience entails
more than merely surviving, getting through, or escaping a harrowing ordeal (Walsh, 1998).
In other words, survivors are not necessarily resilient; some become trapped in a position
as victim, and blocked from growth by anger and blame (Wolin &Wolin, 1993).
Resilient people, on the other hand, learn from their experiences and heal from painful
wounds. They take charge of their lives, living fully and loving well. Building upon their
experience of adversity, they become stronger, more effective people. The experience of
adversity is the privilege of all families; however, Black (non-Hispanic African American)
families have an abundance of social determinants, such as stress, racism, discrimination,
and social exclusion, that create adversity at all social economic levels (Williams, Marks,
& Leavell, 2010). The application of resilience theory to Black families requires that we
consider both the adversity confronting them as individual families and as members of a
racial minority and the qualities by which many are able to thrive and prosper in spite of
the adversity (Hollingsworth, 2013). Additionally, any protocol used to strengthen Black
family resilience must first understand the indigenous skills Black families employ to
overcome circumstances (Hill, 1999; Walsh, 2003). Collectively, family resilience factors
create the foundation for a field-practiced approach that supports Black families with
culturally sensitive interventions designed to enhance family functioning.
ESFT is a nonpathological, skill-based, systems approach to working with families.
Developed by Baltimore-based mental health practitioners in the 1980s, ESFT emerged
from structural family therapy (SFT) advanced originally in the 1960s and 1970s
(Minuchin, 1974). The model is based on sequential, solution-oriented interventions that
identify family competencies and facilitate resilience within the family’s functioning.
Essentially, ESFT is a framework that helps families develop the structure needed to
incorporate concrete skills necessary for members to relate to one another in productive
ways. When families are successful, they become healthier, more functional units, and are
more likely to recover from future stressors without experiencing retraumatization. The
following discussion further defines family resilience and resiliency factors, highlights the
strengths of Black families, and demonstrates how ESFT can support the development of
family resilience.
The central vehicle through which we interact and develop stress reduction processes
and behaviors for effective living is the family. Resilience can be defined as the ability to
withstand and rebound from disruptive life challenges, having been strengthened and
becoming more resourceful (Walsh, 2003). Family resilience research builds on studies of
family stress, coping, and adaptation, as well as research on well-functioning family
systems (Black & Lobo, 2008). It involves dynamic processes that foster adaptation of the
family unit and its members in the context of adversity (Patterson, 2002; Walsh, 1998).
To understand Black family resilience, it is first important to understand the factors that
impact the functionality of Black families. According to data from the Survey of Consumer
Finances the median White household possessed $13 in net wealth for every dollar held by
the median Black household in 2013 (Bricker et al., 2014). The Pew Research Center says
the difference in median household incomes between Whites and Blacks has grown from
about $19,000 in 1967 to roughly $27,000 in 2011 (Hochhar, Fry, & Taylor, 2011).
df_Folio:52

Socioeconomic circumstances strongly influence health and well-being. The risk for
mortality, morbidity, high-risk behaviors, reduced access to healthcare, and poor quality of
care increases with decreasing socioeconomic circumstances (Adler & Stewart, 2010).
Subsequently, Black families are likely to suffer a greater number of chronic stressors and
 An Introduction to Enriched Structural Family Therapy 53
possess fewer physical resources to help cope with problems than White families (Kessler
& Neighbors, 1986). While Black families experience difficulties that are common to all
families, they face unique psychological, environmental, and economic stressors that are
precipitated and maintained, in part, by discrimination and racism (Williams et al., 2010).
Thus, survival for the Black family has necessitated the development of competencies that
can be useful in handling adversity.
To be effective with Black families, interventions must be culturally competent. Culture can
be viewed as the shared experience of a group of people, or the way groups of people attempt
to meet their needs (Gregory et al., 2012). Culture consists of patterns of explicit and implicit
behavior as well as thinking patterns. To be effective with Black families, social workers must
provide services in a manner that is acceptable to the service population to qualify as culturally
competent (Cross et al., 1989). This, to some degree, requires providers to attend to the
dynamics of Black culture.
While there are many variations of Black culture, and few Blacks live exclusively within
Black culture, there are a couple of dynamics that are pervasive. The dominant epistemology
of Black culture includes an affective orientation that shapes the way the world is seen and
assessed (Nichols, 1976). Also of prominence is a premium value placed on relationships in
this worldview. Consequently, effective, culturally competent interventions require an
emotionally competent clinician who attends to and addresses relationship issues for the
purposes of understanding family members’ perspectives. This is a prerequisite and
accompaniment to problem-solving collaboration. Failure to attend to these dynamics
sabotages the relationships needed for effective interventions.

BACKGROUND

Robert B. Hill (1972, 1999), who arguably may be seen as the father of the
competency/strengths movement in mental health, identified five strengths (strong kinship
bonds, work orientation, flexibility in family roles, achievement orientation, and
religious/spiritual orientation) that Black families have used to survive and prosper. His initial
offering on this published in 1972, The Strengths of Black Families, was based on the same
1960s census data as the pathologically oriented work of Daniel Moynihan(BlackPast,20
7),whichcontainedthethesisthatweaknessesintheBlack0 family are at the heart of the
deterioration of the Black community. Hill (1972) reaffirmed his findings with The Strengths
of African American Families: Twenty-Five Years Later (Hill, 1999).
Fromma Walsh (1998, 2003), in her seminal work, categorized family resilience factors into
three domains: belief systems, organization patterns, and communication processes. The belief
system of resilient families consisted of the experience of making meaning of adversity,
developing or maintaining a positive outlook, and being able to io:53
54 Gregory et al.

transcend the immediate adversity using a defined or undefined sense of spirituality to do

so. The organization patterns of resilient families were characterized by flexibility and
connectedness and were influenced by access to social and economic resources. These
families also communicated clearly, were open in expressing emotions, and used
collaboration in problem-solving processes.
Using Walsh’s framework, Gregory (2001) studied Black families who had experienced
hazardous adversities. He added to and nuanced Walsh’s framework to accommodate the
experiences of Black families who were doing relatively well after experiencing losses of
loved ones through violence, suicides, incarcerations, health-related deaths, and threats
from Child Protective Services. The Appendix identifies family resilience processes in the
Walsh (1998) framework and includes the unique cultural findings in the Gregory (2001)
study.

STRENGTHENING FAMILY RESILIENCE

Oftentimes, poverty-related stressors including unemployment, substance abuse, and

lack of education become the catalyst for dysfunctional family functioning in the Black
community (Patterson, 2002). Many members of Black communities typically have
difficulty accessing and engaging in services that lack cultural sensitivity; they are
“understandably distrustful of traditional care because of historical persecution and racism”
(Santiago, Kaltman, & Miranda, 2013). Together, these factors challenge Black families’
ability to get the services they need to survive and thrive.
ESFT is an integrative model of practice that offers a systemized approach to working
with Black families and emphasizes sustaining and enhancing emotional connections
particularly for families who have experienced a disconnect and/or traumas. This model is
rooted in the hypothesis that families want to take care of their members and confronting
issues makes families healthier and thus more able to work through future challenges.

ENRICHED STRUCTURAL FAMILY THERAPY

ESFT is a nonpathological, skill-based, systems approach to working with families. The

model evolved out of the experiences and practices of Ross Ford, LCSW-C, and his
colleagues, W. Henry Gregory, PhD, Richard Norman, LCSW-C, and Jannette
Meriweather Gregory, LCSW-C, at the Baltimore Family Life Center in the 1980s. ESFT
is an enrichment of SFT, originally conceptualized for work with minority families in
Philadelphia, Baltimore, and other cities (Minuchin, 1974). The model employs solution-
oriented steps, which the interventionist can find useful in improving their success in
working with families, and in identifying and facilitating resilience within the family’s
functioning.
According to Gregory (2001), focusing on strengths and resisting inappropriate
“pathologizing” are key processes for facilitating resilience and growth in families.
As such, the hallmark of ESFT is its consistent and prevailing emphasis on family
Pdf_Fol io:4
 An Introduction to Enriched Structural Family Therapy 55

strengths and the capacity for growth and sustainability. ESFT interventions were,
therefore, developed to specifically address the clinical intricacies inherent in urban family
functioning and parenting.

ESFT INTERVENTIONS

ESFT is comprised of three compatible foci that blend well to achieve the emotional and
behavioral restructuring that is necessary to access and promote resilience in families. As in
cognitive behavioral family therapy, the goal is “to facilitate as much change as possible, given
the influence schemas (beliefs) have on family dysfunction. Intervention consists of a series of
cognitive and behavioral strategies used in restructuring the basic core beliefs of the family and
altering or modifying behavior patterns that are associated with schema” (Dattilio, 2005). ESFT
extends Minuchin’s approach, formalizing the behavioral emphasis by adding parenting skills
education, and the emotional emphasis, both supplementing the structural emphasis on the
reorganization of communication patterns.

The three ESFT model components are as follows:

• A fundamental valuing of self and family on the basis of a love that is intrinsic in family
relationships, coined kinship love.
• A modification of SFT, as developed by Minuchin et al. (1967).
• Total love parenting (TLP), based on a parenting skills sequence developed by Bernard and
Louise Guerney, at Pennsylvania State University, and further clarified by Ross Ford and colleagues
(Guerney, 1995).

KINSHIP LOVE

Kinship love is one of the unique additions of Ford and his colleagues to Minuchin’s SFT model
(1967). Kinship love is the active acknowledgment of the emotional bonds between family
members as the driving motivation for cooperation, experimentation, and ultimately, change. It
provides the context through which difficult and challenging issues can be approached. When
family members are helped to directly express love to one another, this facilitates “positive
emotions that help families feel more supported, secure and responsive in relationships” (Bai
& Repetti, 2015). This is especially true for families of color, who may know and experience
the world ontologically, primarily through their emotions (Nichols, 1976). In this process,
feelings are used to identify, assess, and engage their world. The practice and experience of
kinship love is critical to family resilience because, oftentimes, families will not move forward
or deepen their healing work until and unless their emotional needs are acknowledged.
Specifically, kinship love supports communication processes directly related to open emotional
expression, which is a major resilience factor (Walsh, 2003).
Kinship love as an affirmative approach fortifies therapeutic relations and avoids the dangers
of involving vulnerable and trusting clients in negative or otherwise harmful experiences.
While, generally, therapy is instituted because of the family’s or community’s dissatisfaction
with a member’s behavior, kinship love acknowledges that the love is the basis for the concern.
This process reframes the intent of the session, lowers the tension, and connects the family and
the therapist.
56 Gregory et al.

STRUCTURAL FAMILY THERAPY

The second component of the ESFT model relates directly to SFT. According to Ford, Pdf_Folio:55

“Structural Family Therapy is a well-known, well-documented family therapy model that was
developed in inner-city [urban] Philadelphia, Pennsylvania by actually observing the way
indigenous paraprofessional counselors were able to establish rapport and to focus on the
competence and strength of people in the here and now” (personal communication, July 1985).
In SFT, the family is seen as a system wherein the behavior of one member affects, and is
affected by, all other members. Thus, change for the better in any symptomatic area has a
curative and preventative effect relating to other vulnerable family members. This system
operates primarily through characteristic role transaction, particularly between parents and
children, in relation to working through the family’s rules of conduct relative to respect for
others, social obligations, handling stress, and developing balance between closeness and
individualization (Minuchin, 1974).
When various problem areas are addressed within the context of the family, family
members can tap a source of motivation and support far beyond that available to the
individuals alone. Resilience processes like flexibility, social resources, and collaborative
problem-solving are easily highlighted when the family participates in these interventions.
For instance, SFT aims to restructure communication patterns and consequently behavior
(behavior is also communication). Frequently, the effort is to change the family system’s
response to the undesired behavior. The mother who fusses and curses to get her children’s
attention can be helped empathically to achieve her goal of getting her children’s attention
by validating her intention (see case study). Validation helps people relax and, as such,
people are more inclined toward flexibility, which is another major resilience factor.

STAGES OF THE FAMILY INTERVIEW

The ESFT interview proceeds through five precise stages, beginning with (a) the social
stage in which the therapist connects with and joins each family member. It then moves to
(b) the problem stage to identify issues, concerns, and problems to be addressed. In the
third stage of the interview, (c) the enactment stage, family members are directed to relate
to each other in a prescribed manner discussing the presenting problem while revealing
family dynamics. The fourth stage of the interview is (d) the restructuring stage, where the
therapist redirects the communication of family members creating opportunity for positive
change. In the final stage, (e) the closing stage, tasks and home assignment are given and
a brief evaluation of the session takes place.

TOTAL LOVE PARENTING

Following the positive focus and the structural approach, the third intervention of the ESFT
model is TLP. TLP was formulated by Ford and colleagues and based on the parenting
skills sequence developed by the Guerneys at Pennsylvania State University (Daneker &
Hunter-Lee, 2006). The purpose of the sequence is to teach parents to develop influence in
an atmosphere of warmth and mutual respect. Integrated in this approach are parental
expectations, needs of children for successful experiences, and direct expression of
feelings. A unique feature of TLP is that the therapist becomes a part of the family’s
 An Introduction to Enriched Structural Family Therapy 57

network and parenting skills are taught, reviewed, and transferred during each therapeutic
interaction.
Pdf_Folio:56

Additionally, TLP successfully enriches the organizational patterns and communication

processes of families who strive to positively parent their children. “Most important of the
general goals for families is the creation of an effective hierarchical structure” (Nichols &
Schwartz, 2006). Minuchin, Nichols, and Lee (2007) also believed that families reveal their
structure only when they are in action (enactment). Accordingly, adding parenting to ESFT
increases the model’s ability to help families provide critical leadership.
As is shown in the case example below, the ESFT therapist uses the family interview to tap
into key family resources and build and repair “relational lifelines” while addressing parenting
issues.

CASE STUDY

What follows is a transcript of a session with a long-term client–family undergoing ESFT.

Ms. Smith is a 30-year-old African American mother of five. She is currently living in a
homeless shelter with four of her children. Ms. Smith recently gained custodyofher10-
year-oldson,whomshebirthedwhileincarcerated.Throughrecent
courtintervention,Ms.Smithwasabletoreconnectwithherson,whowaskeptaway from her by
a caregiver for his entire life. She has a history of sexual and physical abuse which is being
addressed in individual therapy. Ms. Smith is verbally aggressive and abusive when
parenting her children. She is continuously uncooperative with family, friends, and
professional staff.
During the session below, taking place in the living room of the shelter, the therapist
has just finished discussing family dynamics with Ms. Smith to reflect her strengths. He
then brings in her son and utilizes ESFT interventions to facilitate communication and
support the family in identifying their own patterns, resilience, and solutions. As Minuchin
et al. (2007) discovered, showing families how they function offers them the opportunity
to self-correct and reinforces healing, therefore changing behaviors.

Social Stage
When the therapist calls in the 10-year old son, the son sits on the opposite end of the couch
from his mother. The therapist engages the parent and child in a five-stage ESFT family
interview, directing and supporting communication in the session. He joins the son to bring
him into the session and addresses the mother’s issues first to reinforce the family’s
hierarchy. The mother starts immediately to report the trouble she is having with her son.
The therapist assures the mother that he will get to her issues in today’s session and
redirects her to the business of the social stage, joining (connecting to) each member
around their competence and abilities.
Ms. Smith: I can’t take this no more. He acted up in school today and they want me to
come up there tomorrow.
Therapist: Lots to take care of today. I promise you we will get to it. May I ask who takes
care of this gorgeous plant and say hi to DeShawn? Pdf_Folio:57
 58 Gregory et al.

Analysis: The ESFT therapist respectfully validates mother’s desire to

problem-solve, makes a commitment to follow her lead, and supports the
family’s hierarchy by asking permission to involve the son. He moves
immediately to connect with the family and to connect the family members
with each other. Family leadership and connectedness.
Ms. Smith: Oh sure, he’s the one who’s been watering that plant.
Therapist: Really, hi DeShawn. How are you today?
DeShawn: Fine.
Therapist: I am glad that you are well. Wow, this plant is beautiful.
DeShawn: (he is still sitting on the opposite end of the couch from his mother) I know how to
grow’em from little babies. My mother put it on that stand.
Therapist: That’s a great presentation that the two of you created together. Your mother
and I were discussing her desires for your family. We wanted to call you in to get your
feelings about your family?
Analysis: The therapist highlights the family’s connectedness and collaboration and
sets the mother up in a leadership role-key resiliency factors.
DeShawn: I like it when we all get along.
Therapist: You want peace in your family. It feels good to you. We will talk about that shortly.
Analysis: Therapist joins the son by relabeling his language, “getting along” to
“peace” in the family to highlight and show that the son is seeking reconnection
and reconciliation with his mother and to avoid pathologizing.

Issues Stage
The family is quiet and the therapist senses that they are finished with the social connecting
and ready to get to the business of the day. He gets back to mother’s issues of guiding and
leading her family: her son’s issues in school. He focuses only on how the family members
see the problem while observing their interactions and responses to authority and stress
without pathologizing. He uses gentle reflections to help them to verbalize clearly to bring
out their typical interactions and to make sure he understands their issues from their
perspective. The therapist then reflects his understanding of the family’s interaction to the
family.
Therapist: So, Mrs. Smith, you were telling me that you want to address DeShawn’s school
behavior today.
Ms. Smith: Yea, he got in trouble again today and I am just tired. He got to listen to his
teachers. He’s not trying to have no peace.
Analysis: The client is now using the therapist’s relabel of “peace” in the
Pdf_Fol io:58 family.
An Introduction to Enriched Structural Family Therapy 59

Therapist: You are not pleased that DeShawn got in trouble and you need him to obey
your rules, to listen to his teachers. That would be peaceful to you.
Analysis: The therapist joins mother by reflecting and validating her complaints as
concerns.
Ms. Smith: I sure do. AND YES IT WOULD!
Therapist: You are very clear. Thank you. We will discuss that in a minute. Let me see
what DeShawn wants to add to the agenda today (therapist turns to DeShawn). DeShawn,
you shared earlier that you like it when your family gets along; what else would you like
to talk about in the session today?
Analysis: The ESFT therapist sets up collaborative problem-solving
possibilities early in the family session by structuring communication patterns
that give each member equal voice.
DeShawn: Her hollering and cussing at me.
Therapist: You would like to discuss the way your mother talks to you. Thank you.
Analysis: Therapist joins the son’s contribution by reflecting his concerns and
perceptions.

Enactment/Interaction Stage
The therapist senses that the family is finished identifying the issues that they want to work
on, so he moves to helping them bring out their typical interacting around how DeShawn
responds to rules and how his mother communicates concern and instructions. The ESFT
therapist frames the entrance into this stage in a manner that allows him and the family to
increase their understanding of how the family operates as a unit. The ESFT model allowed
the therapist to skillfully use direct reflections and reframes to guide the family’s
communication and redirect fault-finding and develop competency-based solutions.
Therapist: The family is clear about what we will work on today. Mrs. Smith, please start
by talking to DeShawn about your concerns about how he follows your rules and
cooperates with his teachers at school.
Analysis: The therapist joins the parent’s strengths, reflects the family’s truth-
speaking, and structures open expression of emotions and collaborative
problem-solving.
Ms. Smith: (escalated and yelling) He don’t do a damn thing I say. He starts fights in
school. I told him to listen to those teachers and ignore them stupid children. He’s gonna
get his ass taken again.
DeShawn: (wriggling, pouting and interrupting mother as she talks) See, I told you. She
always fussing and cussing. We never get along.
Therapist: DeShawn, you want peace in your family. It feels good to you. Mother, you
need his attention and cooperation so you don’t lose him again, but before you can discuss
school, you want to address your son’s need for peace and your need to keep him safe.
Pdf_Folio:59
60 Gregory et al.

Would you like to talk to DeShawn about that first? (therapist now turns toward DeShawn
and waits for mother’s response)
Analysis: Therapist sees the mother/son bond, joins it as a strength, relabels it
as a driving motivation for cooperation, and begins to structure cooperation by
restructuring communication patterns. The therapist’s acknowledgement of
that bond provides a context through which these difficult and challenging
issues can be approached. He sees problems and solutions as opposite sides of
the same coin. He feels and acknowledges mother’s pain around the risk of
losing her son again and validates her attempts to guide and protect him.
Ms. Smith: (now yelling and talking over DeShawn) He don’t listen. All his ass want to
do is sit there and talk about what I do. (mother now turns to DeShawn but continues to
talk about DeShawn) This is the fifth damn call this year. How many before they come
take him. He act like he don’t even wanna be here.
Analysis: Therapist sees problems and solutions as opposite sides of the same
coin. He feels and acknowledges mother’s pain around the risk of losing her
son again and validates her attempts to guide and protect him.

Restructuring Stage
The therapist now sees the mother and son’s role performance patterns, their process of
discussing rules, and helping DeShawn to follow rules. He sees the mother’s desire and
effort to guide and protect her son and sees the son’s desire and attempts to cooperate with
his mother. He also feels the family’s pain that blocks their communication and impedes
their ability to see positive solutions. He then becomes very directive and starts to join the
family’s strengths and capabilities in order to shape solutions and encourage cooperation
and accommodation. Collaborative problem solving, a key resiliency process, becomes the
focus of this stage. He achieves this by leading the family though the process of
acknowledging their need for emotional connection.
DeShawn: Me and my mother argue all the time. She cusses me and my sisters out.
Sometimes I wish I still lived in North Carolina with my other family.
Ms. Smith: Well, you can pack your shit up and I will send you back down there.
Therapist: Ms. Smith, now that you are having this conversation with DeShawn, some of
the things he says upset you. When you are hurt and upset, you curse and DeShawn feels
distant and talks about being somewhere else. You are successful in getting DeShawn to
listen to you today. Tell him what you need him to know.
Analysis: Therapist names patterns to show typical interaction, reframed
communication blocks without blaming while facilitating open, and positive
expression of emotions and shaping solutions.
Ms. Smith: (now talking in a softer voice and less volatile, but to DeShawn) Yes, I’m
working hard to take care of you and your siblings, and this is how you say “thank
you.” If you want to go back, I will take you back. Pdf_Folio:10
 An Introduction to Enriched Structural Family Therapy 61

Analysis: The client followed the therapist’s lead and now seeks reconnection
with her son and makes attempts to respect his individual needs; noted
processes for enhancing family resilience.
Therapist: You want DeShawn to know that you love him and want him with you. It hurts
to think that he doesn’t appreciate your efforts to provide for him and that he might not
want to be with you. I see that you care about him very much and you are trying to protect
him. If you agree, tell him that.
Analysis: Therapist reframed mother’s sharing to show that she is seeking
reconnection and highlights her attempts to protect, and structure open
expression and ownership for feelings. He, therefore, moves to support
communication processes directly related to open emotional expression.
DeShawn: (answers before mother while continually looking at therapist) I do appreciate
her.
Therapist: (turns his head toward mother as DeShawn looks at the therapist)You do
appreciate your mother and you want her to know it. She’s next to you, move closer to her
and tell her.
DeShawn: (turns to his mother but does not move closer) Ma, I appreciate you and
everything you do for me. I didn’t mean to upset you. I just don’t like all the fussing and
cussing.
Analysis: The client follows the therapist’s prompts with positive emotions.
Because the ESFT therapist embraces the model’s concept of kinship love, he
believes that family members want to care for each other. He then used gentle
reflections to join parent/child connections and focus the family on their own
strengths and confidence.
Ms. Smith: (looking at therapist) I don’t want to cuss at them. My mother cussed at me. I
know how that feels. (therapist turns whole body toward DeShawn; mother then turns and
talks to DeShawn) I’m sorry for cussing at you. I know I have to do better with my
language. I fought to get you back in my life and sometimes I feel like you don’t want to
be here.
Analysis: Mother now follows with open and direct expression of compassion and
humility; she is taking full ownership for her feelings.
Therapist: You need to know that your fight was successful. Cussing is your way of
handling all the hurt feelings when you think you might lose DeShawn again. You are a
soldier for your family when you need to be. Now the fight is to be close with him and
keep him safe.
Analysis: The therapist named patterns, reframed blocks, and used metaphors
to gently restructure mother’s strengths to address her current situation.
Ms. Smith: It hurts. It hurts really bad. (Starts to cry) All those years I thought about
getting you back into my life and now you don’t want to be with me.
Pdf_Fol io:61
62 Gregory et al.

Analysis: Mother responds to the gentle restructuring with open expression of

difficult feelings.
Therapist: You are fighting to keep your family together. The way the family deals with
pain when it feels like too much is to give up and protect yourself. Mother cusses and
DeShawn talks about going back to live with his other family and stops trying to please
mother in school to show her that he is feeling hurt because he knows that school is
important to her.
Analysis: Mother responds to the gentle restructuring with open expression of
difficult feelings. Therapist names patterns and uses summarizing statements
to shows the family how they function, reinforcing healing/changing behaviors
without pathologizing. He assumes that mother’s behavior is motivated by deep
positive intentions.
DeShawn: Mommy, don’t cry. I’m sorry you are feeling hurt. I love you and I do wanna
be here. I just wanna get along better.
Analysis: The client follows the therapist lead with open expression of empathy. He
is now seeking reconnection and reconciliation.
Ms. Smith: I want to get along better too and I love you too. I was so hurt all the time you
were gone but I know that I could not take good care of you when I was in jail. Now, I
look at it like losing you made me fight harder to get myself together. I just prayed and I
believed I was gonna get you back. (Mom moves close to DeShawn reaches out to hug
him)
Analysis: Mother followed with direct expression of compassion, positive
outlook, spirituality, and meaning making of the adversity she is currently
facing.
Therapist: The two of you are working together to make things better. It is obvious that
you care about how the other is feeling. For the last ten minutes, both of you did a great
job of expressing yourselves without interruption or conflict. We will hold each other
accountable for our actions.
Analysis: The ESFT therapist “monumented” insight, effort, and cooperation while
reinforcing expression of emotions and connectedness.
Ms. Smith: (looking at DeShawn) Well, I know I need to work on cussing less and telling
you I love you more.
Analysis: Therapist’s validation and acknowledgement of strengths and
capabilities facilitated clear communication and collaborative problem solving.
The clients followed naturally with open expression of empathy and ownership
for feelings and behaviors.
DeShawn: I could do more and listen better. I need to do my school work better too. Sorry!
Ms. Smith: YES YOU DO HONEY (we all laugh)
Therapist: You have courageously worked to express hurt feelings to each other and
mother has made promises to stop cussing when giving her messages to DeShawn.
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An Introduction to Enriched Structural Family Therapy 63

Mother, can you spend the next few minutes talking to DeShawn about how he follows the
rules in school?
Analysis: Therapist summarized the family’s work, reinforced insight,
courage, and cooperation, and structures attention to mother’s original issue of
Deshawn’s compliance to the family’s order system.
Ms. Smith: I don’t want him to get taken again and I do want him to have respect for his
teachers.
Therapist: You are concerned about his security with the family and you need him to
follow your rule of respecting authority. I noticed today that he listens and tells you what
he needs to cooperate with you when you talk to him about your feelings and use positive
language.
Analysis: The therapist named patterns, relabeled, and reframed mother’s
response to restructure their communication process and created an opportunity
for positive outlook.
Ms. Smith: Yea, I saw that too. I feel ashamed of cussing at my children and I wanna do
better. I am proud of him. He never told me that he wanted to be here with me before. He
told me that one boy who sits behind him disturbs him. I’m going to talk to his teacher
about it tomorrow. I think we got a chance if he keep listening. I don’t want nobody picking
on him. (DeShawn smiles and leans towards his mother for the first time in the session)
Analysis: Mother followed with open communication, compassion, and
positive outlook. Her role as a leader was structured and reinforced with the
constant “mirrors” (reflections). She then took on the role of leader and
structures positive outcomes for her son. She focused on the goal of success in
school, takes a concrete step, and builds on the success of the session. She is
now nurturing, guiding, and protecting.

Closing Stage
The therapist chose to end the session when the family was having a successful experience.
He summarized their accomplishments, stated any unfinished business, and gave the family
an assignment to continue the positive connection they experienced in the session. He
structured it to protect them from falling into their triggered conflict in this early
restructuring of their communication process. This structuring addresses both the family
relationship and the symptomatic problem.
Therapist: You are feeling really good that DeShawn expressed that he wants to be home
with you. You seem to want to end with good feelings between you and him. You saw
DeShawn respond to your positive communication and you believe that you have a handle
on how he follows rules in school. You have a plan to check on it tomorrow. I would like
for you to spend ten minutes on Monday and Wednesday of next week when you pick
DeShawn up from school telling him about Baltimore. He will count the times you use the
positive words on our list. We will discuss it in the next session on Thursday of next week.
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64 Gregory et al.

Analysis: The ESFT therapist summarized today’s accomplishments, gave

home assignment, and ended with the family feeling connected and proactively
preparing for future challenges. The ESFT therapist assumes that “people are
motivated by good intentions”—although this mother came in having difficulty
acting on her intentions. The therapist reframed the parent’s concerns as
intentions to prevent problems, sustain hope, care for her son, and protect her
family.
There is a history of and liability for conflict and antagonism in the interaction in this
family. The therapist skillfully avoids those traps by attending to the clients’ emotions
providing nurturance, identifying strengths and resilience, and acknowledging their
positive intentions through reframing. This approach is validating and affirming for both
the mother and the child. It provides hope beyond the difficult dynamics. As a result, both
family members lower their defenses, follow the therapist’s lead, and take the risk to be
vulnerable with each other, expressing deeper levels of their realities.
Understanding that most family members have good intentions, the therapist uses every
opportunity to emphasize effort. By labeling and relabeling expressions and behaviors he
attempts to reinforce the productive, growth-oriented movement that is always present but
frequently overshadowed by the habitually negative way many people look at themselves
and others. The key to this positive labeling is to promote enactment of the system’s
communication, right in the session. The central issues of closeness and authority usually
are the themes to be worked on with most families and as such provide direction and focus.
The ESFT therapist is trained to pursue and reinforce family strengths. The ESFT model
focuses the therapist on the transfer of concrete skills, principally parenting, but also
interpersonal relationship skills, in the course of each session. In each family session, the
therapist catches the parent making attempts to use the parenting skills, reinforces the
aspects of the skills that the parent is getting correct, and shapes any new practices and
parenting behaviors that are needed. The therapist is looking to guide the family in
improving the functionality of the structure by helping them to examine and change
ineffective patterns of communication.

DISCUSSION

A family resilience approach aims to identify and fortify key interactional processes that
enable families to withstand and rebound from disruptive life challenges. A resilience lens
shifts perspective from viewing distressed families as damaged to challenged, affirming
their potential for repair and growth (Walsh, 1998). Many Black families experience the
stress common to all families plus the additional stress resulting from discrimination,
racism, and poverty. Understanding family resilience factors, common and culturally
specific, gives the clinician the tools to be genuinely strength oriented with families. ESFT
is a practice-developed approach that focuses on the identification and promotion of
resilience factors to assist with healing and growth in distressed families.
The major challenge to working with Black families is connecting and developing an
authentic therapeutic relationship through which to exercise influence with a population
that has a historic and contemporarily reinforced mistrust of “the sys- tem” and its
Pdf_Folio:14

representatives. Effective interaction requires a skillful approach that

 An Introduction to Enriched Structural Family Therapy 65

attends in a genuine way to the emotional context and expression that is so prominent in Black
families. To be culturally competent and effective with Black families requires that clinicians
do the following:

• Be emotionally competent (able to read and respond to the emotions of their family members and
as well their own)
• Assume a reflective posture that allows the clinician to lead by following the family
• Be focused on connecting, understanding, and problem-solving as opposed to pathologizing
• Be competent in the skill of positive reframing
• Have a model/approach that is organized to attend to the cultural nuances of Black populations and
is capable of facilitating behavioral change with or without accompanying insight.

CONCLUSION

ESFT has successfully supported Black families in the identification and employment of
resilience resources from a culturally sensitive, culturally informed, and culturally relevant
framework for the past 40 years. Through ESFT interventions, families not only acknowledge
their innate resilience, they fortify those assets and enable their subsystems to improve and
increase healthy functioning in the context of a sometimes dysfunctional society.
The central and enriching concept of the ESFT model is kinship love, used within the context
of reinforcing and teaching parenting skills and improving the structure of interpersonal
communications. The primary tasks of nurturance, socialization, and protection (parenting) are
basically motivated by deep, positive feelings. Through a unique training design, therapists are
taught to become sensitized to these feelings in themselves and others, and are then able to
approach families in the same spirit. The therapy then focuses on achieving happiness and
harmony in the family, and in each individual, through giving kinship love and positive
relabeling of experiences and behavior.
The therapist is trained to assess the family’s capabilities instead of disabilities (diagnosis).
Usually by the time that urban and underrepresented families get to family therapy, their
disabilities have been well documented. Since this model seeks problem identification as well
as solutions in the “here and now,” the ESFT therapist is free to follow the family in discovering
what they can do. Problems and solutions are seen as two sides of the same coin. Both the
problems and solutions are present in each session. The therapist does not have to depend on
what can often be outdated and irrelevant history, to see what the family’s issues are.
The ability to recognize resources/strengths/resilience and reframe to a positive is a
byproduct of a basic belief in the goodness of people and an ability to attune to their positive
intentions, beyond the distractions of their behavior. ESFT is an empathetic attitude grounded
in a structural approach to understanding the positive intent inherent in all communications and
interactions between family members. As such it is a nurturing process that attends to the
emotional/affective needs of the client, a primary necessity in working with people of color who
primarily live in an affective epistemology. However, it is our experience that ESFT can be
used successfully with people across cultures because although affect is not the primary
Pdf_Folio:15

orientation for all cultures or worldviews, it is nevertheless always a major dimension of the
human experience.
 66 Gregory et al.

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Disclosure. The authors have no relevant financial interest or affiliations with any commercial
interests related to the subjects discussed within this article.

Acknowledgments. The Rafiki Consortium, LLC, and the authors of this article would like to
acknowledge the life’s work and vision of social worker Ross Ford and offer gratitude for creating the
inspiration in us to document his gifts. We would also like to acknowledge all of the community healers,
both past and present, who by virtue of their contributions to the fabric of culturally competent and
strengths-focused family services to Black families in Baltimore, also inspired this work.

Correspondence regarding this article should be directed to Maisha Davis, LCSW-C, Director
of Case Management, Chase Brexton Health Care, 1111 N. Charles Street,
Baltimore, MD 21201. E-mail: maishadavis930@gmail.com

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 68 Gregory et al.

APPENDIX
BELIEF SYSTEMS
Making meaning of adversity • Affiliative value: resilience as relationally based
• Systemic: the plurality of causality
• Family life cycle orientation:
normalizing,contextualizing adversity and distress
• Sense of coherency: crisis as meaningful,
comprehensible, manageable change
• Appraisal of crisis, distress, and recovery:
facilitative versus constraining beliefs
• Remembering: validation and affirmative of self
Positive outlook • Active initiative and perseverance
• Courage and encouragement
• Sustaining hope, optimistic view, confidence in
overcoming odds
• Focusing on strengths: humility and gratitude
• Mastering the possible; accepting what cannot be
changed
Transcendence and spirituality • Larger values and purpose
• Spirituality: faith, rituals, and communion
• Inspiration: envisioning new possibilities,
creativity, heroes
• Transformation: learning and growth from
adversity
• Experiencing dreams and clairvoyance
ORGANIZATIONAL PATTERNS

Flexibility • Capacity to change: rebounding, reorganizing,

adapting to fit challenges over time
• Counterbalancing by stability: continuity,
dependability through disruption
Connectedness • Mutual support, collaboration, and commitment
• Respect for individual needs, differences, and boundaries
• Strong leadership: nurturing, protecting, guiding
children, and vulnerable members
• Seeking reconnection, reconciliation of troubled
relationships
Social and economic resources • Mobilizing extended kin and social support; community
networks
• Building financial security; balancing work and family
strains
(Continued)

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(Continued)
 An Introduction to Enriched Structural Family Therapy 69

COMMUNICATION PROCESSES
Clarity • Clear, consistent messages (words and actions)
• Clarification of ambiguous situation: truth seeking/truth
speaking
Open emotional expression • Sharing range of feelings (joy and pain; hopes and
fears)
• Mutual empathy; tolerance for differences
• Responsible for own feelings, behavior; avoiding
blaming
• Pleasurable interactions; humor
• Empathy, compassion, and forgiveness
Collaborative problem-solving • Creative brainstorming; resourcefulness
• Shared decision-making; negotiation, fairness,
reciprocity
• Conflict resolution
• Focusing on goals; taking concrete steps; building on
success; learning from failure
• Proactive stance: preventing problems, crises, preparing
for future challenge
 70 Gregory et al.
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