 Regarded as one of the most

influential and widely used

therapies used in the field
 Founded by Salvador Minuchin
◦ Born and raised in Argentina
◦ Psychoanalytically trained child
psychiatrist
◦ Worked with inner city families
◦ Developed an approach to work with
chaotic family structures
◦ Directed the Philadelphia Child
Guidance Clinic during 1960s
◦ Started his own center in NY in 1981
◦ Retired in 1996
 There is an overall organization or structure
that maintains a family’s dysfunctional
interactions.
 Structural Family Therapy is comprised of
various components and themes including:
◦ Family Structure
◦ Family Subsystems
◦ Family Boundaries
◦ An organized pattern in which families
interact
◦ Not deterministic or prescriptive, only
descriptive
◦ Partly universal, partly idiosyncratic
 Universal ex.?
 Idiosyncratic ex.?
◦ Can only be seen when a family is in
action, because verbal descriptions rarely
convey the true structure
 Once patterns are established, family
members use a small range of behaviors
available to them
◦ Once patterns are set, this leads to
predictability and limitations
 Structures typically have some form of
hierarchical structure and also tend to have
reciprocal and complementary functions
◦ parental involvement with children: over vs.
under involved
 Family transactions are repeated 
foster expectations  limit the range of
behaviors
 The first time the baby cries….
 “who is going to..?”  “she’ll probably…”
 “she always…”
 Rules
 “A good mom always takes care of her
baby”
◦ Any problems with this?
 Subsystems are based on:
 age (or generation)
 gender
 interest (or function)
 Power and hierarchy
 Subsystems are often formed based on the
patterns of interaction in a family
 Covert coalitions are often more significant
than obvious groupings
 Boundaries are invisible barriers that
regulate contact between subsystems
and serve to protect the separateness
and autonomy of the family

 Rigid boundaries -Disengagement

promotes independence but limits
warmth and affection

 Diffuse boundaries – Enmeshment

promotes dependence and limits contact
with others outside the family system
  Diffuse  too open . . . . .
 Rigid too closed ________
 Normal boundaries: - - - - - -
 Rigid boundaries disengagement
 Diffuse boundaries  enmeshment
 Boundaries are defined by rules
◦ “no phone calls after 10pm”
◦ “not allowed to interrupt parents”
 Boundaries are reciprocal
◦ A weak boundary (enmeshment) in one
relationship usually means that the same person is
disengaged from someone else.
◦ Ex: A wife who is enmeshed with child and
disengaged from husband
◦ Ex: A father who is very close and enmeshed with
older son who hunts with him, and disengaged
with daughter who is quietly depressed
 Healthy families are not defined by the
absence of problems, but rather by a
functional family structure
 Healthy families can modify their
structure to accommodate changing
circumstances
 Unhealthy families increase rigidity of
structures that are no longer
functional

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 New couple: Accommodation and boundary
making
 New baby: A new subsystem
◦ Mom vs. Dad
 Growing pains vs. pathology
 Inflexible response to developmental and
environmental challenges
 Weak hierarchies
 Conflict avoidance
 Poor boundaries
◦ Disengagement and enmeshment tend to be
compensatory
 “I’m close here to make up for my distance elsewhere”
 Cross-generational coalitions: similar to…?
 The ultimate goal of therapy is structural
changes to the family (roles, rules, hierarchy,
behavior patterns)
 Alter the family structure so that the family can
solve its own problems
 General goal: create or strengthen executive
subsystem
 Enmeshed families: create more appropriate
boundaries (strengthen boundaries) between
individuals and subsystems
 Disengaged families: increase interaction by
making boundaries more permeable (weaken
boundaries)
 Opening Phase:
◦ Joining and accommodating
◦ Effective therapy requires challenge and
confrontation
◦ Enactment
◦ Mapping structural patterns

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◦ Maintenance: validation
◦ Tracking: “let me see if I understand you”
◦ Mimesis: “tuning in”
◦ Family is set up to resist you. You are a stranger,
and know nothing about their struggles
 Obtaining acceptance from the family in order to
disarm defenses and create an environment for
change
◦ Important to build an alliance with every family
member
 Especially with the angry and powerful family
members
◦ Important to respect hierarchy
 I see you don’t want to talk right now, it’s ok, maybe
you will have something to say later”
 Enactment: Ask the family to manifest their
interactions
◦ “She says you are too strict, can you show me how?”
 Therapist pays attention to the dynamics of
the family:
◦ Who interrupts who? Who is speaking for who? Etc.
◦ What are the signs of enmeshment vs.
disengagement?
 Structural Mapping
◦ Working with interaction
◦ Observing enmeshment and disengagement
◦ Ways that capture the interrelationship of members
◦ Family structure manifests itself only when
members interact
 Focus on the underlying family structure
◦ Highlight and modify interactions
◦ Intensity (interrupt rigid and difficult patterns)
◦ Help people do things themselves
◦ Therapists can invite family members to participate
and interact in ways that will help them function
more effectively

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 Highlighting and Modifying Interactions
◦ Your wife says you don’t communicate with her.
Can you please respond to that?
◦ Increase INTENSITY
 How come you are ok with this?
 How come little Johnny is this tall? Whose shoulders is he
standing on?
◦ Shaping competence
 Alter the direction of the flow by She nags

highlighting and reinforcing other

behaviors in their repertoire.
He He
withdraws withdraws

She nags
 Transformation of Family Structure
◦ Boundary Making
 Loosen boundaries in disengaged families
 Strengthen boundaries in enmeshed families
◦ Unbalancing
 change the relationship of family members within a
subsystem by joining a subsystem or individual at the
expense of another – taking sides
◦ Reframing
 adding cognitive constructions

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 Boundary making:
 In enmeshed families:
◦ Family members are encouraged to speak for
themselves
 The Kleenex Box
◦ Some of the sessions can be held with individuals
or subgroups
 In disengaged families:
◦ Increase positive interactions between subsystems
that are disengaged
 Individual boundaries include:
◦ each family member is allowed to talk for
themselves
◦ each family member needs to be listened to by
other members
◦ each family member need to ask a question or
answer a question directed to them
◦ each family member needs to respect the rights of
each family member
◦ each family member needs to be treated equally
relative to their age and level of responsibility
 Most common: the boundary between the
parental subsystem and the children
subsystem
 Where there is triangulation between a child
and one of the parents that weakens the
parental subsystem, the therapist needs
strengthen the boundaries here to re-
establish a better functioning parental bond
that does not stray into involving one of the
children.
 “We have a communication problem, he won’t
tell me what he is feeling. All he cares about
is his damn job”
 Our sex life is lousy, my wife is a frigid, who
can talk to her? All she can do is complain
about the kids?”
 Homework
◦ Increase contact between disengaged parties
◦ Should be something that is not too ambitious
◦ While Minuchin rarely used strategic interventions,
he cautioned family members to expect setbacks,
in order to prepare them for a realistic future.
 Families are competent and capable of
solving their own problems
 Therapist doesn’t solve problems; that’s the
family’s job
 Therapists are collaborators and not experts
 Therapists respect the family’s unique
culture. The question should be, not “What’s
ideal?” but “Does it work for them?”
 Encourage positive interactions
 http://www.youtube.com/watch?v=mPW0UZd
9gQ4