Structural Family Therapy Versus Strategic Family Therapy: A Comparative Discussion

The Chat with Dr. Dave Therapeutic Thoughts of the Week David P Sanchez, Psy.D., LMFT

Structural Family Therapy vs. Strategic Family Therap y: A Comparative Discussion This week ’s Dr. Dave’ Dave’s “Therapeutic Thoughts of the Week ” intends to illustrate the theology and interventions pertaining to Structural Family Therapy and Strategic Family Therapy. Upon identifying the characteristics characteristics of each treatment modality, the inherent similarities between the two will be explored. This will allow for a comparative discussion regarding the theoretical underpinnings for for each model. Finally, Dr. Dave will contrast contrast these models as to identify their respective differences and will discuss the role of the therapist as it relates to each model. My intention is to illustrate the theology and interventions pertaining to S tructural Family Therapy and Strategic Family Therapy. Upon identifying the characteristics of each treatment modality, the inherent similarities similarities between the two will will be explored. This will allow for for a comparative discussion regarding the theoretical basis for each model. Finally, I will contrast these models as to identify their respective differences and will discuss the role of the therapist as it relates to each model. The origins of Structural Family Therapy can be be traced back to the 1960’s in the work of Salvador Minuchin. Minuchin at that time worked at the Wiltwyck School, a residential residential treatment facility in in New York for inner-city delinquents. Minuchin developed Structural Family Therapy as a necessity to accommodate the needs of his clients clients and their families. families. The

 The Chat with Dr. Dave Print document Therapeutic Thoughts of the Week In order to print this document from Scribd, you'll David P Sanchez, Psy.D., LMFT first need to download it.

Cancel is “that Download And Printsymptoms are best understood main thesis for Structural Structural Family Therapy an individual’s

when examined in the context of family interactional patterns” (Gladding 210). Structural Family Family Therapists’ believe that symptoms are relieved when chan ge occurs in the family’s organization or structure (Gladding 210). Minuchin’s Structural Family Therapy was influenced by by the philosophy of Ortega y Gasset, Gasset, which “emphasizes individuals interacting with their environment” (Gladding 212 ). Minuchin postulates that every family has has a structure. The “structure” is “an invisible invisible set of functional demands by which family members relate to each other” (Gladding (Gladding 212). Structure of the family influences the family as to how they relate to each other. Some families may possess possess a well organized hierarchical system system where they can interact with each other easily. In other families a more flexible system may exist where family members interact fluidly with each other. In both cases, structure of the family is susceptible to stress and dysfunction. Families whom possess an open and appropriate structure have a greater probability to recover from stress more quickly than families whom possess a rigid structure (Gladding 212). Structural therapists examine the family as a whole dyad, while simultaneously examining the subsystems found inside of the family dyad. A “subsystem” is a “smaller “smaller unit of the system as a whole” whole” (Gladding 212). Subsystems are merged between between family members in order to carry out certain certain functions within the family family dyad. Subsystems are best defined by the boundaries established between family members. “Boundaries” are “the physical and psychological factors that separate people from one another and organize them” (Gladding 213). Within subsystems, cross-generational alliances and/or coalitions may exist. exist. “Cross-generational “Cross-generational


Cancel fromDownload And Print collude together to obtain alliances” are when two family members different subsystems

certain objectives. “Coalitions” are when two family members collude toge ther against a third family member. member. A stable coalition is one that becomes part of the family’s everyday functioning. A “detouring coalition” is “one in which the pair hold a third family member responsible for their difficulties or conflicts with one another, thus decreasing the stress o n themselves or their relationship” (Gladding 212). Minuchin identifies three types of boundaries within family family systems: clear, rigid, and diffuse. Clear boundaries allow for family members to enhance their relationships with each other as they encourage communication and involve rules rules and habits. Within clear boundaries family members are able to give and receive feedback in a healthy, constructive manner (Gladding 213). Rigid boundaries are inflexible and keep family members away from one another. Within rigid boundaries family family members become emotionally detached or cut off from each other (Gladding 214). Diffuse boundaries occ ur when little differentiation exists between family members. Within diffuse boundaries family members become dependent upon each other and lack independence and autonomy (Gladding 214). In addition to subsystems, hierarchies, and boundaries, Structural Family Therapy also involves roles, rules, and power. power. In regard to roles and rules, rules, family members may be assigned certain expectations according to their function within the family system. Power in the family system refers to both responsibility and authority (Gladding 215). Healthier families usually usually possess flexibility when it becomes necessary to alter family family roles and rules. Unhealthier families are often characterized by few members members possessing power. As a result, these family family members


Cancel Download And Print may become detached or o r enmeshed with others in the pursuit to gain some control (Gladding

216). In Families and Family Therapy, Minuchin Minuchin states that there exists’ three exists’ three overlapping phases in Structural Family Therapy. Phase one involves the therapist joining the family in a leadership position (Nichols (Nichols 191). Phase two involves the therapist mapping the family’s underlying structure and phase three involves the therapist implementing interventions to transform the structure structure (Nichols 191). Minuchin presents a clear model of Structural Family Therapy; however, the phases can become intricately complicated as there are an endless variety of family patterns. Structural Family Therapy involves the use of the following interventions: family mapping, accommodating and joining, enactment, intensity, changing boundaries, and reframing. Family mapping is the use of lines to illustrate boundaries within within families. Diagrams are used to demonstrate how the family relates relates to one another (Sharf 494). Accommodating and joining allows the therapist to align with the family family dyad by using their same language. An example of joining is “mimesis,” which is “imitating the the style and content of a family’s communications” (Sharf 495). The therapist may ask the the family to enact a conflict in the therapy room so that he or she may observe and understand u nderstand the family’s boundaries, alliances, and coalitions (Sharf (Sharf 495). Intensity in Structural Family Therapy refers to “how a suggestion or message is given” (Sharf 495). “By repeating the message, changing chan ging the length of time of a particular interaction, or other means, change can be facilitated” (Sharf (Sharf 495). Changing boundaries involves the therapist to “boundary mark.” The therapist may move family members to different chairs within the


Cancel And Print therapy room, place family members closer orDownload father apart from each other, or create an

unbalance of power by realigning family members within their structure. structure. Reframing is when the the therapist deliberately chooses different words, phrases, or symbols to identify the family’s problem. Reframing a problem into a workable goal, which the entire family can relate to will alleviate additional stress associated with the problem. The origins of Strategic Family Therapy can be traced back to the work of Milton Erickson. Milton Erickson’s work work was described by Jay Haley Haley in 1973 as “strategic “strategic therapy” therapy” (Gladding 232). Erickson believed that the goal of therapy was change. He believed that change can occur by utilizing the specific resources of his clients and designing a “strategy for each specific problem” (Gladding 232). Erickson worked with clients in in a manner that that they would become a change agent for themselves. He facilitated this process by giving directives and indirect suggestions in the therapy session. Milton Erickson presents three guiding principles to be used b y strategic therapists as a road map to implementing Strategic Strategic Family Therapy. First, Erickson suggests accepting the family as they are and emphasizing the successes and strengths of the family (Gladding 233). Erickson would frame all symptoms symptoms of maladaptive behaviors as being helpful. Subsequently, Erickson suggests using “indirect “indirect and ambiguously worded directives” (Gladding 232). Finally, he suggests “encouraging or directing routine beh aviors so that resistance is shown through change and not through normal and continuous actions” (Gladding 232). (Gladding 232). Strategic therapists use Ericksonian principles as the fundamental base for Strategic Family Therapy. Strategic Therapy is considered a short-term treatment approach to therapy and


Cancel And Print is often viewed as a “brief therapy.” The termDownload “brief therapy” refers more to do “with the clarity clarity

about what needs to be changed rather than with time” (Gladding 235). A central principle nciple to brief therapy is the evaluation of what attempts have been made to alleviate the problem already. After the evaluation different solutions are tried to alleviate or eradicate the problem. The strategic family therapist is goal-directed, concise, articulate, and problem-focused. The strategic family therapist will focus on several dimensions in family life such as family rules, family homeostasis, quid pro quo, redundanc y principle, punctuation, symmetrical relationships/complementary relationships, relationships, and circular causality. Family rules refer to the overt and covert rules a family uses to maintain stability stability (Gladding 235). An example example of a “family rule” would be “you must speak when spoken to.” Family homeostasis is the tendency for a family to remain stable or in the same pattern of o f communication until challenged otherwise. Quid pro quo refers to family members treating other members of the family as how they are treated by them. An example of quid pro quo is “tit for tat” or “something “something for something.” The redundancy principle is the fact that a family will interact in a limited, repetitive behavioral sequences (Gladding 235). 235). Punctuation is the rationale that that one’s belief that what one says is caused by what someone else said (Gladding 235). Symmetrical relationships refer refer to the belief that relationships are equal within the family and complementar y relationships refer to the belief that relationships are unequal within the family. Circular causality is the belief that one does not cause another’s behavior but that interactions are interconnected with one another. The strategic family therapist facilitates the process of therapy by immediately identifying and choosing what are the goals for the family. family. The goals are usually concrete and


Cancel to the Download And Print that it acknowledges to the defined. The goal must be communicated the family in a manner

family their anxiety. The strategic family therapist must possess adequate information information pertaining to the family’s problem so that he or she may plan strategies to to reach the family’s goal. The strategic family therapist may assign specific tasks in order for the family to obtain their goal. In strategic family therapy a condition of change chan ge is to “alter specific patterns of communication that maintained problems” (Nichols 159). The strategic family therapist may choose to point out to the family ineffective or problematic exchanges of communication or may choose to be nondirective and manipulate change by implementing implementing an intervention. One strategy for the strategic family therapist to rely on is the power of insight a nd the family’s willingness to change. A second strategy strategy the strategic family family therapist uses is their ability “to beat families at their own games” (Nichols 159). In strategic family therapy the following interventions are mechanisms of change: reframing, directive, paradox, ordeal, pretend, pretend, and positioning. Reframing refers to to the strategic family therapist using language to create a cognitive shift or perception towards a situation. A directive is an instruction from the strategic family therapist to the family asking them to b ehave differently. One of the most controversial mechanisms of change is the paradox. A paradox is very similar “prescribing the symptom” where the strategic family therapist will give the family permission to continue and exaggerate the problem. The intention of the paradox is to lower the amount of resistance towards change within the family. Ordeals involve assisting the the family to give up symptoms that are causing more problems than they are are worth (Gladding 237). The pretend intervention allows family members to “pretend” to engage in a fight during during session.


Cancel Print over their responses and The intent of this intervention is for the familyDownload to b ecomeAnd in control

behaviors. Positioning involves the strategic family therapist therapist to exaggerate what family members are saying in order for them to view the absurdity of certain behaviors. behav iors. Structural Family Therapy and Strategic Family Therap y can be characterized as forms of systemic theories. theories. In both models, circular causality is emphasized. Circular causality is a systemic belief where person A and person B inf luence luence each others’ behaviors. Non-systemic Non-systemic modes of therapy are based on o n linear causality, where person A would c ause person B’s behavior. Both models also share similar mechanisms of change such as reframing reframing and enactments (structural) is interchangeable to the pretend intervention (strategic). Structural and Strategic Family Therapy similarly both view symptoms as related to ineffective or problematic behavioral interactions between family members. The therapist working from either modality would work towards creating change b y interrupting the problematic pattern of interaction with mechanisms of change. Therapists working from either model would agree that a similar guiding principle is the belief of family mapping as coined in Strategic Family Therapy terminology. This refers to the investigation and examination of family structure as it pertains to hierarchy, po wer, roles, and responsibilities. Both models use this information to hypothesize patterns of interaction within the family as well as to create goals and establish establish treatment plans. In Structural Family Therapy a greater emphasis would be placed on this premise than in Strategic Family Therapy. I perceive the two models to be very similar specifically in regard to theoretical fundamentals and mechanisms of change. The area which I am most interested in discussing


Download Andthe Print further is the differentiation of the Cancel role of therapist role between two models. In Structural two Family Therapy the therapist’s role is not stable and changes over time where as in in Strategic Family Therapy the therapist’s role appears more rigid. rigid. I perceive the Structural family therapist to work more collaboratively with a family than than a Strategic family therapist might. might. The Strategic family therapist is more supervisory, assumes the expert position, and can appear manipulative at times. In regards to the role of therapist in Strategic Family Therap y I perceive the therapist’s role to be somewhat cold and aloof aloof as so much emphasis is placed on being solution-focused. solution-focused. I interpret that “something” potentially gets lost, underdeveloped, or no t developed at all between the therapist and family. family. I have a negative reaction to the premise that in Strategic Family Therapy the therapist possesses so much control over the goals for the family. The role of the therapist appears interchangeable to that of a p rimary care physician where the Strategic therapist will “write the family a prescription prescription to fix their problem.” In one regard the Strategic family therapist is imposing his or her views onto the family as he or she is dictating what needs to be implemented to create change where the Strategic family therapist wants it to occur. I perceive that a Structural family therapist also can be directive and spend some time on goals but I view the role of the therapist as being less manipulative than in Strategic Famil y Therapy. An emphasis in Structural Family Therapy is is joining with the family. In Structural Structural Family Therapy, the therapist develops a form of intimacy with the family, which allows the therapist to become more directive directive with the family when necessary. necessary. An example of this idea is when a mother scolds her child child for throwing a ball ball in the house. The child may be punished but


Print he would not be in fear of exile as Cancel he is part ofDownload the family.And I perceive that a Structural family therapist takes the time in fostering human relationships where a Strategic family therapist does not. I have identified the characteristics for both Structural Family Therapy and Strategic Family Therapy, and discussed the inherent similarities between the two. I have also examined these models as to identify their respective differences in my desire to distinguish each model as its own unique model. In recognizing the uniqueness of each model I emphasized a comparison for the role of therapist therapist between the two models. Although one could relate these two treatment modalities as being “sister” therapies to one another , specific treatment scenarios and even the therapists own personal style will lead him/her to utilize the mode l with which they identify most. Personally, I identify more with the theory and app lications behind Structural Family Therapy. It is important important in a therapeutic setting to relate to your patient/s unique communication style so that you may may gain a mutual understanding of the issues at hand. In doing so, change will be achieved as you work side by side with the patient/s to initiate long term change. Although this may still be achieved with Strategic Family The rapy, the methodology implies a more supervisory role in impacting change and as a therapist I prefer to be a partner in the process. In a structural manner, I believe it is possible to build trust and consistently work towards a healthier life, which is ultimately the goal of therapy. This week ’s Dr. Dave’ Dave’s “Therapeutic Thoughts of the Week ” is intended to highlight two theoretical models and to examine the utility of the theology, interventions, and role of therapist


Download And Print for Structural Family Therapy and Cancel Strategic Family Therap y in an effort to highlight for practicing clinicians alternative models to assess needs, conceptualize treatment planning, and present interventions. References

Gladding, S. T. (1998). Family therapy: History, theory, and practice. Upper Saddle River, NJ: Prentice-Hall, Inc. Miller, S., Hubble, M. & Duncan, B. (Eds.). (1996) Handbook of solution-focused brief therapy. San Francisco, CA: Josey-Bass. Minuchin, Salvador (2002). Family therapy techniques. techniques. Cambridge, MA: Harvard University Press. Nichols, M. P., & Schwartz, R. C. (2004). Family therapy: Concepts and methods th

(6 ed.). Boston, MA: Pearson Education, Inc. Inc. Sharf, R. S. (2004). Theories of psychotherapy and counseling: Concepts and cases rd

(3 ed.). Pacific Grove, CA: Brooks/Cole – Brooks/Cole – Thomson Thomson Learning. Sherman, R., & Fredman, N. (1986). Handbook structured techniques in marriage & family therapy. Levittown, PA: Brunner/Mazel.

Structural Family Therapy Versus Strategic Family Therapy: A Comparative Discussion

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