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Structural family therapy
Salvador Minuchin’s structural family therapy
Lindsey Rasmussen
Family Systems LP5 Assessment
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Structural family therapy
Salvador Minuchin was born and raised in rural Argentina where he lived with his
close-knit Jewish family. Before he developed structural family therapy, which has
among other things, led him to be considered one of the top ten most influential
therapists of all time, he was a boy with a dream to help people (Fredricks, 2012). It was
in high school, after listening to his psychology teacher lecture about the philosopher
Rousseau’s ideas that delinquents were victims of society that Minuchin first decided he
wanted to work with juvenile delinquents. This experience eventually led to his decision
to go to medical school, after which he completed a residency in pediatrics and took on
the subspecialty of psychiatry (Doorey, 2012).
After his residency, Minuchin served as a physician in the Israeli army, where he
treated young Jewish soldiers who had survived the holocaust. Following this
experience, Minuchin came to the United States to further his education in child
psychiatry. He worked with psychotic children at Bellevue Hospital in New York City and
with disturbed children in institutional housing, but his training was primary
psychoanalytic, which was not very effective in his work with children. After marrying
psychologist Patricia Pittluck in 1951, he returned to Israel where again he worked with
disturbed children in a residential setting, most of who were orphans of the holocaust. It
was here that Minuchin first began working therapeutically with groups instead of
individuals (Doorey, 2012) and when he “became absolutely committed to the
importance of families” (Anderson, n.d.).
Minuchin and his wife eventually moved back to the U.S., and between 1954 and
1958, Minuchin trained at the William Alanson White Institute of Psychoanalysis, where
he studied the work of Harry Stack Sullivan – the creator of interpersonal psychiatry.
After leaving the White Institute, Minuchin accepted a position at the Wiltwyck School
for delinquent boys; it was here that he began to feel the need to see clients and their
families (Doorey, 2012).
The conceptualization of structural family therapy was the result of a “peculiar
combination of circumstances that existed at Wiltwyck”. First, the population at Wiltwyck
consisted of delinquent boys from dysfunctional families, a group that did not respond
well to traditional psychotherapy. Minuchin and his colleagues observed that changes
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Structural family therapy
which occurred in the school setting, as a result of traditional methods, disappeared as
soon as the child returned home to his family. The second circumstance was that of
timing; Minuchin’s experiences at Wiltwyck took place at a time when the concept of the
‘changing family’ was just emerging as a field of therapy, effectively garnering the
attention of Minuchin and his colleagues who were searching for more effective
techniques in their work with juvenile delinquents (Colapinto, 1982).
These circumstances ultimately led Minuchin and colleagues to shift their
attention away from the inner-workings of the delinquent, and onto patterns of the
family. From this shift came an even deeper understanding of the limitations of
psychotherapy – it did not have the ability to effectively address the underlying problems
faced by delinquents at Wiltwyck, things like poverty and social injustice. Therefore,
Minuchin and colleagues began to develop their own techniques and concepts, which
eventually became the foundation for the theoretical model, introduced a decade later,
structural family therapy (Colapinto, 1982). Commenting on his own work, Minuchin said
(as cited in Lappin, 1988, p.225):
We must be doing something wrong, I thought. At this point I read an article by
Don Jackson or Virginia Satir or somebody, and I said to my colleagues, “Let’s
begin to see families”, and we did. It was a great adventure. We didn’t know
anything. And since we didn’t know anything, we invented everything. We broke
through a wall in our treatment room and put in a one-way mirror and began to
observe one another and to build a theory out of nothing (Malcolm, 1978, p.84).
Thus it was at Wiltwyck that Minuchin and colleagues taught themselves how to
do family therapy. They found that the youths and their families were generally not very
introspective, so as a result, Minuchin and his team focused on communication and
behavior, eventually developing a form of therapy which consisted of dramatic and
active interventions and an actively involved therapist (Doorey, 2012). It was also during
this time that Minuchin first discovered two patterns in dysfunctional families: (1)
enmeshed, chaotic, and interconnected; and (2) disengaged, isolated, and unrelated
(Hershman, 2012).
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Structural family therapy
As a result of his successful work with clients and their families at Wiltwyck,
Minuchin became a widely known practitioner of family therapy, a new and growing
field. In 1965 Minuchin accepted the position as Director of the Philadelphia Child
Guidance Clinic, which at the time consisted of less than a dozen staff members. He
transformed the clinic into a family therapy center and it was from this, that “Minuchin
created one of the largest and most prestigious child guidance clinics in the world”. By
the 1970s, structural family therapy had become the most influential and widely
practiced therapy of all family systems theories (Anderson, n.d.). And in 1974, Minuchin
presented structural family therapy in what would become one of the most clearly
written and popular books in the field of family therapy, Families and Family Therapy
(Hershman, 2012).
At its most basic level, structural family therapy is concerned with family
structure, family subsystems, and boundaries. Family structure is the invisible rules that
determine how family members interact with one another and through observation, a
therapist is able to identify specific structural patterns which include things such as the
family’s hierarchy, the existence of alliances, power dynamics, and boundaries between
members and subsystems. Family subsystems are components of the family system
that have a specific role in the functioning of the larger system, but are at the same time
somewhat autonomous from it, i.e. the spousal, parental, sibling, extended, crossgenerational, and functional subsystems. The third major concept of structural family
therapy is boundaries, the emotional barriers that protect and enhance the integrity of
individuals, subsystems, and families. Minuchin identified these early on as ranging
from clear (evident in healthy families) to rigid (which resulted in disengagement) to
diffuse (resulted in enmeshment) (“Family Counseling Theories”, slides 61-64).
Essentially, the goal of structural family therapy is to disrupt dysfunctional
relationships and reorganize them into healthier patterns. This can be accomplished
through the following: modification of familial rules of interaction; development of
appropriate, clear, and flexible boundaries; creation of an effective hierarchal structure
or other structural change; and/or reduction of distressing symptoms in the family.
Integral to this process is the role of the therapist whose functions include the following:
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Structural family therapy
joining in with the family and assuming a position of leadership; mapping the underlying
familial structure; and intervening in ways designed to transform ineffective structures
into effective ones (“Family Counseling Theories, slides 65-66).
A structural family therapist typically uses family mapping, enactment, and/or
reframing as techniques to elicit change. Family mapping means just that – the therapist
draws a map of the family, identifies existing boundaries as clear, rigid, or diffuse and
transactional styles as enmeshed or disengaged, and highlights the functioning of
interpersonal relationships within the family. Enactment allows members to play out a
conflict situation that typically occurs, allowing the therapist to observe interactions
among family members and draw structural conclusions, ultimately leading to the
restructuring of familial interactions into something much more functional. Reframing, on
the other hand, involves providing a different perspective to a problem within the family,
allowing the family to understand the issue from a different point of view, and ultimately
shifting the view of the family or blame for the problem from an individual to a systems
perspective (“Family Counseling Theories, slides 67-69). Essentially, the structural
family therapist tries to help the family understand their current structure and identify
ways it may be preventing effective adaptation, often resulting in significant, powerful,
and long-lasting changes (Fredricks, 2012).
Overall, the strength of structural family therapy is that it’s versatile; it may be
used with various family structures experiencing a range of different problems. In
addition, it is culturally sensitive and also considered a credible form of family therapy
within the medical and psychiatric communities. Lastly, and perhaps most important, is
that structural family therapy provides a pragmatic and problem-solving approach by
focusing on the removal of distressing symptoms and reorganizing dysfunctional
relationship into healthier patterns of interaction (Hershman, 2012).
Structural family therapy is not without its limitations and there are a couple of
inherent biases that must be acknowledged. First, structural family therapy makes
certain assumptions about what constitutes a healthy relationship and what family
structures are expected to look like. Second, its primary development and application
has been with families where the identified patient has been a minor child, perhaps
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Structural family therapy
limiting its usefulness with other patient populations (Hadfield, 2000, p.91). Additional
critiques of structural family therapy include the following. Although it may be culturally
sensitive, structural family therapy fails to accommodate certain gender issues. For
example, more emphasis seems to be placed on men than women, thus coming up
short in its analysis of what it means to be a woman in society. As a result, it may be
necessary to supplement with a feminist model. Also lacking is specific information on
how to deal with issues of violence within the family (Hadfield, 2000, p.92).
As stated earlier, Minuchin’s structural family therapy is versatile and is
applicable to various family structures facing a range of problems. One particular issue
that it may be effective in addressing is addiction within the family, explicitly because of
the non-blaming stance that it takes by shifting focus away from the individual and
morphing it into a systems perspective. Structural family therapy can be used to achieve
the following: strengthen and rearrange the family’s structural foundation so the family
can function in a healthier manner; adjust boundaries to encourage self-responsibility
and respect for the individuality of others; and the therapist can help the family learn
new ways of interacting with one another, by identifying, modeling, and supporting
healthy, positive behavior.
Overall, perhaps the most effective use of structural family therapy would be in
rearranging the family’s structure and implementing specific boundaries with the
addicted member, so the remaining family members can reestablish healthy
interactional patterns. This being said, the structural family therapist could begin by
conveying to the family that “everything that everybody does is for good reason and is
understandable”; by defining the family’s intentions as “noble”, the therapist can
effectively enlist parents as allies, which is important because they tend to be the most
sensitive to being blamed for their child’s addiction. The next step would be to start with
the parent-addict triad, slowly restructuring the relationship by creating more appropriate
boundaries, in accordance with the parents’ readiness to “let go” of the addict.
Essentially, the goal would be to create boundaries with the addict such that s/he could
no longer attribute to the family’s dysfunction and new, healthier patterns of interacting
with one another could be established.
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Structural family therapy
References
Anderson, H. (n.d.). Background on Salvador Minuchin and structural family therapy. In
Nichols, M. & Schwartz, R. (2003). Family therapy: Concepts and methods.
Boston: Allyn & Bacon.
Colapinto, J. (1982). Structural family therapy. In Home, A. & Ohlsen, M. (Eds.), Family
counseling and therapy. Itasca, Illinois: F. E. Peacock.
Doorey, M. (2012). Salvador Minuchin. In Psychology Encyclopedia. Retrieved from
http://psychology.jrank.org/pages/425/Salvador-Minuchin.html.
Family counseling theories [PowerPoint]. Retrieved from http://morainepark.edu.
Fredricks, R. (2012). Structural family therapy. Retrieved from
http://www.randifredricks.com/randi/minuchin.cfm.
Hadfield, K. (2000). A structural family therapy approach to counseling families.
Retrieved from http://mspace.lib.umanitoba.ca/bitstream/1993/2558/1/
MQ53097.pdf.
Hershman, C. (2012). Salvador Minuchin’s structural family therapy. Retrieved from
http://www.covenant-counseling.com/structuralfamilytherapy.html.
Lappin, J. (1988). In Dorfman, R. (Ed.), Paradigms of clinical social work.
New York: Brunner/Mazel.