Structural
Therapy
The structural approach to family therapy is most
closely identified with Salvador Minuchin, Braulio Montalvo, and
associates. Its litera-ture has been covered by at least two reviews5'
'" and the principles and techniques appear in four books. '"' [In* It has demonstrated its utility and efficacy with a variety of different
kinds of symptoms and problem groups. It has
also been applied with a range of therapist types—a prime example being
the important and effective work with psychosomatic
families by Minuchin et
al.'"L'ul in which their 53 cases were seen by 16 therapists who differed greatly in levels of
experience and who came from four different disciplines.
The coverage of structural therapy here will necessarily be brief. However, while there are specific features of
structural therapy that distinguish
it from other modalities, it is important to note that a structural aspect of treatment applies to all
therapies and to therapists of all
persuasions, as follows: Any therapeutic intervention made by any therapist necessarily includes a structural
component. For ex-ample, by choosing to talk to or interact with
one family member or another, or with two parents together, the
therapist makes a structural decision, whether or not he is aware of it; not
to do so would mean that the therapist acts at random with the
participants. In focusing his attention on, or making a statement about, a
given member (or subsystem) at a particular point, he is, by
nature of the power and stat-us vested in him as a therapist, elevating
that person and separating him from the other(s). He shares his
power by his atten-tion, so that, as Haley°5 states, "A
comment by the therapist is not merely a comment but also a coalition with one
spouse in relation to the other or with the unit against a larger
group- (p. 160). The therapist cannot (and probably should not) avoid
doing this in most treatment contexts, so the important point is
that he should do it with some plan in mind and remain consistent with his plan. In other words, does his (structural) intervention lead the
family toward the change that he would
like to implement? Ignoring this notion handi-caps the therapist and can even prove detrimental to treatment.
Relative to, for example, certain strategic approaches that em-phasize change and, on the average, are more likely to treat in-dividuals,'" in structural therapy the focus is less on theory of
change than on theory of family.'" The model is not
particularly complex, theoretically. Some of the
primary concepts are:
1. Attention is paid to proximity
and distance between family members and
subsystems and these are defined through boundaries,
that is, the rules that determine -who participates and how- in the
family.'°", P
2.
The extremes of the proximity and distance
continuum are enmeshment and
disengagement, with most (i.e., -normal's) families and subsystems lying at intermediate
points between
the two poles.
3.
A family is described or schematized spatially, in
terms
of its hierarchies and its alliances or
coalitions.
4.
Problems result from a rigid, dysfunctional family
structure.
Some of the basic structural therapeutic
techniques are as follows:
1. The primary goal is to
induce a more adequate family organization
of the sort that will maximize growth and potential
in each of its members.'°°
2.
The thrust of the therapy is toward
-restructuring" the
system, such as establishing or loosening
boundaries, differenti‑
ating
enmeshed members, and increasing the involvement of
disengaged members.
3.
The therapeutic plan is gauged against a model of
what
is normal for a family at a given stage in its
development, with due consideration of its cultural and socioeconomic context.
4.
The desired interactional change must take place within
the actual session (enactment), with the
family sitting in the
room.68'
5. Techniques such
as unbalancing a system and intensifying
an interaction are part of the therapy.
6.
The therapist -joins- and accommodates to the
system
in a sort of blending
experience, but retains enough independ-ence both to resist the
family's pull and to challenge (restructure) it at various points. He thus
actively uses himse/f as a boundary-maker, intensifier, and
general change agent in the session
7 . Treatment is usually
limited to include those members of a family who live within a household or have
regular contact with the immediate family. This might involve
grandparents
living nearby, or even an employer, if the problem is
work-rela
ted.
8. The function of assigning tasks and homework is usually
to consolidate changes made during sessions and extend
them to the real world.
9.
The practice is to bring a family to a level of
"health" or -complexity- and then stand ready to be called
in the future, if
necessary. Such a model is seen to combine the advantages
of short- and long-term therapy.
