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Detailed Analysis, Critique and Application of Structural Family Therapy

Detailed Analysis, Critique and Application of Structural Family Therapy

 

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Detailed Analysis, Critique and Application of Structural Family Therapy

Concept of the Model

Families seeking help are always concerned with a particular problem. Most of the families are faced with several issues like a couple who are no longer getting along or misbehaving children. Family therapists normally look beyond the specifics of such issues as the families attempt to solve them. Such an approach leads the therapies to the interaction dynamics. For example, in the case of a misbehaving child, the child might have parents who have never taken time to reward him. In the case of a couple who are disagreeing, they may not be able to communicate without arguing.

Structural therapy adds to such equations through recognizing the overall organization that maintains and supports those inter-actions (Dallos, 2010). The reason why structural therapy is so common is because it is inclusive, it is simple and it is practical. The basic concepts of this type of therapy are boundaries, subsystems, complementary and alignments which are easily applied and grasped.

The concept takes into account the family, individual and social context and offers a clear framework of organization for treating and understanding families. The most important tent of structural family therapy is that every family is made up of a structure and that such structures are revealed only when the respective families are in action. According to this approach, therapists who do not consider the entire structure of a family and intervene in only one of the many subsystems are most likely not to attain a lasting change (Dallos, 2010).

For the case of an over involvement of a mother with her son, makes part of a structure which excludes her husband. In the above case, no therapy that neglects the fathers’ involvement and targets only the son and mother will be in a position to bring about the desired change in such a kind of family.

Subsystems are family units that are based on function. If the family leadership is taken over by a daughter and father, then the two form the executive subsystem and not the wife and husband. The subsystems are regulated and circumscribed by the interpersonal boundaries. Family boundaries that are healthy are clear enough and thus in a position to protect autonomy and independence. Healthy boundaries are also permeable enough to allow for mutual affection and support. Families that are enmeshed are characteristic of diffuse boundaries and this disengages such families following the rigid boundaries.

Structural family therapy has been designed in such away that is solves presenting issues through reorganizing the family structure. The assessment approach requires the presence of all the family members so as to allow the therapist to observe the structure underlying the interactions of the family. In the process, therapists should be able to distinguish between functional and dysfunctional structures. Families that are having growing pains should not be looked at as pathological.

Where structural issues are present, the aim is to come up with an effective hierarchical structure through activating the structures that are dormant and not coming up with new ones. Structural family therapists respond quickly to any structures issues avoiding being inducted as family members they work with. The therapists start by creating concerted efforts to accommodate the accustomed family ways of behaving, so as to circumvent resistance.

Once the therapists have gained the trust of the rest of the members of the family, they go a head to promote family interaction while they take a decentralized role. From such a position, they can watch everything that goes on within the family and hence make their structural assessment that includes the issues that is supporting the organization problem. The assessments are framed on the basis of subsystems and boundaries that are easily conceptualized to be two-dimensional maps used to suggest possible avenues for change (Dallos, 2010).

Once the structural therapists have successfully assessed and joined a family, they proceed to activate the structures that are dormant using techniques that shift power and alter alignments between and within subsystems. The restructuring techniques used are forceful, concrete and dramatic in some cases (Burck and Daniel, 2010). However, the success of the techniques depends more on the assessment and joining as well as the power of the techniques. The popularity of structural family is based on the techniques and theory of treatment.

Critique

Despite the structural family therapy being recognized for enhancing the family treatment competency, it still needs to be included with clinical assessment or diagnosis, treatment planning, case conceptualization, case management, documentation and progress evaluation. Structural family therapy makes use of a variety of intervention strategies and techniques based on the hypothesis of the therapists of the family structure.

Some researches have also shown that structural family therapists tend to have a relative high inter-rater degrees reliability whenever they are required to rate the individual dyads interaction. However, very little is known with regards to whether interventions intended at changing the transaction dyad patterns succeed in their goal or there are the particular interventions that result in changes in the identified family structure symptoms (Burck and Daniel, 2010).

One of the outstanding issues in families looking at them from a structural perspective is that family members tend to blame most or all of their problems on one problem that has been singled out. This phenomenon is often referred by structural family therapists as scapegoating and they have tried to come up with techniques of changing this transaction pattern but itcontinues to exist even in families that have gone through the therapy.

In general the structural family therapies tend to change the manner in which the family views their problem or problems buy reframing the issues as being normal and part of any other family or through pointing out to the family occasions when the members are behaving in away that contradicts bad reputation. The theory supporting this approach is that when the rest of the family members change their view on the family structure that has a problem, the structure will be encouraged to have a positive behavior and the rest of the family will adjust its boundaries to help the problematic structure because they now have a more positive opinion.

Up to now, however, this approach is pursued based on case reports and theoretical principle of its effectiveness. There exist no empirical tests to prove whether the number of session intended at elevating the scapegoats correlated with more positive family structural interactions (Minuchin, Lee, & Simon, 2006).

Another issues associated with the structural family therapy is the inappropriate power structure. This is commonly witnessed when family leaders do not have the ability to come up with rules to govern the rest of the family members hence resulting in an inverted hierarchy now that the power of the family is not where it is supposed to be. There are a number of root causes of such a problem that includes the leaders of the family being present in the family but employ different rules or subvert the attempts of each other at creating structure. This way, the rest of the family members develop the idea that the existing rules are not valid (Minuchin, Lee, & Simon, 2006).

In such a case, the therapists should intervene by promoting more cooperation between the leaders of the family. This can be achieved through having clinical assessment or diagnosis that encourage that will enable the family leadership to have sessions together and come up with plans that respect and maintain the structures of the families without interrupting the boundaries. The structural family theory has it that if the leaders of the families are present in a united front, the rest of the family will show greater respect and obey the rules.

There are cases of invested hierarchy even after structural family therapy. This calls for case management to help the family leaders differentiate themselves from the rest of the family members and establish themselves as the highest in the familial power hierarchy. This way, the family members will not end up following the rules that have been set forth by others rather than the leaders of the family (Minuchin, Lee, & Simon, 2006). Such a case needs a type of therapy that will speak to the family leaders not just about the family structures but also about the rules and ask them to manage the rest of the family members through breaking the family structures at some points like excluding them from some of the leadership discussion.

Once the leaders have come up with the rules of governing and managing the family, the therapists encourage the family leaders to explain the rules, the consequences and their rationale of the rules to the rest of the families. Such interventions are designed in away to assist the family leaders understand that they have to actively take charge of the rules and to help the rest of the members understand their role is to follow family rules.

Therapy theory suggests that such an approach will result in greater family control and organization (Peterson and Bush, 2013). In this case also, there are no empirical tests that have been conducted to determine if the number of sessions on improving power using structural family therapy is related to family organization, closeness or control.

Structural family therapy is recognized for being effective in assisting to improve the ratings of parents when it comes to the total problems facing family members. However, its focus on elevating the scapegoat witnessed among the family members was not the therapeutic process that results to the changes. Instead, there are is a possibility of the existence of other process that led to the changes. It might be that the family members simply responded to the greater family leader involvement.

The change may also have been as a result of the fact that the rest of the family members saw that their behavior was a major concern to the rest of the family structure. The absence or presence of focusing on scapegoat elevation is likely to be inconsequential for the effectiveness of the family therapy. This calls for the application of case conceptualization in addition to the structural family therapy (Dunbar, 2007).

The elevation process of the family member has associated problems as most family members mostly find this approach different to accept and is likely to react negatively to the therapists efforts. The therapists have to include progress evaluation for them to be able to first come up with a strong affiliation with the family under therapy before expressing their views about the interactions of the subsystems and boundaries. The other problem related to scapegoat elevation in structural family therapy is that it needs addition skills that might prove too difficult for the therapists. It may require the therapists to move away from the main objective and the interaction style that the therapist supports actively.

Application of the Structural Family Therapy on Antoine Fisher Big Fish Crazy

The movie Antwone Fisher brings out the importance of the structural family therapy. At the beginning of the movie, Antwone and the other sailors mock therapy and called the psych house, the nut house. They considered this as a foolish profession and they spent most of the time during sessions refusing to appreciate their problems. However, after undergoing a series of sessions, he later relents and realizes the benefits the sessions had on him.

Soon afterwards, Antwone develops a dependence on the therapy sessions and vows not to stop. He involves his family in the therapy sessions by discussing the importance of the sessions with his wife Cheryl. It is also evident that the father to Cheryl had also gone through similar sessions and benefited.

The therapy presents a theme of healing in the movie. Antwone has enormous rage when he is abandoned making him feel alone. In the beginning he takes out his range on the rest of the sailors and keeps away from relationships. After the therapy Antowone is largely different after the guidance of Davenport. He now opens up and deals with the self destruction vicious cycle that was affecting him at the beginning. Antwone develops a friendship bond with Davenport as well as a romantic relationship with Cheryl.

After the therapy, he later recognizes the need to have a family and after finding his family brings healing to him. He confronts his foster mother who is abusive, meets the mother who had abandoned him and finds his father’s family who has died before he was born. From the movie, it is evident how structural family therapy solves issues through reorganizing the family structures and incase of structural issues, its aim is to develop an effective hierarchical structure through activating the structures that are dormant and not coming up with new ones (Piercy, and Wetchler, 1996).

 

 

 

TREATMENT PLAN

Behavior Problems

Goal: Improve overall behavior with regards to mood and attitude and maintaining positive behavior

  • Developing a rewarding system that addresses the targeted problem
  • Learning ways of managing frustration in a positive manner
  • Share positive experiences every week in which the family members are proud of how they behave
  • Remain free of fights
  • Stay free of alcohol and drug use and abuse
  • Remain free of violent behavior
  • Be able to keep feet and hands to self
  • Be in a position to express anger in a way that is productive without destroying personal or property belongings
  • Remain free of threats to others and self
  • Complete day to day tasks
  • Listen to the family leaders and follow the simple rule and directions
  • Put all glasses, dishes, cups and food items back to the kitchen after snacks or meals
  • Clean up after herself or herself
  • Accept and admit personal responsibility for individual behavior and action
  • Remain respectful of all adults as well as avoid talking back

Communication Skills
Goal: Using and learning effective communication strategies

  • Always talk nice or do not say anything
  • Learn three means of communicating verbally when angered
  • Be in a position to express anger in a manner that is productive without destroying personal or property belongings
  • Be in a position to express anger without using foul language and yelling
  • Be in a position to express needs and wants through spoken language
  • Be in a position to narrate about instances and ask questions
  • Be in a position to stick up for yourself assertively
  • Speak in a concise and clear manner so as to be fully understood
  • Learn to express personal feelings verbally

Decision Making  

Goal: Improve skills in decision making

  • Make simple and short “to do” lists and be able to complete at least three tasks every day
  • Celebrate little successes every day using journaling or positive self talk
  • Be in a position to weigh options and come up with simple decisions in 5 minutes
  • List three possible options for any major decisions after which you discuss with family or therapists

Expression of Wants, Feelings and Needs

Goal: Learning the appropriate ways of expressing different feelings

  • Share at least two positive experiences every week
  • Gain the required knowledge on different feelings
  • Seek help from adults when feeling angry, sad or negative feelings
  • Verbally express feelings rather than cry about them
  • Learn how to express feelings verbally without showing them out
  • Learn to verbally express feelings without acting out

Family Conflict

Goal: Learn and apply conflict resolution skills

  • Recognize family conflict patterns discuss them weekly in therapy
  • Avoid angry outbursts through walking away from situations that are stressful
  • Get through X days in a week without fighting with the rest of the family members
  • Be respectful of the rest of the family members through listening following directions and avoiding from talking back
  • Be in a position to live together peacefully in a way that is free from all aggressive physical contact
  • Learn at least three verbal communication ways when angry
  • Resolve and explore conflict with the rest of the family members
  • Be in a position to stick up for yourself assertively and not aggressively
  • Be respectful to adults
  • Get through the entire week without conflicting with any family member
  • Speak in a concise and clear manner for others to fully understand you
  • Learn to verbally express feelings without acting out

Hyperactivity
Goal: Maintain positive behavior or improve overall behavior

  • Be able to keep feet and hands to self
  • Complete daily tasks
  • Listen to parent or therapies and follow directions on one trail
  • Behave in a manner that is age-appropriate
  • Maintain passing grades
  • Be in a position to focus attention and complete tasks related to school every day
  • Take notes and listen in all classes
  • Review homework and projects with parents
  • Remain respectful of adults
  • Be in a position to play with friends peacefully for some minutes
  • Remain free from any behavior which could result in suspension or detention

Parenting

Goal: Improve parenting skills

  • Come up with limits and stick on a plan that expects more responsible behavior
  • Put more focus on positive behavior and give it all the attention, rather than focusing on negative things
  • Learn and be in a position to effectively make use of transactional analysis to remain in adult mode
  • Develop a behavior modification plan and consistently use it to increase or eliminate conflicting behaviors in the family.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Burck, C., & Daniel, G. (2010). Mirrors and reflections: Processes of systemic supervision. London: Karnac.

Dallos, R. (2010). An Introduction to Family Therapy. Maidenhead: McGraw-Hill International (UK) Ltd.

Dunbar, S. B. (2007). Occupational therapy models for intervention with children and families. Thorofare, NJ: SLACK.

Minuchin, S., Lee, W.-Y., & Simon, G. M. (2006). Mastering family therapy: Journeys of growth and transformation. Hoboken, N.J: J. Wiley.

Peterson, G. W., & Bush, K. R. (2013). Handbook of marriage and the family. New York: Springer

Piercy, F. P., Sprenkle, D. H., & Wetchler, J. L. (1996). Family therapy sourcebook. New

York: Guilford Press.

 

 

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