Overview

Numerous families encounter difficulties that can be regarded as significant public health issues. These may encompass marital discord, blending of two families, intra-familial conflicts, mental health issues, and external stressors, all of which influence the functioning of a family unit. Consequently, many families seek out family therapy to address the issues stemming from stress, mental health conditions, employment, finances, or other underlying reasons.

From detrimental patterns to recurring cycles of disruption, there exist a potential avenue for addressing and surmounting family challenges through a therapeutic approach known as structural family therapy (SFT).

What is structural family therapy?

Structural Family Therapy (SFT) is a therapeutic approach that examines the structure of a family unit to enhance interactions among its members.¹ Originally pioneered by Salvador Minuchin, SFT has emerged as a prominent method of family intervention.² It is typically guided by a structural family therapist or a professional trained in SFT principles.

This therapeutic model considers how each family member contributes to the collective dynamic. Initially, a structural family therapist may engage in individual discussions with each family member to comprehend their mental health status and therapeutic objectives. Subsequently, therapy sessions involve the entire family unit, where topics such as mental health challenges, treatment objectives, and overall family needs are addressed.

In cases where a family member is grappling with a mental health condition like bipolar disorder or one of the various eating disorders outlined in the DSM-5, the therapist may adopt a tailored approach. This may involve educating the family about the specific mental health condition, the most suitable therapeutic interventions, and strategies for mutual support among family members.

Structural family therapy technique

Structural Family Therapy relies on a core technique called family mapping to uncover and comprehend patterns of behaviour and interactions within the family unit. The therapist generates a visual representation that illuminates the family's challenges and how these issues may have been originated by the familial dynamics. It portrays the fundamental structure of the family, encompassing its members, their ages, genders, and interrelationships. Elements of the family scrutinised during this procedure include:

• Family rules
• Behavioural patterns
• Family structure and hierarchies

This process often entails encouraging family members to construct their own maps, and articulating their perceptions of the family. This fosters active involvement in therapy and provides therapists with insights into individual family members' perspectives on their roles within the family unit.

Following this initial phase, the therapist observes the family dynamics during therapy sessions and within their home environment. This allows for the tracking of interactions and the formulation of hypotheses regarding the nature of the family's relationships and patterns of interaction.³

Additional techniques commonly used in Structural Family Therapy (SFT) comprise:

• Joining: the therapist establishes a supportive and empathetic relationship to effectively "join" the family system
• Reframing: Through cognitive reframing, the therapist aids family members in reconsidering situations from diverse perspectives or a more positive light, fostering a shift in perception
• Boundary establishment: The therapist assists the family in recognising, exploring, and implementing clear boundaries and hierarchies within their familial structure
• Role-playing: involves the collaborative enactment of scenarios under the therapist's guidance to examine specific behaviour patterns, identify dysfunction, and practice implementing alternative approaches

Application

Structural Family Therapy(SFT) is used in families grappling with tension or turmoil, particularly those with adolescent children. It is frequently employed in scenarios involving:

• Behavioural and mood disorders among adolescents
• Substance abuse issues
• Eating disorders
• Divorce-related challenges
• Blended family dynamics
• Families coping with illness or bereavement
• Situations where a parent is managing a mental health condition
• Significant shifts in family circumstances, such as parental unemployment, relocation, or changes in the gender identity or sexual orientation of a family member

Benefits of structural family therapy

Structural Family Therapy(SFT) offers numerous advantages for families grappling with conflict. It can aid in various ways, including:

• Rectifying imbalances within the family unit
• Establishing healthy boundaries
• Assisting individuals in managing reactions to changing circumstances
• Enhancing communication skills
• Improving the hierarchy within the family system
• Boosting parental competence and satisfaction
• Enhancing relationship dynamics
• Mitigating feelings of anger and resentment²

SFT acknowledges family structure, behaviour patterns, routines, habits, and communication styles, may contribute to dysfunction. However, through this therapeutic approach, families can achieve greater stability and provide better support to individual members who may require additional assistance by addressing these issues. It proves particularly beneficial for families undergoing significant life changes, such as coping with the loss of a family member, adapting to a restructuring due to divorce, or dealing with trauma such as interpersonal violence or accidents.

Effectiveness of structural family therapy 

The effectiveness of Structural Family Therapy (SFT) in addressing familial issues has been well-documented through research studies. Here are some strengths:

1. Research evidence

Studies have consistently demonstrated the efficacy of SFT in resolving family problems. For instance, a study from 2019 focused on adolescents with mental health issues and their families showed that therapy incorporating SFT resulted in reduced externalising and internalising symptoms among teenagers. Additionally, parents reported improvements in family cohesion, parenting practices, and perceived efficacy in parenting.²

2. Marital mediation

A small-scale case study conducted in 2020 highlighted the effectiveness of SFT in enhancing marital mediation and reducing marital distress. However, the researchers emphasized the need for further follow-up to assess the long-term impact of SFT on marital relationships.⁴ Since its inception in the 1960s, SFT has emerged as one of the leading theories in family counselling. Its widespread adoption and continued utilisation in clinical practice underscore its significance and effectiveness in addressing familial issues.⁵

Summary

Structural Family Therapy (SFT) is a therapeutic approach that examines family structure to enhance interactions among its members. Originated by Salvador Minuchin, SFT is guided by a structural family therapist who assesses each member's contribution to the family dynamic. The therapy involves individual discussions followed by sessions with the entire family to address mental health challenges and treatment goals.

Techniques such as family mapping, joining, reframing, and role-playing are employed to understand and modify family dynamics. SFT is commonly used in families facing tension or turmoil, particularly those with adolescent children, and addresses issues such as behavioural disorders, substance abuse, and divorce-related challenges. Its benefits include rectifying imbalances, establishing healthy boundaries, improving communication, and enhancing relationship dynamics.

Research has consistently shown the efficacy of SFT in resolving family problems, with studies demonstrating reductions in symptoms and improvements in family cohesion and parenting practices. Despite its effectiveness, further research is needed to evaluate its long-term impact, but SFT has remained a prominent theory in family counselling since its development in the 1960s.