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Structural Family Therapy

Reviewed by Psychology Today Staff

Structural family therapy is a type of therapy that focuses on the interactions between family members. Looking at the family as a system, structural family therapists work to improve communication between members of the family and encourage adjustments in the rules that govern how the family functions (its structure).

The treatment’s distinctive features are the conception of the family as a structural system, and the active engagement of the therapist in the process of restructuring the way the system works in order to adjust elements that cause dysfunction. This restructuring can include family boundaries, hierarchies of power, and reactions by family members to major life changes.

Structural Family Therapy allows everyone in the family to hear the viewpoint of the others, and allows the therapist to observe how the family interacts in real life, in contrast with individual therapies, where the therapist hears about family dynamics recounted by a single individual.

“The idea of structural family therapy sprang out of a sense that what we were doing was not working,” explained Salvador Minuchin, the principal creator of structural family therapy. “We were all very much oriented toward psychodynamic-oriented psychological approaches, and they didn’t work.”

Minuchin developed structural family therapy in the 1960s. He believed that the more members of a family participate, including extended family members, in some cases, the better the outcome of the treatment would be. The structural family therapy approach has become one of the predominant family counseling theories in the field.

When It’s Used

Structural family therapy is most often used by families experiencing distress or tension, particularly with teenage children. It is most commonly used in cases of:

  • Adolescent behavioral and mood disorders
  • Drug use
  • Eating disorders
  • Divorce
  • Blending families
  • Families affected by illness or death
  • Families in which a parent suffers from a mental health condition
  • Significant changes in family life, such as a parent losing a job, moving cities, or a change in gender identity or sexual orientation among a member of the family
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What to Expect

You should expect a therapy approach in which the therapist is active in the treatment, making suggestions and directing discussions or arguments. Therapists may, at times, change the format of sessions, by changing the position of family members seated in the room, asking some family members to leave the session temporarily while others stay, and even, in some cases, by bringing some members of the family on the other side of a one-way mirror to observe the conversation of other members of the family.

Some of the key tenets of structural family therapy include:

  • Joining: Joining is a process whereby the therapist gets to know the family and sets expectations for treatment. A therapist may ask questions about the family, show their support of the family, and explain the technique of the therapy.
  • Mapping: Mapping is an effort to understand a family’s rules, structures, and patterns. A therapist may draw a diagram and write notes themselves, or may hand members of the family a pencil and paper and ask them to map these functions of the family themselves.
  • Unbalancing: Unbalancing is the act of the therapist challenging family members. It is not meant to be confrontational, but to push family members to reconsider their perception of how the family operates.
  • Reframing: Reframing is a method by which the therapist will present the family’s challenges or complaints. Therapists will often reframe the problem of an individual in the family as a problem that may be a result of the structure and patterns of family dynamics.
  • Enactment: Enactment is the plan for the future. Once the family’s structure has been observed and examined, the therapist, with input from the family, will introduce ideas and practices for the family to execute.

How It Works

The fundamental goal of structural family therapy is to help a family reorganize the way its members interact with each other in order to work more happily and cohesively as a unit and be able to adapt to stressors that may pop up in the course of life.

Therapists may recommend to parents alter their behavior towards their children depending on whether the children need more independence or more support and guidance. They may suggest strategies to parents or other caregivers that highlight the need to present a united front. Ultimately, the objective of the approach is to strengthen the family as a system.

Treatment can last for several weeks or several months, depending on the family.

What to Look for in a Structural Family Therapist

It’s most important to look for someone with experience in the approach and someone with whom you feel comfortable talking about sensitive subjects in front of your family.

Some questions you might want to ask at a consultation include:

  • How the therapist will measure progress
  • What will happen if members of the family have to miss sessions from time to time
  • The amount of experience the therapist has with this specific approach

There is no official accreditation required to practice structural family therapy, but when searching for a therapist online, they will typically include the approach as a treatment option if they have experience with it.

References
Jiménez L, Hidalgo V, Baena S, León A, Lorence B. Effectiveness of Structural–Strategic Family Therapy in the Treatment of Adolescents with Mental Health Problems and Their Families. International Journal of Environmental Research and Public Health. 2019; 16(7):1255. https://doi.org/10.3390/ijerph16071255
Last updated: 09/01/2022