How Structural Family Therapy Works

Structural family therapy (SFT) is a type of family therapy that looks at the structure of a family unit and improves the interactions between family members. This approach to therapy was originally developed by Salvador Minuchin and has become one of the dominant forms of family intervention.

It suggests that dysfunctional family relationships can create stress and mental health problems for members of that family. 

By addressing how members of the family relate to one another, the goal is to improve communication and relationships to create positive changes for both individual family members and the family unit as a whole.

What Are the Primary Components of Structural Family Therapy?

Structural family therapy relies on a technique known as family mapping to uncover and understand patterns of behavior and family interactions. During this process, the therapist creates a visual representation that identifies the family's problems and how those issues are maintained through family dynamics.

This map diagrams the basic structure of the family, including the members of the family unit, their ages, genders, and relationships to one another. Aspects of the family observed during this process include:

• Family rules
• Patterns of behavior
• Family structure/hierarchies

This process frequently involves having family members themselves make their own maps describing their family. This not only boosts engagement in the therapeutic process but also gives a therapist a better understanding of how individual family members view their place within the family.

After this initial process, the therapist observes the family during therapy sessions and in the home environment to track interactions and develop a hypothesis about the nature of the family's relationships and interaction patterns.

Other techniques that may be used during SFT include:

• Joining: This technique involves the therapist developing a sharing and empathetic relationship to "join" the family.
• Boundary-making: The therapist will help the family identify, explore, and adopt clear boundaries and hierarchies within the family.
• Role-play: This involves acting out scenarios with the therapist's guidance to look at certain patterns of behavior, identify dysfunction, and practice enacting alternatives.
• Reframing: In cognitive reframing, the therapist helps family members think about situations in different ways or see things from a different perspective. This can help people see experiences more positively.

What Structural Family Therapy Can Help With

Structural family therapy can be helpful for many families, but it is often recommended in situations or life events that involve:

• Families affected by trauma
• Divorce, separation, or remarriage 
• Blended families
• Intergenerational families
• Single-parent families
• When one family member is affected by a mental health condition such as depression, anxiety, substance use, or post-traumatic stress disorder (PTSD)
• Families affected by chronic illness or disability
• Significant life changes such as changing careers, coming out, or moving

Any family that is coping with tension or conflict can potentially benefit from structural family therapy.

Benefits of Structural Family Therapy

Families struggling with conflict can benefit from this type of therapy for many reasons. Some of the ways it may help include:

• Corrects imbalances within a family
• Establishes healthy boundaries
• Helps individuals improve their reactions to changing demands
• Improves communication
• Improves hierarchies within the family system
• Increases parental competence and satisfaction
• Improves relationship dynamics
• Reduces anger and resentment

SFT recognizes that many aspects of a family's structure—including behavior patterns, routines, habits, and communication—can contribute to dysfunction. However, this approach to therapy can help families become more stable and improve support to individual family members who may need extra help by working to address these issues.

It can be beneficial for families that have dealt with some significant change in their lives. For example, this might involve the death of a family member, a change in the family structure through a divorce, or some trauma such as interpersonal violence or an accident. 

What Are the Strengths of Structural Family Therapy?

Structural family therapy has been shown to be effective at helping to address problems within families. Studies have also demonstrated the efficacy of this type of therapy. 

• A 2019 study looking at the impact of family therapy on adolescents with mental health problems and their families found that therapy incorporating SFT offered several benefits. For example, the results indicated that after treatment, teens exhibited fewer externalizing and internalizing symptoms. In terms of other improvements, parents also reported increased family cohesion, better parental practices, and greater perceived efficacy as a parent.
• A small 2020 case study found that structural family therapy was an effective approach for improving marital mediation and reducing marital distress. However, the study authors noted that follow-up was needed to evaluate the long-term effects of treatment better.

Since its initial development in the 1960s, SFT has become one of the predominant family counseling theories.

Things to Consider

The amount of time needed for treatment to be successful often depends on the dynamics of the family and the situation they are facing. Some families may require relatively short-term treatment lasting a few weeks, while others may need more sessions lasting several months. 

Participation and cooperation play an important role in the success of this type of treatment. However, some family members may be less cooperative or may refuse to participate altogether.

How to Get Started

If you think that structural family therapy may be helpful, ask your doctor if they can refer you to a professional who practices this type of treatment. You may also search an online directory to locate professionals in your area who specialize in SFT. 

Some questions you might ask before you begin treatment include:

• How much experience does the therapist have with SFT?
• How long treatment is expected to take?
• How will progress be measured?
• What happens if some family members miss therapy sessions?

During your first appointment, your therapist will ask you questions to learn more about the problems you are facing and how your family currently functions. They may ask you to create a family diagram to describe relationships between members of the family and work to get a better view of the dynamic between individuals in the family.

After your initial session, your therapist will then be able to provide a fuller view of your family's treatment plan and what else you can expect during treatment.