Understanding the background of those who pioneered structural family therapy helps makes sense of the model they developed, because the model is pragmatic in orientation, has a concern for family organisation, and places emphasis on activity as much as on talking and reflection.
It originated from a project with delinquent families in New York, the results of which were published in the book Families of the Slums (Minuchin et al. 1967). The families were multi-ethnic in origin, frequently impulsive, their needs tending to be communicated by action rather than words and family organisation was frequently chaotic. The chaotic organisation of such families highlighted the central importance of family ‘structure’ i.e. that invisible set of functional demands that organise the ways in which family members interact, thus providing a repetitive set of interactions that underpin the family system in a most powerful way.
Central concepts: family behaviour is self-regulating. The behaviour of any family member (not just that of the symptomatic family member) is viewed as inclined toward homeostasis i.e. returning the family to its habitual mode whenever family members are faced with some external or internal stress. Their active attempts to deal with an erring family member may, as much as the original symptoms, be unconsciously directed at preserving the status quo, so both symptoms and attempted unsuccessful solutions must be scrutinized to establish a systemic diagnosis.
Such homeostasis leads to the perpetuation of certain structural characteristics of the family, accounts of which appear in all structural family therapy texts. These include:
- the nature of the family’s sub-systems and the boundaries between them
- the quality of affective involvement between family members and between sub-systems, which may be described as lying along a continuum from enmeshment to disengagement
- the ‘isomorphic’ characteristics of the family’s transactions and the degree to which the family system is flexible or inflexible.
The term isomorphic is derived from crystallography, conveying the concept of a single structure albeit expressed in many different ways (e.g. interfering, protective, remonstrating, over-controlling as different expressions of an intrusive style of inter-personal responding). Recognising this helps point a therapist toward a core-issue in the family, which in turn can be explored. From a structural point of view, the ‘heart of the matter’ would finally include what particular anxiety prompts the behaviour and what other family factors maintain the pattern.
That might be recognised in a mother’s habitual behaviour toward her youngest son, usually precipitated by his childishness, where the absence of emotional involvement with her husband (whose occupational role has taken him increasingly out of family life) was a disposing factor because neither parent have acknowledged the family life cycle issues they face after 25 years of marriage.
Deepening the systemic understanding of family life: structural family therapy has contributed a number of valuable ideas to how one understands unhelpful family functioning. Although for many years those trained in the model applied it as a single method, many of its concepts have infiltrated the work of systemic therapists of all persuasions. For example, structural concepts added depth to the McMaster approach:
- on the assessment of family roles (particularly of the executive sub-systems)
- on the assessment of affective involvement (enmeshed relationships, etc.)
- to an understanding of how symptomatic behaviour may be homeostatic
- to an appreciation of the important repetitive characteristics of the family system (the ‘family dance’ as Minuchin described it).
Like many systemic models, both McMaster and structural family therapy are concerned with the developmental life cycle of families, believing that different developmental stages confront the family with different developmental tasks.
Some difference in emphasis is evident. In considering the achievement of such developmental tasks with regard to the family’s role as a cultural transmitter, structural family therapy sees the executive aspects of family life as being the most important.
Compared to the McMaster model, structural family therapy places a greater emphasis on the family’s executive functioning, notably on how power is distributed. A structural therapist seeks to establish a hierarchical understanding of the family within their formulation, but that emphasis is not so explicit with the McMaster model, which is more empirical e.g. as long as the family’s necessary roles are filled, who does what, etc., is of less importance (providing they have a say in whatever responsibilities they carry). The difference is not great, as both are as much concerned with how a role is allocated as with who carries out the role, and with what determines the outcome of a particular executive transaction.
In the remainder of this section the following key concepts of the structural model will be introduced and critiqued: sub-systems and boundaries; isomorphism; enmeshment and disengagement and flexibility of family structure.
Summary of Structural Family Therapy’s key concepts
Sub-systems and boundaries: two related concepts are that of ‘sub-systems’ and that of the ‘boundaries’ between these. Sub-systems refer to a functional group involving two or more family members and any one individual family member belongs to several different sub-systems simultaneously. A functional sub-system may involve the children of a family as a sibling sub-system, or may cross generations to involve several family members in some close emotional involvement, for example, those concerned with some specific emotional issue, such as the sharing of intimacy or the denial of vulnerability.
Within the boundary of a particular sub-system, members may be engaged in a collaborative, interactive pattern, not necessarily in coalition against another sub-system within the family. Because of the importance Minuchin places on the differentiation of function within a family in enhancing personal growth and autonomy, he stresses that what takes place within the various sub-systems of a family is often “of less significance than how well the boundaries between these sub-systems are maintained”. Boundaries may vary from the very rigid and impermeable to the very diffuse and ill-defined; Minuchin considers that most families contain examples of all types.
A family is a very complex structure and as Minuchin has acknowledged, the structural map determined by the therapist is no more than “a powerful simplification device to describe its preferred pattern”.
Other therapists warn that such shorthand ways of describing a family not only carry the danger of becoming reified, but frequently give an illusion of understanding to therapists. In the words of Gurman and Kniskern (1981a) therapists mistakenly believing ‘that because they have named something, they have explained it’.
Furthermore, since a description of the dominant structure of a family group is a statement about their total transactional relationships with one another, it is clearly describing more than a particular behavioural configuration; it will also contain important affective and cognitive elements, for example, perhaps fear of conflict or denial of dependency needs. So, in another editors’ note, Gurman and Kniskern point out that whilst a structural family therapist largely pays attention to the behavioural configuration, an experienced therapist would try to be simultaneously aware of the private experience of family members with whom they are interacting.
That dual attention confers two advantages: first, to establish a satisfactory alliance with the family (and later on in order not to inadvertently jeopardize it); second, in order to enrich the structural formulation, as no rigid division can be imposed between private experience and overt behaviour.
For example, the combination of guilt and fear a young woman with anorexia may have experienced on entering adolescence, confused about beginning to emotionally separate from her parents yet (because of her restricted emotional literacy) ill-at ease with her peer group – facing a developmental crisis she had been unable to articulate. Her internal denial of anxiety (i.e. splitting) permits the anorexic symptoms to continue despite possible physical collapse and her parents’ despair. To delineate, in a family session, the young woman’s anorexic symptoms as simply a struggle for autonomy may be useful in developing a conflict focus that is stated in inter-personal terms, but for a structural family therapist to consider it to be the entire truth is also to underestimate severely the resistance there will be to structural challenge.
A shorthand method of diagrammatically representing aspects of family structure and relationships has been developed by Minuchin.
Structural diagrams of family relationships
|Nature of relationship
|——————– / ——————–||conflictual|
|Relationship of one
sub-system to another
No single diagram totally summarizes a complex structural problem, but working on such a diagram can help a therapist develop their observations of a family into a structural formulation, for example, as when using a genogram to discuss a session with others in a supervisory group.
Isomorphism: the dangers of simplifying descriptions of complex family structure have already been pointed out, but there is clear value in a therapist gradually recognising that the many different features in a family they meet, which most often take place beyond the family’s awareness or understanding, may represent a single core issue, repeatedly reflected in countless family interactions. Borrowed from crystallography and somewhat inaccurately applied by structural family therapists, the term is used to illustrate the concept of a single core structural difficulty within a family which, like a vertebral column in X-ray photographs, may differ in appearance according to the viewpoint, yet is clearly a single organising structure.Minuchin and Fishman (1981) describe how such isomorphism is manifested in a variety of transactions “that obey the same systems rules and which are therefore dynamically equivalent”, where “beneath the superficial discontinuities of family transaction, there are many similarities (which) begin to thread together operations that at first seem diverse”. Recognising this is a key structural family therapy task.
The enmeshment-disengagement continuum: since the earliest pioneers of family therapy, family therapy has placed importance on the quality of the emotional involvement between family members, aware that there is considerable variation between families.
In 1974 Minuchin described the involvement as occurring along a continuum that lies between enmeshment at one extreme (perhaps the mother-son relationship in the example above) and disengagement at the other (perhaps the increasing emotional distance between his mother and father). At the enmeshed end of the continuum (as in that example), boundaries between family members or between one sub-system and another are diffuse. Such diffuse boundaries underpin an affective involvement that the McMaster model had described as ‘over-involved’. Conversely, at the disengaged end of the continuum boundaries are inappropriately rigid, underpinning an affective involvement that the McMaster model had described as ‘lack of involvement’. This continuum is illustrated below, in a diagram taken from Minuchin (1974).
The enmeshment-disengagement continuum
As the case of anorexia nervosa illustrated, emotional involvement (or ‘affective involvement’ as described by the McMaster model) must be considered within a developmental context, likewise Minuchin’s enmeshment-disengagement continuum.
Both context and content are crucial:
- an integral part of the flexibility of a family system is its ability to make appropriate alterations in enmeshment-disengagement in accord with the developmental tasks that it faces (see below).
- the early writing about enmeshment by structural family therapists imply a causal direction (to induce symptoms) that subsequent research has not supported.
For example, these authors described how, in a family pattern characterised by enmeshment, symptoms might cross between those involved e.g. a parent develops a migrainous headache when the child is faced with depression, anxiety, or tension. The original position taken in structural family therapy was that in enmeshed families, whether it’s a toddler testing out the safety of a three-metre distance from her mother’s knees early in the family life cycle, or an adolescent daughter struggling later with the depression of a rejected love affair, the capacity of each to tolerate anxiety or despair may be threatened. Today, one would regard such propositions as only part of the eventual story.
In the literature of structural family therapy, a family vignette of this type was frequently described by a metaphor that sums up, often artfully simply, the family system. In Aponte and Hoffman’s (1973) description of a family with an anorexic girl, the ‘open doors’ that were always required by the girl’s father throughout the house were a useful metaphor for noting the absence of boundaries for privacy, which led the anorexic girl to establish a territorial battle over her body, rather than, for instance, her bedroom.
Clearly, such a method of establishing her autonomy would be paradoxical in its effects, as her obviously caring parents would inevitably keep on intruding to prevent their daughter from declining or dying.
Enmeshment is bi-directional, parental concerns about an unwell child due to any cause is likely to induce greater emotional involvement. There would be considerable variation, depending upon the perceived need (or threat), past experience or unresolved issues in the parent, and cultural influences upon emotional expression. The pre-adolescent social development of a young man with Asperger’s is likely to be considerably enhanced by a warm expressive mother, even if outwardly this may appear a somewhat enmeshed relationship; his social development likely to be more problematic if the parental style was buttoned-up.
The rather prescriptive apparent in this early writing probably is as much a result of the authors’ observations of the types of chaotic under-organised families described in Families of the Slums (Minuchin et al. 1967). ‘Disengagement’ between family members was manifestly responsible for maintaining the chaos, preventing the developmental needs of the children for supervision and support being met, and heightening the probability of sibling ‘Lord of the Flies’-type delinquent coalitions.
A structural family therapist’s work involves recognising such patterns, encouraging more developmentally-optimal emotional involvement – beginning in the therapy room.
Flexibility of family structure: anticipating later work on resilience Minuchin (1974) viewed the strength of the family system as “dependent upon its ability to mobilise alternative transactional patterns when internal or external conditions demand its restructure”. As described above, flexibility across the enmeshment-disengagement continuum is necessary if a family system is to meet adequately the developmental tasks of the family cycle. This is but one example of the importance of the flexibility of the family system.
Minuchin’s stress on the importance of the flexibility of structural relationships within normal families was borne out by a study of Lewis et al. (1976) in Texas, where effective family functioning was associated with an adaptive flexibility of the structure. For example, the hierarchical organisation should be flexible so that it can adapt to take account of a concurrent disability of one parent and so that the balance between enmeshment and disengagement can vary in response to changes within its developmental life cycle. This capacity to “mobilise alternative transactional patterns” in the face of need was regarded by Minuchin as a particular measure of the strength of the family system and a key aspect of the structural diagnosis, and all work on family resilience since bears out his proposition.
Families who struggle with problems were regarded as having relatively inflexible family structure, because each of their ‘new’ attempted solutions was isomorphically little different from their previous attempts. A structural family therapist’s work involves recognising such patterns and, using quite directive measures, encouraging more diverse responding – beginning in the therapy room.
Aponte, H., & Hoffman, L. (1973). The open door: a structural approach to a family with an anorexic child. Family Process, 12(1): 1-44.
Gurman, A. S., & Kniskern, D. P. (Eds.). Handbook of Family Therapy. London: Routledge.
Minuchin, S. (1967). Families of the Slums. New York: Basic Books.
Minuchin, S. (1974). Families and Family Therapy. Cambridge, MA: Harvard University Press.