Structural Family Therapy: How It Works, Cost, & What to Expect

What Is Structural Family Therapy?

Structural family therapy is a type of family therapy that looks at the members of the family unit in relation to their role within the family. This approach allows the focus to be on the family as opposed to one individual. Having context regarding how one’s role in the family is shaped gives a lot of information to the family therapeutic process and can help encourage better functioning and communication.¹

Developed by Salvador Minuchin in the 1960s, structural family therapy focuses on the here and now instead of past behaviors and history. Given that families are constantly changing as a result of each member of the family changing and growing over time, focusing on the present allows families to learn tools they can use as they continue to grow and change throughout its lifespan.¹

Core Concepts of Structural Family Therapy

There are a number of core concepts of Structural family therapy, including:

Structure

Structure refers to the behavioral patterns exhibited by the family unit. A dysfunctional structure will lead to more issues within the family unit and among each member of the family. Obtaining a baseline understanding of how a family functions can help the therapist understand what may or may not need to change within the family structure to ensure it can be more functional.

Even in functional structures, families will still experience moments of dysfunction—but they are better equipped to recover from those behaviors before they become a pattern.

Subsystems

Subsystems are smaller units within the larger family unit. The subsystem in each family unit is specific to the relationships and dynamics within each family. Understanding the origins of these subsystems is crucial to unpacking how they influence the family unit.

Subsystems could include dynamics between:

• One sibling and one parent
• Both parents
• Multiple siblings and one parent
• Male siblings vs. female siblings
• Older vs. younger siblings

Power & Hierarchies

Power is the amount of influence each member or subsystem has on one another, another subsystem, and the family unit as a whole. Understanding power dynamics sheds light on the behavioral patterns of a family unit, how decisions are made, and how structure may need to change to ensure all members of the family unit feel power relative to their role within the dynamics of the family unit.

Boundaries

Boundaries are essentially spoken or unspoken rules of how one member of the family and/or subsystem interacts with one another. Boundaries can be both concrete and abstract depending on the situation, and some may have more gray areas instead of black and white barriers. It’s important to understand how boundaries are formed, why they are the way they are, and how effective they are in maintaining a healthy family function.

Boundaries can be too rigid or not rigid enough, and can impact individual members of the family unit. This can have a negative impact on the family unit and lead to dysfunctional patterns and an unstable, unsustainable structure needed for growth and change as the family unit matures.

Enmeshment

Enmeshment is a behavioral pattern pertaining to unhealthy boundaries. In enmeshment, boundaries are so loose that they interrupt individual growth of the family members engaged in the enmeshed dynamic. The needs for autonomy for each individual member of the family is critical to maintain a functional family unit.

Enmeshment blurs the line between members of the family beyond the level of creating a subsystem. This type of dependence becomes codependence, which hurts the potential for the family to mature properly.

Disengagement

Disengagement is basically the opposite of enmeshment. In disengagement, boundaries are so strong that they can lead to major disconnection with members of the family. There is a strong sense of independence and little dependence on the family unit, which is needed to maintain trust, love, respect and growth for each member of the family.

Disengagement can make members of the family unit feel as though they have nothing in common with others in the family unit, leading to dysfunctional patterns.

Alignment/Coalition

An alignment is how a member(s) of the family and/or subsystems(s) relate to one another in the context of the family unit. A coalition is a type of alignment that only has two members of the family, excluding any other members and subsystems. Understanding these coalitions within a family and how they align can be a key to uncovering deeper behavioral patterns within the family unit at large.⁶

Triangulation

Triangulation happens when one family member leans on another during conflict with a third family member. In this dynamic, there is a “triangle” formed and essentially, one family member is forced to take a side between two of the others. There is a shared sense of power and control in triangulation, and the pitting of two family members against one can perpetuate negative cycles of behaviors.

Parentified Children

Parentified children are children who are given expectations and roles that are only appropriate for an adult to do. Children take on the physical, emotional, and/or mental labor as needed to help their parents. Parentified children learn over time that their needs are less important and can build resentment and negative views of self and others overtime.

What Can Structural Family Therapy Help With?

Structural family therapy can help families with a myriad of issues, including those pertaining to raising children with intellectual developmental disorders, incarceration, infidelity with the parental figures, mental health concerns, and trauma.

Common life events that can necessitate structural family therapy include:

• Separation and divorce
• A child coming out with his/her sexuality
• A partner that is transitioning
• A parent changing careers
• Traumatic experiences
• Mental or behavioral disorders like a family member’s depression or anxiety

What’s the Goal of Structural Family Therapy?

The goal of structural family therapy is to create more healthy family dynamics within all members of the family unit, relative to the relationships within the family. This can include helping families create sustainable structure and mutually agreed upon rules and boundaries.

Another goal is to understand how individual members or subsystems can positively influence the family unit with their alignments and understand better ways to function within their subsystems.

The last goal is to help family members stay connected with one another with healthy patterns of communication and engagement. This can include addressing enmeshment and disengagement among family members or subsystems and using roles and power to compliment one another in the family unit.²

Structural Family Therapy Techniques

There are a handful of techniques that a structural family therapist might use, including reframing situations, helping family members build relationships, and using positive reinforcement to encourage behavior change.

Some of the most common techniques used during structural family therapy include: 

• Joining: This involves the therapist attempting to make connections and build a relationship with the family to meet them where they are. It is aimed to increase comfort levels for the family to open up during sessions.
• Mapping: This involves a therapist uncovering information and data points to help figure out where patterns are coming from to know where and how to address them.
• Unbalancing: This involves a therapist briefly aligning with a certain family member to address gridlocked behaviors and perceptions to promote changes in behaviors.
• Reframing: This involves altering a way an event or situation is perceived by offering a different perspective and challenging the family to consider it as an opportunity.
• Enactment: This involves a therapist helping to facilitate a role-play scenario and act out certain situations to come to a better resolution.
• Shaping competence: This involves giving positive reinforcement and acknowledgement when a behavior change is made.

What Are the Benefits of SFT?

There are many benefits of structural family therapy. Given that there are a lot of different and easy-to-understand processes, many different types of families and family units can benefit.

Structural family therapy can help individuals and families: 

• Improve communication: Better communication is a result of SFT when everyone feels more heard and seen.
• Problem-solve difficult scenarios: Families learn how to handle situations better and learn to communicate safely and effectively.
• Reduce family conflict: Conflict decreases overall as a result, as there are new tools to engage and relate to family members.
• Build stronger relationships: Family relationships are improved overall as everyone feels seen and heard.
• Manage emotions: Emotions are better handled in the family and individually, and people are met with compassion.
• Build self-esteem and identity: Good relationships within the family improve self-esteem and self worth for each member.

Is Structural Family Therapy Effective?

Structural family therapy is backed by all the major licensing associations for mental health counselors.

There is evidence that structural family can be effective in a variety of settings:

• This approach to family therapy has been found to be effective with marital mediation and marital distress.⁷
• Structural family therapy is effective with mental health concerns, specifically for families with children struggling with a mental health diagnosis.⁴
• Infidelity issues were also effectively managed and worked out, and subsequent impact of infidelity on the family unit was proven to be helped with structural family therapy interventions.⁵

Structural Family Therapy Examples

In a recent study, it was found that unpacking issues related to infidelity within relationships from the lens of a structural family therapy approach allowed partners to empathize with one another in a meaningful way. The reactions in the clinical setting exhibited by both individuals embodied compassion and care. Couples were able to understand how their dynamics regarding infidelity also impacts their children and how to manage that better as co-parents and/or a couple.⁵

Another study examined the impact of structural family therapy on families with children who struggle with mental health issues. In this study, children were found to have healthier ways of coping with their issues as opposed to internalizing their fears and concerns. Parents of these children reported improved relationships with their children and healthier dynamics within the family structure. Communication improvements were also reported to be a result of structural family therapy interventions for families of children struggling with mental health concerns.⁴

In another study aimed at evaluating the effectiveness of structural family therapy on marital mediation, it was found that these interventions were very effective. Marital mediation process improved greatly as a result of the approach of a solution-focused structural family therapy intervention. Intimacy among couples improved as a result as well, highlighting the ways in which problems were dissected and understood to reach solutions from. Lastly, it was found that some marital conflict was completely resolved as a result from the ways in which engagement and structure were reorganized within the family unit.⁷

How to Find a Structural Family Therapist

You can find a therapist by searching online, using an online therapist directory, or reviewing the in-network providers with your health insurance if your reason for structural family therapy is stemming from a medical condition for someone in the family. Looking through profiles online and narrowing down a few to contact for initial talks is a good first step. Many therapists offer a free phone consultation and that can give families an opportunity to evaluate if that may be the right therapist for what they are looking for.

Who Can Offer SFT?

Any type of mental health clinician is able to facilitate structural family therapy as long as they have the experience. While there is no specific certification or credential for this form of family therapy, there are many continuing education credits and workshops therapists may enroll in to gain experience. The mental health professions which may enroll in these courses are LCSWs, LSWs, LPCs, PsyDs, LMFTs, and any variety of these depending on the state in which you live.

Key Questions to Ask a Structural Family Therapist

Here are key questions to ask a structural family therapist when considering treatment:

• What is your experience with structural family therapy?
• How might this help my family with my issues?
• How long will we have to be coming in for therapy?
• How do we know if we’re making progress?
• What if someone doesn’t want to come to therapy one week?
• Can you see any of us individually?
• Do you diagnose an issue with the family?
• Do we have homework?

What to Expect at Your First Appointment

During your first structural family therapy session, your therapist will review what their role is and take time asking questions to understand what brought you in for therapy. The first session is to gain an understanding of how the therapist works and what the family dynamic is. The therapist will likely ask all members of the family to offer their reason why they all think they are in therapy.

This usually gives a therapist an understanding of any patterns and/or alliances within the family. The first session is usually an hour long and from there, the therapist and family will work together to set up a treatment plan and determine the frequency of future therapy sessions.

How Long Does SFT Last?

SFT is not a short-term therapy approach. It is dependent on the family and the nature of their issues. Some families can take a few months to resolve issues and learn ways to relate to each other before they are done with therapy, while other families can take ten months to a year when issues and behavioral patterns can be harder to break.

Cost of Structural Family Therapy

Family therapy can be covered by mental health insurance in some cases, which include the diagnosis of a medical condition. For example, if a parent is diagnosed with PTSD by a licensed physician, individual and family therapy would be covered since the issues which arise from a PTSD diagnosis can lead to a need for therapy. The same can be true of a teen who is diagnosed with major depressive disorder by a licensed physician, as many types of depression can impact the family structure.

There is usually a copay for mental health services, which can range from $40 to upwards of $100. Looking at “in-network” providers might be able to help with the out-of-pocket costs with copays.

In situations where health insurance does not cover family therapy, such as infidelity or divorce, each session can range from $60-$200 per hour per session. It’s important to consider therapists who offer sliding scale prices for sessions.

How Is Structural Family Therapy Different Than Other Family Therapy Options?

Structural family therapy is among the top forms of family therapy as it’s proven to be very effective. The approach focuses on current problems and finding solutions in a way that promotes the balance and equality of all members of the family. Its focus is based on setting rules and understanding why those rules are significant to the health of the family instead of other models’ emphasis on changing behavior. There are benefits to all approaches to therapy, but the best form of family therapy for you will depend on your goals.

How Was Structural Family Therapy Developed?

Structural family therapy was developed by a psychotherapist named Salvador Minuchin in the 1960s. His focus was aimed at how family dysfunction impacts the family structure and dynamics. He believed that families’ poor communication patterns and relational skills among others in the family developed because of these dysfunctions. By the 1970s, more therapists accepted this new approach to family therapy and it quickly gained popularity based on how effective it was proven to be.³