Structural family therapy is an approach to family therapy that focuses on a family member’s role within the family system and how a family interacts and communicates. Unlike more psychotherapies, this approach focuses on the present instead of the past, allowing families to avoid blame and communicate constructively to solve problems. Any family can benefit from it and can expect treatment to last for at least 3 months.
The cost of this form of therapy can vary; it’s important to look at your health insurance benefits for mental health. Many therapists offer sliding scale prices to ensure treatment is accessible and affordable.
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 of how one’s role in the family is shaped and embodied gives a lot of information to the family therapeutic process. As a result, we can look at how these individual family members are in their family unit environment.1
This approach to family therapy focuses on the here and now instead of past behaviors and history. The idea comes from the goal of changing perceptions and subsequently, behaviors, as a result of examining each member of the family within the family unit. 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 is 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 is very telling in what may or may not need to change with the family structure to ensure it can be more functional.
Even with functional structures, families will still experience moments of dysfunction but are better equipped to recover from those behaviors before they become a pattern.
Subsystems
Subsystems are smaller units within the larger family unit. This could be a dynamic with the siblings, with one sibling and one parent, with both parents, the female siblings and mother, the male siblings vs female siblings, the older siblings vs the younger siblings, etc.
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.
Power
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, boundaries 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 which can impact individual members of the family unit, which 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 boundaries. In enmeshment, boundaries are so loose that they interrupt individual growth of the family members engaged in an 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 a behavioral pattern pertaining to boundaries as well. 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 leads to very little dependence on the family unit, which is needed to maintain trust, love, respect and growth for the family unit as a whole. 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 or subsystems. Understanding these coalitions within a family and how they aligned can be a key to uncovering deeper behavioral patterns within the family unit at large.6
What Can Structural Family Therapy Help With?
Structural family therapy can help families with a myriad of issues. Some include issues 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 are:
- Separation/divorce
- A child coming out with his/her sexuality
- A partner that is transitioning
- A parent changing careers
- Traumatic experiences
Mental & behavioral disorders or concerns which structural family therapy can intervene include:
- Depression
- Anxiety
- PTSD
- Sexuality
- Infidelity
- Life-changes
- Changes in family structure
What’s the Goal of Structural Family Therapy & Who Determines That Goal?
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 assisting 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/or 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 role and power to compliment one another in the family unit.2
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Structural Family Therapy Research Examples
As we discussed above, there are many ways in which structural family therapy has been effective for families, despite their circumstances. These studies will highlight the benefits of structural family therapy interventions in a variety of life examples experienced by a family.
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
Cost of Structural Family Therapy
Family therapy can be covered by 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/family therapy would be covered as 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 and 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, separation and divorce, each session can range from $60-$200 per hour per session. It’s important to consider therapists and practices which may offer sliding scale prices for sessions. In this case, considering that there was no external medical factor that triggered a need for structural family therapy, this would not be covered by health insurances.
How to Find a Structural Family Therapist
The best way to find a structural family therapist is by searching online and reviewing the in-network providers 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.
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
The following 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 take time reviewing what their role is and 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 along with the family will set up a treatment plan for frequency of therapy.
Is Structural Family Therapy Effective?
Structural family therapy is backed by all the major licensing association for mental health counselors. This approach to family therapy has been found to be effective with marital mediation and marital distress.7 In addition, structural family therapy is effective with mental health concerns, specifically for families with children who struggle with a myriad of diagnoses.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
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 promote the balance and equality of all members of the family. Compared to CBT, there is less emphasis on history of how one may think and more emphasis on communicating the experience for themselves.
Its focus is based on setting rules and understanding why those rules are significant to the health of the family versus CBT’s 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.
History of Structural Family Therapy
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. To add, 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
