Restructuring in Systemic Family Therapy

A family therapist is an active participant in bringing about change within a family, engaging therapeutically in concerns and issues that are causing distress. This will be effective and valued from a structural family therapy viewpoint, if s/he can disrupt or ‘shake up’ family patterns and behaviour leading to a restructuring over time. ‘Restructuring’ is defined as “using interventions such as enactments, boundary making, unbalancing, creating intensity or reframing to challenge the prevailing family structure” (Carr 2001;102). This essay will therefore look at each of these interventions in order to understand how restructuring works.

Structural Family Therapy was developed by Salvador Minuchin and his colleagues during the 1960s as part of the growing interest in systemic ways of understanding relationship difficulties and individual distress.

Historically the family was seen as creating ‘the problem’ but this gradually evolved into a new understanding of ‘not knowing’ where the problem lies. If we are less certain of the position we hold we are more likely to become receptive to other possibilities. This includes the therapist’s position, able to approach the work with a safe uncertainty as to how things are or might become, with no fixed view.

“The image of the all-knowing, all-powerful therapist who imposes his assumptions on trusting and gullible family members cannot coexist with the previous description of the therapeutic process. Thus, a therapist is an expert who embraces uncertainty, joins families in the adventure of expanding and enriching their ways of relating, and challenges their certainty by helping them see alternative ways of relating” (Minuchin, Nichols and Lee 2007;13).

A therapist’s initial goal is to be accepted by the family, to form a relationship. In order to do this s/he needs to be alongside, ‘joining’ the family, becoming part of the system. The therapist aligns themselves with each family member at a time, appearing to be allied with each person but infact remaining neutral. There needs to be an appreciation of what is happening, of the current situation, before seeking to change it. A match has to be made between what the therapist can do with where the family members are at. Change has to be collaborative. “..to join a family, experiencing reality as the family members experience it, and becoming involved in the repeated interactions that form the family structure and shape the way people think and behave. It means to use that joining to become an agent of change who works within the constraints of the family’s system, intervening in ways that are only possible with this particular family” (Minuchin 1981; 2).

People will keep talking about problems until they feel heard. Restructuring is based on observing and manipulating interactions by the family, suggested by the therapist within a counselling session, either spontaneous behaviour sequences or enactments. Enactment means asking family members to demonstrate a certain interaction or behaviour rather than just talking about it. It can be acted out, perhaps using role play, infront of the therapist who can then make connections between the patterns of behaviour seen, enabling family members to view these connections from a different perspective. “Firstly the therapist starts framing by listening to the family and what is felt to be most relevant – then to convince family members that the situation can be expanded or modified – reframed – using enactment focusing and achieving intensity are successful to therapeutic framing” (Minuchin 1981; 76).

Restructuring in a session may involve moving people around, a non-verbal intervention, moving someone’s chair away from the family perhaps, suggesting independence or moving a disengaged family member closer to someone else. In order to endeavor to re-structure what is happening within the family dynamic the therapist will use other interventions such as boundary making, unbalancing, creating intensity or reframing to challenge the prevailing family structure, to look at things in a different way. These techniques are all intrinisically linked within the process of restructuring.

Boundary making can help with enmeshed family members such as a parent who is over-involved with a child. A boundary may be introduced or re-enforced to strengthen or change the distance between relationships. An example of unbalancing is “to change the hierarchical relationship of the members of a subsystem” (Minuchin 1981; 161). A subsystem is a group within the system such as the parents or the children. Unbalancing requires briefly taking sides. Creating intensity may be used by repetition of a message due to the ineffectiveness of an intervention.

In terms of power and difference in the therapeutic relationship firstly it is necessary for the therapist to hold in mind that s/he is in a position of power, it may also be important to bring this into the room and talk about the client’s view of the dynamic. To presume that we are all equal therefore the issue of power is not there is not true and potentially patronising.

We are not all compatible. Ideally the therapist needs to be able to refer a client or family to another practitioner in order to have a better match if this is needed. There is a potential limitation to this work if ‘difference’ is not adequately taken into account.

“Unfortunately, in the process of stepping back to see the system, family therapists sometimes lost sight of the individual human beings that make up a family. Although it isn’t possible to understand people without taking their social context into account, notably the family, it was misleading to limit our focus to the surface of interactions – to social behaviour divorced from inner experience” (Minuchin, Nichols and Lee 2007;1).

When joining with a client or family is difficult the work can become more challenging and less effective. Everyone must feel supported and understood before they can be challenged regardless of their position, this in itself can be very difficult depending on the nature of the client work and the context. Techniques learnt too easily and too quickly could undermine the work. The therapist needs to really know the family and its own idiosyncrasies sufficiently well to earn her/his right to lead. This cannot be rushed. Restructuring cannot work without joining successfully with the family.

It is important to look at and discuss why patterns of behaviour are being repeated even if the outcome is not desirable. How does this serve the individual or the family, what is being ‘guarded against’ or defended? Is it so familiar that it is engrained? Are they stuck in old narratives that do not serve them well or even serve any purpose at all. It may be that it is reinforcing the problem. The solution may also perpetuate the problem, take for example overprotective parents, their child could then become dependent on this overprotection.

Reframing when working towards a restructure, involves redefining the problem, taking ‘the label’ and potentially the judgement away and allowing more capacity for change. Reframing works best when it fits the client’s world view and language creating a relational context for change. Someone described as an ‘alcoholic’ could be described instead as having an alcohol problem. A ‘disruptive’ family member could be described as an independent thinker.

“The new framework must be sufficiently congruent with the client’s or family’s Experience and belief frameworks; otherwise it will be rejected. A reframing would almost inevitably place a positive connotation on behaviour or attitudes which would usually be viewed by the family or others in a more negative way” (Cade1987; 42).

Guilfoyle’s discourse markers of uncertainty are a form of potential reframing. ‘I may be wrong about this but…’, ‘I don’t know but it seems like…’, encouraging the client/family to look at this in a different way whilst empowering them ‘this might not be quite right but…are you willing to look at it in this way?’

‘Process not content’ is a useful focus in client work and can be useful when working towards restructuring with a family. If someone is feeling very low for example, it often does not matter what the detail or content is, they will potentially look for evidence that all is not well, look for the negative, if it is not one thing it will be something else, proof will be found.

Staying with the process and not getting pulled into the content/ detail of the client’s work can be key to being able to help and to move things forward.

It is important not to be too attached to any one model when working one-to-one and with a family. Individual strategies for restructuring are best designed for each situation in a client focussed way rather than the intervention being organized by the model or method of working. Minuchin writes of techniques being there to be mastered and then to be transcended. (1981)

To conclude, when looking at restructuring as a process in structural family therapy it is essential to look at each intervention, joining, boundary making, unbalancing, enactment-creating intensity and reframing. They are all intrinsically linked and are aimed at changing the structure of family relationships and dynamics where there is a perceived problem.

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Credits

Carr, A. Carr (2001) Family Therapy Concepts Process and Practice: Wiley
Haley, J. (1976) Problem Solving Therapy. New York: Harper Books/Jossey Bass.
Minuchin, S and Fisherman H.C. (1981) Family Therapy Techniques Cambridge: Harvard University Press.
Minuchin, S Nichols, M and Yung Lee, (2007) Assessing Families and Couples: From Symptom to System Allyn & Bacon
Cade, B. (1987) Brief/Strategic Approaches to Therapy: A commentary
A.N.Z J. Fam Ther 8:1 pp. 37-44