Literature Review:

 

Trauma and Family Systems      

Structural Family Therapy’s foundational approach was combined with a newly formulated version called “Ecosystemic Structural Family Therapy” (Lindblad-Goldberg & Northey. 2013, p. 148).  This approach was formulated to be trauma informed, and to address issues with families experiencing intense emotional disturbances.  The ESFT model is best suited for work with families with children and adolescents, in Outpatient therapy settings. ESFT model follows a similar clinical outline as traditional SFT, however it includes attachment theory in application to the client and family system. It advises clinicians to follow the practice guideline of addressing five specific topics. These topics are: Family Structure, Affective Proximity, Family and Individual Emotional Regulation, Individual differences, and Family Development  (Lindblad-Goldberg & Northey, 2013, p. 150-151).  This model has been proved to be effective in Trauma work with Family systems, and provides a fresh take on the classic structural approach.

 

Low Income Families & Adolescents with Risk of Gang Involvement

            Minunich’s first population to begin developing Structural Family Therapy with was urban adolescent boys, who were referred to as delinquents. Because of this, Structural Family Therapy is still utilized with similar families today. This particular model as formulated by the American Journal of Family Therapy, is a collaboration between SFT and Community Family Therapy. The literature surrounding this model conveyed that SFT is still effective in this population, especially when enhanced with Community Family Therapy. According to the study, “Families are affected by multiple interacting systems. In congruence with systems theory, changing a part of the system will essentially affect the interrelated parts of the system” (McNeil, Herschberger, & Nedela, 2013, p.110).  The intervention is utilized through three stages.  These stages are outlined below:

“First, the family therapist works with the family to alter the family structure, placing the parental figures in a position of leadership in the family. Second, the therapist intervenes with the greater systems in which the child exists, such as in the school or in the neighborhood community, in order to facilitate the development of boundaries for the child with which the parents can cooperate and feel empowered. Third, the therapist’s and clients’ interventions into the community to facilitate positive change impact the greater systems of oppression and poverty that pose limits on these families of focus” ((McNeil, Herschberger, & Nedela, 2013, p.119). 

After these three stages are utilized, the Family system is more readily able to adjust to a healthy structure. Therefore reducing the risk of adolescent gang involvement, and providing a strengthened family unit.

 

Structural Family Therapy and It’s Implications for the Asian American Family

     Structural family therapy revolves around working with the family as one cohesive unit that is made up of structural frameworks and subsystems. Due to the importance of family structure in this modality of therapy, those therapists who practice Structural family therapy tend to look at the family as one unit, as opposed to the individuals themselves that make up the family. For this reason, structural family therapy is a strong contender when working with Asian American Families. The Asian culture holds their elders in high regard, and respects the hierarchy within the family. Because of this, using structural family therapy methods that look at the whole family, their structure, subsystems hierarchy and roles in the family, are beneficial when working with Asian-American populations (Kim, 2003).

 

SALVADOR MINUCHIN’S STRUCTURAL FAMILY THERAPY AND ITS APPLICATION TO MULTICULTURAL FAMILY SYSTEMS

The way that Structural family therapy is set up, works to create a functional family. In the eyes of this theory, a functional family involves a family that has clear boundaries set up between individuals and subsystems, facilitates individual growth and promotes hierarchies. Therefore, when working with a family that is dysfunctional in this regard, Structural family therapy works to change the family structure to accommodate the changes that are needed to make the family functional. This particular case study, demonstrated the use of Structural Family therapy with families of Hispanic and Asian descent. When applying Structural Family therapy to families of a different culture, it is pertinent to be aware of the cultural norms and differences, as well as common problems within a specific culture. Hispanics for example, typically hold the male figure of the household in high regard and esteem, Asian families have high respect for their elders. In both cultures, there can be acculturation issues which can cause disconnect in the family, as well as issues of “closed-ness” meaning that families are not seeking any help or support outside their immediate family unit, which can cause a shift in the typical family structure and impose stress (Navarre, 1998). It is for this reason, that this study feels that structural family therapy is appropriate for working with multicultural families as It sets clear goals, and works to change the entire family unit, not just one individual person (Navarre, 1998).

Child and Mother Mental Health:
            The Weaver, Greeno et al. study was completed in 2013 to observe the linkage between Structural Family Therapy and its effect on maternal reported and child reported symptoms of anxiety and depression. The authors felt SFT might be a good intervention to run because of its focus on the family unit and hierarchy structure. Coming from a social worker’s “person in environment” perspective they felt that treating and studying the family as a unit made more sense than treating and studying an individual as the problem. SFT agrees that it is the reciprocal giving and taking in interactions amongst family members that contributes to the problem rather than a problem or in this case “problem child” itself. The study took place in a semirural low-income community mental health clinic. The family’s participated in 3-4 treatment sessions where they participated in SFT with a trained clinician. The study was dissatisfied with the small treatment dosage but said that it was the most realistic for the type of family’s the community mental health agency served. What was discovered is that mother’s reported significant improvement in their child’s mental impairment in response to time spent in SFT. Mother’s own self-reported symptoms of depression and anxiety also decreased significantly. However, the research found that according to the child-reported results, SFT did not have a significant impact on their mental impairment.
            An important implication of this study was the frequency and importance mother’s place on their own mental health. The study found that even though mother’s indicated high levels of depression and anxiety when they were parenting children with mental illness, the parent was far less likely to request services for themselves even though they were getting services for their child. This puts mothers at risk of not receiving the services they need and instead prioritizing the needs of their child above their own. This makes SFT a wonderful option for families where mother and child may both be experiencing mental illness since it includes all participants in the family.
(Weaver, Greeno, et al., 2013)

Family-Directed Structural Therapy:

Family Directed Structural Therapy (FDST) is similar to the SFT we have been discussing but most importantly is more family-led than therapist led. This treatment incorporates the Strengths Model and Group Work Theory. The therapist therefore takes cues from the family members interactions and helps them to reframe the situations in ways that elicit a sense of empowerment and move towards conflict resolution. Here the therapist asks the family members to identify their own strengths in their system and completes family mapping similar to SFT. One difference in the family map is its consideration of boundaries has more to do with family roles and expectations than it does in the traditional sense of SFT (see Techniques section). The therapist then teaches the family new skills with attention to a particular vocabulary to promote change. The 2005 study by McLendon, McLendon, and Petr and case study from the article were taken from their diverse client population in the rural Midwest. Adults and parents are given more attention in FDST than the children who are introduced to the therapy in later sessions after a foundation has been built. This is different compared to traditional SFT where the therapist aims to have a mutual respect and relationship with each family member. The family, rather than the therapist in FDST initiates even the amount of sessions and time between sessions. The family completes the FDST Assessment Tool at the onset of therapy and throughout the process for ongoing evaluation. The FDSAT Assessment Tool has the participants score themselves and the other family members against personality traits like commitment, empowerment, credibility, control of self and consistency (specific FDST definitions for each).
            During FDST the Therapist helps the family identify strength’s from these FDST Assessment scores and also helps the family to communicate perceptions of one another through the use of the scores and definitions. Sometimes the improvement that takes place in therapy can actually lead to new stressors that need to be addressed. Some couples reported it helped to even have a working vocabulary in order to communicate. Families and the therapist reported appreciating being able to see the progress throughout their sessions with use of the Assessment Tool. The authors concluded that they felt confident with these adaptations to SFT that including the family into more of the decision making had produced favorable problem solving results.
(McLendon, D., McLendon, T., & Petr, C. G., 2005)