Therapy: A Practical Approach to Theory and Clinical
Case Documentation 3rd Edition By Diane R. Gehart
Structural therapy is primarily associated with the work of who? - ANSWER:Salvador
Minuchin
What is the general approach of structural therapists in helping their clients? -
ANSWER:They map family structure—boundaries, hierarchies, and subsystems—,
then they restructure the family, realigning boundaries and hierarchies to promote
growth and resolve problems.
Structural family therapists hold an attitude of what? - ANSWER:Strengths--never
seeing families as dysfunctional but rather as people who need assistance in
expanding their repertoire of interaction patterns to adjust their ever changing
developmental and contextual demands.
Boundaries - ANSWER:rules for managing physical and psychological distance
between family
members, for defining the regulation of closeness, distance, hierarchy, and family
roles
Although boundaries may sound static - ANSWER:they are organic, living processes.
Structural therapists identify three basic types of boundaries - ANSWER:Clear
Boundaries, Diffuse Boundaries, and Rigid Boundaries
Clear Boundaries - ANSWER:"normal" boundaries that allow for close emotional
contact with others while simultaneously allowing each person to maintain a sense
of identity and differentiation.
Diffuse Boundaries - ANSWER:lead to relational enmeshment. Families with overly
diffuse boundaries do not make a clear distinction between members, creating a
strong sense of mutuality and connection at the expense of individual autonomy
When talking with an enmeshed family, therapists typically see family members
doing the following: - ANSWER:■■Interrupting one another or speaking for one
another
■■Mind reading and making assumptions
■■Insisting on high levels of protectiveness and over concern
■■Demanding loyalty at the expense of individual needs
■■Feeling threatened when there is disagreement or difference
, Rigid Boundaries - ANSWER:these type of boundaries lead to relational
disengagement. Autonomy and independence are emphasized at the expense of
emotional connection, creating isolation that may be more emotional than physical.
These families have excessive tolerance for deviation, often failing to mobilize
support and protection for one another.
Therapists working with disengaged families notice the following: -
ANSWER:■■Lack of reaction and few repercussions, even to problems
■■Significant freedom for most members to do as they please
■■Few demands for or expressions of loyalty and commitment
■■Consistently using parallel interactions (e.g., doing different activities in the
same room) as substitutes for reciprocal interactions and engagement
systemic reframing - ANSWER:It usually involves removing
the blame from one person (the identified patient) and "spreading" blame equally by
describing how each person's response contributes to the problem dynamic. Once
this is done, blame becomes a moot point.
How to Generate Systemic reframes - ANSWER:• assess broader interactional
patterns (complementary relationships,
hierarchy, boundaries, etc.)
• redescribe the problem (use interactional patterns to describe the problem in a
larger context).
Boundary making is - ANSWER:a special form of enactment that targets over- or
underinvolvement
to help families soften rigid boundaries or strengthen diffuse boundaries
Boundary making may involve several different directives: - ANSWER:• Asking family
members to change seats
• Asking family members to move seats further or closer together or turn toward
one
another
• Having separate sessions with individuals or subsystems to strengthen subsystem
boundaries
• Asking one or more members to remain silent during an interaction
• Asking questions that highlight a problem boundary area (e.g., "Do you always
answer for your son when he is asked a question?")
• Blocking interruptions or encouraging pauses for less dominant persons to speak
Challenging the family's worldview and unproductive assumptions typically involves -
ANSWER:verbally questioning operational assumptions in the family system,
whether overtly spoken
or covertly acted upon
Common assumptions that create problems for individuals, couples, and families
include