دانلود رایگان ترجمه مقاله خانواده درمانی ساختاری (سال 2001)

خانواده درمانی ساختاری

Structural Family Therapy

Abstract

Structural Family Therapy was developed by Salvador Minuchin and colleagues during the 1960s as part of the growing interest in systemic ways of conceptualising human distress and relationship dilemmas, and in working therapeutically with those natural systems and relationships, thought to give rise to distress. Structural family therapy is underpinned by a clearly articulated model of family functioning, and has been developed and used most consistently in services for children and families. A growing body of empirical evidence attests to the efficacy of structural family therapy. As an approach it was extensively critiqued during the 1980s by feminist writers and during the 1990s by those interested in the implications of a social constructionist position. Structural family therapy continues to evolve in response to challenges mounted from within and outwith the systemic field, and as part of integrative practice and multisystemic approaches, with practitioners ever mindful of the need for regular feedback from family members themselves.

1 Introduction

Structural family therapy is a body of theory and techniques that approaches individuals in their social and relational contexts. It was developed in the context of therapeutic work with families and young people. It is predicated on family systems theory, and brings with it many of the strengths and weaknesses associated with the appropriation of general system theory (von Bertalanffy, 1968) into the realm of social behaviour. This article reflects my interpretation of structural family theory and therapy, modified by my longstanding and continuing use of the ideas and methods. For me, the central creative thesis of structural family therapy is embodied within the paradigm shift of the relational therapies, that distress can be understood not only in the context of the relationships within which it arises and is maintained, but also in seeing the potential for relationships to be the cause of distress. The excitement and challenge of structural family therapy is in the focus on family members’ interaction and in the broad definition of communication to be more than what we say and the way in which we say it. Structural family therapy is an approach mainly identified with the work and writing of Salvador Minuchin, although many other influential thinkers have worked in association with the development of the ideas, such as Jay Haley, Braulio Montalvo, Lynn Hoffman, Marianne Walters, Charles Fishman and George Simon. Many of the concepts are familiar, such as family rules, roles, coalitions, triangulation of conflict, subsystems and boundaries, organisation, feedback, stability and change. However, the thinking and practice of a structural family therapist will likely be characterised by formulation of family members’ difficulties in terms of family structure and dynamic organisation and a preference for working in the here and now. At this point, I wish to note that in my experience in the UK, few working family therapists adhere rigidly to one school of thought; rather an integrated pragmatic approach to conceptualisation and practice is more likely, with a consideration of the fit between family members’ style and preferences, therapist style and the nature of the difficulties driving the dominance of one family therapy model over another. Nor would I want this article to reflect the view that family therapy, of whatever approach, is always the treatment of choice when confronted with human distress. It may be the treatment of choice, or it may be part of an integrated package of care.

Model of change

The term structure refers to the organisational characteristics of the family at any point in time, the family subsystems, and the overt and covert rules that are said to influence interpersonal choices and behaviours in the family. Thus an aim of this therapy is to alter the organisational patterns, particularly where the modes of communication are thought to be unhelpful and where behaviours are considered to be abusive and neglectful or to have the potential to be so. When the structure of the relational group changes, the positions of members in the group changes. Thus it is said, each individual’s experience changes and therein lies the potential to alleviate symptomatic distress. Structural family therapy works with the processes of feedback between circumstances and the people involved, tracking how changes made to our circumstances feedback into choices and decisions about further change. This is a competence model, encouraging people to explore the edges of their known repertoires of responding, assuming that family members have the ability to innovate and draw on less tapped interpersonal and intrapersonal resources. Enactment as a structural family therapy technique is seen as central to this model of change (Simon, 1995) i.e., encouraging family members to problem solve and generate alternative responses to each other in the relative safety of the therapeutic relationship. Thus intervention is promoted at three levels: challenging symptomatic behaviour, challenging the family structure, and challenging family belief systems. The therapy is based on the tenet of action preceding understanding, and vice versa, with the use of cognitive techniques such as reframing. Family members are encouraged to think beyond symptomatic behaviours and current complaints and see their behaviour and choices in the context of family structures and process and in the relationships between the family group and other societal systems. The structural family therapy model of change does not exclude other models of change and structural therapists can work alongside other therapeutic approaches to change as part of a co-ordinated package of care.