Posted: December 3rd, 2022

Structural Family Therapy v. Strategic Family Therapy

Week 4: Structural and Strategic Family Therapy

Individuals are born into families, grow and develop in families, and live most of their lives in families. Therefore, it makes sense that clients are best understood within the context of the family system.

——Dr. Candice Knight, Psychotherapy for the Advanced Practice Psychiatric Nurse

The family system is a social unit that is based on unique relationships and roles. Structural and strategic therapies are important, because they offer unique insights to the theoretical underpinnings of this system. As a psychiatric mental health nurse practitioner, a strong theoretical foundation will help you better understand the family unit and family therapy; this understanding will, in turn, improve the effectiveness of your work with clients.

This week, as you continue exploring family therapy, you examine structural and strategic family therapies and their appropriateness for client families.
Learning Resources
Required Readings

McNeil, S. N., Herschberger, J. K., & Nedela, M. N. (2013). Low-income families with potential adolescent gang involvement: A structural community family therapy integration model. American Journal of Family Therapy, 41(2), 110-120. doi:10.1080/01926187.2011.649110

Méndez, N. A., Qureshi, M. E., Carnerio, R., & Hort, F. (2014). The intersection of Facebook and structural family therapy volume 1. American Journal of Family Therapy, 42(2), 167-174. doi:10.1080/01926187.2013.794046 

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.

Chapter 4, “Bowen Family Systems Therapy” (pp. 56-71)
Chapter 5, “Strategic Family Therapy” (pp. 72-88)
Chapter 6, “Structural Family Therapy” (pp. 89-104

Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207-215. doi:10.1111/famp.12025

Ryan, W. J., Conti, R. P., & Simon, G. M. (2013). Presupposition compatibility facilitates treatment fidelity in therapists learning structural family therapy. American Journal of Family Therapy, 41(5), 403-414. doi:10.1080/01926187.2012.727673 

Sheehan, A. H., & Friedlander, M. L. (2015). Therapeutic alliance and retention in brief strategic family therapy: A mixed-methods study. Journal of Marital and Family Therapy, 41(4), 415-427. doi:10.1111/jmft.12113

Szapocznik, J., Muir, J. A., Duff, J. H., Schwartz, S. J., & Brown, C. H. (2015). Brief strategic family therapy: Implementing evidence-based models in community settings. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 25(1), 121-133. doi:10.1080/10503307.2013.856044

TherapistAid. (2020). Genograms for psychotherapy. Retrieved from https://www.therapistaid.com/therapy-guide/genograms

Required Media

Psychotherapy.net (Producer). (2010). Bowenian family therapy [Video file]. Mill Valley, CA: Author.

The approximate length of this media piece is 118 minutes.

Triangle Productions (Producer). (2001). Brief strategic therapy with couples [Video file]. La Jolla, CA: Author.

Optional Resources

Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313–332. Retrieved from http://www.familyprocess.org/family-process-journal/

Golden Triad Films (Producer). (1986). The essence of change. [Video file]. Mill Valley, CA: Psychotherapy.net.

National Institute on Drug Abuse. (2003). Brief strategic family therapy for adolescent drug abuse. Retrieved from https://archives.drugabuse.gov/TXManuals/BSFT/BSFTIndex.html

Navarre, S. (1998). Salvador Minuchin’s structural family therapy and its application to multicultural family systems. Issues in Mental Health Nursing, 19(6), 557–570. doi:10.1080/016128498248845

Psychotherapy.net. (Publisher). (n.d.). Satir family therapy [Video file]. [With Jean McLendon]. United States: Psychotherapy.net.

Psychotherapy.net (Producer). (2011b). Salvador Minuchin on family therapy [Video file]. Mill Valley, CA: Author.

Radohl, T. (2011). Incorporating family into the formula: Family-directed structural therapy for children with serious emotional disturbance. Child & Family Social Work, 16(2), 127–137. doi:10.1111/j.1365-2206.2010.00720.x

Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., … Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713–727. doi:10.1037/a0025477

Santisteban, D. A., Suarez-Morales, L., Robbins, M. S., & Szapocznik, J. (2006). Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and practice. Family Process, 45(2), 259–271. doi:10.1111/j.1545-5300.2006.00094.x

Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple & Family Psychology, 1(2), 134–145. doi:10.1037/a0029002

Szapocznik, J., Zarate, M., Duff, J., & Muir, J. (2013). Brief strategic family therapy: Engaging drug using/problem behavior adolescents and their families in treatment. Social Work in Public Health, 28(3-4), 206–223. doi:10.1080/19371918.2013.774666

Vetere, A. (2001). Therapy matters: Structural family therapy. Child Psychology & Psychiatry Review, 6(3), 133–139. Retrieved from http://www.iupui.edu/~mswd/D642/multimedia/word_doc/StructuralFamilyTherapy_Vetare.pdf

Weaver, A., Greeno, C. G., Marcus, S. C., Fusco, R. A., Zimmerman, T., & Anderson, C. (2013). Effects of structural family therapy on child and maternal mental health symptomatology. Research on Social Work Practice, 23(3), 294–303. doi:10.1177/1049731512470492

Assignment: Structural Versus Strategic Family Therapies

Although structural therapy and strategic therapy are both used in family therapy, these therapeutic approaches have many differences in theory and application. As you assess families and develop treatment plans, you must consider these differences and their potential impact on clients. For this Assignment, as you compare structural and strategic family therapy, consider which therapeutic approach you might use with your own client families.
Learning Objectives
Students will:

Compare structural family therapy to strategic family therapy
Create structural family maps
Justify recommendations for family therapy

To prepare:

Review this week’s Learning Resources and reflect on the insights they provide on structural and strategic family therapies.
Refer to TherapistAid (2020) in this week’s Learning Resources for guidance on creating a structural family map.

The Assignment

In a 2- to 3-page paper, address the following:

Summarize the key points of both structural family therapy and strategic family therapy.
Compare structural family therapy to strategic family therapy, noting the strengths and weaknesses of each.
Provide an example of a family in your practicum using a structural family map. Note: Be sure to maintain HIPAA regulations.
Recommend a specific therapy for the family, and justify your choice using the Learning Resources.

Note: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided by the Walden Writing Center provides examples of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

By Day 7

Submit your Assignment.
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Structural Family Therapy v. Strategic Family Therapy
Introduction
Structural family therapy and strategic family therapy are essential therapies in addressing multiple family challenges. The role of therapists in structural family therapy is to understand how families operate (Lebow, 2019). In strategic therapy, counsellors utilize different approaches to trigger the change families require for a healthy interaction. Structural and strategic family therapies are essential in addressing behavioral challenges among families. The two models are effective despite their strengths and weaknesses. The purpose of the paper is to examine the structural and strategic family therapies, their differences, similarities, strengths and weaknesses, and a structural family map.
Summary of Key Points
Structural family therapy involves understanding the structures, engagements, and disengagements in families. The role of therapists in structural family therapy is to understand how families operate. Therapy disrupts poor relationships and promotes healthy engagements (Nichols & Davis, 2020). It argues that the problem or solution to a family is with all the individuals and not a single person. Therapy seeks to change the relationships among family members to catalyze change (Lebensohn‐Chialvo, 2019). The change in families is also in gradual steps that lead to the elimination of negative behavior or interactions.
Strategic family therapy focuses on strategies that determine the operation of a family. The strategies include practices and activities that can trigger positive or negative change. For instance, communication is an essential element in the family system (Lebensohn‐Chialvo, 2019). Therapists utilize different approaches to trigger the change families require for a healthy interaction. It involves strategies such as setting objectives and attaining positive outcomes. The therapist strives to analyze the challenges facing their clients. For instance, a therapist will identify the flaws and strengths that operate in families (Lebensohn‐Chialvo, 2019). Counselors will use the strengths they identify in the families to promote positive change.
Comparison
Strategic family therapy argues that families are affected by real problems such as low-income which can lead to dysfunction. Structural family therapy indicates that the problems families experience are symptoms of underlying issues (Weaver et al., 2019). According to the structural family therapy, relationships among the family members change when structures in the families change (Nichols & Davis, 2020). The strategic family model argues that change in families is a gradual process that can lead to successful relationships.
Both structural and strategic family therapies focus on issues affecting families, including communication, dysfunction, and relationships (Weaver et al., 2019). The two models indicate that external forces can affect the functionality of family relationships or structures.
Strengths and Weaknesses
Structural and strategic family therapies are essential in addressing behavioral challenges among families. The two models can effectively address maladaptive behaviors in family members, such as drug and substance abuse (Lebow, 2019). Research shows that therapists can utilize the approaches to enhance the quality of relationships among dysfunctional families (Lebow, 2019). One of the weaknesses of the approaches is that they do not consider other factors that affect families, such as emotions.
Structural family therapy is effective in addressing challenges in parenting roles. A hierarchical approach helps family members to respect authorities (Lebow, 2019). For instance, children are taught to respect the authority of their parents. It helps parents to know they should develop a common approach to addressing issues in the families (Nichols & Davis, 2020). The structural approach is suitable in helping members to visualize the problems that cause dysfunction.
Structural family therapy requires the participation of all the family members. If one member does not participate the therapy may be unsuccessful. The model ignores nuclear families with a different structure (Weaver et al., 2019). Conversely, strategic family therapy focuses on relationships among family members. Therapists criticize the approach since it is narrow does not consider all the factors that lead to family problems.
The two models have strengths and weaknesses that can affect how therapists utilize them to address issues in families. Therapists need to select the best approach to achieve quality outcomes.
Conclusion
Families require different approaches to address their dysfunctional issues. Structural and strategic family therapies address significant issues affecting families. Structural family therapy involves understanding the structures, engagements, and disengagements in families. Strategic family therapy focuses on strategies that determine the operation of a family. The two models can effectively address maladaptive behaviors in family members, such as drug and substance abuse. The approaches have significant strengths and weaknesses that affect the decision of the therapists. It calls for a better understanding of the models to ensure effective utilization to address family issues.
Structural Family Map
Structural family therapy is essential for families experiencing differences in disciplining their children and the behaviors to tolerate. For instance, a family of four is experiencing challenges of substance and drug abuse and failure to report to school. Linda Huz, 38, is married to Jimmy Huz, 40, and together they have two daughters. Allain, 18, and Alie, 16, have been going out to night clubs with a group of boys and girls. The mother believes it is part of a stage of growth while the father believes they should restrict the girls. The dysfunctional family will cause a coalition between the father and the daughters who have the support of their mother.
Figure 1.1 below shows a structural family map;
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References
Lebensohn‐Chialvo, F., Rohrbaugh, M. J., & Hasler, B. P. (2019). Fidelity failures in brief strategic family therapy for adolescent drug abuse: a clinical analysis. Family Process, 58(2), 305-317.
Lebow, J. L. (2019). Current issues in the practice of integrative couple and family therapy. Family Process, 58(3), 610-628.
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.
Weaver, A., Greeno, C. G., Fusco, R., Zimmerman, T., & Anderson, C. M. (2019). “Not Just One, It’s Both of Us”: Low-Income Mothers’ Perceptions of Structural Family Therapy Delivered in a Semi-rural Community Mental Health Center. Community Mental Health Journal, 55(7), 1152-1164.

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