Structural Family Therapy (SFT)

Family challenges can come up for many families and can be considered a public health concern. Marital distress, having two families join, and conflicts between individual family members, mental health problems, and stressors from the outside world can all impact how a family functions. Many families reach out for family therapy, whether based on stress, mental health conditions, work, finances, or other motives. 

Bowen family systems therapy can be an effective approach to address family dysfunction, which can be a source of distressing symptoms and mental health conditions for parents, children, and other involved families and friends. From unhealthy habits to cycles of sabotage, you may be able to manage and overcome family challenges using a method called structural family therapy (SFT).

What is structural family therapy?

There are many types of family therapy, some look at one family member at a time before considering the whole, others focus on marital mediation and improving relationships. Among the various interventions, structural family therapy (SFT) is one of the most popular and predominant family counseling theories. 

SFT is an evidence-based treatment model that emphasizes the whole family system rather than working on each individual's issues before the whole and is led by a structural family therapist or someone with training in SFT. This structural therapy can take into account how each individual may contribute to the overall group of family members. 

A structural family therapist may first talk to each of the individual family members before starting treatment to get an understanding of their mental health and goals for therapy. After interviewing the members, they may come together as a unit for therapy sessions to discuss mental health problems, treatment goals, and overall needs. If one member is living with a mental illness like bipolar disorder or any of the several eating disorders in the DSM-5, the therapist may take a unique approach in addressing the unit as a whole, educating each about the mental health condition, the type of therapy best used to treat it, and ways members can support each other. 

History of SFT 

This form of structural therapy was created in the 1960s, following one therapist's work with inner-city children in New York. These children were considered troubled adolescents. The therapist, Salvador Minuchin, determined that working with the kids and their families through regular talk therapy was not enough to curb worrisome behavior and improve outcomes for all members of the family.  Salvador Minuchins’ belief involving the entire family system was necessary to improve the child's home life, outlook, and habits. “In all cultures, the family imprints its members with selfhood,” explained Salvador Minuchin, highlighting the importance of considering the family members as part of the family as a whole rather than separately.  

How does structural family therapy work?

Using SFT, therapists and therapy participants consider the complex, overlapping subsystems that may impact a family dynamic for its members. The process is an effective approach to family therapy and can differ from strategic therapy, which focuses on individuals, specific issues, or specific relationships within the family context. SFT uses a family-first approach.

Family interactions, dynamics, and patterns may reveal concerns or past experiences. The goal of SFT is often to create positive and healthier routines within family structures to create a vibrant, loving, stable home life for everyone.

What do structural family therapy sessions entail?

To begin, at the first appointment, a structural family therapy practitioner may observe the family structure in question and take note of the family's overall structure. Within this structure may be specific roles, rules, habits, and healthy and unhealthy boundaries. 

Family mapping

Each family’s structure and interaction patterns are different. While observing family structure, the practitioner may use a family mapping technique. They create a chart or a map to show the family's current relationships, parental subsystem, hierarchical structure, and overall dynamics. With family mapping, the therapist can move forward in identifying any specific issues to address and which of the observed family's problems are causing the most concern to create a complete, comprehensive treatment plan. 

Evaluation 

After the first beginning sessions are complete and the chart is drawn, the therapist might begin to evaluate the aspects of the family's dynamics causing tension and creating discord within the family. 

An SFT therapist may become part of the family structure during a session as they move in and out of the family's interactions and dynamics to create a safe space to vent and speak. The therapist helps family members develop a sense of family and help create a culture of well-being through improved communication and understanding. 

Family therapists might step into role-playing, challenge expectations and thoughts, or demonstrate the problematic aspects of bullying, mocking, and other negative behaviors within the unit. Engaging in role play has many benefits, for example, it may allow a family member to see themself through a different lens. Each member of the of the family can expect to play a significant role in the process, which can enhance the connects formed during SFT. 

Like many therapy modalities, there may not be a single amount of time that structural family therapy takes. Instead, therapists may focus entirely on the shifting dynamics of the families involved and work to move in and out of the family dynamics to create a more effective system of functioning, communicating, and boundary-making. 

Treatment can take as little as two months but could be six months or longer, depending on the amount of treatment needed and the degree to which families cooperate. The more a family listens, applies new techniques, and continues to work on all the therapist's suggestions, the sooner the therapy sessions may conclude.

SFT can also undergo a restructuring process. This process can create better communication and function within each family's microcosms. Examples include asking only the parents in the family to attend therapy for one week, then separating the children from their parents the following week. Ultimately, the goal of structural family therapy may be to create a stable family home.

Some insurance companies will cover SFT, while others may see it as an elective therapy. A family that includes a child with ADHD, for instance, might have an easier time getting an insurance company to cover SFT than a family without a diagnosed mental health condition.

Every insurance company can have different requirements for coverage of therapy modalities. Contacting your insurance company with a referral provided by another therapist or family practice doctor could support you in your case. If the therapy is not covered under your plan, you might consider joining online counseling, a cheaper option. 

Who uses structural family therapy?

Blended families might use SFT to improve everyday interactions and dynamics. Families with children experiencing a disability might also benefit from the therapeutic model. Within structural family therapy, families can learn to create smoother, healthier boundaries and transitions and accommodate their child's needs. 

Families affected by trauma, such as losing a loved one, an accident, or another adverse experience, might also benefit from SFT. This form of counseling may allow them the time and space to process their grief and trauma together instead of trying to process them separately. Processing alone might create distance between families. Social connection can be beneficial for those experiencing grief. 

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Single-parent families and other at-risk populations may frequently engage in SFT sessions, as boundaries may be skewed. Communication can break down in these types of settings due to stress and resentment. A family therapist might be able to help rework some of these relationship dynamics to cultivate a smoother, healthier home life and structure.

SFT is a subset of family therapy that treats the entire family as a unit and works to create healthier, more effective behaviors, dynamics, patterns, and hierarchies within families. Therapists first chart out the current family dynamics, work to identify any potential problems within those dynamics, then move forward with treatment based on their initial observations.

This type of therapy can help address problems within the family dynamic and structure and encourage individuals to seek alternative ways to deal with their issues. 

Reinforcement of family values and beliefs can be an aspect of SFT. If you do not have any readily seen family dynamic issues but feel as though conflict often occurs, you may benefit from enlisting the help of a therapist qualified to administer SFT. 

Other types of family therapy may include: 

• Systemic family therapy

• Transgenerational therapy

• Narrative therapy

• General family talk therapy

• Functional family therapy

• Internal family systems therapy (IFS), which can also be done independently 

Counseling options 

Although family therapy can be beneficial, there may be other methods of discussing family and relationship concerns with a licensed provider. For example, individuals can meet with a therapist educated in family dynamics for individual therapy. If unsure where to start, you may consider contacting a provider online.  

Some families and individuals may find that online therapy provides more flexibility than traditional in-person therapy settings. For instance, divorced parents living in different cities may be able to attend the same session through an online video chat. Individuals can also choose between phone, video, or live chat sessions to meet with their providers. 

Online therapy has also proven effective in providing structural family therapy. One review found that families experiencing stress or living with severe mental health conditions could receive adequate support from an online therapist, often at the same efficacy as in-person counseling. If you're interested in trying online counseling, consider signing up for a platform like BetterHelp for individuals or Regain for couples.