Structural Family Therapy

SFT was developed by Salvador Minuchin, and therapy sessions focus on restructuring family dynamics and interactions to address presenting challenges within the family system. It’s is rooted in family systems theory, which attempts to explain how family structures are organized into subsystems and how family members' personal boundaries regulate their interactions. How families interact with one another becomes patterns reinforced by the expectations of the family members. Family members may also be divided into subsystems based on gender, function, or generation. For example, the parents may be their own subsystem, while siblings may form another. If there are multiple children in a family, brothers may create their own subsystem, as can sisters.

Challenges within the family are maintained because of dysfunction, which may be caused by improper boundaries, whether rigid or diffuse. Restrictive boundaries are restrain family members. Diffuse boundaries are non-restrictive and include unlimited contact with outside systems. Families with boundaries on either side may develop problems with how the family interacts. 

SFT doesn’t focus on removing a family’s problems. Instead, it works by helping families develop the structure for dealing with challenges. It approaches the family unit as a structural system and involves the therapist in restructuring that system to adjust elements like hierarchies of power, family boundaries, and individual family members' reactions to significant life changes that can lead to dysfunction.

In SFT, the mental health professional is heavily involved in treatment, actively directing discussions and arguments and potentially changing family members’ seating positions. Therapists use various approaches in SFT, including the following: 

• Enactment: In enactment, the therapist observes as the family members talk to each other. This approach allows the therapist to see how family members interact instead of listening to them describe the experience. It may also help family members experience new ways of interacting.
• Joining: Joining is the therapist's process to form and sustain a therapeutic relationship with the family. This process often occurs early in therapy, but the relationship that forms can be the glue that holds the therapeutic process together throughout treatment. 
• Mapping: Mapping is the process of creating a visual representation of a family and how its members are related to one another and the outside world. Visually representing these behaviors may help families identify where problems appear in their unique dynamics. 
• Reframing: Reframing is the process of helping the family view their problems from another perspective. This new perspective might introduce new solutions for the family’s experience.
• Unbalancing: In SFT, unbalancing is when the therapist changes the hierarchical relationships and boundaries in the family, allowing different family members to try out different roles that before would have been unattainable.

SFT may be helpful for families experiencing tension or distress,³ particularly those with teenage children. Some situations and conditions in which SFT may be effective include the following:

• Substance use 
• Trauma⁴
• Behavioral challenges 
• Divorce
• Intergenerational families
• Single-parent families
• Blended families
• Families in which a close family member has a mental health condition
• Divorce
• Families affected by death or suicide 
• Eating disorders
• Significant changes in family life, including moving cities, a parent losing a job, or a change in sexual orientation or gender identity 

SFT can be beneficial in treating a wide range of family challenges. Recent research found that it can be particularly effective at treating families of adolescents experiencing mental health challenges. This study shows that SFT can positively impact adolescents and their parents and that these improvements were seen regardless of the gender of the parents or adolescents. 

Researchers concluded that SFT is impactful in improving family cohesion, which can be especially relevant to families facing challenges with readjusting to family roles and norms and new demands on family members. This study found that, while SFT did not improve adaptability in these families, parenting practices tended to shift from permissive and authoritarian to authoritative. 

There were other benefits, too. Mothers reported feeling more supported by fathers in the study, and parents reported feeling more competent overall, which may lower parental stress in these families. Less parental stress can positively affect the adolescent and the family unit. This study also found positive results in adolescent behavior, which researchers believe may be a direct result of the improvements in family functioning.

SFT may be effective because it focuses on explaining familial challenges by looking at the relationships within the family instead of focusing on an individual. It places value on helping the family become more efficient at caring for itself and its individual members, which, in turn, may help them cope with the outside world. 

If you’re interested in learning more about SFT, look for a mental health professional in your area who is specially trained in this therapeutic approach. For individual therapy, it may also be beneficial to try online therapy platforms like BetterHelp, which offer resources like weekly phone, video, or live chat sessions and support groups. Because you can attend sessions from anywhere you have an internet connection, online therapy can be a more convenient option. However, platforms often do not offer family therapy online.