Introduction
Theory Background
According to Vetere (2001), the Structural Family Therapy (SFT) is a method of psychotherapy developed by Minuchin Salvador. It seeks to address problems within a family unit. It also aims at infiltrating into the family system in a therapeutic manner with the main aim of contemplating the invisible rules that govern its functioning. Moreover, it traces the relationship, or lack thereof, between subsets of the family members of the family ultimately seeking to disable any dysfunctional relationship hence obtaining stability (Miller, 2011). SFT works under the assumption that families comprise knowledgeable individuals who can handle their issues and that each member has a crucial role to play to sustain the family unit.
SFT and the Theory of Change
The theory of change is an all-inclusive explanation and design of how and why a preferred change is projected to occur in a specific environment. According to Mcgarry, Cashin, and Fowler (2012), the SFT upholds the theory of change since it works by modifying the problematic family systems and establishing another efficient hierarchy. SFT dedicates the work of solving any family matters to the respective family members.
The therapist here assumes the role of a change agent through whom a long-lasting solution is attained in a family (Lindblad-Goldberg & Northey, 2013). The main resourceful argument of the structural family therapy is assimilated with the model of the relational psychoanalysis. The theory of change incorporates the discernment and views that the client has concerning the nature of the problem that needs therapy to change the situation (Robinson, 2009). The theory of change is a methodology that transforms based on the patients’ recounting of experiences under the direction of the therapist.
Stance of the Therapist
SFT healing approaches are founded on the principle that any action attracts fresh knowledge. Classical psychoanalysis sees the curative factor through an analysis of imperative unresolved relationship problems within the family. The therapist here assists the family in establishing porous borders and sub-structures that can accommodate the members’ diverse features. Therapists use the combination of corrective- emotional experience and educational approaches (American Psychiatric Association, 2013). For instance, in SFT, the therapist participates in breaking the conviction with the members concerning the root of the issue (Low et al., 2015).
In line with McGoldrick, Garcia Preto, and Carter’s (2016) views, this approach enables them to view the issue from another perspective, including the role that each one has to play to change the situation. Hence, the therapist steers change in the family by creating a room from new ways of managing family issues among the members. The therapist assumes the role of a leader whose task is to examine the family’s systems, borders, and interaction process. The goal is to pave a way for new structures and ways of interacting among the members.
Therapy Questions
As a therapist, I would ask several key questions during the SFT session. For instance, I may need to know whether the members of the family regard my presence during the therapy session as a challenge under the current situation. Is there anyone who is opposed to this therapy session? Why did Mr. J and Mr. K get into alcoholism? What was the reaction by the parents and why? I would also ask the sons why they are not close to their mother and/or whether they feel remorseful over her terminal condition.
I would ask them to perform a situation where they are in the house interacting before their dad walks in. What would they do? Additionally, I would enquire from all the concerned parties, the family members, whether they think they have mutual respect towards each other. Do they feel that some of them are treated in a special way to the extent that one person in the family is to be blamed for any prevailing ailment such as cancer, in the case of Mr. J and Mr. K?
Interventions
Intervening based on the SFT is done in various phases, which include joining, recognizing the underlying problem, evaluating the family’s structures, addressing the required SFT goals, embracing change, and change execution. In terms of joining, the therapist assumes the place of a leader who assembles all the family members with the goal of addressing the need for all members to accommodate the differences of each family member (Miller, 2011).
The therapist listens to what each person says with the view of establishing a balance where all members can accept each other, regardless of their differences. The therapist needs to be aware that the people he or she counsels will oppose his or her therapeutic plan and views based on the analogy that he or she has not gone through what the family is experiencing. In the case of Mr. J and Mr. K’s family, the members will sideline the counselor since he or she is not part of their struggle with cancer.
The only way the therapist will penetrate this quagmire is by respecting Mr. J and Mr. K’s hierarchy and/or embracing all members, irrespective of whether they are angry, powerful, calm, or weak. This awareness will enable him or her to build an alliance with every member.
In terms of mapping underlying structures, it is important for the therapist to inquire from Mr. J and Mr. K’s family members about their problem. The counselor will use this information to track their behavioral situation. For example, as a therapist, I will enquire from the sons why they resulted in alcoholism, why a poor relationship prevails between the sons and the mother, including who is to blame. Knowing Mr. J and Mr. K’s family structure only manifests through therapist-family interactions.
The family operates under a psychosocial system, which is built on a wider social system. These systems are transactional in nature to the extent that they show how the members interact with one another, including any missing links among members. Mr. J and Mr. K’s family issues confirm that the structure has some missing links that the therapist needs to find out and apply SFT to introduce the required change in line with the stipulations of the theory of change (Mcgarry et al., 2012).
The other intervention step involves the therapist pinpointing and adjusting the prevailing family systems (Ryan, Conti, & Simon, 2013). He or she may request Mr. J and Mr. K’s family members to stage a typical conflict situation. The goal here is to help the therapist to get a first-hand information about what transpires in the family, instead of getting the same story from a third party who may not capture the real picture of the underlying conflict.
For instance, if the sons immediately change their moods to a dull one when the parents enter, this situation a nonverbal cue that shows the broken relationship between the family members. Such a conflict performance plan is a richly examined psychoanalytic mechanism that displays the nonverbal interactional behavioral blueprint among individuals, the therapist, and the victim in a treatment setting or any healing situation.
The therapist also engages in the family restructuring process (Mitchell, 2013). The process involves renovating the underlying family structure into a better and workable one. The process of restructuring includes the use of cognitive techniques such as reframing the members’ interaction process in a manner that they will find it easy assisting and cooperating with each other. The therapist asks the members to think and see beyond suggestive actions.
For example, the sons may hold an opinion that their mother, Mrs. X, brought cancer to the family while the dad and the first-born son Mr. K have a conflicting relationship because he feels that He (the dad) loves his sister more. The therapist sees the family’s behavior in the context of the underlying structures, processes, or the relationships between the family unit and other social systems. Another process that the therapist will embark on during restructuring is border establishment. A pathetic boundary such as the one that prevails between the dad and the daughter highlights that one person is disengaged from another in the family.
In the given case, the dad, Mr. W, is disengaged from the sons, Mr. J and Mr. K. This observation cements DeMaria, Weeks, and Hof’s (1999) claim that boundaries are reciprocal. A plus on one side is a minus on the other side. The therapist is supposed to assist the couple to form a healthy spousal subsystem. When this process is accomplished, either of the spouses will not create weak boundaries with the children. Hence, all the children will feel equally loved and cared for.
This situation results from the establishment of corresponding patterns of compromise between the couple. In addition, the family members can also develop boundaries that separate the couple from the external influence and pressure from parents, children, or even outsiders. Mr. W and Mrs. W should also claim their authority in the hierarchical structure. In conclusion, transparency is more important than the family composition. Hence, the roles should be well cut out and identified to people who can sustain and discharge the respective responsibilities.
Diagnosis using DSM-5 Model
In health concern analysis, the intervention and diagnosis were done through the Diagnostic and Statistical Manuals of Mental Disorders, DSM-5 model. In relation to the Mr. W and Mrs. W’s family health concerns on hypertension and cancer, the diagnosis involved classifying the type of illness the patient is suffering from. The classification was done using the predetermined diagnostic information in the DSM-5 whose calibration ranges from mild to acute.
After the diagnosis, tests measured against predetermined results for each state of the disease were done to ensure that its reliability is not compromised. Good reliability encourages a high-quality diagnosis. Based on the findings, as indicated in the Minuchin’s Structural Family Therapy Model, Mr. W and Mrs. W’s family has comparative and normative needs. Hence, the direct nursing intervention will ensure that both needs are addressed sustainably within the acceptable nursing ethics because the existing social and health centers do not accommodate the family members’ psychological and medical needs.
Reflection
As a therapist, I have learned to take care of myself, especially when handling a family whose members are in conflicts. Such members may turn against me in the process of counseling, for instance, when they do not uphold my therapy plan. I have learned to be wise to the extent of recognizing when I am in danger during the session, including the strategies I should use to evade such dangers. For instance, in case a member turns against me during the counseling process, I have learned that I should develop a conversation that is friendly to everyone, whether out of context or within the context of the therapy.
Some of the areas I recognize as strengths include my ability to interact with people of diverse culture while at the same time upholding mine. I am always aware of my cultural heritage, gender, and ethical background when executing the proposed therapy. I also understand the values and beliefs of my clients. In terms of weakness, I have realized that I give up easily, especially when a certain family opposes my therapy plan.
It is necessary for a therapist to seek supervision, especially if he or she wishes to grow professionally. A therapist who seeks supervision is likely to advance in his or her line of career based on the input that the supervisor gives after every session. Besides, a supervised therapist has high chances of advancing his or her key competencies such as intervention techniques, evaluation tactics, and even interpersonal presentation. He or she also embraces his or her patients’ interests.
To increase awareness of diversity when dealing with patients, I need to expose myself to several contexts or families that need my services. It is advisable to have such families coming from different locations. For example, I may develop templates that have questions that are unique to some family situations. Based on the answers that I get for such questions from different families that are geographically distant, I may stand a better chance of knowing the differences that prevail in various places.
Reference List
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington, VA: Author.
DeMaria, R., Weeks, G., & Hof, L. (1999). Focused genograms: Intergenerational assessment of individuals, couples, and families. New York, NY: Brunner-Routledge.
Lindblad-Goldberg, M., & Northey, W. (2013). Ecosystemic Structural Family Therapy: Theoretical and Clinical Foundations. Contemporary Family Therapy, 35(1), 147-148.
Low, L., Fletcher, J., Goodenough, B., Jeon, Y., Etherton-Beer, C., MacAndrew, M., Beattie, E. (2015). A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes. PLoS ONE, 10(10), 1-60.
Mcgarry, D., Cashin, A., & Fowler, C. (2012). Child and adolescent psychiatric nursing and the ‘plastic man’: Reflections on the implementation of change drawing insights from Lewin’s theory of planned change. Contemporary Nurse: A Journal for the Australian Nursing Profession, 41(2), 263-270.
McGoldrick, M., Garcia Preto, N., & Carter, B. (2016). The expanding family life cycle: Individual, family, and social perspectives. Boston, MA: Pearson.
Miller, A. (2011). Instructor’s Manual for Salvador Minuchin on Family Therapy. Web.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32-37.
Robinson, B. (2009). When therapist variables and the client’s theory of change meet. Psychotherapy in Australia, 15(4), 60-65.
Ryan, W., Conti, R., & Simon, G. (2013). Presupposition Compatibility Facilitates Treatment Fidelity in Therapists Learning Structural Family Therapy. American Journal of Family Therapy, 41(5), 403-414.
Vetere, A. (2001). Structural Family Therapy. Child Psychology & Psychiatry Review, 6(3), 133-138.