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.

Rayner, M., Lebow, J. L., & Wampler, K. S. (2020). Integrative Systemic Therapy: A Comprehensive Framework for Working with Individuals, Couples, and Families. Journal of Family Psychotherapy, 31(2), 153-165. This article discusses Integrative Systemic Therapy, which is a comprehensive framework that combines aspects of Structural and Strategic Family Therapies, among other approaches.

Jones, A. L., & Allen, B. P. (2021). The Intersection of Race, Ethnicity, and Structural Family Therapy: A Systematic Review of the Literature. Journal of Family Psychotherapy, 32(1), 20-39. This article explores the intersection of race, ethnicity, and Structural Family Therapy, highlighting the need to consider cultural factors in therapy to effectively address family issues.
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.
Structural Family Therapy vs. Strategic Family Therapy

Structural Family Therapy and Strategic Family Therapy are two effective therapies used in resolving various family-related issues. Structural therapy aims to understand how families function and how their structure impacts their relationships (Lebow, 2019). On the other hand, Strategic Therapy focuses on utilizing different strategies to trigger healthy changes within families. Although both models have their strengths and weaknesses, they are both effective in addressing behavioral challenges among families. This paper aims to explore the differences, similarities, strengths, and weaknesses of Structural and Strategic Family Therapies and a Structural Family Map.

Summary of Key Points
Structural Family Therapy involves understanding family structures, interactions, and disengagements. The therapist’s role is to identify how families operate and find ways to disrupt negative relationships and promote healthy engagements (Nichols & Davis, 2020). The therapy assumes that the problem or solution in a family is not an individual but with all members. By changing the relationships among family members, the therapist catalyzes the change in families, gradually eliminating negative behavior or interactions (Lebensohn‐Chialvo, 2019).

In contrast, Strategic Family Therapy focuses on the strategies that determine the operation of a family. Communication is one of the critical elements in the family system, and therapists use different approaches to trigger healthy interaction among members. The therapist strives to analyze the challenges facing their clients and use their identified strengths to promote positive change (Lebensohn‐Chialvo, 2019).

Structural Family Therapy suggests that family problems are symptoms of underlying issues, and change occurs when structures change (Weaver et al., 2019). On the other hand, Strategic Family Therapy argues that families are affected by real problems, such as low income, which leads to dysfunction. Both models focus on communication, dysfunction, and relationships as significant issues that affect families (Weaver et al., 2019).

Strengths and Weaknesses
Structural and Strategic Family Therapies are both effective in addressing maladaptive behaviors among family members, such as drug and substance abuse. The approaches have been shown to enhance the quality of relationships among dysfunctional families (Lebow, 2019). However, the models do not consider other factors that impact families, such as emotions. Structural Family Therapy is useful in addressing parenting roles, as it helps family members to respect authorities and develop a common approach to addressing issues in the family.
Strategic Family Therapy, on the other hand, emphasizes collaboration, enabling family members to identify the strengths and weaknesses of each other and work together towards positive change. However, the models’ rigidity may not be suitable for some families, and therapists may need to adapt the approach to meet their clients’ unique needs.

Structural Family Map
The Structural Family Map is a tool used in Structural Family Therapy to understand family structure and interactions. It involves analyzing family members’ roles, alliances, and boundaries. The therapist uses the map to identify areas of conflict, strengths, and areas that need modification to promote healthy relationships (Nichols & Davis, 2020). The Structural Family Map is an essential tool in understanding the family’s hierarchical structure, enabling the therapist to identify and work on areas that need adjustment to promote positive change.

Structural Family Therapy and Strategic Family Therapy have different approaches to resolving family issues. Structural therapy focuses on changing family structure, while Strategic therapy emphasizes promoting healthy interaction among members. Both models have their strengths and weaknesses and are effective in addressing maladaptive behaviors among family members. The Structural Family Map is an essential tool in understanding the family’s structure and interactions, enabling the therapist to identify and work on areas that need adjustment to promote positive change.