Running head: MODEL COMPARISON PAPER 1

Strategic and Structural Family Therapy Model Comparison

Sean McLoughlin

Prescott College
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Abstract

This paper compares and contrasts the models of Strategic and Structural Family

Therapy. The history of the formation of these models is dealt with first. Model

mechanics including core concepts and intervention methods are dealt with in the second

section. In the third section strategic and structural theory and methods are compared and

contrasted.
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Strategic and Structural Family Therapy Model Comparison

This paper compares and contrasts the Strategic and Structural family therapy

models. The history of model formation is discussed in order to examine the social

contexts in which the models arose to see if this context influences the approaches and

intervention styles. Also discussed in the model formation section are key theorists in the

development of the approaches. Model mechanics are addressed in the second section

including core concepts of each model, major intervention techniques, goal setting, and

therapeutic outcomes. The third section compares and contrasts these models addressing

strengths and limitations of the approaches. In conclusion, the practical applications of

these methods in extended care addiction treatment settings are also discussed.

Model Formation

“Structural family therapy was initially based on the experiences of Salvador

Minuchin and his colleagues at the Wiltwyck School, a residential facility in New York

for inner city delinquents” (Gladding, 2007, p. 67). Minuchin created the ideas that led to

the formation of this approach based on the fact that with this population, low

socioeconomic racial minority families, other methods of passive and historically based

approaches had failed (Gladding, 2007). Minuchin observed that the families of these

children often exhibited aggressive tendencies and were quick to blame others for the

presenting problems necessitating a very active and structured intervention strategy

(Gladding, 2007). As a result he developed the notion that therapists had to help families

directly alter their organization (structure) if change were going to occur (Gladding,

2007). Due to the character of the specific clientele Minuchin was working with he
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found that the interventions had to be dramatic and active to be effective (Gladding,

2007).

Structural family therapy techniques and theory were refined at the Philadelphia

Child Guidance clinic in the 1960’s and 70’s (Gladding, 2007). Along with Salvador

Minuchin other prominent theorists include Bernice Rosman, Harry Aponte, and Charles

Fishman (Gladding, 2007). Minuchin was born to Russian Immigrant parents in

Argentina and later came to the United States to study psychoanalysis. His work with

troubled inner city minority children led to the publication of his first book Families of

the Slums in 1967 (Gladding, 2007).

The social context out of which the theory and practical intervention strategies of

structural family theory arose definitely had a profound impact on the formation of this

model. The fact that the children being treated were inner city delinquents from low

socio economic classes and the families often exhibited crude character expressions

clearly had a guiding impact on Minuchin’s approach to altering family structure in order

to effect a long lasting change in the organization operation of the system. It is

interesting to note that Minuchin may have had an inclination to work with this

population due to his own identification with them as a son of immigrant parents in a

country where he didn’t identify with the majority.

Strategic Family Therapy has its root in the Palo Alto research group led by

Gregory Bateson in the early 1950’s (Piercy, Sprenkle, and Wetchler, 1996). His work

focused on treating schizophrenic patients and their families. Based on his observations

Bateson starting conceptualizing schizophrenia as arising out of a discrepancy between

various levels of communication (Piercy, Sprenkle, and Wetchler, 1996). Jay Haley, Don
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D. Jackson, and John Weakland concretized the theories at the Mental Research Institute

when they described “communicational strategies as devices for escaping or establishing

definitions of intrafamilial relationships” (Piercy, Sprenkle, and Wetchler, 1996, p. 50).

Their theories, which came to be known as “strategic” due to the focus on specific

strategies of intervention, were geared towards changing the present complaint of the

family. This goal is accomplished by the therapists first assessing the cycle of family

interaction and then breaking the cycle through straightforward or paradoxical directives

(Piercy, Sprenkle, and Wetchler, 1996). The therapeutic intervention is change focused

and the therapist is considered the agent of change who is responsible for successful

therapeutic outcomes. There is little to no interpretation of current interactions by the

therapist or exploration of the past as the focus stays on current interaction. Other

important theorists that contributed to the formation of this model are Cloe Madanes and

Milton Erikson (Piercy, Sprenkle, and Wetchler, 1996).

The social context in which this model arose impacted the theory and practices of

this model to a great degree. The combined ideas, accumulated research, and writings of

all of the theorists involved in the Mental Research Institute gave this model a formidable

presence in the therapeutic community. The social locations of the theorists were not as

important as their collaborative research in crafting an original model. This union of

professionals with a similar goal does stand out as a defining theme of the formation of

this model.

Model Mechanics

The underlying assumptions about problems and solutions in Structural Family

Theory “are based on the idea that subsystems, structures, and hierarchies within families
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influence or determine the actions of individual family members” (Lindstrom, Filges, and

Jorgensen, 2015, p. 63). “In structural family theory, social interactions are understood

structurally as repetitive patterns of interaction” (Lindstrom, Filges, and Jorgensen, 2015,

p. 63). The structure of any given family or system can range from supportive to

maladaptive and this structure can either maintain positive interactions or maladaptive

ones (Lindstrom, Filges, and Jorgensen, 2015). This view of problem and solutions is a

systemic understanding of the family unit. In the family system view, individuals are

understood by their relation to the whole and each member of the family is considered

important in maintaining either positive or maladaptive interactions. If maladaptive

structures are discovered in structural family therapy these structures are changed to

allow positive interaction to begin to occur again in the system. Structural family

theorists hold that by altering the structure of the maladaptive family system that a family

can begin to function in a positive manner again.

In Strategic Family Therapy the underlying assumptions about problems is based

not on the identification of the problem behavior but how the family system responds to

the problem with interactional patterns (Lindstrom, Filges, Jorgensen, 2015). By

focusing on communication patterns as the way individuals exit in the system strategic

therapists seek to change the family’s interactional sequences. By intervening in this

way the strategic theorists believe that positive functioning will be restored to the system

and the problem behaviors will cease (Piercy, Sprenkle and Wetchler, 1996; Lindstrom,

Filges, and Jorgensen, 2015). The strategic family therapy theory holds that a by-product

of changing the interactional patterns will be structural change (Gladding, 2007).

Strategies to help the family change their actions and interactional patterns are found and
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implemented to correct the dysfunctional repetitive methods used previously to deal with

the dysfunction.

Core Concepts of Each Model

The core concepts of Structural Family Therapy are essentially systemic and

organizational in nature. The family or couple system is looked at and the structure

analyzed for insight into how problems are maintained by interactions that do not arrive

at solutions, even if that is the goal. “Structural family therapy is characterized by its

focus on organizational issues” (Piercy, Sprenkle, and Wetchler, 1996, p. 52). Minuchin

theorized “every family has a structure, an invisible set of functional demands that

organizes the ways in which families interact” (Gladding, 2007, p. 203). Not only is the

family system organization looked at but also the other social systems that the family

interacts with in order to find other negative reinforcement for the problem behaviors

which are usually the presenting concern for therapy. By analyzing subsystems within

the system and hierarchical constructs that have become fragmented the therapist seeks to

restructure the family by modifying the way people relate to one another (Piercy,

Sprenkle, and Wetchler, 1996). Core concepts include analyzing coalitions (subsystems)

or alliances between different family members, evaluating the boundaries in the system

as diffuse, rigid, or stable, and teaching the family about the dangers of triangulation

(Gladding, 2007).

The core concepts of Strategic Family Therapy are systemic, hierarchical, and

based on studying and understanding communication patterns. Strategic family therapists

believe “problems are maintained by faulty hierarchies within the family” (Piercy,

Sprenkle, and Wetchler, 1996, p. 51). By helping families change the ways they interact
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it is believed that the structure will change as well. Another core concept of strategic

family theory is that “it is the family’s sequence of behavior around their attempted

solution that is assumed to maintain, and perhaps exacerbate, the presenting problem”

(Piercy, Sprenkle, and Wetchler, 1996, p. 52). Core concepts include looking at the overt

and covert family rules, analyzing the systems of homeostasis in the family, and applying

the redundancy principle which looks at the limited repetitive behavioral sequences that

family systems get caught in (Gladding, 2007).

Intervention Methods

In Structural Family Therapy, major intervention methods include family

mapping, joining with the family, helping the family members reframing perceptions,

applying disequilibrium techniques, and looking at the presenting problem as a metaphor

for the state of the family (Young, Negash, and Long, 2009; Gladding, 2007; Piercy,

Sprenkle, and Wetchler, 1996). After the initial assessment and disequilibrium

techniques have been applied then a restructuring takes place and the shaping of

competence is focused on to build positive structures and esteem in the system (Nichols

and Tafuri, 2013).

Ford, Durtschi, and Franklin (2012) use family structure mapping and analysis of

coalitions as a brilliant way to interpret addictions. By realigning the coalition between

spouses against the addiction, which becomes objectified in order to detach it from the

person afflicted, these structural theorists have found a way to strengthen the inherent

power structure of the family against the intruding influence of the addiction. They

conceptualize the addiction as forming a coalition with the afflicted individual in an

attempt to triangulate the other spouse into the role of an outsider (Ford, Durtschi, and
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Franklin, 2012). This example of assessing structural dynamics of family dysfunction

illustrates the intervention strategies of structural therapists in their attempt to realign

family strengths.

Strategic family therapy intervention techniques are planned, practical, and

problem focused (Lindstrom, Filges, and Jorgensen, 2015). Strategies are used to address

only the most problematic behaviors and relational structures believed to contribute to the

problematic behaviors. Joining, diagnosing, and restructuring are the three main phases

the therapist goes through with the family in order to effect change strategically

(Lindstrom, Filges, and Jorgensen, 2015). Therapeutic paradox, ordeals, and directives

are unique approaches of strategic family therapy interventions (Gladding, 2007).

Therapeutic paradox involves having family members do the opposite behavior from the

one that is believed to be driving the problem behavior. Ordeals are assignments for

family members to engage in a noxious activity every time they slip back into old

maladaptive patterns of interactions (Gladding, 2007). Directives are precise instructions

given by the therapist for the family members to implement in order to change (Gladding,

2007).

Goals and Expected Outcomes

Goals of structural and strategic family therapy are very similar. Both approaches

seek to alter the structure of the family system through disruption and restructuring

maladaptive relational patterns of communication and behavior. The expected outcomes

for both methods are that if the maladaptive relational patterns are changed that revolve

around problem behaviors then the structure will change and system homeostasis will

reemerge. Brief Strategic Family Therapy “is an integrative model that combines
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structural and strategic family therapy theory and intervention techniques to address

systemic/relational (primary family) interactions that are associated with adolescent

substance abuse and related behavioral problems” (Robbins, Feaster, and Horigian, 2011,

p. 5). The goals and desired outcomes of using the intervention strategies of both

structural and strategic family methods in Brief Strategic Family Therapy is summed up

well:

However, the focus of treatment shifts to implementing restructuring strategies to

transform family relations from problematic to effective and mutually supportive,

and these include (a) directing, redirecting, or blocking communication; (b)

shifting family alliances; (c) helping families develop conflict resolution skills;

(d) developing effective behavior management skills; and (e) fostering parenting

and parental leadership skills (Robbins et al, 2012, p. 6).

Structural Family Therapy has evolved over time to include new understandings

about the ways relational processes effect development such as attachment theory.

“Ecosystemic Structural Family Therapy is a systemic, strength based, and trauma-

informed family therapy model that has evolved from structural family therapy”

(Lindblad-Goldberg and Northey, 2013, p. 147). It is an evidence-based approach that

continues to focus on families of children who are experiencing behavioral problems and

are at risk of out of home placement (Lindblad-Goldberg and Northey, 2013). As such,

structural family therapy continues to focus on treating troubled adolescent populations

and their families. This commitment to serving these struggling populations is an

admirable aspect of this approach which continues to strive towards a better

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understanding of intervening on serious dysfunction and providing corrective effort to

reduce delinquency and save families from falling apart.

Strategic Family Therapy ideas have been incorporated into the modern model

known as Brief Strategic Family Therapy. This model is evidence based and is used

primarily to treat young drug abusers and adolescents with behavioral problems and their

families (Robbins, Feaster, and Horigian, 2011). This method also incorporates structural

family therapy ideas and methods in an attempt to bring together the best practices

available to treat this troubled population. This method has undergone extensive research

and has been found to be useful in helping with client retention in treatment setting and in

helping families understand dysfunction (Robbins, Feaster, and Horigian, 2011). This

method has yet to be proven to be effective in lessening adolescent drug usage but more

research is necessary in this field (Robbins, Feaster, and Horigian 2011).

Models Compared and Contrasted

By studying the foundational elements of Structural and Strategic Family Therapy

models one can see that they share many similarities. Taking a systemic approach to

understanding pathology is what makes each of these models stand out as unique. By

moving away from the psychoanalytic model of focusing on individual’s intrapsychic

world as the key to health and integration, both of these models began by focusing

instead on the family system and both understanding and changing interpersonal actions

as the key to achieving therapeutic success. This fundamental switch in the way the

pathological behavior is approached seems to be a hallmark of these early family therapy

models.
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Similarities can also be seen between Structural and Strategic Family Therapy

models based on their proposed target clientele. Both of these models were created to use

specifically with troubled youth and their families. In the case of Structural Family

Therapy the young people were inner city delinquents and in the case of Strategic Family

Therapy the young people were inpatient schizophrenic patients. Both models were

created as a method for resolving the troubling systemic elements in the family

communication and relational styles that may be contributing to the symptomatology of

these young people. These models continue to be utilized for helping troubled youth and

their family as is evidenced by the newer models of Ecosystemic Structural Family

Therapy and Brief Strategic Therapy (Robbins, Feaster, and Horigian, 2011; Lindblad-

Goldberg and Northey, 2013). While both of the models were created to be used

specifically with troubled youths and their families, researchers and practitioners have

been able to apply them to other systemic populations with successes as well.

The fundamental difference between Structural and Strategic family therapy

models is the order by which each seek to change the system. Structural family therapists

believe that by changing the structure within the system that relational styles will change

as a natural consequence. Strategic family therapists believe that by changing the

relational strategies that the structure will change as a natural consequence. Due to the

closeness of these theoretic approaches many of the most important intervention

strategies are very similar including joining with the system and assisting in the

restructuring (Gladding, 2007).

The strengths of these approaches lie in their ability to include systems both

within the family and outside of it in interpreting, understanding, and changing

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maladaptive relational styles to the environment. Another strength embedded in both of

these models is that the therapeutic goal is to help the young person change but also to

help the family change. As such, achieving successful outcomes becomes complicated

but also broader in scope with an altruistic component that could be considered

ecosystemic. The weaknesses are that both models may focus too strongly on the

interpersonal relation styles of the system and possibly miss the intrapsychic and

emotional elements of the individuals involved (Gladding 2007).

Due to the obvious social justice approaches of each model with their focus on

serving populations that do not traditionally receive this type of attention, I believe they

both exemplify positive regard for diversity in race and class. Critics of early structural

therapy models have claimed that the intervention strategies support sexist hierarchies in

family systems (Gladding, 2007).

Applying concepts and intervention strategies from both structural and strategic

family therapy models in an extended care treatment facility for adults with addiction

problems would be very simple. By examining the way Brief Strategic Family Therapy

has blended the best elements of both of these models in order to effect change in family

systems affected by addiction and behavioral problems, a practitioner could easily use the

model with a family with an addicted adult member. As chronic addictive behaviors

delay the maturation process many of the adults served in addiction treatment centers

seem to be living extended adolescence. As such the realigning and strengthening of the

parental subsystems would still be of primary importance when working with adults in

this scenario. Joining with the family system, diagnosing the maladaptive interpersonal

relational styles that may be contributing to the problem, and assisting in the restructuring
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of system are elements that could be very useful when working with addicted adults and

their families.

Conclusion

In conclusion one can see that Structural and Strategic models of family therapy

both exemplify groundbreaking therapeutic approaches for treating systems in which

dysfunction is occurring. Their focus on interpersonal relational styles, communication

patterns, and hierarchical organizational power structures as both the sources of

dysfunction and the solution to solving them makes these models extremely important for

practitioners who choose to serve groups of people. The ecosystemic qualities of these

approaches could be utilized in working with couples, families, businesses, communities,

etc. due to their unique insight and intervention strategies for resolving maladaptive

group dynamics through structural and relational interventions.

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References

Lindblad-Goldberg, M., & Northey, W. (2013). Ecosystemic Structural Family Therapy:

Theoretical and Clinical Foundations. Contemporary Family Therapy: An

International Journal, 36(1), 147-160.doi:10.1077/s10591-012-9224-4

Lindstrom, M., Filges, T., & Jorgensen, A.K. (2015) Brief strategic Family therapy for

young people in treatment for drug use. Research on Social Work Practice, 25(1),

61-80. Doi:10.1177/1049731514530003

Ford, J.J., Durtschi, J.A., & Franklin, D.L. (2012). Structural therapy with a couple

battling pornography addiction. American Journal of Family Therapy, 40(4). 336-

348. Doi:10.1080/01926187.2012.685003

Gladding, S. (2007). Family therapy: History, theory, and practice (4th ed.). Upper

Saddle River, N.J.: Merrill.

Knapp, D.J., Sandberg, J.G., Novak, J., & Larson, J.H. (2015). The mediating role of

attachment behaviors on the relationship between family of origin and couple

communication: implications for couple therapy. Journal of Counseling &

Relationship Therapy, 14(1), 17-38.doi:10.1080/15332691.2014.9536650.

Nichols, M., & Tafuri (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

Piercy, F., & Sprenkle, D. (1996). Family therapy sourcebook (2nd ed.). New York:

Guilford Press.
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Rambo, A., West, C., Schoole, A., & Boyd, T.V. (2013), A brief history of structural/

strategic models. Family Therapy Review: Contrasting contemporary models

(pp.83-85). New York, NY, US: Routledge/Taylor & Francis Group.

Robbins, M.S., Feaster, D.J., Horigian, V.E. (2011) Brief strategic family therapy versus

treatment as usual: results of a multisite randomized trial for substance using

adolescents. Journal of Consulting & Clinical Psychology, 79(6), 713-727.

Doi:10.1037/a0025477

Rynes, K.N., Rohrbaugh, M.J., Lebensohn-Chialvo, F.,& Shoham, V. (2014). Parallel

demand-withdraw process in family therapy for adolescent drug abuse.

Psychology Of Addictive Behaviors, 28(2), 420-430. Doi:10.1037/a0031812

Young, T. L., Negash, S. M., & Long, R. M. (2009). Enhancing sexual desire and

intimacy via the metaphor of a problem child: Utilizing structural-strategic family

therapy. Journal of Sex & Marital Therapy, 35(5), 402-417.