What Is Structural Family Therapy (SFT)?
Popular media doesn’t always portray families in the best light. Sitcoms, movies, and dramas constantly depict families as large, messy, loud, and confusing. What might make for good TV, however, can make for an unsafe and uncomfortable home life.
Family dysfunction is often the source of potential mental health issues down the road for parents, children, and other involved family and friends. From annoying habits to cycles of sabotage, you can 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. Among the various interventions, SFT is among the most popular. It is an evidence-based treatment model that emphasizes the whole family system, rather than trying to figure out each individual's issues first, then moving forward with group therapy.
SFT 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 alone was not enough to curb worrisome behavior and improve outcomes, and that involving the entire family system was necessary to improve the child's home life, outlook, and habits.
Families were brought in as a single unit and treated as a whole, rather than called upon to focus on one child who is presenting "problem" behaviors. Minuchin found that children's outcomes were far better when parents, siblings, and even extended family were brought in as sources of support, encouragement, and accountability.
Using SFT, a therapist and therapy participants consider the complex, overlapping subsystems that impact a family dynamic. This is quite different from strategic therapy, which focuses on individuals, specific issues, or specific relationships within the family context. SFT uses a family-first approach.
Looking at family interactions, dynamics, and patterns may reveal a lot. The goal of SFT is often to create positive and healthier routines within family structures in order to create a dynamic, loving, stable home life for everyone.
Structural family therapy is often a recommended treatment for families who have gone through trauma, blended families, single-parent families, and families at risk of experiencing poverty, homelessness, or other forms of financial hardship. However, structural family therapists can help with any concern affecting the family structure, including troubled adolescents, families affected by mental illness (such as depression, anxiety, or eating disorders), changing demands, or any other serious family problems. Any kind of family can participate in a structural family therapy session.
What Does A Typical SFT Session Look Like?
To begin, a structural family therapy practitioner will observe the family structure in question and take note of the family's overall structure. Within this structure will be certain roles, habits, and boundaries, both healthy and unhealthy.
While observing the family structure, the practitioner will use a tool called family mapping, where they create a chart or a map that shows the family’s current relationships, parental subsystem, hierarchical structure, and overall dynamics within the family. With family mapping, the therapist can then move forward in identifying any specific issues that need to be addressed and which of the observed family’s problems are causing the most concern to create a full, comprehensive treatment plan.
The reason the family came in will also be taken into account when creating a treatment outline; for example, some families might come in because a child is having trouble in school, and the whole family is affected, or they may come in because a newly blended family is having trouble creating boundaries and delineating parental roles. Family therapy can help improve parenting and give you solutions about how to move forward as a family. Sometimes talking to the parent(s) about their individual roles can help you understand the dynamic.
After the first or several beginning sessions are complete the chart is drawn, the therapist then begins to evaluate the aspects of the family's dynamics that are causing tension and creating discord within the family.
An SFT therapist essentially becomes a part of the family structure during a session, as they are required to move in and out of the family's interactions and dynamics to create a safe space in which to vent, speak, and open up. They aid in the development of the family and help create a culture of well-being for the family. Family therapists might step into role-playing, act as a sort of devil's advocate in escalating interactions, or demonstrate the problematic aspects of bullying, mocking, and other negative behaviors.
How Long Does SFT Last?
Like many therapy modalities, there is no single, set length of time for therapy to go on. Instead, therapists 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 are cooperating. 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 its own restructuring process. This can help create better communication and functioning within each of a 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 next week. Ultimately, the goal of family therapy is to create a stable family home, so the process is usually afforded plenty of time to see itself through.
Does Insurance Cover SFT?
Some insurance companies will cover SFT, while others see it as an elective therapy. The degree to which families are experiencing negative dynamics will play a role, as will the presence of other disorders or dysfunctions. 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 disability or disorder of any kind. There is no hard and fast guarantee, either way, as every insurance company has different requirements for coverage of therapy modalities. Contacting your insurance with a referral provided by another therapist or family practice doctor could certainly help.
Who Uses SFT?
Blended families commonly use SFT to improve familiar interactions and dynamics. Families with children with a disability have also been shown to benefit from the therapeutic model, as it allows families to create smoother, healthier boundaries and transitions, which can be extremely difficult when a child has mental health problems.
Families affected by trauma, such as the loss of a loved one, an accident, or something similar, can also benefit from SFT. It can allow them the time and space to process their grief and trauma together instead of trying to process everything separately, which may create an even greater distance than the distance already established before the trauma.
Single-parent families and other at-risk populations are also frequently engaged in SFT sessions, as boundaries are often skewed, and communication can break down in these types of settings, usually due to stress and resentment. A family therapist might be able to help rework some of these relationship dynamics to cultivate a smoother, easier home life and structure.
What Is Family Therapy, In General?
SFT is actually 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 can help address problems within the family dynamic and structure and encourage individuals to find alternative ways to deal with their issues.
Reinforcement of important family values and beliefs is important. If you do not have any readily seen family dynamic issues but feel as though something is always just slightly off in family interactions, you may benefit from enlisting the help of a therapist qualified to administer SFT. You may also want to visit a standard therapist first, who can then refer you to an SFT practitioner to get your family back on track.
How Effective Is Structural Family Therapy?
If you are unsure where to start, you may consider reaching out to a licensed online mental health professional.
Adolescents in a study who struggled with their mental health showed significant improvement. They also greatly improved their behavior, which was previously affecting the family in negative ways. Furthermore, there was a significant increase in parental competence, which means that the parental subsystem (i.e., the parents or caregivers) was able to develop better parental practices in alignment with their child’s wellbeing.
Some families may find that online therapy provides more flexibility than traditional in-person therapy settings. For instance, if it is important for divorced parents living in different cities to meet jointly with a therapist, online therapy provides a simple platform for uniting them. Additionally, you can schedule appointments at your convenience. This advantage is important, especially if, as a parent, you need to schedule a session when your child, partner, or other families are not present.
Online therapy has also proven effective in providing family therapy. In a literature review of studies focused on family therapy administered via telehealth services, researchers discovered that the efficacy of telehealth interventions for childhood behavioral issues, parental depression, and family problem-solving were superior to the in-person control interventions. Read below for some testimonials of those who found BetterHelp to be a valuable resource in our society:
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Whether your family is merging with another family, grieving a shared loss, or experiencing challenges due to one member’s choices or actions, structured family therapy has been proven effective for helping families deal with issues that affect the entire family unit. Reach out to a licensed SFT therapist today to start mapping out your family dynamics and identifying what shifts need to happen.