What Is Structural Family Therapy (SFT)?
By: Corrina Horne
Updated August 28, 2020
Dysfunctional families are often the butt of jokes. Sitcoms, movies, and dramas constantly depict families as large, messy, loud, and confusing, with very few showing a well-oiled machine of a family, opting instead for hijinks, misunderstandings, and mockery. What might make for good TV, however, makes for a horrible home life, as families filled with dysfunctional relationships, fighting, and cruelty are usually the source of large-scale mental health issues down the road, for parents, children, and anyone else involved. What might seem like a good joke-or an impossible situation in real life-can actually be managed, assisted, and overcome via whole-family intervention and therapy.
What Is Structural Family Therapy?
Although there are many types of family therapy, Structural Family Therapy (SFT) is among the most popular, through its use of a whole-family base, rather than trying to figure out each individual's issues first, then moving forward with group therapy. In SFT, therapists work to uncover any habitual patterns, routines, or behaviors that negatively impact family dynamics, and seek to establish healthier routines within family structures in order to create a dynamic, loving, stable home life for everyone.
Structural Family Therapy is often recommended for families who have gone through trauma, blended families, singe-parent families, and families at risk. Although any kind of family can attend an SFT session, the ability of SFT is such that many families on the brink of giving up seek out this type of help, and benefit greatly from its precepts.
This particular modality was created in the 1960s, following one therapist's work with inner-city children in New York. Considered troubled youth, the therapist (Salvador Minuchin) determined that working with the kids alone was not enough to curb worrisome behavior and improve outcomes, but that the entire family was needed 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 merely focusing on one child with "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.
What Does a Typical Session Look Like?
To begin, an SFT practitioner will observe the family 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 in nature. Creating a chart or a map, the therapist can then move forward in identifying any specific issues that need to be addressed, and which of the observed issues are causing the most problems, in order to create a full, comprehensive treatment plan. The reason the family came in will also be taken into account when creating a treatment outline; 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.
After the first session (or first few sessions) has been completed and the chart is drawn, the therapist then begins to evaluate and unravel the aspects of the family's dynamics and interactions that are causing tension and creating discord within the family. Treatment may include role-playing, discussing feelings and perceptions, and encouraging family members to communicate in a safe space, using the therapist as a guide to develop clearer, more helpful language, rather than resorting to shouting, accusing, or blaming.
An SFT therapist essentially becomes a part of the family 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. Family therapists might step into role-playing, may act as a sort of devil's advocate in escalating interactions, and may demonstrate the problematic aspects of bullying, mocking, and other negative behaviors. Therapists may also take the side or encourage the opinion of one family member over another, which allows an angry or hurt dialogue to happen in a safe, violent-free environment.
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-setting. 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 of the therapist's suggestions, the faster the therapy sessions will conclude.
SFT can also undergo its own restructuring process. The therapist may initially see the entire family, then request some weeks with only a few family members, to focus on smaller, more specific issues. Other family members might be asked to come back, and therapy might simply move back and forth between a larger-scale family unit, and a smaller family unit, to create better communication and functioning within each of a family's microcosms. This could be asking only the parents in the family to therapy 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 given 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 suffering will play a role, as will the presence of other disorders or dysfunctions. A child with ADHD, for instance, might have an easier time getting an insurance company to cover SFT, than a family without a designated 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, but 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 a pervasive disorder of some kind.
Families who have suffered from trauma, such as the loss of a loved one, an accident, or something similar can also benefit from SFT, as it allows them the time and space to process their grief and trauma together, instead of trying to process everything separately and create even greater distance than the distance already established prior to the trauma.
Single-parent families and other at-risk populations are also frequently engaged in Structural Family Therapy, as boundaries are often skewed, and communication very often breaks 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 create a smoother, easier home life.
What Is Family Therapy?
Family therapy is any form of therapy that treats the family as a unit, rather than trying to improve relationships and relationship dynamics by treating just one member of the family. Structural Family Therapy (SFT) is a subset within 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, and move forward with treatment based on their initial observations.
As treatment continues, the therapist becomes almost like a temporary family member, as therapists jump into communications and interactions freely, switching back and forth between acting as a liaison, and an advocate, before leading families in role-playing exercises and encouraging family members to consider different points of view in conflicts. This allows family members to all build trust toward the therapist while creating healthier self-images, healthier boundaries, and healthier communication patterns.
SFT is most commonly used with families at risk, blended families, single-parent families, and similarly-challenged families, but can be useful for people of all backgrounds and dynamics, as at its core, it is designed to optimize the possibilities of familial relationships in order to provide a stable, loving environment for everyone within the family unit, in the hopes of improving outcomes for everyone.
If your family experiences dysfunction in any capacity-if someone in your family has special needs, has substance abuse or addiction, or if you are a member of a blended family or a single-parent family - you may qualify for SFT via your insurance. 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 in order to get your family back on track.