What Is Structural Family Therapy (SFT)?
By: Corrina Horne
Updated May 28, 2021
Families are often not portrayed in the best light in popular media. Sitcoms, movies, and dramas constantly depict families as large, messy, loud, and confusing. Very few of these show a well-oiled machine of a family - opting instead for hijinks, misunderstandings, and mockery. What might make for good TV, however, can make for unsafe and uncomfortable home life. Families that experience dysfunctional relationships are often the source of potential mental health issues down the road, for parents, children, and anyone else involved. What might seem like a funny joke, or an impossible situation in real life, can be managed, assisted, and overcome via whole-family intervention and therapy.
What Is Structural Family Therapy?
There are many types of family therapy. Structural Family Therapy (SFT) is among the most popular. Its emphasis is on 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 may negatively impact family dynamics. They may 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, single-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 can 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. These children were 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 involving the entire family was neccessary 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. After 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, 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) have been completed and 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. Treatment may include role-playing, discussing feelings and perceptions, and encouraging family members to communicate in a safe space. Family members may be encouraged to view 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, act as a sort of devil's advocate in escalating interactions, and 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; therapy might simply move between a larger-scale family unit and a smaller family unit. 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 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 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, 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 mental 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. 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 even greater distance than the distance already established before 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, then move forward with treatment based on their initial observations.
As treatment continues, the therapist becomes almost like a temporary family member. Therapists can 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. At its core, it is designed to optimize the possibilities of familial relationships 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 or experiences substance abuse, 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 to get your family back on track.
If you are unsure where to start, you may consider reaching out to a licensed online mental health professional. Online therapy is considered a newer form of therapeutic practice compared to traditional therapy, but it can be quite effective. A study published earlier this year showed that most participants in a supervised family therapy session felt as safe and contained as they did in regular in-person therapy. The study revealed that online therapy can grant access to mental health care to those who have limited resources in their immediate area.
As mentioned above, online therapy can be a great first step for many people to engage in productive evaluation of their mental health care. As opposed to having to schedule an appointment around your family’s busy life and drive everyone to a physical location through traffic, online sessions can be held from your own home and according to your family’s schedule. Additionally, if you or your family members are not comfortable speaking face-to-face with a therapist, online therapy does not necessarily require face-to-face contact. In fact, platforms like BetterHelp offer multimodal communication tools such as live messaging and phone calls. As you and your family become more comfortable with the idea of therapy, you can change your communication strategies later on. Read below for some testimonials of those who found BetterHelp to be a valuable resource:
“Patricia Corlew is very knowledgeable and is genuinely interested in helping me and my family. I would highly recommend Patricia to anyone seeking advice/help coping with their problems.”
“Robin is amazing. This is my first time ever doing counselling and I was paired up with Robin. I have no regrets. I was going thought major changes with my family and Robin really help me to put everything in perspective and help me see things in a new light. She is very easy to talk to and work with. I’m really grateful to have met her as she has taught me so much. Thank you Robin. Both my husband and I really appreciate everything you do for us.”
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