Salvador Minuchin: Family Therapy

Family therapy is a type of therapy developed to look at each family's thoughts, emotions, and behaviors to see how they come together to form a whole. Salvador Minuchin was one of the leading experts in the field of family therapy and one of the creators of structural family therapy, a type focused on family dynamics and how the individuals in a family make up that whole.

Born in Argentina in 1921, Salvador Minuchin is often credited with changing how family therapy techniques work. Minuchin's past provided examples of how a family's dynamics routinely change and impact how the family can function. Salvador Minuchin's family was involved, strict, and fair and worked together to support one another. He witnessed a change in his family's hierarchy when his father lost his business, and Minuchin's uncle took over as the head of the household.

Salvador attended medical school, planning on becoming a practicing pediatrician. He enlisted as a physician for the Israeli army in 1948 before finishing his medical studies. After serving, Minuchin studied child psychology in New York, training with psychotic children at a children’s hospital before returning to the Middle East with his wife. While there, he worked as a child psychiatrist and co-directed five residential institutions to support disturbed children struggling with mental health concerns, many of whom were survivors of the holocaust.

After several years, Minuchin returned to the United States with a plan to become a psychoanalyst. and train at the William Alanson White Institute. After completing his training, he began practicing child psychiatry at the Wiltwyck School for delinquent boys in New York. While working at the Wiltwyck School in New York, Salvador Minuchin noticed a difference in supporting the New York children living in low-income neighborhoods. The treatments they were taught to use were ineffective in reaching these children.

Salvador's Discoveries 

When Salvador Minuchin began supporting children at the WiltWyck School, therapists used a "sit back and listen" approach. Minuchin felt that the root of many childhood problems was not within the child but the family unit. Therefore, to change the child's behavior, he believed the therapist must offer support to change the family dynamics.

Salvador realized psychoanalysis was not working and aimed to figure out how to change the processes. While studying new methods, he and other therapists developed a process where they asked teachers, supervisors, and colleagues to sit behind a one-way mirror and watch as they interviewed families and their children together. Salvador and the therapists wanted feedback on their new projects, and from those studies, they began to build the idea of active family therapy. Through this process, Minuchin developed structural family therapy. Years later, Salvador also developed a psychosomatic model for treating anorexia nervosa from these studies. Later, Salvador Minuchin’s experience and theories led him to become the director of the Philadelphia Child Guidance Clinic. In 1981, he went back to New York to practice child psychiatry. Once there, he began to teach family therapists at the Family Studies Institute (later renamed the Minuchin Center for the Family). Today, the center still teaches Salvador Minuchin’s discoveries and his books, “Family Kaleidoscope” and “Psychosomatic Families,” continue to spread his findings to the world.

Structural Family Therapy

Where individual therapy often focuses on the individual in treatment and their behaviors, family therapists focus on the family dynamics and their impact on an individual. For example, Salvador saw the impact family life often had on the children in the school he worked at. He noticed that sitting back and listening to the family was not working to help the family improve their behavior or result in any family healing.

In the 1960s, Salvador Minuchin developed structural family therapy. The form of therapy effectively provided treatment for at-risk children and families, helping them move through maladaptive family patterns. He noted that it was particularly beneficial for single-parent families, blended families, extended families, and those that faced difficult socio-economic situations.

How Structural Family Therapy Works

When therapists use structural family therapy with patients, they pinpoint the family hierarchy. They may look to find out the family rules, who has the power, and what structures exist, if any. To successfully do this, the therapist may actively work with the family instead of sitting back and observing. 

Family Subsystems

Family subsystems were known as smaller groups existing within the family structure. Each group serves its specific purpose, and the main groups include the following: 

• Spousal: Husband and wife, wife and wife, husband and husband, spouse and spouse, or multiple partners 
• Parental: Parent and child, or parent relationship vs. the child 
• Siblings: Brothers and sisters or siblings as a unit 
• Extended: Includes grandparents, aunts, uncles, and other distant relatives and family members.

Each person may belong to multiple groups. For example, a married woman with children may be a wife to her spouse, a parent to her children, and a daughter to her parents. If she has siblings, then she also belongs to a sibling sub-system. When one of these groups intrudes into another group, it may cause dysfunction within the family unit. 

For example, when children intrude into the spousal subsystem, Salvador believed it could cause problems within the marriage. He also believed that in-laws overstepping their role and becoming hyper-involved with raising children could impact family dynamics. If a new sub-system formed in a family and excluded others, he believed this might also cause dysfunction.

Family Structure

Every family may have rules that establish the routines of the family structure. When the rules are healthy and the entire family is on the same page, this could build trust within the family. Therapists can see the family structure as they watch how the family group interacts and talks to one another. By doing this, they can also observe the family's hierarchical structure and who holds the authority within the family. 

Boundaries

This therapy often defines boundaries as rules about what can and can't enter the sub-systems. There are three types of boundaries:

1. Rigid Boundaries: Rigid boundaries may be restrictive and limiting. They allow for minimal contact from those that are outside of the sub-system. These boundaries create isolation but can also be safer in some situations.
2. Diffuse Boundaries: When boundaries are diffused, they may be unclear. The sub-system in the family may lack limits that lead to unhealthy behaviors. A lack of boundaries could allow others to intrude on the system and become over-involved.
3. Healthy Boundaries: Boundaries may be healthy when they are clear, respectful, and healthy for all parties. 

The Goal Of Structural Family Therapy

In structural family therapy, the providers may help establish healthy boundaries within the family and sub-systems. They could also establish an appropriate hierarchical structure where the children do not control the parents, and outer circles are not intruding. 

To accomplish these goals, family therapists may take an active and involved role within the family structure to help establish proper leadership. After observing how the family interacts, the therapist can create a map that shows the current family structure. It may display the current boundaries, hierarchy, and sub-systems. With this in place, the family can see where they need to make changes, and the therapist can implement interventions to make the necessary changes to reach a healthy functioning level.

The therapist may use a specific process to lead the family through structural family therapy, including the following steps: 

1. The therapist joins and accommodates the group. Trust between the family and the therapist should develop for the process to work. 
2. The therapist then observes how the family behaves together. During this process, they watch for which person is leading the family, which is defensive, and which may be most likely to cause conflict. 
3. Next, the therapist maps the underlying structures of the family.
4. The family then completes role-playing exercises, so the therapist can watch and intervene to teach appropriate behavior.
5. Work on restructuring to create new boundaries is often necessary for the family to strengthen their bonds. The therapist may assist in this process. 
6. When needed, the therapist may go through an unbalancing process where they join with a sub-system or individual to help break an impasse in the system to support the relationship.

Minuchin's Impact On Family Therapy

Minuchin's work led to the development of a type of family therapy that has helped many families understand their structures. Minuchin's family therapy techniques are present-oriented, focusing on the current problems and addressing them. The structural family therapy model is often seen as a way to treat the individual by treating the underlying cause of their troubling behavior.

Salvador Minuchin work in family studies has made a lasting impact on family therapy that has helped many individuals, and Minuchin's work may live on for decades to come.

Finding Support 

If you're interested in finding a structural family therapy provider, consider doing an online search to find providers that offer structural family therapy. If you are more interested in individual or couples therapy, you can find support online for affordable rates and attend therapy sessions from home. 

With online therapy, you will be matched with an available counselor that fits your preferences to gain support immediately without worrying about being put on a waiting list. You can also choose between phone, video, and live chat sessions. 

Research shows that people feel more comfortable in online therapy, whether it's due to feeling less intimidated because they're not meeting with a therapist face-to-face or more empowered because they are attending therapy from behind the comfort of home. If you want to learn more about online therapy, consider signing up for a platform like BetterHelp for individuals or Regain for couples. Both platforms offer a growing database of therapists specializing in many types of therapies. 

Takeaway

Salvador Minuchin was a psychiatrist who realized how much a family structure and faulty family organization could affect an individual. He developed structural family therapy to work through family challenges actively and diligently. At times, working through individual concerns with family can also be effective. Many therapy models are available, so consider reaching out to a counselor for further guidance about your options for family therapy.