Compare structural family therapy to strategic family therapy

Although structural therapy and strategic therapy are both used in family therapy, these therapeutic approaches have many differences in theory and application. As you assess families and develop treatment plans, you must consider these differences and their potential impact on clients. For this Assignment, as you compare structural and strategic family therapy, consider which therapeutic approach you might use with your own client families. Learning Objectives Students will: Compare structural family therapy to strategic family therapy Create structural family maps Justify recommendations for family therapy To prepare: Review this week’s Learning Resources and reflect on the insights they provide on structural and strategic family therapies. Refer to Gerlach (2015) in this week’s Learning Resources for guidance on creating a structural family map. The Assignment In a 2- to 3-page paper, address the following: Summarize the key points of both structural family therapy and strategic family therapy. Compare structural family therapy to strategic family therapy, noting the strengths and weaknesses of each. Provide an example of a family in your practicum using a structural family map. Note: Be sure to maintain HIPAA regulations. Recommend a specific therapy for the family, and justify your choice using the Learning Resources Compare structural family therapy to strategic family therapy.

ABSTRACT
Family therapy is not a single theory solution for new family therapists. Although it is common for a young therapist to pick a model that he or she may feel most comfortable with, it is a manner of limiting the scope of learning in the early stages of education and even practice. Gaining a full understanding of the four primary constructs of family therapy can assist a young therapist in not only selecting a model that feels right but also in the ability to employ aspects of multiple models when working with various clients and their diverse spectrum of issues. Although each model has significant differences, they also share some similarities. This paper will examine the differences and similarities of structural and strategic family therapy models Compare structural family therapy to strategic family therapy.

Keywords: Structural Theory, Strategic Theory, Family Therapy Models

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STRUCTURAL AND STRATEGIC FAMILY THERAPY COMPARISON
Understanding the differences and similarities of the different family therapy models enhances the ability of a therapist to determine if a particular model or combination of models are best suited for their practice and the individual needs of the client[s] (Silva, et al., 2003). This paper contrasts and compares the Strategic and Structural models of family therapy by discussion the constructs of both models. By careful examination of the different approaches, development, and intervention styles associated with the two models, we can better understand the core concepts, intervention techniques, processes, social contexts, and outcomes represented in each model.

THE CREATION OF EACH MODEL
Salvador Minuchin and his colleagues at the Wiltwick School residential facility in New York developed Structural family therapy base don their experiences working with inner city delinquents (Issitt, 2013; Gladding, 2007). Pulling from their experiences, Minuchin and his colleagues asserted that passive and historical approaches to working with families posed difficulties in working with families in lower socioeconomic and racial minority families (Gladding, 2007; Nichols, 2013). Based on his observations, Minuchin asserted that the households in this demographic tended to display more aggressive behaviors and place blame on other family members or influences when troubles within the family were present (Issitt, 2013; McAdams et al., 2016). Minuchin further surmised that when a dysfunction within the family arose, that it was the result of an inability for the family structure to adjust to changing conditions and that families incorporate subsystems that establish individual roles and responsibilities (Issitt, 2013; Gladding, 2007). Based on these observations and assertions Minuchin developed the concept that therapists should engage families directly to aid in changing the family structure to facilitate change, and that the particular type of clientele they were working with required active and dramatic interventions to be successful (Issitt, 2013; Gladding, 2007)Compare structural family therapy to strategic family therapy.

In the 1960’s and 70’s Minuchin and his associates expanded on the social context that formed the basis of structural family therapy mainly because the clientele of inner city tended to display a heightened level of crude characteristics (Israelstam, 1988; Issitt, 2013). Structural family therapy also assumes that problems arise when family boundaries are not clear and when difficulties are present within the family hierarchal structure. Furthermore, cross-generational influences like coalitions and alliances add additional challenges within the family (Isrealstam, 1988; McAdams et al., 2016). Sequentially families with diffused boundaries are more likely to be enmeshed while families with rigid boundaries are more likely to be disengaged than households with a healthy set of boundaries and hierarchal structures (Isrealstam, 1988; Gladding, 2007; McAdams et al., 2016)Compare structural family therapy to strategic family therapy.

Gregory Bateson (1904-1980) of the Palo Alto research group developed strategic family therapy in the early 1950’s. His primary focus on treating schizophrenic patients and the problems their families experienced as a result of the illness, and he surmised that schizophrenia was a result of discrepancies in various levels of family communications and interactions (Isrealstram, 1988; Nichols, 2013). Strategic family therapy is primarily composed of two subgroups. The first being Haley’s structural-strategic group and the second being the MRI group (Israelstam, 1998). It is fair to note that while both of these subgroups share much in common, they have strong fundamental differences. One aspect of strategic family therapy is that therapists working with families take a lead role in defining the process fo treatment and design the strategies required to aid families in changing their system (Israelstam, 1998). Also, D. Jackson (1920-1968) and John Weakland (1919-1995) expounded on Bateson’s concepts by describing various communicational strategies as processes an individual uses to escape or define intrafamilial relationships (Israelstam, 1988; Sheehan, & Friedlander, 2015). Based on the focus on specific strategies for intervention aimed at changing the current problem within the family, Jackson and Weakland’s theories also became known as strategic family therapy (Israelstam, 1988; Sheehan, & Friedlander, 2015). The process involves a complete assessment of the family interactions and developing a strategy to disrupt the cycle by providing straightforward or paradoxical interventions. The therapeutic process focuses on changes, and the therapist is responsible for the successful outcome of these processes. It is fair to note that strategic therapists do not make interpretation of current interactions of the therapist themselves or exploration of the past when addressing the family’s current interactions.

The strategic family therapy model significantly impacted by social context, combined ideas, accumulated research, and writings of all the theorists at the Mental Research Institute [MRI] established a strong presence in the psychotherapy community. Although there were various therapists and schools of theory involved in the creation of strategic theory, the collaborative research and shared objectives of all concerned defined the theme used to form the model into a modern family therapy technique Compare structural family therapy to strategic family therapy.

MECHANICS OF EACH MODEL
The structural theory asserts that changing the structure of a dysfunctional family will enable the family to interact in a positive manner and overcome the pressing issues. Structural family therapy assumes that problems and solutions develop on a series of hierarchal, subsystem, and architectural influences within the household that affect the behaviors of individual family members (Israelstam, 1988). A further assumption is that people interpret issues like social interactions as patterns of interaction that occur on a repetitive basis (McAdams et al., 2016). The dynamics of a family network or structure ranges from dysfunctional to supportive and based on the level of cohesiveness will either promote negative or positive household interactions (McAdams et al., 2016). The structural interpretation of problems versus solutions provides a systemic comprehension of the family unit as an operational network and provides insight into the routine functionality of both the family system and individual components. If the therapist determines a dysfunction in family operations, he or she assists the family in changing the issues to encourage more positive interactions (Israelstam, 1988; McAdams et al., 2016)Compare structural family therapy to strategic family therapy.

The underlying assumptions about problems in strategic family therapy focus on the family system and how it interacts with a problem instead of identifying the problem itself (Gardner, Burr, & Wiedower, 2006; McAdams et al., 2016). Strategic family therapists attempt to change the household interactional processes by focusing on individual communication patterns and developing strategies designed to aid the family to recognize and change actions and interactions associated with the dysfunction (Horigan, Anderson, & Szapocznik, 2016). Strategic family therapists believe that this manner of intervention will aid in the restoration of active family function and the dysfunction will cease (Lindstrom, Filges, & Jorgensen, 2015).

MODEL CORE CONCEPTS
The fundamental concepts of structural family therapy emphasize a systemic and organizational process where the therapist analyzes the family structure to determine how the household interactions maintain the dysfunction without identifying the solution (McAdams et al., 2016). A primary assumption of Minuchin is that a family network core function centers on functional expectations that establish individual interactions and affect household homeostasis (Issitt, 2013; Lindstrom, Filges, & Jorgensen, 2015). Besides the inner workings of the family itself, the therapist also reviews external social influences that potentially affect the dysfunctional behaviors in a negative manner. Another area of focus is subsystems intertwined with the primary system and hierarchal processes identified as potentially harmful influences, hence allowing the therapist to aid in modifying how individuals relate to one another and create a positive rebalance of the primary system (Issitt, 2013; McAdams et al., 2016)Compare structural family therapy to strategic family therapy.

The fundamental concepts of strategic family therapy emphasize systemic process, hierarchal structure, and understanding the intricacies of individual and family communication patterns (Horrigan, Anderson, & Szapocknik, 2016; Sheehan & Friedlander, 2015). The process includes analyzing invisible and visible family guidelines [rules], family function, and repetitive behavioral patterns that appear to reoccur within the family Israelstam, 1988). Emphasizing that problems are inherent to dysfunctional hierarchies in the family structure; therapists seek to aid families to correct the problems by modifying personal interactions to change the family structure. Other concepts of strategic family therapy include the household’s behavioral sequences and the processes that potentially exacerbate or maintain the dysfunction (Szapocznik, Schwartz, Muir, & Brown, 2012)Compare structural family therapy to strategic family therapy.

MODEL INTERVENTIONS
Applying unbalancing techniques, aiding individual family members to reframe perceptions, family mapping, joining with the family during sessions, and presenting the dysfunction as a metaphor are core intervention methods employed in structural family therapy (Nichols & Tafuri, 2013). Applying these techniques, a therapist can diagnose the dysfunction and aid the family in restructuring, which allows the process to develop structure and improved esteem within both the individuals and family network (Nichols & Tafuri, 2013). For example, if a therapist is working with a family that has an addiction problem, he or she may choose to use a family structure map to analyze various coalitions to interpret the underlying cause of the addiction (McAdams et al., 2016; Nichols & Tafuri, 2013). The therapist, in this case, objectifies the addiction to detach it from the affected family member and realigns the spousal coalition to strengthen the family’s center of power to combat the influence of the dependency (Nichols & Tafuri, 2013).

Strategic family therapy focuses on a set of planned, practical, and problem-focused strategies to address dysfunctional behaviors and familial structures that are associated with or contribute to the underlying problems (Lindstrom, Filges, & Jorgensen, 2015; Szapocznik, Schwartz, Muir, & Brown, 2012)Compare structural family therapy to strategic family therapy. The unique or core fundamental approaches of strategic family therapy include providing directives, assessing ordeals, and therapeutic paradoxes during interventions. A Therapeutic paradox is a tactic used to engage family members to evaluate unfavorable interactions and to redirect efforts into different interactions or behaviors (Lindstrom, Filges, & Jorgensen, 2015). Directives serve as precise instructions for the family members to enact to facilitate change, whereas ordeals are behavioral prescriptions that direct the family to engage in pernicious behaviors when maladaptive interactions return (Lindstrom, Filges, & Jorgensen, 2015; Szapocznik, Schwartz, Muir, & Brown, 2012).

     Considering that both models were primarily developed to treat addiction problems in young family members and provide assistance to the family unit to restructure the family network either by changing the structure or the strategy of the household dynamic, the benefits of both models apply in other therapeutic settings. For example, the application of both models in long-term care facilities and addiction rehabilitation for adults are both viable use-case scenarios. Hybrid models like brief strategic family therapy have combined elements of structural and strategic family therapy models of effecting changes in family networks troubled with dysfunctional addiction and behavioral problems. Using this hybrid model, a therapist can apply proper treatment to a family with an adult member suffering the same dysfunction. Although the primary applications of these models remain to treat families with children suffering from addiction and dysfunctional behavior, the transition to intervention programs for adults is beneficial and practical. Considering the systems and structures of families with dysfunctional children and dysfunctional adults are similar, if not identical, therapists only need make minor modifications to the intervention process to adapt the treatment to fit the needs of the family.

        A key factor of consideration in adapting these models to adult therapy is the effect addiction has on the mental state of a patient. Chronic addiction modifies and even retards human maturity, and therefore adult addiction patients may, in fact, have reduced mental capacity, or immature behavioral attributes. In cases of adult addiction or dysfunction, there are factors of treatment that remain relevant. Treating the parental structure or system would be considered a primary aspect of treating the dysfunction or an adult family member. The core processes of joining the family system, providing an in-depth evaluation of dysfunctional personal relationships, and aiding in the adjustment of the family structure or system are all viable approaches when providing therapy to families with dysfunctional adults Compare structural family therapy to strategic family therapy.

MODEL GOALS AND OUTCOMES
In comparison, the goals of structural and strategic family therapy share similarities of altering the family network via methods of behavior modification, communication enhancement, and disruption and restructuring dysfunctional interactions. In both models, the desired outcome is a change in maladaptive patterns that affect both the individuals and family unit. Assuming that changing the structure to recognize and disrupt dysfunction within the person and the family structure, a proper balance will be achieved and family homeostasis returned. Therapists are usually not dedicated to a particular model. Hybrid therapies like Brief Strategic Family Therapy, which incorporates both structural and strategic theories along with intervention are sound methods to engage families coping with adolescent substance abuse and behavioral dysfunction (Robbins et al., 2012; Szapocznik, Schwartz, Muir, & Brown, 2012)Compare structural family therapy to strategic family therapy.

The strategies for structural and strategic therapy model interventions applied to brief strategic family therapy shifts slightly to focus on reconfiguring the overall strategy to emphasize the transformation of family relationships for dysfunctional to an efficient, mutually supportive process. Therapists using this technique concentrate on helping families develop and enhance conflict resolution skills, behavior management skills, parenting and leadership skills, and blocking, directing or redirecting communications within the family network (Robbins et al., 2012).

The evolution of structural family therapy has made advancements in how therapists understand how relational issues affect areas like attachment theory and evolved the original concepts into new practices. For example, ecosystemic structural family therapy focuses on a systemic process (Lindblad-Goldberg, Jones, & Dore, 2004). Ecosystemic structural family therapists concentrate on an evidence-based process that focuses on families with adolescents and children suffering behavioral dysfunction. The primary goal is to aid families in addressing dysfunction and restore household homeostasis (Lindblad-Goldberg, Jones, & Dore, 2004)Compare structural family therapy to strategic family therapy.

Brief strategic family therapy models incorporate the core concepts of strategic family therapy and structural family therapy. The combination of both core models provides an evidence-based model designed to deliver treatment to families with young addicts (Robbins et al., 2012). By combining aspects of both strategic and structural therapy models, brief strategic family therapy increases therapeutic retention, and aids families comprehend and combat the dysfunction (Robbins et al., 2012; Szapocznik, Schwartz, Muir, & Brown, 2012). It is fair to note that although the model itself has undergone extensive research, there is still question as to the effectiveness on actually combating the actual addiction problem (Robbins et al., 2012)Compare structural family therapy to strategic family therapy.

MODELS CONTRASTED AND COMPARED
Structural and strategic family therapy models share numerous similarities in the foundational concepts of practice. A unique identifier of each of these models is the systemic approach employed to understand pathology and by redirecting efforts from a psychoanalytic approach to focus on the individual in conjunction with the family network. In doing so, both models emphasize the importance of understanding how the intrapsychic world affects an individual’s health and integration into the family structure, and how changing interpersonal interactions aids the family in achieving successful outcomes in therapy. Further similarities include the target market [clientele] that both models cater to servicing. Both models emphasize understanding and treatment of dysfunction in family communications and interpersonal relationships that contribute to significant problems in young family members and continue to expand with emerging hybrid therapy models like ecosystemic structural family therapy and brief strategic family therapy (Robbins et al., 2012). A fair comparison of the theoretical approaches of both models is the intervention strategies both employ. In both models, key therapeutic techniques include joining with the family system and assisting the family in restructuring the family dynamic. It is important to state that although these models were developed to combat families with dysfunctional youth, therapists have successfully applied both models to clients outside this demographic Compare structural family therapy to strategic family therapy.

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In contrast to the similarities both models share, there are also fundamental differences. A primary difference between structural family therapy and strategic family therapy is the method in which each model applies changes to the family system. Structural family therapy models assert that relational interactions become altered by focusing on changing the dysfunctional family structure, whereas strategic family therapy models state that family structure will change organically once the relational strategies become modified Compare structural family therapy to strategic family therapy.

        Both models share unique strengths and weaknesses, and although these attributes exist in the similarities of the models, it is appropriate to separate them for comparison. Both models emphasize the importance of systems inside and outside the family structure by exploration, interpretation, comprehension, and modification of dysfunctional relation to environmental factors. Secondarily, the therapeutic objective of assisting the younger family member[s] and the entire family to change the dysfunctional systems and structures are the most important aspects of resolving family conflict and dysfunction. Although these issues are considered shared strengths, they also present weaknesses in therapy. Those weaknesses being the fact that both models focus highly on intrapersonal relations within the family system, they often fail to investigate and address the intrapsychic and emotional factors of individual family members involved in the dysfunctional network. A reasonable assertion of both models is the roots fo where they started. Both models were developed to focus on sociocultural and socioeconomic populations most commonly overlooked (Israelstam, 1988). For various reasons, both models have provided a looking-glass view of these communities by emphasizing the importance of diversity of race and class structure (Nichols, 2013)Compare structural family therapy to strategic family therapy.

CONCLUSION
In conclusion, one can quickly take note that structural and strategic family therapy models have made revolutionary advancements in the field of family therapy. The emphasis on evaluating and addressing the dysfunction in the family structure or system that allows the structure to operate outside of standard tolerances has not only opened the door to successful treatment of addiction in young family members but also applies to the treatment of adults suffering the same issues. Emphasizing focus on interpersonal relationships, communication, and hierarchal power struggles as a core aspect of family dysfunction and aiding families in implementing proper solutions to address these issues is a critical factor in successful treatment Compare structural family therapy to strategic family therapy.

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