As one evolves throughout their career as a therapist, they may decide to work with clients individually as well as with the individual and their family. Understanding and know the different types of theories and techniques utilized in family therapy will help a professional in the mental health field be an effective therapist. A few theories that one may benefit in knowing and should be familiar with are Strategic, Structural, and Milan Systemic family theories. It is also necessary for a professional to distinguish who the major contributors are for each theory, the history of the theory, interventions used for each theory, the similarities and differences of each theory as well as a possible contributor of a specific theory one may want to model.
Major Contributors
A few major contributors to Strategic family therapy are Milton Erickson, Gregory Bateson, Jay Haley, John Weakland, and Don Jackson (Nichols & Davis, 2017). Structural Family therapy's major contributors are Salvador Minuchin, Braulio Montalvo, Jay Haley, Bernice Rosman, Harry Aponte, Carter Umbarger, Marianne Walters, Charles Fishman, Cloe Madanes, and Stephen Greenstein (Nichols & Davis, 2017). The major contributors to Milan Systemic Family therapy are Mara Selvini Palazzoli and Guiliana Prata (Nichols & Davis, 2017).
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The History
It is essential to understand the history of each approach as one begins to choose an appropriate theoretical style. Strategic family therapy is based on communications theory. Communication theory is the study of relationships and how verbal and nonverbal messages are exchanged (Nichols & Davis, 2017). Communications theory was established during Bateson's schizophrenia project. In 1952, Bateson was given a grant and invited Haley, Weakland, and Jackson to study the paradox in communication in Palo Alto (Nichols & Davis, 2017). They concluded that the exchange of complex communications between people explains their relationship. In 1959, Don Jackson founded the Mental Research Institute (MRI), where the founders of Bateson's schizophrenia project developed three different models. These models were MRI's brief therapy, Haley and Madanes' strategic therapy, and finally the Milan systemic model (Nichols & Davis, 2017).
The MRI brief therapy approach is centered on identifying and interrupting ironic processes that occur when repeated attempts to solve a problem keep the problem going and making it worse (Nichols & Davis, 2017). The Haley and Madanes strategic approach was influenced by Erikson, Bateson, and Minuchin. Erikson assumed the unconscious was filled with knowledge and that he specifically did not need to offer individuals insight, but to provide assistance in aiding them in accessing insight on their own (Nichols & Davis, 2017).
Salvador Minuchin was one of the major contributors to structural family therapy (Nichols & Davis, 2017). Minuchin was a physician in the Israeli army and was born and raised in Argentina. When he arrived in the United States, he began training in child psychiatry and started working with and training Nathan Ackerman. Minuchin later returned to Israel and began working with displaced children (Nichols & Davis, 2017). In 1954, he returned to the United States, where he engaged in psychoanalytic training at William Alanson White Institute. In 1962, Minuchin was at Palo Alto and met Jay Haley and by 1965, he became the director of Philadelphia Child Guidance Clinic. Minuchin's associates in Philadelphia were Braulio Montalvo, Jay Haley, Bernice Rosman, Harry Aponte, Carter Umbarger, Marianne Walters, Charles Fishman, Cloe Madanes, and Stephen Greenstein and were all contributors to the development of structural family therapy (Nichols & Davis, 2017). There are three structures that define structural theory, which are structure, subsystems, and boundaries. Structural therapy addresses patterns of interaction that create problems within families. Mental health concerns are often perceived as signs of a dysfunctional family (Nichols & Davis, 2017). In Structural family therapy, the goal of treatment is adjusting the family structure instead of modifying the individual family members (Nichols & Tafuri, 2013). By the 1970s, structural family therapy had become the most widely practiced approach of family therapy (Nichols & Davis, 2017).
The Milan systemic family therapy approach was first presented by a group of family therapists, who were working with Mara Selvini Palazzoli and developed her own approach to family therapy (Lorås, Bertrando & Ness, 2017). By 1967, she managed a group of eight psychiatrists and formed the Center for the Study of the Family in Milan, where they developed the Milan systemic model (Lorås, Bertrando & Ness, 2017). The team utilized cybernetic systems and saw that irrational behavior was a result of people being isolated in their struggles and unable to maintain certain relationships within the family. The main goal of this therapy was to establish a change in interaction patterns between members of the system. This was achieved by reframing, use of circular questions, and the therapist practicing neutrality (Lorås, Bertrando & Ness, 2017).
Specific Interventions Used
Specific interventions used in strategic family therapy come from the MRI Approach, The Haley and Madanes Approach, and the Milan Model. Interventions that involve the MRI Approach are reframing, paradoxical interventions, symptom prescriptions, and restraining techniques (Nichols & Davis, 2017). An intervention used in the Haley and Madanes Approach is the use of directives. Directives are utilized to establish relationships as well as bring change, they can be straightforward and/or indirect (Nichols & Davis, 2017). Positive connotations and rituals are interventions used in the Milan Model. Interventions used in structural family therapy are joining and accommodating, enactment, structural mapping, highlighting and modifying interactions, boundary making, unbalancing, and challenging unproductive assumptions (Nichols & Davis, 2017). An example of joining and accommodating in structural therapy would be for the therapist to build a therapeutic alliance to establish a bond so they are able to join the family in therapy, which can aid in members from resisting the therapeutic process.
Similarities and Differences
Understanding the similarities and differences of each approach can help the therapist determine what model or combination of models are best to practice and what is best for the family system. Strategic, structural, and Milan systemic approaches integrate from a systems approach (Darwiche & Roten, 2015). Strategic and structural models highlight understanding and treatment of dysfunction in family communications and interpersonal relationships that aid in significant difficulties (Darwiche & Roten, 2015). The structural family theory emphasizes in changing the structure of a dysfunctional family and by doing this will allow the family to interact in a positive way and identify the dysfunctional patterns (Nichols & Davis, 2017). In structural family therapy, treatment is initiated with joining, accommodating, testing boundaries, and restructuring. Strategic family theory concentrates on the family system and their interactions with a problem instead of recognizing the problem (Nichols & Davis, 2017).
A Major Contributor to Model
A major contributor that one may choose to model when providing system work is Salvador Minuchin. Minchin's major concepts of structural family therapy highlight a systemic and structural process. The therapist begins to examine the family structure in order to determine how the family’s interactions created dysfunction within family. The advancement of research and knowledge indicates how the development of structural family therapy assists the therapist in recognizing how interpersonal problems affect areas the family. As one gains knowledge about family systems, they may consider that an individual’s behavior are a function of their relationship with others. One following in the footsteps of Minuchin may believe that the primary goal is to aid families in addressing dysfunction and bring the household back to homeostasis.
Conclusion
Being able to understand the different approaches and theories of family therapy is essential in establishing competency as a family therapist. Understanding the similarities and differences of each approach is a key to choosing which theory would be appropriate to use or would benefit the family system. Utilizing empirical research and comprehending each theory will help an individual to develop into an effective therapist.
References
- Darwiche, J., & Roten, Y. (2015). A couple and Family Treatments: Study Quality and Level of Evidence. Family Process, 54(1), 138–159. https://doi.org/10.1111/famp.12106
- Lorås, L., Bertrando, P., & Ness, O. (2017). Researching Systemic Therapy History: In Search of a Definition. Journal of Family Psychotherapy, 28(2), 134–149. https://doi.org/10.1080/08975353.2017.1285656
- Nichols, M., & Tafuri, S. (2013). Techniques of Structural Family Assessment: A Qualitative Analysis of How Experts Promote a Systemic Perspective. Family Process, 52(2), 207–215. https://doi.org/10.1111/famp.12025
- Nichols, M. P. & Davis, S. D. (2017). Family therapy: Concepts and methods (11th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
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