APPLICATION OF THE MODEL TO THERAPY

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In discussing the practical applications of structural family therapy, the first point to be made is that the model is not just a cluster of techniques with specific indications, but rather a consistent way of thinking and operating~ derived from the basic tenet that human problems can only be understood and treated in context. As such, the model is in principle applicable to any human system in need of change.

The family, however, presents some unique characteristics that make it a com­paratively accessible and rewarding field of application, it is a natural group with a history and a future, whose members tend to remain associated even under circum­stances that would be lethal for the fate of other human groups —such as high levels of ongoing conflict, extreme negative feel­ings and ultimate dysfunctionality—_and can then be expected (more than as mem­bers of other groups) to endure the chal­lenges of therapy. Families usually have the motivation to invest time, money, energy and affect for the sake of one of their members, and they also offer a pros­pect of continuity for the changes initi­ated during therapy.

In actual practice structural family therapy has been mostly applied to—and has grown from families where a son or daughter is the identified patient. This context offers some additional advan­tages, in that cultural expectations define the family as a most relevant environment for a child, and the parents as directly responsible for his or her well-being. The extent of the bias, if any, built into the model’s current formulations by virtue of the specifics of child psychotherapy will only be measurable upon extensive appli­cation of structural family therapy to “adult” problems.

There are no specific requirements that families and/or problems should meet for the model to be applicable. True, the fam­ily needs to be motivated and resourceful, but a systemic understanding implies that any family can be motivated and no fam­ily is resource less—or the point of meeting the therapist would never have been reached. Similarly, the problem must be a “transactional” one, but this according to system thinking is a matter of how the problem is defined, described or framed. In addition to the work with low socioeconomic families, delinquency and psychosomatic illness (already men­tioned in connection with’ the historical development of the model), the literature on structural family therapy includes case material from many different origins. School related problems (Aponte, 1976; Berger, 1974; Moskowitz, 1976), drug abuse (Stanton, 1978; Stanton & Todd, 1979; Stanton, Todd, Heard, Kirschner, Kleiman, Mowatt, Riley, Scott & Van Deusen, 1978), mental retardation (Fish-man, Scott & Betoff, 1977), specific symptoms such as elective mutism (Rosenberg & Lindblad, 1978) and en­copresis (Andolfi, 1978) are some ex­amples; although not a complete list, they give an idea of the variety of clinical con­texts to which the model has been applied.

While it is difficult to imagine a family problem that could not be approached from structural family therapy, there are however certain contexts, of a different sort, that limit the applicability of the model. Hospitalization of the identified patient, for instance, hinders the efforts to restructure the family because of the unnatural isolation of a key member, the confirmation of the family’s definition of the problem and the naturalization of a crucial source of energy for family change. By artificially removing stress from the family’s reality, hospitalization tends to facilitate and reinforce the opera­tion of homeostatic mechanisms; the re­sulting therapeutic system is one in which the therapist’s power to effectively chal­lenge stereotyped transactional rules is greatly diminished. A similar constraint is typically associated with medication, and in general with any condition that ap­peases crisis and takes the motivation for change away from the system.

Another crucial variable in determining the applicability of structural family ther­apy is the therapist’s acceptance of the goals set by the model for the therapeutic enterprise, and of the function prescribed for him or her. These are areas in which structural family therapy departs con­siderably from some other approaches, as will be described in the following discussion.