Goals and Function of Therapy

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The basic goal of structural family ther­apy is the restructuralization of the family’s system of transactional rules, such that the interaccional reality of the family becomes more flexible, with an expanded availability of alternative ways of dealing with each other. By releasing family mem­bers from their stereotyped positions and functions, this restructuralization enables the system to mobilize its underutilized resources and to improve its ability to cope with stress and conflict. Once the constricting set of rules is outgrown, in­dividual dysfunctional ‘behaviors, in­cluding those described as the presenting problem, lose their support in the system and become unnecessary from the point of view of homeostasis. When the family achieves self-sufficiency in sustaining these changes without the challenging support of the therapist, therapy comes to an end.

This statement of goals may appear as too ambitious an objective; after all, the “presenting problem” was perhaps orig­inally characterized as one aspect in the behavior of one out of seven family mem­bers. But from the model’s point of view, the structural relationship between system and problem behavior is not just a far­fetched conceptual connection: it is an observable phenomenon. Whenever the “problem” is enacted in a session, the structure of related transactions is set in motion with the regularity of a clock--work. Again, the presenting problem ulti­mately is the structure of relationships, and each occurrence of the problem be­havior or symptom provides a metaphor for the system. Changing one of the terms in this equation implies changing the other—not as a prerequisite but as a co variation. in structural family therapy it is not necessary to postpone considera­tion of the original complaint in order to pursue structural change. On the contrary it is possible, and frequently inescapable, to weave the fabric of the one with the threads of the other.

The therapist’s function is to assist the family in achieving the necessary restruc­turalization. The position prescribed for him by the model is similar to that of a midwife helping in a difficult delivery. Once change is born and thriving the therapist must withdraw and resist the temptation to “overwork” his temporary association with the family by taking over the rearing of the baby. Some therapists are specially vulnerable to this temptation because of the tradition in psychotherapy that calls for a complete, ultimate “cure” of the client—an improbable goal whose equivalent can not be found in other health disciplines (an internist will hardly tell a patient that he or she will never need a doctor again). The concept of an ulti­mate cure is unthinkable in structural family therapy, which emphasizes con­stant growth and change as an essential feature of the family system. Hence, the structural family therapist is encouraged to limit his participation to the minimum that is necessary to set in motion the fam­ily’s natural healing resources.

It certainly may happen that as a result of’ the therapist’s intervention the family is helped not only to change but also to metachange -that in addition to the over­coming of its current crisis, the family will also improve its ability to deal with future events without external help. This high level of achievement IS of course desir­able, but that does not mean that other more modest accomplishments are value­less. A restructUralizati0~~~ that allows Danny to go back to school while his father takes care of mother’s depression and emptiness may be a perfectly legiti­mate outcome, even if the family comes back 4 years later, when Jenny runs into adolescent trouble. From the point of view of structural family therapy, this prospect is more sensible, natural and economic than the protracted presence of a therapist accompanying the family for years, unable to separate because of his need to make sure that things are develop­ing in a satisfactory way.

I yet another sense, the therapist’s role as prescribed by structural family therapy runs contrary to psychotherapy tradition. Much of the confessor-like behavior en­couraged by other approaches is here regarded as therapeutically irrelevant— and mostly counter indicated. The thera­pist is not there primarily to listen to and answer sympathetically his clients’ fan­tasies, secrets, fears, and wishes, but to assist in the development of a natural human context that can and should pro­vide that kind of listening. He is not there to provide extensive one-to-one reparative \ experience for this and that family mem­ber, but rather to operate an intensive “tune-up” of the natural healing system.

By limiting the duration and depth of the therapist’s incursion into the family system, the model places restrictions upon his curiosity and desire to be helpful, and ultimately upon his power to control events. This loss of control on the part of the therapist is an inevitable consequence of the broadening of his scope (Minuchin, 1970).