The Process of Therapeutic Change

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Consistent with its basic tenet that the problems brought to therapy are ultimately dysfunctions of the family struc­ture, the model looks for a therapeutic solution in the modification of such struc­ture. This usually requires changes in the relative positions of family members: more proximity may be necessary between husband and wife, more distance between mother and son. Hierarchical relations and coalitions are frequently in need of a redefinition. New alternative rules for transacting must be explored: mother, for instance, may be required to abstain from intervening automatically whenever an in­teraction between her husband and her son reaches a certain pitch, while father and son should not automatically abort an argument just because it upsets Morn. Frozen conflicts have to be acknowledged and dealt with so that they can be solved—and the natural road to growth reopened.

Therapeutic change is then the process of helping the family to outgrow its stere­otyped patterns~ of which the presenting problem is a part. This process transpires within a special context, the therapeutic system which offers a unique chance to challenge the rules of the family. The privileged position of the therapist allows him to request from the family members different behaviors and to invite different perceptiOn5~ thus altering their interaction and perspective. The family then has an opportunity to experience transactional patterns that have not been allowed under its prevailing homeostatic rules.

The system’s limits are probed and pushed, its narrow self~definiti0n5 are questioned; in the process, the family’s capacity to tolerate and handle stress or conflict in­creases, and its perceived reality becomes richer, more complex.

In looking for materials to build this ex­pansion of the family’s reality -alterna­tive behaviors, attitudes, perceptions, af­finities, expectations- the structural family therapist has one primary source from which to draw: the family itself. The model contends that beyond the systemic constraints that keep the family function­ing at an inadequate level there exists an as yet underutilized pool of potential re­sources. (See Figure 1, the shaded areas.) Releasing these resources so that the sys­tem can change, and changing the system so that the resources can be released, are simultaneous processes that require the restructuring input of the therapist. His role will be discussed at some length in the following section.