Therapist’s Role

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The therapist’s role, as prescribed by this model, includes an element of para­dox. The therapist is asked to support while challenging, to attack while encour­aging, to sustain while undermining. A crucial conceptual distinction is necessary here to protect the therapist from confu­sion or hypocrisy: he is requested to be for the people in need of help, against the sys­tem of transactions that cripple them.

The first task for the structural family therapist is to enter the system that is in need of change and to establish a working relationship. This requires a certain degree of accommodation to the system’s rules—but not up to a point in which the therapist’s leverage to promote change is lost. Too much challenge to the system’s rules at the entry stage would lead to the therapist’s dismissal; too much accommo­dation would void his input by absorbing it into homeostasis. The therapist has to find the right equation of accommoda­tion/challenge for each particular family through a process of probing, advancing, and withdrawing that guides his entrance and at the same time gives him clues about the family structure.

So the structural family therapist is ac­tively engaged in a dance with the family right from the beginning of their contact. There is little room in this model for neu­tral listening or floating attention. The therapist approaches the family with a series of initial hypotheses built on the basis of minimal intake information, and proceeds to test, expand, and correct those hypotheses as he joins the family. His attention is selectively oriented toward process and away from content; he is more interested in how people relate than in what they have to say, and he listens to content mostly as a way of capturing the language of the family, the \, metaphors that will later help him catch the ears of his clients. As processes and themes unravel, the therapist’s selective attention privileges some of them and dis­cards the others. A map of the family begins to emerge in him—a map depicting positions, alliances, hierarchies, comple­mentary patterns.

Soon the dancer turns into stage direc­tor, creating scenarios where problems are played according to different scripts. The embedding of the symptom in family transactions is explored and highlighted. Family members are invited to talk to each other, or excluded from participa­tion. Distances and positions are pre­scribed, alternative arrangements tried. The therapist-director uses whatever knowledge he is gaining about the actors to create situations that will uncover hid­den resources or confirm suggested limita­tions. He is looking for the specific ways in which this system is keeping its homeo­stasis, so that he can disrupt them and force a new equilibrium at a higher level of complexity. But he is also searching for the system’s strengths that will indicate possible directions for his challenge. The stage director is out to make trouble for the cast.

While the model prescribes activity, ini­tiative, and directiveness, it also warns against centrality. The therapist is sup­posed to organize a scenario and start the .action, but then to sit back as a spectator for a while. If he becomes too central the system can not fully display its limitations and potentialities; the therapist himself gets trapped in a stereotyped position where he will most probably be absorbed by homeostasis. He needs to be mobile, to constantly redefine his position, displac­ing himself from one role to another, from one alliance to another, from one challenge to the next—while at the same time maintaining a focus, a thread, a rele­vant theme connecting all of his moves together and to the presenting problem. In this the structural family therapist resembles a camera director in a television studio, who decides to air the close-up “take” from one of the cameras. Far from indulging in self-praise for the beauty of the achieved picture, he is already planning the next -knowing also that from time to time the total pic­ture will be needed as a reminder to the audience of what it is all about.

In short, the role of the therapist is to move around within the system, blocking existing stereotyped patterns of transac­tions and fostering the development of more flexible ones. While constantly negotiating the immunological mechanism­/ isms of the family organism in order to be accepted, he behaves as a strange body to \ which the organism has to accommodate by changing and growing.