Change in Family Therapy

A fundamental theoretical premise in Structural Family Therapy (SFT) is that changes in individual members and improvements in intra-familial relations are realized by repairing the family structure. Dysfunctional families are conceptualized in terms of individuals taking on inappropriate roles (e.g., children acting as if they were parents) and the boundaries between parental executive levels and the children/sibling level are unclear, too rigid, or highly permeable. The therapist's role is to temporarily engage (join) with family members in a way that generates in-session interactions that exemplify the desirable family structure. While the theory supporting these interventions are well developed, there has been little work done on explicating how such tasks may be interactively accomplished in clinical practice. Drawing from the methods of conversation analysis, our aim for this paper is to show how a master therapist in SFT accomplishes some of these transformations during a single therapy session. We focus on the discursive resources through which the therapist is able to readjust the role relationships between a mother and her daughter (i.e., in such a way that the mother can adopt a more agentive position vis-a-vis her children) and how the therapist's actions indexed core SFT principles of restructuring the family.