One Minuchin joining strategy that was used with the C. family was “respecting the family’s values and hierarchies”. In this treatment strategy communication is addressed through a dominant spouse or switchboard for the family. During the early sessions, communication was addressed through Mrs. C. the dominant spouse. This accommodated to the structure of the family system and thereby the sessions moved with the family rather than disrupting it. “Mirroring and mimicking”, other Minuchin joining
strategies, were used as the family’s mood, pace, and communication patterns were matched by the therapist. Internal adjustments were made by the therapist so that if the family became somber so did the therapist. He experienced the rhythms and demands of the family.
The mood of Mr. C. was mirrored by the therapist in the following exchange(Gwin 1996):
Wife: You can’t tell him anything. He just sits there. I don’t really expect him to do much work around the house. But I’d like just once of he’d ask if I wanted help.
(silence)
Therapist: Ted, I feel pretty uncomfortable right now, kind of frustrated. I sense this is the way you may be feeling just now.
If the therapist has done a good job in the process of joining, the stage is set for therapeutic restructuring efforts. The mother is assessed to be in a subsystem alliance or enmeshed with the children and needs to be weaned away from this tight bond. Her autonomy and competence are inhibited and her perception of self is poorly differentiated. This enmeshment pattern was validated by asking the children to “See what your parents say about staying up this late?” Their communication was directed
solely to the mother.
The husband-wife subsystem have one-way communication. This was validated by observation of both verbal and nonverbal communication patterns between the husband and wife during the therapy sessions. One restructuring technique that was used in this situation is to “escalate stress” by baiting the conversation to establish this one-way communication and quickly point this out to the family. Escalating stress is one of
Minuchin’s more radical techniques that forces members to develop alternative more functional ways of resolving stress. This stress escalation can be accomplished by blocking usual transactional patterns, siding with only one family member, identifying previously unidentified symptom bearers by pointing out previously unnoticed symptoms, or by asking for opinions. In this case previously unidentified symptom
bearers were identified by pointing out the one-way communication pattern initiated by the wife and labeling this as dysfunctional. This also blocks usual transactional patterns forcing the development of newer more functional communication patterns. By baiting the conversation to produce the one-way communication pattern and relabeling this symptom negatively, the therapist has used this symptom to increase its intensity and thereby mobilize family resources to cope with the increased stress produced.
Data was gathered. Family patterns assessed and plans of intervention therapy made by staging the family drama. The therapist is looking for a specific confirmation, and having obtained it, he shares his finding with the family. The wife was told she “sets up” an argument by anticipating her husband’s response before he gives it to her. An example of the one-way communication patterns used.
According to Minuchin, each family has its own unique map or patterns of behavior (Minuchin, 1974). Change can take place, but to accomplish this goal, an initial assessment of family boundaries is necessary. Both individual and subsystem boundaries should be assessed. These boundaries establish the relative individuality or autonomy of family members. In Minuchin’s concept of enmeshment, boundaries and personal space are weak and change rapidly. In Minuchins’s concept of disengagement, family members have rigid boundaries and communication between subsystems is poor.
In the family studied, the wife and husband exhibit patterns of behavior that fit the criteria of disengagement. Both husband and wife work in administrative positions in retail sales. Both of them partake of the materialistic benefits of the wife working. The husband feels that he deserves everything that he has attained and easily and quickly blames others if the need arises. The wife places the victim role. She anticipates trouble, stores resentment, walks a tightrope, and is easily thrown off balance. The children further separate the couple with there enmeshment with their mother and ineffective relationship with their father.
The goal of therapy was to open the boundaries that separate the husband and wife and reduce the enmeshment of the mother and the children. This was addressed by rearranging family space and positioning during the therapeutic sessions. In the third session the graduate nurse therapist took the favorite seat of the husband. Due to the arrangement of the other seating during the session, the husband was forced to sit next to his wife on the sofa. The co-therapists played with the children during the session thus also pushing the couple closer together. The nonverbal behavior that was observed was an indication of the success of the intervention. The husband at first was with his wife seated on the sofa and nothing more. He looked nervous and disconcerted. He spoke little and looked more at the children playing than at his wife. Later in the session as the wife talked about how difficult it was to deal with her anger, the husband reached out for her hand on the back of the couch and held and occasionally squeezed it.
Another restructuring technique used with the C family was the “assigning of tasks”. This is done inside or outside of sessions and structures the setting for alternative interactions and behavior to occur between family members. All critically involved members should be give a portion of the task to complete. The task assigned was to have the father spend at least 15 minutes each day he was home playing with the 2 year old girl. The wife could be present, but she was not to participate. She was to keep the 6 year old son occupied during this time. This task was to improve the relationship between the father and daughter and decrease the enmeshment between the mother and the children. The other task assigned was for the couple to discuss the anger the wife was feeling about the lack of help her husband offered at home. The couple was instructed not to spend more than 20 minutes on just one occasion talking about this, If it seemed that an argument might ensue, the couple could stop for a minute or so, but neither should leave the room or the house. This task addressed their communication patterns. The task assignment was evaluated by the therapists. The husband stated he really enjoyed the four 15 minute periods he spent with his daughter and felt a little guilty about not spending more time with her. The couple were not as successful at completing their assigned task. The co-therapists pointed out that it is sometimes very difficult to face a sensitive issue. It was pointed out that better communication was needed to avert continuing anger.
CONCLUSION
The C. family was exposed to a comparatively brief therapeutic process. During this time the therapist dealt with anger, one-way, incomplete communication and disengagement of the couple and enmeshment of the mother and children. Their therapy is continuing. Hopefully the dramatization of their problems and the restructuring techniques utilized will assist the couple to accomplish the long term goal of structural therapy of changing dysfunctional family structures such as inappropriate coalitions, enmeshments, and disengagements. The C. family was assisted to see that they can think, feel, and act differently to achieve more effective family communication and improve their family environment.
GENOGRAM
Both husband and wife came from homes where beatings were common between husband and wife and of children. Mr. C’s father was an alcoholic and died of the complications of the disease. Mr. C and his mother had a very conflictural relationship. He maintains little contact with her. Mrs. C. came from a very rigid parental setting. She had little to do with her father and was dominated by her mother. The conflict and poor patterns of communication that the C’s are now experiencing has led to the disengagement between Mr. and Mrs. C. Mrs. C’s over involvement with her children mirrors the pattern of her mother and her relationship with her father is also reflected in her relationship with her husband.
Resources
Friedman, S. (1981). Symbols and stories of the family. New York, NY : Norton Press.
Gwin, D. (1996). Structural therapy: a case study of a family in therapy. Journal of
Family Psychology, 10, 20-47.
Jacobson, N.S. (1995). Couples and family in crisis: a reflection on couples and family
therapy. Journal of Marriage and the Family, 48, 410 441.
Miller, P. (1992). A history of family systems therapy. New York, NY: Norton Press.
Minuchin, S. (1974). Families and family therapy, Cambridge, MS: Harvard University
Press.
Minuchin, S., and Fishman H. C. (1981). Family therapy techniques, Cambridge, MS:
Harvard University Press