Salvador Minuchin and Structural Family Therapy

Salvador Minuchin arguably had the greatest influence on the development of family therapy as an intervention. He grew up a Jewish Argentinean with a strong sense of kinship and a willingness to oppose established authorities. Trained originally in child psychoanalysis, Minuchin became disenchanted with this nonactivist way of working when he began working with low-income children at the Wiltwyck School for Boys in New York in the early 1960s. After becoming exposed to family systems theory through the Palo Alto group and other family therapy pioneers, Minuchin became a prominent figure in the field after 1965 when he became the first director of the Philadelphia Child Guidance Clinic, where Jay Haley joined him in the 1970s to create a powerhouse training program. Other key colleagues in Philadelphia were Braulio Montalvo, Harry Aponte, and Marianne Walters.

Minuchin’s structural family therapy model arose during the early years of the community mental health movement and the antipoverty movement, which were attempts to create alternatives to hospital-based treatment and psychodynamic private practice treatment. Structural family therapy was developed from work with “under-organized” poor families by focusing on immediacy, on problem solving, and on the environmental context. The training model was practical and teachable, with an emphasis on direct observation and coaching behind one-way mirrors and videotaped review. The structural family therapy model was later extended to “over-organized” families of the middle class whose children developed disorders related to anorexia nervosa.

Minuchin emphasized the family as a system operating through subsystems that require adequate boundary clarity and permeability. Minuchin proposed that families have functions, particularly socialization of children and mutual support of married couples, that are carried out through well-bounded subsystems. Thus, parents form an executive subsystem that is responsible for children; coalitions between a child and a parent against the other parent are inherently dysfunctional because they violate universal norms of power hierarchy in families.

In structural family therapy theory, families experience trouble when their boundaries are too porous (enmeshed) or too rigid (disengaged). The former prevents children from achieving autonomy and the latter prevents them from receiving enough support. All of these family dynamics are visible to the therapist who analyzes family interaction patterns. Minuchin was one of the pioneers, along with Lyman Wynne, who embraced a biopsychosocial model that allowed for the interplay of biology and family dynamics. In their classic work on children with brittle type I diabetes, Minuchin and his colleagues demonstrated how metabolic changes in children from certain kinds of enmeshed families are correlated with parental interactions. The “psychosomatic family” is characterized by a constellation of qualities whose description sums up the key initial contributions of structural family therapy to the field: enmeshed parent–child boundaries (overinvolved and hyper-responsive parenting), overprotection, rigidity, poor conflict resolution or conflict avoidance, triangulation (two family members aligning against a third one, especially when one parent forms a coalition with the child against the other parent), and detouring (when parents maintain a false solidarity in their own relationship by focusing on and thereby reinforcing the negative behavior of the child; Minuchin, Rosman, & Baker, 1978).

An additional important emphasis of structural family therapy stemmed from Minuchin’s work with low-income urban families—that families can become dysfunctional in response to a hostile environment that overwhelms their adaptability. Adaptability, defined as the family’s ability to access and execute alternative interactional patterns, becomes the “master trait” that determines how functional a family will remain in the face of major stressful events.

In its classic form as described by Minuchin (1974) the therapist’s role is highly active, like a choreographer or director. The first phase of therapy is joining/accommodating: connecting with the family through politeness, confirming their feeling and fears, and initially showing respect for their transactional rules. The second phase is restructuring problematic family patterns through altering perceptions of the problem (such as de-emphasizing the symptom or relabeling it, for example, not as anxiety but as stubbornness); through enactments, which are in vivo experiences of an alternative family pattern (such as blocking interruptions, unbalancing coalitions, or enforcing boundaries between the generations); and task assignments for the home to stabilize the new patterns (such as assigning an uninvolved father the responsibility to eat meals with his anorexic daughter). One reason for the prominence of structural family therapy over the past four decades has been its straightforward set of practical strategies. Structural family therapy has changed over the years as Minuchin and his collaborators have developed interests in individuals in families and in larger systems, and it has influenced many other approaches to family therapy.