Theoretical and treatment approaches to family treatment Structural family therapists have developed a number of techniques; some of the following techniques are frequently used in restructuring families (Janzen) Confirmation: The therapist who is giving a sympathetic response to a family member’s affective presentation of herself, for example, may employ this technique: “You seem to be worried. Confirmation can also be executed by describing an obviously negative characteristic of the client, followed immediately by a statement that removes blame for the behaviour; for example, the therapist may say to the wife, “You are very critical of your husband. What does he do to make you unhappy? ” Reversal: The therapist directing a family member to reverse her attitude or behaviour regarding a crucial issue that elicits a paradoxical response from another member operationalizes this technique.
For example, Minuchin and Fishman (1981) report a situation in which the wife resented her husband’s overly close relationship with his mother. The therapist instructed the wife (in private) to reverse her attitude regarding the relationship. Instead of opposing it, she should praise the beauty of the devotion between mother and son and encourage her husband to spend more time with his mother. The husband did not appreciate his wife telling him what he should do and defied her instructions by becoming less involved with his mother (p. 48). This technique is used when one family member is cooperative and will follow advice while another member will resist it. The person on the receiving end should not be present when the reversal is given, as success depends on that individual’s being surprised by the change in attitude of the other person and, therefore, reacting spontaneously to the unexpected changes. Reversals have also been used in helping parents manage rebellious children.
Boundary making: boundary making occurs when the therapist defines an area of interaction as being open to some family members but closed to others. When the mother who is over involved with the children is asked to leave her seat between the children and take a seat next to her husband, this is a beginning effort on the part of the therapist to establish appropriate boundaries around both the parental and sibling subsystems.