350 Chapter 41
Box 41.2An example of classical structural family therapy
Mr Jones is a maths teacher, and Mrs Jones is a former nurse who looks after their
three children. Robert, 15, has incapacitating abdominal pain with no obvious
organic cause and has missed most school for the last six months. Jane, 13, has
no reported problems and is doing very well academically. John, 10, refuses to do
what his mother asks and frequently swears at her.
During questioning it emerges that to make it easier for Mrs Jones to help
Robert with his frequent bouts of pain in the night, he sleeps in the parents’
bedroom in a camp bed. The repeated night disturbances led Mr Jones to suffer
from lack of sleep, which was affecting his teaching, so he had moved into the
spare room. Most evenings he spends correcting students’ scripts in his study, and
at weekends he goes fishing alone. He explains that he thinks Robert’s problems
derive from a delicate constitution worsened by appendicitis three years ago.
The therapist does not respond to this explanation for events rooted in the
past, but she notices that Mr Jones and Jane sit together on one side of the room,
John is in the middle, and Mrs Jones is at the other end sitting very close to Robert
and whispering to him. After a while she decides that the boundary between
Mr and Mrs Jones is rigid and they are disengaged, whereas that between Robert
and Mrs Jones is too fluid and they are enmeshed. She therefore intervenes by
altering the seating arrangements so Mr and Mrs Jones have to sit next to each
other away from the children and are set the task of finding two practical steps
to help Robert back to school for one hour a day. Meanwhile the three siblings
are sat in the other corner of the room and instructed collectively to plan a treat
for their parents.
These manoeuvres are designed to promote parental authority and strengthen
the marital subsystem, and the sibling subsystem. For homework, the parents are
instructed to go out one evening a week and to agree a joint implementation of
their plan to get Robert back to school. Mr Jones, who hitherto hardly ever did
anything with Robert, is instructed to take him fishing with him on Saturdays. In
later sessions the sleeping arrangements are addressed, and Mrs Jones is asked
what Robert does to get her to mollycoddle him so much. The therapist is thus
reframing his behaviour as sympathy-seeking to avoid school rather than illness.
Mrs Jones begins to see his role in organising her caring behaviour and gets quite
angry at him, with the result that he moves out of the bedroom and Mr Jones
moves back in. Both parents are supported in their programme to be consistent
in accepting no excuses for not going to school. His abdominal pain ceases to be
discussed much at all during sessions and gradually diminishes.coalitions are based on detouring, for example, couple appear to get
on, because they detour their problem via the child.
Triangulation, where each parent demands that the child is an ally in
a conflict with the other.
Alliances when two share an interest not shared by a third. This is a
healthy supportive structure, which is not detrimental to others.
Powerrefers to relative influence.
Identified patient. The person brought for help, although in fact the cause
of the problem lies in the interaction patterns at a family-wide level