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By Dr Kate Owen
Clinical Psychologist and Clinical Family Therapist
Have you ever conducted a mental health assessment for a child and heard the parents say “It’s like walking on eggshells around him!”, or “It’s just easier if we do what she wants to keep the peace”.
How have you made sense of those statements? How have they informed your formulation on what is maintaining the presenting problem?
With my Structural Family Therapy hat on these statements provide me with clues about the hierarchy in the family - who is holding the most power in the family, taking the lead, and calling the shots. And with these statements, who do I hypothesise might be sitting on top of the hierarchical ladder…….the child!
Don’t get me wrong. I don’t believe that parents intentionally give their power away. I also don’t believe that parents should act like dictators and dismiss their child’s need for autonomy. The creation of the “inverted hierarchy” is often a process that creeps up over time. From a Structural Family Therapy framework, we would say “Families are doing the best they can, and somewhere along the way something has happened in the family process that needs adjusting”.
From a Structural Family Therapy framework, the therapist is not too concerned with WHY the family dynamics have shifted so that children hold the power. The Structural therapist is more concerned with helping the family make the interactional and relational changes required to shift back into a more functional dynamic whereby parents are the “executives” of the household and children have increasing power and responsibility as they grow older (i.e., teenagers).
How does the therapist assist this change process?
Given the theory of change in Structural Family Therapy is to modify and amplify patterns of behaviour in the session, the therapist is constantly observing and monitoring the family dynamics in order to “catch” a moment that can be shaped in the session. And given that family interactions are so familiar and automatic, there will always be opportunities to witness these enactments in the therapy room, the waiting room, or as the family walk into or out of the building. Even though the family is “on display” to the therapist which might inhibit their interactions, nonetheless, snippets of relational dynamics and processes will be revealed.
When the therapist observes a healthy and helpful hierarchical process they might choose to amplify this dynamic with the hope that this will continue to be repeated outside of the session. An example of amplifying a positive interaction would be to applaud and praise a parent if they momentarily set a boundary with their child. The therapist might even ask the parent to repeat the exact phrase that they used in an attempt to intensify that interaction and increase the parents’ feeling of confidence in having set a limit without fear.
When the therapist observes an unhealthy hierarchical process they might choose to modify the interaction by coaching a different parental response or to disrupt the pattern in whatever way best fits the situation at that moment. For example, if the parent asks the child to pack away the toys in session and the child refuses, the therapist might assist the parent to try alternative strategies as opposed to the parent packing away the toys themselves.
Assisting families with this restructuring process often requires the Structural therapist to join respectfully with the family in a position of leadership. This technique of joining is in itself a hierarchical intervention that promotes a healthy adult as “steering the ship”, which is often what parents are searching for when it feels like “stormy seas” and the child is the powerful tornado. However, as parents feel more confident and empowered, which in turn creates a sense of containment for the child, the therapist hands over the wheel to the parents.
For those of you who integrate behavioural techniques into your clinical practice, Structural Family Therapy ideas might be a good fit for your therapeutic toolbox. And for those working in settings whereby family problems are maintained by a child having more power than the adults in the home, Structural ideas might help shift these problematic dynamics so that no matter what problem the family encounter they will have a healthy process in place to navigate challenges. Just imagine what the family could accomplish simply by having parents feeling empowered, and children feeling contained.
Please note that this article is educational in nature and does not constitute professional advice.
Please note that this blog article was originally published on The Queensland Institute of Family Therapy (QIFT) website on May 22nd 2021. QIFT operated from 2018 to 2024, and is no longer in operation.
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