Structural family therapy (SFT) reduces dysfunction by helping families change how they interact.
This type of therapy views family challenges as systemic issues. Instead of focusing on one person, it encourages families to “restructure” their roles to help everyone heal.
Structural family therapy can be helpful for families facing mental health concerns, major transitions, trauma, and more. Outcomes in SFT can improve when key family members attend sessions regularly and stay engaged with care.
Think of your family sort of like a baseball team. Everyone has a different position to play, but you all need to work together to win the game. If someone refused to play by the rules or got injured and couldn’t participate, the whole team would be affected. This is because a sports team — like a family — is a system. Within this system, each person’s actions (or inactions) can impact the whole group.
Structural family therapy is an evidence-based [1] approach that focuses on how each member’s behaviors affect everyone else. This type of therapy is one of the most common forms of family therapy. It can help reduce conflict and challenging behaviors, strengthen parenting skills, and improve family connection.
How structural family therapy works
Structural family therapy works by examining how family members interact [2] and communicate. Once problems are identified, the therapist helps the family begin to relate to one another in healthier ways. This is sometimes referred to as restructuring or redefining [3] the family system.
Often, a family will come to therapy due to serious concerns about one member. This person is sometimes called the identified patient [4]. For example, imagine there’s a family with a teenage daughter who’s acting out and skipping school. Her parents would typically reach out to a therapist to get their daughter services as the “identified patient.”
In structural family therapy, family problems are viewed as systemic rather than individual. So, in this case, the family would explore how their dysfunctional patterns might be contributing to their daughter’s behavior. This would include reviewing interactions within the broader family unit and within subsystems [5] (like parent-child or sibling relationships).
SFT emphasizes that by working together to repair the family structure, conflict and problematic behaviors can be reduced. This strengths-based approach asserts that families can find innovative ways to repair dysfunctional patterns. In sessions, the therapist is actively involved in the family [6] and acts as a supportive guide.
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When structural family therapy is used
If you’re interested in SFT, it might be helpful to know the types of challenges and mental health concerns it’s typically used to treat. SFT is used to support families [6] experiencing:
Parent and/or child mental health concerns, including mood and behavioral disorders
Trauma
Major life transitions
Divorce and/or remarriage
Joining or blending families
Grief and loss
Keep in mind that this isn’t a complete list, and SFT can help with other issues your family might be facing. However, it might not be a good fit if key members are unwilling to participate. SFT is often best for families who are ready to invest in relationship repair, interrupt unhelpful patterns, and work together to improve the health of the family unit.
What to expect in structural family therapy
Your family’s experience in SFT will be personalized based on your needs. However, some of the activities and approaches used by SFT therapists [6] include:
Joining: This is when the therapist is first getting to know the family and their structure. It’s used to build rapport and help all members of the family see the therapist as a trustworthy source of support.
Mapping: They might draw a physical “map” that captures each member’s roles and family rules to help everyone better understand their family’s dynamics. This activity will help the therapist understand how each family member relates to the others.
Boundary setting: Setting boundaries can be beneficial for any relationship. This component is about learning to take responsibility for how you might be contributing to problems, but not shouldering blame for others.
Enactment: With this role-playing activity, family members reenact a past interaction during a therapy session. Afterward, the therapist might reflect what they witnessed and offer helpful suggestions.
Unbalancing: This is a way for the therapist to challenge the hierarchical structure of the family in a non-confrontational way. The therapist will try to interrupt power imbalances or one-sided coalitions.
Reframing: Reframing emphasizes learning to empathize with others. When family members can understand each other’s perspectives, they’re better equipped to respond compassionately and shift their behavior.
Sometimes, SFT therapists will assign “homework” [7] so families can practice applying these skills between sessions. The amount of time you’ll need to be in SFT can vary from several weeks to months, depending on your family’s needs.
However, you’re more likely to make progress if key members regularly attend sessions. This doesn’t mean that everyone needs to be completely on board with SFT for it to have a positive impact. But, like other forms of care, for family therapy to be effective, engagement matters [8].
Getting started with structural family therapy
To get started with SFT, you’ll first need to talk to your family about it. Try to have this discussion in a quiet, private space, and choose a time when you won’t be rushed. Let your family know that you’d like to attend SFT together.
You might start the conversation by saying something like, “Things have been pretty rocky lately, and I know it’s affecting everyone. I want us to work together to make things better, and I really think family therapy could help. What do you think?”
If you experience resistance, try to keep an open mind and validate concerns. If someone seems hesitant, offer a compromise. For example, you can tell them that they won’t be forced to talk unless they’re ready. See if they’re open to attending sessions as a listener at first. If someone is worried about being blamed, it might help to tell them a bit about SFT. Emphasize that SFT views family challenges as systemic, not individual. It’s about working together toward solutions, not blaming one person for family problems.
Once you get buy in from your family, the next step is to find a therapist. See if an existing healthcare provider (like a doctor, psychiatrist, or individual therapist) can provide a referral. If not, look into online therapy platforms or directories. You can narrow your search by looking for therapists who use terms like “family therapy,” “family systems theory,” or “structural family therapy” in their profiles.
The system shifts when family members begin responding to each other instead of reacting. These small changes in interaction indicate the family is starting to create healthier patterns together.
Ashley Ayala, LMFT
Clinical reviewer
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Structural family therapy (SFT) focuses on helping families resolve challenges by changing how members interact. It helps improve family functioning by emphasizing the importance of healthy boundaries and communication.
Instead of focusing on one person’s problems, SFT encourages everyone to work together to find solutions. Therapists use activities like mapping, reframing, and unbalancing to increase connection and interrupt unhelpful patterns. If your family has been impacted by mental health concerns, trauma, major changes, or other stressors, SFT can provide an opportunity to come together and heal.
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References
- Effectiveness of Structural–Strategic Family Therapy in the Treatment of Adolescents with Mental Health Problems and Their Families https://pmc.ncbi.nlm.nih.gov/articles/PMC6479931/
- Structural family therapy. https://psycnet.apa.org/record/2018-59954-007
- Resolving school problems with structural family therapy. https://psycnet.apa.org/record/1988-09185-001
- STRUCTURAL FAMILY THERAPY https://familybasedtraining.com/app/uploads/2021/02/SFT2016.pdf
- Theory and Practice of Structural Family Therapy: Illustration and Critique https://www.researchgate.net/profile/Laurie-Mackinnon-2/publication/232448726_Theory_and_Practice_of_Structural_Family_Therapy_Illustration_and_Critique/links/5a3c5202aca272dd65e4c77b/Theory-and-Practice-of-Structural-Family-Therapy-Illustration-and-Critique.pdf
- Structural Family Therapy: Focusing on Interactions https://www.smumn.edu/blog/structural-family-therapy-focusing-on-interactions/#:~:text=The%20therapist%20is%20actively%20involved,the%20family%20and%20their%20concerns.
- Structural Family Interventions https://www.jssa.org/wp-content/uploads/2014/02/Structural-Family-Interventions-Aponte-1.pdf
- Family Interventions: Basic Principles and Techniques https://pmc.ncbi.nlm.nih.gov/articles/PMC7001353/#:~:text=Many%20therapeutic%20efforts%20fail%20because,the%20need%20arises%20is%20recommended.
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Ashley Ayala, LMFT
Ashley is a Licensed Marriage and Family Therapist who specializes in generational healing and family dynamics. Ashley has worked in schools, clinics, and in private practice. She believes that people’s relationships, including our relationship with ourselves, greatly shape our experiences in life.
Ashley is committed to empowering others to show up authentically and deepen their self understanding. This passion stems from taking a critical lens on her own life story and doing inner healing. One of her favorite quotes is “Be yourself and the right people will love the real you.”
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