Families can solve their own problems by accessing the skills they already have
Presenting Problem: Leah and Yehuda come for help with their daughter’s difficult behavior.
Tools Used: Structural Family Therapy
Recap: The C. Family came into treatment to seek help in managing the behavior of their third daughter, Shevy. Shevy is at risk of being expelled and her attitude is affecting the entire family. Her parents, Yehuda and Leah, are in the process of learning Structural Family Therapy. While two of the older daughters came for a session, Shevy refuses to attend.
The following week, Yehuda and Leah came alone. After I welcomed them, they sat down and got right into it.
“Shevy refuses to come. We met with her principal on Monday. Shevy was there. We shared that we were getting family therapy help, but Shevy started to cry and said she refuses to come.”
“How did that make you feel?” I asked.
“Honestly, a part of me was relieved to see Shevy cry. It showed she actually cares about something. But I’m concerned that she won’t even give family therapy sessions a chance.”
“I hear why that may cause you some anxiety, but remember, the essence of Structural Family Therapy is to look at the whole system. An individual’s symptoms are best understood when examined in the context of family interactional patterns. Everyone’s behaviors are interconnected.”
“Right. I guess I just find that hard to believe.” Leah looked at Yehuda. “But I’m willing to give it a try. At the school, we made up a behavioral contract together, and the principal said as long as Shevy stuck to the basic conditions of the contract, and we continue to seek outside support, then she can stay in the school.”
“It’s good they’re not forcing her to come, but are still setting strong boundaries. How is it going so far?”
“Well, it’s only been three days, but it seems like there’s less conflict at school. I think she sees we’re really serious. She doesn’t want to leave her friends and have that type of record. Shevy sees we’re coming here, united. I think she’s scared.”
“It’s amazing what a little bit of structure and consistency can do. That’s the reworking of boundaries and alliances in action. How about the other girls?”
“They would’ve come back if we forced them. But they were less than enthusiastic. Is it possible for us to act like ambassadors for the family? Can we come and learn the skills and bring it home ourselves?”
“Yes. SFT can be done even with just one person. It’s better with more people for the reenactment of scenarios, but if you can record the most problematic incidents that happen at home, and we can do the processing and reframing here, then you can bring it back home to share with your kids.
“I’d recommend everyone be there for your family meetings. Even if the others are quieter or not directly involved, the purpose is a joining of the family unit and developing the family’s strengths, which involves everyone.”
Yehuda and Leah agreed that they thought this would be possible. They earmarked Sunday evening right after dinner for family discussions.
“Do you mind if I repeat what you’ve said? I want to make sure I’m getting it.” Yehuda’s brow was furrowed, and he was tugging at his beard.
“Yes, great idea! Tell me what you know and where we stand in this process so far.”
“Shevy refuses to come, but that’s okay because her school is keeping her in line somewhat. It’s also okay because you think that through these family discussions, we can work through our problems together.”
“Right. SFT believes that families have the skills to solve their own problems, but for some reason, they don’t utilize those skills. Here the therapist enters to help you find and engage the natural skill set you possess. This is also why big change can happen in three to six months of treatment — because we’re teaching foundational, bigger picture skills.
“Remember last session? We discussed that underneath a lot of your pain and your own angry responses to Shevy’s behavior is fear, which stems from love. You have the strength and the capabilities to find your own solutions with some practice.”
“Okay. That makes sense. I mean it’s pretty optimistic, but I’ll take it for now.” Yehuda had a calm and open expression.
“All right, so something you said earlier speaks to the first major tenet of SFT that I wanted to discuss today. Hierarchy. Leah, you mentioned that Shevy seems scared that you and Yehuda are serious and, more notably, united. Correct?”
“Yes, I think that’s one of the things keeping her in line,” Leah responded.
“Having structure in a family is central to SFT, as you can tell by its name. And the first part of that is that parents maintain a hierarchy, and that they’re united. I noticed at the beginning of last session that there was some conflict between the two of you, mostly pertaining to how you were reacting to Shevy’s behavior.”
Yehuda jumped in gratefully. “Yes, I think that Shevy’s behavior is atypical most of the time, and Leah thinks it’s mostly normal teenage stuff with some atypical moments. But I feel that Leah’s perspective is shifting.”
Leah looked meaningfully at her husband. “Yes. I suppose you’re right that there’s some change of perspective on my end. I think it happened here, when Shevy stormed out during our first session. It was so humiliating. But the worst part was that she didn’t even seem to care afterwards. She didn’t apologize or ask any questions. It seemed really entitled and off-base to me.”
“That’s really good insight, Leah. Let’s talk about this hierarchy. It’s more than just the understanding that the parents are in charge. In SFT, there are three identified subsystems. You make up two of those subsystems ⸺ the spousal subsystem and the parental subsystem. From the spousal subsystem, the children learn about intimate relationships. From the parental subsystem, the children will learn about authority, trust, and develop a sense of self.
“Then there’s the sibling subsystem, which is the child’s first peer group. It’s in this system that they learn how to get along, how to negotiate, and how to deal with conflict. A note on that. It’s important that the parental subsystem allow the sibling subsystem to function without too much interference.”
“Okay, that makes sense. But how do we create these subsystems?” Yehuda inquired.
“They already exist. They just need to be reinforced with boundaries. The first step is knowing and acknowledging that there are subsystems. And the second is creating the boundaries to enforce them.”
“What type of boundaries do we need to impose? I’d like to think our house isn’t a crazy free-for-all. I think we have boundaries.” Leah sounded defensive.
“Yes, I’m sure you do have boundaries. However, the key piece here is consistency and clarity. Some families may be more rigid, some less so. But whatever way you choose to be needs to be reinforced. It also needs to be developmentally appropriate.
“For example, let’s say you have expectations that the children sit and eat quietly at dinner or through the Shabbos seudah. That may be okay for your older kids, but is it an appropriate expectation for your three-year-old?
“Also, it’s important to reinforce both physical and emotional boundaries. Can you think of some that may apply?”
“A physical boundary that comes to mind is the kids not coming into our room without knocking. Sometimes the little ones barge in, and I don’t like it.”
“That’s a good example. That sets a physical boundary between the spousal subsystem and the children. Excellent. What are some other physical boundaries?”
“The kids fight a lot over people touching each other’s stuff. Maybe they can each have their own drawers or boxes that no one else is allowed to touch? I wish they could have their own rooms, but that’s not an option. We have five bedrooms, including ours, so each of them shares with a sibling.”
“Great idea! And I think it’s good for them to share rooms because they can practice being respectful of their sibling roommate ⸺ a skill that’s important for seminary or yeshivah, and of course, marriage. What are some other boundaries you can think of?”
“Well, it bothers me when the older kids try to parent the younger ones. Sometimes, they all gang up on Shevy. In thinking of these boundaries, wouldn’t it make sense that we make it very clear that we’re the parents?” Yehuda inquired.
“Yes. That should be a clear demarcation. However, here’s the thing. When we have large families, it’s sometimes necessary for us to rely on the older kids to help the younger kids. So, if you expect your older girls to help the younger ones often with things that normally parents do ⸺ like making supper or doing bath and bedtime ⸺ then it’s more difficult to draw that boundary. On one hand, you’re giving them a lot of adult responsibility, but on the other, you don’t want them voicing their opinions.
“I think if you’re conscious of this dynamic, you can work with it. Don’t give the older ones too much parent-like responsibility. To do bath time or bedtime or babysit once in a while is normal, but not to do so on a regular basis. You can also ask them for their opinions in a thought-out, controlled way.”
“Okay. I hear that.” Leah nodded. “But in the moment, how can we establish and enforce boundaries? When a kid starts parenting another kid, what do we say? Do they get a punishment?”
“What do you think?” I intoned back.
“We can’t just punish them. We have to give them warning. I guess we can just say, ‘I’m the parent and you’re the child,’ or something like that?”
“Perfect! It doesn’t have to be anything harsh. You can simply say, ‘Thanks, but I’m the mother, and I have this under control’ or ‘I appreciate that you care about your sister so much, but Mommy and Tatty are handling this. You don’t have to worry.’”
Yehuda and Leah nodded. Leah reached for the clipboard I keep near my couch with blank paper and jotted down a few notations.
“You know,” I continued, “one of the benefits of drawing these boundaries is not only do you have more control and cohesion as the authorities in your family, but the older kids are at less of a risk of being ‘parentified.’ It’s important for them to feel secure in their roles as children, even if they’re in their late teens.”
I definitely felt an energy shift between the couple. “What are you both feeling right now?” I implored.
“I feel more in control. Like we have a plan,” Yehuda shared.
“Yes, I feel more…empowered? Part of what was so stressful about Esty’s journey with her eating disorder was the unpredictability and the loss of control. While I’m not looking to control Shevy, we were definitely relegated to a more reactive or passive stance, and it was bad for everyone. I’m feeling more proactive, and therefore more grounded.”
It was the first time I saw Leah smile.
“That’s wonderful. For homework, try to come up with a list of house rules and expectations so everyone is aware of what is going on. Also, please note any altercation so we can review it here in session for you to bring back to the family meetings.”
We booked for the following week. Yehuda and Leah left, their homework in hand, walking in step with each other.
Dealing with Dynamics
The next week Yehuda and Leah walked in comfortably. This usually happens around session three or four, when the client feels at ease with the therapeutic dynamic, and sits down as relaxed as if they’re in their own living room.
“Hi to both of you. How was your week?”
Leah gave a half smile. “Um, it was interesting. The kids were laughing that we were taking notes on everything. We felt like amateur journalists.”
“It’s strange to see your family dynamics through a reporter’s lens, huh? Before we get to the incidences, were you able to create a system of responding to Shevy and the other kids’ misbehaviors?”
“Yes.” Leah handed me a printed copy of rules and consequences. “But honestly, it was a challenge. We don’t see eye to eye on a lot of things. But we managed a basic protocol of how we respond, in what time frame, and we discussed concrete consequences based on behaviors.
“We printed up the list for Shevy so she can know exactly what is required of her. Any of the actions and consequences that applied to all the kids we put up on the fridge ⸺ things like not doing homework or skipping school.”
“Wow! Excellent idea. Not only does that set really clear expectations for the others, but it probably made Shevy feel less like she was the focus.”
“I would say there was about 80 percent compliance,” Yehuda commented.
“That’s pretty impressive for the first week! Okay, did you record a particular altercation that we can discuss here and enact what happened?’
“What do you mean, enact?” Leah looked slightly alarmed.
“Just what it sounds like, Leah. What was the altercation? Who was involved?”
“Yehuda and Shevy. And then Esti got involved and our 12-year-old, Dovid.”
“All right, Yehuda, you’ll play yourself, and Leah, you be Shevy.” I scribbled two names on some paper. “Then when necessary, Leah, you will transition to be Esti, and Yehuda, you’ll also be Dovid.”
Leah and Yehuda looked confused.
“This is why it’s great if more people from your family can come in, so you don’t have to double up on roles, but honestly, this isn’t a full-feature Bais Yaakov play. It’s just a reenactment of what happened so I can see it through your perceptions. No one is judging your acting skills. Go ahead.”
“Okay. Let’s do this, Yehuda. I’m Shevy now.”
“Ta.” Leah pretended to chomp on some gum and slouched on the couch. “I need some money.”
“Um, uh, Shevy,” Yehuda answered somewhat awkwardly. “What do you need money for?”
“Shopping.” Leah extended her hand and rolled her eyes.
“No, Shevy. You have your babysitting money if you want to buy something new. Mommy just got you all the new clothes you need.”
“Ta, I’m saving my money for new headphones! I can’t believe you’re not going to give me some money for clothes. It’s like a basic human need. What am I going to tell my friends? That my parents are abusive and don’t give me clothing?”
My eyebrows shot up. I looked over at Yehuda for verification that Shevy had actually said that. He nodded.
Leah grabbed her “Esti” sign. “Shevy! You’re so disgusting! Mommy just took you shopping. Use your own dumb money, you spoiled brat.”
Leah expertly switched back to “Shevy.” “I’m spoiled?! Excuse me, Mrs. Queen of the House. Why don’t you just suck up to Mommy and Tatty more? Get out of here! I wasn’t talking to you.”
Yehuda grabbed his Dovid sign. “Can you guys stop? My friend is over, and we can hear you! It’s totally embarrassing.”
Leah, holding her “Shevy” sign, looked squarely at “Dovid.” “This family is embarrassing, Dovid. You should know that by now.”
Both dropped their signs. “And then Shevy left.” Yehuda sounded tired. “She was gone for six hours, presumably out shopping with her friends. She didn’t answer her cell phone. When she came home, she went straight to her room and fell asleep.”
“Wow. That was painful to watch here. It must have been even more so in real-time. Leah, where were you?”
“I was there. Watching in horror, knowing we would have to come and report it back to you. Although, honestly, there were several interactions like that this week. We just chose this one because the scenes are basically all the same: Shevy demanding and exaggerating, Esti rescuing, and then Shevy raging.”
“Okay, so let’s unpack this. Yehuda, you stuck to your boundary of not giving Shevy any money. That’s very good. What were you doing while the siblings were fighting?”
“Well, I was a bit confused. You had said that we should let the sibling subsystem figure it out on their own.”
“Yes, good point. However, in this case, Esti overstepped her role and got involved in what should have been an exclusively parent-child conversation. So next time that happens, what can you say?”
“Something like, ‘Thanks, Esti. I know you’re trying to help, but this conversation is between me and Shevy.’ ”
“Exactly. That will shut down any explosive sibling sub-reaction. And how about Dovid?”
“I’m not sure.” Yehuda looked over to Leah, who shrugged.
“What do you think Dovid was feeling then?”
“Yes. Maybe insecure. Maybe scared. It’s a good idea here to validate this real concern of Dovid’s. What could you have said to him?”
“Dovid, you’re right. I’m sorry. Shevy will not be allowed to continue to carry on like this.”
“That works. Did Shevy get a consequence the next day for how she spoke and the fact that she was unreachable?”
“I wanted to punish her, but Leah wasn’t certain and said we should wait for your input.” I noticed Yehuda shoot Leah an annoyed look.
“Okay. I hear that, but Shevy definitely needed to get the message that talking and acting like that isn’t acceptable. An appropriate consequence would be no going out shopping or with friends for a period of time. Remember, kids feel safe when there are boundaries. As much as they may rail against them, ultimately, when they feel their parents are in control ⸺ especially when parents are fair and full of love, like you two ⸺ your kids will feel more secure.”
Leah looked over at Yehuda nervously. I could sense there was something going unsaid. “Shevy actually said something very interesting when we spoke to her the next day. I asked her what she meant that Esti was the queen of the house…” Leah explained.
“Excellent question! Great job trying to understand what’s behind her strong words and reactions.”
“Yes, well, she said we love Esti more. I asked her why she thought that, and basically it became apparent that while we were helping Esti with her eating disorder, Shevy got the message that she was loved less than Esti and her other older sisters, who knew more about what was going on.
“Shevy was in fifth grade at the time. We were just trying to protect her. Why should an 11-year-old know about these things? But obviously Shevy felt ignored and shut out.”
“That’s incredible awareness and honesty. How did you respond?”
“I told her we were just trying to protect her out of love. And we love everyone the same. But I don’t know if she believed me.”
“I think the more you model consistency and establish your boundaries, the more she’ll feel secure. And knowing this information, is it possible to see Shevy not as the belligerent 14-year-old she is now, but as the hurting 11-year-old who didn’t understand what was going on? Maybe it’s time to address the fears of that 11-year-old, and even spend time with Shevy that she missed out on as a younger child.”
“I don’t think she’ll want to hang out with us.” Leah sounded doubtful.
“Could be. But you can offer to take her out for a hot chocolate. Keep showing up emotionally for her. Now that you see that at the core of her acting out may be a feeling of rejection, I’d just consistently offer to be there for her, on her terms.”
Leah and Yehuda nodded.
“That doesn’t mean letting her get away with being disrespectful behavior. Remember, you’re the adults. Don’t feel rejection or resentment if she doesn’t want to hang out with you. She may be testing your intentions.”
“Okay, so homework is…taking Shevy out?” Leah inquired.
“Yes. And reinforcing your house rules and following up on consequences, as well as recording any major altercation to process back here in session.”
Leah and Yehuda seemed lost in thought as they left. There was a definite shift, however, with the new information that better framed Shevy’s reactions.
I worked with the family for 20 sessions, which is approximately the projected number of sessions needed to fully implement SFT. The majority of the sessions involved only Yehuda and Leah. They were diligent in following through with their homework, family discussions, and follow-up. As the months progressed, it became apparent that Shevy responded well to both the consistent establishing of boundaries and the reframing of core motivations.
She eventually said yes to hanging out with her parents. Due to her revelation, Yehuda and Leah were often able to see Shevy as a hurting little girl instead of an obnoxious, defiant teen. Soon, Shevy began to receive the type of attention and love she needed, and her overall behavior changed. At our termination session, Yehuda and Leah were exuberant.
“It’s not like it’s all roses,” Yehuda summarized. “But now, Leah and I are definitely on the same page that whatever comes up truly is normal teenage stuff. We have the ability to reframe and work with the feelings that are present. It’s so empowering. Such a turnaround!”
“This is from the kids.” Leah beamed as she held out a plate of fresh cookies and a handmade card signed by all the children. “Even though they didn’t attend sessions, they want you to know this whole process led to such important change at home, and they’re grateful.”
“Thank you. I hope both you and they know you guys did all the hard work. The restructuring and the reframing all came from the two of you. You have a lot to be proud of.”
Leah and Yehuda got up together and left, as I marveled at how a whole family can change course with hard emotional work, consistency, awareness, and honesty in just a matter of months.
Reframing is all about shifting one’s perspective so it’s more constructive and positive. This can be done at the individual or familial level.
Shift from passive to active: “I really doubt I can do anything about this.” Instead say, “What is one small step I might take?”
Shift from negative feeling to positive feeling: “I don’t want to work on that now because it makes me feel sad.” Instead say, “What small part of that might leave me feeling a bit happier?”
Shift from past to future: “I’ve never been good at public speaking.” Instead say, “Imagine yourself to be successful at public speaking. How would you speak?”
Shift from future to past: “I can’t seem to get started on achieving this goal.” Instead say, “Has there been a time in the past when I achieved a goal and if so, what did I do then to be successful? How might I use that approach now?”
Shift from others to oneself: “They don’t seem to like me.” Instead, ask, “What do I like about myself?”
Shift from victimization to empowerment: “That always seems to happen to me.” Instead say, “Sometimes we mess ourselves up. Perhaps it’d be useful to explore if I’m somehow getting in my own way?”
Shift from a liability to an asset: “I’m such a perfectionist.” Instead say, “How might being a perfectionist help in my job and life?”
Abby Delouya maintains a private practice in Montreal, Canada.
(Excerpted from Family First, Issue 686)
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