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advancedstructural family therapyenactmentenmeshmentMinuchinanorexia nervosafamily boundaries
A PMHNP is conducting family therapy with a 16-year-old adolescent presenting with anorexia nervosa and her parents. During the session, the mother answers every question directed at the daughter, corrects the daughter's statements, and physically leans forward between the therapist and the daughter. The father sits silently at the periphery. When the daughter attempts to speak, the mother interrupts with 'What she means is...' The PMHNP, using structural family therapy, asks the mother and father to discuss together how they will support their daughter's recovery, while instructing the daughter to observe without speaking. During this conversation, the mother repeatedly turns to the daughter for validation, and the father defers to the mother on all decisions. Which structural family therapy concept and technique is the therapist employing?
Explanation
Enactment is structural family therapy's primary technique, in which the therapist directs family members to interact in session to reveal and restructure relational patterns. In families with enmeshment, enactments that strengthen parental subsystem boundaries and differentiate generational hierarchies address the structural dysfunction that maintains symptoms such as anorexia nervosa.
Key Takeaway
Structural family therapy uses enactments to make family interaction patterns visible in session. In enmeshed families, the therapist restructures boundaries by strengthening the parental subsystem and establishing clear generational hierarchies.