Ecosystemic Structural Family Therapy: Theoretical and Clinical Foundations

Ecosystemic structural family therapy (ESFT) is a systemic, strength-based, and trauma-informed family therapy model that has evolved from structural family therapy (SFT; Minuchin in Families and family therapy, Harvard University Press, Cambridge, 1974). ESFT is an evidenced-based family therapy approach designed to intervene with families of children who are experiencing behavioral health problems and are at the risk of out-of-home placement. In this article we review the theoretical, applied, and empirical evolution of ESFT relative to extant SFT models. ESFT is based on the fundamental assumption that child, parental, and marital functioning are inextricably linked to their relational environment. Five interrelated constructs guide ESFT therapists in their understanding of clinical problems: family structure; family and individual emotional regulation; individual differences (e.g., historical, biological, cultural, developmental); affective proximity; and family development (Gehart 2010). ESFT has an extensive evaluation history dating back to the 1980s involving over 4,000 families in 39 different sites. While ESFT is considered evidence-based, it might be more consistent with “Practice-Based Evidence” given its long, extensive, and successful, history in the child mental health system in Pennsylvania.