By far the strongest empirical support for
structural family therapy comes from a series of
studies with psychosomatic children and adult
drug addicts. Studies demonstrating the effec-
tiveness of therapy with severely ill psychoso-
matic children are convincing because of the
physiological measures employed, and dra-
matic because of the life-threatening nature of
the problems. Minuchin, Rosman, and Baker
(1978) reported one study that clearly demon-
strated how family conflict can precipitate ke-
toacidosis crises in psychosomatic-type diabetic
children. In baseline interviews parents dis-
cussed family problems with their children ab-
sent. Normal spouses showed the highest levels
of confrontation, while psychosomatic spouses
exhibited a wide range of conflict-avoidance
maneuvers. Next, a therapist pressed the par-
ents to increase the level of their conflict, while
their children observed behind a one-way mir-
ror. As the parents argued, only the psychoso-
matic children seemed really upset. Moreover,
these children’s manifest distress was accom-
panied by dramatic increases in free fatty acid
levels of the blood, a measure related to ke-
toacidosis. In the third stage of these inter-
views, the patients joined their parents. Normal
and behavior-disorder parents continued as be-
fore, but the psychosomatic parents detoured
their conflict, either by drawing their children
into their discussions or by switching the sub-
ject from themselves to the children. When this
happened, the free fatty acid levels of the par-
ents fell, while the children’s levels continued to
rise. This study provided strong confirmation of
the clinical observations that psychosomatic
children are used (and let themselves be used)
to regulate the stress between their parents.