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 effectiveness of therapy with severely ill psychosomatic children are convincing because of the
physiological measures employed, and dramatic 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 ketoacidosis crises in psychosomatic-type diabetic
children. In baseline interviews parents discussed family problems with their children absent. Normal spouses showed the highest levels of confrontation, while psychosomatic spouses
exhibited a wide range of conflict avoidance maneuvers. Next, a therapist pressed the parents to increase the level of their conflict, while their children observed behind a one way mirror. As the parents argued, only the psychosomatic children seemed really upset. Moreover, these children’s manifest distress was accompanied by dramatic increases in free fatty acid
levels of the blood, a measure related to ketoacidosis. In the third stage of these interviews, 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 subject from themselves to the children. When this
happened, the free fatty acid levels of the parents 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.