Strategic Family Therapy

1
Strategic Family Therapy

• Chapter 6

2
Theoretical Formulations

• Watzlawick, Beavin and Jackson focused on mapping
  the framework of human communication using the
  concept of The Pragmatics of Human Communication
• The Pragmatics of Human Communication is composed
  of a series of different axioms
• The first axiom states that people are always
  communicating
• It is important to remember that the framework of
  all behavior is communicative
• Communication still takes place in situations
  where there is an absence of mutual
  understanding or if it was done unconsciously or
  unintentionally
• The second axiom states that all messages contain
  two functions report and command

3
Theoretical Formulations

• The presence and utilization of Command messages
  within a family, results in the individuals
  accepting these messages as rules.
• This phenomenon can be witnessed from the
  observation of the redundancy of interactions
  between family members
• Don Jackson used the term family rules to
  describe regularity, and not regulation.
• There isnt a specific individual who sets the
  rules as a matter of fact, family members often
  fail to recognize their presence.

4
Theoretical Formulations

• The rules which govern family interaction
  function as a method of ensuring the maintenance
  and preservation of family homeostasis.
• Homeostasis is responsible for bringing the
  family back to its original state (equilibrium)
  when experiencing any type of disturbance making
  the family very resistant to change
• Jacksons definition of homeostasis closely
  resembles the conservative idea of a family
  system as well as, bearing a very close
  resemblance to the concept of negative feedback.

5
Theoretical Formulations

• Communication researchers hold that families are
  inherently goal-oriented
• Researchers decided avoided searching for basic
  motives
• Instead they chose to assume circular causality,
  in order to investigate specific modes of
  communication bonded by additive chains of
  stimulus and response as feedback loops
• For example if a member of the family elicits a
  response in reaction to a challenging behavior or
  situation exhibited by another member of the
  family, this response chain is defined as a
  positive feedback loop

6
Theoretical Formulations

• The benefit of this procedure lies in its focus
  on specific relationships which cause various
  difficult situations.
• These interaction can then be modified and
  altered, instead of making various assumptions
  about the causes which are very resistant to
  change

7
Theoretical Formulations

• Strategic Therapists employed the concept of the
  positive feedback loop as the primary component
  of their models
• The MRI therapists stated that all families will
  inevitably come into contact with a number of
  problems in their lives
• The reactions exhibited by the family in response
  to the aversive or unfavorable events, determine
  whether or not the difficult transforms into a
  problem
• Families make various attempts, which at the time
  seem reasonable but in actuality, turn out to be
  faulty attempts made in trying to uncover a
  resolution for their problems
• When they discover that their issues still
  exists, individuals end up using the same
  ineffective and maladaptive response methods
• This results in the production of a vicious cycle
  of these behaviors.

8
Theoretical Formulations

• The majority of family behaviors are controlled
  and regulated by unspoken rules
• Rules promote and encourage inappropriate
  solutions to problems it turns out that it isnt
  only the behavior needing to be altered, but the
  rules need to be changed as well
• First-Order Change occurs when only a particular
  behavior within the system changes
• Nichols defines First order changes as
  temporary or superficial changes within a system
  that do not alter the basic organization of the
  system itself
• Nichols defines Second-order changes as basic
  changes in the structure and functioning of a
  system
• Second-Order Change takes place when there is a
  modification or alteration to the rules within
  the system

9
Theoretical Formulations

• The question remains of How Do We Change The
  Rules?
• One method which can be utilized to change the
  rules is through Reframing
• Reframing involves the complete transformation of
  the families definition of behavior in order to
  facilitate, its compliance and willingness to
  achieve therapeutic change
• The method used by the MRI group to deal with
  problems is
• Identify the positive feedback loops responsible
  for maintaining the problem
• Determine the Rules or Frames supporting those
  interactions
• Find a way to change the rules to interrupt the
  maintenance of the problem

10
Theoretical Formulations

• Jay Haley stressed the importance of the rules
  surrounding the hierarchical structure of family
• Haley believed that the cause of most behavioral
  problems lies in ineffective parenting
  hierarchies
• Haley utilized Eriksons method for ordeals in
  order to set a higher price for the individual,
  for maintaining a symptom than for giving it up

11
Normal Family Development

• The General Systems Theory model states that
  normal families, like all living systems, depend
  on two vital processes
• They maintain integrity in the face of
  environmental challenges through negative
  feedback
• All living systems require a coherent structure
  in order to survive however having an overly
  rigid system hinders the families ability to
  adapt to changing conditions and situations
• This is the reason why appropriately functioning
  families also possess a positive feedback system

12
Normal Family Development

• Negative Feedback defends the system from any
  disruptions in order to provide a state of
  stability and balance
• Positive Feedback works to intensify or increase
  change in order to adjust to various alterations
  and variations of events and behaviors
• In essence, the main point is that healthy
  families have the capability and willingness to
  change.
• This is achieved as a result of the establishment
  and preservation of open and clear lines of
  communication as well as, the families
  adaptability

13
Normal Family Development

• The individuals in the MRI group firmly oppose
  the idea of standards of normality, stating that
• As therapists, we do not regard any particular
  way of functioning, relating, or living, as a
  problem if the client is not expressing
  discontent with it.
• The MRI group strongly opposed taking a position
  regarding what they believe constitutes proper or
  appropriate behavior in families.
• The Milan Associates made every effort to
  maintain a position of neutrality refraining
  from using any preconceived goals or normative
  models when treating families.

14
Normal Family Development

• They chose to discuss various questions and
  uncertainties which in turn, facilitated the
  families ability to examine themselves.
• The central focus of Haleys approach
  concentrated on the notion of sound family
  functioning
• The purpose of his therapeutic method aimed to
  assist families in the process of reorganizing
  themselves, into more functional structures
  which encompass explicitly stated boundaries, as
  well as a generational hierarchy

15
Development of Behavior Disorders

• Communication theory stresses that the
  fundamental purpose of symptoms is responsible
  for sustaining homeostasis within the family
• Poorly functioning families were regarded as
  being trapped in homeostatic, dysfunctional
  patterns of communication
• These particular families displayed a strong
  adherence towards inflexibility responding to
  various alterations and modifications as negative
  feedback
• These particular families regard change as
  something that is threatening instead of an
  opportunity for growth

16
Development of Behavior Disorders

• Strategic Models provide three different
  explanations, which describe the method by which
  problems develop
• The first is Cybernetic Difficulties are turned
  into chronic problems by misguided solutions,
  forming positive-feedback escalations
• The second is Structural Problems are the
  results of incongruous hierarchies
• The third is Functional Problems result when
  people try to protect or control one another
  covertly, so that their symptoms serve a function
  for the system
• The individuals in the MRI group associated
  themselves with only the first explanation
• Haley and The Milan Associates acquainted
  themselves with all three explanations

17
Development of Behavior Disorders

• The central theme of the strategic model states
  that self-defeating behaviors are responsible for
  the maintenance of problems in an individuals
  life
• Haley drew attention to the notion that
  self-defeating patterns of behavior may possibly
  be a contributing factor to dysfunctional family
  organizations
• Families must be able to alter their
  configuration or construction in order to
  facilitate changes within the family

18
Goals Of Therapy

• The therapeutic methods of Strategic Family
  Therapy proclaims that as soon as the individuals
  presenting problem is treated, the therapy is
  terminated
• The policy of terminating therapy as soon as the
  presenting problem is resolved, even extends to
  situations where other issues exist.
• If the family members fail to personally request
  therapeutic intervention for these behaviors, the
  therapist refrains from targeting them
• MRI therapist provide an explanation in regards
  to this issue by stating that, they view those
  individuals who have problems as being stuck
  rather than sick
• Their role and responsibility as a therapist lies
  in proving a little assistance or a small push to
  help the individual get moving again

19
Goals of Therapy

• One of the obligations that MRI therapists are
  held responsible for is assisting the family
  members to identify and define clear, attainable
  goals this way all the family members are made
  aware to recognize when the treatment is deemed a
  success
• Strategic therapists go on to state that the
  majority of the time in the treatment session is
  spent driving and motivating the clients to
  establish a set of clear behavioral goals
• The reason for this is that through the
  establishment of clear behavioral goals, clients
  are pressured to clarify ambiguous
  dissatisfactions
• Pushing clients to provide concrete definitions
  of their goals, leads to the disappearance of
  their utopian desires and wishes which almost
  always result in disappointment

20
Goals of Therapy

• The foundations of the MRI model are behavioral
  in its goals, as well in its observations of
  pattern interactions
• In order to achieve the largest objective of
  problem resolution, the primary priority lies in
  altering the behavioral reactions exhibited by
  the individual in response to their problems
• The therapist may employ a number of different
  methods to accomplish their target goal of
  behavioral change
• Such as reframing the problem, while
  simultaneously, presenting a cognitive element to
  the client.
• Strategic theorists should never engage in
  practices of placing the blame on the clients
  lack of motivation, as a result of the treatment
  failing conversely, they should discover methods
  to provide their clients with motivation

21
Conditions For Behavior Change

• The MRI method of resolving problems is to alter
  the behaviors that are associated with them
• The theory holds that through the clients
  visualization of the results that occur in
  response to the alteration of rigid behavioral
  responses, this will yield a higher degree of
  flexibility of problem-solving skills in clients
• The presence of this event, causes clients to
  achieve a second-order change (Changes in the
  rules governing their responses to problems)

22
TherapyAssessment

• The objectives of MRI assessment are
• 1. Define a resolvable complaint
• 2. Identify attempted solutions that maintain the
  complaint
• 3. Understand the clients unique language for
  describing the problem
• The first two goals direct the therapist to the
  point where they should intervene, while the
  third goal relates to the how

23
Assessment

• The first step of assessment requires the
  therapist to become very specific regarding, the
  behavioral complaint, the individual who sees
  this behavior as maladaptive or problematic, and
  what features currently make it a problem
• As soon as there is a clear definition of the
  problem, the therapist goes on to determine the
  individuals who have made attempts to try and
  solve the issue, and what methods or
  interventions they used
• Posing this question, results in the appearance
  of a specific procedure or method of the
  problem-solution loop, as well as the target
  behaviors which will become the focus of
  intervention
• The strategic method represents a 180-degree
  rotation from what the client has previously been
  doing
• The main focus of assessment is to prohibit the
  performance of the behavior responsible for
  maintaining the problem \

24
Assessment

• It is crucial to acquiring a solid understanding
  of the clients unique language along with the
  specific modes they employ to see their problem.
• It is vital component necessary to acquire in
  order to facilitate the process of framing
  suggestions which relate with specific tactics
  and strategies the client will recognize and
  agree to

25
Therapeutic TechniquesMRI Approach

• The MRI model adheres to a six-step treatment
  procedure
• 1. Introduction to the treatment setup
• 2. Inquiry and definition of the problem
• 3.Estimation of the behavior maintaining the
  problem
• 4.Setting goals for treatment
• 5.Selecting and Making Behavioral Interventions
• 6.Termination

26
MRI Approach

• Once the introductory steps have been completed,
  the therapist then proceeds to ask for a clear
  definition of the target problem
• If the client states the problem vaguely, the
  therapist steps in to assist the process of
  translating the problem to feature clear and
  concrete goals
• After a clear definition has been established for
  the clients problems and goals, the MRI
  therapist proceeds to make inquiries about the
  previously attempted solutions, which might serve
  as the feature responsible for the maintenance of
  the problem

27
MRI Approach

• Typically, the solutions which have an
  inclination to be held responsible for the
  production of the problems fall into one of three
  categories
• 1. The solution is to deny that a problem exists
  action in necessary but not taken.
• 2. The solution is an effort to solve something
  that isnt really a problem action is taken
  where it shouldnt be
• 3.The solution is an effort to solve a problem
  within a framework that makes a solution
  impossible action is taken but at the wrong
  level

28
MRI Approach

• Once the therapist generates a strategy which
  will be utilize for changing the problem-
  behaviors maintaining the sequence, clients must
  then be persuaded and influenced to ensure that
  they will adhere to this method
• To accomplish the goal of persuading the client,
  MRI therapists reframe the problem in efforts of
  increasing the probability that the individual
  will comply
• To produce a disruption of the problem-maintaining
  sequences, strategic therapists may bring the
  family members into play, by attempting to get
  the family members to perform a behavior that
  contradicts common sense.
• These types of counterintuitive techniques are
  called paradoxical interventions

29
MRI Approach

• The methods that are frequently referred to as
  paradoxical represent symptom prescriptions which
  communicated information to the family
  instructing them to maintain or elaborate the
  specific behavior they find to be problematic
• In some situations these types of prescriptions
  may be accomplished with the anticipation that
  the family will attempt to act in accordance with
  it, and in turn require the reversal of their
  attempted solutions.
• In other situations the therapist may assign the
  symptoms, while secretly desiring that the
  clients will react against their assigned command
  with rebellion
• In other instances the therapists purpose of the
  prescribing symptoms is to increase the
  likelihood that this will expose the network of
  relationships maintaining the problem

30
MRI Approach

• MRI therapist attempt to steer clear of
  undertaking a position of power or authority
• Their one-down stance stand for the
  representation of equality, and summons clients
  to decrease their levels of anxiety and
  resistance

31
The Haley and Madanes Approach

• The definitive technique is the use of directives
  (Homework Assignments designed to help families
  interrupt homeostatic patterns of
  problem-maintaining behavior)
• Haley starts out by interviewing the entire
  family
• His approach to his preliminary interview adheres
  to a four stage model
• 1. Social Stage
• 2. Problem Stage
• 3. Interaction Stage
• 4. Goal- Setting Stage

32
The Haley and Madanes ApproachSocial Stage

• Initially family members display defensiveness
  when they first come to therapy as a result, of
  not knowing what to expect, or a fear that the
  therapist will place all the blame on them for
  their problems
• So Haley utilizes the first couple minutes of the
  session to help everyone calm down

33
The Haley and Madanes ApproachProblem Stage

• Haley asks each individual to describe their
  personal perspectives
• He asserted that since mothers are generally
  assume a more focal role than fathers, Haley
  preferred to speak with the fathers first in
  efforts of increasing their participation
• Haley makes a special effort to actively listen
  and understand the manner used by each individual
  in describing the problem making it a point to
  prevent any interruptions before each person has
  had their turn
• Haley uses this stage to locate and uncover
  various clues about triangles and hierarchy
• Haley resists providing his comments and opinions
  about these observations, to avoid running the
  risk of a particular family member interpreting
  his comments in a defensive manner

34
The Haley and Madanes ApproachInteraction Stage

• When everyone has spoken, Haley instructs the
  family members to talk to each other and discuss
  the statements and arguments each of them made
• This stage provides the therapist with the
  opportunity to observe, rather than just listen
  to the discussions and conversations which
  surround the problem
• As the individuals converse, specifically looks
  to locate any coalitions between the family
  members against one another
• Haley states that the definition of a truly
  effective therapist is not someone who tells
  people what to do, but one who gets them to do it
  

35
The Haley and Madanes Approach Haley

• An truly unique aspect about Haleys technique is
  his concentration on interpersonal payoff of
  psychiatric symptoms
• The notion that individuals receive something
  from their symptoms was rejected by the majority
  of schools of family therapy because it was seen
  as a method of placing blame on the victim
• The point that Haley was trying to emphasize, was
  that the development of problems such as anxiety
  contained the possibility of influencing,
  promoting and maintaining interpersonal
  struggles within the family

36
The Haley and Madanes Approach Haley

• The primary goal of Haleys treatment technique
  is to understand the heart of the family drama
  that symptoms revolve around
• Haley declares that peoples hardships carry a
  deeper meaning with it, and in turn suggest the
  ability of discovering reasonable solutions
• The solution lies in providing assistance to
  families with finding new methods and approaches
  they can utilize to resolve their issues

37
The Haley and Madanes Approach Madanes

• Cloe Madens illustrated the method by which one
  relationship can metaphorically imitate another
• Madens also focused on attending to the issue of
  power balance in couples, and the effects brought
  upon the role it plays on numerous symptoms
• Her concentration focused upon the lives of
  couples, where there is a regulation of power
  including issues of money, education, control of
  children, coalition with in-laws, religion and
  sex
• What Maden discovered was that the partner who
  held the least amount of power developed the most
  emotional problems
• Symptoms included depression, headache,
  substance abuse, eating disorders, and phobias
• Madanes made the observation that individuals
  will exhibit behaviors they wouldnt normally
  perform, if the behaviors are framed as play to
  develop an entire range of pretend techniques

38
The Haley and Madanes Approach

• The current name for Haley/Madanes therapeutic
  approach is strategic humanism
• Its still entails giving directives, however the
  directives are geared more towards encouraging
  and strengthening the family members capabilities
  to provide love and comfort to each other,

39
The Milan Model

• The previous Milan Model operated through
  treating families with a male-female co
  therapist, while being observed by other members
  of the team
• The customary layout contained 5 parts
• 1. Presession
• 2. Session
• 3. Intersession
• 4. Intervention
• 5.Postsession Discussion

40
The Milan Model

• The Positive Connotation was by far the most
  distinguished advance to emerge from the Milan
  Model
• Positive Connotation is Selvini Palazzolis
  technique of ascribing positive motives to family
  behavior in order to promote family cohesion and
  avoid resistance to therapy
• Rituals were employed in efforts of attempting to
  engage families in a sequence of actions which
  contradicted or exaggerated rigid family rules
• Rituals were also made use of to dramatize
  positive connotations

41
The Milan Model

• The Milan team originally represented therapy in
  terms of a struggle to achieve power between the
  therapist and the family
• Their main advice to the therapist was to remain
  neutral and avoid taking sides
• The exhibition of neutrality in the therapist was
  demonstrated as distance, so the therapist
  presented their melodramatic statements all while
  behaving in a remote and detached
• What ended up happening was families often became
  infuriated and never returned to therapy

42
The Milan Model

• In the early 1980s the original Milan group
  split.
• In the 1990s Selvini Palazzoli reinvented her
  therapeutic technique discarding the use of
  short-term, strategic therapy for long-term
  therapy with patients and their families
• The new technique focuses on understanding the
  denial of family secrets and suffering over
  generations

43
The Milan Model

• Circular Questioning hallmark feature of the
  Milan Model
• Circular Questioning designed with the intention
  of decentering clients by orienting them towards
  seeing themselves in a relational context and
  seeing that context from the perspective of other
  family members

44
Other Contributions

• 1. Strategic family therapists lead the way to
  the establishment of the team approach
• The interaction between teams and the therapist
  paved the way for later approaches where the team
  entered into a room and openly discussed the
  family while they watched
• 2. Functional Family Therapy focuses on the
  function that family behavior is designed to
  achieve
• Functional family therapists believe that the
  majority of behaviors exhibited by families are
  attempt to become either more or less intimate
  and through relabeling, facilitate the ability of
  family members being able to see each others
  behaviors in a benign light
• Also assists families in setting up contingency
  management programs to help them obtain the type
  of intimacy they desire