STRATEGIC FAMILY THERAPY

STRATEGIC FAMILY THEORY AND THERAPY

BACKGROUNDS

The concept was inspired by the work of Milton Erickson, MD and Don Jackson, MD and has been associated with (but not limited to) the work of Jay Haley and Cloe Madanes (founders of Family Therapy Institute of Washington, DC in 1976), the Brief Therapy Team at the Mental Research Institute (John Weakland, Dick Fisch, and Paul Watzlawick), the Milan School of Family Therapy, and the work of Giorgio Nardone.

The theory of strategic family therapy evolved from many of the gains in early family therapy models that were made by Milton Erickson and Don Jackson, with many other influences from such therapists as Salvador Minuchin, Gregory Bateson, and other prominent early family therapists. Strategic family therapy grew along with, and out of, other theories, most importantly, structural family therapy in the late 1960s and early 1970s at the Mental Research Institute in Palo Alto, and later at the Philadelphia Child Guidance Center. Many early family therapy theories were growing and influencing each other between the late 1950s and late 1970s. At first glance these theories don’t seem to have direct connections,but many of the influential therapists of the time worked with each other and there was a natural give and take between these theories.

Strategic family therapy was no exception to this organic growth of the theory. The main proponents and creators of the theory were Jay Haley and Cloe Mandanes. Jay Haley had worked at the Mental Research Institute in Palo Alto and the Philadelphia Child Guidance Center, and had worked directly with Erickson and Minunchin. Haley and Mandanes took their knowledge of structural therapy and the ideas of how families work on a structural level, but added ideas like making the therapist take more initiative and control over the client’s problems.

The therapist seeks to identify the symptoms within the family that are the cause of the family’s current problems, and fix these problems. In strategic family therapy the problems of the clients stem not from their family’s behaviors toward the client, but instead it is the symptoms of the family that need to be corrected. In strategic terms a symptom is “the repetitive sequence that keeps the process going. The symptomatic person simply denies any intent to control by claiming the symptom is involuntary.

GOAL

Fisch (1978) stated 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 strategic family therapy model does not presuppose any model or notion of normality; it only consider what the client system brings to the therapy as the identified issue that has generated some "discontent". This notion of neutrality in regard to ideas about normal family functioning clearly puts this model at odds with other models of family therapy.

The primary goal of therapy, then is the resolution of the presenting concern. The main way such a resolution is reached is by creating first-and second-order changes in the family system through the use of the techniques mentioned above. Strategic family therapy tends to work on mutually agreed-upon behavioral goals that lead to such change within the system. As such, this model shares some similarities with cognitive-behavioral family therapy. The behaviors of the family members, individually and as a system, can be identified through the process of assessment and steps taken (techniques) to move the family toward trying new behaviors to break the circular causality that has led to the escalation of the identified problem.

The strategic family therapy model does not presuppose any model or notion of normality; it only considers what the client systems bring to the therapy as the identified issue that has generated some ‘discontent’. The primary goal of the therapy is the resolution of the presenting concern. The main way such as a resolution is reached is by creating first – and second – order changes in family system through the use of the techniques. Strategic family therapy tends to work on mutually agreed-upon behavioral goals that lead to such change within the systems.  

CONCEPTS AND PROCESS

There are a number of concepts and processes that must be applied that are instrumental for SFT to succeed. The initial session is one of these processes, and is broken down into five different parts, the brief social stage, the problem stage, the interactional stage, goal-setting stage, and finally the task-setting stage.

• The brief therapy stage seeks to observe the family’s interactions, create a calm and open mood for the session, and attempts to get every family member to take part in the session.

• The problem stage is where the therapist poses questions to the clients to determine what their problem is and why they are there.

• The interactional stage is where the family is urged to discuss their problem so the therapist can better understand their issues and understand the underlying dynamics within the family. Some of the dynamics that strategic family therapists seek to understand are: hierarchies within a family, coalitions between family members, and communication sequences that exist.

• The goal-setting stage is used to highlight the specific issue that needs to be addressed, this issue is identified by both the family members and the therapist. In addition when discussing the presenting problem initially identified by the family, the family and the therapist work together to come up with goals to fix the problem, and better define the parameters for attaining those goals.

• The final stage of the initial session is the task-setting stage. In the task-setting stage the therapist wraps up the session by coming up with concrete homework assignments or directives the family can do outside of therapy to start to change their problems. Additional therapy sessions seek to further gain understanding to a family’s problems, dynamics, and to dig deeper in addressing their needs through a confident, controlling, and compassionate therapist.

INTERVENSION

Some less complicated but often used interventions in SFT would be, prescribing the symptom, relabeling, and paradoxical interventions. Prescribing the symptom would be when the therapist attempts to exaggerate a specific symptom within the family to help the family understand how damaging that symptom is to the family. The relabeling intervention is done within the session by the therapist to change the connotation of one symptom from negative to positive. In this way the family can view the symptom in a new context or have a new conceptual understanding of the symptom.

Finally a paradoxical intervention is similar to prescribing the symptom, but is a more in depth intervention than prescribing the symptom.

• Initially the therapist tries to change the family’s low expectations to one where change within the family can happen.

• Second, the issue that the family wishes to fix is identified in a clear and concise manner.

• Third, and in line with the goal-setting stage, the therapist seeks to get the family to agree to exactly what their goals are in addressing their problem.

• Fourth, the therapist comes up with very specific plans for the family to address their issue.

• Fifth, the therapist discredits whomever is the controlling figure of the issue.

• Next the therapist replaces the controlling figure with their own authority and issues a new directive to fix the family’s identified problem. The new directive for the family is usually to paradoxically do more of the problem symptom, and thereby to highlight it more within the family.

• Finally the therapist learns the outcome of the directive and seeks to push the paradox even further until the family rebels, or change occurs within the family.

TECHNIQUES
The Strategic approach focused mostly on strategies adapted to the specific situation of the person and problem, as did Erikson. Each of the three models is somewhat different.

A. The Mental Research Institute (MRI) Techniques - there are basically 6 steps to treatment   1.introduction and setup - MRI's limit session to 10 and set up a powerful motivator 2.definition of the problem in clear behavioral terms 3.estimation of the behavior (run away positive feedback loops) maintaining the problem 4.setting goals 5.selecting and making interventions   a.reframing - providing the family with a rational for treatment. The MRI therapist may not believe what they tell the family, but that is unimportant as long as its a rational explanation. The point of it is not to bring insight, but to induce compliance b.outpositioning - having someone take the role other family members place on them to the extreme c.paradoxical interventions - compliance based, to simply get the family to change their behavior by complying with a directive, or defiance based, in the hopes that the family will defy the directive and improve d.symptom prescription or an exposure based paradox - to expose the family's hidden relationships e.restraining techniques - telling the family they can't move very fast because they aren't ready 6.termination B.Haley and Madanes use many of the same strategies listed above, but with the hope of changing the family's structure in the long run. Therapy begins by   1.a social stage - everyone is greeted and spoken to in order to make everyone feel more relaxed and less defensive 2.a problem stage - introduce yourself and repeat what you know, then speak to each person and get their opinions and ideas about the problem. Haley engages the father first, and observes all the family members interactions to uncover hidden triangles. 3.an interaction stage - Haley has members talk about differing perspectives on the problem. He can observe then the family interactions around the problem. By asking what they have tried before, he gains information and also underscores the family's need of his help. Haley may end a first session with a simple directive, not advice, but a directive. Haley may prescribe some ordeal, such that the cost of maintaining the symptom is more than the benefit of the symptom. Usually each member is told they will benefit from the directive to increase compliance. Madanes often had people follow a directive by telling them it was just for pretend or play. Haley focused more on restoring power to the parents, while Madanes focused more on creating new and pleasurable interactions for the parent and child. Madanes developed a classification system for families, as well as guidelines for when to use hers, Haley's, or MRI techniques. C.Milan - There are several Milan models. The original model was very strategic. Families were treated by a male and female cotherapist team; therapy were observed by other members of the team; families were seen once a month for only 10 sessions. Therapy were supposed to be neutral and distant. Sessions had 5 parts   1.presession - tentative hypothesis are made 2.session - the hypothesis are tested and refined 3.intersession - the team would meet with the therapy while the family waited 4.intervention - the therapy would return to deliver the intervention. There are several interventions usually used   a.positive connotation - reframe the problem but in a way that the family members are not blamed or labeled as bad b.rituals were directives to engage the whole family in some behavior that exaggerated or broke rules and family myths. Family members may thank each other for their respective symptoms, mother and father may alternate days for parental responsibilities…. 5.post-session - the team would analyze the family's reaction and plan for the next session Later, Palazzoli explored dirty games and power struggles in the family, ways to restore boundaries, and separate members. Boscolo continued the interviewing, but made that the focus of his intervention, rather than strategies.

REFERENCES

Alan Carr.(2006). Family Therapy- Concepts , Process and Practice- Concepts , Process and Practice Second Edition: Wiley Series in Clinical Psychology. m/s 85-135.

Janice M. Rasheed,Mikal N.Rasheed, James A.Marley.(2011).  Family Therapy-Models and Techniques. America:SAGE Publications. m/s 245-262.

Goldenbeg, Goldenberg, 2008 p. 277

Richard N, Phd Resources  for student and professional .www pchypage.com