Lecture 4: Strategic Family therapy

Systemic Comparative moduleNewham College University Centre

Kevin Standish

• hallmark of strategic thinking: A problem-centered and pragmatic approach that is more interested in creating change in behaviour rather than change in “understanding.”

Learning Outcomes

1. Describe the core concepts of Strategic Family Therapy (StFT)2. Conceptualisation of problems in StFT3. Therapeutic goals in StFT4. Therapist role in StFT5. StFT interventions6. Evaluation of StFT

Background/History of development

• Strategic family therapy developed from the strategic therapy of Milton Erickson,

• the brief therapy model of the Mental Research Institute (MRI),

• the structural therapy of Minuchin • the cybernetic theories of Gregory Bateson, • and the communication theory of Don Jackson. • Jay Haley & Cloe Madanes combined these elements

into strategic problem-solving therapy, which then evolved into a family systems approach .

Background influences• Pragmatics of Human Communication(Watzlawick, Beavin,

& Jackson, 1967), heavily influenced Haley and Madanes,: cannot not communicate.

• All messages have a report and a command function (Watzlawick, Bavelas, & Jackson, 1967).

• The report, or content of the message, conveys information.

• The command function may be implicit or implied. • EG the report, “our neighbor just insulted me!” may

convey a command: “Do something about it.” The command is not captured by words alone, but also through nonverbal communication.

• In families, command messages are patterned as rules, which Jackson termed family rules(Jackson, 1965).

Background influences• Strategic therapists used the concept of feedback loops and

made it central to their model. • The MRI group (Watzlawick, Weakland, & Fisch, 1974) : families

experience difficulties throughout their development. • Whether the difficulty becomes a problem or not depends on

how the family responds. • The family may attempt to solve the problem through various

means;• if the problem persists, they tend to do more of the same • attempted solution. • This escalates the problem, at which point the family will try

“more of the same solution,” and a cycle is created.

CORE CONCEPTS OF STFT

Core Concepts

– Family members’ behavior can only be understood within the family context

– Feedback loops maintain the solution as the problem.

– Symptoms are the result of misguided attempts at changing an existing difficulty

– Haley (1973) - therapist initiates what happens in therapy and plan for solving each problem

Core Concepts

Normal families are:• Flexible enough to modify solutions that do

not work.• Flexible enough to adjust to development.

Core Concepts• Symptoms and attempted solutions are

imbedded in a recursive feedback loop.• Symptoms are a homeostatic mechanism

regulating marital or family transactions.• Feedback loop is a positive loop that equals:

problem – attempted solutions – more problems – more (greater) attempted solutions, etc. Positive feedback loop says keep going in the direction. The answer is a negative feedback loop (restraint of any of the points in the system) or 1800

change.

Core concepts

• To interrupt this cycle, a totally new solution is required

• family rules govern much of the family’s behavior (Jackson, 1965) and restrict which solutions can be tried.

• In such cases, change is required not only in the • problem behavior, but also in the underlying rule. • This concept raises the distinction between a

first-order change and a second-order change

Core concepts• First order change – change that occurs within

a system according to the rules of that system. (compliance) we think it is a logical change to a problem.

• Second order change – a change in the rules of the system, thus the change is within the system. (operating principles are changed) It is outside the box change that effects the whole system

• Manipulation is unavoidable (all relationships have hidden agendas).

Connect the dots using only four straight lines.

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Connect the dots using only four straight lines.

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Core concepts• Utilization – using persons strengths to

effect change.• One down vs. one up – utilizing hierarchy

and complementarity as a means of changing patterns.

• Rituals – forcing changes in patterns through ordeals. (breaking up is hard to do)

• Tasks will compress to the time allotted.

Core concepts• Metaphors – unconscious bypass• Directives - homework• Reframing negative behaviour into

functional behaviour• Restraining – go slow, there are costs and

reasons not to change so quickly.• Positive Connotations – No one can

change when the system has a negative connotation of them.

CONCEPTUALISATION OF PROBLEMS

Conceptualisation of problems

• Relativistic view of family life as well as human behavior.

• Neutrality with respect to life.• Problems are only defined as such by

those who are involved and who believe them to be problems.

Conceptualisation of problems

• Problems maintained through misguided solutions. (attempted solutions).

• Problems in hierarchy or structure• Functional problems- Members try to

protect or control others. (no longer seen as a function of the symptom but as a misguided attempt to correct the problem)

GOALS OF STFT

The uniqueness of strategic family therapy lies in how the therapist focuses on the problems of families. The goal of strategic family therapy is to motivate the family to change signature behavioural patterns associated with the identified problem through second order change

Change

• According to strategic family therapy, two types of change can occur within the family system.

• First-order change occurs when family members attempt to solve a problem repeatedly with the same solution, only by increasing the level of intensity

• Eg shouting more loudly at the teenager

Change

• Strategic family therapists focus on creating second-order change

• allows the system to shift into a new level of homeostasis and allows for permanent rather than temporary change (Foley, 1986).

• GOAL: Achieved by changing the existing rules within the family system to create new behavioural responses to the identified problem (Fraser, 1982)

six dimensions of therapy

1. Involuntary versus voluntary behavior: A strategic therapist prefers to think of allsymptoms (excluding organic illness) as voluntary and under the control of the individual.

2. Helplessness versus power: The symptom bearer can appear helpless if he or she presents unfortunate and/or involuntary behavior that he or she cannot change even though he or she wants to do so (Madanes, 1991). The helplessness, however, is actually a source of power over the other family members whose lives and actions are restricted and even ruled by the demands, fears, and needs of the symptom bearer.

six dimensions of therapy

3. Metaphorical versus literal sequences: The idea that a symptom may be a metaphor or the problems of another family member may lead the therapist to focus on resolving those other problems instead of focusing directly on the symptoms. 4. Hierarchy versus equality: When the family hierarchy is incongruous, problems arise. Strategic therapy addresses this problem by changing the structure to its proper hierarchy. Structural change.

six dimensions of therapy

5. Hostility versus love: Strategic therapists prefer to think of people as being benevolently motivated, rather than motivated by negative characteristics (Madanes, 1991). The therapist attributes meaning to the motivations of the people involved. This meaning is important when the therapist considers his or her choice of strategy and interventions

six dimensions of therapy

6. Personal gain versus altruism: • if a person is hostile, he or she is being motivated by

personal gain or power. • If the person is concerned with helping others or

receiving more affection, he or she is being motivated by love.

• The strategy is determined by the motivation. The therapist has to arrange for the same consequences of the problematic symptom to take place without the symptom occurring, and the problem behavior should abate. (Madanes, 1991).

THERAPIST ROLE IN STFT

“Therapy can be called strategic if the clinician initiates what happens during therapy and designs a particular approach for each problem” (Haley, 1973, p. 7).

Therapist Role

• The therapist plans a strategy that sets clear goals, which will lead to solving the presenting problem.

• The therapist designs interventions, which is appropriate for the client’s social situation (Madanes, 1981).

• The therapist uses metaphors, which are created specifically for each client and his or her presenting problem

Therapist Role

Haley (1976) describes stages of a typical interview:1. Social Stage: build rapport and assess2. Problem Stage: get clear statement of concern3. Interaction Stage; family interacts4. Goal Setting: define therapy goal in concise,

observable, behavioral terms5. Selecting and making interventions 6. evaluation of results and homework

STFT INTERVENTIONS

Strategic Techniques

• Therapeutic change comes about through and interactional process that occurs when a therapist intervenes actively and directively in a system.

• The therapist works to substitute new behaviors or sequences for the vicious, positive feedback circles already existing.

• The goal is to change the dysfunctional sequences of behavior.

Strategic Techniques

• The utilization of tasks and directives is the cornerstone of this approach.

• The problem must be put in some solvable form. It must be something that is objectively agreed upon, so all can assess the outcome (poor self-esteem is not a good goal, unless accompanied by behavioral tags).

Strategic Techniques

• Considerable emphasis is placed on extra-session (outside of sessions) change – altering the process occurring outside the sessions. The use of directives, homework, experiments, etc. are used to create opportunities.

Strategic Techniques

• Power struggles with the family (client) are generally avoided, the tendency being to take the path of least resistance and use indirect ways of turning the family’s involvement into positive use.

• Positive interpretation to the client of its symptoms or motives and homeostatic tendencies are employed.

Strategic Techniques

• Paradoxical interventions, restraining change, “go slow” messages, and prescribing the symptom are typical techniques used in strategic therapy, and may be directed toward the whole family or to certain members.

Evaluation of StFT

• Haley focused on theory development and did little research in validating his ideas

• Compared with child focused behavioural therapy the outcomes were equal ( Szykula et al 1987)

• Structural & Strategic combined (Brief systemic therapy) effective in substance abuse treatment

• Many of core ideas have been influential in development of Milan therapy and Solution focused therapy

Readings

• Dallos, R. & Draper, R. (2010) chap 1• Metcalf, L. (2011) chapter 11• Dammann & Jurkovic (1986) Strategic Family Therapy A

Problem-Focused, Systemic Approach.• http://www.mri.org/strategic_family_therapy.htmlJay Haley website: • http://www.jay-haley-on-therapy.com/html/strategic_thera

py.html• Advanced Readings• Haley, J (1991) Strategies of Psychotherapy Norton & Co• Gardner et al (2006) Reconceptualizing Strategic Family

Therapy Insights from a Dynamic Systems perspective

Useful websites/extra powerpoints

• http://www.slideshare.net/f3brik4/p660-chapter-6-strategic-family-therapy-natalie-15995812?fro m_search=1

• This is a very good powerpoint that covers the material in a clear and detailed manner