50 terms

Theories of MFT II - Strategic

What is the goal of strategic family therapy?
The goal is to eliminate the specific problem in deliberate stages and to help the client develop new ways of defining their relationships.

Less focused on the meaning of the symptom or its origins, strategists typically issue a series of directives or tasks to the family.

Less concerned with promoting personal growth or working through any underlying family emotional issues or teaching families specific problem-solving skills
What is the communication outlook?
o Concern themselves with how verbal and nonverbal messages are exchanged within a family
o Communication patterns - the manner in which the information is exchanged within a family; the precision, clarity, or ambiguity of the transmission and the behavioral or pragmatic effect of the communication, as much as the content of what is communicated
o Attend to the family's sequence of interactions and its hierarchy of interactions
o The communication concept that each participant in a transaction believes whatever he or she says is caused by what the other says, in effect holding the other responsible for his/her actions.
♣ It is meaningless to search for a starting point - a complex, repetitive interaction is not a simple, linear cause-and-effect situation with a clear beginning and end.
What is the MRI?
o MRI = Mental Research Institute - in Palo Alto, existed next to Bateson Project
♣ Founded by Don Jackson in 1959, staff included Satir and Riskin
♣ Based on general systems theory, cybernetics, and information theory
♣ Focused on the family interaction sequences to understand how faulty communication patterns might lead to family dysfunction
Pragmatics of Human Communication
♣ studied semantics, syntax and pragmatics
• All behavior is communication on some level (even non-spoken communication is communication)
• Communication may occur simultaneously at many levels (what is spoken, plus body language, etc.)
A message about a message, typically nonverbal (a smile, a shrug, a nod, a wink), offered simultaneously with a verbal message, structuring, qualifying, or adding meaning to that message.
Symmetrical relationship
Participants mirror each other's behavior risk becoming competitive - each partner's actions influence the reactions of the other in a spiraling effect called symmetrical escalation
Complementary relationship
Relationships are based on inequality and the maximization of differences - one partner takes the "one-up" position and the other takes the submissive "one-down" position

Complementary communication inevitably involves one person who assumes a superior position and another who assumes an inferior one
Paradoxical injunction
A communication to obey a command that is internally inconsistent and contradictory, as in a double-bind message, forcing the receiver to disobey in order to obey. Participants must have a close complementary relationship and the recipient cannot sidestep or otherwise avoid responding to the communication or metacommunication.
The view that an individual who receives important contradictory injunctions at different levels of abstraction - about which he or she in unable to comment or escape - is in a no-win, conflict-producing situation.

A double-bind is a particularly destructive form of paradoxical injunction.
Pathological double bind
Trying to induce change by offering explicit or implicit directives - therapeutic tasks aimed at extinguishing ineffective interactional sequences - appear to make no common sense - purpose is to jar or interrupt established but ineffective patterns of interaction by indirect means - places an individual in a no-win predicament.
Therapeutic double bind
A variety of paradoxical techniques used to change entrenched family patterns, places an individual in a no-lose situation (ie a therapist telling a depressed person not to be in a hurry to give up the depression).
Prescribing the symptom
A paradoxical intervention in which the client is directed to voluntarily engage in the symptomatic behavior; as a result, the client is put in the position of rebelling and abandoning the symptom or obeying, thereby admitting it is under voluntary control.

Forces people to understand that their quarreling does not "just happen" involuntarily but can be brought under voluntary control
A paradoxical intervention
Verbal redefinition of an event in order to make dysfunctional behavior seem more reasonable and understandable, intended to provoke in others a more positive reaction to that behavior.
MRI Brief Family Therapy
Brief family therapy as practiced at the MRI is a time-limited (usually no more than 10 sessions), pragmatic, nonhistorical, step-by-step strategic approach based

The client's complaint is the problem, not a symptom of an underlying disorder

Brief therapists tend to "think small" and to be satisfied with minor but progressive changes.

They urge clients to go slow, this is designed to provoke the family to try to prove to the therapist wrong with their caution

Often a team effort, with other team member behind a one-way mirror and team discussions after sessions
Misguided Solutions
In MRI brief family therapy:

- Some action is necessary, but not taken - eg family denies there is a problem

-An action is taken when it is unnecessary

-Action is taken at the wrong level (first order change vs. second order change)
Strategic Family Therapy (Haley and Madanes)
-Jay Haley, 1980's
-Therapist takes responsibility for devising strategy to solve client's presenting problem.
-Goal is to eliminate presenting problem, therapy is carefully planned
-Change occurs as family carries out directives given by therapist
-Struggle for control of the definition of the relationship, gaining power and control
-Claims symptom in involuntary, resorting to subtle, indirect methods of communication
Problems involve the interaction of at least 3 parties with a coalition of a minimum of 2 against at least one another. Won't view it as an issue between spouses, rather, will look at the effect issue is having on others, children, in-laws, etc.
Track interactional sequences of events, which are likely to be circular. Not just an individual act, sequence of events involve peers, parents, etc. Rather than treating the individual offender, strategists change the relevant interactional sequence of the presenting problem, replacing painful or escalating sequences with calmer ones.
Strategists want to know what roles each member plays and whether problems arise because people are unhappy with their roles.
The Initial Interview (Strategic Family Therapy)
Haley believes the first interview sets the stage for the entire course of therapy
• 1) Brief Social Stage - create cooperative and relaxed environment
• 2) Problem Stage - getting down to the business of why the family is there
• 3) Interactional Stage - family discusses the problem aloud with one another, therapist observes
• 4) Goal-setting stage - determine the presenting problem, create contract
• 5) Task-setting stage - homework or directives are assigned
♣ Directives are assignments of tasks to be performed outside of the therapeutic session.
♣ Directives are the basic tool of strategic therapy.
♣ The direct approach is frequently unsuccessful and oftentimes an indirect approach works better.
Paradoxical directive
An attempt to provoke the family to rebel or resist the directive so they give up the symptom. They ask their client to refrain from change which is designed to provoke defiance in the recipient. These should be used infrequently, either in a crisis or when a client is resistant to change. Two types:
• Prescriptive paradox - ask the client to do something "keep a list of everything you worry about to become a more competent worrier"
• Descriptive paradox - relabel in a positive manner something already being done. "It would be too risky to confront your differences this far into your marriage."
Paradoxical interventions
A therapeutic technique whereby a therapist gives a client or family a directive he or she wants resisted; as a result of defying the directive, a change takes place. It is an issue of control - the domineering wife is no longer in control if she's being told to dominate.
A paradoxical intervention
"he checks on you not because he's jealous but because he's thinking about you."
A paradoxical intervention
• "don't do anything about the problem this week, let's see how bad it really gets."
Offering prescriptions
A paradoxical intervention
"keep a list of everything you worry about to become a more competent worrier"
Ordeal therapy
A paradoxical intervention - a form of offering prescriptions
Another form of offering prescriptions, therapist instructs client to carry out an unpleasant chore whenever the symptom appears. Tries to make it more difficult for the client to have the problem than to give it up.
Offering descriptions
A paradoxical intervention
"It would be too risky to confront your differences this far into your marriage."
Predicting a relapse
A paradoxical intervention
"you got along well this week, you'll probably have a major blow-up soon."
Declaring hopelessness
A paradoxical intervention
"you're right, there's no hope now."
3 steps to designing a paradox
1) Redefining - intended to change the family's perception of the symptom. Therapist appears to support behavior that maintains the symptom. Anger becomes caring, etc.

2) Prescribing - the wording of the prescription must be concise, brief and unacceptable, but the therapist must appear sincere by offering a convincing rationale for the prescription. "practice being depressed."

3) Restraining - strategies are efforts to emphasize that the system's homeostatic balance is in danger if improvement occurs too rapidly. "Go slow. Change takes time." Have the added benefit of normalizing relapse.
The Milan Systemic Model
Led by Mara Selvini-Palazzoli

The Milan group shifted the focus away from observing sequences toward questioning family belief systems. Helped family members see themselves from the perspective of other family members.
Systemic family therapy
A Milan model therapeutic approach in which the family, as an evolving system, is viewed as continuing to use an old epistemology that no longer fits its current behavior patterns; the therapist indirectly introduces new information into the family system and encourages alternative epistemologies to develop.

Began by prescribing no change.
Essentially therapeutic double binds - warned family against premature change, allowing members to feel more acceptable and unblamed for how they were.
Positive connotation
Reframes behavior so symptoms are seen as positive, well-intentioned, and seen as voluntary
Address aspects of family relationships that the therapist believes is significant for family functioning. Seen as temporary experiments.
Structured family sessions
from the Milan Systemic Model
Five segments:
o presession (initial phone call taken by a team member, intake issues taken to entire team to propose tentative hypothesis)
o session
o intersession - break during session to discuss with team
o intervention - therapist offers prescription or ritual
o postsession - discussion focused on analysis of the family's reaction to the intervention and gave the therapists a chance to plan for the following session
A continual interactive process of speculating and making assumptions about the family situation
The therapist is interested in and accepts without challenge each member's unique perception of the problem.
Circular questioning
Involves asking each family member questions that address a difference between two other members of the family
Reflexive Questioning
Designed to help families reflect on the meaning they extract from their current perceptions, actions, and belief systems, stimulating them to consider alternative constructive cognitions and behavior.
Future-oriented questions
A type of reflexive questioning
considering alternative behavior in the future
Observer-perspective questions
A type of reflexive questioning
help people become self-observers
Unexpected counterchange questions
A type of reflexive questioning
what does it feel like when you're not fighting?
Embedded suggestion question
A type of reflexive questioning
what would happen if you told her you felt hurt instead of withdrawing?
Normative-comparison questions
A type of reflexive questioning
suggesting problem is not abnormal
Distinction-clarifying questions
A type of reflexive questioning
What would be more important to you - showing your boss's ignorance or helping him so that the project can be successfully completed?
Questions introducing hypotheses
A type of reflexive questioning
You know how you become silent when you think your husband is angry with you? What would happen if next time you told him how you feel?
Process-interrupting questions
A type of reflexive questioning
You just got quiet and upset, and I wonder if you thought I was siding with your wife?