Lecture 4: Strategic Family

therapy
Systemic Comparative module
Newham 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 StFT
3. Therapeutic goals in StFT
4. Therapist role in StFT
5. StFT interventions
6. 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
0
the points in the system) or 180 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)
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

GOALS OF STFT
 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).
“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 IN STFT
 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 assess
2. Problem Stage: get clear statement of
concern
3. Interaction Stage; family interacts
4. Goal Setting: define therapy goal in concise,
observable, behavioral terms
5. 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.html
Jay Haley website:
• http://www.jay-haley-on-
therapy.com/html/strategic_therapy.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