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P660 chapter 6 - strategic family therapy - natalie


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P660 chapter 6 - strategic family therapy - natalie

  1. 1. Strategic Family Therapy Chapter 6
  2. 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. 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 isn’t a specific individual who sets the rules; as a matter of fact, family members often fail to recognize their presence.
  4. 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• Jackson’s 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. 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. 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. 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. 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 isn’t 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. 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 : 1. Identify the positive feedback loops responsible for maintaining the problem 2. Determine the Rules or Frames supporting those interactions 3. Find a way to change the rules to interrupt the maintenance of the problem
  10. 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 Erikson’s method for ordeals ; in order to set a higher price for the individual, for maintaining a symptom than for giving it up
  11. 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. 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. 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. 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 Haley’s 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. 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. 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. 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. 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. 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. 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. 21. Conditions For BehaviorChange• The MRI method of resolving problems is to alter the behaviors that are associated with them• The theory holds that through the client’s 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. 22. Therapy Assessment• 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. 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. 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. 25. Therapeutic Techniques MRI 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. 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 client’s 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. 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 isn’t really a problem; action is taken where it shouldn’t 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. 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. 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. 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. 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. 32. The Haley and Madanes Approach Social 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. 33. The Haley and Madanes Approach Problem 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. 34. The Haley and Madanes Approach Interaction 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. 35. The Haley and Madanes Approach Haley• An truly unique aspect about Haley’s 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. 36. The Haley and Madanes Approach Haley• The primary goal of Haley’s treatment technique is to understand the heart of the family drama that symptoms revolve around• Haley declares that people’s 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. 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 wouldn’t normally perform, if the behaviors are framed as play to develop an entire range of pretend techniques
  38. 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. 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. 40. The Milan Model• The Positive Connotation was by far the most distinguished advance to emerge from the Milan Model• Positive Connotation is Selvini Palazzoli’s 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. 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. 42. The Milan Model• In the early 1980’s the original Milan group split.• In the 1990’s 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. 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. 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