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Strategic Family Therapy
Transcript of Strategic Family Therapy
The Milan Model
Artful use of Directives and ordeals
Initial Interview model:
1. Social Stage: to reduce defensiveness
2. Problem Stage: from each member point of view
3. Interaction Stage: observation of coalitions, hierarchies…
4. Goal- Setting Stage
Symptoms as metaphors of underlying problems
Power Balance (Madanes):
Power by holding onto troublesome symptoms
The Haley and Madanes Approach
: Use language to give new meaning to a situation which may result in changes in interactions and/or in rules
A directive that appears illogical to the goals of treatment, normalizes current patternsm makes the behavior conscious and produces a disruption of the problem-maintaining sequences.
restraining techniques... don't change
positioning: therapist exaggerates the explanation of the problem until the family disagrees.
MRI Pragmatic Explanations for
1. The solution is to deny that a problem exists; action is necessary but not taken.
2. The solution is an effort to solve something that is not really a problem; action is taken where it should not 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.
1. Define a resolvable complaint (what does it look like?)
2. Identify attempted solutions that maintain the complaint. Leading to the problem-solution loop.
3. Understand the clients unique language for describing the problem to frame suggestions in acceptable ways.
Definition of the problem from each member
Observation of interactions during session (structural)
Interpersonal Payoffs of problem behaviors (Madanes)
model is behavioral in goals and observable patterns of interactions.
Tries to interrupt the vicious feedback loops
Structural reorganization of the family
Goals are always directly related to the presenting problem
Find ways to interrupt destructive family games.
Less problem focused and more interest in changing families' beliefs.
The therapist was responsible for change (later more collaborative)
Goals of Therapy
Interrupt vicious cycles of problematic feedback loops.
Terminating therapy as soon as the presenting problem is resolved.
MRI view individuals who have problems as being stuck not sick. Therapist’s role is proving a little assistance or a small push to help the individual get moving again
MRI therapists are responsible for 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
The majority of the time in the treatment session is spent driving and motivating the clients to establish a set of clear behavioral goals
Pushing clients to provide concrete definitions of their goals, leads to the disappearance of their utopian desires and wishes
Goals Of Therapy
Difficulties are turned into chronic problems by misguided solutions, forming positive-feedback escalations
Problems are the results of incongruous hierarchies
Symptoms serve a function for the system
Negative Feedback defends the system from any disruptions in order to provide a state of
Positive Feedback works to intensify or increase change in order to
to various alterations and variations of events and behaviors
Healthy families have the
and willingness to change.
Through the establishment and preservation of open and
clear lines of communication
; and adaptability.
Normal Family Development
"All behavior is perfectly logical within the family system" Families viewed as functional rather than normal/abnormal
MRI: “As therapists, we do not regard any particular way of functioning, relating, or living as a problem if the client is not expressing discontent” (Fisch, 1978)
Families maintain integrity in the face of environmental challenges through negative feedback
Ability to adapt to changing conditions and situations through a positive feedback system.
Hayley made assumptions about family structures.
Normal Family Development
HOW TO CHANGE THE RULES
involves the complete transformation of the families definition of behavior
Identify the positive feedback loops responsible for maintaining the problem
Determine the Rules supporting those interactions
Find a way to change the rules to interrupt the problem maintaining behavior
Importance of the rules surrounding the hierarchical structure: inadequate parental hierarchies.
Borrowed Erikson’s method for ordeals; makes it more difficult to maintain a symptom than giving it up
The Role of
: The majority of family behaviors are controlled and regulated by unspoken rules
If rules promote and encourage inappropriate solutions to problems; it turns out that it is not only the behavior needing to be altered, but the rules need to be changed as well
Family patterns of interaction change only at a
level. It's superficial or temporary without altering the basic organization of the system.
alteration of the
within the system. Changes in the structure and function of the system.
Nature of Change
MRI: 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.
Development of Symptoms
Negative Feedback :
ways a family corrects a deviation in functioning to return to a previous homeostasis.
family attempts to add new info into the system, as part of growth. Often attempted solutions that worsen or maintain a symptom.
that serves to maintain a problem
: "The map is not the territory" (Bateson, 1972)
Nature of Symptoms
: purpose in the family.Change can be rapid and does not require insight into the etiology of the problem.
4. Reframing and prescribing the symptoms
Strategic Family Therapy
(Selvini Palazzoli’s) technique of ascribing positive motives to family behavior to preserve the family’s harmony. E.g. Carlo should continue to sacrifice.
to engage families in a sequence of actions which contradicted or exaggerated rigid family rules and myths.
: designed with the intention of de-centering clients by orienting them towards seeing themselves in a relational context and seeing that context from the perspective of other family members
The Milan Model
MRI 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 (attempted solutions)
4.Setting goals for treatment and Exploring previous attempts
5.Selecting and Making Behavioral Interventions
Techniques (indirect methods to induce change)
Communications Theory Developed by Bateson's Schizophrenia Project MRI, Haley & Madanes Strategic & Milan
Cybernetics/ Family Systems
Fundamental Rules of Communication (Watzlawick et al., 1967)
1. One cannot not behave...
one cannot not communicate
. All behavior in the context of another person is communication.
2. All communication has
report level and command level
. The command level defines the nature of the relationship and rules.
3. All behavior/communication must be
examined in context
. Otherwise, complete understanding is impossible.
7. Problems are maintained within the context of
recursive feedback loops
of recurrent patterns of communication.
4. Every systems is characterized by
according to which the homeostatic balance is maintained and the system is preserved (Cybernetics)
5. Relationships may be described as either
6.Each of us punctuates our
in different ways.
Development of Behavioral disorders:
1. Name and briefly describe at least 3 main ideas from the chapter o Strategic Family Therapy (3 points)
2. Give an example of a circular question (1 point)
Systems are self correcting and controlled by feedback loops
Feedback Loops: Cycle of interaction through which information is returned to the system
Nature of Change:
1. Rules need to change because they regulate behavior
2. First order change: behavioral, temporary, superficial
3. Second order change: alteration of the family rules, the structure and functioning of the system.
HOW TO CREATE CHANGE:
1. Identify positive feedback loops
2. Determine the rules that support those interactions
3. Find a way to change the rules... Interrupt the problem maintaining behavior.
Use Circular questions to:
1.Define the problem in clear and concrete terms
2. Investigate attempted solutions to the problem
3. Define the change in clear and concrete terms
4. Meet with the team to formulate and then implement a strategy for change.
Dr. James Coyne in session
Samuel Gladding Microtraining (summary of main concepts with examples)