26 Mar In describing the role of the therapist in structural family therapy, the therapist should never be a ?player in the family inte
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- In describing the role of the therapist in structural family therapy, the therapist should never be a ‘player’ in the family interaction, but instead works to change the family structure without becoming a part of it. Discuss how this can be done and why it is important to not become a part of the family structure.
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1. Paradoxical interventions are controversial and powerful techniques used by strategic family therapists in the change process. What are these interventions and what makes them so controversial? Take a position for or against the use of paradox and defend your position.
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Structural Family Therapy
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Structural Family Therapy
Initially based on the experiences of Salvador Minuchin and his colleagues at the Wiltwyck School
Major thesis: Individual’s symptoms are best understood when examined in the context of family interactional patterns
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Major Theorists
Salvador Minuchin
Braulo Montalvo
Bernice Rosman
Harry Aponte
Charles Fishman
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Salvador Minuchin
Medical director of the Wiltwyck School
Director of the Philadelphia Child Guidance Clinic
Created the Institute for Family Counseling
Has written several books, including Families and Family Therapy and Mastering Family Therapy: Journeys of Growth and Transformation.
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Premises of the Theory
Every family has a family structure.
The structure is revealed only when the family is in action.
Structure influences families for better or worse.
Emphasizes the family as a whole, as well as interactions between subunits of family members.
Recognizes the potential for coalitions.
Stable coalition
Detouring coalition
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Premises of the Theory
A person’s symptoms are best understood as rooted in the context of family transaction patterns.
Subsystems, or small units of the system as a whole, exist to carry out various family tasks.
Spousal subsystem
Parental subsystem
Sibling subsystem
Boundaries, the physical and psychological factors that separate people from another and organize them, must be clear for healthy functioning
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Premises of the Theory
Boundaries, the physical and psychological factors that separate people from another and organize them, must be clear for healthy functioning
Strengths of boundaries represented in structural family mapping systems
Clear Boundaries
Rigid Boundaries
Diffuse Boundaries
Triangulation
Alignments
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Premises of the Theory
Roles – positions under which families operate
Rules – behaviors first developed may be adhered to regardless of the changes that have occurred within the family
Power – ability to get something done
Dysfunctional Sets – family reactions, developed in response to stress, that are repeated without modification whenever there is family conflict
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Treatment Techniques
Joining – “process of coupling that occurs between the therapist and the family, leading to the development of the therapeutic system” (Sauber et al., 1985, p. 95)
Tracking – following the content of the family
Mimesis – therapist becomes like the family
Confirmation of a family member – using an affective word to reflect an expressed or unexpressed feeling of that family member
Accommodation – adjustments made by the therapist to achieve a therapeutic alliance
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Treatment Techniques
Reframing – changing a perception by explaining a situation from a different context
Punctuation – the way a person describes a situation, that is, begins and ends a sentence, due to a selective perspective or emotional involvement in an event
Unbalancing – procedure by which the therapist supports an individual or subsystem against the rest of the family
Enactment – occurs when the therapist “invites client-system members to interact directly with each other (Simon, 2004, p. 260)
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Treatment Techniques
Working with Spontaneous Interaction – involves focusing the spotlight of attention on some particular behavior
Boundary Making – helping the family create appropriate boundaries between people and subsystems
Intensity – changing maladaptive transactions by using strong affect, repeated intervention, or prolonged pressure
Restructuring – helping the family make structural changes
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Treatment Techniques
Shaping Competence – helping families become more functional by highlighting positive behaviors
Diagnosing – describing the systemic interrelationships of all family members
Adding Cognitive Constructions – words to help families help themselves
Pragmatic fictions – pronouncements that help families and family members change
Paradox – confusing message meant to frustrate or confuse families and motivate them to search for alternatives
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Role of the Therapist
Observer
Active expert (Theater director)
Assumes responsibility for setting up dramatic scenes that show the family in action
Changes roles, based on circumstance
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Process and Outcome
Change occurs gradually yet steadily
Emphasizes action over insight
Families are given homework to do outside of the session
Successful treatment means that the overall structure of the family is altered and reorganized
It enables family members to relate to one another in a more functional and productive manner.
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Unique Aspects of the Theory
Its versatility
Its emphasis on terminology and ease of application
It helped make family therapy as a whole acceptable to medicine and psychiatry
Its emphasis on symptom removal and reorganization of the family
Its emphasis on pragmatism and problem-solving
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Strategic Family Therapy
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Strategic Family Therapies
Strategic Family Therapies are method oriented and brief in duration.
Influenced by the work of Milton Erickson
Three distinct branches of strategic family therapy
The strategic family therapists of the mental research institute
The strategic family therapists of the Family Therapy Institute (Jay Haley)
The strategic family therapists of the Milan Institute
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Strategic Family Therapy: Influence of Milton Erickson
The term, strategic therapy, was coined by Jay Haley to describe the work of Milton Erickson
Milton Erickson
Especially attuned to the power of the unconscious mind as a creative, often positive, solution-generating entity
Paid particular attention to details of the symptoms his clients presented
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Milton Erickson
Achieved his objected in therapy through the following procedures:
Accepting and emphasizing the positive
Using indirect and ambiguously worded directives
Encouraging or directing routine behaviors so that resistance is shown through change and not through normal and continuous actions
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Major Strategic Theorists
Paul Watzlawick
John Weakland
Jay Haley
Cloé Madanes
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Jay Haley
Learned hypnosis from Erickson in 1953
Incorporated much of Erickson’s ideas into his own concepts about how to do therapy
First editor of the initial journal in the field of family therapy, Family Process.
Helped to organize the Institute for Family Counseling
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Cloé Madanes
Born and raised in Argentina
Gentler in her approach to strategic family therapy than Haley
Developed the pretend technique
One of her lasting contributions was in the areas of sex and violence
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Premises of the Theory
Follows many of Milton Erickson’s principles
Emphasize short-term treatment of about 10 sessions
“No one evaluates which solutions have so far been attempted for the patient’s problems” (Priebe & Pommerien, 1992, p. 433)
Concentrates on seven dimensions
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Dimensions of Strategic Family Therapy
Family rules: overt and covert rules families use to govern themselves
Family homeostasis: tendency of the family to remain in its pattern of functioning unless challenged to do otherwise
Quid pro quo: responsiveness of family members to treating others in the way they are treated
Redundancy principle: fact that a family interacts within a limited range of repetitive behavioral sequences
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Dimensions of Strategic Family Therapy
Punctuation: idea that people in a transaction believe that what they say is caused by what others say
Symmetrical relationships and complementary relationships: fact that relationships within a family are both among equals (symmetrical) and among unequals (complementary)
Circular causality: idea that one event does not cause another, but that events are interconnected and that the factors behind a behavior are multiple
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Treatment Techniques
Reframing: involves giving a different interpretation to induce a cognitive shift within family members and alter the perception of a situation
Directive: instruction from a therapist for a family to behave differently
Nonverbal messages (e.g., silence, posture)
Direct and indirect suggestions (e.g., “Go fast”)
Assigned behaviors (e.g., “When you think you won’t sleep, force yourself to stay up all night”)
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Treatment Techniques
Paradox (similar to prescribing the symptom) – gives client families permission to do something they are already doing and is intended to lower or eliminate resistance
Restraining: telling family they are incapable of doing anything other than what they are currently doing
Prescribing: instructing families to enact a troublesome dysfunctional behavior in front of the therapist
Redefining: attributing positive connotations to symptomatic or troublesome actions
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Treatment Techniques
Ordeals: involves helping the client to give up symptoms that are more troublesome to maintain than they are worth
Pretend: involves asking family members to pretend to engage in a troublesome behavior, such as having a fight, or to imagine that something is disconnected so they do not have to respond to a stimulus
Positioning: acceptance and exaggeration of what family members are saying
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Role of the Therapist
First task: Define a presenting problem so that it can be worked on and solved
Most are overtly active
Use presenting problems as a way to bring about change in families by giving the tasks that are usually carried out between sessions.
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Process and Outcome
Goal: Resolve, remove, or ameliorate the problem on which the family agreed to work
Four common procedures for ensuring a successful outcome:
Define a problem clearly and concisely
Investigate all solutions previously tried
Define a clear and concrete change to be achieved
Formulate and implement a strategy for change (Watzlawick,1978)
Focus of changing vicious cycles to virtuous ones
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Unique Aspects
Flexibility
Belief that real change is possible at the individual and dyadic level
Focus on innovation and creativity
The way it can be employed with a number of other therapies, particularly behavioral and structural family therapy
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