First Order Family Therapy

							Strategic Family Therapy



        Chapter 6
            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
      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.
          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.
        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
       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
          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.
         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
       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
      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
     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
    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
     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.
    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
  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
    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
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
                 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
               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
                   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
Conditions For Behavior Change
• 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)
                    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”
                    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 \
                  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
       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
              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
                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
               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
•
                  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
            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
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
 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
     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
    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
      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
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
      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
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,
             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
                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
              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
              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
          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
               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