Strategic Family Therapy
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Strategic family therapy seeks to address specific problems using theoretical and clinical principles that have the potential of rapid effectiveness and successful outcome; especially with difficult, entrenched problems that have failed to improve in previous treatment efforts. As a result of its potential effectiveness and problem focused orientation, family therapy can often be completed in a shorter time frame than other therapy modalities. It is one of the major models of both family and brief psychotherapy. Jay Haley of the Strategic Family Therapy Center says that it is known as Strategic Therapy because "it is a therapy where the therapist initiates what happens during therapy, designs a specific approach for each person's presenting problem, and where the therapist takes responsibility for directly influencing people." The concept of "brief therapy" is a misnomer and often misunderstood, as Brief Strategic Therapy is not suggesting a time limitation or a restricted number of sessions, but referring to the tendency for therapy to end up being briefer as a result of the potential effectiveness of the model to achieve successful goal attainment rapidly.
The concept was inspired by the work of Milton Erickson, MD and Don Jackson, MD and has been associated with (but not limited to) the work of Jay Haley and Cloe Madanes (founders of Family Therapy Institute of Washington, DC in 1976), the Brief Therapy Team at the Mental Research Institute (John Weakland, Dick Fisch, and Paul Watzlawick), the Milan School of Family Therapy, and the work of Giorgio Nardone.
The theory of strategic family therapy evolved from many of the gains in early family therapy models that were made by Milton Erickson and Don Jackson, with many other influences from such therapists as Salvador Minuchin, Gregory Bateson, and other prominent early family therapists. Strategic family therapy grew along with, and out of, other theories, most importantly, structural family therapy in the late 1960s and early 1970s at the Mental Research Institute in Palo Alto, and later at the Philadelphia Child Guidance Center. Many early family therapy theories were growing and influencing each other between the late 1950s and late 1970s. At first glance these theories don’t seem to have direct connections,[according to whom?] but many of the influential therapists of the time worked with each other and there was a natural give and take between these theories.
Strategic family therapy was no exception to this organic growth of the theory. The main proponents and creators of the theory were Jay Haley and Cloe Madanes. Jay Haley had worked at the Mental Research Institute in Palo Alto and the Philadelphia Child Guidance Center, and had worked directly with Erickson and Minuchin. Haley and Madanes took their knowledge of structural therapy and the ideas of how families work on a structural level, but added ideas like making the therapist take more initiative and control over the client’s problems.
The therapist seeks to identify the symptoms within the family that are the cause of the family’s current problems, and fix these problems. In strategic family therapy the problems of the clients stem not from their family’s behaviors toward the client, but instead it is the symptoms of the family that need to be corrected. In strategic terms a symptom is “the repetitive sequence that keeps the process going. The symptomatic person simply denies any intent to control by claiming the symptom is involuntary.” 
Concepts and processes
There are a number of concepts and processes that must be applied that are instrumental for SFT to succeed. The initial session is one of these processes, and is broken down into five different parts, the brief social stage, the problem stage, the interactional stage, goal-setting stage, and finally the task-setting stage.
- The brief therapy stage seeks to observe the family’s interactions, create a calm and open mood for the session, and attempts to get every family member to take part in the session.
- The problem stage is where the therapist poses questions to the clients to determine what their problem is and why they are there.
- The interactional stage is where the family is urged to discuss their problem so the therapist can better understand their issues and understand the underlying dynamics within the family. Some of the dynamics that strategic family therapists seek to understand are: hierarchies within a family, coalitions between family members, and communication sequences that exist.
- The goal-setting stage is used to highlight the specific issue that needs to be addressed, this issue is identified by both the family members and the therapist. In addition when discussing the presenting problem initially identified by the family, the family and the therapist work together to come up with goals to fix the problem, and better define the parameters for attaining those goals.
- The final stage of the initial session is the task-setting stage. In the task-setting stage the therapist wraps up the session by coming up with concrete homework assignments or directives the family can do outside of therapy to start to change their problems. Additional therapy sessions seek to further gain understanding to a family’s problems, dynamics, and to dig deeper in addressing their needs through a confident, controlling, and compassionate therapist.
In SFT the assigning of homework or directives that take place outside of therapy is essential to the therapy having a successful outcome. The underlying goal of the homework is to try to change the way the family dynamics function around the presenting problem that was identified in session. Different from other theories, the therapists take a more active and controlling approach in dealing with the family. They seek to impose upon the family new directives that fundamentally alter the way the family functions. The therapists use the initial session to gain trust and understanding with the family so that the therapists' commands to the family are followed through in a manner where the family has confidence and trust in the therapists' intentions.
There are some specific assumptions for family communications that SFT utilizes that are unique to SFT. The communication models utilized are; “Every communication has a content report, and a relationship command aspect.”, “Relationships are defined by commanding messages.”, “Relationships may be described as symmetrical or complementary.”, and “Symmetrical relationships run the risk of becoming competitive.” Once a therapist establishes the mechanisms of control, and command in a family, the methods of communication can be further broken down by identifying double-binds in a family and paradoxical injunctions. These are forms of unhealthy communication that send two messages at the same time, and that contradict one another.
Since SFT seeks to change family dynamics on multiple levels that may contradict one another, understanding how to achieve first-order change and second-order change are key for SFTs success. First-order change, are those symptoms that are superficial and obvious to correct. For example pointing out body language within the family. Second-order change would be the more difficult to achieve changes within the very basic construct of a family structure, to bring about positive changes.
Some less complicated but often used interventions in SFT would be, prescribing the symptom, relabeling, and paradoxical interventions. Prescribing the symptom would be when the therapist attempts to exaggerate a specific symptom within the family to help the family understand how damaging that symptom is to the family. The relabeling intervention is done within the session by the therapist to change the connotation of one symptom from negative to positive. In this way the family can view the symptom in a new context or have a new conceptual understanding of the symptom.
Finally a paradoxical intervention is similar to prescribing the symptom, but is a more in depth intervention than prescribing the symptom.
- Initially the therapist tries to change the family’s low expectations to one where change within the family can happen.
- Second, the issue that the family wishes to fix is identified in a clear and concise manner.
- Third, and in line with the goal-setting stage, the therapist seeks to get the family to agree to exactly what their goals are in addressing their problem.
- Fourth, the therapist comes up with very specific plans for the family to address their issue.
- Fifth, the therapist discredits whomever is the controlling figure of the issue.
- Next the therapist replaces the controlling figure with their own authority and issues a new directive to fix the family’s identified problem. The new directive for the family is usually to paradoxically do more of the problem symptom, and thereby to highlight it more within the family.
- Finally the therapist learns the outcome of the directive and seeks to push the paradox even further until the family rebels, or change occurs within the family.
Strategic family therapy differs from many other models of therapy in that the therapist takes a more hands on approach to fixing the family’s problems, and attempts to insert themselves into the problem as part of the solution to the family’s problems. Most other models of therapy stay away from a format like this, because of the inherent dangers within the practice, such as the family not following along with the therapist, or the therapist losing sight of their proper role within the family. Strategic family therapy appears to be a therapy that when utilized correctly can address long standing family issues in a new and imaginative manner, but comes along with many pitfalls if the therapist isn’t adequately trained and experienced in the model and able to direct the sessions with a thorough understanding of the theoretical and clinical principals and their application. Therapists tend to perceive strategic therapy as the utilization of techniques and underestimate the theoretical complexity of the model, the need for sophisticated assessment in determining appropriateness of treatment interventions, the role of authentic relationship, relationship reciprocity, and therapist influence in the therapy. Therapists need to be comprehensively trained in order to understand the models relationship to essential theoretical and clinical principles in psychotherapy as a whole, and the competency level required to at minimum not produce treatment failure and at worst create unnecessary risk.
- Goldenbeg, Goldenberg, 2008 p. 277
- Goldenberg, Goldenberg, 2008 p. 265