Strategic Family Therapy

Strategic Family Therapy

Strategic therapy is built upon the premise that a therapist is responsible for planning a strategy that solves successfully the family’s presenting problem. The therapist sets clear goals that intervene by changing relational and communicational processes in the family (Madanes, 1981; Stanton, 1981). Strategic therapy was designed as a counterpoint to psychodynamic psychotherapy by emphasizing “how” people can behave differently in order to solve problems, rather than “why” they behave as they do.

What to Think About

The focus of strategic therapy is upon problem solving. Prob-lems are viewed as persistent efforts by one or more family members to apply a solution that makes sense but is inadequate for the problem at hand, such that “the solution becomes the problem”. Common-sense understandings often lead people to pursue unsuccessful strategies even though it ought to be ap-parent that the problem is not resolving. For example, people intuitively attempt to cheer up a person who is depressed, even though cheering up (a solution) usually makes the depression (the problem) worse.

Strategic therapists commonly view clinical problems as emerging out of difficult life-cycle transitions, both predictable ones (e.g., marriage, birth of a child, separating/individuating of an adolescent) and unpredictable ones (e.g., loss of job, sudden illness, a death in the family) that necessitate shifting to new pat-terns of perceiving and acting. At such times when innovative problem-solving is needed, people nevertheless persist with once successful strategies that are now outdated.

What to Look For

Strategic therapists are most interested in the here-and-now context of the problem, rather than in its history. They seek to learn what each involved person believes about the problem and how these beliefs are acted upon in efforts to generate a solution. Questions are asked about who, what, when, where and how peo-ple are involved, in order to ascertain how moves are sequenced in the family game.

What to Do

The central aim of a strategic therapist is to motivate family mem-bers to try novel solutions, rather than repeating what has been tried in the past. Psychoeducation, direct behavioral assignments, and paradoxical or defiance-based directives are the cornerstones of strategic therapy. In-session interventions and out-of-session homework are used. Strategic therapists have become best known for their paradoxical directives. Paradoxical directives include:

·              Reframing or Relabeling the Symptom By changing the context of actions constituting the symptom, the meaning of the event is reframed. For example, a husband’s emotional dis-tancing could be reframed as “his way of getting his wife to notice him”.

·  Prescribing the Symptom or Behavioral Sequence By using a rationale that is plausible in its logic, a therapist can encourage family members to engage in the very behavior that needs to be eliminated. For example, a wife whose husband is emotionally distancing might be told to continue to pursue her husband because “this lets him know that he is the center of her life and that there is nothing else about her life that she finds valuable or interesting”. She might be instructed to con-tinue in her behavior for his sake, even though it may give her friends a distorted idea about her. When the reframe “fits”, yet the new meaning feels distasteful, the rebound against the directive can paradoxically propel therapeutic change.

·  Restraining the System The therapist can attempt to dis-courage or even deny the possibility of change. For example, a therapist may tell couple-partners to “go slow” or may em-phasize dangers of improvement. Family members may then react against the therapist’s conservative outlook by pressing forward to change.

·              Positioning The therapist attempts to shift a problematic “position” (usually an assertion that the patient is making about self, the problem, or a partner) by accepting but exaggerating that position. This intervention is used when the partner’s po-sition is thought to be maintained by its complementary, recip-rocal response from the other partner. For example, when one partner takes an optimistic stance and the other a pessimistic one, a therapist may suggest the pessimistic spouse to worry even more so that the optimistic spouse can feel more secure and even more happily optimistic. Here, too, if a new explana-tion has a plausible logic, but frames the behavior in a manner that renders it aversive, the behavior will change.