Strategic Family Therapy: Main Questions

1. What are the basic tenets of this approach to therapy?

Jay Haley and Cloe Madanes combined the elements of combines elements of strategic therapy by Milton Erickson, the brief therapy model of the mental research institute, structural therapy by Salvador Minuchin, cybernetic theories by Gregory Bateson, and communication theory by Don Jackson to develop strategic problem-solving therapy. The basic tenets include the belief that family members’ behavior can only be understood within the family context and feedback loops maintain the solution as the problem. Haley believed that people do not develop problems in isolation, but as a response to their social environment, therefore families are perfect storms to create dysfunction. Furthermore, negative feedback loops promote constancy and might be used by family members when someone or something challenges the set of rules the family lives by in order to keep things the same. In contrast, positive feedback loops promote change and if a family responds in this way then there is encouragement to break away from the norm. Strategic family therapy assumes that families’ symptoms are the result of wrong attempts to change an existing difficulty and dysfunctional families do not have the flexibility to deal with change or modify solutions that may not work the first time when trying to solve a problem. For example, a family may be having a tough time balancing the many responsibilities (i.e. chores, homework, sports etc.) of each child and instead of the family being flexible and working through the difficulty, they get stuck in the negative feedback loop of trying to balance everyone’s schedules, feeling overwhelmed, and then going back to the chaos of not being able to balance everything. Strategic family therapy postulates that a totally new solution is needed to interrupt this cycle and even further, the family’s rules need to be changed since family rules govern what solutions can be tried. For example, if a family has the rule that each child has to play an instrument and do a sport, then the solution would not be to cut down on the children’s activities in order to give them more time to do homework and complete chores. SFT believes that this rule must change in order for a new solution to work. Furthermore, brief strategic family therapy believes that change can happen quickly and that a small change can lead to a bigger change (McDowell, Knudson-Martin & Bermudez, 2018).

2. How does this approach understand health and pathology?

This approach understands health and pathology in the sense that individual family members do not develop problems by themselves, but as a reaction to their social environment. Strategic family therapy assumes that families often try to solve problems in ways that make sense but do not work. Strategic family therapists also view symptoms as metaphors for other problems in the family. For example, similarly to the example the book uses, if a daughter is staying out past curfew and the parents are complaining that the daughter is continuously sneaking out, it may be that the shared concern is that one of the parents wants to leave the marriage. These problems then are viewed as metaphors and/or resulting from incongruent hierarchies and the family members who carry “symptoms” are the ones who are resisting power dynamics and other family members are unable to address it.

3. How does this approach understand individual, couple and family dynamics?

Similar to the above response, this approach understands different dynamics that each action is also a reaction, and it affects and is affected by all surrounding actions. Furthermore, problems are only defined by those who are involved and believe them to be problems; for example, a child might believe his parents are too strict, and therefore the child creates the problem when in reality, the child needs to accept the authority. Or on the contrary, the parent is too strict but does not think so and creates the problem. Each time a family member acts, they are reacting to someone else’s action and the cycle continues.

4. What are the core therapy techniques?

The core therapy techniques include developing solutions in order to help the family solve the problem and the solutions will be specific to how the family dynamic works. The therapist will study how the family behaves and try to change through second order change. Second order change is developing new solutions to the problem so that the new solution becomes homeostasis for the family and will become permanent. For example, if a daughter is acting out and the solution is just to yell louder and more often at her, the therapist will try to point this out and then come up with a new solution that will change the yelling behavior and maintain that. The therapist is viewed as “an agent of change.” Strategic family therapists hope for the family to get to third order change which is when the family shifts in how they see the world, allowing them to consider more possibilities for how to understand and negotiate their relationships (McDowell, Knudson-Martin & Bermudez, 2018). Again, this type of therapy believes that change will happen quickly, and the solution will satisfy all members of the family.

5. How does this theory compare and contrast with the other theories you read this semester?

This theory is very similar to structural family therapy in the sense that it looks as the family as a whole instead of one person in the family that is “the problem.” Also, many parts of the theory incorporate the work of Salvador Minuchin including emphasizing solution-focused approaches rather than psychoanalysis or other types of intrapsychic exploration. It is also similar in the sense that the therapist takes an active role in the therapy and does not sit back and just watch the family interact. However, unlike Bowen or Minuchin SFT does not utilize a genogram or structural maps to point out dysfunctional interactions or relationships.

6. What is the interface between this theory and gender, class, race, sexual orientation, religion/spirituality, and culture? What are your thoughts about the lack of this interface with the theory?

It is important for structural family therapists to take into account how different cultures solve problems. For example, as the book mentions, European Americans and the US value individuality and independence and families may solve problems differently than a culture that values collectivism. Strategic family therapists may also view resistance in a family as resistance to much larger power imbalances in society. For example, a man who is having panic attacks because his workplace is stressful may also be resisting larger issues of class privilege in society. This is why third order change is so important because it helps the family discover that there are other potential solutions than just the ones, they are stuck in considering their culture.

7. What are your reactions to the theory? What have you learned from this theory that may help you clinically? How do you imagine using this theory in practice?

I enjoyed learning about this theory, however, it did not resonate with me as much as the other theories we have learned about. I like that the therapist helps the family develop different solutions, but I really like how many other theories use visual maps or charts to help the family see their disruptive patterns of communication. Also, this theory seems very behavioral in context and I prefer more cognitive approaches. However, I learned that it is important to consider cultural differences in behavior when working with a family and how it may be helpful to guide the family to solutions that are outside of their comfort zone in order to help promote change.