Family & Couple Therapy PPT 4 – The Strategic Approach – Flashcards

Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. The Art of Strategic Therapy The Power Tactics of Jesus Christ and Other Essays Strategies of Psychotherapy Problem-Solving Therapy Ordeal Therapy: Unusual Ways to Change Behavior Learning and Teaching Therapy Directive Family Therapy (written with Madeleine Richeport-Haley) Leaving Home: The Therapy of Disturbed Young People, Second Edition. (Brunner/Routledge 1997)

*Strategic family therapy* seeks to address specific problems that can be addressed in a shorter time frame than other therapy modalities. It is one of the major models of both family and brief psychotherapy. Jay Haley 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."* This is a method that is brief in duration, and the primary goal for treatment is change *(NOT insight or understanding).* *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, 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 able to control the sessions as the theory dictates.

Haley combined a systemic understanding of human problems and strengths with a pragmatic approach to intervention. His method of therapy--he claimed not to have a theory of therapy—-emphasizes creative and sometimes provocative instructions for the clients to react to. The approach emphasizes careful contracting between clients and the therapist, experimenting with possible solutions (in a manner sometimes inspired by the therapist and sometimes inspired by the client), review of the results, and informed resumption of experimentation until the goal of therapy is achieved. In the 1960s and 1970s when psychodynamic approaches to therapy dominated, such practicality was commonly seen as heretical. The here-and-now emphasis of Haley and others of his generation of pragmatic practitioners is now the norm in the field of family psychotherapy.

Non-normative view of couple functioning -*How a problem persists is much more relevant to therapy* than how the problem began -*Ironic processes* are engaged in by those in the system: --Ironic in that the families *want to stop the behavior, yet they do things to continue it* Vicious cycle of interaction continues the maladaptive process within the family culture

*Reframing:* involves the use of language to induce a cognitive shift within family members and alter the perception of a situation *Giving directives:* formal instruction to behave differently *Paradox:* gives client families and their members permission to do something they are already doing (usually to a greater degree) and is intended to lower or eliminate resistance

*There is a very complex legacy to strategic family therapy ..... The focus of this work is not so much on family therapy theory, as it is on the theory of what contributes to change in various types of systems.* The *strategic approach* was *inspired by* the work of *Milton Erickson, Minuchin, Gregory Bateson, Cloe Madanes, the Brief Therapy Team at the Mental Research Institute (MRI in Palo Alto, CA) (founded by Don Jackson in 1959 and that included John Weakland, Dick Fisch, Virginia Satir, and Paul Watzlawick), and the Milan School of Family Therapy.*

While at Stanford, Haley met the *anthropologist Gregory Bateson* who invited him to join a communications research project that later became known as The Bateson Project, a collaboration that became one of the driving factors in the creation of family therapy and that *published the single most important paper in the history of family therapy,* *"Towards a Theory of Schizophrenia."* The central members of this Project were Bateson, Donald deAvila Jackson, Haley, John Weakland, and Bill Fry. In addition to his personal involvement in the birth and evolution of family therapy, Haley was an observational researcher of psychotherapy in the 1950s and early 1960s. The Bateson Project arranged for Haley and John Weakland to observe and record clinicians including Milton Erickson, among others. In 1962, while working at the Mental Research Institute in Palo Alto, Hay became the founding editor of the family therapy journal "Family Process," continued his professional relationship with Milton Erickson, and worked closely with Minuchin. Haley moved to Philadelphia in the mid-1960s to take a position at the Philadelphia Child Guidance Clinic. Through his collaboration with Minuchin there, Haley influenced and was influenced by the evolution of Structural Family Therapy in the early 1970s. Haley founded *the Family Therapy Institute of Washington DC* with *second wife Cloe Madanes* and was a *central force in the evolution of Strategic Family Therapy. * His publications from the years at the Family Therapy Institute include one of the field's most influential best-selling books, Problem Solving Therapy. After leaving the Family Therapy Institute in the 1990s, Haley moved to the San Diego area and, in collaboration with his third wife Madeleine Richeport-Haley, produced a number of films relating to both anthropology and psychotherapy. His *third wife also collaborated in the writing of Haley's final book, Directive Family Therapy. * At the time of his death, Haley was also a Scholar In Residence at California School of Professional Psychology at Alliant University.

*Each person is a unique individual.* Hence, psychotherapy should be formulated to meet the uniqueness of the individual's needs, rather than tailoring the person to fit a hypothetical theory of human behavior. Believed in utilizing the resources of his clients and designing a *"strategy for each specific problem."* Did not care if people gained perspective, as long as their actions produced beneficial results. Conducted therapy by paying extreme attention to details of the symptoms his clients presented. One of Erickson's guiding premises was *that problems apparently residing in one person are frequently associated with the difficulties resulting from a family need to change and reorganize at key transitional stages.*

Erickson achieved his objectives in therapy by: -Accepting and emphasizing the positive. -Using indirect and ambiguously worded directives. *-Encouraging or directing routine behaviors so that resistance is shown through attempts to change and not through normal and continuous actions.*

An English anthropologist, social scientist, linguist, and cyberneticist whose work intersected that of many other fields. In the 1940s he helped extend systems theory (cybernetics) to the social/behavioral sciences, and spent the last decade of his life developing a "meta-science" of epistemology to bring together the various early forms of systems theory developing in many fields of science. Bateson was the first person to identify *"double bind"* in literature; *communication problems inherent in the double bind became an essential component of strategic therapy.*

In 1956 in in Palo Alto, Bateson and his colleagues Donald Jackon, Haley, and John Weakland articulated a theory of schizophrenia as stemming from double bind situations. The double bind refers to a communication paradox described first in families with a schizophrenic member. The *victim of double bind receives contradictory injunctions or emotional messages on different levels of communication (for example, love is expressed by words, and hate or detachment by nonverbal behavior; or a child is encouraged to speak freely, but criticized or silenced whenever he or she actually does so).* An example would be when a child hug their parent and the parent stiffens at the child's touch, while at the same time the parent makes the statement "I love you." Verbally the parent says I love you but the non-verbal communication says they are not feeling what was expressed in their words. No meta-communication (all the nonverbal cues (tone of voice, body language, gestures, facial expression, etc.) that carry meaning that either enhance or disallow what we say in words.) is possible - for example, asking which of the two messages is valid or describing the communication as making no sense. The victim cannot leave the communication field. Failing to fulfill the *contradictory injunction* causes the victim to be punished (for example, by withdrawal of love). The strange behavior and speech of schizophrenics was explained by Bateson et al. as an expression of this paradoxical situation, and were seen in fact as an adaptive response, which should be valued as a cathartic and transformative experience. The *double bind was originally presented as part of the etiology of schizophrenia.* Currently, it is considered to be more important as an example of Bateson's approach to the complexities of communication which is what he mainly understood it to be. Sometimes this perspective is know as the Communication/Strategic Approach.

Communication theorists are interested in *circular causality* and analyze patterns of communication rather than looking for a purpose for the behaviour. When the response to a *family's problem aggravates the problem, that chain is seen as a positive feedback loop.* Strategic therapists would surmise that when positive feedback loops emerge in a system, *it can be indicative of a change that needs to occur in the system.*

In addition, Haley believed that hierarchy in family was crucial to observe as he had worked with Minuchin and had engaged with structural concepts. Haley stated that he found *many inadequate parental hierarchies behind most problems.* He stated "...an individual is most disturbed in direct proportion to the number of malfunctioning hierarchies in which he is embedded."

The Milan associates came together in 1971 and followed the basic MRI concepts but added to these. The group consisted of Selvini Palazzoli, Prata, Boscolo and Cecchin, and they utilized Watzlawick as a consultant. Their background was psychoanalysis and psychiatry. They were interested in ascertaining what the *"family games"* were and then attempting to positively coax the behaviour the family wanted (but feared) *by using interventions that neutralized resistance.* Cecchin and Boscolo presumed that the family is attempting to survive as a family - if a family is thought to be doing something 'bizarre' it is useful to ask the family how they think this behaviour contributes to the survival of the family. Therapy is about *conversations that helps clients bring forth, out of its own store, new possibilities for itself.*

Therapist is neutral in respect of individuals - he/she doesn't side with anyone in particular. He/she is not prejudiced about an idea, solution, hypothesis or definition of the problem. He/she is not on the side of change versus no change. *Paradoxical intentions.* Also uses "rituals" which is asking the family to behave in certain prescribed ways between sessions. *Reframes families reluctance as their wisdom at not wanting to change or rock the boat.* Use of teams and long breaks in between sessions.

*"An interviewing position of impartiality, characterised by an openness not only to the validity of each member's viewpoint, but also an openness to multiple possible constructions of clients' situations and a respect for the integrity of the system and its way of operating. Cecchin offered curiosity as a social constructionist refinement of the therapeutic position of neutrality." (Carr 2000:145)* *Being circular* in one's approach means to include everyone in the conversation, where one builds on what already has been discussed, and *elaborating and developing questions in a way that introduces new information into the system.* Circular questions accommodates this position. Circular questions allows one to check out the validity of one's hypothesis in relation to the family and the therapeutic system. Information gleaned from the circular questions are used to modify successive hypotheses. This is a recursive process.

Questions about sequence of events and interactions: What happened next? Questions about comparison: Who was the most worried, upset, active, inactive? Questions about agreement: Who would agree and who would disagree? Questions about explanation: What explanation would you give and/or do you think others would give for..? Questions about the future: Suppose X were to happen; then how would things be different in 6 weeks/months?

Views psychopathology as an *interpersonal problem* within the family instead of an intrapersonal problem within one member (identified patient). Psychotic and pathological behaviors occur to maintain homeostasis when the system is threatened. Rules of relating provide organization for family functioning and are seen in the ways in which members of the family communicate. When rules are ambiguous, *psychopathology is more likely to develop to restore order* to the disorganized system.

Normal families are: (a) Flexible enough to modify solutions that do not work. (b) Flexible enough to adjust to development. *Symptoms are the result of misguided attempts at changing an existing difficulty. Attempted solutions to the problem are what maintains the problem. Symptoms and attempted solutions are imbedded in a recursive feedback situation. Symptoms are a homeostatic mechanism regulating marital or family transactions.*

Relativistic view of family life as well as human behavior. Problems are only defined as such by those who are involved and who believe them to be problems Problems in systems are maintained through misguided (attempted) solutions. Problems in families *are typically situational* and have to do with the failure of the family to adapt to developmental/life changes that impact most families. *Positive feedback loops promote the persistent of a problem:* problem - attempted solutions - more problems - more (greater) attempted solutions, etc. Positive feedback loops are further affirmed and are very resistant to withdraw from. *The answer is to establish a negative feedback loop (restraint of any of the points in the system) to inspire a 180 degree change.*

Therapeutic change comes about through interactional processes that occur when a therapist intervenes actively and directly in a system. The therapist works to substitute new behaviors or sequences for the vicious, positive feedback circles already existing. The goal is to change the dysfunctional sequences of behavior. *-Interruption of ironic processes depends on:* *--Accurate identification of the particular solution efforts that maintain or exacerbate the problem* *--Specifying what less of those same solution behaviors might look like* *--Designing an intervention that will persuade at least one of the people involved to do less or the opposite of what he/she has been doing*

The utilization of tasks and directives is the cornerstone of this approach. The problem must be put in some solvable form. It must be something that is objectively agreed upon, so all can assess the outcome (poor self-esteem is not a good goal, unless accompanied by behavioral tags). Considerable emphasis is placed on extra-session (outside of sessions) change - altering the process occurring outside the sessions. The use of directives, homework, experiments, etc. are used to create opportunities. *Focus is on solving problems in the present. Primary goal is to resolve, remove, or ameliorate the problem the family agreed to work on.* Small, concrete, behavioral goals (anything that interrupts positive feedback loops). *Therapy is brief.*

-The guidepost of change is to assess level of commitment to change. --Customer (involved in all dimensions, agreement with goals, treatment process, assessment of outcome) --Complainant (someone else is the problem - goal is to get them to either bring in the person that they complain about, or find ways of changing their own behavior that will create other changes) --Visitor (checking therapy out - goal is to make them comfortable so that they might engage at a later time)

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.

(1) Conceptualization/formulation of problem (2) Reframing (3) Giving directives and (4) Reviewing progress ......... Directives often consist of homework and different types of paradox interventions ...... --Restraining --Prescribing the Symptom --Redefining

Belief is that any attempt to change a member is met with either conscious or unconscious sabotage and resistance. Therefore paradoxical techniques are used, such as "reverse psychology" ..... --sometimes can be risky or controversial --Paradoxical interventions, restraining change, "go slow" messages, and prescribing the symptom are typical techniques used in strategic therapy, and may be directed toward the whole family or to certain members. *Reframing* - altering the way one understands and interprets a given behavior. *The focus is entirely on interrupting ironic processes in the present*, with no assumption that insight or understanding is necessary for such interruption to happen.

Paradoxical interventions involve strategic therapist's wanting to overcome the family system's resistance and also learning more about the relationships between family members by making interventions which are counter-intuitive. Power struggles with the family (client) are generally avoided, the tendency being to take the path of least resistance and use indirect ways of turning the family's involvement into positive use. Positive interpretation to the client of its symptoms or motives and homeostatic tendencies are employed. Types of paradoxical interventions include: -*Restraining*-the therapist tells the client family that they are incapable of doing anything other than what they are already doing -*Redefining*-attributing positive connotations to symptomatic or troublesome actions

*Prescribing the symptom*-family members are instructed to enact a troublesome dysfunction behavior; 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 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.

The initial session is broken down into *five different parts*: the *brief social stage, problem stage, interactional stage, goal-setting stage, and task-setting stage.* The *brief social 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.

1. Define the problem clearly and concisely. 2. *Investigate all solutions that have previously been tried.* 3. Define a clear and concrete change to be achieved. 4. Formulate and implement a strategy for change. Determine what are the *acts of commission:* behaviors that perpetuate a problem through action Determine what are the *acts of omission:* behaviors that are absent and perpetuate a problem through inaction

Strategic Family Therapists concentrate on the following dimensions of family life: *Family Life* - the overt and covert rules families use to govern themselves. *Family Homeostasis* - the tendency of the family to remain in its same pattern of functioning unless challenged to do otherwise. *Quid Pro Quo* - the responsiveness of family members to treating others in the way they are treated.

*Redundancy Principle* - the fact that a family interacts within a limited range of repetitive behavioral sequences. *Punctuation* - the idea that people in a transaction believe that what they say is caused by what others say.

*Symmetrical Relationships* - the fact that relationships within a family are both among *equals (symmetrical) an unequals (complementary).* Symmetrical relationships run the risk of becoming competitive. *Circular Causality - the idea that one event does not "cause" another but that events are interconnected and that there are multiple factors behind a behavior.*

Since strategic therapy 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 this model's success. *First order change:* occurs when a specific behaviour changes in the system *Second order change:* occurs when the rules of the system change. One means of doing so is to use technique of *reframing*

*Structural family therapists* emphasize the *importance of role relationships* whereas *strategic therapists* emphasize *function or process* *Structural views* are focused on *breaking up homeostasis*, whereas *strategic therapists* are focused on *creating new, healthy, interactive cycles*

Haley and Mandanes 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 roles of strategic therapists differ among their schools. --Share a belief in being active and flexible with their family clients. --Emphasize short-term treatment, about 10 sessions. --"Brief therapists hold in common the belief that therapy must be specifically goal-directed, problem-focused, well-defined, and, first and foremost, aimed at relieving the client's presenting complaint" (Wylie, 1990).

This type of therapy is *based on interrupting ironic processes* is a pragmatic embodiment of an "interactional view", that explains behavior-especially problem behavior-in terms of what happens between people rather than within them. The work at the Palo Alto Brief Therapy Center emerged a model of therapy that focuses on observable interaction in the present, makes no assumptions about normality or pathology, and remains as close as possible to practice. This approach is *based on interrupting ironic processes; this approach to couple therapy makes no assumptions about healthy or pathological functioning.* At the heart of brief problem-focused therapy are two interlocking assumptions about problems and change: ---The problems people bring to psychotherapists persist only if they are maintained by ongoing current behavior of the client and others with whom he interacts ----Correspondingly, if such problem-maintaining behavior is appropriately changed or eliminated, the problem will be resolved or vanish, regardless of its nature, or origin, or duration.

These assumptions imply that how a problem persists is more relevant to therapy than how a problem originated, and that problem and that problem persistence depends mainly on social interaction. Given that problems persist because of people's current attempts to solve them, therapy need consist only of identifying and deliberately interdicting these well-intentioned *yet ironic "solutions" thereby breaking the vicious cycles (feedback loops) that maintain the impasse.* Gladding Text Chapter 13 Treatment should be pragmatic and short term Insight and history are not a part of treatment In general strategic family therapists concentrate on the following dimensions of family life:

*Family rules*- the overt and covert rules families use to govern themselves, such as "you must only speak when spoken to". *Family homeostasis*- the tendency of the family to remain in its same pattern of functioning unless challenged to do otherwise, for example, getting up and going to bed at the same times. *Quid pro quo*- the responsiveness of family members to treating others in the way they are treated, that is, something for something. *Redundancy principle*- the fact that a family interacts within a limited range of repetitive behavioral sequences. *Punctuation*- the idea that people in a transaction believe that what they say is caused by what others say. *Symmetrical relationship and complementary relationships*- the fact that relationships within a family are both among equals (symmetrical) and among un-equals (complementary). *Circular causality*- the idea that one event does not "cause" another, but that events are interconnected and that the factors behind a behavior, such as a kiss or a slap, are multiple.

Having a clear behavioral picture of what clients will accept as a sign of improvement helps to bring the complaint itself into focus Setting a minimum of goal for outcome supports the therapist's tactical aim of introducing a small but strategic change in the problem-solution patterns, which can then initiate a ripple or domino effect leading to further positive developments. Emphasizing "intermediate" or "mediating" goals rather than ultimate outcomes. Before setting goals it is necessary to inquire in detail about clients' complaint(s) and establish what is most pressing.

*Define a resolvable complaint:* to get a very specific, behavioral picture of the complaint and assess who sees it as a problem and why it is a problem now. *Identify solution patterns that maintain the complaint:* requires an equally specific inquiry into the behaviors most closely related to the problem, namely, what the clients (and any other people concerned about it) are doing to handle, prevent, or resolve the complaint, and what happens after these attempted *Solutions.* From this step emerges a formulation of a problem-solution loop, and particularly of the specific solution behaviors that will be the focus of intervention. The final assessment goal-*understanding client's unique language and preferred views of the problem, themselves, and each other:* grasping clients' unique views, of the "patient position"-is crucial to the later task of framing suggestions in ways clients will accept. It is also important to understand how (if at all) the clients sought help in the past, that they found helpful or unhelpful, how the helpers viewed their problem and how the therapy ended.

Interventions are designed to interrupt demand-withdraw interaction, a common couple pattern associated with not only marital distress but also many health complaints and addictions Because interrupting an ironic problem-solution loop usually requires persuading clients either to do less or the opposite of what they have been committed to doing, it is crucial to frame suggestions in terms compatible with clients own language or worldview- especially with how they prefer to see themselves. General interventions include telling clients to go slow, cautioning them about dangers of improvement, making a U-turn, and giving instructions about how to make a problem worse. One intervention involves asking the couple to collaborate in performing the problem pattern (e.g. argument) deliberately, for the ostensible purpose of helping the therapist better understand the how they get involved in such a no-win encounter, and specifically, how each partner is able to get the other to be less reasonable than he or she would normally. Loops: demand-refuse, discuss-avoid, criticize-defend, accuse-deny-fits the problem- solution loop formula, because more demand leads to more withdrawal, which leads to more demand and so on.

To the extent the partner on the demand side of the sequence is the main customer for change, intervention focuses on encouraging that person to do less of the same. Ex: Wife gets help to suspend the overt attempts to influence her husband. Another problem cycle is characterized by indirect demands Ex: wife may complain that her husband not only ignores her but he also he should know what to do without her having to tell him. The recommendation for these situations is to get the person who is asking for something to do so directly. In other complaint-maintaining complementary exchanges, one partner may be domineering or explosive and the other placating or submissive. Here, less of the same usually requires getting the submissive partner to take some assertive action. In instances where combative couples are embroiled in symmetrically escalating arguments, the strategy could be to get at least *one partner to take a one-down position, or prescribe the argument under conditions likely to undermine it.*

Interventions for marital complaints usually focus on one or both members of the couple, yet there are circumstances in which other people-relatives, friends, or even another helper-figure prominently in this approach to couple therapy, especially when the third party is a key customer for change. Ex: mother consoles daughter with her marriage difficulties yet it amplifies the problem, goal is to help the mother reverse her solution efforts and take up later, and spouses interactions are likely to change when mother becomes less involved. For a small subset of marital complaints, the goal of brief therapy is to help couples reevaluate their problem as "no problem" or as a problem they can live with; strategies for achieving this goal typically involve some sort of *reframing.*

*Reframing*- involves the use of language to induce a cognitive shift within family members and alter the perception of a situation. A different interpretation is given to a family's situation or behavior. *Directive*- an instruction from a family therapist for a family to behave differently. The directive is very important and is the basic tool of the approach. *Paradox*- like "prescribing the symptom", it gives client-families and their members permission to do something they are already doing and is intended to lower or eliminate resistance.

*Restraining*- the therapist tells the client-family that they are incapable of doing anything other then what they are doing. *Prescribing*- family members are instructed to enact a troublesome dysfunctional behavior in front of the therapist. *Redefining*- attributing positive connotations to symptomatic or troublesome actions. The idea is that symptoms have meaning for those who display them, whether such meaning is logical or not. *Ordeals*- the ordeal technique involves helping the client to give up symptoms that are more troublesome to maintain than they are worth. In this method, the therapist assigns a family member(s) the task of performing an ordeal to eliminate a symptom. *Pretend*- the therapist asks family members to pretend to engage in a troublesome behavior, such as having a fight. The act of pretending to fight helps the individuals change through experiencing control of a previously involuntary action. *Positioning*- The act of positioning by the therapist is one that involves acceptance and exaggeration of what family members are saying. If conducted properly it helps the family see the absurdity of what they are doing.

The goal of strategic family therapy is to resolve, remove, or ameliorate the problem the family agrees to work on. Therapist is active and flexible and designs strategies to resolve family problems Therapist brings about change by giving tasks and homework

(1)Defining a problem clearly and concisely (2) Investigating all solutions that have previously been tried (3)Defining a clear and concrete change to be achieved (4)Formulating and implementing a strategy for change

*Empathic restraint-* is where the therapist aims to avoid apprehension and resistance by conveying that only the client can decide whether and when to change. Once change begins, continued gentle restraint helps the therapist respect the clients' pace and avoid pushing for more change than they can handle.

Accurate identification of the particular solution efforts that maintain or exacerbate the problem. Specifying what less of those same solution behaviors might look like. *Designing an intervention that will persuade at least one of the people involved to do less or the opposite of what he or she has been doing.* *The focus is entirely on interrupting ironic processes in the present, with no assumption that insight or understanding is necessary for such interruption to happen.* Therapists of competing theoretical persuasions object to the fact that these brief therapies pointedly ignore personality and relationship dynamics that, from other perspectives, may be fundamental to the problems couples bring to therapists.

This brief strategic model is applicable to any couple that presents a clear complaint and at least one "customer" for change. This approach may be particularly relevant for couples and clients who seem resistant to change. Strategic therapy is most indicated when other, more straightforward approaches are unlikely to work.

Some intervention strategies are criticized and need to be addressed in informed consent materials.