Chapter 12: Theory, treatments, and outcomes of strategic family therapy. – Flashcards

The Institute of Family Counselling was a project training people from the Philadelphia ghetto, who had no formal education beyond high school, to be family therapists.

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 - something for something. REDUNDANCY PRINCIPLE: the fact that a family interacts within a limited range of repetitive behavioural sequences. PUNCTUATION: the idea that people in a transaction believe that what they say is caused by what others say. SYMMETRICAL RELATIONSHIPS AND COMPLEMENTARY RELATIONSHIPS: the fact that relationships within a family are both among equals (symmetrical) and among non equals (complementary). CIRCULAR CAUSALITY: the idea that one event does not cause another, but that events are interconnected and that the factors behind a behaviour, such as a kiss or a slap are multiple.

Reframing Directive Paradox Ordeals Pretend Positioning

Reframing

Directive. These directives might be "nonverbal messages" eg silence, voice tone and posture "direct or indirect suggestions" eg go fast or you may not want to change too quickly and "assigned behaviours" eg when you think you won't sleep force yourself to stay awake

Paradox

RESTRAINING: therapist tell clients that they are incapable of doing anything other than what they are doing. PRESCRIBING: Family members are instructed to enact a troublesome dysfunctional behaviour 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 this meaning is logical or not.

Ordeals: eg making a client exercise vigorously prior to the onset of depression. The hope is that the client will want to avoid the constructive behaviour (eg exercise) so will therefore modify their symptoms (depression).

Pretend

Positioning

Strategic therapy

Define a presenting problem in such a way that it can be solved. To make changes that alter family dynamics from a competitive stance (in which there are winners and losers) to a cooperative position (in which everyone wins)

Resolve, remove or ameliorate the problem the family agreed to work on.

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

It's a flexible form of therapy that can address issues such as enmeshment, eating disorders, and substance abuse. Real change is possible at the individual and dyadic level, the entire system need not be involved in lower order change. It's innovative and creative It can be employed with a number of other therapies, particularly behavioural and structural family therapy.

It concentrates on one problem at a time. It is thought to be too "cookbookish" and mechanical. One of its proponents controversial view that schizophrenia doesn't exist. It demands considerable training of practitioners before it can be implemented properly. Number of therapeutic sessions are restricted. lack of collaborative input from client-families.Therapists who don't produce desired results in clients usually take the blame.

Because these methods were developed on more highly resistant clients.

systemic family therapy also known as the Milan Approach.

Systemic family therapy

The Milan family systems approach

therapeutic neutrality

Hypothesizing

A type of reframing in which each family member's behaviour is labelled as benevolent and motivated by good intentions.

A type of questioning that focusses attention on family connections through framing every question so that it addresses differences in perception by family members about events or relationships. The goal is to highlight information, differences, and circular processes within the family system.

A type of ritual given to parents with psychotic or anorexic children in an attempt to break up power struggles (dirty game) between generations that are sustained by symptomatic behaviours. It requires parents to unite so that children can't manipulate them or stereotype them as winners or losers.

Rituals

Membership, belief expression, identity, healing, celebration

Hypothesizing Using positive connotations Engaging in circular questioning Making invariant and variant prescriptions (to disrupt dirty games) Engaging in rituals

Non-blaming, neutral expert & cocreator Give directives & use circular questioning stress the positive hypothesize and develop strategies for helping families change

Family symptoms are removed family members experience how they're interlinked family members give up outdated ideas change focusses on breaking up vicious cycles of interaction and replacing them with virtuous cycles.

seeing symptoms in a positive way Short term treatment (10 or less sessions) changing present problematic behaviour. Tailor made techniques for each family innovative treatments flexible, evolving, and creative approaches that combine easily with other theories.

Historical patterns ignored medical model is emphasized the use of teams (in milan approach) Paradox os widely used Families can change but not understand why Confusion exists between difference between strategic and structural family therapy.