Strategic Family Therapy

Problem-Solving

Hayalee Joy C. Vicente-Estoya

Topics
▫ SKETCHES OF LEADING
FIGURES
▫ THEORETICAL
FORMULATIONS
▫ FAMILY DYNAMICS
▫ MECHANISMS OF CHANGE
▫ THERAPY
▫ EVALUATING THERAPY
THEORY AND RESULTS
2
▫ CONCLUSION
Introduction
▫ Strategic therapy once captivated family therapy with
its compelling application of cybernetics and systems
theory.
▫ Its appeal lay in its pragmatic, problem-solving focus
and strategies aimed at outwitting and provoking
families into change, with or without their cooperation.
▫ However, the manipulative nature of these strategies
eventually turned people against strategic therapy.
▫ Twenty-first-century approaches have shifted focus
towards elevating cognition over behavior and
promoting collaboration over manipulation.
▫ Therapists now emphasize reinforcing solutions
and inspiring change rather than solving problems
and provoking change.
▫ Consequently, influential figures of strategic
therapy such as Jay Haley, John Weakland, and
Mara Selvini Palazzoli have been largely
forgotten.
▫ Despite this, strategic therapy introduced
powerful insights in family therapy, including the
recognition that families often perpetuate
problems and that tailored directives can bring
about sudden and decisive change.
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SKETCHES OF
LEADING
FIGURES

4
 Leading Figures
Gregory Bateson:
- Pioneering anthropologist and
cybernetician.
- Developed communications theory in
Bateson's schizophrenia project.
- Invited Jay Haley, John Weakland, and
Don Jackson to join him in Palo Alto in
1952.
- Concluded that multilayered messages
define relationships.
- Introduced project members to Milton
Erickson.
Milton Erickson:
- Influential hypnotherapist.
- Believed in sudden, brief
therapeutic change.
- Applied hypnotic principles to
therapeutic interventions.
- Influenced paradoxical
interventions in strategic therapy.
Don Jackson:
- Founder of the Mental Research
Institute (MRI) in 1959.
- Assembled a creative staff
including Jay Haley, John Weakland,
and Paul Watzlawick.
- Developed the elegantly brief MRI
model focused on interrupting
vicious cycles in problem-solving.
Jay Haley:
- Maverick figure in family therapy.
- Entered the field without clinical
credentials.
- Known for his incisive analysis and
sarcasm.
- Co-founded the Family Therapy
Institute with Cloé Madanes.
- Made significant contributions to
training and supervision.
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Leading Figures
Cloé Madanes:
- Co-founder of the Family Therapy
Institute with Jay Haley.
- Works with motivational speaker
and life coach Anthony Robbins.
- Notable for her work in strategic
therapy.
James Keim, Neil
Schiff, Scott Sells,
Jerome Price:
- Practitioners carrying on the
Haley-Madanes tradition.
- Known for innovative approaches
in family therapy.
Mara Selvini
Palazzoli:
- Prominent Italian psychoanalyst.
- Developed Milan systemic model
with colleagues.
- Focused on eating disorders and
family dynamics.
- Formed the Center for the Study
of the Family in Milan.
- Incorporated psychoanalytic
concepts into her work.
Luigi Boscolo and
Gianfranco Cecchin:
- Milan Associates focusing on
circular questioning in family
therapy.
- Split from Palazzoli and Prata's
group.
- Contributed to the development of
the Milan systemic model.
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Leading Figures

Giorgio Nardone:
- Prominent Italian family therapist.
- Trained at the MRI.
- Collaborated with Paul Watzlawick.
- Operates a large clinic and training program in strategic therapy in Italy.

7
THEORETICAL
FORMULATIONS

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Axioms of Human Communication:
▫ Developed by Watzlawick, Beavin, and Jackson in "Pragmatics of Human
Communication" (1967).
▫ First axiom: People are always communicating, as all behavior is communicative.
▫ Second axiom: All messages have report (content) and command (relationship) functions.
▫ Example: "Mommy, Sandy hit me!" conveys information and implies a command to take
action.
▫ Command messages in families are patterned as rules, deduced from repeated interactions.

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Axioms of Human Communication:
▫ The term "family rules" describes regularities, not regulations, within family dynamics.
▫ Family rules operate to maintain stability and resist change, similar to the concept of negative
feedback.
▫ Families operate as goal-directed, rule-governed systems, according to communications analysis.
▫ Circular causality is assumed, with patterns of communication analyzed as feedback loops.
▫ Positive feedback loops perpetuate problems by exacerbating responses to problematic behavior.
▫ Focus on changing interactions that perpetuate problems rather than inferring underlying causes.

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Positive Feedback Loop in Strategic Therapy
▫ Central concept in strategic therapy.
▫ Families encounter many difficulties, but whether they become problems depends on
family responses.
▫ Families often make misguided attempts to solve difficulties, leading to escalation of
problems.
▫ Example: Jamal feels threatened by the arrival of a baby sister, becomes temperamental.
▫ Father responds with punishment, confirming Jamal's belief of being unloved, leading to
further alienation.

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Positive Feedback Loop in Strategic Therapy
▫ Escalating positive feedback loop: Family reacts to deviation with feedback designed to
dampen it, but it amplifies the deviation.
▫ Intervention involves reversing ineffective solutions.
▫ Example: Father should comfort rather than criticize Jamal to break the cycle.
▫ Family system governed by unspoken rules, limiting interpretations of behavior.
▫ Changing rules is essential for altering family dynamics and breaking harmful patterns.

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Changing Family Rules:
▫ In most families, unspoken rules govern behavior.
▫ If a rule promotes rigid attempted solutions, changing the rule is necessary.
▫ First-order change: Specific behavior changes within the system.
▫ Second-order change: Rules of the system change.
▫ Changing rules is essential for fundamental change in family dynamics.
▫ Reframing is a technique for changing rules by altering interpretations of behavior.
▫ Example: Changing father's interpretation of Jamal's behavior from disrespect to fear of
displacement or from bad to sad.

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Changing Family Rules:

▫ MRI (Mental Research Institute) approach:

▫ Identify feedback loops maintaining problems.
▫ Determine rules supporting these interactions.
▫ Find ways to change rules to interrupt problem-maintaining behavior.

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Jay Haley's Contributions:
▫ Added a functionalist emphasis to the cybernetic interpretation in family therapy.
▫ Emphasized the interpersonal payoff of behavior, observing how behaviors serve
individuals within the family system.
▫ Incorporated structural concepts developed during his collaboration with Minuchin.
▫ Noted dynamics such as Jamal's mother protecting him during conflicts with his father,
which diverted attention away from the primary issue.
▫ Stressed the importance of hierarchical family structure in understanding and addressing
problems.

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Jay Haley's Contributions:
▫ Believed that inadequate parental hierarchies were often at the root of family issues.
▫ Proposed that individuals are more disturbed when embedded in malfunctioning
hierarchies.
▫ Borrowed Erickson’s technique of prescribing ordeals to counteract problem payoffs.
▫ For instance, he might prescribe tasks such as setting an alarm to wake up and complete a
household chore each night to outweigh the benefits of maintaining a symptom.
▫ Haley's approach aimed to disrupt problematic patterns within family dynamics by
addressing underlying hierarchies and behaviors.

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Mara Selvini Palazzoli's Approach:
▫ Like Jay Haley, focused on understanding family dynamics and their impact on individual
behavior.
▫ Collaborated with associates Boscolo, Cecchin, and Prata.
▫ Emphasized the role of power games within families.
▫ Recognized the protective function of symptoms within family systems.
▫ Explored multi-generational family histories to understand the origins of symptoms.
▫ Sought evidence to confirm hypotheses about the necessity of children's symptoms.

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Mara Selvini Palazzoli's Approach:
▫ Often discovered elaborate networks of family alliances and coalitions influencing
symptom development.
▫ Concluded that patients often developed symptoms as a means to protect one or more
family members.
▫ Believed symptoms served to maintain the delicate network of extended family alliances.
▫ Palazzoli's approach aimed to uncover the underlying dynamics within family systems to
facilitate therapeutic interventions.

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FAMILY DYNAMICS
▫ Strategic therapists emphasize pragmatic problem-solving over comprehensive
explanations of family development.
▫ They suggest that "whatever works is normal" and attribute family dysfunction to
ineffective solutions.
▫ The focus is on addressing the problems families present rather than delving into
complex theoretical frameworks.
▫ The theory prioritizes practical solutions for immediate issues rather than
overarching theoretical models.

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Normal Family Functioning:
▫ Rooted in general systems theory, which identifies two vital processes.
▫ Maintenance of integrity through negative feedback is essential for survival.
▫ Negative feedback provides stability, but too much rigidity hinders adaptability.
▫ Healthy families also employ positive feedback mechanisms.
▫ Positive feedback amplifies innovations to accommodate changing circumstances.
▫ Communication serves as the channel for both negative and positive feedback.
▫ Healthy families communicate clearly and exhibit flexibility.

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Normal Family Functioning:
▫ The MRI group rejected standards of normality in family functioning.
▫ They did not consider any particular way of functioning problematic unless the client
expressed discontent.
▫ By focusing on eliminating presented problems, the MRI group avoided prescribing
specific behavioral norms for families.

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Normal Family Functioning:
▫ Milan Associates:
▫ Adopted an attitude of neutrality in therapy sessions.
▫ Avoided applying preconceived notions or normative models.
▫ Raised questions to encourage families to examine themselves.
▫ Exposed hidden power dynamics within families.
▫ Trusted families to reorganize independently.

▫ Jay Haley's Approach:

▫ Based assessments on assumptions about sound family functioning.
▫ Therapy aimed to help families reorganize into more functional structures.
▫ Emphasized clear boundaries and generational hierarchy within families.
▫ Took a more directive approach compared to the Milan Associates' neutrality.
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Development of Behavior Disorders:
▫ Communication theory suggests symptoms serve to maintain homeostatic equilibrium
within family systems.
▫ Symptomatic families are viewed as ensnared in dysfunctional communication
patterns.
▫ They adhere rigidly to these patterns and perceive change as negative feedback.
▫ Change is perceived as a threat rather than an opportunity for growth within these
families.

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Development of Behavior Disorders:
▫ Explanations of Problem Development in Strategic Models:
▫ 1. Cybernetic Explanation:
▫ Difficulties become chronic problems due to misguided solutions.
▫ Positive feedback escalations perpetuate the problem.
▫ 2. Structural Explanation:
▫ Problems arise from incongruous hierarchies within the family.
▫ 3. Functional Explanation:
▫ Problems emerge when individuals covertly try to protect or control one another.
▫ Symptoms serve a function within the family system.

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Development of Behavior Disorders:
▫ Approaches of Different Groups:
▫ MRI Group:
▫ Primarily focused on the cybernetic explanation.
▫ Limited itself to understanding problems as a result of misguided solutions.
▫ Haley and Milan Associates:
▫ Embraced all three explanations.
▫ Recognized the role of incongruous hierarchies and functional aspects of
problems within families.

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Case: Sixteen-year-old Juwan recently began
refusing to leave the house.
▫ Approaches to Understanding Juwan's Behavior:
▫ MRI Therapist:
▫ Focuses on the parents' attempted solutions to Juwan's refusal to leave the house.
▫ Assumes that the parents' framing of the problem might be driving their false
solution.
▫ Seeks to uncover how the parents' actions may be maintaining Juwan's refusal.

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Case: Sixteen-year-old Juwan recently began
refusing to leave the house.
▫ Approaches to Understanding Juwan's Behavior:
▫ Haley-Style Therapist:
▫ Inquires about the parents' marriage and family dynamics.
▫ Explores how Juwan may be involved in struggles between family members.
▫ Considers the possibility that Juwan's behavior is part of a dysfunctional triangle
fueled by unresolved conflicts.

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Case: Sixteen-year-old Juwan recently began
refusing to leave the house.
▫ Approaches to Understanding Juwan's Behavior:
▫ Madanes-Style Therapist:
▫ Investigates the protective nature of Juwan's behavior and its impact on family
dynamics.
▫ Interested in how Juwan's behavior may shield his parents from confronting
threatening issues.
▫ Focuses on understanding the dynamics of the family triangle.

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Case: Sixteen-year-old Juwan recently began
refusing to leave the house.
▫ Approaches to Understanding Juwan's Behavior:
▫ Milan Systemic Therapist:
▫ Less focused on attempted solutions, instead delves into past and present family
relationships.
▫ Seeks to uncover a network of power alliances and family "games."
▫ Explores how Juwan's symptoms may serve to protect other family members.
▫ Considers intergenerational patterns and how they influence current family
dynamics.

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MECHANISMS OF
CHANGE IN
STRATEGIC THERAPY
Mechanisms of Change in Strategic Therapy:
▫ Focused Perspective:
▫ Strategic therapists offer a circumscribed view on what needs to change and how to achieve it.
▫ This perspective is concentrated and targeted, aiming to address specific problems.
▫ Identification of Problem-Maintaining Solutions:
▫ Strategic therapists concentrate their attention on identifying and altering solutions that perpetuate
problems.
▫ They focus on changing behaviors, communication patterns, and interactions that contribute to
maintaining the problem.
▫ Limited Approach:
▫ Depending on one's viewpoint, this approach may be seen as focused or restricted.
▫ It emphasizes addressing specific issues rather than delving into broader systemic dynamics.
▫ The goal is to bring about targeted and effective change within the family system.

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Goals of Therapy in Different Approaches:
▫ MRI Group:
▫ Minimalistic approach, focusing on resolving the presenting problem.
▫ Therapy concludes once the presenting problem is resolved, without targeting
other issues.
▫ View people with problems as stuck rather than sick, aiming to get them moving
again.
▫ Help families define clear and reachable goals to measure treatment success,
primarily focusing on behavior change.

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Goals of Therapy in Different Approaches:
▫ Haley's Approach:
▫ Behavioral orientation, prioritizing action over insight.
▫ Emphasizes structural reorganization of the family, particularly hierarchy and
generational boundaries.
▫ Goals directly related to the presenting problem, aiming for structural changes to
address family dynamics.
▫ Focuses on improving family functioning, rather than delving into individual
insights.

34
Goals of Therapy in Different Approaches:
▫ Milan Approach:
▫ Direct offshoot of the MRI model, expanding the network of people involved in
maintaining problems.
▫ Less problem-focused and more interested in changing family members' beliefs
about covert collusions and motives for strange behavior.
▫ Concentrates on interrupting destructive family games and changing family
dynamics.
▫ Places importance on understanding and altering covert dynamics within the
family system.

35
Conditions for Behavior Change:
▫ Early Days of Family Therapy:
▫ Initially focused on improving communication within families.
▫ Later refined to altering specific patterns of communication maintaining problems.
▫ Therapists can either point out problematic sequences or block them to effect change.

▫ MRI School:
▫ Resolves problems by reversing misguided solutions maintaining them.
▫ Clients become more flexible in problem-solving strategies by seeing results of altering
rigid behavioral responses.
▫ Achieves second-order change, altering rules governing response to problems.

36
Conditions for Behavior Change:
▫ Example:
▫ Maria argues with her father about curfew, gets grounded, then runs away.
▫ First-order intervention might find a more effective punishment.
▫ Second-order intervention might involve father acting disappointed and sad, shifting
Maria's perspective and promoting more reasonable behavior.

▫ Haley's Perspective:
▫ Believed telling people what they're doing wrong mobilizes resistance.
▫ Changes in behavior alter perceptions rather than vice versa.

▫ Milan group focused on getting families to see things differently, shifting from behavior to
cognition, setting the stage for constructivist and narrative movements. 37
THERAPY
Therapy Assessment:
MRI Group:

▫ Goals: Define a resolvable complaint, identify attempted solutions maintaining the complaint,
understand unique client language.
▫ Steps:
▫ 1. Obtain specific, behavioral description of the complaint.
▫ 2. Clarify who sees it as a problem and why it's a concern now.
▫ 3. Inquire about clients' vague or attributive complaints.
▫ 4. Define complaints in precise terms using hypothetical scenarios.
▫ 5. Determine who attempted to solve the problem and how.
▫ 6. Assess whether attempted solutions worsened the issue.
▫ Key Concept: The problem may be maintained by attempted solutions.
▫ Interventions: Focus on reversing problem-maintaining solutions.
▫ Example: A wife nags her husband to spend time, but it drives him away. 39
Therapy Assessment:
Haley's Approach:

▫ Assessment: Careful definition of problem from each family member's perspective.

▫ Considerations: Explore structural arrangements contributing to problems (i.e. cross-
generational coalitions)
▫ Interpersonal Payoff: Analyze how apparent helplessness in a patient may exert power over
others.
▫ Assumption: Symptomatic behavior is voluntary, with symptomatic individuals exerting power
over others.
▫ Example: A person with schizophrenia may refuse medication to avoid work.

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Therapy Assessment:
Milan Model:

▫ Assessment: Begins with the preliminary hypothesis, confirmed or disconfirmed in the initial
session.
▫ Focus: Problems of the identified patient may serve a protective function for the family.
▫ Questions: Designed to explore interconnected relationships within the family.
▫ Goal: Achieve a systemic perspective on the problem.
▫ Example: Assess family response to the problem to understand the family's dynamics.

41
Therapeutic Techniques:
MRI Approach:

▫ Treatment Procedure:
▫ 1. Introduction to treatment setup
▫ 2. Inquiry and definition of the problem
▫ 3. Estimation of behavior maintaining the problem
▫ 4. Setting treatment goals
▫ 5. Selecting and implementing behavioral interventions
▫ 6. Termination
▫ Once the problem has been defined, therapists help clients set clear and reachable goals
for treatment. Establishing specific objectives allows both therapists and clients to track
progress and determine when treatment has been successful.

42
Therapeutic Techniques:
MRI Approach – Specific Therapeutic Techniques

▫ Defining Problems:
▫ Translate vague complaints into clear, concrete goals.
▫ Therapists work with clients to define the specific nature of the problem in concrete and behavioral terms.
By clarifying vague complaints and identifying the individuals involved, therapists gain a clearer
understanding of the issues at hand.
▫ Identifying Attempted Solutions/ Estimation of Behavior Maintaining the Problem:
▫ Denial of the problem's existence
▫ Efforts to solve non-existent problems
▫ Solutions at an impractical level
▫ Therapists explore the attempted solutions that perpetuate the problem. By identifying ineffective
strategies or actions taken at the wrong level, therapists can develop strategies to interrupt problem-
maintaining sequences.
43
Therapeutic Techniques:
MRI Approach – Specific Therapeutic Techniques

▫ Reframing Problems:
▫ Increase compliance by reframing problems.
▫ Example: Explaining punishment as an expression of love.
▫ Therapists reframe problems to alter clients' perceptions and increase the likelihood of compliance. By
presenting problems in a new light, therapists can encourage clients to view their situations differently and
adopt alternative perspectives.
▫ Paradoxical Interventions:
▫ Encourage counterintuitive actions to interrupt problem sequences.
▫ Example: Instructing a couple to act helpless to reduce parental interference.
▫ This technique involves encouraging counterintuitive actions to interrupt problem sequences. By prescribing
behaviors that seem contrary to common sense, therapists aim to disrupt dysfunctional patterns and prompt
clients to reconsider their responses to problems.
44
Therapeutic Techniques:
MRI Approach – Specific Therapeutic Techniques

▫ Symptom Prescriptions:
▫ Prescribe continuing or embellishing complained-about behavior.
▫ Purpose: Reverse attempted solutions or expose relationship dynamics.
▫ Therapists may prescribe continuing or embellishing complained-about behaviors. The purpose of this
technique is to either reverse attempted solutions or expose underlying relationship dynamics that contribute to
the maintenance of the problem.
▫ Preventing Power Struggles:
▫ Maintain a one-down posture to reduce resistance.
▫ Example: Discourage fast change, expressing concern about relapse.

45
Therapeutic Techniques:
THE HALEY AND MADANES APPROACH
▫ Haley's therapeutic approach is highly individualized and tailored to address the specific needs of each case.
▫ The definitive technique in Haley's therapy is the use of directives, which are thoughtful suggestions
targeted to the unique requirements of the family.
▫ Haley begins therapy by interviewing the entire family in four stages: social, problem, interaction, and goal-
setting stages.
▫ During the social stage, Haley helps everyone relax and feel welcome, ensuring each family member is
comfortable.
▫ In the problem stage, Haley listens to each family member's perspective without interruption, looking for
clues about family dynamics.
▫ Haley encourages discussion among family members in the interactional stage, observing interchanges and
looking for coalitions and functional hierarchies.
▫ Directives play a central role in subsequent sessions, but they are not simple advice; they are tailored to
address the underlying reasons for the problem's persistence.
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Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Directives:
▫ Haley's approach emphasizes the use of directives, which are strategic suggestions given to the family to induce
change in their interactions and behaviors.
▫ Directives are utilized not only to instigate change but also to establish a specific therapeutic relationship.
▫ If clients exhibit resistance to direct suggestions, therapists may adjust their approach by focusing more on listening
and understanding the client’s perspectives.
▫ Some directives are straightforward and explicit, providing clear instructions on how to change behaviors or
interactions.
▫ Other directives are indirect, prompting clients to engage in certain behaviors or reflections without explicitly
stating the desired outcome.
▫ Indirect directives are often employed when straightforward directives are not effective or when clients encounter
difficulties in implementing them.
▫ For instance, clients may be asked to keep a record of their interactions or behaviors to gain insight into their
patterns and challenges.
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Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Individualized Assessment:
▫ Haley conducts a thorough assessment by interviewing the entire family in multiple stages, including a
social stage to establish rapport and a problem stage to understand each family member's perspective.
▫ Observation of Family Dynamics:
▫ Haley observes family interactions closely during sessions to identify patterns, coalitions, and hierarchies
within the family system.
▫ Task Assignments:
▫ Haley sometimes assigns tasks or homework to families between sessions to encourage specific behaviors
or interactions that contribute to therapeutic goals.

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Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Task Assignments Examples

▫ Task 1: Teaching Affection
▫ A couple, lacking in affectionate behavior, was instructed to exhibit affection towards each other.
▫ The rationale provided was to demonstrate affectionate behavior to their child, aiming to teach them how to
express affection.

49
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Task Assignments Examples

▫ Task 2: Preparation for Military School
▫ A mother struggling to control her 12-year-old son considered sending him to military school.
▫ Haley suggested an alternative approach: the mother would help prepare her son for military school.
▫ The tasks included teaching the boy military-style behaviors such as standing at attention, being polite, and
maintaining a disciplined routine.
▫ The interaction between the mother and son during this task resembled a game, with the mother assuming
the role of sergeant and the son as private.
▫ After two weeks of following these instructions, the son's behavior improved significantly, leading the
mother to reconsider sending him away.

50
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Strategic Maneuvering:
▫ Haley strategically interacts with family members to increase engagement, involvement, and collaboration
in the therapy process.
▫ Focus on Goal-Setting:
▫ Haley collaborates with the family to establish clear treatment goals and objectives that guide the
therapeutic process.

51
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Interpersonal Payoff of Symptoms

▫ Haley's approach uniquely focused on exploring the interpersonal benefits or payoffs associated with
psychiatric symptoms.
▫ He emphasized that symptoms, once developed, might serve a covert function in family dynamics and
interpersonal struggles.
▫ Unlike other therapeutic approaches that may view symptoms solely as misguided solutions, Haley delved
into the underlying meaning and function of symptoms within the family context.

52
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Hypothesizing and Problem-Solving

▫ Haley's approach involved hypothesizing about the core family dynamics underlying the symptoms.
▫ Understanding the central theme of the family drama surrounding the symptoms was crucial for identifying
appropriate interventions.
▫ Haley emphasized finding reasonable solutions to address the underlying family dynamics rather than
focusing solely on symptom reduction.

53
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Addressing Interpersonal Power

▫ Practitioners in the Haley/Madanes tradition openly acknowledge and address the issue of
interpersonal power dynamics within families.
▫ Communication influences family members' relationships, either enhancing or diminishing their
influence, according to Haley.
▫ Haley observed and analyzed power dynamics within families, recognizing the therapist's role in
either ignoring or resolving power struggles.

54
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Interplay of Presenting Problem and Underlying Dynamics

▫ There are cases in which the underlying dynamics of the family emerged only after the presenting
problem improved.
▫ Brad's misbehavior served as a distraction for his mother, preventing her from addressing her own
struggles until Brad's behavior improved.
▫ Metaphor in Therapy
▫ Haley's approach utilizes metaphor to understand and address family dynamics.
▫ Symptoms are often seen as metaphors for underlying problems within the family system.
▫ For instance, a child's misbehavior may reflect the unresolved emotional struggles of a parent.
▫ Metaphorical exploration helps uncover hidden issues and dynamics within the family.

55
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Replication of Relationships
▫ Madanes describes how relationships may metaphorically replicate one another within families.
▫ Parents may project unresolved conflicts onto their children, leading to similar patterns of behavior.
▫ Children may manifest symptoms that deflect attention from underlying family issues.

▫ Power Imbalances in Couples

▫ Madanes discusses power imbalances within couples and their role in various symptoms.
▫ Power dynamics affect areas such as money, education, child-rearing, in-law relationships, religion, and
sex.
▫ The partner with the least power may develop more emotional problems, impacting the entire family.

56
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Flexible View of Couple Dynamics

▫ Understanding power balancing helps therapists adopt a more flexible view of the couple's struggles.
▫ Therapists consider whether certain behaviors, such as abuse, reflect unmet needs or desires for a more
significant role in specific aspects of life.
▫ Understanding High-Conflict Divorce
▫ Haley's approach views high-conflict divorcing couples developmentally, considering them in terms of the
family life cycle.
▫ Rather than pathologizing, Haley's therapists aim to understand clients in the best possible light, focusing
on their need for an emotional divorce.

57
Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Reframing and Negotiation Process

▫ Keim and Lappin reframe marital conflicts as breakdowns in the negotiation process.
▫ Couples are introduced to negotiation exercises to resolve conflicts, starting with simple issues and
progressing to more challenging ones.
▫ The negotiation process is presented as a "fun exercise" to facilitate agreement and avoid power struggles.

▫ Pretend Techniques
▫ Madanes employs pretend techniques where symptomatic children and parents pretend to engage in
symptom-related behaviors to address family dynamics.
▫ Pretending allows the family to fulfill the same function without the actual symptom, facilitating symptom
resolution.

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Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Ordeal Therapy
▫ Haley uses ordeals to make symptoms more troublesome than they're worth, encouraging clients to give up
symptoms.
▫ Examples include strenuous exercise for symptoms or giving presents to difficult relationships.
▫ Ordeals can also be used to restructure family dynamics, as seen in Haley's case of a boy putting items up
his behind.
▫ Strategic Humanism
▫ Strategic humanism, the current form of Haley/Madanes therapy, focuses on increasing family members'
abilities to soothe and love rather than control.
▫ Directives are oriented toward promoting harmony within the family.

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Therapeutic Techniques:
The Haley and Madanes Approach – Specific Therapeutic Techniques

▫ Example: Oppositional Children

▫ Keim's work with oppositional children emphasizes compassion and cleverness.
▫ Parents are reassured and coached to reinforce authority through nurturing and setting rules and
consequences, avoiding power struggles.
▫ The strategy empowers parents without escalating conflicts, promoting calm and effective parenting.

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Therapeutic Techniques:
Original Milan Model
▫ Highly scripted approach involving male-female co-therapists and team observation.

▫ Five-part format: pre-session, session, intersession, intervention, and post session discussion.
▫ Presession: The team develops an initial hypothesis about the family's presenting problem.
▫ Session: The team validates, modifies, or changes the hypothesis during the session.
▫ Intervention: The team meets to discuss the hypothesis and formulate an intervention.
▫ Treating therapists deliver intervention to the family, often using rituals or positive connotations.
▫ Postsession Discussion: The team analyzes family reactions and plans for the next session.

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Therapeutic Techniques:
Original Milan Model

▫ Primary Intervention
▫ Rituals or positive connotations.

▫ Positive Connotation
▫ Distinctive innovation from the Milan model.
▫ Derived from MRI technique of reframing symptoms to preserve family harmony.
▫ Avoids implication that family members benefit from patient's symptoms.

▫ System-Serving Connotation
▫ Each family member's behavior is construed as preserving overall family harmony.

62
Therapeutic Techniques:
▫ Positive connotation, in the context of family therapy, refers to a therapeutic technique used to reframe or
reinterpret behaviors, attitudes, or interactions in a more positive light. Instead of viewing certain behaviors as
problematic or dysfunctional, positive connotation highlights the underlying positive intentions or functions
behind them within the family system.

▫ For example, if a family member is overly controlling of others' activities, instead of labeling this behavior as
controlling or intrusive, positive connotation might reinterpret it as an expression of concern for the well-
being of others or a desire to maintain order and structure within the family.

▫ The goal of positive connotation is to shift the perspective of family members and therapists alike,
encouraging them to view behaviors in a more constructive and empathetic manner. By highlighting the
positive aspects of behaviors, positive connotation can help foster understanding, empathy, and ultimately,
facilitate positive change within the family system.
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Therapeutic Techniques:
▫ Positive Connotations:
▫ Imply that all family members contribute to the stability and cohesion of the family system.
▫ Avoid labeling some members as "good" and others as "bad," promoting a systemic unity.

▫ Examples:
▫ "You two are very generous. Leon, you keep secrets so that Marta won’t worry. And, Marta, you
question Leon about his comings and goings so he’ll know you care."
▫ "Henry, you keep busy at work so as not to interfere with Candice’s handling of the children.
Candice, you control the children’s activities so that they will not waste their time and Henry will
not be bothered to participate. Seth and Paula, you avoid initiating your own activities so that your
mother will continue to feel needed."

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Therapeutic Techniques:
Original Milan Model

▫ Hypothesizing
▫ The treatment team hypothesizes how the patient's symptom fits into the family system.
▫ Delivery of Hypothesis
▫ After the midsession break, therapists deliver the hypothesis to the family.
▫ Family instructed not to try to change behaviors.

▫ Example Intervention
▫ Carlo should continue to sacrifice himself by remaining depressed to reassure the family.
▫ Mother should maintain over-involvement with Carlo to make him feel valued.
▫ Father should continue to criticize Carlo and mother’s relationship to prevent the mother from abandoning
Carlo.
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Therapeutic Techniques:
Original Milan Model

▫ Rituals in Milan Model:

▫ Used to engage families in actions that counter or exaggerate rigid family rules and myths.
▫ Examples:
▫ Encouraging a family enmeshed with their extended family to hold family discussions
behind locked doors every other night while redoubling courtesy to the extended family.
▫ Designing odd-and-even-day rituals to interrupt rigid family sequences, such as alternating
parental control over a child's behavior.
▫ Rituals were aimed at defining the nuclear family as a distinct unit, allowing individual
expression without contradiction, and preventing secret coalitions.

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Therapeutic Techniques:
▫ Changes in the Milan Model Over Time:

▫ Shift in Therapeutic Focus:

▫ From strategic interventions like positive connotations and rituals to collaborative
approaches.
▫ Development of Circular Questioning:
▫ Designed to shift clients from individual-focused thinking to understanding relational
dynamics and interdependence.
▫ Structured questions to prompt relational descriptions rather than linear causality.
▫ Example of Circular Questioning:
▫ Questions shift the frame of understanding Carlo's depression from a psychiatric
problem to a symptomatic change in family structure.

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Therapeutic Techniques:
▫ Changes in the Milan Model Over Time:

▫ Therapeutic Approach:
▫ Emphasis on genuine curiosity and a research expedition mindset rather than strategic
manipulation.
▫ Aimed at creating an atmosphere where families arrive at new understandings of their
predicament.

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Therapeutic Techniques:
Other Contributions

▫ Team Approach to Therapy:

▫ MRI Group: Used teams behind one-way mirrors to brainstorm strategies.
▫ Milan Group: Utilized teams similarly.
▫ Ackerman Institute: Papp and colleagues integrated the team directly into therapy sessions, acting
as a "Greek chorus" to react to events and even disagree with the therapist for strategic purposes.
▫ This approach allowed family members to feel represented in their ambivalence, paving the
way for later approaches where the team might enter the treatment room to discuss the
family while they watched.

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Therapeutic Techniques:
Other Contributions

▫ Functional Family Therapy (FFT):

▫ Developed by Jim Alexander, a behaviorist who incorporated strategic ideas.
▫ Concerned with the function of family behavior and assumes that most behaviors are attempts to
become more or less intimate.
▫ Utilizes relabeling (reframing) to help family members see each other's actions in a benign light.
▫ Implements contingency management programs to help families achieve the desired level of
intimacy.
▫ Represents a blend of strategic and behavioral therapies and maintains the behaviorist ethic of
basing interventions on sound research.

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Evaluating Therapy Theory and Results
▫ 1. Focus on Communication Process: Strategic therapy introduced a new conceptualization by
focusing on the process of communication rather than its content. This shift allowed for a deeper
understanding of interpersonal dynamics within families.

▫ 2. Mainstream Integration: The concepts of communication theory pioneered by strategic therapy

have been absorbed into the mainstream of family therapy. Symptom-focused interventions have
become the basis of strategic and solution-focused models.

▫ 3. Popularity and Backlash: Strategic therapy reached its peak of popularity in the 1980s due to its
clever and expedient nature. However, a backlash ensued as critics highlighted its manipulative
aspects, particularly when dealing with anxious and inflexible families.

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Evaluating Therapy Theory and Results
▫ 4. Move Towards Collaborative Models: In the 1990s, collaborative models began to replace strategic approaches
as the primary focus of family therapy. However, useful aspects of strategic therapy, such as clear therapeutic goals
and tracking sequences of interaction, should not be overlooked.

▫ 5. Research on Effectiveness: Early research on the effectiveness of strategic therapy was largely anecdotal.
However, recent studies have attempted to provide more rigorous empirical support, particularly in areas such as
couples therapy and adolescent substance use.

▫ 6. Legacy and Contemporary Applications: While the original Milan model may have diminished, contemporary
strategic therapy camps such as the MRI group, the Washington School, and Nardone’s Strategic Therapy Center
continue to thrive. Additionally, newer models like Brief Strategic Family Therapy (BSFT) have emerged, drawing
on strategic principles to address contemporary issues such as adolescent substance use.

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Evaluating Therapy Theory and Results
▫ 7. Importance of Therapeutic Relationship: The success of strategic therapy interventions often hinges on the
therapeutic relationship and the spirit in which interventions are delivered. Genuine curiosity and collaborative
exploration can lead to more meaningful outcomes.

▫ 8. Critique of Gimmickry: While some rebelled against the gimmickry of formulaic techniques associated with
strategic therapy, the underlying principles, such as reversing ineffective solutions, remain valid. The challenge lies
in applying these principles thoughtfully and creatively.

▫ Overall, while strategic therapy has evolved and faced criticism over the years, its contributions to family therapy
theory and practice are significant, and its principles continue to inform contemporary therapeutic approaches.

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The Current Status of the Strategic Therapy
Model:
▫ 1. Integration of New Ideas: Strategic therapists are actively integrating new ideas and adapting to the
postmodern spirit of the twenty-first century. Authors such as Haley have published books showcasing the
evolution of their thinking, and efforts have been made to integrate strategic concepts with narrative
approaches.
▫ 2. Changes at the MRI: The Mental Research Institute (MRI) in Palo Alto, which was a central hub for
strategic therapy, is undergoing changes. The board has decided to sell the original building and expand its
mission to address larger systems problems. This shift suggests a move away from traditional strategic
therapy.
▫ 3. International Presence: The Centro di Terapia Strategica (Center for Strategic Therapy) in Arezzo, Italy,
led by Giorgio Nardone and his colleagues, remains a significant center for strategic therapy. They have
trained numerous therapists worldwide and conducted practice-based research studies demonstrating the
effectiveness of their approach.
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The Current Status of the Strategic Therapy
Model:

▫ 4. Practice-Based Research: Nardone and his team have contributed to the field through practice-based research
studies that validate the efficacy of their strategic therapy approach. These studies provide empirical support for
the continued relevance of strategic therapy in contemporary clinical practice.

▫ Overall, while some changes are occurring within traditional hubs like the MRI, strategic therapy continues to
evolve and maintain its relevance in the field of psychotherapy. The integration of new ideas and ongoing research
efforts contribute to its continued growth and adaptation to contemporary therapeutic contexts.

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Conclusion
▫ In conclusion, communication therapy, rooted in general systems theory, revolutionized family treatment by
focusing on communication patterns as the key to understanding family dynamics. Therapists recognized
families as rule-governed systems, maintained by feedback mechanisms, which could either promote stability or
hinder adaptability.

▫ Although therapists like Haley, Jackson, Satir, and Watzlawick employed different strategies, they shared the
common goal of altering destructive communication patterns. While Satir favored direct approaches,
encouraging clear communication, others, like Haley, acknowledged the challenge of resistance and employed
more indirect, paradoxical directives to provoke change.

▫ Strategic therapy, influenced by Ericksonian hypnotherapy and Batesonian cybernetics, emphasized problem-
centered, pragmatic interventions to alter behavioral sequences. Unlike the MRI's strictly observational
approach, Haley and Madanes delved into motives, with Haley focusing on control and Madanes on the desire
for love. 76
Conclusion
▫ The Milan Associates initially explored multigenerational dynamics and developed interventions like positive
connotation and rituals to expose and shift problematic family dynamics. Over time, the Milan group underwent
transformations, with different members pursuing varied therapeutic approaches, such as long-term therapy
based on family secrets or a more collaborative, questioning-based approach.

▫ Overall, while each therapeutic approach within the realm of communication and strategic therapy has evolved
differently, they have collectively shaped the landscape of modern family therapy, emphasizing the importance
of communication, understanding family systems, and adapting interventions to provoke meaningful change.

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Thank You!

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