• invented by Jackson
• this technique devised to interrupt problem-maintaining sequences.
• Strategic clrs may try to get family members to do something that runs counter to common sense - counterintuitive techniques p. 107

1. people are always communicating

2. all messages have report and command functions

The report or content of a message conveys information, while command  is a statement about the defined relationship.

• in families command messages are patterned as rules which can be observed in families interactions.
• a term to describe the regularity (something that is regular).
• the rules of family interaction operate to preserve the family homeostasis 
• in most families unspoken rules govern behavior

Ch 5 Strategic Therapy: Theoretical formulations - Family homeostasis p102

• homeostatic mechanisms bring families back to equilibrium when there is a disruption and serve to resist change
• describes the consevative aspect of family systems
• is similar to cybernetics positive feedback loop
• rules of families interaction preserve the family homeostasis
• communication analysis-families operate as goal-directed rule-governed systems. 

• in most families unspoken rules govern behavior.
• where a rule promotes the kind of rigid attempt to solution, it is that both the behavior and the rule must change.
• when a specific behavior within a system changes
• when the rules of the system change
• one way to change the rules is by ---that is changing the families interpretation of a member's behavior; relabeling a family's description of behavior to make it more amenable to therapeutic change

1. identify the positive feedback loop that maintains the problems

2. determine the rules that support those interactions

3. find a way to change the rules in order to interrupt the problem-maintaining behavior

normal families depend on two vital processes:

1. they maintain integrity in the face of environmental challenges thru negative feedback

2. too rigid a structure leaves a system ill-equipped to adapt to changing circumstances.

• they maintain an attitude of neutrality
• they did not apply any preconceived notions or models to the family
• instead they raised questions that helped families examine themselves

• his assessments are based on assumptions about sound family functioning p103
• his therapy was designed to help families reorganize into more functional structures with clear boundaries and generational hierarchies p103
• believes that the rules around hierarchial structure of a family is crucial
• he found inadequate parental hierarchies behind most problems
• he suggests that the individual is more disturbed as the malfunctioning hierarchies he is embedded.
• all therapy is based on ordeals, suggesting that people will change in order to avoid the ordeals
• ex. insominac wakes up qnights to wax the kitchen floor

3 explanations for how problems develop:

1. cybernetic - difficulties are turned into chronic problems by misguided solutions forming positive feedback escalations

2. structural - problems are the result of incongrous hierarchies

3. functional - problems result when people try to protect or control one another covertly so that their symptoms serve as a function for the system.

MRI limit to the first

Haley and the Milan group embrace all three

16yo refuses to leave the house.

MRI clr might ask the parents how they tried to get him to venture out-

• the focus would be on getting the parents attempt solution
• they assume the parents' response would be the likely way they are maintaining their son's refusal
• by framing their problem, this drives their false solution

Haley clr would also be interested in the attempt solution

• but would inquire about the marriage
• the ways in which their son was involved in struggles between them and other family member
• and the protective nature of the boy's problem
• clr assume that the boy's behavior might be a part of a dysfunctional triangles
• clr also assumes that this triangular pattern was fueled by unresolved conflicts  between the parents

Milan clr would ask about past and present relationships

• they would be trying to uncover the network of power alliances across generations that represents the family game
• Conclude: the boy fears succeeding b/c he will make his father look bad by exceeding him in accomplishment
• the mother will have to resort back to the conflict with her parents, chose not to so enable her son's behavior for her own need.

MRI -

• minimalistic: when problem is solved, the therapy is terminated.
• they dont see their clts as sick but stuck - help them to move on
• they help families define clear and reachable goals
• they push their clts to set concrete goals -clts are forced to clarify vague issues
• they helps family release the utopian aspirations which leads to disappointmt
• their immediate aim is to change people's behavioral responses to their problems
• they tend to reframe the problem and introduce a cognitive element

Haley -

• his approach is behavioral
• his goal is structural reorganization of the family hierarchy and generational boundaries

Milan group -

• they expand the network of people involved in maintaining the problem
• they were primarily interested in interrupting the destructive family games
• their techniques were less behavioral
• but were designed to expose covert (secret agreement) and reframe motives for strange behavior
• less problem-focus but more interested in changing family beliefs than other strategic clrs
• the resposibility is on clr to outwit resistance
• after 1980 focus of therapy changed:
• clr entered the session w/out specific goals or strategies
• they trust that the self-examination process would allow families to choose to change their unproductive patterns
• clr was released from certain responsibility for any outcome
• clr adopted an attitude of curiosity toward families

early days of family threapy:

• goal was to improve communications
• this relied on insight and depend on a willingness to change

later days:

• goal was to alter specific patterns of communication that maintained the problems
• clr can point out problematic sequences or block them to effect therapeutic change
• this was manipulative to beat family at their own game

MRI -

• the way to resolve the problems is to change the way they are being maintained
• when clts see the results of altering rigid behavioral responses, clts will become more flexible in solving their problems
• when this occur, clts would have achieved second-order change-a change in the rules governing their response to problems

Haley -

• believes that telling people they are doing something wrong only mobilize resistance
• he was convinced that change in behavior alter perceptions

Milan group -

• they were more interested in getting the families to see something different through a reframing technique called positive connotations than getting family members to behave differently

Assessment

MRI goals of assessment:

1. define a resolvable complaint: get a specific behavioral picture of the complaint

2. identify attempt solutions that maintain the complaint

3. understand the clt's unique language for describing the problem - ask the clts - exactly what the complaints mean or what they would look like.

- once problem is define, clr has to determine who will solve it and how

- the key is to stop the performance of the problem-maintaining solution.

Haley:

- begins with a careful defining of the problem expressed by qmember of the family

- he also explores  that its possible structural arrangements in the family maybe contributing to their problem

- esp. pathological triangles and cross generational coalition

- said problem children tend to determine what happens in families which screws up the hierarchy

- the clt's helplessness often turns out to be a source of power in relations to others whose lives are dominated by the demands and fears of the symptomatic person

- all symptomatic behavior is voluntary

Milan group:

- assessment begins with a preliminary hypothesis

- confirmed or not in the first session

- these hypotheses are generally based on the assumption that the indentified clt's problems serve a protective function for the family

- therefore the assessment of the presenting problem and the family's response to it is based on questions designed to explore the family as a set of interconnected relationships

- ultimate goal is to achieve a systemic perspective on the problem

MRI Approach: follows a 6 step tmt model

1. introduce to the treatment setup

2. inquiry and define the problem

3. estimate the behavior maintaining the problem

4. setting treatment goals

5. selecting and making behavioral interventions

6. termination

- clr will ask for a clear definition of the major problem

- if vague, clr will help to translate into clear/concrete goal

- he will proceed to ask questions

- clr will inquire about the attempt solutions, which might be maintaining the problem

- solutions that perpetuate the problem

1. deny that there is a problem - action is warranted but none is taken

2. to solve something that is not a problem - action taken but not necessary

3. to solve a problem but solution is impossible - action taken at wrong level

- once clr has decided on a strategy for changing the problem-maintaining sequence, clt must be convince to follow

- MRI clr reframe problems to increase compliance

- to interrupt problem-maintaining sequences, strategic clr may try to get the family members to do something that runs counter to common sense. paradodxical intervention - counterintuitive technique

- to prevent power struggles, clrs avoid taking a directive posture

- their one-down stance implies equality and helps anxiety and resistance

- the restraining technique - when clr advise clt to go slow and to worry out loud about possible relapse when improvement occurred

- this reinforces the one - down position.

• to interrupt problem-maintaining sequences, strategic clrs may try to get family members to do something that runs counter to common sense
• counterintuitive techniques used by strategic therapists

Ch 5 Strategic Therapy: Therapeutic Techniques: Symptom prescriptions p108

• most commonly paradoxical intervention
• family is told to continue or embellish the behavior that is a problem
• clrs hope family will comply and be forced to reverse their attempt solution
• clrs may prescribe a symptom hoping the family will not comply with it
• ex. be depressed and let your brother become more superior

Haley

• tailored to each case
• uses directives - strategic technique -suggestions targeted at different requirement to the case
• he begins interviewing the entire family
• his initial interview follows four stages: social, problem, interaction and goal-setting stages
• Social stage - he makes qone feel relax, friendly greeting, make sure all are comfortable
• Problem stage - he asks each member their perspective on the problem; he usually he starts with the father to increase his participation; during problem stage, he looks for clues on dyfunctional triangles and hierarchy
• Interactional stage - after each has offered their opinion, he ask them to talk among themselves (enactment); clr can observe the interchanges that surround the problem; as they talk he looks for coalitions between family members against others
• sometimes he ends with a task for the family
• he focus on interpersonal payoffs of psychiatric symptoms
• Goal-setting stage - the primary goal of hypothesizing is to understand the heart of the family drama that the symptoms revolve around
• he focused on the meaning behind people's problems
• he believe that problems should have a reasonable solution
• metaphor - clt mimicks a destructive behavior seen as metaphor for unresolved conflict of the past

Milan

• highly scripted
• standard format had 5 parts: presession, session, intersession, intervention, and postsession
• Presession - team came up with a hypothesis
• Session - team would validate, modify, or change the hypothesis
• Intersession - team would meet alone to decide the intervention
• Intervention - clr will inform family of the intervention
• Postsession team would meet to discuss and analyze the family's reactions and to plan for next session
• primary intervention - ritual or positive connotation
• positive connotation - derive from MRI reframing technique - Selvini technique ascribing positive motives to family behavior in order  to promote family cohesion and avoid resistance to therapy
• rituals - set of prescribed actions designed to change a family system rules
•  neutrality - distance, objectivity
• invariant prescription - technique - parents are directed to sneak away together
• the goal is to strength the parent alliance and reinforce boundaries between generation
• Boscolo Cecchin - collaborative  style of therapy
• in the interview, they focused on circular questioning - questions are asked that highlight differences among family members
• design to shift from lineaar to reciprocity and interdependence

• one relationship may replicate another
• address power imbalance in couples and how the play a role with wide range of symptoms
• looks at areas in their lives where power is regulated
• turn out person with least power has emotional problems
• used pretend techniques - people will do something they won't ordinarily do
• strategic humanism - technique - involves directives
• more geared toward family abilities to soothe and love than gain control over each other

• they reframe the problem as a breakdown in negotiation process
• negotiations - a conversation in which person makes a request and the other names a price