Ch. 4 Strategic and Systemic Models: Haley and Madanes

Question 1

Haley and Madanes intro

Answer 1

Haley and Madanes opened the Family Therapy Institute in DC together

• Haley’s model is strategic but influenced by structural models
• He believed that not only must the symptoms or the presenting problem be addressed in treatment, but also the underlying family structure that results in the symptoms.
• clearly influenced by Erikson with his used of directives (between sessions tasks) and paradoxical interventions

Question 2

Haley and Madanes: Theory of normal development and dysfunction

Answer 2

• more theoretical than MRI
• like structuralists they consider family life cycles and general systems concepts (e.g. homeostasis, feedback loops, etc)
• believe that symptoms stem from faulty organization within the family and serve a function in maintaining its structure and homeostasis
• The hierarchical arrangement of the family is critical
• Haley: the more malfunctioning hierarchies a person is part of the more disturbed they are
• Madanes: symptoms may also function in incongruous hierarchies created when kids use symptoms to try to change their parents

Question 3

Haley and Madanes: Theory of normal development and dysfunction

incongruous hierarchies

Answer 3

• Madanes

- a dysfunctional structure in which children use symptoms to try to change their parents

Question 4

Haley and Madanes: Goal of treatment

Answer 4

• like strategic: interested in present behaviors and sequences of interactions
• like strategic: use strategic interventions to alter interactions
• unlike strategic: also want to change the structure of the family

Question 5

Haley and Madanes: Assessment

Answer 5

• first session most important
• therapist makes a clean plan for treatment from the beginning. Must discover the social situation that makes the problem necessary (child’s symptoms reflect issues in marital system)
• require all people living in household or who are integrally involved in the problem be present for the first session.
• where they meet and length of sessions are flexible

Question 6

Haley and Madanes: 4 stage assessment process in first session

Answer 6

1. social stage - goals: join and make members feel comfortable. observe. make tentative hypotheses
2. problem stage; ask about people’s POV of the problem. Start with least involved person. Avoid starting with the IP - goals: observe and note hierarchical structure, notice disagreements in the explanation of the problem, T takes charge by bringing in other family members to block the family from repeating previous patterns of interactions
3. Interactional stage; have family members talk to each other about the problem, have them enact it, DO NOT talk to T, talk to each other - goals: test hypotheses, observe sequences and malfunctioning hierarchies, coalitions, quality of parenting, etc.
4. Goal-setting stage; T asks what each family would like from therapy, directive is given for homework, next session is scheduled; goals - figure out a solvable problem that can be addressed in therapy, If articulated in such a way the T and family will know when to end therapy.

Question 7

Directives

Answer 7

• Haley
• tasks that have three purposes:
  1. to get family members to do things differently and have different experiences
  2. to involved the T in the treatment and “intensify the relationship with the T”
  3. to gather additional info about how the family responds to the task. The family may be directed to do something they have not done, or refrain from doing things they have done in the past

goal is to strengthen the parental subsystem so as to fix the malfunctioning hierarchy

Question 8

Ordeal

Answer 8

• Haley
• directives that are aimed at making the symptom harder to keep than give up
  ex: whenever the symptom occurs the husband has to give his brother in law a gift. He doesn’t want to do that, so the symptom stops
• like directives, they aim at symptom relief AND family restructuring

Question 9

Strategic humanism

Answer 9

• most recent Haley and Madanes model

- more directed toward increasing family members’ ability to soothe and love than to gain control over one another

Question 10

Madanes: Assessment and treatment

Answer 10

• figure out who is being protected by the child’s symptomatic behavior and how
• T designs a directive to help the parents take back power and re-establish them in a superior position
• the changed structure no longer supports the child’s symptoms
• don’t need to have insight in how or why the problem behavior is occurring
• dramatizations, pretending, make-believe play

Question 11

Madanes: dramatization

Answer 11

• encourages the child to intentionally perform the problem behavior
• typically parent ignores his/her own problem to focus on the child’s issues. But if the child is purposefully having symptoms, then the parent is free to think about solving his/her own problems
  ex: mom is losing job and kid gets headaches to distract mom. Tell kid to play up the headache. As a result, the symptom does not draw as much parental attention and the mom’s fear will resurface and she can address the real problem with the T’s help

Question 12

Madanes: Pretending

Answer 12

• ask kid to pretend to have the symptom and the parents to pretend to help.
• do this once a day for a week at home
• encourages closeness and the symptom eventually disappears

Question 13

Madanes: Make-believe play

Answer 13

• therapeutic technique in which parents are asked to make-believe they need the child’s help and the child is to make-believe helping them. since the parents explicitly ask for help and the child overtly helps them, there is no need for the covert symptomatic behavior.
• when parents are put in this inferior position covertly, they may feel at odds with what is appropriate and reassert a superior position

Question 14

Current Madanes

Answer 14

• moved away from strategic and structural models and is closer to the work of Satir
• believes that family issues arise from a “dilemma between love and violence”
• family has 4 aims in this model:
  1. to dominate and control, leading to behavioral problems
  2. to be loved, leading to depression, psychosomatic problems, phobias, eating disorders
  3. to love and protect, leading to suicide, abuse, neglect
  4. to repent and forgive, leading to incest, murder, abuse
• goals is to intervene in a 16 step program to bring the family towards love and away from violence.

Question 15

How to induce first-order change?

Answer 15

• give the family a little push
• offer advice
• or suggest alternative behaviors

Question 16

How to induce second-order change?

Answer 16

• escalate positive feedback loops (runaway positive feedback loop)
• increase stress
• create therapeutic confusion
• interrupt and alter rigid recursive cycles

Question 17

bi-modal feedback mechanism

Answer 17

• From Ashby
• the rule bound mechanism by which a system remains unchanged so long as the internal or external environment is stable, but when the fluctuation exceeds the range of stability the system must respond in some new way.
• The system either breaks down or it makes a leap into new levels of functioning.
• the change results in a new set of patterns that, like the old pattern, is also bound by rules, and it, too, remains unchanged, so long as the environment is stable

Question 18

crises of accession v. crises of dismemberment

Answer 18

• From Hoffman
• discontinuous changes in families, like symptom development, often occur at times of stress
• changes in the family composition are particularly demanding.

Crises of accession - when someone joins the family (marriage, birth)
Crises of dismemberment - when members leave (divorce, death)

Question 19

simple bind

Answer 19

• From Hoffman
• a mechanism for change in which a message or request is given and the recipient’s new behavior is rewarded.
• Distinguished from a double bind in which the nature of the message ensures that no response will be rewarded.
• a double bind is a simple bind that in continually imposed and then continually lifted.

Question 20

Paradoxical intervention

Answer 20

• A strategic intervention that is built around a statement containing messages at different logical levels that contradict one another.
• this subtle contradiction is used to perturb the system and to generate change
• the symptomatic family member might be asked to keep or intensify his/her depression. If s/he rebels, the symptom must be given up. If s/he complies, the symptom has come under his/her conscious control

Question 21

Neurolinguistic Programming (NLP)

Answer 21

• NLP practitioners focus on the hidden effects of language, the meaning of non-verbal behavior, and the utilization of communication and trance to create change.
• attends to how language reflects a person’s ability to change or not to change
• through the structure of language, concepts such as generalizations, deletions, and constraints emerge that shape belief systems and life choices.
• Richard Bandler and John Grinder studied audiotapes and movies of Satir’s and Erickson’s clinical work. Also influenced by Bateson.