Chapter 13 Flashcards
Milton Erickson
Erickson’s goal in treatment was CHANGE.
Achieved his objectives in therapy by the following procedures:
- EMPHASIZING the positive (i.e., he framed all symptoms and maladaptive behaviors as helpful)
- Using indirect and ambiguously worded DIRECTIVES
- ENCOURAGING ROUTINE BEHAVIORS so that resistance is shown through change and not through normal and continuous actions
UTILIZE the resources of his clients and designing a strategy for each specific problem then worked with his clients to help them become active in assisting themselves. He did so by giving them DIRECTIVES and indirect SUGGESTIONS.
He did not care whether people gained insight, as long as their actions produced beneficial RESULTS.
Jack Haley
establish the FAMILY THERAPY INSTITUTE OF WASHINGTON with his then wife, Cloé Madanes.
published two of his most influential books, PROBLEM SOLVING THERAPY (1976B) AND LEAVING HOME (1980). These books spelled out the essence of strategic family therapy an approach that distinguishes itself by its emphasis on power and hierarchy.
Chloe Madanes
one of her strongest and most lasting techniques—the PRETEND TECHNIQUE—is evidence of her innovation and creative spirit.
Another lasting contribution of Madanes has been her work in relation to issues of sex and violence (Madanes, 1990). Her work with sexual offenders, which is also covered in this chapter, is both unique and powerful.
Brief therapies
here, one evaluates which solutions have so far been attempted for the patient’s problem. After the evaluation, different solutions in therapy are tried. These solutions are often the opposite of what has already been attempted.
strategic family therapists concentrate 7 Family Life Dimensions:
- Family Rules
- Family Homestatis
- Quid Pro Quo
- Redundancy Principle
- Punctuation
- Symmetrical relationships and complementary relationships
- Circular causality
- Family rules:
rules families use to govern themselves, such as “you must speak only when spoken to.”
2.• Family homeostasis:
the tendency of the family to remain in its same pattern of functioning unless challenged to do otherwise—for example, rising 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 relationships and complementary relationships:
the fact that relationships within a family are both among equals (symmetrical) and among unequals (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.
Six Treatment Techniques:
- Reframing
- Directives
- Paradox
- Ordeals
- Pretend
- Positioning
- REFRAMING: 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
- DIRECTIVES: instruction from a family therapist for a family to behave differently. This includes nonverbal messages, suggestions and assigned behaviors
- PARADOX: gives client-families and their members permission to do something they are already doing and is intended to lower or eliminate resistance. Includes A. restraining, the therapist tells the client-family that they are incapable of doing anything other than what they are doing. B. prescribing: families are instructed to enact a troublesome dysfunctional behavior in front of the therapist. C. Redefining: attributing positive connotations to symptomatic or troublesome actions.
- ORDEALS: helping the client to give up symptoms that are more troublesome to maintain than they are worth (Haley, 1984). In this method, the therapist assigns a family or family member(s) the task of performing an ordeal in order to eliminate a symptom.
- PRETEND: gentler than most of the other procedures used in strategic family therapy where the therapist asks family members to pretend to engage in troublesome behavior. Helps individuals change through experiencing control of previously involuntary action.
- POSITIONING: acceptance and exaggeration of what family members are saying. If conducted properly, it helps the family to see the absurdity of what they are doing.
Role of the Therapist in Strategic
being ACTIVE and FLEXIBLE with their family clients
therapist’s responsibility in this family therapy approaches to plan STRATEGIES to resolve family problems.
Therapists often proceed QUICKLY and specifically in their focus on resolving
HOMEWORK: Research on couples given homework has found that those who complete more recommendations experience the most rapid treatment gains
Process and Outcome for Strategic Family Therapy
GOAL: to resolve, remove, or ameliorate the problem the family agreed to work on
The following are 4 common procedures for ensuring a successful outcome:
1. DEFINE PROBLEM CLEARLY and CONSISELY.
- INVESTIGATE PREVIOUS SOLUTIONS
- DEFINING A CLEAR AND CONCRETE CHANGE
- Formulating and implementing a STRATEGY for change
Four Unique Aspects of Strategic Family Planning
- FLEXIBILITY: viable means of working with a variety of client-families and has successfully used in treating enmeshment, eating disorders, and substance abuse
- Most therapists who now concede that REAL CHANGE is possible at the individual and dyadic level
- Focus on INNOVATION and creativity.
- It can be EMPLOYED WITH OTHER THERAPIES particularly behavioral and structural family therapy
Six Comparing Strategic Family Planning with Other Theories
- FOCUSES on a SINGLE PROBLEM and helps families marshal their resources in dealing with an identified difficulty quickly and efficiently (Snider, 1992).
- too “COOKBOOKISH” and “mechanical”
- controversial view about SCHIZOPHRENIA proposed by one of its leading proponents, Jay Haley, who, in essence, denied its existence.
- strategic family therapy approaches demand CONSIDERABLE TRAINING of practitioners before they can be implemented properly.
- TIME AND EMPHASIS: All subschools within this orientation restrict the number of therapeutic sessions. Although this format motivates families to work, it is limiting.
- LACK of collaborative INPUT from client families.
Systemic family therapy / The Milan Approach
Premised on the idea that therapists will take a SYSTEMIC (circular) view of problem maintenance and a STRATEGIC (planned) orientation to change.
stresses the INTERCONNECTEDNESS of family members while also emphasizing the importance of second-order change in families
Client-families as engaged in a series of GAMES. Children and parents stabilize around disturbing behaviors to benefit from them. To break up these games, family therapists must first meet with families and then with parents separately to give them an invariant or variant prescription that is designed to produce a clear and stable boundary between generations.
therapeutic neutrality
It keeps the therapist from being drawn into family coalitions and disputes and gives the therapist time to assess the dynamics within the family. This type of neutrality also encourages family members to generate solutions to their own problems
Treatment Techniques of Milan Systemic therapists
1. PARADOX:
- HYPOTHESIZING
- POSITIVE CONNOTATION:
- CIRCULAR QUESTIONING:
- INVARIANT PRESCRIPTION:
- RITUALS:
- PARADOX: gives client-families and their members permission to do something they are already doing and is intended to lower or eliminate resistance.
- HYPOTHESIZING: formulation by a therapist based upon information that he or she possesses about a family and involves a meeting of treatment team members before the arrival of a family in order to formulate and discuss aspects of the family’s situation that could be generating a symptom.
- POSITIVE CONNOTATION: a type of reframing in which each family member’s behavior is labeled as benevolent and motivated by good intentions. It is the “therapist’s explanation to the family that symptoms are meaningful”
- CIRCULAR QUESTIONING: questions as interventions in their own right” and an effective way to introduce the news of difference among family members into the family system. framing every question so that it addresses differences in perception by family members about events or relationships.
- INVARIANT PRESCRIPTION: ritual given to parents with children who are psychotic or anorexic to break up the family’s dirty game/power struggle between generations sustained by symptomatic behaviors. A VARIANT is given for the same purpose as an invariant one. The difference is that a variant prescription is tailored to a particular family and considers unique aspects of that family.
- RITUALS: specialized directives that are meant to dramatize positive aspects of problem situations. They include five components essential to family health: membership, belief expression, identity, healing, and celebration. In essence, a ritual is a type of prescription that directs the members of the family to change their behavior under certain circumstances.
Role of the Therapist in Milan Family Systems Approach
expert
co-creator
noblaming stance
gives directives
nuetral
Process and Outcome for Systemic Family Therapy
- symptom resolution 10 OR FEWER SESSIONS.
- FAMILY DYNAMIC CHANGE: The family experiences how family members are interlinked.
- FAMILY EVOLVES and discards the old epistemology, or outdated ideas that do not fit their current situation and MORE PRODUCTIVE BEHAVIORS EMERGE
