Strategic - Haley & Madanes Flashcards
Who developed Haley & Madanes Strategic Family Therapy?
Jay Haley, later with Cloe Madanes, his wife.
Haley worked at MRI.
Influenced by (and worked with) both Erik Erikson and Gregory Bateson.
- Erikson believed the unconscious was full of wisdom - thus, he didn’t need to give people insight, just help them get access to it on their own.
Also influenced by Minuchin… Minuchin developed Structural Family Therapy, and Minuchin & Haley cross-influenced each other.
What are the stages in Haley & Madanes SFT?
- Define a problem
- Plan for solutions - customized to family culture
- Solve the problem via structural re-org, breaking patterns
- Terminate when problem is solved
- Re-initiate with new problems
What are key components of Haley & Madanes’ SFT?
- A focus on family interactional patterns
- Identifying who the family comprises, who have roles that involve the identified patient
- Systemic diagnosis of adaptive & maladaptive interactional patterns, which are viewed as malleable
- Strategy is the theoretical foundation:
– The treatment plan is designed to treat the maladaptive interactions: it is PLANNED
– Plans are focused on the problem the Cts came in for
– Treatment is customized to family culture & ideosyncracies - Sees CBT triangle as relevant - changes to all 3 are needed
- There is a risk Dangers of Improvement - potential new problems that may arise if the original problem is resolved. (Also a concept in MRI SBFT.)
How does Haley & Madanes SFT use paradox?
Paradox can be prescribing the symptoms, forbidding change, or telling the fam to go slow with solutions – outwitting the family to get them to lean into the problem.
Paradoxical interventions could best be described as when a therapist directs his or her client to perform the very problem the client is seeking to eradicate. The underlying principle is that clients’ implement certain emotions and actions for specific reasons. Paradox is based on the idea that families experiencing symptoms find it hard to make change, and/or are resistant.
What is a paradoxical injunction?
NOT an intervention. A Paradoxican Injunction is a statement that intrinsically contradicts itself, until the content is teased apart from how it is meant. Related to a double bind message.
How long does Haley & Madanes’ SFT last?
Haley & Madanes Strategic family therapy (BSFT) is a short-term model that typically consists of 12 to 17 weekly sessions (prof. said 6-10 sessions), depending on the severity of the presenting problem. A typical session lasts 60 to 90 minutes.
When does termination happen in Haley & Madanes SFT?
Therapy terminates when presenting problem is resolved. Either Ct or Therapist can determine this and decide to terminate.
BUT one source said: After the immediate problem is resolved, Haley would explore other problems (unlike MRI)
What makes the Haley & Madanes’ version of Strategic Therapy unique?
Haley & Madanes Structural Family Therapy - is also called “Strategic Humanism” - has a more existential bent, and more focused on human connection
- This modality combines aspects of structural and strategic family therapy to quickly, effectively, and PARADOXICALLY solve family problems, which are believed to result from POWER/LOVE IMBALANCES and struggles. Central to the problem-solving therapy interventions are directives that outwit families into changing by LEANING INTO THEIR PROBLEMS, as opposed to resisting them.
GOAL is to help clients find ways to love without dominating, intruding upon, or harming each other.
The mechanism for change is STRUCTURAL REORGANIZATION and BREAKING THE PATTERN. Therapists try to realign hierarchies, since problems develop in skewed hierarchies
- Interested in motivation: power (Haley) or love (Madanes)
- Further insight has low importance
- Interested in both short term (acute issues) and long term (years - chronic issues)
ASSUMPTIONS -
– Believes behavioral symptoms serve functions. Families go through dysfunctional stages to get to functional ones.
– Believe Rules follow hierarchical order: improving hierarchies & boundaries prevents dysfunctional feedback loops from starting.
– Believe in clear generational boundaries (as does Milan)
– 4 causes (& categories) of problems - based on desire…
1. to control & dominate
2. to be loved
3. to love & protect others
4. to repent and forgive
ASSESSMENT -
– Look for STRUCTURAL ISSUES: intergenerational collusions and incongruous hierarchies and rules (& related power & love imbalances)
– Look for:
— TRIANGLES
— POWER STRUGGLES
— CHILDREN USING SYMPTOMS TO CHANGE PARENTS’ BEHAVIOR (also in Milan: Family Game in that model)
– Get specific behavioral picture of complaint, who sees it as a problem, and why it’s a problem now. Only a prob if someone in family thinks it is!
– Identify attempted solutions that maintain/exacerbate complaint
– Hypothesize METAPHORICAL nature of problem - comms/messages are metaphorical for family functioning
INTERVENTIONS -
- USE OF DIRECTIVES
– Prescribe ORDEALS, including prescribing the symptom, so the cost of keeping it up outweighs the gains
– Pretend techniques- Openly address issue of interpersonal power
- Use METAPHOR & stories
- Frame suggestions using CLIENT’S LANGUAGE so they will accept them (therapist’s power play)
- Correct hierarchy
- Reduce intrusion or increase engagement
- Reunite family members
- Change who is helpful and how (including children)
- Repent for injustice, or forgive
- Increase expressions of compassion & unity
What is the goal of restructuring in Haley & Madanes’ Strategic Family Therapy?
- Create more adaptive alliances
- Shift boundaries to create flexibility and improved connections
- Open up lines of communication
What is the role of the therapist in Haley & Madanes’ Strategic Family Therapy?
The therapist must:
- Serve as the expert
- Identify solvable problems.
- Set goals.
- Design interventions to achieve those goals.
- Take responsibility for creating conditions for change (but also tell the Ct they are responsible for change!)
- Be active & directive
- Examine the responses and be skeptical of change
- Work with client resistance
- Examine the outcome of the therapy.
What is the Pretend Technique, in Haley & Madanes’ Strategic Family Therapy?
In the pretend technique, the symptoms are enacted OUTSIDE of the context in which they are embedded, to help individuals and families separate themselves from problematic symptoms.
Encouraging the family to act “AS IF” (imagining different circumstances) encourages a shift in control over the symptom.
What are Ordeals in H&M SFT?
Interventions where the therapist makes it more difficult for a person to have a symptom than to give it up. How? By directing the client to complete another task before/after the symptom. More about shaking up/perturbing the system so Ct can make changes or navigate around the issue.
Does Haley & Madanes Strategic Therapy concern itself with the functional nature of the problem?
Yes. Unlike MRI Strategic therapy, Haley & Madanes Strategic Therapy IS concerned with the function that symptoms/problems serve.
What are the stages of the first session, in Haley & Madanes SFT?
The first session is about identifying the problem & the goal of therapy.
- Social Stage - The therapist greets & speaks with each member of the family.
- Problem Stage - The therapist talks to each person to get their ideas about the problem and look for triangles.
- Interaction stage - Therapist has members discuss the problem, observing family interactions. Circular questions. End session with a simple directive, or prescribe an ordeal.
