Strategic Therapy: MRI, Haley Problem Solving, Haley-Madanes Strategic, Milan Systemic

Question 1

Strategic Family Therapy

Answer 1

◦ Rooted in Communication Theory
◦ Is defined by three “different” approaches
◦ Milan, MRI, and Haley/Haley-Madanes Approach
◦ Directive for therapist, geared toward action-oriented problem-
solving for clients

Question 2

Milton Erickson

Answer 2

◦ People had the ability to solve own problems
◦ Could be induced to try new behaviors
◦ Change can be swift
◦ Client’s own resistance to change could ironically
be used to bring about change

Question 3

Paradox

Answer 3

◦ Contradiction or puzzle
◦ Symptomatic families are naturally resistant to change
◦ Sometimes, it is more useful either to forbid them to change or ask
them to change in ways that seem to run counter to the desired
goals
◦ Can predict rebellion; thus, change occurs

Question 4

Mental Research Institute
(MRI)

Answer 4

◦ Early 1950s: Group studied family communication patterns of people
diagnosed with schizophrenia to try to determine the origin of
symptoms
◦ Theoretically-based in cybernetics (patterns of interaction)
- “psychotic behavior in one member of a family might make sense
in the context of pathological family communication”
* Double bind => psychotic symptoms in family member
◦ MRI founded in 1959
- Don Jackson, Paul Watzlawick, Jay Haley, Virginia Satir, John
Weakland, Arthur Bodin, and Janet Beavin
◦ 1967: Brief Therapy Center
- Therapist designs or selects a task in order to solve the problem
- One-way mirror
- Telephone connecting observers
- Suggestions offered
- Debriefing

Question 5

Axioms of Communication

Answer 5

Paul Watzlawick
◦ Communication is Complementary or symmetrical
◦ Symmetrical: “based on equal power”
- No dominant individual
- Ex: couples who are free to pursue careers and share household
chores
◦ Complementary: “based on differences in power”
- One dominant individual
- Ex: Parent-child relationship; “toxic friendships”
- Can be extremely harmful

Question 6

Jay Haley & Cloe Madanes: Theory of Dysfunction

Answer 6

◦ Symptoms
- Stem from a faulty organization within the family (problems with
HIERARCHY)
- Serve a function in maintaining structure and homeostasis
◦ Emphasizes transitions between family life cycle stages are where
problems emerge
◦ Dysfunctional hierarchy
- Triangles and coalitions
- “Incongruous hierarchies” (Madanes): when children use symptoms
to try to change parents
◦ Interventions are designed to interrupt patterned sequences and
realign the hierarchic incongruities of the malfunctioning system

Question 7

The Milan Group

Answer 7

◦ The Milan Group was founded by:
- Maria Palazzoli, Luigi Boscolo, Gianfranco Cecchin, Guilana Prata
◦ They treated severely disturbed children
- Psychoanalytic methods
◦ They applied Bateson’s work to family problems
- Devised paradoxical interventions to counteract families’ tendency
toward homeostasis
◦ They were strongly influenced by MRI group
- Watzlawick was a consultant

Question 8

Milan Group Basics

Answer 8

◦ Co-therapists (male-female dyad)
- Team observations
◦ 5-part session:
1. Presession
2. Session
3. Intersession
4. Intervention
5. Post session discussion
◦ One month between sessions; limit to 10 sessions

Question 9

Neutrality and Irreverence

Answer 9

◦ Basic therapeutic stance
- Conveys attitude of curious exploration when asking questions or
responding to answers
◦ Therapist should not be inclined toward any particular set of rules or
beliefs that might govern the family interactions or family members
◦ Data gathering and neutral stance of the therapist permits useful
interactional data (feedback) and self-report information to emerge
◦ Odd day/even day ritual

Question 10

The Bases of Strategic Therapy

Answer 10

◦ We cannot not communicate
◦ Families strive to maintain equilibrium
- How might this present?
- Dysfunction=families trapped to maintain homeostasis
◦ Three explanations of problem development:
- Cybernetics, Structure, and Function

Question 11

Cybernetics

Answer 11

◦ Problems present when families persistently try to solve their own
problems in misguided ways. This creates positive feedback loops
that families struggle to break out of AND find difficult to maintain
◦ MRI ONLY uses this explanation of problem development
- Watzlawick, Weakland, & Fisch
◦ Also used by: Haley; Haley & Madanes; Milan

Question 12

For MRI Clinicians

Answer 12

◦ Families encounter many difficulties over the course of their lives,
but whether a difficulty becomes a problem depends on how family
members respond to it

Question 13

“Normal” Family Pattern Development in Strategic means…

Answer 13

◦ MRI Group opposed advocating standards of normality for families
- Took no position on how families should behave
- Task is to eliminate problems
◦ Healthy families are able to change because they communicate
clearly and are adaptable

Question 14

“Dysfunctional” Family Pattern Development in Strategic means…

Answer 14

◦ Difficulties are turned into chronic problems by persistence of
misguided solutions, forming positive-feedback escalation
- Causality is circular
◦ Context is pathological; not the symptoms

Question 15

Strategic Structure

Answer 15

◦ Problems are a result of flaws in a family’s hierarchy or boundaries
◦ Haley; Haley & Madanes
◦ Also used by: Milan
◦ Underlying dynamics in families don’t emerge until after the
presenting problem improved
◦ Metaphors abound in families as symptoms
- Child struggling at school might mirror work problem of a parent
- An underachieving child might parallel an under-functioning parent
- An addicted child in the family might mean another family member
is also acting self-destructively

Question 16

Madanes’ Contributions

Answer 16

◦ Parents fight with children about things they should address
between themselves
◦ Power between couples is regulated through money, education,
control of children, coalitions with in-laws, religion, and sex. It often
turns out that the partner with the least power develops the most
emotional problems

Question 17

Function

Answer 17

◦ Problems result when people try to protect one another indirectly,
such that their problems come to serve a function for the system
◦ Milan
◦ Also used by: Haley; Haley & Madanes

Question 18

Strategic Therapies are…

Answer 18

◦ Pragmatic
◦ Directive in their focus on problem-solving
◦ Intentional in applying intervention to outwit resistance and provoke
change, with or without the cooperation of the client family

Question 19

Strategic approaches introduced two of the most powerful insights in all of family therapy: They are…

Answer 19

1. Families often perpetuate problems by their own actions
2. Directives tailored to the needs of a particular family can
   sometimes bring about sudden decisive change

Question 20

Strategic Interventions

Answer 20

◦ (all) Identify the positive feedback loop
- (Haley) Inadequate parental hierarchies are to blame
◦ (all) Determine the rules that govern behavior
◦ (MRI) Identify attempted solutions
- From this inquiry emerges a formulation of the problem-solution
loop and the specific behavior that will be the focus of intervention.
Typically, the strategic objective will be a 180-degree reversal of
what the clients have been doing.
◦ (MRI) Reframe
- This allows the rules of the loop to change as one member
reinterprets another’s behavior
- One of the first interventions used by strategic therapists
◦ (MRI) Paradoxical Interventions / Injunctions
-
◦ (Haley) Prescribing Directives and Ordeals
- Make the problem harder so that the price of keeping the
symptom outweighed that of giving it up
◦ (Madanes) Help Children Help Parents
- Incongruous hierarchies: Find ways of letting symptomatic children
help their parents openly so that they won’t have to resort to
symptoms as “sacrificial offerings”

Question 21

Paradoxical Interventions

Answer 21

◦ Asking family to do something that seems in opposition to goals of
treatment
- Therapeutic double bind: “Win-win situation,” promotes progress
no matter how a client responds
◦ Prescribing symptoms: continue or expand symptom
◦ Restraining techniques: warn against dangers of change/restrained
from trying to change/asked to change slowly
◦ Positioning: amplify or exaggerate family’s explanation of the
problem to the point the family will disagree

Question 22

Directives and Ordeals

Answer 22

◦ Track family sequences and then assign directives (tasks) to family to
alter the sequence
◦ Two Types of Haley’s Directives:
1. Suggestions to do something differently
2. Suggestions to continue to behave the same
◦ Goals of directives:
1. Get family members to do things differently and have different
experiences
2. To involve therapist in treatment and “intensify the relationship to
the therapist”
3. To gather additional information about how the family responds
to the task
◦ Ordeal: directives that are aimed at making the symptom harder to
keep up than maintain
- Requires client to do something they do not want to do, but is
something that would benefit them in some way
- Aimed at symptom relief and family restructuring

Question 23

Other Haley/Madanes Interventions

Answer 23

◦ Hierarchy-fixing intervention
◦ Strategic humanism: increasing family members’ ability to soothe
and love rather than gain control
◦ Rituals: prescription of action(s) that are designed to alter family’s
roles
◦ Dramatizations: parent directed to request his/her child to
intentionally perform problem behavior
◦ Pretending: parents ask child to pretend to have the symptom and
parents pretend to help child
◦ Make-believe play: Asks parents to make believe they need child’s
help and children make believe helping them