Book Title: eTextbook: Mastering Competencies in Family Therapy
Systemic–Strategic Family Therapy
The Big Picture: Overview of Treatment
The Big Picture: Overview of Treatment
Systemic and strategic therapies focus solely on resolving the presenting
problem, with the therapist imposing no other goals or agendas. Therapists see
the presenting problem not as an individual problem but as a relational one,
specifically an interactional one (Cecchin, 1987; Haley, 1987). Neither an
individual nor a relationship is considered “dysfunctional”; instead, the
problem is viewed as part of the interactional sequence of behaviors that have
emerged through repeated exchanges, with no one person to blame.
The early stages of all three approaches involve getting a clear, behavioral
description of the interaction sequence surrounding the problem, beginning
with the initial exchange prior to the escalation of symptoms and ending with
the interaction sequence that returns the system to homeostasis. Once the
therapist has identified the interactional behavioral patterns and meanings
associated with the problem, they use one of many potential interventions to
interrupt, not correct, this sequence. Much the way a school of fish cannot be
shepherded but only interrupted and allowed to regroup, systemic and
strategic therapists do not try to linearly instruct clients in preferred behaviors,
because it rarely, if ever, works (Haley, 1987). Instead, they interrupt the
problem sequence of behaviors, allowing the family to reconfigure itself
around the new information that has been introduced to the system. For
example, if a parent and child complain of frequent arguments, the therapist
does not try to educate them in better communication. Instead, the therapist
interrupts the sequence by reframing the child’s defiance as a veiled attempt to
remain close to the parent because the child fears the transition to college, or
the therapist may ask the parent and child to ritualize the process with hats
symbolizing their positions. For example, in the case study at the end of this
chapter, the therapist working with Alba, a 16-year-old who started drinking
and smoking pot after Alba’s parents separated, reframes acting-out behaviors
as attempts to bring the parents together over a common goal and to distract
the family from the pain of the father’s affair; the therapist does not believe
Alba does this consciously or intentionally but rather is following the “pull” of
the system to restore family homeostasis.
Usually, the therapist gives the family a task or reframe before they leave the
session, with instructions to either complete the task or reflect on the new
interpretation presented by the therapist. The next week, the therapist follows
up on the prior week and then designs another task or reframe based on the
response to the prior week’s intervention. This process continues only as long
as is necessary to resolve the presenting problem; then, therapy is terminated.
To recap, the general flow of systemic or strategic therapies is as follows:
The Process of Systemic Therapy
Assess the interactional sequence and associated meanings: The
therapist identifies the interactional behavior sequences that
constitute the problem, including the actions and reactions of
everyone in the system and the associated meanings.
Intervene by interrupting the interactional sequence: Using a
reframing technique or a task, the therapist interrupts the sequence
(avoids trying to fix or repair the sequence), allowing the family to
reorganize itself in response to the perturbation. Note: The differences
between MRI, strategic, and Milan therapies are primarily seen in the
preferred method of interrupting the interactional sequence.
Evaluate outcome and client response: After the intervention, the
therapist assesses the family’s response and uses this information to
design the next intervention.
Interrupt the new pattern: The therapist then interrupts the new
pattern with another intervention. This continues—interrupt
behavioral sequence, allow family to reorganize and respond, and
intervene again—until the problem is resolved.
