C H A P T E R 11
STRATEGIC MODELS
Strategic therapies offer an active, straightforward set of therapist interventions aimed at reducing or eliminating the presenting set of family problems or behavioral symptoms. Less focused on the meaning of the symptom or its origins, strategists typically issue a series of directives or tasks to the family, directed at changing those repetitive interactive sequences within families that lead to cross-generational conflict. Whereas other approaches rely on interpretation or relationship building, strategists zero in on those behavioral sequences within the family that perpetuate the problem, then offer directives to provoke the family to change the way they deal with one another, sometimes without their cooperation or knowledge that they are being manipulated into doing so. Among the greatest virtues of strategic family therapy is its insistent attention to the task at hand—removing the disturbing symptom or dysfunctional behavioral sequence—continuous tracking of the family’s patterns of interpersonal exchanges, and its use of assignments of tasks to achieve therapeutic ends.
Strategic therapies derive from the work of the Palo Alto research group projects of 1952–1962 on family communication described earlier in the text. The seminal ideas of Gregory Bateson, Don Jackson, Jay Haley, John Weakland, Paul Watzlawick, and their associates helped shape the family therapy field and are fundamental to how practitioners view family relationships even today. Feedback loops, the redundancy principle, double binds, family rules, marital quid pro quo, family homeostasis—all are such familiar and basic concepts that young family therapists today might assume they were always known. They were not; they are part of communication theory, which emerged when Bateson and his colleagues set out to study communication patterns in families with schizophrenic members.
THE COMMUNICATIONS OUTLOOK
Communication theorists concern themselves with how verbal and nonverbal messages get exchanged within a family. They pay attention to the question of what is occurring rather than why it is occurring—to the ongoing process between and among people within a system and the ways in which they interact, define, and redefine their relationships, and not to drawing inferences about each participant’s inner conflicts. Communication patterns—the style or manner in which information is exchanged (that
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is, coded and encoded) within a family; the precision, clarity, or degree of ambiguity of the transmission; and the behavioral or pragmatic effect of the communication, as much as the content of what is communicated—help determine those relationships.
In shifting the locus of pathology from the individual to the social context and the interchange between individuals, these family therapy pioneers were not denying that intrapsychic mechanisms influence individual functioning (although an examination of these mechanisms was played down in practice). Rather, they were giving greater credence to the power of family rules to govern interactive behavior; to them, a breakdown in individual or family functioning follows from a breakdown in rules. Feedback loops revealed a great deal about how family members communicated with one another, how they went about resolving conflict, what chain of command existed within their ranks. To this day, the strategic therapist’s primary way of viewing problems is to attend to the family’s sequence of interactions and its hierarchy of interactions (Keim, 1998).
Communication theorists argue that a circular interaction continues between people because each participant imposes her own punctuation; each arbitrarily believes that what she says is caused by what the other person says. In a sense, such serial punctuations between family members resemble the dialogue of children quarreling:“You started it!”(“I’m only reacting to what you did.”)“No, you started it first!” and so on. As Weakland (1976) contends, it is meaningless to search for a starting point in a conflict between two people because it is a complex, repetitive interaction, not a simple, linear, cause-and-effect situation with a clear beginning and end.
Once considered iconoclastic if not radical, this view of redundant patterns of communication within the family as offering clues to family dysfunction provided a linguistic leap forward for the emerging field. While its early view of the therapist as an authoritative expert strategically directing—manipulating—families to change is largely out of fashion today (replaced by the collaborating therapist or coach without fixed ideas of how the family should change), the communication perspective itself has undergone considerable revision as it has evolved over four decades; current proponents also can be considered to represent the strategic approach. For clarity of presentation, however, we have separated four outlooks: the original Mental Research Institute (MRI) interactional view, the brief therapy principles and therapeutic procedures that characterize current MRI activities, the strategic therapy refinements advanced primarily by Jay Haley and Cloé Madanes, and the strategic-related efforts developed in Milan, Italy, by Mara Selvini-Palazzoli and her associates. The last group’s labors, much of which have evolved in the social construction direction, are discussed more fully in the next chapter.
THE STRATEGIC OUTLOOK
Efficiency and technical parsimony are the hallmark of these models; all are change oriented, brief in duration, and view families in non-pathological terms. All four approaches involve active therapists who tailor their novel strategies or interventions specifically to a family’s presenting complaint and terminate therapy as soon as that complaint is resolved. Their specific aim is to help the family resolve its presenting problem; they are less concerned with promoting personal growth or working through any underlying family emotional issues or teaching families specific problemsolving skills (Shoham, Rohrbaugh, & Patterson, 1995). The family receives help for what they came for, without the therapist speculating on whether other, as yet unidentified problem areas might still exist or that further therapy perhaps is called for.
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While there are noteworthy differences in the four approaches, we group them together because all represent, in varying degrees of refinement, elaborations on the theme that clients determine what the problem is and therapists are responsible for change. Therapists can initiate interventions to change the family’s problem-solving management or strategies without attending to, or providing insight into, why that behavior occurred in the first place. Specific, reachable goals are delineated clearly at the outset of treatment, and the family and therapist together recognize when such concrete goals are met.
MRI INTERACTIONAL FAMILY THERAPY
Leading Figures
Founded by Don Jackson in 1959, and initially with a small staff consisting of social worker Virginia Satir and psychiatrist Jules Riskin, the Mental Research Institute in Palo Alto at first existed side by side with the neighboring Bateson Project. When the Bateson team ended its research endeavors in 1962, Haley, Weakland (coauthors, along with Bateson and Jackson, of the double-bind theory), and briefly, Bateson himself, joined the MRI as research associates; also at MRI were psychologists Paul Watzlawick and Arthur Bodin and psychiatrist Richard Fisch. Other prominent family therapists discussed elsewhere in this text—John Bell, Carlos Sluzki, Cloé Madanes, and Steve de Shazer come to mind—have been affiliated with this outstanding training center at one time or another over the years.
Developing a Communication Paradigm
In the decade ending not long after Jackson’s death in 1968 at the age of 48, the theoretical groundwork for the interactional approach of the MRI was laid, based largely on ideas derived from general systems theory, cybernetics, and information theory. Moving beyond their original formulations regarding the familial origins of schizophrenia, these researchers zeroed in on the family interaction sequences in all families in an effort to understand how faulty communication patterns might lead to family dysfunction. Watzlawick, Beavin, and Jackson’s (1967) Pragmatics of Human Communication is considered the classic pioneering text in the communication field, drawing the attention of family therapists to the need for the simultaneous study of semantics (the clarity of meaning between what is said and received), syntax (the pattern as well as manner or style in which information is transmitted), and pragmatics (the behavioral effects or consequences of communication). These authors presented a series of axioms regarding the interpersonal nature of communication:
•All behavior is communication at some level. Just as one cannot not behave, so one cannot not communicate. The wife who complains in utter frustration that her husband “refuses to communicate” with her but instead stares at the television set all evening is responding too literally to his failure to talk to her. On a nonverbal level, she is receiving a loud and clear message that he is rejecting her, withdrawing from her, may be angry or bored with her, wants distance from her, and so on.
•Communication may occur simultaneously at many levels—gesture, body language, tone of voice, posture, intensity—in addition to the content of what is said. In some cases, the message at one level contradicts one at another level. People can say one thing and mean another, modifying, reinforcing, or contradicting what they have just
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said. In other words, they are both communicating (“How are you?”) and at another level communicating about their communications (“I do not really expect you to answer, nor do I especially want to know the answer, unless you say you are fine”). All communication takes place at two levels—the surface or content level and a second level called metacommunication, which qualifies what is said on the first level. Problems may arise when a message at the first level (“Nice to see you”) is contradicted by a facial expression or voice tone that communicates another message (“How can I make a quick getaway from this boring person?”) at the second level.
•Every communication has a content (report) and a relationship (command) aspect.
Every communication does more than convey information; it also defines the relationship between communicants. For example, the husband who announces “I’m hungry” is offering information but also, more important, is telling his wife that he expects her to do something about it by preparing dinner. He is thus making a statement of his perceived rights in the relationship; he expects his wife to take action based on his statement. The way his wife responds tells him whether she is willing to go along with his definition of the relationship or wants to engage in what could be a struggle to redefine it (“It’s your turn to make the dinner tonight” or “Let’s go out to a restaurant tonight”or“I’m not hungry yet”).
•Relationships are defined by command messages. These messages constitute regulating patterns for stabilizing relationships and defining family rules. In operation, the rules preserve family homeostasis. In a family, when a teenager announces she is pregnant, or parents decide to get a divorce, or a handicapped child is born, or a family member becomes schizophrenic, it has an effect similar to flinging open a window when the home heating system has been warmed to the desired temperature. The family goes to work to reestablish its balance.
•Relationships may be described as symmetrical or complementary. If it is a relationship based on equality the interactive pattern is symmetrical; if the context of the behavioral exchange is oppositional, the pattern is complementary. In the former, participants mirror each other’s behavior; if A boasts, B boasts more grandly, causing A to boast still further, and so on in this one-upmanship game. By definition, complementary relationships are based on inequality and the maximization of differences. In this form of reciprocal interaction, one partner (traditionally the male) takes the“one-up”position and the other (traditionally the female) assumes the submissive“one-down”position. However, despite appearances, these positions need not be taken as an indication of the partners’ relative strength or weakness or power to influence the relationship.
•Symmetrical relationships run the risk of becoming competitive. In this case, each partner’s actions influence the reactions of his or her partner in a spiraling effect called symmetrical escalation. Quarrels may get out of hand and become increasingly vicious as a nasty jibe is met with a nastier retort, which prompts the first person to become even more mean and ill-tempered, and so on. Squabbling partners may continually vie for ascendance over one another, neither willing to back down nor to concede a point. (In one Woody Allen movie, an exchange between a bickering couple goes something like this:“The Atlantic is the best ocean”;“You’re crazy—the Pacific is a much better ocean”; “You’re the one who’s crazy and doesn’t know what he’s talking about”; and so on.) Clearly, in this transaction, the content of the argument is meaningless; it’s the escalating conflict that is notable. The process of the exchange rather than its content defines the relationship.
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•Complementary communication inevitably involves one person who assumes a superior position and another who assumes an inferior one (a bossy wife, a submissive husband, or vice versa). One partner’s behavior complements the other’s; if A is assertive, B becomes submissive, encouraging A to greater assertiveness, demanding still more submissiveness from B, and so on.
•Each person punctuates a sequence of events in which he or she is engaged in different ways. Such punctuations organize behavioral events taking place into each participant’s view of cause and effect and thus are vital to ongoing interactions.
•Problems develop and are maintained within the context of redundant interactive patterns and recursive feedback loops. Haley, who had been a graduate student in communication when first recruited for the Bateson project, underscored the struggle for power and control in every relationship that is inherent in the messages that sender and receiver exchange. Who defines the relationship? Will that person attempt to turn it into a symmetrical or complementary one? Who decides who decides? Observe a couple discussing how to allocate expenditures, or what television program to watch, or who will answer the telephone, balance the checkbook, go to the refrigerator to get a snack, or pick up the dirty socks and underwear from the bedroom floor, and in each of these see if you do not learn a great deal about how the partners define their relationship.
Paradoxical Communication
The communication theorists were the first to point out that there is no such thing as a simple message. People continually send and receive a multiplicity of messages by both verbal and nonverbal channels, and every message may be qualified or modified by another message on another level of abstraction (Weakland, 1976). Not infrequently, the receiver can become confused when contradictions appear between what is said and what is expressed in tone or gesture.
A double-bind message is a particularly destructive form of such a paradoxical injunction. As we described it in Chapter 5, a double-bind message is communicated when one person, especially someone in a powerful position, issues an injunction to another that simultaneously contains two levels of messages or demands that are logically inconsistent and contradictory, producing a paradoxical situation for the recipient. In addition, the person receiving the paradoxical message is unable to avoid the incongruity or to comment on the impossibility of meeting its requirements, resulting in confusion.
Paradoxical injunctions are forms of communication that must be obeyed but that must be disobeyed to be obeyed! Two conditions typically must exist: (a) the participants must have a close complementary relationship; and (b) the recipient of the injunction cannot sidestep or otherwise avoid responding to the communication or metacommunication.
Consider the following injunction from a person in a position of authority:
IGNORE THESE INSTRUCTIONS
To comply with the instructions, a person must not follow instructions, since one message denies or negates the other (“I order you to disobey me”). Unable to discriminate which order or level of message to respond to, the recipient nevertheless is called upon to make some response. He or she is thus caught in a bind, being called upon
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to make a response but doomed to failure with whatever response is chosen. Although initially speculated to be the type of paradox that might be responsible for schizophrenia in a child who repeatedly receives such double-bind communications, it is now assumed that double binding, while still considered damaging, may exist at varying times and with varying degrees of serious consequences in all families.1 Admittedly a linear construct, the double-bind concept (Bateson, Jackson, Haley, & Weakland, 1956) nevertheless was truly groundbreaking and heralded a breakthrough in the psychotherapy field by providing a new language and set of assumptions regarding relationships reflected in communication patterns to account for symptomatic behavior.
Therapeutic Assumptions
Led primarily by the innovative thinking of Paul Watzlawick (Watzlawick, 1978; Watzlawick, 1984; Watzlawick, Weakland, & Fisch, 1974), a longtime researcher into interpersonal communication and the language of change, the MRI therapeutic model emphasizes that, ironically, the solutions people use in attempting to alleviate a problem often contribute to the problem’s maintenance or even its exacerbation. That is, people are not being difficult or resistant to change, but rather are “stuck” in repeating inappropriate and non-workable solutions. In this view, problems may arise from some ordinary life difficulty, perhaps coping with a transition such as the birth of an infant or an older child going off to school for the first time. Most families handle such transitions with relative ease, although occasionally the difficulty turns into a problem, particularly when mishandled or allowed to remain unresolved while the family persists in applying the same“solution”despite its previous failure to eliminate the difficulty. Ultimately the original difficulty escalates into a problem“whose eventual size and nature may have little apparent similarity to the original difficulty”(Fisch, Weakland, & Segal, 1982, p. 14).
In a pragmatic, therapist-directed approach, aimed at solving the current problem for which the family came seeking help, the task is to break into the family’s repetitive but negatively self-perpetuating cycle. Confronted with family members engaged in repetitive and often mutually destructive behavior patterns, the MRI therapist wants to know what makes the behavior persist, and what he or she must do to change it (Watzlawick, Weakland, & Fisch, 1974), but not what in the past caused it, or how the family needs insight or restructuring.
First, the therapist must carefully delineate the problem in clear and concrete terms. Next, solutions previously attempted by the family must be scrutinized. The therapist is now prepared to define, again as precisely and concretely as necessary, just what change is sought, before implementing a strategy or therapeutic plan for achieving change (Watzlawick, 1978). As a general rule, the interactional therapist is seeking
1The double-bind situation is no longer believed to be the cause of schizophrenia, although it remains a historically significant formulation in that it drew attention to the possible role of family communication patterns in developing and maintaining family dysfunction. Today it is assumed that many families engage in such flawed communication at times; perhaps this is excessively so in families with severe but unacknowledged interpersonal conflict. Having lost its original pathological referent to schizophrenia, the double-bind concept is currently used loosely to refer to a variety of interactive communication patterns whose messages leave the receiver confused.
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B O X 1 1 . 1 C A S E S T U D Y
TREATING AN ALCOHOLIC SYMPTOM
In the following case, the therapist asks the patient to make what seems to be a small alteration in how he handles his drinking problem. Seeing it as a minor adjustment, he accepts the directive easily, not aware that he is beginning the process of modifying his “solution” to the problem. Therapy is concluded when the presenting symptom is eliminated or the presenting problem resolved, despite the fact that other problems remain.
Don was a 38-year-old high school teacher who had contacted the therapist 10 years earlier with indecisions over a career. This time, his anxious call for an appointment alerted the therapist that some crisis had occurred, and when Don appeared in her office the next day he was agitated and distraught. He told her how he had embarrassed himself and his wife and teenage children at a family wedding. Ordinarily a meek, mild-mannered person, he drank too much and got into a physical fight with a stranger. He reported that his family was angry with him, that he was determined to quit drinking, and he was ready to start working on the problem now.
The therapist recommended a self-help, 12-step AA program, but Don insisted he could conquer the problem on his own. The therapist was skeptical, however, and encouraged him to at least enlist the support of his older brother, who had quit drinking, and to talk to him as a“sponsor”every day.
After several sessions of weekly therapy, Don suffered a relapse, when his wife, Gwen, invited him to stop for a drink on their way home after he had picked her up
at the airport. Gwen also had a drinking problem, which she claimed was under control, and by now it had become clear to the therapist that drinking was a core part of their relationship. When Gwen was asked to attend the therapy sessions with Don, she resisted, explaining that he was the one with the uncontrollable problem.
The therapist’s initial efforts to provide insight into the connection between the use of alcohol and their relationship did not seem to help or lead to change. Deciding to concentrate on the presenting symptom— Don’s drinking—the therapist suggested that he make a small change: to only drink together with Gwen, and at no other time. Since she was going on a business trip, and he had sole responsibility for caring for the children, he had earlier decided himself he would not drink during her absence, so he agreed to the directive.
Later, he told the therapist that her assignment was not hard to comply with, and that he had not had drinks with the other teachers after school on Friday, as had been the group’s custom. He was even more gratified by realizing he had voluntary control over when he drank. He did continue drinking with Gwen when she returned, as he had been directed to do, but recognized there needed to be more to their relationship than being drinking buddies. They began to discuss their relationship—for the first time in years—and Gwen decided to seek help for her drinking. When Don called the therapist six months later, he seemed proud to report that the drinking was under better control and that he and his wife and children had become closer.
ways to change outmoded family rules, reveal hidden personal agendas, and modify or attempt to extinguish paradoxical communication patterns.
First-Order and Second-Order Changes
One especially useful set of concepts introduced by Watzlawick, Weakland, and Fisch (1974) concerns the level of change sought by the therapist. First-order changes are superficial behavioral changes within a system that do not change the structure of the
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system itself. These changes are apt to be linear and little more than cosmetic or perhaps simply a reflection of a couple’s good intentions—for example, not to raise their voices and argue anymore.
These first-order changes are likely to be short-lived; even if the symptom is removed—the couple tries to control their quarreling—the underlying systemic rules governing the interaction between them have not changed, and the cease-fire is likely to be violated sooner or later.
Second-order changes require a fundamental revision of the system’s structure and function. Here the therapist moves beyond merely helping remove the symptom, also striving to help the family alter its systemic interaction pattern—not just calling a halt to fighting, but changing the rules of the family system and consequently reorganizing the system so that it reaches a different level of functioning. If the therapy is successful, the old rules are discarded as obsolete; as a result the family may become temporarily confused, but then will attempt to reconstitute itself in a new way.
According to Watzlawick (1978), therapy must accomplish second-order changes (a change in viewpoint, often due to a therapist’s reframing of a situation) rather than mere first-order changes (a conscious decision by clients to behave differently).
The Therapeutic Double Bind
Interactional therapists (and strategic therapists in general) argue that it is their responsibility, as outsiders, to provide the family with an experience that will enable the members to change their rules and metarules concerning their relationships with one another and with the outside world. Couples need to learn how each punctuates an interaction (who each thinks is responsible for what), and how conflict often follows differences in such perceptions. Families must examine their patterns of communication (including report and command functions) and especially the context in which communication occurs.
More specifically, faulty but persistent solutions to everyday difficulties must be examined to learn if the family (a) ignores a problem when some action is called for;
(b) overreacts, taking more action than is necessary or developing unrealistic expectations from actions taken; or (c) takes action at the wrong level (making cosmetic first-order changes when second-order changes are necessary). As we demonstrate shortly, the MRI Brief Therapy Center approach incorporates this time-limited, highly focused therapeutic effort toward problem resolution.
While focusing on the presenting problem and helping the family develop clear and concise goals, strategists often try to induce change by offering explicit or implicit directives—therapeutic tasks aimed at extinguishing ineffective interactional sequences (examples are given later). To the therapist, these are clever maneuvers designed to subtly gain control over the presenting symptoms and force families to attempt different solutions; to the family these directives often appear to fly in the face of common sense, but family members nevertheless put themselves in the hands of the expert and follow instructions. The overall purpose of such paradoxical approaches is to jar or interrupt the family’s established, but ineffective, pattern of interaction by powerful indirect means. Since second-order change is the goal, the therapist is attempting to circumvent family resistance to altering the interactive patterns that maintain the problematic behavior.
One direct outgrowth of research on the pathological double bind has been the notion of the therapeutic double bind, a general term that describes a variety of paradoxical
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techniques used to change entrenched family patterns. Just as a pathological double bind places an individual in a no-win predicament, so a therapeutic double bind is intended to force that person (or couple or family) into a no-lose situation: A symptomatic person is directed by the therapist not to change (for example, a depressed person is told not to be in such a hurry to give up the depression) in a context where the individual is expecting to be helped to change. In effect, the therapist’s directive is to change by remaining the same. The person thus is caught in a trap: If the directive not to do anything is defied and the individual tries to lift the depression, he or she learns to acquire control of the symptom and this constitutes desired therapeutic change; if the person complies and does not attempt to change, he or she acknowledges a voluntary exercise of control over the symptoms. Since symptoms, by definition, are beyond voluntary control, the person can no longer claim to be behaving symptomatically through no fault of his or her own. Either way, the person gains control over the symptom; the symptom no longer controls the person. The symptoms have fallen under therapeutic control.
In a form of therapeutic double bind called prescribing the symptom, strategists try to produce a runaway system by urging or even coaching the client to engage in or practice his or her symptoms, at least for the present time. A family is instructed to continue or even to exaggerate what it is already doing (for example, a mother and daughter who continually fight might be directed to have a fight on a regular basis, every evening for fifteen minutes immediately after dinner). Since the family has come in desperation for help from the therapist (who seems to have high qualifications and to know what he or she is doing) and since the directive not to change appears easy to follow because the symptomatic behavior (the fighting) is occurring anyway, the family attempts to comply.
The therapist, asked to help them change, appears to be asking for no change at all. Such an assignment, however, undermines family members’ fearful resistance to anticipated efforts to get them to change by rendering such opposition unnecessary. The therapist is actually on the way toward outwitting any resistance to change. At the same time, the therapist is challenging the function or purpose of the symptom, suggesting the family behaves that way because it serves to maintain family balance. In our example, confronted with the repugnant task of fighting on a regular basis, thereby exercising voluntary control over a previously uncontrolled situation, the mother and daughter resist the directive and begin to interact in a different manner. The unstated rules by which they operated before may become clearer to them, as does the notion that their quarreling does not “just happen” involuntarily but can be brought under voluntary control.2 Since their interactive pattern no longer serves the family function of providing balance, the entire family must seek new ways of interacting with one another.
2Maurizio Andolfi (1979), director of the Family Therapy Institute in Rome, Italy, is particularly adept at unbalancing rigid family systems, often through effective use of “prescribing the symptom.” In a family in which an anorectic adolescent girl controls family communication and defines all relations, including the relationship between her parents, Andolfi will forbid the girl to eat during a lunch session when the therapist and family eat together normally. Since her symptom (not eating) is now involuntary, it no longer serves as a means of controlling family interactions. At the same time, the family can no longer use its typically incongruent message,“Eat, but don’t eat.”The prescription interrupts the family game based on the daughter’s eating problem and helps expose the rules of the anorectic family system.