Another form of therapeutic double bind, relabeling (essentially changing the label attached to a person or problem from negative to positive) attempts to alter the meaning of a situation by altering its conceptual and/or emotional context in such a way that the entire situation is perceived differently. That is, language is used to alter the interpretation of what has occurred, and thus invites the possibility of a new response to the behavior. The situation remains unchanged; but the meaning attributed to it, and thus its consequences, are altered.

The classic example comes from Mark Twain’s Tom Sawyer, who relabeled as pleasurable the drudgery of whitewashing a fence and thus was in a position to ask other boys to pay for the privilege of helping him. Relabeling typically emphasizes the positive (“Mother’s not being overprotective; she merely is trying to be helpful”) and helps the family redefine disturbing behavior in more sympathetic or optimistic terms. Relabeling provides a new framework for looking at interaction; as the rules by which the family operates become more explicit, the family members become aware that old patterns are not necessarily unchangeable. The goal of relabeling, like that of the other therapeutic double-bind techniques, is to change the structure of family relationships and interactions.

MRI BRIEF FAMILY THERAPY

Brief therapy calls for finding alternative ways of facilitating beneficial changes that are relatively quick and inexpensive, and that are especially suited at symptomatic junctures in the life cycle of individuals and families (Peake, Borduin, & Archer, 1988). Typically they are active, highly focused, short-term methods that attempt to enable the family system to mobilize its underutilized resources to solve or resolve the problem(s) that led them to seek help.

The MRI version of brief therapy focuses on resolving problems that result from prior attempts to solve an ordinary difficulty. After identifying the family’s more-of- the-same solutions that prolong the problem, the MRI brief therapist tries to discover the family rules and communication sequences that maintain and perpetuate the problem. Interventions then are directed rather specifically at changing the rules that sustain the problem the family wants fixed. Once the problem is eliminated, the therapist’s task is completed; no effort is made to seek further changes, unless requested by the family. The focus of all clinical interventions at the Brief Therapy Center is on solving specific problems and/or reducing presenting symptoms, rather than seeking changes in the overall family system. If client families change what they are doing to solve a problem, then changes in the presenting problem can be achieved, since it is assumed that their attempted solutions are feeding the problem and thus perpetuating it (Schlanger & Anger-Diaz, 1999). Thus it can be said that the focus is on treating the solution, not treating the problem.

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Brief family therapy as practiced at the MRI3 is a time-limited (usually no more than 10 sessions), pragmatic, non-historical, step-by-step strategic approach based on the notion that most human problems develop through the mishandling of normal difficulties in life. In the MRI view, the attempted “solutions” imposed by families become the problem, as people persist in maintaining self-defeating “more of the same”attempts at problem resolution. Thus, from the MRI behavioral perspective, the client’s complaint is the problem, not a symptom of an underlying disorder, as more psychodynamic approaches might theorize.

Put in more graphic interpersonal terms, the client is like a person caught in quicksand, grabbing onto someone else: The more he or she struggles, the more likely he or she is to sink and pull others in; the more he or she sinks, the more the struggling escalates and the more others are caught in the quicksand. In other words, ineffective attempts persist, and now the “solution” itself only makes matters worse. According to advocates of this approach, it is only by giving up solutions that perpetuate the problem and attempting new solutions that are different in kind that changes can occur in the self-perpetuating behavior.

The time limitations of this approach force clients to specifically define their current problem (“We believe our teenage boy is using drugs”) rather than speak in generalities (“We’re having family problems”). Here the therapist is interested in how, exactly, this problem affects every participant’s life, and why they are seeking help just now (rather than earlier or later).

The strategically oriented brief therapist tries to obtain a clear picture of the specific problem as well as the current interactive behavior that maintains it, then devises a plan for changing those aspects of the system that perpetuate the problem (Segal, 1987). By restraining people from repeating old unworkable solutions (and by altering the system to promote change), the therapist can help them break out of their destructive or dysfunctional cycle of behavior.

Brief therapy advocates argue that most therapists, in attempting to help a distressed person, encourage that person to do the opposite of what he or she has been doing—an insomniac to fall asleep, a depressed person to cheer up, a withdrawn person to make friends. These approaches, by emphasizing opposites or negative feedback, only lead to internal reshuffling; they do not change the system. Watzlawick and associates (1974) call such moves superficial first-order changes, effecting change within the existing system without changing the structure of the system itself. Real change, however, necessitates an alteration of the system itself; it calls for a second-order change to make the system operate in a different manner. First-order changes, according to Watzlawick, Beavin, and Jackson (1967), are“games without end”; they are mistaken attempts at changing ordinary difficulties that eventually come to a stalemate by continuing to force a solution despite available evidence that it is precisely what is not working (Bodin, 1981).

Three Types of Misguided Solutions

MRI therapists take this position on problem formation—that complaints typically presented to a therapist arise and endure because of the mishandling of those normal,

3Several brief therapy approaches currently exist side by side, no doubt stimulated in part by the restrictive reimbursement practices instituted by managed care companies. Consequently, many agencies set limits on the number of sessions provided. In Chapter 14 we contrast the MRI problem-focused approach with that of the Brief Family Therapy Center in Milwaukee’s solution-focused effort.

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everyday difficulties occurring in all of our lives. Repeatedly employing unsatisfactory solutions only produces new problems, which then may increase in severity and begin to obscure the original difficulty. From the MRI perspective, there are three ways in which a family mishandles solutions so that they lead to bigger problems: (a) some action is necessary but not taken (for example, the family attempts a solution by denying there is a problem—the roof is not leaking, sister is not pregnant, money is no problem even though father has lost his job); (b) an action is taken when it is unnecessary (for example, newlyweds separate soon after the wedding ceremony because their marriage is not as ideal as each partner fantasized it would be); (c) action is taken at the wrong level (for example, marital conflicts or parent-child conflicts are dealt with by “common sense” or first-order changes, such as each party agreeing to try harder next time, when revisions in the family system—second-order changes—are necessary). The third type is probably most common, since people with problems attempt to deal with them in a manner consistent with their existing frame of reference. Repeated failures only lead to bewilderment, frustration, and intensification of the same responses.

Paradoxical interventions, especially reframing, are emphasized in order to redefine the family’s frame of reference so that members conceptualize the problem differently and change their efforts to resolve it. As we saw in our earlier discussions of the structural approach to therapy, reframing involves a redefining process in which a situation remains unchanged but the meaning attributed to it is revised so as to permit a more constructive outlook. Reframing allows the situation to be viewed differently and thus facilitates new responses to it. As language changes about a problem, changes in feelings are likely to follow.

MRI Brief Therapy in Action

As practiced at the MRI, brief therapy, presented to the clients as being of short-term duration, sets up a powerful expectation of change. At the same time, the therapists tend to “think small,” to be satisfied with minor but progressive changes. They also urge their clients to “go slow” and to be skeptical of dramatic, sudden progress; this restraining paradoxical technique is actually designed to promote rapid change as the family is provoked to prove the therapist wrong in his or her caution and pessimism. In general, the therapists do not struggle with the client’s resistance to change, neither confronting the family nor offering interpretations to which the members might react negatively or defensively. Brief therapy aims to avoid power struggles with the family while it reshapes the members’ perspectives on current problems and on their previous attempts to overcome difficulties.

MRI brief therapists do not insist that all family members attend sessions; they are content to deal only with those members motivated enough to do so. An important aspect of their work is first to collect data on previously failed solutions so as not to repeat them. They then set up specific goals of treatment, formulating a case plan and implementing interventions whenever there is an opportunity to interrupt earlier repetitive attempted solutions that merely serve to perpetuate the problem (Segal, 1991).

The MRI brief therapy program is a team effort. Although each family is assigned a primary therapist who conducts the interviews, other team members may watch from behind the one-way mirror and telephone the therapist with advice, feedback, and suggestions while treatment is in progress—all efforts directed at speeding up a change in family interactive patterns. In special cases (for example, a therapist-family

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impasse) one of the team members may enter the room and address the primary therapist or the clients, perhaps siding with the client to increase the likelihood that forthcoming directives from the observer will be implemented. Families are not screened prior to treatment and are taken into the program on a first-come, first-served basis. Team discussions precede and follow each session after the initial family contact. Telephone follow-ups, in which each family receiving treatment at the center is asked by a team member other than the primary therapist to evaluate change in the presenting problem, take place 3 months and 12 months after the last interview.

The cybernetic nature of both problem formation and problem resolution, with its recursive feedback loops and circular causality metaphors, is basic to MRI thinking and therapeutic endeavors. Ineffective solutions to everyday difficulties lead to symptomatic behavior; once a family member manifests a symptom, the family, believing it has the best way to deal with the problem, responds by repeating the interactive behavior that produced the symptom in the first place. The further repetition of poor solutions intensifies the original difficulty, as the family clings to behavior patterns that are no longer functional or adaptive (Peake, Borduin, & Archer, 1988). Therapists,