Research Paper by Terri Fisher
Jay Haley originally started his research with the Mental Research Institute (MRI) in Palo Alto, California, where he developed a model known as Strategic Family Therapy. This model represents a combination of his work at the Mental Research Institute in Palo Alto California and his work with Salvador Minuchin. A model know as Brief Strategic Family Therapy was also developed to represent adherence to basic strategic techniques which seek to only solve the problem initially presented. Both of his approaches are brief in nature and use general systems theory along with cybernetic theories (Gehart, 2014). General systems theory and cybernetics are often used interchangeably (Becvar and Becvar, 2009). In fact, there are many similarities. Both seek to understand how rules within relationships affect behavior. Additionally, both seek to observe the function of the system or family in terms of interactional patterns which create boundaries, stability, and change. Cybernetics looks more at the question of how relationships are affected by change within the observer status. First order cybernetics views change from an observational perspective. Change occurs similar to a teacher providing directions to a class. Specifics are defined, then the students complete their assignments. Second order change occurs when the teacher joins the student in their learning experience. Rather than providing an outline and sending the students to complete the task, the teacher joins with the students with thoughtful questions that promote discussion. Through the discussion, the students apply material and reach self-directed conclusions.
Change occurs through the use of interventions which include reframing, directives, enactments, paradoxical interventions, and most importantly, the therapist-client relationship. Fraser, Solovey, Grove, Lee, and Greene (2012) suggest that the relationship between the therapist and family system is integral to both the joining process and the intervention phase of therapy. Additionally, the success of interventions may depend on the therapists’ ability to engage with the family and join in the family system. This relationship supports the possibility of intrinsic second order change.
In the case of one client, Anne, Strategic Family Therapy may provide relief from the family’s difficult and challenging life circumstances. This family is comprised of a mom who is 48, her two adult children ages 21 and 18, and the baby of one of the children. Mom works two jobs to support the family. She reports feeling in pain, tired, and not feeling good for a long time. Her mother is sick. She has a brother, however; he will not assist with the mother’s care. The mom feels like a “mess” including her clothes. She constantly thinks about her problems and doesn’t engage in her social or church activities anymore. Her two adult children do not work and continue to live at home with her and the baby.
Robbins, Alexander, and Turner (2000) describe reframing as a way to interrupt negative interactional patterns while supporting and eliciting positive feedback from the family system. Through the process of elicit and describe, the therapist is able to gently ask questions that relate to specific and noticeable sequences that may be damaging family relational patterns. An example with Anne would be to elicit how she feels about what is happening with her family. She may describe that she is overwhelmed and unable to manage the multiple life circumstances. A reframe may be to suggest that Anne must love her family dearly to take on the total responsibility for the family by herself. This promotes acknowledgement of her circumstances, her desire to be a good mom while also allowing opportunities to acknowledge how challenging her position is. This also promotes discussion from other family members about how they may see how they are helping. Specifics are then elicited from members about what they are contributing. These nuggets of promise promote self-directed opportunities for goal setting.
Muir, Schwartz, and Szapocznik (2004) describe the reframing process as culturally sensitive to the immediate needs of the family in session. Strategic therapy techniques including reframing have also been proven to meet the unique needs of Cuban, Mexican, Caribbean, and Puerto Rican Hispanic cultures. Additionally, this research has been extended to African American families. Long term outcomes have also been evaluated with Strategic Family Therapy. Santisteban, et al., (2006) discovered that outcomes with Hispanic families demonstrated continued improvement one year post study.
Research also indicates that strategic therapy techniques promote empowerment and support the natural flow of the family system (Amini and Woolley, 2011). The use of directives are unique and often paradoxical interventions. Directives are culturally sensitive as the therapist is only asking the family system to do what they currently do, and to just adjust a minimal factor. For example, in the case of Anne, a directive may be to continue to complain about her pain factors every day. The therapist would elicit from Anne when during the day she generally complains the most. The directive would be to ask Anne to change the time of the day she normally complains about the pain. This may also be extended to incorporate who she complains to. If she generally complains to her brother, Anne would be asked to complain to her adult daughter with the baby. This minor shift alters the patterns of interaction while concurrently changing the focus of the interaction.
Haley stressed the importance of being aware of the smallest indicators of feedback such as small facial movements. This awareness provides opportunities to reflect on the effectiveness of interventions in order to promote change (Karam, Blow, Sprenkle, and Davis, 2015). In the case of Anne, paying close attention to small changes such as body language and position allows the therapist to understand what topics are affecting family members. Enactments are then able to be used to essentially rewind the interaction and focus on the interactions within the movement. For example, if the daughter with her baby shifted away from Anne during the discussion of the directive, the therapist may ask permission to discuss the experience of the daughter. The family would be asked to enact the interaction again in order to focus attention on the discomfort of the situation. Gentle and thoughtful questions would be generated to elicit information that is specific to the body language and verbal interactions. The family would be asked to reflect on what has happened and generate possibilities for the action. This would then be followed up with reframes that elicit the nature of the interactions while supporting the members within the process.
Lebowitz, Dolberger, Nortov, and Omer (2012) suggest that this family may have adults with “adult entitled dependence” (p. 90). Adult entitled dependence (AED) is a growing and global phenomena. Lebowitz, et al., (2012) cite studies in Japan, Italy, Germany, England, Greece, Spain, and France that show adults living with their parents. This causes parental complaints similar to Anne. One of the ways to assist in this dilemma is the use of techniques used in Strategic Family Therapy.
According to Lebowitz, et al., (2012) the use of systems theory to interrupt the negative interactional patterns promotes change within the family. Techniques that can be learned just by Anne have shown promise in alleviating stress from the parent. In fact, use of these systemic techniques demonstrated more accountability for the adult children at the end of the study.
Strengths of Strategic Family Therapy include its ability to translate into homes and in group settings (Henggeler and Sheidow, 2012). Studies show that the model performs well and respects the family system throughout the phases of therapy. These phases include joining, intervention, and termination. Another strength is that it is able to be brief. Brief Strategic Family Therapy shares all the similarities of its regular counterpart. The exception lies in its very defined and specific session tasks. Brevity is helpful for low socio-economic families who may not have the time to devote to a lengthy period of therapy. It also is beneficial for insurance companies who seek to provide benefits but have limited dollars.
Limitations of the use of Strategic Family Therapy include the lack of research pertaining to cultural adaptations with global populations (Henggeler and Sheidow, 2012). Strategic Family Therapy has a broad base of applied studies with people of Hispanic origins. The origins are limited to primarily Caribbean, Puerto Rican, Mexican American, and Cuban American populations. Additionally, the research only extends to African Americans with the southeastern United States. There is currently no translation into Caribbean and African Americans or Hispanic populations that do not have some level of acculturation within the United States. Additionally, research has not extended into other continents with African, Asian, or European populations.
Research does indicate that within the above mentioned populations that have undergone extensive research, the model is ethically sound. The American Association for Marriage and Family Therapists (AAMFT, 2016) suggests that therapist use models that align with the values and beliefs of the family. Additionally, that therapists are mindful of the imbalance of power within the therapeutic relationship. As such, respectful and empowering processes should be used when working with families of all cultural and diverse backgrounds.
References
AAMFT. (2016). Code of ethics. Retrieved September 4th, 2016, from Web site: http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx
Amini, R.L., and Woolley, S.R. (2011). First-session competency: The brief strategic therapy scale-1. Journal of Marital and Family Therapy, 37(2), 209-222.
Becvar, D.S., and Becvar, R.J. (2009). Family therapy: A systemic integration (7th ed). Boston: Pearson.
Fraser, J.S., Solovey, A.D., Grove, D., Lee, M.O., and Greene, G.J. (2012). Integrative families and systems treatment: A middle path toward integrating common and specific factors in evidence-based family therapy. Journal of Marital and Family Therapy, 38(3), 515-528.
Gehart, D. (2014). Mastering competencies in family therapy: A practical approach to clinical case documentation. Belmont, CA: Brooks/Cole.
Henggeler, S.W., and Sheidow, A.J. (2012). Empirically supported family-based treatments for conduct disorder and delinquency in adolescents. Journal of Marital and Family Therapy, 38(1), 30-58.
Karam, E.A., Blow, A.J., Sprenkle, D.H., and Davis, S.D. (2015). Strengthening the systemic ties that bind: Integrating common factors into marriage and family therapy curricula. Journal of Marital and Family Therapy, 41(2), 136-149.
Lebowitz, E., Dolberger, D., Nortov, E., and Omer, H. (2012). Parent training in nonviolent resistance for adult entitled dependence. Family Process, 51(1), 90-106.
Muir, J.A., Schwartz, S.J., and Szapocznik, J. (2004). A program of research with Hispanic and African American families: Three decades of intervention development and testing influenced by the changing cultural context of Miami. Journal of Marital and Family Therapy, 30(3), 285-303.
Robbins, M.S., Alexander, J.F., and Turner, C.W. (2000). Disrupting defensive family interaction in family therapy with delinquent adolescents. Journal of Family Psychology, 14(4), 688-701.
Santisteban, D.A., Suarez-Morales, L., Robbins, M.S., and Szapocznik, J. (2006). Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and practice. Family Process, 45(2), 259-271.