Strategic HALEY

STRATEGIC THERAPY

HALEY STRATEGIC THERAPY

MADANES STRATEGIC HUMANISM

THEORISTS: JAY HALEY AND CLOE MADANES

In Strategic therapy, overt and covert patterns of communication are viewed as attempts to have influence or power over others. The foundation is based on the idea that symptoms are a result of dysfunctional family structure and exist to maintain homeostasis. Therefore, the therapist utilizes techniques that will ultimately assist the family in changing its behavior and interactions with one another.

NOTE: Haley’s work was influenced by Minuchin’s Structural model. After working with Minuchin for 10 years, Haley came to the conclusion that the underlying family structure, as well as symptoms, should be addressed. Haley was also influenced by Erickson’s use of directives and paradoxical interventions. The use of directives is one of the primary differences between Haley’s Strategic Model and MRI.

Madanes theorized that all problems can be conceptualized as a struggle between love and violence. She maintained that there are four ways of resolving this conflict: (1) to dominate and control; (2) to be loved; (3) to love and protect others; (4) to repent and forgive

GOALS

• Resolve the presenting problem that is behavioral, concrete, and specific. If it is not a  behavioral issue, it is not considered a problem
• Distinguished from purely strategic models in that the goals of therapy are not only to change the sequences of the interactions, but also to alter the structure of the family
• Promote a change that alters people’s subjective experiences, i.e., mood, thoughts, and behaviors
• Interrupt covert hierarchical structure and address power struggles within the family
• Four Dynamics of therapy (PUSH):
  • Protection (theory of motivation): motivation (usually positive intention) behind the behavior
  • Units (theory of coalition): problems exist within families, typically in a triangle
  • Sequence (patterns of behavior): sequences are interactional (linear or circular)
  • Hierarchy (family roles and functioning): balance between responsibilities is critical for effective family functioning

TERMS

• Directive
  • Directions given by the therapist with the goal of repairing malfunctioning hierarchies (often by strengthening the parental unit). The tasks given rarely seem logical, nor are they linear solutions to the presenting problem, but are given to interrupt the system’s interactional patterns in order to create new interactions.
  • Directives push people out of their habitual patterns with the smallest possible change

• Ordeal
  • Directive given by the therapist with the intention of  eliminating the symptom by making it harder to keep than give up. Instructs the client to do something unappealing prior to engaging in their symptomatic behavior. The client soon realizes that the cost of maintaining the symptom outweighs the gains. Ultimately, the symptom disappears.

• First Order Change
  • Occurs when a family’s interactional patterns or sequences are modified at the behavioral level only.
• Second Order Change
  • Occurs when there is a change in the rules or underlying beliefs that govern the family members behaviors.
• Hierarchy
  • The natural organization and distribution of power within any organizational system, i.e., “who tells whom what to do.”
• Paradoxical interventions
  • Prescribing the symptom that the client is trying to eradicate; a form of “reverse psychology” that seems in opposition to the clients goals of treatment.
• Symptom prescription
  • Directing the family to continue to engage in the symptom, by prescribing the continuation of their actions or advancing the symptom. The intervention may be compliance-based if the therapist wants the family to do as suggested, or defiance-based when he/she wants the family to defy the directive.
• Metaphoric Task
  • A directive in which the family engages in a conversation or an activity that is not about the problem, typically something that indirectly facilitates change because of the symbolism and the content (but something easier for the family to handle).
• Reframing
  • The idea that language can be used to change the meaning of an individual’s underlying belief, usually from a negative to a more positive perspective.
• Restraining techniques
  • Family members are warned of the dangers of the change, restrained from trying to change, or are asked to change slowly.
• Pretend technique
  • Clients are asked to pretend that they have achieved their goal for a specific amount of time, in the hope that by simply pretending, the option for a new interactional pattern of behavior, feeling, or perspective will be created.
• Homeostasis
  • The tendency for family members to maintain equilibrium or stability often through dysfunctional patterns of interaction.
• Incongruous Hierarchies
  • Occurs when children create symptoms in an attempt to change their parents

ASSESSMENT AND TREATMENT

• Focus on presenting problem
• Focus on facts, behaviors, and opinions (rather than interpretation or attempts to create insight)
• Focus on context in which symptoms make sense
• Goals must be defined in terms that are observable, measurable, and countable so that the clients can see clearly when change has occurred
• Identify family rules and patterns of interactions (coalitions and triangles)
• There must be a large range of behaviors for problem resolution
• Haley required all members living in the household to be present at the first session
• Four Stage Process
  • Social:
    • Small talk/casual conversation help family members feel comfortable
    • Therapist makes tentative hypotheses about family structure
  • Problem:
    • Therapist observes hierarchical structure and triangles and gathers information about the problem
    • Therapist notices different perspectives which forms the basis for the interaction that follows
    • Therapist takes charge of the session
  • Interactional:
    • Therapist encourages the family members to interact with each other, rather than with the therapist
    • Therapist continues to observe interactions and the structure governing behaviors, such as malfunctioning hierarchies and coalitions
  • Goal-Setting:
    • Therapist identifies and addresses therapeutic goals in behavioral and operational terms
    • Family is given tasks or directives as homework
    • Shifts in structure and hierarchy remain as appropriate goals

STANCE OF  THE THERAPIST

• Active and deliberate
• Expert (therapist takes responsibility for the direction of therapy)
• Uses language of family
• Interest is in present behaviors and sequences of interactions
• Clever, prescriptive, and systematic