STRATEGIC MRI

STRATEGIC THERAPY

MENTAL RESEARCH INSTITUTE (MRI)/PALO ALTO GROUP

THEORISTS: DON JACKSON, JOHN WEAKLAND, RICHARD FISCH, AND PAUL WATZLAWICK

Don Jackson founded The Mental Research Institute in 1959 and was influenced by general systems theory (the whole is greater than the sum of its parts) and principles derived from cybernetics and communications theory. Basic premise of MRI: Problems arise and persist through the mishandling of normal life difficulties. By breaking the cycle of unsuccessful solutions, the problem is no longer maintained. Thus, it is no longer a problem. When the problem is solved, therapy is terminated.

GOALS

• Facilitate change in the rules/structure of the system (second order change) by disrupting attempted solutions
• Change the presenting complaint and resolve the problem, rather than interpreting the interactions of the family or exploring the past
• Focus is on techniques for change, rather than theoretical concepts
• Discover attempted solutions, i.e., what client has been doing to solve the problem that has not been working
• Explore what family members are doing that are maintaining the problem, rather than why they are doing it
• Interrupt the interactional/behavioral sequence or pattern, rather than correcting it

TERMS

• Cybernetics
  • The study of how information flows in and out of a system.
• Negative feedback loop
  • Attempt by a family to make corrections following a significant change in the family system in order to maintain homeostasis.
• Positive feedback loops
  • Unsuccessful attempt by a family to solve problems within the family system; these attempted solutions usually worsen or maintain the problem.
• First Order Change
  • Occurs when a family’s interactional patterns or sequences are modified at the behavioral level only, i.e., change in roles within the system, but the interactional pattern remains the same.

• Second Order Change
  • Occurs when there is a change in the rules or underlying beliefs that govern the family members’ behaviors.

• “More of the Same solutions
  • Solutions that perpetuate the problem.

• Report
  • The content of a message, i.e., the literal message.

• Metacommunication
  • Communication about the communication (also known as the “command” element of communication, i.e., the nonverbal element that defines relationship function).

• Symmetrical Relationship
  • The partners mirror each other’s behavior.

• Complementary Relationship
  • The partners are in opposite positions, i.e., pursuer/distancer; passive/aggressive.

• Double Bind
  • A type of communication in which an individual simultaneously sends contradictory report and command messages. A double bind requires:
  • Two or more people;
  • Repeated experience and interactions;
  • A primary negative injunction;
  • A secondary injunction conflicting with the first injunction;
  • A third injunction that prohibits the victim from escape.

• 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.

• 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.

• Restraining techniques
  • Family members are warned of the dangers of the change, restrained from trying to change, or are asked to change slowly.

• Positioning
  • The therapist exaggerates the family’s definition of the problem until the family feels the need to intervene and decrease their view of the seriousness of the problem.

• Homeostasis
  • The tendency for family members to maintain equilibrium or stability, often through dysfunctional patterns of interaction.

• Self-correction
  • The ability to identify when a system has gone too far from homeostasis and has self-corrected to maintain balance.

ASSESSMENT AND TREATMENT

• Unit of treatment can be one person
• Therapist focuses treatment on the most motivated person in the system
• The complaint that the client presents in therapy is the problem, and not a symptom of an underlying disorder
• Assess cycle of problematic interaction (problems are interactional not intrapsychic)
• Focus on misguided and unsuccessful attempts to solve problems (“stuck solution behavior”)
• Identify the “vicious cycle” and behaviors and cognitions that support it
• Break the problematic cycle (disrupt homeostasis), using straightforward or paradoxical interventions

• Six steps of MRI Therapy
  • Introduction to Treatment Set-Up
    • Engage the family
    • Basic info, length of treatment
  • Identify Problem
    • Obtain clear and specific problem definition (Who is doing what to whom and how is that a problem?)
    • Observe circular causality while focusing on presenting problem
  • Explore family’s attempted solutions that maintain the problem (i.e., “stuck solution behavior”)
    • Denial of problem by family
    • Attempts to solve a problem that is not actually the problem
    • Efforts to work within a framework that will not resolve the real issue.
  • Set Goals for treatment
    • Explore previous attempts to solve problem
    • Behavioral, resolvable, and concrete goals set with the family
  • Develop behavioral interventions to change rules of the system (second order change)
    • Paradox
    • Reframe
    • Symptom prescription
    • Restraining (“go slow”) technique
  • Terminate therapy (when behavioral change objectives are met)

STANCE OF THERAPIST

• Active
• Attends to process over content
• Interactional/Systemic view of problem
• Non-normative (there are no specific criteria to measure health of family)
• Symptom-focused
• Begins with most motivated person in the family system
• Therapist takes responsibility for change