EP85 Workshop 14 - Advances in Strategic Family Therapy - Cloe Madanes

Description:

New developments will be presented in the theory and technique of strategic therapy with individuals, families, and couples, including prescribing the metaphor and the use of confusional techniques with families. Concepts will be illustrated with videotaped examples.

Educational Objectives:

1. To list three new developments in the theory and technique of strategic therapy
2. To be able to use the technique of pretending, or prescribing the metaphor, or reversing the hierarchy 

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Foundations of Strategic Therapy

• Evolved from Milton Erickson’s work, emphasizing planned strategies to resolve presenting problems.

• Focuses on changing relationships and social contexts.

• Assumes metaphorical communication and values family hierarchy as the key social context.

Direct Strategies

• Reinforce or change parental roles (e.g., putting parents in charge, involving marginal parents).

• Modify involvement of professionals like probation officers or schools.

• Use contracts between family members, coaching, and positive reframing.

Indirect Strategies

• Prescribe symptoms or their symbolic representation (e.g., rocking horse for compulsive masturbation).

• Have clients pretend to have symptoms to receive care in new ways.

• Shift the symptom across people or settings (when, where, how it happens).

Advanced Indirect Techniques

• Reverse hierarchy: children take charge to restore family balance.

• Paradoxical ordeals: turn symptoms into challenges (e.g., cleaning rituals).

• Paradoxical contracts: pair two destructive behaviors to neutralize each other.

• Restrain change or prescribe specific scripts in long-term conflicts.

Illustration via Videotape

• Therapist Richard Belson demonstrates coaching, humor, and metaphor in marital and depressive issues.

Marital Interventions

• Suggest small positive actions (e.g., aftershave, planned dates).

• Use humor and absurdity (e.g., wife physically stepping on husband’s efforts) to shift perspective.

• Implement playful financial incentives for chores to reframe roles.

Family Therapy: Divorce and Childhood Fears

• Case of a boy with nightmares stemming from loyalty conflict post-divorce.

• Therapist uses pretend play (e.g., mother fearing a werewolf) to empower children and address fears.

• Emphasis on helping children feel they can support their mother.

Expressing Parental Fears

• Therapists voice mother's unspoken fears (loneliness, financial struggles).

• Children are guided to comfort their mother and reassure her through daily role-play.

Outcomes and Dynamics

• Symptoms like nightmares and encopresis disappear as children feel more capable and family dynamics shift.

• Reinforces children’s role in helping their mother feel supported.

Balancing Support and Boundaries

• Therapists clarify realistic support vs. inappropriate burden on children.

• Value lies in rehearsing therapeutic directives in-session to increase follow-through.

Confusion Technique

• Hypnotic strategy using incongruent suggestions to make clients more open to change.

• Techniques include tangents and contradictions to disorient and redirect tension.

Confusion in Couples and Families

• Use confusing directives to shift control (e.g., mother letting father lead parenting).

• For expulsion due to masturbation, reframe through disciplined activities (ballet, gymnastics).

Prescribing the Metaphor

• Inspired by Erickson’s storytelling model.

• Clients write essays symbolizing their situation and solutions.

• Therapists adapt clients’ stories to therapeutic directives (e.g., a contract, financial consequences for violence).