EP90 Workshop 18 - Directive Therapy - Jay Haley, MA

Description:

Strategic directives are powerful methods to elicit change. Varieties of directives will be discussed and illustrated with videotaped examples.

Educational Objectives:

1. To learn the different types of directives useful in therapy
2. To learn the stages of Directive Therapy 

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

Outline:

• Workshop Overview

  • Focused on directive therapy using video examples and live discussion.

  • Videos recorded in a supervised training setting; families gave permission for educational use.

  • Directive therapy is distinct from cognitive, behavioral, or psychodynamic models.

• Core Principles

  • Therapist takes responsibility for producing change, not just understanding clients.

  • Clear, goal-directed interventions replace interpretive or insight-based methods.

  • Works with individuals, couples, families, and groups; views dysfunction as systemic.

• Theoretical Considerations

  • Avoid mixing theories; choose one that supports active change.

  • A linear model is better suited for directive therapy than systems theory.

  • Therapists can develop their own practical theories.

• Types of Directives

  • Straightforward: advice, coaching, ordeals, penance.

  • Indirect: metaphors, paradoxical tasks (e.g., scheduling symptoms).

• Techniques in Action

  • Ordeals: client performs a task harder than the symptom (e.g., nightly walks for bedwetting).

  • Penance: symbolic acts to resolve guilt (e.g., doing good deeds in a deceased’s name).

  • Paradox: clients are instructed to "do" their symptom intentionally to reduce its power.

• Case Studies

  • Couple resolving money/sex conflict through structured directive.

  • Young woman gaining independence via a dinner invitation directive.

  • Boy with intrusive behavior redirected through supervised outdoor tasks.

  • Couple shifted through therapist intentionally siding with one partner.

• Couple Therapy Tactics

  • Unbalancing a pair to prompt change.

  • Often more effective to focus on one partner rather than equal treatment.

  • Absurd interventions can disrupt rigid dynamics and stimulate action.

• Ethics and Professionalism

  • Gender neutrality is important; therapists shouldn’t align based on gender.

  • Professionalism helps avoid perceived bias and maintains therapeutic alliance.

  • Directive methods must be tailored to fit client personality and context.

• Therapist Decisions

  • Choosing whether or not to use reciprocal contracts or involve money depends on client style.

  • Sometimes being “unfair” or provocative gets better results.

• Family Involvement

  • Family can support directive tasks (e.g., disposing of food in bulimia cases).

  • In sexual behavior cases, therapy may stay client-focused but still consider relational dynamics.

• Client Resistance and Success

  • If clients resist or fail to act, therapist may reconsider or escalate intervention.

  • Punishment is a last resort and used sparingly.

  • Success can create nostalgia for symptoms—terminate therapy appropriately.

• Medication and Practical Concerns

  • Involve family in managing clients on medication.

  • Transfer medication supervision to a psychiatrist when needed.

• Brief Therapy

  • Single-session and short-term therapy models can be effective.

  • Staging therapy in focused phases helps manage short-term goals.

  • Recommended resource: Moshe Talmon’s work on single-session therapy.

• Audience Q&A Highlights

  • Preventing partner self-righteousness after siding with them.

  • Ensuring one spouse doesn’t feel ganged up on.

  • Getting adolescents to do chores through parent involvement.

  • Balancing ethics, professionalism, and assertiveness in directive practice.