NCE – Strategic Family Therapy

Based on the work of Milton Erickson & Jay Haley, this pragmatic model is more focused on problem solving than insight (Metcalf, 2011). According to this theory, problems develop due to an unbalanced hierarchical structure and dysfunctional communication patterns. The therapist’s role is to observe these patterns in the family, and develop a strategy to address them. It is a directive therapy that isn’t as concerned with how one defines the problem as much as it is with the fact that you’re taking some sort of action to resolve things.  Metcalf, (2011) states that family therapists should focus on “the purpose of the problem” (p. 272).  Action is the key to change, not insight.

Definition of the Problem

According to “SFT” communication in families always comprises a “command message” (Metcalf, 2011, p. 276), defined as unspoken and implied rules of conduct and interaction.  These family rules can be observed in patterns of interaction and behavior by a therapist.  The purpose of this rules is to main an interactional homeostasis.  The term “feedback loops” (Metcalf, 2011, p. 276), refers to stimuli and response interactions that are frequently observed.  As you might expect positive feedback loops create a problem and negative ones solve it.  In therapy, the key to solving problems is to first address the aforementioned rules that define the family’s interactions.  By focusing and defining on the problem and the factors related to it, the family can become motivated to change.  “Strategic family therapists believe that to change family organizational patterns and therefore alleviate the identified problem, the routine in which the clients communicate with one another must be altered.” (Metcalf, 2011, p. 277).

Theoretical Assumptions

SFT aims to solve the problems in the family and alter the underlying structure that produces it.  Many concepts from systems theory can be found in SFT.  For example, homeostasis describes the tendency of a family to maintain the status quo.  The butterfly effect describes the tendency of small changes to produces tremendous ones.   SFT also uses the concept of triangulation in which the tension between two family members is the byproduct of a third one.

How Change Happens

There are two types of change in SFT.  “First-order changes occur when family members attempt to solve a problem repeatedly with the same solution only by increasing the level of intensity” (Metcalf, 2011, p. 280).  Second order change occurs when the family system can shift into a new homeostasis by altering the rules in the family (Metcalf, 2011).

One Concept: Directives

​As a directive and pragmatic therapy model, SFT utilizes directives that are helpful in redefining the rules, structure and boundaries in a family (Metcalf, 2011). The goal of these directives is to motivate clients to modify the interactional patterns which underlie ongoing problems. Two types of directives are described in our textbook: (1) straightforward directives and (2) indirect directives (Metcalf, 2011). Straightforward directives are utilized when the therapist lays out his instructions for helping the family modify their existing interaction patterns (Metcalf, 2011). In contrast, indirect directives utilize metaphor and paradox to provide motivation for change (Metcalf, 2011). For example, paradox directives involve instructing clients to engage in more of the very behaviors that cause problems. This creates a double-bind situation in which change becomes more attractive than inaction (Metcalf, 2011). Ordeal interventions, a slight variant paradox directives, are also utilized by SFT. They involve imposing significant changes that are much more extreme than the desired transformations. This is thought to make those needed transformations much more attractive to the client.

Strengths & Weaknesses

​Benefits of SFT are its pragmatic nature, and tendency to provide a positive spin on problems, not based psychopathology. Despite these benefits, there are several concerns I have about this theory. In fact, I was not surprised to learn that SFT is not a popular model of therapy (Metcalf, 2011). Criticisms of this approach include the manipulative nature of its interventions, and a failure encourage the careful examine underlying issues (Metcalf, 2011). Paradox directives provide just one of many manipulative interventions utilized by SFT.
I also had concerns about how SFT conceptualizes the nature of helplessness (Metcalf, 2011, p262). In keeping with this pragmatic approach, SFT is not concerned with how the therapist conceptualizes evidence of helplessness (Metcalf, 2011). The only thing that appears to matter, is how the therapist’s conceptualization of problems, guides their manipulative strategies (Metcalf, 2011). Finally, I feel the textbook’s discussion of helplessness on page 262, reflects an attitude of blame (Metcalf, 2011, p262). In my opinion, it is wrong to blame a client for a symptoms of learned helplessness.

Working Template

  1. Building rapport – greet family, point out successes/strengths.
  2. Understanding the Presenting Issue – Work towards an agreed-upon understanding of the problem
  3. Assess Family Dynamics – Focus on problem now not their origins.
  4. Developing Goals – Negotiation of goals with family members
  5. Amplify Change – don’t take credit for change, and remain neutral in how chance occurs since this promotes lasting change.

References

Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company

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