Lecture on Systemic Therapies: Strategic Therapy

Introduction

• Presenter: Dr. Diane Gehart
• Focus: Strategic therapy
• Context: Follows part 1 on MRI and Milan approaches
• Related Texts:
  • Mastering Competencies in Family Therapy
  • Theory and Treatment Planning in Family Therapy

Development of Strategic Therapy

• Developers: Jay Haley and Cloe Madanes
• Historical Context:
  • Jay Haley worked at MRI Institute
  • Influenced by carpooling with Salvador Minuchin (Structural Family Therapy)
  • Notable disagreement with Gregory Bateson on power

Core Concepts

• Grounded in: General systems theories
• Brief Therapy Approaches: Similar to MRI and Milan
• Focus: Interrupting systemic interaction patterns

Strategic Directives

• Definition: Directions for completing a specific task
• Characteristics:
  • Non-linear, not logical corrections
  • Aim to interrupt problem interaction sequences
• Example: Having arguments in unconventional settings (e.g., sitting on a toilet)

Treatment Overview

• Therapy Structure:
  • Brief with five formal stages:
    1. Social stage - informal conversation
    2. Problem stage - description of the problem
    3. Interaction stage - trace interaction patterns
    4. Goal-setting stage
    5. Task stage - assign directives
• Initial Contact: Begins with first phone call

Therapist Role

• Strategic Positioning:
  • Adjust role based on client needs
  • Willing to be the "bad guy" if it promotes change
• Positions:
  • Social courtesy
  • One-down position to provoke client response

Case Conceptualization

• Focus on: Interactional sequences
• Five Frames for Problems:
  • Involuntary vs. voluntary
  • Helplessness vs. power
  • Metaphorical vs. literal meanings
  • Hierarchy vs. equality
  • Hostility vs. love

Family Life Cycle

• Stages: Birth, early childhood, school age, adolescence, leaving home, etc.
• Focus: Transitions and renegotiation of independence

Power and Hierarchy

• Assessment of: Influence and flow of power
• Cultural Considerations: Norms vary widely
• Therapist's Bias: Must consider own background influences

Contemporary Developments

• Strategic Humanism: Focus on love and nurturance

Goal Setting

• No Predefined Norms:
  • Encourage a new set of behaviors without symptoms
  • Correct hierarchies, reduce intrusiveness, reunite family members

Interventions

• Directives:
  • Straightforward vs. indirect (paradoxical)
  • Focus on subtle intervention based on systemic assessment
• Ordeal Therapy: Tasks to interrupt behavior patterns

Diversity and Evidence Base

• Culturally Friendly: No predefined norms
• Evidence-Based Treatments: Developed for Hispanic, African-American adolescents
• Applications: Conduct issues, substance abuse, working with diverse populations

Summary

• Strategic Therapy: Shares similarities with MRI and Milan
• Focus: Interactional sequences, systemic approach
• Applications: Particularly useful with behavioral issues in children and adolescents
• Brief and Adaptive: Interrupt patterns to allow natural reorganization

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These notes provide a comprehensive overview of the key points and methodologies discussed in Dr. Diane Gehart's lecture on strategic therapy, part of systemic therapies. The emphasis is on understanding the interaction patterns within family systems and how strategic interventions can induce change.