UNIT-3

1. Introduction and History 2. Classical schools of Family Therapy- Systemic Family therapy, Structural

Family therapy, Strategic Family therapy- Basic Principles, Treatment goals and Basic Techniques

3. Postmodern Schools of Family Therapy- Solution Focused Brief therapy with Families, Narrative

Family Therapy: Basic Principles, Treatment goals and Basic Techniques

There are two compelling stories here: one of personalities, one of ideas. The first story revolves
around the pioneers—visionary iconoclasts who broke the mold of seeing life and its troubles as a
function of individuals and their personalities. Make no mistake: The shift from an individual to a
systemic perspective was a revolutionary one, providing those who grasped it with a powerful tool
for understanding and resolving human problems. The second story in the evolution of family
therapy is one of ideas. The restless curiosity of the first family therapists led them to ingenious new
ways of conceptualizing the joys and sorrows of family life

The Undeclared War

1. Historical Context of Asylums:

Initially, asylums were built to provide care and shelter for the mentally ill, removing them
from neglect or harmful environments, such as being confined to attics. However, as
institutionalization evolved, family involvement in treatment was minimal, often limited to
financial responsibility.

2. Family's Role in Mental Health:

By the 1950s, therapists began observing peculiar patterns:

o When one family member began to recover from a mental illness, another often
exhibited symptoms or experienced distress.

o This suggested that the family system operated as a unit where dysfunction was
redistributed, akin to a game of "tag." Someone always seemed to play the
symptomatic role.

3. Illustrative Case - Don Jackson (1954):

Jackson described a case where a woman’s recovery from depression destabilized her
husband. Her improvement challenged the existing family equilibrium, leading to his
eventual psychological breakdown and suicide. This tragic outcome underscores how deeply
interconnected family members’ mental states can be, with one person's "role" sometimes
supporting another's emotional stability.

4. Patients Relapsing at Home:

Many patients improved in structured environments like hospitals but regressed upon
returning home. This indicates that family dynamics or unresolved systemic patterns
contributed to the patient's distress, counteracting their treatment progress.

5. "Strange Glue" of Families:

The metaphor of families as "strange glue" suggests a paradox:
 o Families are resilient and cohesive, adapting to changes while resisting complete
dissolution.

o This resistance can prevent individual members from fully breaking free of
dysfunctional patterns, even unintentionally.

6. Ambivalence Toward Families in Therapy:

The narrative suggests a dual perspective:

o On one hand, families are seen as essential, supportive units worthy of respect.

o On the other hand, there’s a latent perception, reminiscent of adolescent rebellion,

that families can inhibit personal growth and autonomy.

These observations prompted a shift in understanding mental health within a systemic context,
where therapists began involving families in treatment. The idea is that treating the family as a
whole, rather than isolating the individual, can lead to more sustainable progress and address the
root of dysfunctional patterns.

SMALL GROUP DYNAMICS

Group Dynamics and Family Therapy

Family therapy drew inspiration from group dynamics, recognizing that families, like groups, consist
of individual personalities interacting within a system. Early theorists like William McDougall
emphasized the need for boundaries and predictable interactions, while Kurt Lewin's field theory
introduced the idea that groups—and by extension families—are more than the sum of their parts.
The concept of “unfreezing” was pivotal in understanding how families resist change and how
therapists can intervene.

Resistance to Change in Families

Families are often entrenched in established patterns, resisting change unless external disruptions
compel them. Unlike individuals who may independently seek therapy during crises, families bring
their collective traditions and habits, requiring therapists to disrupt their homeostasis to foster
transformation.

Bion’s Group Behavior Patterns

Wilfred Bion identified patterns like fight-flight, dependency, and pairing in group dynamics, which
are mirrored in family behaviors. Families may avoid addressing conflicts directly, rely excessively on
therapists, or form alliances that undermine relational balance, all of which require careful
navigation in therapy.

Process vs. Content in Communication

Effective therapy focuses on the process of communication rather than just the content. How family
members express themselves—such as dismissing another’s feelings—can undermine relationships.
Therapists must help families navigate these dynamics to improve understanding and connection.

Role Theory and Family Dynamics

Families, like groups, rely on roles to maintain structure. Over time, these roles become rigid and
mutually reinforcing, such as a strict parent and a lenient one polarizing their behaviors.
Understanding and reshaping these roles is crucial to facilitating family change.
Similarities Between Groups and Families

Both family and group therapy involve dynamic interactions among multiple participants and
emphasize interpersonal communication as the primary mechanism of change. Therapists use these
interactions to explore and address relational patterns.

Differences Between Families and Groups

While group therapy involves temporary relationships among strangers, family therapy involves
individuals with deep histories and futures together. Power dynamics in families are hierarchical, and
the identified patient often feels stigmatized, unlike the equal status typically found in therapy
groups.

Therapeutic Atmosphere

Group therapy provides a neutral and supportive environment for participants to open up. In family
therapy, however, the stress of familial dynamics is brought into the session, creating a less neutral
atmosphere that requires sensitive handling by the therapist.

The Child Guidance Movement

It was Freud who introduced the idea that psychological disorders were the result of unsolved
problems of childhood.

The chief cause of children’s problems, according to David Levy (1943), was maternal
overprotectiveness. Mothers who had themselves been deprived of love became overprotective of
their children. Some were domineering, others overindulgent. Children of domineering mothers
were submissive at home but had difficulty making friends; children with overindulgent mothers
were disobedient at home but well behaved at school.

Frieda Fromm-Reichmann (1948) coined one of the most damning phrases in the history of
psychiatry, the schizophrenogenic mother. These domineering, aggressive, and rejecting women,
especially when married to passive men, were thought to provide the pathological parenting that
produced schizophrenia.

The tendency to blame parents, especially mothers, for problems in the family was an evolutionary
misdirection that continues to haunt the field.

RESEARCH ON FAMILY DYNAMICS AND THE ETIOLOGY OF SCHIZOPHRENIA

Gregory Bateson—Palo Alto One of the groups with the strongest claim to originating family therapy
was Gregory Bateson’s schizophrenia project in Palo Alto, California.

Levels of Communication: Report and Command

Gregory Bateson highlighted that communication operates on two levels: report (the content of the
message) and command (how the message should be interpreted). The command level, or
metacommunication, is often covert. Misalignment between the report and command levels can
cause tension in relationships, as seen when subtle power dynamics influence how messages are
received.

Feedback and Homeostasis in Families

Bateson and colleagues proposed that families maintain stability through feedback mechanisms.
Symptoms or problematic behaviors often function as homeostatic tools to preserve family
equilibrium, such as a child’s disruptive actions uniting parents during conflict.

The Double Bind Theory

Bateson introduced the double bind as a communication pattern in families, particularly in

schizophrenia. A double bind involves:

1. An important relationship.

2. Repeated contradictory experiences.

3. A primary negative injunction ("Don’t do X, or you’ll be punished").

4. A second, conflicting injunction at an abstract level.

5. A tertiary injunction that prohibits escape or addressing the contradiction.

The cumulative effect is a conditioning where the victim feels trapped, unable to resolve the conflict.

Clarifying the Double Bind

Bateson’s concept emphasizes contradictions on different levels of communication. Simple

contradictions (e.g., "Be tough" vs. "Be gentle") are not double binds unless the conflicting directives
are enforced simultaneously and at different levels, creating an inescapable paradox. This distinction
is critical to understanding the theory.

Theodore Lidz—Yale

Theodore Lidz refuted the notion that maternal rejection was the distinguishing feature of
schizophrenic families. Frequently the more destructive parent is the father. What he found was an
absence of role reciprocity. In a successful relationship, it’s not enough to fulfill your own role—that
is, to be an effective individual; it’s also important to balance your role with your partner’s—that is,
to be an effective pair.

Lidz identified two types of marital discord (Lidz, Cornelison, Fleck, & Terry, 1957b). In the first,
marital schism, husbands and wives undermine each other and compete openly for their children’s
affection. These marriages are combat zones. The second pattern, marital skew, involves serious
character flaws in one partner who dominates the other. Thus one parent becomes passive and
dependent, while the other appears to be a strong parent figure but is in fact a pathological bully. In
all these families, unhappy children are torn by conflicting loyalties and weighed down with the
pressure to balance their parents’ precarious marriages.

Lyman Wynne

What struck Wynne about these families was the strangely unreal qualities of their emotions, which
he called pseudomutuality and pseudohostility, and the nature of the boundaries around them—
rubber fences—apparently flexible but actually impervious to outside influence (especially from
therapists).

Pseudomutuality (Wynne, Ryckoff, Day, & Hirsch, 1958) is a facade of harmony. Pseudomutual
families are so committed to togetherness that there’s no room for separate identities. The surface
unity of pseudomutual families obscures the fact that they can’t tolerate deeper, more honest
relationships or independence.
Pseudohostility is a different guise for a similar collusion to stifle autonomy (Wynne, 1961). Although
apparently acrimonious, it signals only a superficial split. Pseudohostility is more like the bickering of
situationcomedy families than real animosity. Like pseudomutuality, it undermines intimacy and
masks deeper conflict, and like pseudomutuality, pseudohostility distorts communication and impairs
rational thinking. The rubber fence is an invisible barrier that stretches to permit limited extrafamilial
contact, such as going to school, but springs back if that involvement goes too far. The family’s rigid
structure is thus protected by its isolation. Instead of having its eccentricities modified in contact
with the larger society, the schizophrenic family becomes a sick little society unto itself.

Murray Bowen's Focus on Schizophrenia and Family Dynamics

Murray Bowen began his work with schizophrenic patients, emphasizing the emotional dynamics
between mothers and children. This exploration led to his foundational concept of differentiation of
self, which measures autonomy and emotional stability within relationships.

Triangles and Emotional Reactivity

Bowen discovered that unresolved conflicts between two individuals often result in the involvement
of a third party, forming a triangle—the smallest stable relationship unit. While triangulation
temporarily alleviates tension, it prevents direct resolution of issues and can perpetuate dysfunction.

Emotional Neutrality in Therapy

Bowen observed that therapists often risk becoming part of the emotional drama within families. To
counter this, he advocated focusing on processes rather than content, and encouraging family
members to communicate with the therapist instead of each other to reduce emotional reactivity.

Personal Journey and Differentiation of Self

Bowen's personal experiences with his family shaped his theory significantly. He recognized that
avoiding family dynamics does not equate to emotional independence. By addressing unfinished
emotional business and breaking triangulation patterns in his own family, Bowen demonstrated how
differentiation fosters healthier relationships.

Breaking Triangulation

Bowen advocated confronting triangulation directly, such as redirecting complaints back to the
concerned parties. This disrupts unhealthy patterns and encourages direct communication, reducing
emotional dependency.

Strengthening Family Connections for Differentiation

Bowen emphasized the importance of maintaining individual connections with family members
without becoming emotionally reactive. Differentiation is achieved through balanced relationships
that avoid triangulation and foster emotional autonomy.
BOWEN FAMILY SYSTEMS THERAPY

According to Bowen, we have less autonomy in our emotional lives than we like to think. Most of us
are more emotionally reactive to one another than we realize. Bowen’s theory describes how the
family, as a multigenerational network of relationships, shapes the interplay of individuality and
togetherness using eight interlocking concepts (Bowen, 1966, 1976; Kerr, 2000): differentiation of
self, triangles, nuclear family emotional process, family projection process, multigenerational
transmission processes, emotional cutoff, sibling position, and societal emotional processes

Differentiation of Self

This concept is the cornerstone of Bowen’s theory, describing the balance between thinking and
feeling in an individual. Differentiation of self refers to the ability to maintain one’s sense of self and
make thoughtful decisions despite emotional pressures or anxiety from relationships. Differentiated
individuals can balance their emotions and logical thinking, showing emotional restraint while still
experiencing strong feelings. They can form their beliefs, take a stand on issues, and act based on
rational thought rather than emotional reactivity. In contrast, undifferentiated individuals are easily
swayed by their emotions and the opinions of others. They often react impulsively, either
submissively or defiantly, and struggle to maintain autonomy in relationships, especially during
conflict.

Emotional Triangles

Triangles form when two people in a relationship involve a third party to alleviate tension or anxiety
between them. This third party could be a person, a memory, or even a work focus. Anxiety is the
driving force behind triangles, which help distribute emotional pressure but also lock the original
conflict in place, preventing resolution. A fixed triangle emerges when the third person remains
persistently involved, creating entangled relationships where each interaction depends on the
behavior of the others. For instance, a spouse may shift attention to a child to cope with marital
dissatisfaction, inadvertently drawing the child into the marital dynamic. Healthy relationships differ
from triangles as they allow independent interactions between individuals without reactive
emotional entanglement.

Nuclear Family Emotional Process

This describes four patterns through which families respond to stress or prolonged anxiety:

1. Marital Conflict: Partners direct their anxieties at each other, leading to blame and control
rather than resolving the issue collaboratively.

2. Dysfunction in One Spouse: One partner absorbs the other's anxiety, accommodating their
emotional demands, which leads to physical or emotional dysfunction.

3. Impairment in Children: Parents may project their anxieties onto one child, causing that
child to bear the family’s stress. This often leads to developmental or psychological issues in
the child.

4. Emotional Distancing: Family members regulate anxiety by withdrawing and avoiding

meaningful engagement, leading to detachment rather than conflict resolution.

Family Projection Process

This concept outlines how parents transfer their anxiety onto their children, which may result in the
children internalizing the belief that something is inherently wrong with them. Bowen described a
three-step process:

1. A parent excessively focuses on a child, believing there is an issue with them.

2. The child begins to exhibit behaviors that align with the parent's fears.

3. The parent reinforces the belief by treating the child as if the perceived problem is real.
This process often results in the child developing symptoms or characteristics that align with
the parent’s anxieties, reducing the child’s independence and increasing their vulnerability to
external pressures.

Multigenerational Emotional Processes

This concept highlights how emotional patterns and anxieties are passed down through generations.
Families with low levels of differentiation exhibit fusion, where emotional reactivity is high, and
relationships are enmeshed. This fusion often leads to emotional distance, dysfunction, conflict, or
projection of problems onto children. Over generations, the child most involved in the family’s
emotional fusion tends to have the lowest differentiation, while those less involved may achieve
greater independence. For instance, a parent focusing anxiously on one child can stunt that child’s
emotional growth, perpetuating patterns of dependency or rebellion in the next generation.

Emotional Cutoff

Emotional cutoff refers to how individuals manage unresolved family anxiety by distancing
themselves from family members. This can involve physical distance, such as moving away, or
emotional detachment, like avoiding intimacy or deep conversations. While some mistake cutoff for
maturity, it often signifies unresolved emotional fusion with the family. For example, an adult may
avoid their parents entirely, only to find themselves unable to handle even minor interactions with
them. Emotional cutoff perpetuates unresolved issues, affecting future relationships.

Sibling Position

Bowen observed that birth order influences personality development and relationships. For example,
oldest siblings often take on leadership roles, middle children balance traits of both leadership and
following, and youngest siblings tend to be more dependent or adaptable. Sibling positions also
impact adult relationships; for instance, two oldest siblings might struggle for dominance, while two
youngest siblings may lack direction. Differentiation levels further explain exceptions, such as an
eldest child becoming indecisive under parental pressure or a youngest child gaining independence
due to family dynamics.

Societal Emotional Process

Bowen acknowledged the influence of societal factors, such as crime rates, sexism, and prejudice, on
family functioning. Families with higher differentiation are better equipped to resist negative societal
pressures. Feminist Bowenian therapists, such as Monica McGoldrick, emphasized the role of gender
and ethnicity in perpetuating inequalities. They highlighted how women often bear the brunt of
societal and familial constraints, while men benefit from privileges that enable them to succeed in
broader social contexts. Cultural and ethnic differences also play a role in shaping family dynamics
and resilience.
Goals of Bowenian Therapy

Bowenian therapy focuses on promoting self-awareness and understanding rather than directly
changing behaviors or resolving problems. The goals of therapy center on helping individuals:

1. Learn About Themselves and Relationships: Therapy serves as a platform for individuals to
explore their emotional dynamics and relationships, enabling them to assume responsibility
for their roles in family conflicts.

2. Reduce Blame and Increase Self-Responsibility: Bowenian therapists guide family members
away from blaming others and towards recognizing their own contributions to relational
issues.

3. Detriangulation and Differentiation: The primary focus is on altering the family system's
dynamics, especially in the central triangle involving the marital couple. This involves helping
individuals differentiate between their emotions and thoughts, and enabling partners to
engage in healthier, less reactive relationships.

4. Strengthen Parental and Couple Functioning: By improving the emotional functioning of

parents, they become more capable of managing family dynamics and their children’s
behavior. This includes addressing unresolved anxiety in their families of origin.

Key Therapeutic Processes

Active Inquiry

Therapists actively explore patterns of emotional reactivity (process) and the structural
relationships within family triangles. This helps family members gain insights into their
dynamics rather than focusing on immediate problem-solving.

Detriangulation

To change a family system, the therapist facilitates modifications in the central marital
triangle. This requires the therapist to remain emotionally neutral and engage with both
partners individually to reduce the tendency for blame and to promote differentiation.

Increasing Emotional Differentiation

Therapy emphasizes helping individuals distinguish between thinking and feeling, equipping
them to handle relationship problems more effectively. This differentiation enables clients to
lower anxiety and develop self-awareness, a process that strengthens their role within the
family.

Conditions for Behavior Change

1. Lowering Anxiety and Emotional Reactivity: Reducing emotional tension is crucial for
fostering an atmosphere of reflection and self-focus.

2. Encouraging Self-Focus: Therapists help clients examine their roles in family dynamics rather
than reacting impulsively to emotional triggers.

3. Minimizing Emotionality During Sessions: The therapeutic setting discourages emotional

outbursts or heated dialogues, favoring calm, structured interactions to foster
understanding.
Therapeutic Techniques

 Neutral Questioning: Therapists ask individual questions to encourage reflection, avoiding

collective discussions that might escalate emotional reactions.

 Self-Control of Therapist Reactivity: Bowenian therapists maintain emotional neutrality,

resisting the urge to take sides or become triangulated in family conflicts.

Reconnecting with the Extended Family

Bowen emphasizes the importance of rebuilding connections within the extended family network.
Establishing multiple family relationships helps individuals diffuse emotional investments, reduce
anxiety, and increase flexibility. This relational diffusion mirrors Freud’s concept of mature emotional
flexibility, where greater outlets for energy allow for resilience and delayed gratification.

By encouraging individuals to form balanced, multi-layered relationships, therapy helps spread

emotional energy, reducing reliance on a few intense connections and fostering overall family system
health.

Six Techniques in Bowen Family Systems Therapy

Bowenian therapy employs six prominent techniques, each designed to deepen understanding of
family dynamics, promote differentiation, and reduce emotional reactivity. These methods enable
family members to uncover systemic patterns and their roles within them.

Genograms

The use of genograms in Bowenian therapy serves as a visual and analytical tool to map family
relationships and uncover systemic patterns of conflict, cutoffs, and emotional triangles. These
diagrams go beyond traditional family trees by including biographical data and emotional dynamics
across generations. Often, the process of constructing a genogram provides therapeutic insight, as
family members begin to see how events and relationships are interconnected. This tool helps clients
understand generational influences on current family problems, fostering a deeper awareness of
their roles within the system.

Neutralizing Triangles

Emotional triangles are a natural but problematic way families manage tension, often diverting
conflicts rather than resolving them. Bowenian therapists aim to neutralize these triangles by
remaining emotionally detached and refusing to take sides. This detriangulated stance models
calmness and clarity, encouraging family members to take responsibility for their roles in conflicts. By
reducing anxiety and emotional entanglement, the therapist creates an environment where families
can address their dilemmas more constructively.

Process Questions

Process questions are designed to lower emotional reactivity and encourage self-reflection among
family members. These questions focus on exploring the mechanisms driving the family’s problems
rather than assigning blame. For example, a therapist might ask, “What do you feel when your
partner responds that way?” or “How do you think your reaction influences their behavior?” This
approach calms anxiety, promotes clearer thinking, and helps family members gain new perspectives
on their interactions, ultimately uncovering alternative ways to manage their relationships.

Examples:
  “When your sibling ignores you, what do you feel and how do you respond?”

 “How do you think your reaction affects the overall relationship?”

Relationship Experiments

Relationship experiments are exercises that help family members disrupt habitual emotional patterns
within key triangles. These experiments encourage participants to observe and modify their
behaviors to better understand their impact on family dynamics. For example, emotional pursuers
may be asked to reduce their pursuit behaviors, while distancers are encouraged to share personal
feelings and move closer emotionally. These exercises are not intended as quick fixes but as tools for
increasing awareness and fostering healthier relationships by clarifying emotional processes.

Examples:

 For Pursuers: Reduce pursuit behaviors (e.g., making fewer emotional demands) and
observe how it affects the relationship.

 For Distancers: Move toward the partner emotionally, sharing personal thoughts and
feelings to counter avoidance.

Coaching

In Bowenian therapy, the therapist adopts a coaching role, guiding clients to analyze and understand
family processes rather than dictating solutions. This approach avoids emotional entanglements and
empowers clients to take responsibility for their emotional functioning. Through thoughtful
questions, therapists help clients identify patterns, recognize their roles in family dynamics, and
develop strategies for navigating challenges independently. Coaching fosters self-reliance and equips
clients to manage their relationships more effectively.

The “I”-Position

The “I”-position involves expressing personal opinions and feelings in a calm and non-reactive
manner. By focusing on their own experiences rather than blaming others, family members learn to
break cycles of emotional reactivity. For example, instead of saying, “You never help around the
house,” a person might say, “I feel overwhelmed and need more support.” Bowenian therapists also
model this approach to maintain neutrality and encourage differentiation. Taking an “I”-position
fosters accountability, stabilizes emotional tension, and promotes healthier communication patterns
within families.

Examples:

 Instead of “You never help me,” say, “I feel overwhelmed and would like more help.”

 Instead of “You’re spoiling the kids,” say, “I think we should be stricter.”

STRATEGIC FAMILY THERAPY

Strategic therapy grew out of the communications theory developed in Bateson’s schizophrenia
project, which evolved into three distinct models: the MRI’s brief therapy, Haley and Madanes’s
strategic therapy, and the Milan systemic model.

Positive Feedback Loops

Strategic therapy emphasizes the role of positive feedback loops in problem formation. Families
often escalate problems through misguided solutions, creating cycles of behavior that amplify the
issue instead of resolving it. For instance, if a child, like Jamal, becomes temperamental due to
jealousy over a sibling, a parent’s punitive response may intensify the child’s behavior, creating a
vicious cycle. Breaking this loop requires reversing the attempted solution, such as offering comfort
instead of criticism. However, unspoken family rules often enforce rigid interpretations of behavior,
which must change to interrupt these loops.

First-Order and Second-Order Change

In family systems, behavioral changes within the current framework are considered first-order
changes. For deeper transformation, second-order changes are required, involving shifts in the
underlying rules of the system. Reframing—a key technique in strategic therapy—helps alter these
rules. By reframing Jamal’s behavior from defiance to fear of displacement, the family can adopt a
more empathetic perspective, promoting second-order change and resolving the issue at its root.

MRI Approach to Problem Solving

The MRI approach simplifies therapy into three steps:

1. Identifying Feedback Loops: Recognizing patterns that perpetuate problems.

2. Determining Supporting Rules: Understanding the unspoken rules that maintain these loops.

3. Changing the Rules: Introducing changes to disrupt problem-maintaining behaviors.

This method prioritizes modifying systemic interactions to alleviate presenting issues.

Jay Haley's Functionalist Perspective

Jay Haley expanded the strategic therapy model by exploring the interpersonal payoffs of behaviors
and the importance of family hierarchies. For example, in a family where Jamal’s mother criticizes his
father during conflicts, Jamal’s behavior may serve to divert attention from parental discord. Haley
emphasized the role of hierarchical dysfunctions in family problems, suggesting that disturbed
individuals often reflect faulty family hierarchies. His interventions often targeted restoring
appropriate authority within families.

Prescribing Ordeals

Haley employed Milton Erickson’s technique of prescribing ordeals to counter the payoff of
problematic behaviors. By making symptoms more burdensome than giving them up, families are
motivated to change. For example, an insomniac might be instructed to wake up every night and
complete an inconvenient task, like waxing the floor, making sleeplessness less appealing than
finding a solution.

Milan Group and Generational Patterns

Mara Selvini Palazzoli and her colleagues focused on the protective function of symptoms within
family systems. They examined multi-generational histories to uncover alliances and coalitions that
perpetuated symptoms. For instance, a child might develop issues to shield a family member or
preserve fragile family dynamics. By addressing these intricate networks, therapists aimed to
dismantle the necessity for symptoms and foster healthier interactions.

Three Explanations of Problem Development

In strategic family therapy, problems are explained through three distinct models:

1. Cybernetic Explanation
Problems develop due to misguided solutions that create positive feedback loops, escalating
the issue. For instance, in Juwan's case, an MRI therapist would focus on how his parents’
efforts to encourage him to leave the house may inadvertently reinforce his refusal. The
therapist would explore the parents' framing of the issue, assuming their interpretations
contribute to their ineffective solutions.

2. Structural Explanation
Problems arise from dysfunctional family hierarchies. A Haley-style therapist would examine
how Juwan’s behavior might be linked to struggles within the family, such as unresolved
conflicts between his parents. The focus would include exploring how Juwan’s refusal might
result from his involvement in a dysfunctional family triangle, where his actions perpetuate
or stem from parental disputes.

3. Functional Explanation
Problems serve covert purposes within the family system, such as protecting or controlling
other members. Madanes, in particular, would explore how Juwan’s behavior shields his
parents from addressing a threatening issue, such as marital discord. In this context, his
refusal to leave the house might prevent his parents from confronting deeper conflicts.

The Milan Systemic Approach

Milan systemic therapists expand on these ideas by examining family relationships and generational
patterns. Their goal is to uncover networks of alliances and coalitions within the family. For example,
they might discover that Juwan’s symptoms prevent his mother from re-entering a power struggle
with her own parents, which she avoided by focusing on her symptomatic child. Additionally, Juwan’s
lack of success might protect his father from feelings of inadequacy, as a successful child could
highlight his own shortcomings.

Goals of Therapy

1. MRI Group Goals

o The MRI group adopts a minimalist approach, concluding therapy once the
presenting problem is resolved.

o They view individuals with problems as "stuck" rather than "sick," aiming to get
them "moving" again.

o Therapists emphasize setting clear, reachable goals to define success and guide the
process.

o The primary focus is on behavioral change rather than insight.

 2. Haley’s Approach

o Haley's approach also prioritizes behavior change but extends to structural

reorganization within the family, specifically hierarchies and generational
boundaries.

o Unlike structural family therapy, Haley’s interventions always address the presenting
problem directly, avoiding unrelated family issues. For instance, in dealing with
rebellious teenagers, he focuses on improving parental collaboration instead of
exploring marital problems.

3. Milan Approach

o The Milan group builds on the MRI model but is less problem-focused, aiming to
change family members' beliefs about covert collusions and the motives behind
problematic behaviors.

o This approach centers on interrupting destructive family dynamics rather than solely
addressing symptoms.

Conditions for Behavior Change

1. Communication Patterns

o Initially, family therapy sought to improve communication. This evolved into

targeting specific communication patterns that sustain problems.

2. Problem-Sequencing Strategies

o Therapists may either point out problematic sequences to foster insight or block
them directly to enforce change.

o For example, Maria's father grounding her for arguing could be reframed using
second-order interventions, where he expresses disappointment instead of
punishment, leading Maria to feel concern rather than defiance.

3. First-Order vs. Second-Order Change

o First-Order Change: Alters specific behaviors without modifying underlying rules

(e.g., finding a more effective punishment for Maria).

o Second-Order Change: Modifies the rules governing interactions (e.g., altering

Maria’s father’s reaction to inspire a shift in their dynamic).

4. Haley’s Behavior Focus

o Haley emphasized that changes in behavior can shift perceptions, minimizing

resistance from family members. He discouraged directly telling clients what they
were doing wrong.

5. Milan Group’s Cognitive Focus

o The Milan group emphasized reframing through techniques like positive connotation
to alter how families interpret and respond to behaviors.
 o This shift from behavioral to cognitive change foreshadowed the constructivist and
narrative movements in family therapy.

The Haley and Madanes Approach to Therapy

Jay Haley’s strategic family therapy approach focuses on tailoring interventions to address the unique
dynamics of each family. It emphasizes using carefully crafted directives and ensuring a strong
foundation in the early stages of therapy. His method is systematic yet flexible, aiming to provoke
behavioral change while addressing family hierarchies and interactions.

Four Stages of the Initial Interview

Haley structured the first therapy session into four distinct stages, ensuring a comprehensive
understanding of the family system and setting the tone for effective treatment.

1. Social Stage

o Goal: Help family members feel at ease and establish rapport.

o Process:

 Haley greeted each family member individually, ensuring they felt welcome
and comfortable, much like a host receiving guests.

 He used this stage to observe the family’s natural dynamics and gauge how
members interact in a relaxed setting.

o Significance:

 Creating a comfortable environment encourages openness and helps reduce

defensiveness in later stages.

2. Problem Stage

o Goal: Gather each family member's perspective on the presenting problem.

o Process:

 Haley asked every individual to describe the problem from their viewpoint,
giving everyone a chance to speak uninterrupted.

 He often started with fathers to increase their involvement, recognizing that

mothers usually play a more central role in family discussions.

o Significance:

 This stage highlights differing perceptions, potential conflicts, and roles

within the family while offering the therapist insight into relational
dynamics.

3. Interaction Stage

o Goal: Observe the family's natural interactions around the problem.

o Process:
  Haley encouraged family members to discuss the problem among
themselves.

 During this exchange, he paid close attention to:

 Coalitions: Alliances that pit some members against others.

 Hierarchy: The balance of authority and decision-making in the

family.

 Parental teamwork: Whether parents support or undermine each

other.

o Significance:

 Observing real-time interactions offers valuable clues about the structure

and patterns maintaining the family’s difficulties.

4. Goal-Setting Stage

o Goal: Establish clear objectives for therapy that are relevant and attainable.

o Process:

 Based on the problem discussion, Haley worked with the family to define
specific goals for therapy.

o Significance:

 Goals provide direction for the intervention and ensure all family members
are aligned on what success looks like.

Directives as the Central Technique

Definition:
Directives are tasks or instructions given by the therapist to encourage the family to act differently
and disrupt problematic patterns.

1. Characteristics of Directives:

o They are not generic advice but carefully crafted to suit the specific family dynamics.

o Directives are designed to be actionable and achievable, focusing on behavioral

changes.

o They often leverage existing family structures or relationships to promote change.

2. Examples of Directives:

o Asking parents to create a united front in decision-making to address a rebellious

child.

o Encouraging a withdrawn family member to initiate specific interactions to foster

connection.

o Assigning tasks that subtly challenge dysfunctional hierarchies without directly

confronting them.
 3. Purpose of Directives:

o Interrupt Patterns: Directives disrupt rigid, maladaptive cycles within the family.

o Promote Change: They encourage the family to experiment with new behaviors and
observe the outcomes.

o Reduce Resistance: By giving tasks instead of directly pointing out issues, families
are less likely to become defensive.

Haley's Beliefs and Techniques

1. Starting Strong:
Haley emphasized the importance of starting therapy on the right foot, as a well-structured
initial session can set the tone for success.

2. Observation and Strategy:

o During early interactions, Haley refrained from analyzing or commenting on family

patterns directly, as this could provoke resistance.

o Instead, he observed family dynamics to identify subtle issues such as triangles

(alliances that exclude others) and dysfunctional hierarchies.

3. Focus on Behavior:

o Haley believed in changing behavior first, with the understanding that perceptions
and insights would follow.

o Insight, while valuable, was secondary to practical change in his approach.

4. Task-Oriented Approach:

o Tasks were often assigned at the end of the first session to initiate change and
provide a sense of progress.

Key Takeaways from the Haley and Madanes Approach

 Individualized Therapy: The method is adaptable, emphasizing unique solutions for each
family rather than applying a one-size-fits-all approach.

 Directive-Focused: Thoughtful, action-oriented interventions lie at the heart of this

approach.

 Behavioral Change as the Priority: Changing behavior is viewed as the catalyst for altering
perceptions and improving family dynamics.

 Hierarchies and Coalitions: Addressing structural imbalances and dysfunctional alliances is

central to resolving problems.

 Systematic yet Artful: Haley’s work combined a strategic structure with creative
interventions tailored to the nuances of each family system.
THE MILAN MODEL

The original Milan model was highly scripted. Families were treated by male–female cotherapists and
observed by other members of the team.

several key concepts guide the therapeutic process and help foster positive change within family
systems.

Neutrality refers to the therapist's ability to remain unbiased and nonjudgmental, ensuring all family
members feel heard and valued. This stance allows the therapist to maintain a balanced perspective,
creating a safe space for families to explore their dynamics without fear of favoritism or blame. By
upholding neutrality, the therapist helps families address sensitive issues collaboratively.

Circular questioning is a technique used to uncover family dynamics by exploring relationships,

perceptions, and roles within the system. Instead of focusing on individual problems, the therapist
asks questions that highlight interactions between family members, encouraging a broader
understanding of how behaviors influence the family as a whole. This approach deepens insight into
patterns and connections, promoting systemic awareness.

Positive connotation involves reframing problematic behaviors or interactions in a constructive light.

By interpreting seemingly negative actions as serving a functional or protective purpose within the
family system, this technique fosters empathy and reduces blame. For instance, a child's rebellious
behavior might be reinterpreted as an attempt to draw attention to unmet family needs, encouraging
cooperation and understanding.

Rituals are structured, intentional activities designed to strengthen connections, reinforce family
roles, and facilitate change. These repeated actions often signify transitions, resolve conflicts, or
highlight shared values within the family. By engaging in rituals, families can create meaningful
experiences that reinforce desired behaviors and foster unity, ultimately supporting healthier
dynamics. Together, these concepts form a comprehensive framework for addressing and
transforming family challenges.

STRUCTURAL FAMILY THERAPY

Family structure refers to the way a family is organized into subsystems whose interactions are
regulated by interpersonal boundaries. The process of family interactions is like the patterns of
conversation at the dinner table. The structure of the family is where family members sit in relation
to one another. Who sits next to whom makes it easier to interact with some people and less so with
others. Family structure is reinforced by the expectations that establish rules in a family. For example,
a rule such as “family members should always look out for one another” will be manifest in various
ways depending on the context and who is involved. If a boy gets into a fight with another boy in the
neighborhood, his mother will go to the neighbors to complain. If a teenager has to wake up early for
school, her mother wakes her. If a husband is too hung over to go to work in the morning, his wife
calls to say he has the flu. If the parents have an argument, their children interrupt

Discovery of Subsystems and Enactments in Family Therapy

Family systems theory recognizes that families are organized into subsystems—smaller units like the
parental subsystem or sibling subsystem—that have unique roles and interactions. Boundaries
regulate the level of contact and communication between these subsystems. The concept of
enactments is pivotal, as it involves encouraging family members to engage directly with one
another during therapy sessions. These interactions allow the therapist to observe the family’s
dynamics in real time and intervene to modify dysfunctional patterns.

Goals of Structural Group Therapy

1. Enhance Communication Skills

One of the primary objectives is to improve interpersonal communication among group members. By
addressing misunderstandings and teaching effective communication techniques, the therapy fosters
healthier interactions within families or groups. Members learn to express their thoughts and
emotions clearly while listening empathetically to others, reducing conflict and promoting mutual
respect.

2. Identify and Restructure Relationships

Structural group therapy seeks to identify dysfunctional patterns within families or social structures.
For instance, patterns such as overdependence or avoidance are explored. Once these are
recognized, the therapist guides group members to restructure these relationships, creating more
functional and balanced dynamics that support individual and collective well-being.

3. Foster Support Systems

Creating a robust support network is a crucial aspect of therapy. Members are encouraged to share
experiences, offer emotional support, and rely on one another as they work through their
challenges. These support systems not only sustain recovery but also help maintain emotional health
outside the therapy sessions.

4. Promote Insight and Awareness

The therapy encourages members to reflect on their behaviors and understand how their actions
impact others within the group or family. By fostering insight and awareness, participants gain clarity
about their roles in sustaining dysfunctional dynamics and are empowered to implement positive
changes.

Key Concepts

1. Parental Subsystem

This refers to the unit within the family system comprising the parents or caregivers. The parental
subsystem plays a vital role in decision-making, providing discipline, and setting the tone for family
interactions. Effective parental subsystems maintain healthy boundaries and provide emotional and
structural stability for children.

2. Child Subsystem

The child subsystem includes the siblings and their interactions. This unit is essential for socialization,
learning conflict resolution, and understanding peer relationships. In structural family therapy,
therapists evaluate whether the child subsystem is appropriately separated from adult conflicts to
prevent undue stress or developmental issues.
3. Accommodation

Accommodation involves the adjustments family members make to adapt to one another’s needs
and roles. While some level of accommodation is necessary for a functioning family, excessive
accommodation can lead to enmeshment, where individual boundaries are blurred, or neglect,
where needs are unmet.

4. Boundary Making

Boundaries regulate the flow of information, roles, and interactions between subsystems. Rigid
boundaries can isolate members, while diffuse boundaries may lead to enmeshment. Therapists
help families establish clear and appropriate boundaries to ensure healthy communication and
respect for individual autonomy.

5. Family Hierarchy

The family hierarchy refers to the power dynamics and leadership within a family system. A healthy
hierarchy ensures that parents or caregivers maintain authority and responsibility while children
have the freedom to develop under their guidance. Dysfunctional hierarchies, such as overly
permissive or authoritarian structures, can disrupt family harmony and development.

6. Cross-Generational Coalition

A cross-generational coalition occurs when a member from one generation (e.g., a child) aligns with
a member from another generation (e.g., a grandparent) against a third member (e.g., a parent). This
alliance can create rifts within the family structure, undermining the authority of the excluded
members and fostering long-term conflict.

Development of Behavior Disorders: A Structural Perspective

Behavioral disorders often arise when families fail to adapt to external pressures or developmental
transitions. Changes such as a job loss, relocation, or children reaching new life stages require
modifications in family structure. Healthy families adjust their boundaries and interactions to
accommodate these shifts, while dysfunctional families maintain rigid or unproductive structures,
contributing to the development of disorders.

Disengaged Families

Rigid Boundaries and Lack of Support

Disengaged families exhibit rigid boundaries, which limit emotional and practical support among
members. This detachment can result in family members failing to recognize or address problems
until they escalate. For example, disengaged parents may remain unaware of a child's struggles with
depression or academic challenges, as illustrated by the case of a single mother who discovered only
after two weeks that her son had been skipping school.

Structural Analysis of Disengagement

From a structural perspective, disengagement in one relationship often reflects preoccupations

elsewhere. In the example above, the mother’s disengagement from her son might stem from her
struggles with the financial or emotional burdens of single parenthood. Structural therapy avoids
blame, instead exploring external stressors or other systemic dynamics that occupy the disengaged
individual.

Enmeshed Families

Diffuse Boundaries and Dependency

In enmeshed families, boundaries are overly diffuse, leading to excessive emotional involvement
and dependence among members. Parents who are overly intrusive may hinder their children’s
development, limiting their ability to gain independence or solve problems autonomously.

Reciprocal Dynamics of Enmeshment and Disengagement

Enmeshment and disengagement often coexist in reciprocal patterns. For instance, a father deeply
engaged in his work may neglect his family, while the mother compensates by becoming overly
involved with the children. This dynamic—commonly referred to as the enmeshed
mother/disengaged father syndrome—illustrates how family subsystems can become imbalanced.

Criticism and Feminist Perspective

Cultural Context of Family Roles

Feminists have criticized the notion of the enmeshed mother/disengaged father syndrome, pointing
out that this arrangement often reflects culturally sanctioned roles rather than personal failings. The
overemphasis on mothers’ involvement and fathers’ detachment can inadvertently place undue
blame on women.

Sensitive Application of Structural Concepts

Structural therapy acknowledges the systemic nature of skewed relationships, focusing on the
interplay of roles rather than assigning blame. The goal is to address problematic dynamics
collaboratively, ensuring no single individual is solely responsible for the necessary changes.

THERAPEUTIC TECHNIQUES

In Families and Family Therapy, Minuchin (1974) listed three overlapping stages in structural family
therapy. The therapist: (1) joins the family in a position of leadership, (2) maps the family’s
underlying structure, and (3) intervenes to transform this structure. The program is simple, in the
sense that it follows a clear plan, but complicated because of the endless variety of family patterns

Steps of Structural Family Therapy

Structural Family Therapy (SFT), developed by Salvador Minuchin, is centered on the idea that family
dysfunction is caused by problems in the family structure, such as misaligned boundaries or
ineffective hierarchies. The therapist works to reorganize the family structure, modifying patterns of
interaction and fostering healthier relationships. The steps of SFT are designed to guide the therapist
through the process of facilitating change. Here is a detailed explanation of each step:

1. Joining and Accommodating

Objective: Establish rapport and build trust with the family to create a collaborative therapeutic
relationship.
  Joining refers to the therapist becoming a part of the family system to understand the
family’s dynamics. This is done in a way that is respectful and empathetic. The therapist must
show acceptance and non-judgment to be seen as a helpful part of the system.

 Accommodating means adapting to the family’s communication style, values, and beliefs.
The therapist doesn't impose their own ideas but rather understands the family’s reality to
create a bond.

 This step involves engaging with the family in a warm, respectful manner to avoid resistance
and create an environment conducive to change.

2. Enactment

Objective: Encourage family members to act out certain scenarios to gain new perspectives and
change dysfunctional patterns.

 Enactment involves family members role-playing specific interactions, either past or

hypothetical, to gain insight into how their behaviors affect each other. This allows them to
step outside the situation and view it from a different perspective.

 This technique can be used to help family members experience and express their emotions,
practice new behaviors, and resolve unresolved conflicts.

 For example, a parent might role-play how they would respond to a child's emotional
outburst in a more supportive, non-punitive way.

3. Structural Mapping

Objective: Create a visual representation of the family’s current structure to identify problematic
patterns.

 Structural Mapping is the process of assessing and visually organizing the relationships and
boundaries within the family system. This includes identifying subsystems (e.g., parental,
sibling) and the relationships between these subsystems.

 This map helps to identify who interacts with whom, the power dynamics, and where
dysfunctions lie (e.g., enmeshed or disengaged boundaries, hierarchical imbalances).

 The therapist may draw the map to show how the family’s interactions influence behavior
and help the family understand their patterns of interaction.

4. Highlighting and Modifying Interactions

Objective: Focus on specific interactions to bring about change in problematic behaviors and
dynamics.

 This step is about observing and intervening in real-time family interactions to highlight
dysfunctional patterns, such as coalitions, empathy, and shaping competence.

o Coalitions refer to alliances formed between family members that exclude others,
often resulting in dysfunctional dynamics (e.g., child aligning with one parent against
the other).

o Empathy involves the therapist helping family members understand each other’s
emotions and perspectives, promoting healthier communication and interactions.
 o Shaping competence involves reinforcing positive behavior changes, helping family
members feel more capable in their roles and relationships.

 By drawing attention to these behaviors, the therapist can guide the family towards more
productive and functional interactions.

5. Boundary Making

Objective: Help family members establish and reinforce appropriate boundaries within subsystems
to improve family functioning.

 Boundary Making involves the therapist helping family members establish and strengthen
appropriate boundaries between subsystems (e.g., between parents and children, or among
siblings).

o Enmeshed boundaries occur when family members are overly involved with each
other’s emotional lives, while disengaged boundaries occur when family members
are overly isolated.

o The therapist encourages clearer boundaries to ensure appropriate roles and

responsibilities are maintained. For example, parents may need to become more
authoritative and stop sharing inappropriate personal information with their
children.

o In some cases, the therapist may need to intervene directly by asking family
members to physically distance themselves or create symbolic boundaries during
sessions.

6. Unbalancing

Objective: Disrupt the family’s equilibrium to introduce change and encourage new ways of thinking
and behaving.

 Unbalancing refers to temporarily shifting the family’s power dynamics or behavioral

patterns to challenge entrenched roles and beliefs. This might involve the therapist
temporarily siding with one family member (e.g., siding with the child in a family dispute) to
unbalance the system and encourage new perspectives.

 By doing this, the therapist challenges family members to reconsider their usual responses
and explore alternative ways of interacting. This technique is particularly useful when
families are stuck in rigid patterns.

 For example, a therapist might ask a passive parent to become more assertive or push a
controlling parent to allow their child more independence.

7. Challenging Unproductive Assumptions

Objective: Help family members challenge the dysfunctional beliefs and assumptions that contribute
to the problem.

 In this step, the therapist works with the family to identify and challenge the unproductive
assumptions that underlie their behavior. These assumptions often involve fixed beliefs
about roles, behaviors, and expectations within the family (e.g., “children should be seen and
not heard” or “only one person can have power in the family”).
  By confronting these assumptions, the therapist helps family members develop a more
flexible understanding of their roles and behaviors, promoting healthier and more adaptive
ways of interacting.

 This process may involve reframing the family’s views on conflict, power, authority, and
emotional expression.

SOLUTION-FOCUSED THERAPY

Solution-focused therapists believe it isn’t necessary to know what causes problems in order to make
things better. Solution-focused practitioners assume that people who come to therapy are capable of
behaving effectively but that their effectiveness has been blunted by a negative mind-set. Drawing
their attention to forgotten capabilities helps release clients from preoccupation with their failures
and restores them to their more capable selves. Problems are seen as overwhelming because clients
see them as always happening. Times when problems aren’t happening aren’t noticed or are
dismissed as trivial. The art of solution-focused therapy becomes a matter of helping clients see that
their problems have exceptions—times when they don’t occur—and that these exceptions are
solutions they already have in their repertoires.

Solution-focused therapists believe that people are constrained by narrow views of their problems
into perpetuating rigid patterns of false solutions. When you put all your eggs in one basket, you
must clutch that basket for dear life.

Family Dynamics in Solution-Focused Therapy

Solution-focused therapy (SFT) minimizes emphasis on family dynamics as complex, interwoven

forces constraining individual actions. Instead, SFT focuses on seeing people as fluid and capable of
change. Clients are viewed as experts in their own lives, and therapists prioritize understanding the
client's frame of reference over imposing their own. This approach creates an environment where
individuals can constructively explore their goals and resources.

Core Principles

1. Client Expertise
Clients are regarded as the primary experts on their challenges and potential solutions.
Therapists routinely ask questions such as, "Is there anything else I should know or that you
need to share?" This openness affirms clients' autonomy and encourages them to take
ownership of their treatment process.

2. Resourceful Clients
SFT assumes that people are resourceful and capable of solving their problems. Challenges
are viewed as normal life-cycle complications, not as evidence of failure. This optimistic
stance empowers clients to focus on solutions rather than problems.

3. No Singular "Normal" Family

SFT rejects the idea of a universal "correct" way of living. What works for one family may not
suit another. Families, rather than therapists, define the goals of therapy, ensuring that the
process aligns with their unique values and needs.

Mechanisms of Change
SFT focuses on clear goal-setting and amplifying exceptions to problems. By reframing issues in
solution-oriented terms, clients are encouraged to envision positive outcomes rather than dwelling
on dissatisfaction.

Goals of Therapy

The primary goal of SFT is to resolve the presenting complaint efficiently, without exploring deeper
psychological or structural issues. This approach dismisses the need to uncover underlying flaws like
covert parental conflicts or incongruent hierarchies. Instead, therapists focus on what clients want to
change, not how families should be structured.

Example:

 A client saying, "I want to be less depressed," might be prompted with, "What will you be
doing instead when you're less depressed?" This reframing encourages actionable, positive
steps.

Conditions for Behavior Change

SFT emphasizes the amplification of exceptions—instances where the problem is absent or less
severe. By shifting the narrative to focus on solutions rather than problems, clients begin to perceive
change as achievable. This reframing is grounded in the idea that changing language can alter
perceptions, leading to positive thoughts and actions.

Example:

 A client struggling with overeating may benefit more from focusing on healthy behaviors
(e.g., eating low-fat meals, exercising) rather than concentrating on avoiding unhealthy
habits.

Process of Goal Setting

Goal setting in SFT is seen as both an intervention and a foundational step in therapy. Goals should
be:

 Specific and well-defined.

 Framed positively (e.g., "I want to feel more confident at work" instead of "I want to stop
feeling anxious").

 Realistic and achievable to build momentum for change.

Therapeutic Example:
When a family says, "We want Roger to stop smoking pot," the therapist might ask, "What will Roger
be doing differently instead?"

Language as a Tool for Change

SFT heavily relies on language as a vehicle for transformation. By focusing conversations on solutions
rather than problems, clients naturally shift toward a positive outlook. This belief aligns with the idea
that talking about solutions fosters belief in their reality, facilitating actionable change.

Key Idea:

 Talking differently about problems → Thinking positively → Acting positively.

Therapeutic Approach in Solution-Focused Therapy

Solution-focused therapy (SFT) emphasizes identifying solutions rather than dissecting problems. Its
approach to assessment, client motivation, and interventions is grounded in proactive, client-
centered principles.

Assessment in Solution-Focused Therapy

SFT practitioners focus on understanding clients’ desired outcomes rather than conducting extensive
diagnostic evaluations. The assessment phase involves direct questions aimed at clarifying goals and
identifying exceptions to the problem:

 Clarifying the Presenting Complaint:

Questions such as, "What do you think the problem is now?" or "How will you know the
problem is solved?" help clients articulate their concerns and desired changes.

 Identifying Exceptions:
Therapists explore instances where the problem is absent or less severe, fostering hope and
demonstrating the possibility of change.

 Minimal Intake Information:

Unlike other models, SFT avoids delving into family histories or dynamics, focusing instead on
clients' perceptions of their issues.

Mechanisms of Change

SFT uses goal setting and reframing to foster change:

1. Reframing Problems into Goals:

Problems are reframed in positive, actionable terms.

o Example: "I want my daughter to stop hanging out with friends" becomes "What
steps can we take to help her focus more on her homework?"

2. Amplifying Exceptions:
Clients are encouraged to identify and replicate moments when the problem is less
significant, building confidence in their ability to manage challenges.

3. Strategic Compliments:
Therapists affirm clients’ strengths and progress, which reinforces motivation and
engagement.

Motivation for Change in Solution-Focused Therapy

In Solution-Focused Therapy (SFT), clients are categorized based on their readiness to engage in
therapy, as outlined by De Shazer (1988). This framework allows therapists to tailor their approach,
maximizing the effectiveness of the therapeutic process. The categories—Visitors, Complainants,
and Customers—describe the client’s motivation and willingness to participate actively in change.

1. Visitors

Characteristics:
  Visitors attend therapy not out of personal motivation but at the insistence of external
authorities (e.g., a court order, parental demand, or workplace requirement).

 They often do not view themselves as having a problem or needing therapy.

 Visitors may resist engaging in the process because they feel coerced or believe the
responsibility lies with someone else.

Therapeutic Strategy:

 The therapist avoids pressuring visitors to engage in deep therapeutic work, as this can
create resistance.

 Instead, the focus is on minimal goals that align with the visitor’s external obligations. For
example:

o Therapist: “What needs to happen so that your principal doesn’t call you into their
office again?”

o Therapist: “What’s the minimum outcome we can aim for to satisfy the court?”

 The therapist works to create a non-threatening and supportive environment, allowing

visitors to feel heard and respected.

 Success with visitors often involves reframing the situation to show them how small steps
toward change can benefit them personally, not just satisfy the authority figure.

2. Complainants

Characteristics:

 Complainants acknowledge that there is a problem, but they view the responsibility for
change as lying with someone else.

 They may seek therapy to address the behavior of others, such as a parent frustrated with
their child’s lack of discipline or a spouse blaming their partner for communication issues.

 While complainants want the situation to improve, they may not initially see themselves as
part of the solution.

Therapeutic Strategy:

 The therapist avoids challenging the complainant’s perspective directly, as this can lead to
defensiveness.

 Instead, the conversation is shifted from problem talk to solution talk, focusing on desired
outcomes and the client’s role in achieving them.

o Therapist: “What do you think needs to happen so that your partner communicates
better with you?”

o Therapist: “What would be different if your son started taking more responsibility for
his homework?”

 The therapist gently introduces the idea that the complainant’s behavior might influence the
situation. This is done without blame, often through hypothetical or future-focused
questions:
 o Therapist: “If your son did his homework, what would he notice about how you’re
different with him?”

 The ultimate goal is to help the complainant recognize their potential agency in creating
solutions, often by observing exceptions to the problem when things go well.

3. Customers

Characteristics:

 Customers are highly motivated and actively willing to work on change.

 They clearly identify the problem and take ownership of their role in addressing it.

 These clients are solution-focused from the start and ready to collaborate with the therapist
to set goals and take actionable steps.

Therapeutic Strategy:

 With customers, the therapist can move directly to goal-setting and developing specific,
actionable solutions.

 The process involves:

o Clarifying Goals: The therapist and client define clear, measurable objectives for
therapy. For example:

 Therapist: “What would success look like for you by the end of our sessions?”

o Building on Strengths: The therapist highlights the client’s existing skills and
resources that can facilitate change.

 Therapist: “What strategies have worked for you in the past when faced with
similar challenges?”

o Reinforcing Motivation: The therapist affirms the client’s commitment and progress
to sustain engagement.

 Therapist: “It’s clear you’ve already put a lot of thought into this. How can
we build on what’s already working?”

 Homework or tasks are often assigned to customers, as they are more likely to follow
through. These might include:

o Observing and recording times when the problem doesn’t occur.

o Practicing specific strategies or behaviors discussed in therapy.

Why This Framework is Effective

 Tailored Interventions: By understanding the client’s motivation, therapists can avoid

imposing strategies that may feel overwhelming or irrelevant.

 Building Trust: Respecting the client’s readiness to engage fosters a collaborative and
nonjudgmental therapeutic relationship.
  Gradual Change: The framework allows for progression, as visitors or complainants may
eventually evolve into customers as they see the benefits of change.

Therapeutic Techniques in Solution-Focused Therapy

Solution-Focused Therapy (SFT) emphasizes collaborative goal-setting and building on clients’

strengths by focusing on exceptions—moments when the problem is less severe or absent. It is brief,
practical, and future-oriented, typically lasting three to five sessions (De Jong & Berg, 2002). The
techniques used are tailored to empower clients to envision their preferred future and to identify
small, actionable steps toward change.

Key Concepts and Techniques

1. Miracle Question

The miracle question is a central technique in SFT designed to help clients articulate their desired
future without their current problems. It shifts focus from the problem to solutions and generates
hope.

Example:
Therapist:
"Suppose tonight, while you are sleeping, a miracle happens, and the problem that brought you here
is solved. But because you were asleep, you don’t know this happened. When you wake up tomorrow,
what would be the first small sign that tells you the miracle has occurred?"

Purpose:

 Helps clients clarify goals by visualizing a life without the problem.

 Encourages a focus on actionable changes rather than dwelling on the past.

 Reveals implicit strengths and resources that clients might already have.

2. Scaling Questions

Scaling questions help assess progress, motivation, and confidence in achieving goals. Clients are
asked to rate their current situation or efforts on a scale, typically from 0 to 10, where 0 represents
the worst-case scenario and 10 the ideal outcome.

Example:
Therapist:
"On a scale from 0 to 10, where 0 means the problem is as bad as it can be, and 10 means the
problem is completely resolved, where are you now?"

Follow-up questions:

 "Why did you choose this number and not a lower one?"

 "What would it take to move up just one point?"

Purpose:

 Encourages clients to recognize progress, even if small.

 Highlights what is already working and identifies areas for improvement.

  Helps clients set realistic, incremental goals.

3. Exceptions

Identifying exceptions—times when the problem is less intense or does not occur at all—is
foundational to SFT. Exceptions represent opportunities to understand what strategies or
circumstances contribute to success.

Example:
Therapist:
"Can you think of a time recently when the problem was less severe or didn’t happen at all? What
was different about that time?"

Purpose:

 Helps clients focus on solutions rather than problems.

 Encourages them to replicate successful behaviors or conditions.

 Builds confidence by showing clients they have already experienced progress.

4. Reframing

Reframing involves changing the client’s perspective on a problem, often transforming it into an
opportunity or challenge that can be overcome.

Example:

 A parent complains, “My child never listens to me.”

o The therapist reframes: “It sounds like your child has a strong will. How can we
channel that strength into something positive?”

Purpose:

 Shifts focus from negative interpretations to strengths or opportunities.

 Encourages a more optimistic outlook.

 Reduces resistance by validating the client’s experience while presenting an alternative

perspective.

Additional Techniques

1. Understanding Family Systems

While SFT does not extensively focus on family dynamics, it borrows concepts from family systems
theory to understand the role of interactions and relationships.

 Problems are often influenced by patterns of communication within families.

 The therapist encourages clients to observe how changes in their behavior affect family
dynamics.

2. Role of Interaction

Communication and relationships are central to SFT. The therapist works with clients to explore how
their interactions with others contribute to or alleviate the problem.
Example:
Therapist: “When you respond calmly to your partner during an argument, how does that change the
way they respond to you?”

Purpose:

 Encourages clients to view relationships as dynamic systems.

 Helps them see how their actions can influence outcomes.

Combining Techniques

SFT techniques are flexible and often used together to create a collaborative and empowering
process. For example:

1. Start with the Miracle Question to identify the client’s preferred future.

2. Use Scaling Questions to assess current progress toward that future.

3. Highlight Exceptions to demonstrate what is already working.

4. Reframe problems to focus on strengths and possibilities.

Common Suggestions in Solution-Focused Therapy

Solution-Focused Therapy (SFT) uses creative and practical suggestions to empower clients to
identify and build on their strengths and successes. These suggestions are designed to shift focus
from problems to solutions, fostering self-efficacy and positive change. Below are six commonly used
strategies in SFT:

1. The Formula First-Session Task (de Shazer, 1985)

This task encourages clients to observe and identify what is already working well in their family or
environment. By doing so, clients begin to recognize their strengths and positive patterns.

Example:
Therapist:
"Between now and the next time we meet, I would like you to observe what happens in your family
that you want to continue to have happen."

Purpose:

 Highlights existing strengths and successes.

 Shifts the focus from problems to positive actions.

 Helps the client envision their ideal future by reflecting on current positives.

2. Do More of What Works

This strategy encourages clients to replicate actions or behaviors that have previously been effective
in improving relationships or resolving conflicts.

Example:
Therapist:
"Since you said that you usually can talk together when you go for a walk, maybe you should try that
once or twice and see what happens."

Purpose:

 Reinforces successful behaviors.

 Builds on the client’s existing strengths and solutions.

 Encourages small, actionable steps toward change.

3. Do Something Different

When current strategies fail, SFT suggests experimenting with new approaches. This can help clients
break out of unhelpful patterns and discover alternative solutions.

Example:
Therapist:
"You mentioned that when you rely on Janine to be responsible for her own homework, she often fails
to do it. Maybe you should try something different?"

Creative Case:
A family struggling with their son’s encopresis was advised to fill the potty seat with water and a toy
boat, assigning him the task of sinking the boat. This playful experiment worked and changed the
dynamic around a stressful issue (Berg & Dolan, 2001).

Purpose:

 Breaks unproductive cycles by introducing novelty.

 Encourages clients to explore flexibility in problem-solving.

 Engages clients through creativity and playfulness.

4. Go Slow

Borrowed from the MRI model, this suggestion addresses clients’ fear of change. It invites reflection
on the potential consequences of change and emphasizes gradual steps to reduce anxiety and
resistance.

Example:
Therapist:
"I have what may seem like a strange question: Could there possibly be any advantages to things
staying the way they are?"

Purpose:

 Normalizes hesitation about change.

 Encourages thoughtful, incremental adjustments.

 Reduces the fear of failure or overwhelming consequences.

5. Do the Opposite

For problems perpetuated by ineffective solutions, this strategy recommends doing the opposite. It’s
particularly useful in conflicts between two people where habitual patterns sustain the issue.
Examples:

 If scolding a child for bad behavior isn’t working, the parent might try praising the child for
good behavior.

 A husband avoiding relationship talks with his wife might instead initiate them when he feels
prepared and positive.

Purpose:

 Breaks dysfunctional cycles by reversing behaviors.

 Offers a new perspective on problem resolution.

 Creates opportunities for unexpected positive interactions.

6. The Prediction Task (de Shazer, 1988)

This strategy helps clients track and analyze their own perceptions of progress.

Example:
Therapist:
"Before you go to bed tonight, predict whether the problem will be better or the same tomorrow.
Tomorrow night, rate the day and compare it with your prediction. Think about what may have
accounted for the right or wrong prediction. Repeat this every night until we meet again."

Purpose:

 Encourages mindfulness and self-reflection.

 Highlights patterns or factors influencing progress.

 Builds awareness of internal and external resources.

NARRATIVE THERAPY

The narrative approach is a hallmark of the postmodern revolution in family therapy, emphasizing
the idea that knowledge and experience are constructed rather than discovered. It shifts the focus
from observable behaviors to the meanings people assign to their experiences. The underlying
premise is that personal experience is inherently ambiguous. This does not mean that experiences
lack reality but rather that their understanding depends on how individuals interpret and organize
them. Meaning is not fixed; it is shaped by how elements of experience are prioritized and
contextualized. For instance, the tension felt before public speaking can be labeled as “stage fright”
or “excitement.” While the former frames the experience as a problem, the latter normalizes it,
creating an empowering narrative.

A key distinction between narrative therapy and other approaches lies in how change is facilitated.
While strategic therapy might rely on reframing—offering new interpretations for experiences—
narrative therapy goes deeper, targeting the client’s underlying story. For example, instead of
convincing a client that their trembling before an audience is excitement, narrative therapy helps
them develop a story where they view themselves as competent and valuable. This broader narrative
shift allows the client to reinterpret their feelings in a way that aligns with their newfound self-
perception

Goals of Therapy

In narrative therapy, the goal is not to directly solve problems, but to help clients distance
themselves from problem-saturated stories and destructive cultural assumptions. The emphasis is on
transforming the way individuals view themselves by helping them reframe their identities from
flawed or problem-laden to preferred and empowering ones. Rather than focusing on family
conflicts, narrative therapy seeks to separate individuals from the problems they face and then unite
the family as a collective force to challenge these problems. This is done by exploring the family’s
history for "unique outcomes"—moments when they resisted the problem or behaved in ways that
contradicted the dominant problem story.

Narrative therapy takes on a political dimension, as therapists view their role as helping clients break
free from the ingrained prejudices and limiting narratives imposed by society. This approach
empowers clients to become the authors of their own lives, rather than passive recipients of societal
expectations. By separating individuals from the problem, family members can unite with one
another and with external support networks, fostering a sense of agency, optimism, and persistence
in addressing their issues.

For example, if Alice identifies herself as codependent because of the way she interacts with men, a
narrative therapist would not focus on exploring the root causes of her codependency or suggest
ways to change her behavior. Instead, the therapist would engage Alice in a process of
deconstructing what codependency means to her. The therapist might help Alice recognize the
negative impact of self-blame—one of the harmful effects of her codependency—and work with her
family members to challenge these self-blaming thoughts. Furthermore, the therapist would
highlight times in Alice’s life when she interacted with men in a way that aligns with her preferred
self-concept, helping her build an alternative narrative.

Conditions for Behavior Change

Deconstruction and Reconstruction in Narrative Therapy

In narrative therapy, the aim is to help clients deconstruct unproductive or harmful stories and
reconstruct more empowering narratives. Deconstruction involves questioning the underlying
assumptions and beliefs that support these unhelpful stories. This helps clients view their problems
differently, allowing them to challenge disempowering thoughts and behaviors. On the other hand,
reconstruction focuses on creating new, more optimistic interpretations of their experiences,
enabling clients to reshape their identity and their perspective on their issues.

Externalizing Conversations

A central technique in narrative therapy is externalizing conversations, where therapists encourage

clients to separate themselves from their problems. Instead of labeling someone as “lazy” or
“irresponsible,” the therapist might ask about how a particular issue, like “procrastination,” takes
control of the individual. By viewing the problem as external, clients can begin to resist or challenge
its influence on their lives, rather than seeing it as an intrinsic part of themselves.
Effects Questions

Effects questions are used in externalizing conversations to explore the impact of the problem. For
example, a therapist might ask, “How does the problem affect you? Your relationships? Your
attitudes about yourself?” These questions broaden the understanding of the problem and help
clients identify areas in their lives where the problem has been less powerful. This allows clients to
see the problem in a more manageable light and creates room for the identification of unique
outcomes—instances when the client has successfully resisted the problem.

Unique Outcomes

Unique outcomes refer to moments when the problem has had less influence or when the client has
responded in ways that contradict the problem narrative. These moments offer evidence that change
is possible and provide a foundation for constructing a new, more empowering story. For example, a
person who sees themselves as “depressed” may start to recognize times when they were able to
resist feelings of self-doubt, opening up space for a more positive narrative.

Totalizing Views in Families

In family therapy, narrative therapists work to shift totalizing views—when family members reduce
each other to a single negative label. For instance, parents may view their child as "irresponsible,"
and the child may label the parents as "unfair." These polarized perspectives trap family members in
negative cycles, making it hard to see beyond the problem. Narrative therapy encourages family
members to view each other as more complex, multidimensional people, rather than being defined
by a single issue.

Shifting Perspectives for Healthier Relationships

By helping family members shift away from these totalizing views, narrative therapy fosters healthier
relationships. Instead of focusing on meeting others' expectations, family members can learn to
recognize each other's preferences and desires. This shift in perspective allows for more empathy,
understanding, and ultimately, the opportunity to work together to overcome challenges in a more
collaborative and constructive way.

Therapeutic Techniques in Narrative Therapy

In narrative therapy, the therapist employs specific techniques that focus on asking questions rather
than offering interpretations. These questions guide the clients to explore their own stories, reflect
on their experiences, and engage in a collaborative process with the therapist. The therapist avoids
imposing direct solutions, instead creating space for clients to uncover their own answers.

Initial Session and Collaborative Atmosphere

In the first session, the therapist begins by exploring how the client spends their time. This allows
the therapist to understand the client's worldview and perspective without delving into blame-heavy
histories. The therapist pays attention to the client’s talents and competencies, aiming to establish a
collaborative relationship. As part of this, the therapist may invite the client to ask any questions
about the therapist, fostering an open, transparent dynamic. The therapist might also allow clients to
read the therapist's notes, reinforcing respect for their perspective and encouraging trust in the
process.

Externalizing Conversations
A central technique in narrative therapy is the externalizing conversation, where the therapist helps
clients separate themselves from their problems. Instead of viewing the issue as an inherent part of
the client, such as “laziness” or “irresponsibility,” the therapist uses language that externalizes the
problem, such as "Procrastination takes hold of you." This shift in language helps clients see the
problem as something separate from themselves, empowering them to take action against it.

Relative Influence Questions

Therapists use relative influence questions to explore how much a problem has disrupted family
dynamics and how much control the family members have had over the problem. These questions
make the problem appear as an external force that disturbs relationships. Examples might include
questions like, "How has Bulimia affected your relationship with Jenny?" or "When Depression takes
over Dad, how does that affect family life?" These questions aim to illustrate the disruptive power of
the problem and show how the family’s efforts to manage it may have been influenced by it.

Identifying Unique Outcomes

While discussing the problem’s influence, the therapist listens for unique outcomes—moments
when the client successfully resisted the problem or when the problem didn’t dictate the client's
behavior. The therapist then encourages clients to elaborate on these experiences. For example, "Can
you remember a time when Anger didn’t take control of you? How did you manage that?" These
moments serve as evidence that change is possible and provide a foundation for constructing a more
empowering narrative.

Reauthoring the Client’s Story

Narrative therapists aim to help clients reauthor their story by connecting past victories over the
problem to their personal strengths and competencies. Therapists ask questions like, "What does it
say about you that you were able to defeat Depression on those occasions?" or "What qualities of
character must your son possess to do that?" This process helps clients see themselves as capable
individuals and provides a new foundation for their identity, one that is not defined by the problem.

Reinforcing the New Story

To reinforce the new story, narrative therapists emphasize the importance of social support. Clients
are encouraged to involve people from their lives who can affirm the new narrative and act as "allies"
to the client’s efforts. This might include people who can share examples of the client acting
competently. Additionally, some therapists use support groups or "leagues" of individuals facing
similar struggles to foster collective resistance against the problem.

One technique that helps extend the therapeutic process beyond sessions is therapeutic letters.
These letters express appreciation for the client's progress, outline the new story, and offer support.
The letters serve as a tangible reminder of the client’s growth, with many clients revisiting these
letters over the years to reinforce their journey.

Deconstructing Destructive Cultural Assumptions

At times, narrative therapists also help clients deconstruct harmful cultural assumptions. For
instance, a woman struggling with anorexia might be asked how she came to believe that her worth
was tied to her appearance, leading to a discussion about societal pressures on women. Similarly, a
violent man might be questioned about how cultural expectations of masculinity shaped his beliefs
about vulnerability. By making these cultural narratives explicit, narrative therapy helps clients
challenge societal beliefs that contribute to their problems, empowering them to adopt healthier,
more personal definitions of themselves.