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Flashcards in Haley/Madanes Strategic Deck (17):

Theorists of Strategic:

1. Haley

2. Madanes


Major Concepts of Strategic:

1. All problems brought to therapy stem from the dilemma between love and violence (Madanes)

2. Clear rules should govern hierarchy (Haley)

3. Flexibility

4. Haley's concepts influenced by Milton Erikson (directives, paradox), Gregory Bateson (cybernetics), and Salvador Minuchin (address structure)

5. Symptoms are communicative acts embedded in a pattern of interactions.

6. There needs to be a large repertoire of behaviors for problem resolution and life cycles.


Theory of Dysfunction in Strategic:

1. Symptoms are maintained by the family's unsuccessful problem-solving efforts.

2. Inability to adjust to life-cycle transitions (describe clients in the best possible light).

3. Dysfunctional hierarchy, especially parents, how power is used and misused.

4. Symptoms serve a function of covertly protecting or controlling another, ex. triangulation or coalitions; 'metaphor' for underlying problem.

5. All symptomatic behavior is voluntary (Haley)


Theory of Change in Strategic:

1. Change behavior or alter perceptions and increase flexibility (rather than the other way around -- MRI)

2. Increase strategies for developmental and non-developmental change.

3. Structural reorganization (re-establish hierarchy)

4. Eliminate triangles and coalitions

5. Resolve presenting problem only


Stages of Therapy in Strategic:

1. Structured initial interview (hopefully with full household).
- Social Stage (greeting)
- Problem Identification (multiple perspectives)
- Interactional Stage (demonstrate the problem between members, observe hierarchy, coalitions)
- Goal Setting (solvable problem)

2. Establish goal of therapy.

3. Sequence of interactions are observed.

4. Intervention (tasks and directives)

5. Symptom relief.

6. Termination

Brief therapy


Stance of Therapist in Strategic:

1. Active and deliberate, loop in less involved members

2. Joins with family

3. Responsible for therapy

4. Focuses on presenting problem, not helping family understand how or why the problem behavior occurs.

5. Uses language of the family

6. Observer


Methods/Techniques of Strategic:

1. Directives (straightforward and paradoxical)
2. In-session enactment promoted by therapist
3. Feedback on tasks and directives
4. Pretending (Madanes)
5. Ordeals
6. Reframing


Diagnosis/Assessment in Strategic:

1. Non-historic

2. Family life cycle, transition points

3. Careful definition of the problem expressed from each family member's perspective.

4. Observing family interactions, structural arrangements.

5. Consider interpersonal payoff of problem behavior.


Describe directives:

Haley/Strategic - tasks, homework

1. Get fam members to do things differently and create different experiences.
2. Involve therapist and intensify therapeutic relationship
3. Observe how family responds to the task.

Alter problematic sequence and correct malfunctioning hierarchies (usually by strengthening parental unit)


Describe ordeals:

Haley/Strategic - Erikson roots

Directives aimed at making the symptom harder to keep than give up and require the clients to do something they do not want to that would benefit them in some way.

Aimed at symptom relief AND family restructuring.


Madanes explanation for child psychopathology:


Structural explanation: in dysfunctional families, the child has become hierarchically superior to one or both parents, causing parents to focus on child's symptoms instead of their own issues.

Aim to find ways for children to help parents more openly so they won't have to resort to symptoms as sacrificial offerings.


What are the strategic paradoxical interventions (with children):


1. Dramatization - parent is directed to request child to intentionally perform the problem behavior. Paradoxically, the symptom does not draw as much attention and the parent can attend to his or her real problem.

2. Pretending - parents directed to ask the child to pretend to have the symptom and the parents pretend to help the child. Makes the problematic sequence a game.

3. Make-believe play - Makes covert symptomatic behavior overt by asking parents to make believe they need the child's help and the child to make believe helping them. Highlights the problematic hierarchy, encouraging parents to regain superiority.


What is a bi-modal feedback mechanism?


Rule-bound mechanism by which a system remains unchanged as long as the internal and external environment is stable.

When fluctuation exceeds the range of stability, the system either breaks down or makes a leap into new levels of functioning. The change results in a new set of patterns that is also bound by rules and remains unchanged as long as the environment is stable.


What are the similiarities between the strategic models? (6) dysfunction, therapist role

MRI brief, Haley/Madanes, Milan

1. Stem from cybernetics: pos. and neg. feedback loops

2. Problems often occur during life cycle transitions and are maintained by faulty, recursive sequences where symptoms preserve homeostasis

3. Treatment usually includes the entire family

4. Therapist interrupts sequences with directives, straightforward or paradoxical

5. Focus of treatment is the presenting problem and is brief

6. Therapist is fully responsible for change


Difference in strategic goals for therapy:

MRI - Resolve presenting problem (client as customer)

Haley/Madanes - symptom relief and restructuring dysfunctional hierarchies

Milan - create an environment where new information is introduced to the family system, allowing the family to create a new, more useful epistemology to guide their behaviors and interactions


Which strategic model is normative?

Haley/Madanes - functional families have clear generational boundaries and a functional hierarchy.

MRI and Milan are non-normative, believing there is no "right" way for a family to be.


Difference in therapist stance in strategic models?

MRI - less directive, one-down stance with clients as customers

Haley/Madanes - directive, hierarchal, active, and deliberate

Milan - non-directive, curious, irreverent/neutral about specific outcome of therapy