STRATEGIC THERAPY,ECLECTICISM, AND THE THERAPEUTIC RELATIONSHIP

Although profoundly influencing the family field by highlighting the deficiencies of pathology-based views, strategic therapy has come under fire in two general areas: (a) adherence to a “black box” philosophy that discounts the value of intrapersonal phenomena; and (b) interventions that appear exceedingly instrumental, manipulative, and based on a position of therapist power. This article will examine these criticisms in light of the rise of eclecticism and the resurgence of the primacy of the therapeutic relationship. It will be argued that if strategic therapy is to remain viable, it must evolve to include the contributions of other models and consider the relationship context from which intervention arises.     

FAMILY THERAPY AND IDEOLOGY*

Contemporary family therapy is examined in terms of its ideological content. The adoption of cybernetics and biological systems theory to the family has led to the erroneous belief that familytherapy is exclusively concerned with natural systems, is process oriented, content relative, and above ideology. This article argues that the family and the enterprise of family therapy are social systems and under the influence of the ideology particular to a given society. The strategic family therapy treatment of a family with a drug-addicted member serves as an example to clarify the ideological themes of contemporary family therapy. These themes are: (a) family reductionism and blaming; (b) the relabeling of personal injustice into communicational terminology; (c) the assumption that the nuclear family is optimal; (d) the conceptualization of therapy as a commodity; and (e) the model of human relatedness and intimacy supported by family therapy.     

FAMILY SYSTEMS THERAPY AFTER OPERATIONS DESERT STORM WITH EUROPEAN-THEATER VETERANS

We describe a quasi-experimental trial of time-limited family therapy with veterans and families of veterans who served in Europe, outside the war zone, during Operation Desert Storm (ODS). Family systems therapy was provided both to individuals and conjointly to couples or families during the acute postwar readjustment period. The intervention adapted strategies from structural, strategic, intergenerational, and behavioral family therapies in a brief-treatment protocol for systemic stressor resolution. Veterans given family system therapy were able to resume functional levels of psychosocial adjustment and reduce the risk of long-term (Chronic or delayed) psychosocial impairment. Based on these preliminary findings, controlled evaluation of family systems therapy appears warranted for indi-     

Reconstructing the Family's Reality — The Struggle of a Young Anorectic Woman and Her Family's Way of Viewing the World.*

It is argued that systemic family therapy has much to gain from phenomenological social psychology and the sociology of knowledge. The similarities between social psychological concepts of social rule theory and concepts from structural/strategic therapy are discussed, as is the need for an examination of the construction of reality to complete these concepts. The theory of the social construction of reality is presented and its relevance to the ways in which families behave discussed. A case involving a young anorectic woman and her family is presented in detail to demonstrate the process of altering the processes of reality construction in the family so as to allow the members to pursue alternatives.     

The prediction of learning in family therapy training programs*

Research on family therapy training has produced very little data regarding the kinds of trainees that do best in family therapy training programs. This study attempts to provide some rough and preliminary data on that issue. One hundred and seventy trainees, drawn from seven different structural!strategic training experiences, were evaluated as to how much they learned by taking the Family Therapy Assessment Exercise pre- and posttraining. Their performance was correlated using a hierarchical regression analysis with a number of trainee variables such as amount of conjugal family experience, amount of experience doing family or individual therapy, or prior knowledge of family therapy. The results indicate that, as predicted, conjugal family experience was positively related, and prior knowledge was negatively related to performance. Prior experience doing individual therapy was also positively related to performance.     

Family Therapy and the Family Doctor − 1

The author shows that the family doctor's burden of responsibility in the area of psychological dysfunction in the community is immense. Traditionally he has little training, limited knowledge, and a paucity of skills, in the areas of counselling and psychotherapy. The author argues that structural and strategic family therapy skills may be applicable to family practice and of benefit to the family doctor. A brief introductory course and subsequent feedback are described.     

STRATEGIC RITUALIZATION AND ETHNICITY: ATYPOLOGY AND ANALYSIS OF RITUAL ENACTMENTS IN AN ITALIAN AMERICAN COMMUNITY

This investigation utilizes a theoretical framework that focuses on ritual enactments to examine the ways members of an Italian American community in southeastern Oklahoma use social rituals to achieve different outcomes. Several methodological strategies (especially interviews and historical analysis) are utilized to document how individuals within this ethnic community have, for over the last century, employed numerous rituals to, among other things, express their ethnicity, create community ties, enhance personal gain, and survive. Building upon the theory of structural ritualization, the concept of strategic ritualization is employed and expanded upon to examine this issue. A typology of three types of strategic ritualization is presented and defined: ritual legitimators, ritual entrepreneurs, and ritual sponsors. This conceptualization represents the first elaboration of structural ritualization theory addressing this topic. In focusing on this little studied ethnic community, the importance of ritualized practices and their strategicuse throughout society are emphasized. The relation of this research to broader concerns dealing with the social constructionist approach to ethnicity and the intersection of decision-making, culture, and structure are briefly highlighted and directions for future theory development and research are indicated.     

INTEGRATING INDIVIDUAL AND SYSTEMS APPROACHES: STRATEGIC-BEHAVIORAL THERAPY

The existing literature on the integration of family and individual approaches, largely analytic in orientation, consists of models which, for the most part, are not brief in application. An alternative, brief model is presented which integrates an individual, cognitive-behavioral approach with a strategic approach at both pragmatic and theoretical levels. The Strategic-Behavioral model justifies the selective use of behavioral frames in strategic therapy and offers guidelines for their selective application.     

A Curriculum for Graduate-Level Marriage and Family Therapy Education*

The Delphi technique of refining group opinion was used to develop a graduate level marriage and family therapy curriculum. Opinions were synthesized from a national panel of 20 AAMFT Approved Supervisors and 25 training directors of graduate-level marriage and family therapy programs. Three rounds of questionnaires were employed and 101 content areas met the criteria for inclusion into the final curriculum. Discussed are the similarities and differences of this curriculum and the current “model” AAMFT curriculum. It is hoped that the curriculum devised from this study will lead to the continued rethinking, refinement, and evolution of marriage and family therapy education.     

A MODEL FOR TRAINING PRACTICING PROFESSIONALS IN FAMILY THERAPY*

This paper offers a model for high quality training in family therapy. The unique aspects of the Family Consortium's model are that it: (a) is aimed at practicing professionals; (b) emphasizes structural family therapy principles with strategic and experiential elements; (c) is geared secondarily toward training members as effective peer consultants and trainers; and (d) uses an awareness of the isomorphic nature of training, therapy and family transactions. Part I describes the practical organization structure of the Consortium. Part II discusses the current theoretical philosophy and training approach of this evolving group. Examples are given of how the Consortium has dealt with specific training issues.     

Training family therapists to work with children and families: a modified Delphi study

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.     

ECLECTIC STRATEGIC PRACTICE: A PROCESS CONSTRUCTIVE PERSPECTIVE

The development of an integrative individual and family therapy approach has been hampered by fundamental differences in philosophy and theoretical conceptualization among approaches. Given these largely irreconcilable differences systemic framework for a technical eclecticism may represent a logical step toward a more flexible consideration of both individual and family approaches. This article will describe an extension of the strategic therapy model that enables and encourages the selective application of content and techniques from individual and family approaches. Three case examples will illustrate a process-oriented, constructivist rationale for eclectic strategic practice as well as a more collaborative and relationship-oriented perspective of strategic therapy.     

Family Therapy and Substance Abuse

The approaches of family therapies to substance abuse are reviewed and evaluated. Questions from a systemic perspective are raised about the therapeutic efficacy of the structural/strategic family therapies which predominate in the literature. Consideration is given to certain clinical issues and to the place of a systemic perspective in a drug and alcohol service.     

COMMON FACTORS ACROSS THEORIES OF MARRIAGE AND FAMILY THERAPY: A MODIFIED DELPHI STUDY

The Delphi methodology was used to explore common factors across theories of marriage and family therapy (MFT). Leading clinicians and researchers from the American Family Therapy Academy and select faculty members from MFT training programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education were asked to achieve consensus regarding common factors. Respondents were asked to report on commonalities across the various MFT theories, as well as what they personally considered to be the core ingredients of change. A final profile of items was created from the responses. Qualitative interviews were conducted with selected panelists to clarify discrepancies as well as to add meaning to the data. Implications for the training and practice of MFTs as well as direction for future research are discussed.     

A REFLECTING TEAM APPROACH TO FAMILY THERAPY: A DELPHI STUDY

Due to different conceptualizations and unclear theoretical guidelines, a reflecting team approach to family therapy has lacked conceptual and practical clarity. The purpose of this exploratory study was to outline the theory and practice of a reflecting team approach to family therapy. A Delphi technique was employed for panelists to consider the theoretical assumptions, techniques, how change occurs, major goals, when to use, and contraindications of a reflecting team approach. Analysis of data revealed where consensus was reached and a profile was formed to aid in further clarifying this approach.     

Coming of Age: An Individual Perspective*

This paper attempts to examine some of the broader system constraints to family therapy's ‘Coming of Age’ and to relate these constraints to more personal issues that arise for the presenter as a recently qualified family therapist. These issues and constraints are clustered around the question of hierarchy, and it is the presenter's belief that, although family therapy has much to offer as a direct service method, it has less to offer as a tool for analysing phenomena of a structural nature.     

STRATEGY AND INTERVENTION VERSUS NONINTERVENTION: A MATTER OF THEORY?*

The question of whether or not intervention and strategy are necessary components of competent therapy is described and related to the metaphorical assumptions of underlying theory. Passive listening and expert interpretations are consequences of psychodynamic theory. Active manipulation of social structure and strategic intervention into feedback are described as consequences of the mechanical assumptions of structural and cybernetic theory. Conversational participation and non intervention are described as necessary consequences of hermeneutic and linguistic approaches to therapy. It is concluded that different theoretical assumptions yield different conclusions regarding the nature of therapy and human problems. From this perspective the question of Intervention Versus Non-Intervention is more a matter of the theory held than a question to be answered in terms of the “right” or “adequate” thing to do or not do.     

A Re-Introduction to Family Therapy Clarification of Three Schools

Family therapy is not easily understood, especially by the beginner therapist. This is not surprising given the confusing overlap between the various models and proliferation of new and often unexplained concepts and terms. This article serves to reverse this trend by presenting an overview of family therapy that can be understood by the novice. It clarifies the assumptions, terms, methods and goals of the main three schools of thought, namely structural, strategic and systemic. The similarities and differences between these schools are discussed and a summary table has been inserted for comparison purposes. A glossary has been included to assist the reader in defining commonly used terms and concepts.