Week 6 Case Study Discussion – Strategic Family Therapy
Table of Contents
Strategic Family Therapy
Instructions – Case Study Outline
- Read the following case study.
· Week 6 Case Study Discussion – Strategic Family Therapy
The Beyers family has come for therapy. Bill and Maria are the parents, and Veronica and Justine are their two teenage daughters, age 16 and 14, respectively.
Bill: I guess we’ve come to see you because we fight all the time. We don’t have any good times together anymore.
Maria: (interrupting) Baloney! We’re in trouble because we don’t have any money. Period. Bill refuses to get a job even though he has an MBA. We should be well off. Instead, we live off of the money my father left us- and that’s going fast. If Bill would just develop a little backbone and get a job, we’d all be fine.
(You notice that Bill withdraws, and Veronica rolls her eyes as her mother talks.)
Maria: I make what little money we earn, and to do it I have to work 10 hours a day. When I get home, no one has done a thing to help the family. Bill is playing computer games likes a 12-years-old, and the girls are text messaging everyone in creation. The other night I refuses to cook dinner and took myself out to a restaurant. They could all starve as far as I am concerned.
Of course, I don’t want things to be like this, but what an I supposed to do, give in every single day of my life? Frankly, I am married to a coward, and the girls are spoiled brats. No one cares about me at all.
Bill: That’s not true, Maria. We all care about you very much.
Maria: Yeah, well, thanks is cheap. Prove it. Go get a job.
Bill: I am trying, but in this market there isn’t much out there. You know I send out my resume to someone practically every day.
Veronica: I am so tired of listening to this same old battle. Mom says Dad’s a wuss, and Dad tires to calm her down. (Turning to her parents): Why don’t you get divorce a already? You obviously don’t love each other anymore.
- 2.Complete the Case Study Outline.
Case Study Outline – Week 6Read the Beyers Family case study. Please respond to this case study from Strategic Family Theoretical Perspective.
1. Background information and Socio-cultural considerations.
2. Assessment (assessment methods must be consistent with the theory you have read for this week’s assignments, video clips or theory mentioned in the vignette).
3. Treatment plans, must list 3 treatment goals that follow logical problem solving.
4. Interventions (Interventions must be consistent from theory/ theories you are using for the case study) include collateral stakeholders as part of the interventions as needed.
5. Discuss future research that may be needed.
Your Case Study Outline should be attached as a Word .doc file (.doc, .docx)
Video links
1. Jay Haley on Directive Family Therapy (2000
3. Behavioral Couples Therapy Video
Chapter 11 & 12
Goldenberg, I, Stanton,M & Goldenberg, H. (2017). Family Therapy: An Overview (9th Edition). Cengage Learning.
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 1
Strategic Models
Communications Outlook
• What Is Occurring in the Family, not Why It It Occurring.
• Social Context for Pathology
• Sequence and Hierarchy of Interactions
• Punctuation
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 2
Strategic Models
• MRI Brief Family Therapy • All behavior is communications
• Communications occur simultaneously and at different levels
• Content (report) and relationship (command)
• Relationships defined by command messages
• Relationships as symmetrical or complimentary
• Symmetrical relationships may become competitive (symmetrical escalation)
• Complementary relationships and superior/inferior roles
• Dynamics of punctuation
• redundant interactive patterns and recursive feedback loops
(continued on next slide)
Strategic Models
MRI Brief Family Therapy (continued)
• Paradoxical Communication • Paradoxical injunction • Double bind message • Redefining, prescribing, restraining
• How Attempted Solutions to Problems Contribute to the Problem Itself
• First Order and Second Order Change
• Relabeling (continued on next slide)
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 3
Strategic Models
Strategic Family Therapy (continued)
• Three Types of Misguided Solutions • Actions needed but not taken
• Unnecessary action taken
• Action taken at the wrong level
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 4
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 5
Strategic Models
• SFT: Haley and Madenes • Brief and active treatment
• The meaning of symptoms/Symptom as strategy
• Power and control
• Triangles, sequences and hierarchies
• Developing therapeutic strategies
• The initial interview
• The use of directives
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 6
Strategic Models
The Milan Systemic Model
• Selvini-Palazzoli, Boscolo, Cecchin, & Prata
• The Early Model • Paradoxes, counterparadoxes, rituals, and positive connotation
• Long brief therapy
• Structured family sessions
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 7
Strategic Models
Milan Systemic Model (continued)
•Hypothesizing, Neutrality, and Circular Questioning • Define each of the above and their role in the theory.
• The role of underscoring “relatedness” with each of these principles
• The invariant prescription
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 8
Strategic Models
• A Post Milan Epistemology
• Karl Tomm • Reflexive questioning
• The addition of “strategizing” to the repertoire of the systemic model
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 9
Behavioral and Cognitive-Behavioral Models
Behavioral Theory
• Leading Figures
• Reinforcements
• Adopting and Family Framework • Couples therapy
• Classical and operant conditioning
• Contingency contract
Behavioral and Cognitive-Behavioral Models
Cognitive Behavioral Theory
• Ellis and Beck
• Cognitive Restructuring
• Schemas
• Role of Assessment • Behavioral analysis
• Problem and functional analysis
• Homework Assignments
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 10
Behavioral and Cognitive-Behavioral Models
• Behavioral Couples Therapy
• Manipulating the Contingencies of Reinforcement
• From Reinforcement to Skills Building
• Therapeutic Contracts
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 11
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 12
Behavioral and Cognitive-Behavioral Models
• Integrative Couples Therapy • Jacobson and Christensen
• Themes of acceptance
• Research on the Behavioral Model • John Gottman
• The four horsemen of the apocalypse
• The 5:1 ratio of positive to negative
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 13
Behavioral and Cognitive-Behavioral Models
• Parent Education (A Behavioral Model) • Family management skills building
• Positive reinforcement, shaping
• Contingency contracting
• Functional Family Therapy • Focus on outcomes of behavior and how to change
them.
Goldenberg/Goldenberg, Family Therapy, 8th
edition © Brooks/Cole Cengage 2013 14
Behavioral and Cognitive-Behavioral Models
• Conjoint Sex Therapy • Sex as a metaphor for couple dynamics
• Need for sexual education
• Skills building
• Masters and Johnson
• Sensate focus, systemic desensitization, communications training
• David Schnarch
• Donald Meichenbaum
Case Study Outline
1. Background information and Socio-cultural considerations.
2. Assessment (assessment methods must be consistent with the theory you have read for this week’s assignments, video clips or theory mentioned in the vignette).
3. Treatment plans, must list 3 treatment goals that follow logical problem solving.
4. Interventions (Interventions must be consistent from theory/ theories you are using for the case study) include collateral stakeholders as part of the interventions as needed.
5. Discuss future research that may be needed.
Please refer to your Case Study Rubric for your outline for your submission.
Initial Video Responses
Please be concise. Write out your case study prior, video practice on your phone, and time your response. Be sure you have good lighting and good sound for others to view your video submission.
These Video submissions must be between 1 – 2 min. maximum in length.
Week 6: Overview
Strategic, Behavioral, and Cognitive-Behavioral Models
By now you may be feeling a bit overwhelmed by the many different models of family therapy which we have covered. However, I hope that you will find solace in knowing that the goal here is never to overwhelm, but to enlighten you on the different ways in which you can approach your work with families. You may find it useful to focus on what stands out for you about a theory, and what makes it different from other theories in order to clearly understand its purpose. For instance, while many family therapy models focus on relationship building, the Strategic Model, which will be covered this week, focuses on the actual behavioral sequences within the family that fuel the problem or issue.
This week’s lecture will also cover Behavioral, and Cognitive-Behavioral Models of Family Therapy. We will discuss the history and leaders of these models, as well as the therapeutic interventions used within each model. Lastly, we will explore the interview and assessment tools used in each approach. You will be asked to watch a video on Jay Haley’s Directive Family Therapy. You will also be asked to respond to three discussion questions, and respond to one peer for two different questions, as well as complete one writing assignment this week. Remember to properly integrate and cite the readings in your work and include a reference list.
Learning Objectives
By the end of this week, you will:
· Recognize the historical growth of strategic, behavioral, and cognitive-behavioral models of family therapy.
· Identify the pioneers of this field.
· Discuss the therapeutic interventions used in strategic, behavioral, and cognitive-behavioral models of family therapy.
· Distinguish between the interview and assessment techniques used by strategic, behavioral, and cognitive-behavioral models of family therapy.
Readings
Please read the following for this week as well as All Week 6 Online Course Materials:
· Goldenberg, H., & Goldenberg, I. (2013): Chapter 11 & 12
· Media: Here are instructions on how to access this video .
· Jay Haley on Directive Family Therapy (2000).Links to an external site.
History and Leaders
Strategic, Behavioral, and Cognitive-Behavioral Models of family therapy have unique histories and leaders, but share the overall goal and purpose of richly contributing to the field of family therapy. Strategic therapies originated from the work of the Palo Alto research group projects of 1952-1962 on family communication. Gregory Bateson, Don Jackson, Jay Haley, John Weakland, and Paul Watzlawick are some of the trailblazing figures. The development of the Milan Systemic Model was initiated by Mara Selvini-Palazzoli. Luigi Boscolo developed a post-Milan therapeutic intervention based on the interviewing process and the use of circular questioning. This would be a good point in the lecture to review the video on Jay Haley, as this will provide you with more insight into his perspective on Directive Family Therapy. Milton Erickson served as Jay Haley’s mentor. Haley deems Erickson the visionary of strategic family therapy.
Behavioral and cognitive-behavioral models of family therapy do not have the same historical visibility as strategic family therapy, since behavioral and cognitive-behavioral models of therapy have only been applied to the family unit within the last thirty years. Cognitive therapy specifically has only recently been used with the family unit since the early 1980s. This application of cognitive therapy to the family unit occurred as an outgrowth of earlier behavioral approaches to couples experiencing turmoil in their relationships. Some of the key figures in the behavioral therapy movement were Richard Stuart, Gerald Patterson, and Robert Liberman. Albert Ellis and Aaron Beck represent two of the leading figures in Cognitive-Behavioral Therapy.
We will now turn our attention to the therapeutic strategies applied with each of these models.
Therapeutic Strategies
It is important to understand that the strategic, behavioral, and cognitive-behavioral models of family therapy sought to apply different therapeutic strategies to address a family’s issues based on how they frame the issue. This is usually what makes each model unique, in that their approach to addressing the issue or the way in which they conceptualize the issue may differ, which in turn makes their intervention or strategy applied to the issue somewhat different. Again, the idea here is not to convince you as counselors in training that one approach is better or worse than the other; instead the expectation is that you walk away with a clear understanding of how each approach can be applied to family therapy. The goal is also for you to assess your level of comfort or discomfort with applying these strategies.
Strategic Models of family therapy can be described as offering very straightforward and direct interventions in order to address the family’s presenting issues. When you think of operating as a strategic family therapist, think of what it would be like to issue a set of tasks to the family. As a strategic family therapist, your focus would not be on the meaning of symptoms, instead you would focus on behavioral patterns that contribute to the problem. Therefore, while focusing on the presenting issue and helping the family to develop treatment goals; strategic family therapists promote change by providing directives to eliminate the negative patterns of interpersonal exchange within the family. An example of this can be seen with the use a therapeutic double bind known as prescribing the problem. The idea here is to shift the family organization so that the presenting issue no longer serves its function in the family.
Behaviorists, on the other hand, are more likely to address specific behavioral problems that occur in families. Behavioral family therapists focus less on gaining an overall picture of family dynamics and more on behavior they can observe in order to eliminate identified troubling behaviors. Cognitive-Behavior Family Therapy focuses on the cognitive and behavior interactions among family members. It is important to note that behavioral family therapists view the family as burdened by the patient, however most systems-oriented family therapists believe that family involvement plays a role in the presence of the issue. Cognitive-behavioral family therapy focuses on restructuring distorted beliefs that may have been learned from the family of origin.
Prior to employing the use of the therapeutic strategies discussed here, the therapist must first gather accurate information about the issues that are occurring within the family. This information gathering process occurs through interviews and assessments. We will now explore the components of the interview and assessment process for each of these models.
Interview and Assessment
The goal of Interview and Assessment is to collect information from families that will provide direction on how to best work with them. Strategic, Behavioral, and Cognitive-Behavioral Models of Family Therapy have each developed their own methods for this information collection process, which assists with determining the therapeutic interventions that are ultimately used with families.
Strategic family therapists work with the family, using a five stage model to determine what problems need to be addressed and the best plan of action to combat these problems. The stages consist of the brief social stage, where all family members are encouraged to become involved. The second stage is the problem stage, where the issue that brought the family into counseling is identified. The third stage is the interactional stage, where the family discusses the problem; therefore providing the counselor with the opportunity to observe the way in which the family communicates about the problem. The fourth stage is the goal-setting stage which gives the family and the counselor an opportunity to identify the problem that they would like to address. Finally, the task-setting stage is the final phase of the initial interview where the first set of directives will be assigned.
A Behavioral Assessment typically occurs at two levels, to consist of a problem analysis and a functional analysis. The purpose of the problem analysis level is to identify the specific behavioral issues. The purpose of the functional analysis level is to uncover the connection between the behavioral issues and the environment in which the problem behavior functions. Cognitive Behavioral Therapists on the other hand, gather information using self-report questionnaires, individual and joint interviews, and direct behavioral observations of family interaction.
Week 6: Activities
Readings
Please read the following for this week as well as All Week 6 Online Course Materials:
· Goldenberg, H., & Goldenberg, I. (2013): Chapter 11 and Chapter 12
· PowerPoint Handout: Chapter 11 & 12 pdf
Videos
· Jay Haley on Directive Family Therapy (2000)Links to an external site.
· The following video is streaming from Webster University’s Films on Demand. To access the film, you will be prompted to login to the library’s site with your last name and your 7-digit student ID number (ex. 1234567). Additionally, if you can not see the video below, you may need to allow the content on your browser. To do this, follow the directions in the tutorial: How to View VideosLinks to an external site. .
· MFT Exam Strategic Therapy (Links to an external site.)
· Behavioral Couples Therapy Video (Links to an external site.)
Assignments
· Week 6 Case Study Discussion – Strategic Family Therapy
The Beyers family has come for therapy. Bill and Maria are the parents, and Veronica and Justine are their two teenage daughters, age 16 and 14, respectively.
Bill: I guess we’ve come to see you because we fight all the time. We don’t have any good times together anymore.
Maria: (interrupting) Baloney! We’re in trouble because we don’t have any money. Period. Bill refuses to get a job even though he has an MBA. We should be well off. Instead, we live off of the money my father left us- and that’s going fast. If Bill would just develop a little backbone and get a job, we’d all be fine.
(You notice that Bill withdraws, and Veronica rolls her eyes as her mother talks.)
Maria: I make what little money we earn, and to do it I have to work 10 hours a day. When I get home, no one has done a thing to help the family. Bill is playing computer games likes a 12-years-old, and the girls are text messaging everyone in creation. The other night I refuses to cook dinner and took myself out to a restaurant. They could all starve as far as I am concerned.
Of course, I don’t want things to be like this, but what an I supposed to do, give in every single day of my life? Frankly, I am married to a coward, and the girls are spoiled brats. No one cares about me at all.
Bill: That’s not true, Maria. We all care about you very much.
Maria: Yeah, well, thanks is cheap. Prove it. Go get a job.
Bill: I am trying, but in this market there isn’t much out there. You know I send out my resume to someone practically every day.
Veronica: I am so tired of listening to this same old battle. Mom says Dad’s a wuss, and Dad tires to calm her down. (Turning to her parents): Why don’t you get divorce a already? You obviously don’t love each other anymore.
Maria: See what I mean? She is such a brat. Of course I love Bill. We’re just going through a tough time.
Veronica: Yeah, for about a century. (You notice that Justine has remained silent throughout.)
Case Study Outline – Week 6
Read the Beyers Family case study. Please respond to this case study from Strategic Family Theoretical Perspective.
1. Background information and Socio-cultural considerations.
2. Assessment (assessment methods must be consistent with the theory you have read for this week’s assignments, video clips or theory mentioned in the vignette).
3. Treatment plans, must list 3 treatment goals that follow logical problem solving.
4. Interventions (Interventions must be consistent from theory/ theories you are using for the case study) include collateral stakeholders as part of the interventions as needed.
5. Discuss future research that may be needed.
