Monday, July 7, 2014

Strategic Therapy & MRI model/ Mental Research Institute Model

Overview :

The word "Strategic Therapy" was applied to therapy by Jay haley in his book about Milton Erickson, uncommon therapy. by the word strategic haley means that therapist makes a unique plan for each client. The origin of this approach goes back to studying "communication"

Two main ideas came from this communications project that influenced strategic therapy : 
  • Symptoms are not primarily caused by a trauma froma  clients past, but were caused by the client's current environmental situation
  • being placed in a paradoxical dilemmas by one's own intimates required symptomatic responses by the client
Jay Haeley along with john weakland along with batesonworked with Milton Erickson who brought the element of "change" i.e how to change the client by giving directives designed to resolve the clients presenting complaints. 


 

Leaders in Strategic Therapy : 

Jay Haley, Madanes

Leaders in ST MRI model : 

John Weakland, Don Jackson, Paul Watzlawick, Richard Fisch

Concepts  in Strategic Family Therapy:

  1. symptoms as messages
  2. family homeostasis 
  3. family rules
  4. inter generational collusion
  5. first and second order change
  6. metaphors
  7. re framing
  8. symptoms serve functions
  9. content & process
  10. Report and Command
  11. in-congruence hierarchies
  12. paradox
  13. paradoxical injunction
  14. pretend techniques
  15. "go slow" messages

Concepts in MRI model : 


  1. symptoms as messages
  2. family homeostasis 
  3. family rules
  4. cybernetics - feedback loops, positive feedback, negative feedback
  5. first order change
  6. second order change
  7. reframing
  8. content & process
  9. report and command
  10. paradox
  11. paradoxical injunction
  12. "go slow" messages
  13. positive feedback escalations
  14. double binds
  15. "one down" position
  16. patient position
  17. attempted solutions maintain problems and become problems themselves

Assumptions :

  • Attempted solutions are the problems i.e most of the times the problem is the way the problem is handled
  • people resist change
  • you cannot "not" communicate, communication is happening always
  • communication and messages are metaphorical for family functioning
  • symptoms are messages- which help the system survive
  • behavior and especially symptoms are multi determined. it is assumed any important events from the past, all meaningful issues, all interpersonal involvements are simultaneously expressed in rituals of client symptoms
  • the societal situation clients are in requires them to have the symptoms.
  • voluntary control of behavior
  • abnormal behavior results from abnormal environment

The General Process

  1. Determine the principal participants in the patterns around the symptom
  2. determine who is the principal helper of the client, the therapist can compete or collaborate with that helper
  3. conduct interviews hierarchically. a family is not a group of equals rather an organization with a hierarchy. when there are problems it is assumed that the hierarchy is broken down
  4. hear everyone out and establish empathy with everyone's point of view
  5. reframe the problem as solvable 
  6. establish agreements on the specific goals of the therapy and elicit a clear request for help to change
  7. directives should only be tentatively offered unless the above steps have been completed
  8. develop an initial hypothesis, offer a directive and observe the family's response. adjust new hypothesis and directives according to family's response
  9. interviews focus from specific problems to wider issues and then back to specific problems

Devising hypothesis 

in this approach the therapist is attempting to understand the interpersonal goal of the symptom. what inter personally is being accomplished by the occurrence of the problem?
  • who is closer to whom as a result of the symptom
  • who is farther apart?
  • does the problem prevent someone from leaving the family?
  • or does it prevent someone from coming back?
  • how does symptom define power?
  • between who and whom?
  • how does symptom define the family heirarchy?
  • how does the symptom help? who does it help
  • for who or for what the client will drop the symptom?
these questions helps the therapist develop the hypothesis about the problem that in turn leads to directive. 

Techniques / Intervention



  • Paradox - Paradoxical interventions involve prescribing the very symptom the client wants to resolve. For example: the client fears failure, so the therapist asks the client to fail at something. A man has problems with procrastination, so the therapist asks him to schedule one hour a day to procrastinate. Your four year-old resists brushing her teeth so she's told she isn't allowed, and may end up doing it out of spite. Or a woman who can't initiate sex with her husband is advised not to initiate for a month. 
The underlying principle is that we engage in behaviors for a reason, which is typically to meet a need (rebellion, attention, a cry for help, etc). In prescribing the symptom the therapist helps the client understand this need and determine how much control (if any) they have over the symptom. By choosing to manifest the symptom, they may recognize they can create it, and therefore have the power to stop or change it. 


  • Directives (as stated above)
  • interrupt unhelpful sequences of interaction
  • "Go SLow" messages
  • prescribe the symptoms
  • metaphors, stories
  • ordeal - an ordeal is an intervention that seeks to extinguish a maladaptive behavior by introducing an activity that is more of an “ordeal” to engage in than the problem behavior itself.  Thus, by enforcing an ordeal you decrease the frequency and severity of the undesired behavior.
  • "pretend" technique


References :


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