Strategic therapy

Theory of change

Change occurs when the relational pattern that maintains the problem stops organising the system's behaviour and the system has to try out a new form of regulation.

Core ideas

1. The symptom as part of a relational pattern

   Strategic Therapy understands the symptom as a phenomenon organised within a sequence of interaction. Its clinical importance lies not only in what the person expresses, but in what the symptom does within the system: it regulates responses, activates attempts at control, displaces conflicts or maintains relational balances. The therapist observes the pattern surrounding the symptom in order to intervene on the maintaining circuit, and not solely on individual experience. (Haley, 1976, Problem-Solving Therapy; Madanes, 1981, Strategic Family Therapy).

2. Attempted solutions maintain the problem

   The model starts from the premise that many difficulties persist because the responses designed to resolve them end up reinforcing them. Arguing more, monitoring more, explaining more, protecting more, avoiding more or demanding more can become part of the problem. The clinical task consists in identifying these attempted solutions and blocking, reversing or replacing them with actions that alter the sequence. (Haley, 1976, Problem-Solving Therapy; Watzlawick, Weakland & Fisch, 1974, Change).

3. The therapist as directive strategist

   The therapist takes an active role in formulating the problem and designing the intervention. Passive neutrality proves insufficient when the system is trapped in rigid cycles; the therapist therefore organises tasks, introduces manoeuvres, regulates timing and uses their position of influence to produce concrete change. Therapeutic authority operates as a technical tool in the service of reorganising the system. (Haley, 1963, Strategies of Psychotherapy; Haley, 1976, Problem-Solving Therapy).

4. Hierarchy organises the possibility of change

   Haley and Madanes gave a central place to hierarchy, especially in families with children and adolescents. Symptoms may appear when parental authority is weakened, inverted or triangulated, or when a member occupies a position that does not correspond to them within the system. The intervention seeks to restore a functional organisation of power, protection and responsibility, so that the symptom loses its regulatory function. (Haley, 1976, Problem-Solving Therapy; Madanes, 1981, Strategic Family Therapy).

5. Paradox uses the logic of the problem to produce change

   Paradoxical interventions draw on the very structure of the symptom, the resistance or the struggle for control in order to alter its function. Prescribing the symptom, ritualising a behaviour or asking that a pattern be deliberately maintained can transform an involuntary behaviour into a chosen action, reduce escalation and deactivate direct opposition. Paradox works when it fits the logic of the system and the strategic aim of the case. (Haley, 1963, Strategies of Psychotherapy; Madanes, 1981, Strategic Family Therapy).

6. Change may precede insight

   Strategic Therapy holds that a deep understanding of the origin of the problem is not a necessary condition for modifying it. When the interactional pattern changes, subjective experience and subsequent understanding may reorganise themselves as a consequence. The model gives priority to producing an observable difference in the maintaining sequence rather than to exhaustively elaborating the history of the symptom before acting. (Haley, 1976, Problem-Solving Therapy).

7. The present sequence has clinical priority

   The strategic therapist is interested in the order of events: who initiates, who responds, what effect that response produces, what happens next and how the cycle closes. This sequential view makes it possible to locate concrete points of intervention. Historical causes may be relevant, but clinical change is organised around the current pattern that keeps the problem alive. (Haley, 1976, Problem-Solving Therapy; Watzlawick, Weakland & Fisch, 1974, Change).

8. Resistance is incorporated into the strategy

   Resistance is not interpreted solely as the patient's opposition, but as part of the organisation of the system and as information about how the intervention should be designed. The therapist may work around it, prescribe it, use it or reduce it through reframes and indirect tasks. This position derives from the Ericksonian influence and allows change to advance without entering symmetrical struggles for control. (Haley, 1963, Strategies of Psychotherapy; Haley, 1973, Uncommon Therapy).

9. The intervention is judged by its pragmatic effect

   The validity of a strategic intervention is measured by its capacity to modify the problem pattern. A formulation may be elegant yet clinically irrelevant if it does not alter attempted solutions, hierarchies, cycles or observable behaviour. The model is characterised by a pragmatic epistemology: what matters is whether the intervention produces a useful difference in the system. (Haley, 1976, Problem-Solving Therapy; Madanes, 1981, Strategic Family Therapy).

Influences

• Palo Alto school / MRI
• Ericksonian hypnosis
• Cybernetics
• Theory of human communication
• Systems theory
• Structural family therapy
• Milton H. Erickson (clinical hypnosis)
• Gregory Bateson (cybernetics and communication)

Key references

• Haley, J. (1963). Strategies of Psychotherapy. New York: Grune & Stratton.
• Haley, J. (1973). Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. New York: Norton.
• Haley, J. (1976). Problem-Solving Therapy. San Francisco: Jossey-Bass.
• Haley, J. (1984). Ordeal Therapy. San Francisco: Jossey-Bass.
• Madanes, C. (1981). Strategic Family Therapy. San Francisco: Jossey-Bass.
• Madanes, C. (1984). Behind the One-Way Mirror: Advances in the Practice of Strategic Therapy. San Francisco: Jossey-Bass.
• Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: Principles of Problem Formation and Problem Resolution. New York: Norton.