The Art of Strategic Therapy

Jay Haley, Madeleine Richeport-Haley

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135941727
• Edition: 1
• Topic: Psychologie
• Subtopic: Conseil en psychothérapie

Experience the art of Jay Haley's strategic therapy as he personally utilizes a variety of techniques in treating depression, violence, and psychosis with couples, children, families and various ethnic groups.Visit www.haley-therapies.com for additional resources by Jay Haley, including live videos of the pioneering therapist in action.

1
Strategic Therapy

The ideas of strategic therapy are deceptively simple. Carrying out these ideas in action is not so simple. A simple idea of presenting strategic therapy is to notice that it is the opposite of the traditional therapies. One can outline a few of the opposing ideas between traditional and strategic ideas.

The Past

In the strategic approach, interviews are not focused upon abuse, trauma, and guilty pastimes. Unless there is a special circumstance, time is not spent on remembering in a strategic interview. Rather than beginning with a genogram or history, the therapist focuses on what task to follow. A traditional therapist often feels that it is improper to focus on the present, particularly when one is faced with the idea that what is caused now must have been caused by the past. It is difficult to minimize the past when established theories and even official diagnosis emphasizes the past as cause.

To illustrate, suppose a woman comes in who suffered sex abuse as a child. She now has difficulty with sex with her husband. Should one assume her sexual problem is caused by the childhood abuse or by the current problems with her husband? One might prefer the strategic current problem theory since that idea includes attention to the husband’s problems as well her own.

Cause of Change

Other differences between a strategic and a traditional approach are more controversial. The cause of change is different. A common assumption in the traditional approach is that if people understand themselves they can change. Therefore, the interpretation is the tool of insight. The strategic approach does not assume that an understanding of oneself leads to change. In fact, it can be a negative intervention in many situations since many clients change without insight, and many do not like interpretations.

For example, when the therapist interprets to parents that their daughter was attempting suicide to help the parents with their problems, this interpretation upsets the parents and so increases the frequency of the daughter’s suicide attempts. The idea that insight is the basis of change could be the result of being educated in universities where intellectuals believe insight and understanding lead to change.

Directives

Action must happen if change is to happen. Nondirective therapy is actionless. Therefore nondirective therapy is traditional therapy. In fact, the therapist takes pride in not telling the client what to do. With a strategic approach, it is assumed that conversation does not lead to change. Action must be taken if change is to happen. With a strategic approach, the therapist must prescribe a directive, either direct or metaphoric. Where does one learn such directives? It is difficult to find training in giving directives.

A Unique Plan for Each Case

With the complexity of our social life these days, one cannot apply one method to cases. There are just too many differences among situations. To use the same intervention in many different cases is traditional, not strategic. The competent therapist learns to design a therapy for each case. The therapist presents the case in training, and the supervisor, therapist, and group devise a plan based on what the case brings in and how it develops. The one-way-mirror supervision facilitates tailoring therapy to each case.

Learn to Deal with Colleagues

One of the necessities for a strategic therapy is the need to deal both with colleagues on the periphery of a case and with any ethnic groups involved. Therapy is not simply private. The therapist must involve the probation officer in a case in a positive way. Negotiating medication with a psychiatrist on the case is an important skill. A therapist must have good judgment about when to hospitalize a case so that it is not done too soon or too late. Dealing with court cases takes skill. In the case of a violent family (see chapter 5), there were six professionals working separately on the case with individual family members. The success occurs when the family therapist persuaded the others that she had to deal with the whole family. She accomplished this by taking all of the other professionals into account.

The Normal Situation

When you accept the idea that the client is responding to a social situation, it is best to arrange a situation as normal as possible and as quickly as possible. For example, to be able to work and make a living is essential for all of us. If an adolescent responds to a difficult situation by staying home, it is best to get her back into school and away from home. It is best for young people to be functioning in a normal situation. In a case of a psychotic couple presented in chapter 10, the supervisor’s suggestion is to treat the couple as normal and perhaps to expect them to go to work.

Hierarchy

When two people get together there is a communication structure and, so, an issue of power. A strategic approach requires the exploration of hierarchical structures since the communication is in that form. A symptom indicates a problem in a hierarchy. To resolve the symptom can require a change in structure. The trainee must learn to assume what family structures are typical. For example, the obvious ones are that parents should not form coalitions against each other or mothers-in-law should respect structural boundaries. Such simple ideas are woven through this book. In the case of an African-American family (see chapter 7), a primary intervention is having mother and sons respect the stepfather, thereby raising his position in the family hierarchy.

The Evolution of Live Supervision in Strategic Therapy

The one-way mirror that we take for granted didn’t just appear out of nowhere. I was in the Bateson project in Menlo Park, California in the 1950s (Bateson, Jackson, Haley, & Weakland, 1956). We were just beginning to see whole families, and I heard there was a psychologist seeing families in a juvenile hall in San Leandro. So I went over to see him. There were only a few therapists in the country that I knew were seeing whole families for therapy. So it was always interesting to find another person working with families. I met Dr. Charles Fulweiler (Haley & Hoffman, 1967) and found he had a one-way mirror that he used in training teachers for the psychological testing of students. The teacher sat behind the mirror watching somebody test. He said he began to do therapy with the mirror. So I asked him how did he come to do that. And he said that he had a family come in with a delinquent girl—she was found out in the valley somewhere drunk and was brought in to the juvenile hall. He tested her with psychological tests, and she came out with no neurotic problems, so he assumed that she had none. If the tests say it, it must be true. So he turned her loose. He told the parents she was normal. Two or three months later she showed up at a bar in town drunk again. So they brought her back. Now he was curious to discover how this testing could be off. He wondered for the first time what kind of family this problem girl came from. So he brought the family in, and he put them in the interview room while he went behind the mirror. He watched the family together, and he saw them behaving in very banal fashion. The father said to the girl, “Can you get cigarettes here?” And the mother said, “What do they let you wear?” This was a daughter with some serious problems. Fulweiler was a very intense guy. He went around to the door into the other room and pulled the father out into the hall and he said, “Do you love your daughter?” And the father said, “Yes.” Fulweiler said, “You go in there and tell her so.” So the father went in, and it took him about 10 minutes but he said, “I love you.” Everybody then got emotional, including the father. The mother began to cry, and the girl began to cry. The mother said, “Where have you been?” Fulweiler was so pleased with the interaction that he asked them to come back and do this again. Then he began a series of treatments. At first he put the family in the room and pulled the members out one at a time to talk. Then he began to go in himself and join them. Now everybody does a therapy that fits the therapist’s personality, but at the time Dr. Fulweiler’s procedure was unusual. He didn’t want to be so intense with that family, so he stopped going in and stayed behind the mirror. He would then call one of them out and send them back in. He did various things with this mirror. After talking to him, I returned to our project, and we put in a one-way mirror. Through it I could see a family for the first time actually dealing with each other, and we did not have to use expensive film for teaching. We began to have a lot of visitors. All the visitors admired the mirror and thought that working behind the mirror was what family therapy was. So, people put in mirrors around the country.

At once a problem arose: How was the therapist going to communicate with the trainee in front of the mirror while she was interviewing a family? One alternative was for the supervisor to knock on the door and call the trainee out for consultation. This often rescued trainees in difficulty while permitting discussion of the situation outside the presence of a client. However, interruptions were disruptive. The next innovation in this process was to install a telephone in both rooms, the therapist and the supervisor’s. The supervisor used the telephone primarily to make suggestions in line with a previously determined plan. While observing through the oneway mirror, the supervisor could call the trainee and make a suggestion. When the telephone in the therapy room lit up, the trainee would pick it up, listen, and go on with the interview. There would not be an exaggerated response to the call. Therefore calls needed to be brief and to the point.

Another intervention was the “bug in the ear” (Neukrug, 1991). With a small earphone placed in the trainee’s ear, advice could be given without the client knowing that any suggestions had been made. If mishandled, the arrangement could be like instructing a robot. The trainee needed to attend to both the client and the supervisor while hoping that she didn’t develop glazed eyes in the process.

In many of the cases presented in this book, a computer monitor is the principal means of supervision. In general, a monitor is placed in the interview room where the therapist can see it and the clients cannot. The clients are informed that the purpose of the monitor is to receive suggestions from the room behind the one-way mirror. This is acceptable to the clients because they cannot see the messages. The directives need to be short and clear. Computer-monitor supervision developed using a strategic approach that is based on giving active directive supervision and not passive listening (Scherl & Haley, 2000). In summary, the different techniques of live supervision are not mutually exclusive and were all used in this therapy series. Sometimes a succinct computer-monitor suggestion is not always possible and a supervisor will need to talk at greater length to a trainee; he will then call him or her out of the interview for consultation.

What Is Diagnosis?

There has always been a confusion about diagnosis in the field of therapy. The goals of therapy and the ways to define them have always been unclear. As ideology changes, the ways to label what is wrong might change. For example, the goal can be to provide insight, or it might be to provide a growth experience for the client. What is that? How does one measure it? What is the outcome the therapist must list as failure or success? These questions have plagued the field since the 1950s. They cannot be avoided. Here we can specify the type of diagnosis appropriate for strategic therapy. There are several issues to be clarified.

The problem can be one person, two persons, or three or more persons. For example, a woman seeks therapy because she cannot stop eating. That is her problem. The quarrels with her husband make this a two-person problem. Her mother blames her husband, and there is a three-person problem, etc. It is the same woman. The choice of unit will have a decisive influence on the therapist’s way of thinking about diagnosis.

As another example, a 12-year-old boy is diagnosed as depressed and he won’t go to school. He is the problem. When father insists he go to school, the boy becomes more depressed and the mother fights with the father. The triangle can be seen once again.

The problems of diagnosis can be illustrated with another case. A social worker was given the responsibility for a five-year-old boy who set fires. He not only set fires at home and at school, but he walked through the agency tossing lit matches into wastebaskets. The worker protested that she did not know what to do with a fire-setter. She was advised that the case would be staffed and she would be helped with the problem. A few weeks and a few fires later, a staff meeting was called, and everyone discussed the case. After a while the director of the agency said it was obviously an oedipal problem, and he stood up and dismissed the meeting. The social worker sat down and cried. She had not heard a word about what she was to do. A therapist passed by and asked her what was the problem. She told him what had happened. He said, thinking like a behaviorist, “Well, let’s see, to light a fire you have to light matches. We can arrange that.” He said to give the boy a penny for every 10 matches he brought in unlit. “Could you do that?” the social worker was asked. She said she would try anything. She arranged the plan with the parents, and the boy was delighted to make money. The parents were delighted that someone gave some help. The boy stopped setting fires.

Traditionally, diagnosis was a set of ideas that was used to classify clients for administrative purposes. What was needed, and still is, is a diagnosis that is designed for therapy. Obviously, it would be a practical set of categories, easily understood, that would guide the therapist into taking action that would make a successful therapy. That simple idea still awaits a therapist to provide it.

How to Give Directives

Skill in the use of directives is essential in strategic therapy when one understands that action causes change and conversation does not, unless there are directives in the conversation. For clinicians who are uncomfortable about telling clients what to do, one should note that one cannot not give directives. Ray Birdwhistell, the body-movement authority, estimated that two people in a conversation exchange 100, 000 messages a minute. That’s how complicated an exchange of communication is. Carl Rogers, who preferred to call his directives nondirective, seemed to be giving evident directives when he talked with a client. In fact, he seemed to be giving evident directives even when he said he did not want the client to expect him to say what to do. The therapist cannot be neutral.

In the age of nondirective therapy it is difficult to get training to select and give directives. Often people are opposed to directives because they do not know how to give them. One source of directives is Milton H.Erickson, M.D. (Haley, 1973, 1985, 1993). As an example, a woman brought her 50-year-old son to Dr. Erickson and said the son was helpless and dependent on her. She said, “I cannot even read a book because he constantly bothers me.” Dr. Erickson did not help them understand their mutual dependency needs. Instead, he told the woman he wanted her to take her son out in the desert one mile. Then he was to push the son out of the car (he could see mother was stronger). She was to drive one mile and park the car. Then she should sit in the car in the air conditioning and read her book. The son would walk in the heat back to the car, and it would be good exercise for him. Mother liked this idea. The son did not. They came in the next week, and she had done the mile walk three times. The mother was pleased. The son was not. The son said, “Couldn’t I do some other exercise not out in the hot sun?” “What do you have in mind?” Dr. Erickson asked. The son said, “I could go bowling, and while I’m doing it, my mother can sit in the place and read her book.” That was agreeable to everyone, and other tasks were given that helped to disengage the son from the mother.

Milton Erickson used hypnosis to change the past and did it pretty well. Did you ever hear of the “February Man?”

That was a case where Dr. Erickson changed the past. A woman came to him saying she was lonely and had always been lonely. She was afraid to have children because she didn’t think she would raise them properly because she had had such an unhappy past. So he hypnotized her. He took her back to childhood and had her imagine she was a child again. A man came to visit her father, and she let him in. Her father was away at the time, so she started talking to this visitor. She called him the February Man because he came in February. So she had a nice time with this gentleman and remembered it as a very pleasant time. Then Erickson took her forward to a few years later, and the February Man showed up again. And he took them through an experience where they played games together and she enjoyed their times together. Then he took her forward again two or three years to when she was older, and he took her up to adulthood and woke her up. She began to enjoy what...