Comparison of Theory
There are an abundance of valid theoretical orientations to choose from in family therapy. For a family therapist to be effective, it is important for them to choose a theory they feel comfortable using. This selection process must involve previewing the different theories to see which ones match their own unique personal style of counseling. This paper will discuss and compare strategic family therapy, structural family therapy, and Milan systemic family therapy. It will also include a discussion on the major contributors, the history, and the specific interventions of each approach.
History and Main Contributors of Strategic Family Therapy “Strategic therapy grew out of the communications theory developed in Gregory Bateson’s schizophrenia project, which evolved into three distinct models: MRI’s brief therapy, Haley and Madanes’s strategic therapy, and the Milan systemic model” (Nichols, M. 2010, p. 141). These three theories were established at the Mental Research Institute in Palo Alto. The main contributors to strategic therapy were Gregory Bateson and Milton Erickson, an anthropologist and a psychologist (Nichols, M. 2010).
History and Main Contributors of Structural Family Therapy In the early 1960’s, Salvador Minuchin assembled a brilliant team of therapists who set out to transform the then current family systems theory to better deal with the juvenile delinquency he observed. Minuchin believed that therapy should be more simple, tangible and action-oriented, rather than abstract, or subconscious. According to Nichols and Tafuri, Manuchin believed “the trajectory of assessment in structural family therapy moves from a linear perspective, in which problems are located in the identifiedpatient, to an interactional perspective, in which problems are seen as involving other members of the family” (Nichols and Tafuri, 2013). Minuchin’s ideas became extremely appealing and popular because they are easier to grasp for the patient and the clinician and easier to execute (Nichols, M. 2010). As a result, many therapists flocked to Minuchin to be taught his contemporary ideas. Like a pendulum shift, there was a distinct move away from structural family therapy after its rise because it became the subject of many criticisms (Nichols and Tafuri, 2013).
History and Main Contributors of Milan Systemic Family Therapy Milan Systemic therapy was developed by Mara Selvini Palazzoli, Luigi Boscolo, Gianfranco Cecchin, and Guiliana Prata and was based upon tenets found at the Mental Research Institute. The founders were attempting to assimilate the ideas of Gregory Bateson’s strategic family therapy with their own new research findings. This team of therapists decided to take a more collaborative approach with family therapy, believing the strategic family therapy route was too encroaching. Specific Interventions for Strategic Family Therapy
According to Amini and Woolley, interventions used in strategic family therapy are symptom focused, and different for every patient. They are tailored to meet each client’s individual presenting problem. The goal of the intervention is to change the way the family dynamic works around the presenting problem. Interventions are to be performed by a highly skilled clinician who can assert his or her leadership in the context of the family (Amini and Woolley, 2011). The clinician then discredits the controlling power of the issue in order to place themself as the controlling figure in the family.
Interventions are goal directed, and can include specific homework assignments that the family agrees to complete. One general strategy is the use of paradoxical interventions. This can include prescribing the symptom to the family to exaggerate that particular symptom in them family and highlight the level of damage it is causing (Amini and Woolley, 2011). It can also facilitate a rebellion by the family against the symptom, helping them move toward a positive change in behavior. Specific Interventions for Structural Family Therapy
Structural therapy employs the use of family mapping to display unspoken family rules, and dysfunctional patterns in communication. The main goal of structural family therapy is for the therapist to enter the family system and ultimately breakup and interrupt the dysfunctional relational patterns within the family, causing it to realign into a healthier pattern. This is accomplished by distributing and shifting the power to key members of the family, therefore, changing their style of interaction. Specific Interventions Milan Systemic Family Therapy
With Milan systemic family therapy, the clinician uses hypothesizing, revolving questioning, and neutrality as they attend to the beliefs of the family rather than the behavior as effective interventions (Campbell, D. 1999). Interventions include the use of circular questioning to identify double-bind scenarios, homeostasis disruption, and invariant prescription. The clinician also helps the family understand and acknowledge the “dirty game” cycle, by providing insight into these common disruptive patterns. Therapy interventions also include identifying problems maintained by behavioral sequences and patterns of behavior.
The clinician will help the family develop alternative dynamics by creating an environment in which new information is introduced into the family. Comparing Differences When comparing these three theories it is easy to find differences because each approach was developed in order to create a different therapy process. Strategic therapy is uniquely different from structural therapy, as well as Milan systemic therapy, in that the strategic therapist takes a much more direct and controlling approach with the family and their issues. The clinician strives to impose upon the family a new way of dealing with each other.
This includes specific directives and homework assignments that will alter the way the family functions. The therapist also attempts to establish a level of control so that the family will honor his/her commands. For this reason, it is very important that the clinician establishes trust and confidence with the family early on in the treatment process to maximize the effectiveness of this approach. The structural family therapist will operate in a less commanding authoritarian manner. The clinician attempts to become part of the family system, instead of an outside entity, to alter the way the family functions.
The Milan systemic family approach also has its differences from the strategic and the structural approach. With this approach, the clinician uses a more collaborative position, rather than the authoritative position. Differing from strategic theory, the clinician “wouldn’t focus so much on attempted solutions but instead would ask about past and present relationships in the family” (Nichols, M. 2010, p. 147). This would help to identify a network of power alliances that are passed on from generation to generation. Another major difference between these three theories lies in their differing ideas of how to solve the presenting problems.
“The essential insight of the strategic model was that problems are often maintained by self-defeating patterns of behavior within the family” (Nichols, M. 2010, p. 147). Conversely, a Milan systemic therapist would place more focus exposing covert conspiracies and reframing causes for strange behavior. The focus is also less on the presenting problem, and more interested in changing family beliefs (Nichols, M. ). Structural therapy places more of the focus on changing the governing family hierarchy and uncovering invisible rules that are causing dysfunction. The goal is to realign the system to a more stable, healthier pattern.
Comparing Similarities Similarities and parallels can be found when comparing strategic family therapy, structural family therapy, and Milan systemic family therapy. Each of these theories attempts to include the family for the therapeutic process, believing the family is a rule-governing system that can be best understood in context. Another similarity is that these theories consider the idea that the presenting problem can serve as a function within the family. This idea is counter-intuitive and provided much needed insight into the dysfunctional family dynamics.
These three theories also share a similar view of the family life cycle in that the system usually tries to find homeostasis and effects family functioning and behavior (Zeig, & Gilligan, 1990). Lastly, these theories share the basic premise that the family is the context of human problems. This idea is completely opposite to Sigmund Freud’s previously popular psychoanalytic theory. Conclusion I personally identified with the major contributors of the Milan systemic family Therapy. I believe the Milan systemic approach was a noteworthy advance in the field of family therapy and can be very effective today.
I would find it natural to use circular questioning to identify “dirty game” patterns, and double bind occurrences. I agree with the tenets of Milan systemic family therapy such as focusing on the family beliefs rather than the behaviors. I believe that our beliefs have a profound effect on our behavior, so if you change the beliefs, you will change the behaviors. If I can help a family correct their dysfunctional patterns, this would be a huge accomplishment. I can see myself modeling my counseling after this approach when working with compromised or dysfunctional families.