Is Strategic Family Therapy Still Relevant?
By Dr Kate Owen
Clinical Family Therapist & Clinical Psychologist
I was supervising a Family Therapy student the other day and they were perplexed as to how they could have two families in their clinic with similar presenting problems, but respond in totally opposite ways. They wondered if they needed to develop different skills to be able to work with both of these families, and were surprised when I commented that although the families were responding in different ways, the intervention provided could actually be “the same”.
First, let’s understand the presenting problem raised in therapy.
Family A consisted of a mother and father who had brought their teenage daughter to therapy because she was self-harming. This was extremely distressing for the parents who would yell at their daughter, send her to her room, and punish her for hurting herself because ultimately they felt helpless in knowing what to do. This reaction typically resulted in the teenage girl harming herself further. In this case, we hypothesised that the parents were potentially “over-responding” to the problem and were exacerbating the problem.
Family B consisted of a mother and step-father who had also brought their teenage daughter to therapy because she was self-harming. This too was extremely distressing for the parents who felt helpless in knowing what to do, and therefore responded by pretending that everything was ok and hoping that this was “just a phase” that would pass. This avoidant reaction to her distress typically resulted in the teenage girl harming herself further. In this second case, we hypothesised that the parents were potentially “under-responding” to the problem and exacerbating the problem.
So how could the Family Therapy student assist both of these families?
We wondered if Strategic Family Therapy ideas could be helpful given that it was the RESPONSE from the family to the problem, regardless if it was an over- or under-response, that appeared to be maintaining the problem.
It was hoped that by tracking the family's pattern around the self-harm, that each family would see how each member played a part in the interactional cycle. The therapist’s systemic enquiry could shift the focus away from the teenager and her act of self-harm, to a relational perspective to appreciate how all family members unknowingly contributed to the pattern.
Some common tracking questions that we explored in supervision included:
Q: Who did what when?
Q What did they say or do?
Q: What happened just before that?
Q: What happened next?
Q: What was said and what were they thinking?
As we practiced this tracking technique a lightbulb moment occurred for the Family Therapy trainee. Regardless of the “content” that each family would present about who did what and when, the purpose of taking a Strategic approach was purely to disrupt the identified unhelpful pattern of behaviour, shifting family rules contributing to their responses, and encouraging alternative actions. Any change in the family could potentially lead to a new cycle of interaction.
The trainee could apply the same intervention with both families regardless of how different their responses seemed.
Although some Strategic interventions are no longer popular in therapy (e.g., paradoxical interventions) this supervision experience highlighted the enduring principles of the approach that continue to hold value in contemporary practice.
For those professionals who have been trained in behavioural therapy approaches, Strategic Family Therapy ideas and techniques might be an interesting framework for you to consider using and integrating into your clinical practice.