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If One Should Not Marry a Hypothesis, Should One Marry a Model?
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In reaction to a current move toward eclecticism in family therapy, the Structural and Strategic schools of therapy are examined. Both a conceptual and practical framework for relating these two, often contradictory, schools to one another is presented through the use of some of Gregory Bateson's recently presented views. The therapist's dilemma in trying to integrate these two approaches is discussed in the light of self-fulfilling prophecies and the necessity for second-order change as related to the therapist's actions. A conclusion is reached that conceptual integration of the approaches may be possible at a higher level, yet practical integration of the two by the practitioner may be difficult, if not impossible, due to the different units of analysis and subsequent action commanded by each approach.
Therapeutic modalities centered in interpersonal processes, in structural phenomena, and in reality constructions — the three core orientations in the field of family therapy — are here defined as mutually nonexclusive “translations” of the systemic paradigm into clinical practice. This definition does not attempt to blur the distinctions among these models but seeks to show their common denominator and thus expands the conceptual and clinical repertoire of the systems-oriented family therapist.
Three related models of therapy are often grouped together as the strategic therapies. These are brief therapy model associated with the Mental Research Institute, approaches developed by Jay Haley and Cloë Madanes, and the model developed by the Milan associates. Controversy exists, however, as to whether the Milan model should be included as a strategic therapy. It appears that the similarities among the three models can mask deeper differences, thus confounding the confusion. This paper contrast the models in their development, theory, and practice.
The Milan systemic approach probably reflects a significant advance in the field of family therapy and possibly in psychotherapy in general. This, the first of two papers, provides a historical overview of the development of the approach, an articulation of some major assumptions and background theory, and a brief description of the overall pattern of practice.
The Eating Disorders Center (EDC) is a clinical research project of the Mental Research Institute (MRI) centered in the study and treatment of Anorexia Nervosa (self-starvation), Bulimia (binge-eating and purging) and weight/diet obsessions/compulsions.
We present a classification system which presumes that information about families can be seen from three different perspectives (historical, interactional, and existential) and that treatment proceeds from three approaches (understanding, transformation, and identification). Using this scheme, we discuss how theories from different schools of thought are substantially overlapping, show that families may respond according to principles other than those the therapist had in mind, indicate how traditional links between certain evaluation perspectives and approaches are unnecessarily limiting, and define two current poles or modes in family therapy (the “ingenious” and the “involved”), suggesting indications for the use of each mode. Various teaching benefits of the scheme are outlined.
This paper considers the strengths and weaknesses of an integrative approach to family therapy. An integrative approach can explain a broad range of human behavior, can shape intervention strategy in a manner appropriate to each case, can allow for treatment of a broad client population, can combine the strengths of each of the specific approaches, can promote objectivity in selection of strategies of change, and can permit easy expansion of the repertoire of techniques. The potential pitfalls basically revolve around the complexity of practice; in particular, the possibility of inconsistency of approach. With care, these pitfalls can be avoided. Integration is viewed as a viable alternative to school-specific practice in family therapy.
While the structural and strategic family approaches have many similarities, their espoused differences have sometimes left therapists in a position of having to choose between them. However, they may be more compatible than has commonly been believed. This paper reviews their basic concepts and operations and presents a model for integrating both approaches in a concurrent and contrapuntal fashion, drawing on the best and most appropriate features of each. Case examples are used to clarify points. Special attention is given to the technique of “strategic disengagement.” A set of rules is provided for decision-making as to when one approach or the other might be applied.
Emerging from the growing trend toward integration in the field of psychotherapy, Integrative Problem-Centered Therapy (IPCT) provides a model for applying different modalities (individual and family) and orientations (behavioral, communicational and psychodynamic) to the broad range of problems patients bring to psychotherapy. Based on the assumption that each modality and orientation possesses its own domain of expertise, IPCT attempts to interrelate the major modalities and orientations to maximize their strengths and minimize their weaknesses. The goal is to create a maximally effective and efficient problem-centered psychotherapy. This paper presents an overview of IPCT, delineating its core principles and premises as well as the basic methodological steps in IPCT.
Towards the Integration of Structural and Strategic Family Therapy
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