Brief Strategic Couple/Family Therapy (BSCT) revolves around one central idea, the idea of ironic processes. An Ironic Process is a solution process that occurs when an individual repeatedly tries to solve a problem, wherein the solution is perpetuating the problem and could potentially be making it worse. BSCT uses this idea of ironic processes as the basis for all types of therapy, couple, family, and individual. If ironic processes are maintaining the problem, then the central goal of therapy should be to interrupt these problem solution patterns (Gurman, 2008, pg.299).
If the therapist can successfully prevent the client from further use of their solution processes the problem should resolve itself. A problem as defined by a Brief Strategic Therapist is the presence of a “vicious cycle involving a positive feedback loop between some behavior someone considers undesirable and some other behavior intended to modify or eliminate it” (Gurman, 301). According to BSCT the nature, duration and origin of the problem are not determining factors of how effective therapy will be (Gurman, 2008, pg.301). Successful problem resolution requires only that the vicious cycle (positive feedback loop) is broken indefinitely and replaced with a new virtuous cycle. A virtuous cycle will be accomplished when the client is able to perform less of the solution thereby leading to less of the problem and so on, until the problem is resolved (Gurman, 2008, pg.301). A strategic therapist might say that the goal for their clients is not trying to get them anyplace, or move them forward. Rather the goal is to confuse them so that they “will not continue to go on the way they have been going” (Coche, 1990, pg.238).
The origin of the problem in strategic therapy is also strongly tied to this central idea of ironic processes. In the case of therapies evolving from a psychodynamic approach the origin of a problem is generally linked to a childhood experience or some manifestation of the unconscious. In a cognitive approach the problem is linked to a series of distorted thinking patterns and the validity of the clients actual distress versus imagined distress is questioned. BSCT differs from other approaches in that problems are said to originate not from past experiences but rather from faulty problem-solution patterns (ironic processes) (Coche, 1990, pg.241). This results in therapy focusing almost exclusively on the here and now. The therapist has little interest in the client’s childhood or past relationship patterns, the therapist does not seek to gain insight into the problem or even understanding (Gurman, 2008, pg.311). The focus remains on the problem at hand and the successful interruption of the ironic processes responsible for the maintenance of that problem.
BSCT is “a pragmatic embodiment of an interactional view that explains behavior- especially problem behavior – in terms of what happens between people rather than within them” (Gurman, 2008, pg. 300). In 1967 Fish, Weakland, Watzlawick formed the Brief Therapy Center at MRI. The center set out with the goal of studying effective ways to do therapy briefly. The zeitgeist of the time was strongly psychodynamic (Gurman, 2008, pg.300). This meant that the individuals at the MRI Center, later known as the Palo Alto Group, were challenging the thinking of the time. Psychodynamic approaches were lengthy and it was thought that real progress could not be made in a short period of time. After approximately six years of research the Palo Alto Group released a paper titled “Family Process, Brief Therapy Focused Problem Resolution.” This was the first document to present BSCT as a new model of therapy. The paper described BSCT as a model focusing on external rather than internal processes. The therapist was to focus on observable interaction patterns, without drawing conclusions regarding the normalcy or pathology of the clients behaviors (Gurman, 2008, pg.300). The next major publication to outline BSCT did not emerge until nearly eight years later, “The Tactics of Change: Doing Therapy Briefly” (Gurman, 2008, pg.300). To date, this is the most comprehensive how to guide describing the clinical method of BSCT.
Neither of these documents specifically address strategic therapy in terms of couples counseling. However, the clinical principles of strategic therapy support couple complaints (Gurman, 2008, pg.301). Interestingly, when the success rates of the cases seen at the Brief Therapy Center were calculated it was found that 40% of all cases seen involved some form of marital or couple complaint. Out of all cases seen at the Brief Therapy Center there was a success rate of 2/3 and the average length of therapy was six sessions (Gurman, 2008, pg.301).
BSCT does not focus on helping clients achieve a greater self awareness. According to Haley, one benefit of ignoring self awareness issues such as “patient expectations, cultural mores and values, paralinguistic cues, and traditional hierarchies” is the ability to be significantly briefer than other methods of therapy (Richeport-Haley, 1998, pg.87). Clients entering into BSCT will quickly realize that any cultural issues or identities they have are seen as insignificant. In fact, BSCT focuses almost exclusively on family structure and strategies. In this respect clients in BSCT might feel as though the client therapist connection is very on the surface.
This on the surface type thinking is also reflected in the way strategic couple therapists view their client’s problems. Strategic therapy is complaint based, if a couple reports that they have no problems therapy will cease. Further, strategic therapy is non normative meaning that, while clients may report something that the therapist personally feels is unhealthy, or, not normal, the therapy avoids making a judgment unless the client also recognizes that the topic at hand is problematic (Gurman, 2008, pg.301).
Once the client has identified a problem to be the focus of therapy the therapist will begin a very important reframing process to help the couple shift their focus from the problem onto their “miscarried coping or problem-maintaining solutions” (Coyne, 1987, pg.539). In other words, the therapist helps the couple begin to understand how the problem is maintained by the solution, therefore the chosen solutions, and/or coping skills are the real problem.
According to BSCT the only way for change to occur is through the interruption of ironic processes. In order for ironic processes to be successfully interrupted the therapist must successfully accomplish the following three tasks. First, the problem maintaining solution must be accurately identified. Second, the therapist must help the client visualize what performing less of the solution would look like. Third, the therapist must develop an intervention that results in at least one of the involved individuals doing less of the same (Gurman, 2008, pg.311).
“Strategic therapy emphasizes gaining leverage in a system through the members of it who are most committed to change. Yet, these persons are often precisely those who are most preoccupied with failure or convinced that the more they try the worse their situation gets” (Coyne, 1990, pg.239). In other words, brief strategic couples therapy attempts to change a relationship pattern by working with an individual who is often, at least some what resistant. Resistance is an important aspect of all brands of therapy and, if not properly handled, can potentially threaten successful change. Resistance can be defined as, any behavior within a therapeutic system which prevents the system from achieving the family’s goal for therapy (Coche, 1990, pg.237). Generally speaking resistance is present when a client is trying to maintain a state of static equilibrium. In order to maintain this balance the client must avoid shock, frustration and psychic pain all of which are thought to derive from the therapeutic process. Therefore the client concludes that resisting therapy is the only way to maintain balance (Coche, 1990, pg. 238).
BSCT has a very unique way of handling resistance, in fact, they are able to turn the table and use resistance as a vehicle of change. This is accomplished by “reframing the resistance as a precondition for, or even an aspect of change” (Coche, 1990, pg.237). This is accomplished by the therapist accepting the clients resistance and to a certain extent, encouraging the client to continue resisting. The clients resistant behaviors were designed to represent their uncooperative attitude toward the therapy process. Once the therapist encourages this behavior the clients resistance is now reframed as co-operative behavior. With the client and therapist now in cooperation with one another the therapeutic process can continue and the therapist will be able to divert the client into a new behavior (Coche, 1990, pg.238). Erickson used the following analogy of a river to describe therapeutic resistance: The therapist is similar to a person who wants to change the course of a river. “If he opposes the river by trying to block it, the river will merely go over and around him. But if he accepts the force of the river and diverts it in a new direction, the force of the river will cut a new channel.” (Coche, 1990, pg.238).
Brief Strategic Couples Therapy has a four stage system for handling a resistant client/couple. During stage one resistance usually results from the halo effect and cynical disbelief. The halo effect is “an imaginary fan club for the chosen therapist that can sometimes be discerned in the enthusiastic voice of a potential client (it was so hard to get an appointment with you)” (Coche, 1990, pg.241). Cynical disbelief refers to resistance resulting from the “healthy and natural dose of cynicism and doubt” clients come to therapy with (Coche, 1990, pg.241). Therefore resistance is stage one is lessened by diverted the clients attention away from the validity of therapy and re directing it toward possible problems with the structure of therapy. This can be as simple as getting the client to question or show resistance related to the number of times they will be meeting for therapy. During stage two the couples are joined and the problem is reframed in order to reduce resistance related to dealing in therapy with the presenting problem. This is accomplished by first allowing the couples to openly discuss their problems in an open conversation. Secondly, the therapist uses circular questioning in order to bring the couple into a systemic viewpoint (the problem is the result of a malfunction in the system not an individual) (Coche, 1990, pg. 241). If the client is still presenting with resistance the therapist will begin to point out this resistance in terms that leave the client feeling hopeless. The feelings of hopelessness and despair help the client recognize the need for change and therefore begins the clients transition into a customer of change. Lastly, stage 4 encompasses the therapeutic process that ensues after resistance has ended. The client “comes to realize that positive change has occurred and that to the future belong new solutions not the stubbornly clung-to dysfunctional paths of the past” (Coche, 1990, pg. 249)
“In theory the BSCT model is applicable to any couple that presents a clear complaint and at least one customer for change. In practice, however this approach may be particularly relevant for couples and clients who seem resistant to change.” (Gurman, 2008, pg.311-312). In fact “controlled studies of both individual and couple problems suggest that strategic interventions are more effective than straightforward affective or skill-oriented interventions when clients are more rather than less resistant to change” (Gurman, 2008, pg.312). BSCT’s ability to work with individuals resistant to therapy as well as those who are minimally engaged is important as it is very rare for both partners, and their surrounding family system to all be enthusiastic about therapy, particularly, when the problem is viewed as being one person rather than the system as a whole” (Santisteban, et.al., 2006, pg.261). BSCT provides a philosophical shift in thinking regarding engagement, in other forms of family and couple therapy engagement began after the initial in office interview. With BSCT, therapists are trained to “begin diagnostic work and interventions focused on engagement over the phone, prior to having the family in the room” (Satisteban, et. al., 2006, pg.261).
More often than not therapists will be attempting to produce change by working with the member of the couple who is the “most demoralized and convinced that they cannot exert a positive influence” (Coyne, 1987, pg. 539). The individual who “expresses the greatest interest in therapy often does so because he or she is locked into a problem-solving strategy and is preoccupied with failure or convinced that all efforts are only making the situation worse.” Coyne, 1987, pg.540). This individual is generally experiencing a greater amount of distress surrounding the current relationship patterns and is most open to finding a new way to facilitate change (Coyne, 1987, pg.539). As opposed to the resistant client previously described, this client can be labeled a customer for change. That is, they are open to change through whatever means necessary. They recognize that their current interaction pattern is faulty and needs to be interupted. A customer for change and a resistant client are similar in that their level of pessimism may be similar and both may feel like they have tried every possible solution. The difference is that the customer for change has the will to give therapy a chance, there is a certain amount of determination behind their actions. Whereas the resistant client will actively seek to sabotage therapy in order to support their claim that finding a solution is a lost cause.
“This model is probably least applicable to couples whose concern is relationship enhancement prevention of marital distress or personal growth because therapy requires a complaint and would rarely continue more than a few sessions without one” (Gurman, 2008, pg. 312). In other words, BSCT should be used for couples who are in therapy to handle a specific presenting problem or problems. BSCT should also be used with some amount of caution when there is potential drug, alcohol or spousal abuse. ” The non normative constructivist premise of brief therapy which rejects the idea of objective standards for what is normal or abnormal or good or bad behavior may too easily excuse the therapist from attempting to discover conditions such as alcoholism or spousal abuse” (Gurman, 2008, pg.312). The exception to this is if the couple is openly presenting with this type of issue. Past research regarding BSCT has shown this type of therapy to be very effective at treating these types of problems (Gurman, 2008, pg.313). As long as the couple is open about the problem at the beginning of therapy BSCT is a viable therapy solution for them, otherwise the therapist should be very cautious of continuing further.
One potential problem with BSCT is that it lacks cultural sensitivity. According to Haley, “therapy can be briefer if one avoids cultural immersion” (Santisteban, et. al. 2006, pg.87). Brief Strategic therapists “ignore cultural issues for the mot part and concentrate on family structure and strategies to bring about behavior changes” (Santisteban, et. al. 2006, pg.87). Clients who have a strong cultural background may not feel comfortable with addressing their problems outside of a cultural context, or may be simply unable to work with a therapist who views their cultural background as unimportant (Richeport-Haley, 1998, pg.87). This type of client will be better suited for a different brand of therapy.
Interestingly enough, BSFT has been shown to be effective in the engagement and treatment of substance abusing youth and was the first empirically supported treatment for Hispanic substance-abusing youth (Santisteban, et. al. 2006, pg.260). BSFT was able to successfully treatment the substance abuser as well as improve their relationships with their families and significant others. This supports the idea that this brand of therapy can be briefer by avoiding cultural immersion while still providing effective change. BSCT is therefore appropriate and effective for those clients from cultural rich backgrounds who are open to receive therapy that ignores their cultural differences.
The main role of the therapist in BSCT is to “persuade at least one participant in the couple to do less of the same solution that keeps the complaint going” (Gurman, 2008, pg.304). The therapist has a responsibility to work with the client who is the customer of change regardless of the reluctance of the other individual(s) involved. The therapist in this brand of therapy places a high value on maintaining what is referred to as maneuverability. Maneuverability “means that the therapist aims to maximize possibilities for therapeutic influence, which in this model is his or her main responsibility” (Gurman, 2008, pg.304). A different way of looking at maneuverability is that the therapist needs to restrict the clients options while ensuring that his/her options remain open. In order to do this the therapist must carefully monitor how much enthusiasm they place on any particular aspect of the problem or solution. By remaining more neutral the therapist is allowing for more flexibility in the instance that the client fails to comply with the original request. A key trait for a Brief Strategic Therapists involves empathic restraint. Empathic restraint is often but into terms of the ‘go slow message.’ The therapist encourages the clients to go slow, “the therapist aims to avoid apprehension and resistance by conveying that only the client can decide whether and when to change” (Gurman, 2008, pg.304).
Brief Strategic Therapy places little importance on the therapeutic relationship. “This does not mean that strategic therapists come across as cold, manipulative, or uncaring. On the contrary, most therapists we have known and seen working this way would likely receive high ratings on client rapport and “therapeutic alliance” (Gurman, 2008, pg.305). Although conceptual empathy is a very good indicator of how successful a brief strategic therapist will be it is generally noted that “a strategic therapist becomes more a chameleon than a firm rock in a sea of trouble” (Gurman, 2008, pg.305). Therefore one of the most desirable traits of a Brief Strategic therapist is the ability to be flexible and adapt to each clients individual needs.
BSCT follows a basic eight step template. First the problem is defined in detail. Second, the minimum acceptable goals for change are established. Third, determine the current solution patterns. Fourth, determine which solutions are maintaining the problem (the ironic problem-solution loops. Fifth, explore what the problem would look like if the client began doing less of the same. Sixth, determine what the clients would like to see in terms of their view of themselves, the problem, and their partner. Seventh, using the clients views as a starting point, begin formulating suggestions for how the client is to find a solution doing less of the same. Eighth, encouraging the resulting change and help prepare clients for future success (Gurman, 2008, pg.302). Upon completing the eighth step the therapist will begin to assess the stability of change. If the therapist feels comfortable that change is stable therapy will end without an excitement. If at the time of termination the clients are apprehensive the clients will keep any unused therapy sessions “in the bank” for future use (Gurman, 2008, pg.303).
In BSCT goal setting serves two main purposes. First, setting a goal that identifies what acceptable change consists of helps the therapist obtain a clearer picture of the complaint. Second, Brief strategic therapy supports the idea that a small strategic change in the couples problem-solution pattern can create a “domino effect and lead to further positive developments” (Gurman, 2008, pg.306). Goal setting occurs throughout the therapeutic process due to the fact that the goals set are mediating goals and not ultimate outcomes. In other words, brief strategic therapy encourages the formation of short term goals, small changes now lead to big changes later. Therefore, after the initial goals have been met it will be necessary to set another mediating goal. All goals created throughout the process should focus on the end not the means (Gurman, 2008, pg.306).
Brief strategic therapy follows a goal setting principle known as the unresolved remnant. This principle states that when the therapist is setting goals they should avoid setting a goal that suggests complete elimination of a problem. Subsequently, all goals should represent an, attainable level of improvement in regards to the problem. Setting goals that do not represent a complete elimination of the problem demonstrates a rejection of the all or nothing attitude regarding change. The client is freed “from the burden of having to be totally successful in order to avoid total failure” (Coyne, 1987, pg.542). Further, by setting smaller goals there is a higher likelihood that the client will be able to exceed those goals giving the client a sense of self initiative. (Coyne, 1987, pg.542).
BSCT techniques are separated into two categories, “specific interventions are designed to interdict ironic, case-specific problem-solution loops, from general interventions that tend to applicable across most cases” (Gurman, 2008, pg.307). Examples of general intervention techniques include “telling clients to go slow, cautioning them about dangers of improvement, making a U-turn, and giving instructions about how to make the problem worse” (Gurman, 2008, pg.307). Another example of a general intervention involves the therapist asking the couple to intentionally perform the problem-solution pattern in order to help the therapist better understand the process. The therapist is looking for information to explain how the partners are able to get each other to react in an unreasonable manner. Due to the forced nature of this interaction, “negative spontaneity is cut” and the couple often experiences a shift in the way that the problem solution pattern plays out. It is sometimes the case that this one time shift can provide long term change (Gurman, 2008, pg.307).
An empowered client “views their situation in terms of a manageable coping task for which they have the necessary resources, and as affording the possibility of a positive outcome” (Coyne, 1987, pg.539). Frequently therapists are working with individuals who have a problem that they have been unable to solve for quite some time. These individuals almost always present with a sense of hopelessness and despair. In order for them to become successful agents of change and improve their current situation the therapist must intervene and build up a sense of empowerment within them (Coyne, 1987, pg.540). In order to empower the individual the therapist needs to help them see their current problem as manageable, their skill level as sufficient, the number of opportunities for change plentiful, and the possibility of a positive outcome (despite the number of past failures) (Coyne, 1987, pg.541).
There are six strategies commonly used in BSCT to empower clients. Determining which technique to use with a particular client depends on the ironic process patterns that are currently in place, the coping strategies of the individual, and any other significant individual differences relating to the clients situations (Coyne, 1987, pg.540).
Strategy one involves the therapist obtaining a better understanding of the clients’ current perspective and acknowledging their view point. The therapist then offers praise to the client in recognition of the accomplishment that their problem could be worse than it is (Coyne, 1987, pg.540).
Strategy two involves “insulating clients from insoluble tasks and other sources of failure” (Coyne, 1987, pg.541). The purpose of this strategy is to help the client relinquish the responsibility for the outcome of the problem by helping them realize that it is beyond their control. If a client is able to recognize that their solution attempts are futile not because they are inadequate but rather that they do not have control over the outcome they may experience “a resurgence of morale and energy and sometimes a renewal of their relationships” (Coyne, 1987, pg.541).
Strategy three consists of the therapist aiding the client in reframing their view of what an adequate coping task consists of and what represents an accomplishment. The therapist will help the client separate the task ahead, solving the problem, into smaller, more manageable goals. Subsequently, the therapist will help the client see how each smaller goal represents a small success and represents progress. For a clients who are skeptical and do not feel like the small goals represent any real success with dealing with the larger problem the therapist is encouraged to warn them of the dangers of improving too quickly and continue to send out take it slow messages (Coyne, 1987, pg. 540-541).
Strategy Four involves empowering the client through the idea of working together with their partner as a team. The therapist should “work to reduce the negativity of exchanges with positive reframing and prescriptions that introduce playful and even absurd elements” (Coyne, 1987, pg.542). If the therapist can successfully get the client’s to lessen their level of hostility the client will be more receptive to the positive interactions or behaviors they are receiving from their spouse.
Strategy five involves empowering the individual by helping them find “dignity in facing a situation rather than succeeding in it. One shows that although one may have failed a particular test one is still a worthy human being. Noble endurance of failure may actually lead to more social credit than arrogant exploitation of success” (Coyne, 1987, pg.543).
Strategy six involves reeducating the client on their ability to make choices in their life. “It is sometimes necessary for clients to see they are making choices which either leave them in their unpleasant situation or leave them more vulnerable to its unavoidable unpleasantness. Thus they have the power to make different choices” (Coyne, 1987, pg.543). Not only does this empower the individual to continue trying new solutions and making different choices it also encourages the individual break the cycle of ironic processes that have them stuck in the first place.
A new brand of Brief Strategic Couples Therapy is emerging known as strategic hope-focused relationship enrichment counseling (Worthington, Hight, Ripley, Perrone, Kurusu, & Jones, 1997). This counseling program has been empirically validated, it is based on modern research and techniques, and, it is the only relationship enrichment program that is brief in duration. Hope building in the context of this type of couple-enrichment counseling refers to a couples feelings of hope that they will continue to be successful in their relationship and/or marriage, as well as, hope for a better overall future. Hope building in the relationship context, particularly in marriage is recognized as a crucial task for a happy successful marriage and is linked with a decreased divorce rate (Worthington et. al. 1997). Generally speaking, hope focused therapy occurs over a period of five sessions ( or five and a half hours) each couple is seen individually with a counselor, there are no group sessions (Worthington, et al. 1997). Hope focused therapy results not only in increased levels of hope but also increased partner satisfaction. The higher satisfaction level attained through therapy has been found to be maintained over a period of at least 3 weeks (Worthington, et al. 1997). Although enrichment counseling has been shown to decrease divorce rates, there is no reported increase in relationship stability, attraction or commitment. Worthington et al. concluded that while hope focused therapy does not improve relationship stability the increase in relationship satisfaction and hope are more important to overall relationship and marital success.
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