Family Therapy

Strategic

Cloé Madanes
 Index
1.-Dimensions of family therapy
2.-Elements of strategic family therapy
3.-Marital problems: the balance of power
4.-Childhood problems: three paradoxical strategies
5.- Problems of the parents: The modification of the
interactions between parents and children
6.-Serious problems in adolescence: how to achieve that
the parents take charge.
7.-Night terrors: case study.
8.- A depressed man: case study.
 1.- Dimensions of therapy
familiar
Son los temas en los cuales discrepan los diversos
therapists and approaches to family therapy. From these
items the current therapeutic approaches derive from.

Past or
present Personal growth or
Interpretation or problem presented
action
Equality or Digital communication or
hierarchy analog
Problematic unit: 1,2,3 or General method or plan
more people specific for each
problem
Direct interventions or
deliberately
paradoxical
 2.-Elements of family therapy
Strategic
LaT.F.E. developed from the
strategic therapy of Milton Erickson.

A primordial trait: the therapist assumes

the responsibility of planning a
Strategy to solve problems
from the client. The same method does not apply.
for all cases, but design one
for each particular problem.
 2. -Elements of Family Therapy
Strategic

General objective of the T.F.E.: To help

to cope with the crisis to move on to a
next stage.
Stages that lead to family crises. Haley (1973)
1) Courtship
Early days of marriage
3) Birth of children and treatment with them
4) Intermediate period of marriage
5) 'Weaning' of the parents regarding the children
Withdrawal from active life and old age.
 2. -Elements of Family Therapy
Strategic

• Diagnostic criteria are rarely used for

psychiatry and psychology.
• The strategic approach emphasizes the analog.
• It is taken for granted that analogically or metaphorically
a symptom is an expression of a problem and also
an unsatisfactory solution. The focus of the therapy is
position in the modification of analogies and metaphors.
• He/She is interested in the family hierarchy. He/She observes the
hierarchical position of the therapist.
• The role of a therapist is that of an expert and it is
highly directive.
 2. -Elements of Family Therapy
Strategic

• The therapist's first mission is to define

the problem in such a way that it is possible
solve it, remembering the level
metaphorical.
• The interventions are directive,
deliberately planned. It does not make
emphasis on the insight is not given
interpretations.
• It focuses on the solution to the problem
presented only in the present.
 2. -Elements of Family Therapy
Strategic
The clearer it is conceptualized
the problem and the objective of the
therapy, the easier it will be to plan
the directives.
Papp (1980) distinguishes direct directives or
based on compliance, referred to the
therapist's expectation that the family will have
to comply with them, and paradoxical or based directives
the challenge, related to the therapist's expectations
that the family must resist them.

Steps to give paradoxical directives.

Define the symptom as motivated by intention
benevolent in preserving family stability.
2. Prescribe the interaction cycle that generates symptoms.
3. Restrict the family whenever they show signs of
wanting to change.
 3.- Marital problems: The
balance of power.
Every couple struggles with the problem
what sharing power represents and
organize a hierarchy such that the
control spheres of responsibilities
they are divided between the spouses.
This power does not only refer to dominating
the spouse, but also to comfort him,
take care of it, reform it and take on the
responsibility for him.
Use of a symptomatic spouse for
balance the power
 3. Conjugal Problems: Balance
of power

One of the spouses can develop a

symptom in their attempt to change the
hierarchical ordering and the division of
power of the diad. But the behavior
symptomatic, is the unfortunate solution,
since instead of balancing power in the
relationship produces an incongruence
hierarchical in marriage.

In case the behavior disappears

symptomatic, the spouses will relapse into the
struggle for the division of power that was given
origin to the symptom.
 3. Marital problems: balance
of power

• Case 1.- The Man

depressed.
• Case 2.- Binge eating and vomiting
• Case 3 - Drunkenness.
 3. Marital problems: balance
of the power

• A symptom is a metaphor about the situation.

in what is one found person, and the
way in which the couple interacts around
the symptom is a systemic analogy of others
interaction systems in marriage.
• A cycle can be generated in which each
one member of the couple exerts control over the other
another by alternating focus on the
marital problem (money, the profession, the ...
relatives), in the symptom of one of the
spouses or in the problem of a child.
 4.- Childhood Problems: Three
paradoxical strategies
The child's disturbed behavior,
keeps the parents
involved in trying to help him
and to change their behavior. The
the couple will set aside their own
problems, at least temporarily,
to assist your son or control him.
the child's problem offers the father a
convenient excuse to evade
unpleasant situations.
 4. Child Problems: Three Strategies
paradoxical

This behavior is beneficial for the parents,

he will give them a respite from their tribulations
and a reason to overcome their difficulties.
s
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request, protection or punishment, makes the
concern of these focuses on him and that they
see themselves as parents of a child
who needs them, instead of seeing themselves as
individuals overwhelmed by difficulties
personal, economic or social.
 4. Child Problems: Three Strategies
paradoxical

The fact of helping his

parents, make the child feel
found in a superior position
like that of the parents. If their
abnormal behavior, the son
would lose power and in
consequence the possibility of
to help them.
The more they try the
parents of change the
behavior of the son, more it
they maintain the positions of
power.
 4. Problemas Infantiles:Tres estrategias
paradoxical

Strategies to Reinstate an Organization

hierarchical where the parents are in position
superior

1.- The parent asks the child to have the problem:

Getting the father to encourage the child to have the symptom.
2.-The parent asks the child to pretend to have the
problem: father and son pretend to have the problem,
focusing now only on the interaction.
3.-The parent asks the child to pretend to help him.
Ambos simulan. Resultados impredecibles pero
spontaneous.
 4. Child Problems: Three Strategies
paradoxical

• Steps to execute the therapy:

1.- Clearly define the problem and set objectives

specific.

2.- Conceptualize the problem (for yourself) considering

that the child, through his symptoms, is protecting one
either parent, or a relative.

3.- Plan an intervention in the form of a directive that

the parent or parents have to impart to the child. The
family members participate as assistants. The
directive includes a prescription of a) having a problem or
b) simulate having the problem, or c) simulate helping the
parents.
 4. Child Problems: Three Strategies
paradoxical

4.- Generally, the directive is practiced first in

the session and then fulfilled at home.

5.- In the next session, a report is required on

the compliance with the directive and the therapist continues
prescribing the same directive.

6.- As change comes and disappears

the problematic behavior, the therapist abandons the
issue of the symptom and starts to address others
problems in the same or another way, or it puts
end of therapy.
 5.-Parents' issues: The
modification of interactions
between parents and children

Approaches to modify the system of

interaction and solving the child's problems:

1. The change of the metaphorical action:

Replace the symptom with another action, from
so that the new metaphorical action fulfills
its positive function in the family without the
unfortunate consequences of
symptomatic behavior
 5. Parents' problems: The modification of the
interactions
between parents and children

2.-The provision of a metaphor for success in

place of failure: As an index that the
progenitor is successful and is a suitable person,
who has overcome the difficulties of his life and
You can help your child to do the same.

3.-Change of metaphorical solution: Change the

consequences of behavior in a sacrifice
for the parent or in a solution
unpleasant for the son.
 5. Parents' problems: The modification of the
interactions
between parents and children

• Understanding the metaphor: "It is

as if one could see in a certain way
place and obtain an image of it
what happens elsewhere. For example,
a depressed mother has a son
depressed.
 5. Parents' problems: The modification of the
interactions
between parents and children

Questions to ask the family to generate hypotheses

strategic:

When does the problem occur, where, and with whom? And how does it disappear?
What does each member do when the symptom occurs?
Who is most affected by the problem?
What other family member has gone through something similar? What
What was happening then?

Is there something that worries you, or are you involved in a special situation?
out of the problem?
Which relatives does each one have a closer relationship with?

Does the person presenting the problem resemble any of those?

Are relatives or their problems similar?
Who does the problem in the family unite and who does it distance?
What things would change if the problem disappeared?
 5. Parents' problems: The modification of the
interactions
Between parents and children

Questions that the therapist should ask themselves.

What is the metaphor expressed by the symptom?

What is the implicit request or order in symptomatic behavior?
Who is the concern of the P.I. and what is it about?
protecting that person?
What is the interpersonal gain disregarding behavior?
symptomatic?
How to organize a family to help each other
another way to each other?
How is it possible to restore a family with children, a hierarchy?
unique, in which parents take care of their children?
How can a more equal bond be promoted between the
spouses?
 5. Parents' problems: The modification of the
interactions
between parents and children

Questions that lead to the formation of a

hierarchy.

Who is in charge of the family?

Who has to ask permission from whom?
What are the house rules? What are the consequences?
bring that they disobey?

Determine who has power over whom in the

following spheres:
A) Manejo del dinero, B) Empleo del tiempo, C)
Information exchange.
 6. Serious problems of the
adolescence: How to achieve that the
parents take charge.
For the handling of serious problems
a therapeutic system will be necessary
more rigid and controlled. The therapist
should ignore to a certain extent the
familiar metaphors, for it could
perderse en ellas, y debe trabajar
about literal and broadly aspects
practical and managerial.
 6. Serious problems of adolescence: How
to get the parents to take responsibility.

In cases of highly disturbed youth, it

characteristic is that the therapist is in
a situation of hierarchical family incongruences:
based on his disturbed behavior, the
young person finds themselves in a position of power superior to
the parents, who fear the reactions that the
son present before the imposition of dominion.

The hierarchy is defined within a family by

repetitive sequences of who communicates to whom what
what should be done.
 6. Serious problems of adolescence: How
to get the parents to take responsibility.

The therapist must intervene in such a way that

modify these sequences by changing them
for others in which the parents tell their child
what he has to do and he obeys
repeatedly.

The content of these sequences

communication should be such that the
parents set the expectations they harbor
regarding the son and the rules that he
must continue and establish the consequences
que acarreará su incumplimiento.
 6. Serious problems of adolescence: How
to ensure that the parents take responsibility.

At the beginning of the treatment, the parents are

they find themselves at a disadvantage in this situation
by ability, the therapist must influence them
so that they establish rules y
rigorous consequences to increase
his power over the son. When the young man
loses power that I perceive over their parents,
it will drive normally and in the long run it will be
independent.
7.-Night Terrors: Study of a
case
A mother of 4 children presented it as a problem
that the son heard voices at night. The son of
He presented as a problem that he had been 7 years old.
recurring nightmares in which a witch
attacked and women screaming. The mother was the
the only one who reported feeling afraid
occasionally.
When the son was scared, the mother
calmed and protected. When it comforted
her son, she was not afraid and positioned herself in
upper position.
 7.-Night Terrors: Study of
a case

Interventions:
Definition of the problem: From hearing voices to
the "nightmares" which is an easier problem to
to try
Dramatization of the nightmare in the session.
He asked the mother to pretend to be scared and the
Son will pretend to help her in the session and then at home.
Reorganization:
Mother in a superior position, both resumed.
activities appropriate for their ages.
8.-A depressed man: Study of
a case.
• 60-year-old man,
comes with a diagnosis of
depression for 5
years, has neglected his
company since that
time. For those dates
the woman resumes her
studies as a therapist
and it starts to be
productive, stopping
ser el marido su centro
 8. A depressed man: Study of
a case

• Intervention:
Redefinition of the problem of
depression to irresponsibility.
To entrust the wife that
she will watch over her husband's work.
(exaggeration of the position)
+Ask the husband to pretend to be a
inept and will surpass its own
performances.
Paradox of sleeping and working.