2. Basic Plan & Basic Questions - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Out of the Monkey Trap, Breaking Negative Cycles for Relationships and Therapy
Chapter 2: BASIC PLAN & QUESTIONS
by Ronald Mah





A strategic approach suggests a basic plan for therapy based on the underlying principles of strategic theory.   Therapy can be broken down into five sequential and progressive stages:

1. identify the problematic behaviors and the sequencing of the cycle;

2. identify what has been done up to now unsuccessfully to remedy the negative behaviors;

3. identify what are the desired new behaviors;

4. design a plan to interrupt the sequence and hierarchy of negative behaviors, using straight and paradoxical interventions.  Paradoxical interventions are needed for extremely "stuck" behaviors that are particularly resistant to direct interventions- paradoxical interventions are often needed to create second order change;

5. design an evaluation plan to monitor the efficiency of the directives and to make adjustments to the plan.

The therapist should ask him or herself the following questions about the individual, couple, or family.  Some of the same questions may be appropriate to ask directly of the partners.

What are the negative behaviors that are problematic among and between the individual and others or between couple or among family members?

What's been done before to remedy these problems?

What do we want to happen instead?

What can be remedied with straightforward directives?  What would these directives be?

What are the consequences of the directives being followed? of the directives being ignored or subverted?

Will these consequences be sufficiently rewarding or punitive to effect change?

What are the particularly resistant behaviors between and among the individual and others or the couple or family that require paradoxical interventions?

What are the values, rules, and parameters that are preventing the individual, couple, or family from considering different approaches or remedies (second order change)?  What paradoxical interventions would these be?

How (and who) will monitor the effectiveness of the interventions, i.e. has the behavior changed for the better?  What are the next steps?

The therapist becomes a part of the system (intrapsychic system with an individual or the couple or family) that he or she is observing and trying to change.  "The therapist then has to hypothesize about the family as a 'family-being-observed-by-a-therapist-in-family-therapy'" (Campbell, 1999, page 78).  The therapist should accept that his or her role in couple or family therapy is not neutral.  He or she is a part of the system not only in sessions, but also away from therapy.  An individual, partners, or family members often invoke the therapist both implicitly and explicitly.  "The therapist said, I (or we) should…"  "Remember what the therapist said about that?"  The therapist not only has opinions about what happens in the system, but also is expected by the individual, partners, or family members to share them.  Therapeutic neutrality "refers to the attempt to appreciate that all points of view in a family discussion are valid within some particular context.  A neutral therapist tries to withhold judgment, and instead arouse their own curiosity about what particular context would validated the things the family member is saying" (Campbell, 1999, page 78).  While well intended, therapist neutrality may not be possible and more importantly, not therapeutic.  Domestic violence between partners, for example challenges therapeutic neutrality as it implies the therapist gives permission for abuse to continue.  From strategic principles that look to interrupt a hierarchy or cycle of behaviors, the therapist's opinions or stances become intrinsic parts of a new potentially different hierarchy or cycle.  They may reveal secretly held values, deny permission for dysfunction, uncover passive aggressive behavior, or empower a partner to assert him or herself.  

Rhodes' (2008) discussion of the first session relative to family therapy has application to all therapy.  The therapist has as the key goal to get involved in dialogue with the individual, couple, or family.  Involvement rather than neutrality enables both the therapist and the client to identify cyclical patterns of relating and behavior that maintains the problem in an individual, partner, or the couple or family.  The therapist takes a stance of systemic empathy that honors the positive intentions of the individual with others, both partners in their respective behaviors in the couple, and all members in the family.  The therapist emphasizes understanding each person rather than giving or having a simplistic- usually negative explanation of the relationship problems.  The therapist helps them develop a new interpretation of their issues that is circular, rather than linear.  This helps prevent the individual from blaming another or partners or family members from blaming each other, while also not pathologizing the individual, or the couple or family as a unit.  Following initial assessment, the therapist looks for ways to interrupt or disrupt the behaviors that perpetuate problems.  When the therapist purposefully or accidentally interrupts a system pattern, the pattern is revealed.  "In this sense, the first session is concerned with homeostasis.  The conversation with the family is aimed at isolating and making sense of the negative feedback processes, developing a reflective capacity that allows room for small deviations to occur" (Rhodes, 2008, page 35).  Subsequent sessions reverse the assessment by "isolating the small deviations that might have occurred between the two sessions, placing them within a virtuous, rather than a vicious cycle of interactions, and amplifying them so that these deviations can eventually develop into a new and more adaptive homeostasis… thus allows for the integration of a systemic understanding of virtuous cycles with the strength building and storied practices of these models."

The relationship is a complex and dynamic system with the individuals constantly acting and reacting to each other.  If the relationship is a couple with children, then there are additional members making the number of potential interactions even greater.  The therapist immediately and continually observes communication and interactions in the session, including an individual's self talk or thinking.  The individual, couple, or family naturally or may be asked to duplicate or re-enact their conversations or arguments about an issue. "Such an approach allows the therapist to get a feel for the family's interactional behaviors and dynamic patterns around their identified problem, and to begin to develop directives or interventions that may create change in the family system" (Gardner, et al., 2006, page 346).  

continue to Chapter 3
ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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