Family and Systemic Therapies 351and will be affecting all members in different ways. The task of therapy
includes revealing the way the symptoms of the identified patient are
used by the family to support its functioning, and how they fit its
transactions (Box 41.2).Intervention techniques
The therapist isactive,anddirective. He or she challenges patterns of family
interaction and reveals covert rules. This is done throughjoiningthe family
system andaccommodatingto its style, getting to feel what it is like. He
or she will acknowledge the painful situation, but absolve the individual
from responsibility, for example, ‘You are quite childish: how do the others
manage to keep you that way?’ He or she willreframethe symptom as part
of the family structure and use the force of their personality, which should
be powerful and empathetic, to help bring about change. To do this they
may need tounbalancethe system by exposing dysfunction, and destabilise
it to encourage the emergence of a healthier structure. They may get
the family toenactthe problem within the room to see what is going on
and provide alternatives, for example, if the daughter is anorexic, have a
family meal.
Strategic family therapy
Here therapists use a range ofstrategiesto get rid of the specific set of
presenting symptoms. Unlike structural therapists, strategic therapists are
not concerned about imposing some predetermined normative structure
on the family.
This mode of working arises out of an interactional approach, where one
communication is seen as arising in the context of another, not in isolation.
In the case of children fighting, for instance, it is inappropriate to ask ‘who
started it’; since each party would say that they were only reacting to what
the other did. Therefore, it is necessary to take the whole system as the
unit of study.
Watzlawick stated that ‘All behaviour is communication’: just as it is
impossible not to behave, so it is impossible not to communicate. For ex-
ample, the husband who withdraws and ‘refuses to communicate’ with his
wife is in fact speaking volumes about his resentment, anger and rejection
of her. Paradoxical communication is confusing, typified by the double
bind, where the first ‘bind’ is that the content and form of the message may
contradict each other, and the second bind is the meta-communication
that you are not allowed to notice the contradiction, for example, when
a mother says to her daughter ‘lovely to see you’, while giving her a
frozen stare.
The current pattern of communication and behaviour is held to maintain
the presenting problem; its history and aetiology are seen as irrelevant. As
a consequence, this can be a very optimistic therapy where, for example,