352 Chapter 41
years of rancorous feelings and despondent explanations can be bypassed
in favour of concentrating on what can be done differently from now on.
Jay Haley and his wife, Cloe Madanes, were major developers of strate-
gic therapy. Haley wrote a number of influential books, includingProblem-
solving Therapyin 1976. He argued that symptoms were not behaviours
beyond one’s control, but a strategy for controlling a relationship when all
else failed. He cited the example of a woman who insisted her husband be
home every night or she would have panic attacks. In this way she blamed
her control of the situation on the panic attacks. Symptoms are used to
control relationships when more up-front methods fail.
Strategic therapists concern themselves with current daily communica-
tion patterns as well as with repetitive sequences of interactions between
family members. Communication defines the relationship; symptoms are
tactics in this struggle. The therapist’s goal is to manoeuvre the patient into
developing other ways of defining the relationship so the use of symptoms
as a method of exerting control will be abandoned.
Techniques
The therapist has to design a strategy for each problem, and is responsi-
ble for change. The approach is pragmatic, concerned with what works.
The therapists use their power to overcome ‘resistance’ of patients, and
are ‘manipulative’, that is, keep the rationale for intervention hidden
from patients.
Relabelling. This is a tactic to emphasise the positive, making apparently
dysfunctional behaviour seem reasonable. For example, Haley describes
telling a wife whose husband chased her with an axe that he was trying
to get close to her. Thus, both sides of a communication are examined,
and the less obvious aspect is brought out, sometimes described as
‘addressing the meta message’, in this case that the husband cared
desperately for his wife. Such relabelling can change the context of
relationships and lead on to improvement.
Directives. These are assignments set for families to perform outside the
session. For example, a mother is told to stop interrupting when father
and son are talking together. However, often these directives do not
work as the families are resistant and have invested in the status quo.
Prescribing the symptom. This may then be tried as a form ofparadoxical
intervention. The patient is told to keep on doing what they came to
therapy to stop doing. This is designed to provoke defiance in the
patient, who may come back next time and say they did it far less than
previously. If they carry on, they are forced to recognise that they have
some control over the behaviour, and confront its unreasonableness and
the effect it has on others. The domineering mother may be instructed
to carry on running absolutely all the small details of the family’s lives
and not to let anyone else have the slightest say about anything. A boy
refusing school may be instructed never to go out of the house, and
not even to look at a book. The issue then becomes one of control, as
the patient is told they are in charge of the symptom. The domineering