Module 8:
Brief Strategic/
Interactional Therapies
TIP 34 Reference
Chapter 5: Brief Strategic/Interactional Therapies (pp. 87-104)
TIP 34 Book
Trainer Notes
Training Emphasis
1. Key Concepts of Brief Strategic/Interactional Therapies
2. Models Used for Brief Strategic/Interactional Therapies
3. Research on Brief Strategic/Interactional Therapies
4. Types of Settings and Clients Appropriate for Brief Strategic/ Interactional
Therapies
5. Applications of Brief Strategic/Interactional Therapies in Substance
Abuse Treatment
6. Duration of Brief Strategic/Interactional Therapies
7. Evaluation of Effectiveness of Brief Strategic/Interactional
Therapies
8. Strategies Used for Brief Strategic/Interactional Therapies
9. Participant Strategy Integration
Learning Objectives
1. Participants will be able to identify three key concepts about brief strategic/interactional therapies.
2. Participants will be able to identify three models used for brief strategic/interactional therapies.
3. Participants will be able to identify three research findings about brief strategic/interactional therapies.
4. Participants will be able to identify three settings or clients appropriate for using brief strategic/interactional therapies.
5. Participants will be able to identify three applications of brief strategic/interactional therapies with substance abusers.
6. Participants will identify one new brief strategic/interactional therapy strategy to integrate into their practice.
7. Participants will identify at least one quality assurance and improvement procedure for the new brief strategic/interactional therapy strategy.
Agenda
1. Welcome (2 Minutes)
2. Brief Strategic/Interactional Therapies Summary Grid Overview and
Discussion (20 Minutes)
3. Strategy Identification Exercise (10 Minutes)
4. Strategy Integration Mind-Map Exercise (10 Minutes)
5. Assignments and Closing (3 Minutes)
Training Equipment and Supplies
1. White board and erasable markers – OR – newsprint pad, markers, and easel
2. LCD projector – OR – overhead transparency projector
3. PowerPoint slide CD – OR – overhead transparencies
4. Moveable seating
5. Nametags (optional, reusable or disposable)
6. Attendance record
7. Pens and colored pencils or crayons
8. Continuing education certificates (optional)
Definition of Terms
Deliberate Exception: A situation in which a client has intentionally maintained a period of sobriety or reduced use for any reason. For example, a client who did not use substances for a month in order to pass a drug test for a new job has made a deliberate exception to his typical pattern of daily substance use. If he is reminded that he did this in the past, it will demonstrate that he can do so in the future.
Miracle Question: A solution-focused interviewing strategy in which the therapist asks the client the question, “If a miracle happened and your condition was suddenly not a problem for you, how would your life be different?” This forces the client to consider a life without substance use and to imagine him/herself enjoying that life.
Random Exceptions: An occasion upon which a client reduces substance use or abstains because of circumstances that are apparently beyond his control. The client may say, for example, that he was just “feeling good” and did not feel the urge to use at a particular time but cannot point to any intentional behaviors on his part that enabled him to stay sober. In such instances, the therapist can ask the client to try to predict when such a period of “feeling good” might occur again, which will force him to begin thinking about the behaviors that may have had an effect on creating the random exception.
Participant Workbook
(One for Each Participant)
Participant Workbook
Time Clock
1. Module 8 Handouts
a. Module 8 Packet Cover
b. Brief Strategic/Interactional Therapy Summary Grid c. Strategy Identification Exercise
d. Strategy Integration Mind-Map Exercise
2. Homework: Handouts for next TIP 34 Training Module
Module 8 – Section 1
Welcome Introduction
Time: 2 Minutes
Trainer Notes
This section can be didactic or involve low group interaction.
Trainer and participant introductions are not necessary as these were done in Module 1.
Trainer Script
Welcome Topic Introduction
Welcome to the TIP 34 training on brief interventions and brief therapies.
Our topic for this training is “Brief Strategic/Interactional Therapies.”
A basic tenet of this approach is the assertion that human problems can be understood by applying the principles of human systems. Problems do not exist in a vacuum. They exist because of relationships with others. A positive
change to one part of a system will positively affect the rest of the system.
We will explore a variety of aspects about brief strategic/interactional therapies that are highlighted in the Summary Grid in your handout packet.
We will also use the Strategy Identification Exercise and the Strategy Integration Mind-Map to identify a new brief therapy strategy that you want to integrate into your personal practice.
Time Clock
Trainer Notes
Module 8 - Section 2
Brief Strategic/Interactional Therapy Summary Grid
Time: 20 Minutes
Trainer Notes
This section is a combination of didactic presentation and large group discussion. It can involve low to high group interaction.
The trainer should not read each item from the Summary Grid. Summarizing each section of the grid, as well as adding additional information available in the trainer script or through personal clinical experience, will make the training more interesting.
Integrating group discussions with each section will enhance the effectiveness of the training. Group discussions allow participants to learn from one another as well as from the trainer.
The trainer always facilitates the group discussion and interaction. The trainer’s role is to provide expertise and guidance, and not to prescribe the use of any one model for brief interventions. The trainer maintains focus of discussions on the topic, and is also the leader and timekeeper for the group.
The focus topic of the discussions is the feasibility of using these approaches within the guidelines and services of the agency.
The trainer can initiate discussion with open questions:
■ Does anyone in the group have expertise in using brief strategic/
interactional therapies?
■ What types of brief strategic/interactional therapies strategies are within the established guidelines for our agency?
■ What types of brief strategic/interactional therapies strategies are currently used in our agency?
■ What other types of brief strategic/interactional therapies could be used in our agency?
■ What resources for brief strategic/interactional therapies exist outside of our agency?
TIP 34 Reference
Chapter 8: Brief Strategic/Interactional Therapies (pp. 87-104)
Participant Workbook
Participant Workbook
■ Brief Strategic/Interactional Therapies Summary Grid
Trainer Script
Key Concepts
Brief Strategic/Interactional therapy identifies client strengths and creates personal and environmental situations where success can be achieved. The therapist helps the client solve significant problems while strongly reinforcing the client’s success.
Interactional therapy is based on the assumption that problems can best be understood by examining the client’s interactions (often dysfunctional) with others and the resulting problems.
Strategic therapy is a form of interactional therapy because it does not focus on the root causes of the client’s problems but tries to increase competency and develop problem-solving skills that will help the client in his/her interactions with others.
Brief Strategic/Interactional therapies are based on three primary theoretical assumptions:
1. These therapies take a constructivist view of reality, and assert that reality is determined by individual perceptions that are influenced by cultural, sociopolitical, and psychological factors.
2. These therapies stress the importance of the attribution of meaning. The meaning that a client attributes to situations determines if a problem exists. An important therapeutic goal is to understand the meanings that clients attribute to events— often referred to as a “frame of reference”— and to use this knowledge to promote constructive change. This can involve helping the client to construct a different meaning that is more useful in the recovery process.
3. These therapies focus on human interactions and the problems that evolve from
ineffective ways of coping with situations. There is always some element of
social interaction in the development, maintenance, and change process for any
problem. By taking these interactions into account, the therapist can better
support the client through the change process.
Client Frame of Reference
Strategic/interactional therapies offer a client ways to make effective changes by working within the client’s frame of reference:
1. The therapist can define what the client might do to change key interactions that contribute to substance abuse.
2. A strategic approach accepts the fact that a client may not always provide accurate information about the real nature of his/her problem.
3. Instead of trying to convince the client that s/he really does have a problem, the therapist works within the client’s view of the situation and what is happening, even if that view is only partially “correct.” (e.g., “So your boss thinks you have a problem. What would it take to get him off your back?”).
4. The assumption that the client wants to be free of the problems gives the therapist something on which to focus without challenging the client’s view of the situation.
5. Because this approach works within the client’s language and functional level, a client with a cognitive disability may be able to identify and meet goals appropriate to his/her skills and abilities.
Client Types
Clients are traditionally defined as customers, complainers, or visitors:
1. Customers are clients who state that they have a problem, they cannot cope with the problem on their own, and they need the therapist’s help. Most clients with substance abuse disorders can be viewed as “hidden customers” who desire some sort of change in their behavior, even if they are not willing to articulate that fact.
2. Complainers are those who think someone else should change to resolve the presenting problem.
3. Visitors see their presence in treatment as involuntary.
4. The therapist’s task is to make the “complainer” or “visitor” aware that s/he is in fact a “customer” of the therapist’s services.
Family Interactions
Because the substance abuser typically feels helpless, inadequate, and denigrated by family members, family—or the client’s reaction to them—may have influenced his/her decision to begin or stop using.
Even if a client seems to have no existing family connections, the family sometimes plays a role in his/her substance abuse.
This approach is distinct from a structural view of systems. The structuralist sees the need to change dysfunctional aspects of the larger family structure, whereas the strategic therapist does not posit a system-wide dysfunction—only the existence of ineffective interactions within the system.
For example, in a situation where one partner pushes the other to stop drinking, the partner who has been drinking may feel controlled and demeaned and, therefore, may withdraw in a passive manner or reacts with an explosive temper. He then gets drunk to further express his anger or to get even. The partners’ respective behaviors maintain the problem.
When the strategic/interactional approach is applied to power struggles within the family, it can help to “open up the system,” change the client and family’s perceptions of one another and their relationships, and enable them to see a broader range of options.
Brief Strategic/Interactional Therapies
TIP 34 includes four models for brief strategic/interactional therapies:
1. Eriksonian Therapy
2. Solution-Focused Therapy
3. Mental Research Institute (MRI) Therapeutic Model
4. Jay Haley’s Problem-Solving Therapy
Eriksonian Therapy
All strategic/interactional models owe their origins, in part, from the work of Milton Erikson. Erikson coined the term “strategic therapy” to describe an approach in which the therapist takes responsibility for finding new and effective strategies to help clients in distress.
With his unique use of hypnotherapy, Erikson fostered rapid changes in his clients, often in an indirect fashion. This approach has been especially useful in helping people let go of trauma, break through resistance to change, and alter obsessive–compulsive, phobic, or addictive behavior.
Erikson emphasized the unconscious factors in change and the importance of indirect ways to shift meanings and behavior. The symptom is viewed as a communication that conveys information about developmental needs.
Metaphor is used as an indirect intervention—a way to help the client retrieve resources and create a unique response that builds a bridge for learning. Suggestion is used as a means of bypassing an impasse, reframing the problem, and taking a first step toward its solution.
The Eriksonian approach is active, building on the client’s resources to
attain goals. The therapist and client cooperate in building an awareness of the client’s experience and an understanding of its meaning. Together, they build a context for change.
Eriksonian therapy has an orientation toward the future (e.g., depression is seen as the result of focusing on past associations; as the client works toward change and begins to accomplish goals, s/he lets go of depression). This approach emphasizes acquiring new skills to meet the requirements of new situations (such as different ways of socializing associated with abstinence) and to handle developmental tasks.
The cure is conceptualized as the loss of the symptom and the development of new relational patterns that allow a creative response to the environment.
Solution-Focused Therapy
Steve De Shazer and his colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin developed this therapy. They shifted the focus of treatment from problems to solutions, calling their modality “Solution-Focused Therapy.”
Solution-Focused Therapy is always brief and concentrates on improving the situation.
The emphasis is placed on building exceptions to the presenting problem, and making rapid transitions to identify and develop solutions intrinsic to the client or the problem. Using exceptions to the problem and past successes opens the door to optimism and fosters confidence.
Three rules form the “central philosophy” of solution-focused therapy:
1. “If it ain’t broke, don’t fix it!”
2. Once you know what works, do more of it!
3. If it doesn’t work, then don’t do it again—do something different!
The solution-focused therapist works closely with the client to understand the client’s own perspective of the problems. It helps the client to recognize his/her own ability to solve problems, and shares the responsibility for change with the client.
The approach focuses on competence rather than pathology. Importance is placed on finding a solution to the problems that the client identifies as significant, then reinforcing the client’s success in solving those problems.
This therapy finds a unique solution for each client, and the client is viewed as the expert. Goal-setting is used to chart a path toward change.