Professional Documents
Culture Documents
Brief Strategic Psychotherapy
Brief Strategic Psychotherapy
I, 1995
This paper describes and illustrates the brief, strategic consultative process
of the Mental Research Institute (MRl). A verbatim transcript of an actual
consultation is provided to demonstrate the isomorphism between strategic
clinical practice and consultation and the integration of strategic interven-
tion within a psychodynamic frameworlc. The inherent challenges ofprovid-
ing MRI consultation to therapists who subscribe to different therapeutic
models is evidenced and discussed in this paper.
Address correspondence to Patrick Morrissette, Alberta Child Guidance Center, S40S #47A Avenue,
Wetaskiwin, Alberta, Canada T9A OLB.
46
Strategic Psychotherapy: Mental Research Institute Model 47
DRAWING A DISTINCTION
CASE EXAMPLE
TH: I have a client who is now 53. I have seen her since 1986, which is longer
than I see most people, two and a half years.
JW: I should tell you that while I am known as a brief therapist, I sometimes do
brief therapy rather extensively. I usually blame myself when that happens, but
I can still blame the patient sometimes.
[To increase cooperation, and sidestep power struggles, the consultant avoids
assuming an authoritarian position by sharing a personal shortcoming with the
therapist. This position implies equality and invites the therapist to reduce his
own anxiety.]
TH: I love to blame her because she is driving me up the wall. She has gotten her-
self very much in a pickle in all kinds of ways, and is not paying attention to
Strategic Psychotherapy: Mental Research Institute Model 49
that. She is not going to do any better unless she does. She insists on finding
herself gUilty and responsible for all of the bad luck she has. She is an adult
child of an alcoholic among other things and, is part of the pattern, except that
I don't seem to be able to break it!
JW: What did she say she came to see you about in the first place?
TH: She has been in a marriage, her third, after having been single for many
years. She had married a widower, a recent widower. She had been with him a
year and a half, and this is something she really wanted, being married. The
man is very nice, witty, charming, debonair, and everything; occasionally has
big rages. And he walked out on her. He may have married too soon after
being a widower, he wasn't ready, all kinds of reasons in his psyche, and she
was left abandoned after finally having reached her life's dream, which was to
be Mrs. Something. She was totally distraught and wanted to find out what it
was about her which made her get hated that much by men, by people. She
proceeded to be very hostile to me in no time at all, making it harder for me to
be of help. I thought that in her situation it would help if one saw what was
going on in this marriage. Maybe it can be put together. Anyway, I called the
husband and got him to come in with the wife, and 10 and behold after we
worked together for a while, they got back together. She was really very happy
and content.
JW: This sounds like a so-far-so-good story. Then what?
[The consultant models an "if it ain't broke, don't fix it" approach and contin-
ues to track the therapist. Strategic therapists take the position that a contract for
therapy should only be agreed upon when a client asks for a change in their lives,
regardless of the therapist's personal assessment.]
TH: They were doing so well that they stopped coming together, and when they
stopped coming together things didn't go so well. And six months after I
stopped seeing them as a couple, he walked out again. Now she is much lower
than she was in the first place and blaming herself and vituperating against an
evil world, and totally unable to detach from this man. All she talks about is
him and why does he hate her and why doesn't he want to be friends and civil
and so on. And I cannot move her away from that, into a place that would be
constructive, into a place that would be doing things for herself. She will not
let me. And the complaint that she has about the world is she is now 53 and
terrified of growing older, which has some reality in this society. Her one great
50 Weakland, Johnson, and Morrissette
asset is extraordinary beauty, that saved her from terrible places along the way,
and that is failing or changing. She doesn't see men coming to life when she
comes into the room. Second is financial fears. Her husband is very much of a
penny pincer. He is intent on not giving her any more than he is forced too.
Her job, she now selling real estate which is very "iffy" and not paying her-
self enough to survive. And she is really flaking out in so many ways. She
totalled her car while in a conversation. Not a suicidal gesture, she didn't look
at the light or something like that. She misses appointments or comes at the
wrong time.
JW: Is she pursuing her business in the same fashion?
(The consultant searches for a stylistic feature (Beier & Young, 1986) which,
when changed, can create a ripple effect in the client's life [Rabkin, 1977].)
TH: Probably. I insist she write things down, but then she forgets where she puts
it when she writes it down. So she is really flaking out in so many ways. Now
Sam has put her on antidepressants.
SAM: When she first came in she really had an agitated depression. It was very
hard to regulate her on antidepressants. The only thing that worked was a very
small dose of a major tranquilizer plus antidepressant. It quieted down her
thinking and got her to think a little more clearly, and that is the period of time
when she did well and the marriage got back together. And then I didn't hear
from her and she got off the antidepressants, and she came in all agitated
again. The original medication didn't work and she is now on an unusual anti-
depressant, Ludiomil. The therapist's description is very accurate. She is very
angry, very irritable, grating kind of person, and completely unaware of that. I
don't think she has always been like that. It is hard to believe she could work
with people with that kind of personality she has now, being in a people job.
TH: She would run out of medication on Friday night and call Sam and be totally
upset at the fact that Sam is unavailable.
SAM: And uncaring. And at the pharmacy she wanted me to call the medication
into would be one of those pharmacies which closed Friday at 7:00 pm, so
there was no way I could call it in, and then she would just berate me.
JW: If I am picking this up, that wasn't her fault, that was your fault?
TH: She was telling Sam how terrible I am and telling me how terrible Sam is.
SAM: She's fallen into a den of thieves, you know.
TH: And what we want to know is where we can refer her out!
(general laughter)
Strategic Psychotherapy: Mental Research Institute Model 51
JW: Let me make sure I have got my ticket to San Francisco before I go any fur-
ther with that.
(general laughter)
[The consultant responds with humor [Belson & Furman, 1988] in a process
which was beginning to take on a air of frustration and desperation. Rather than
offering any comments on the client's personality or behavior, the consultant con-
tinues to track and remain focused on patterns by asking the question "how?".
This is significant in that this word usage assists the consultant in avoiding
becoming entangled in a web of emotions and hypotheses which typically fol-
lows the question "why?".]
JW: All right, have you any information as to how they split up again after the six
month honeymoon?
TH: We would defuse possible arguments, and the husband, a witty man, would
appreciate a little joke and everything would be back in proportion. And she is
a beautiful woman, and he was very much in love with her. And once they
defused the arguments, they could function very well and have fun. When I
stopped diffusing and they got me out of their lives, arguments started build-
ing up.
JW: What kind of arguments?
TH: The big thing is money. He is close to retirement and thinking of saving for
retirement. He would drive a Chevrolet and she got him stuck with a Porsche.
This woman is elegant and classy, and at the same time a pain. He felt out-
classed in some of her needs and demands. She is not a big spender, but in gift
giving she would buy him something elegant or expensive. He saw her as
wanting to spend more. Her need is for him to be present. Wanting him to be
there, and he wouldn't be. He needed space at different times, which she could
not accept. What provoked the break, she lost her job again. She lost a couple
of jobs in the time I have known her. She had a very good job when he met her,
lost that, and is still in court with that company that fired her. She lost a couple
of other jobs and he saw her as someone who was going to be draining him,
financially and emotionally. He cannot stand her depression, her poverty, or
any of her needs. She lost the job at the time they were both talking about sell-
ing her condo into which they both moved when they got married. They sold
his house and had the money. They were thinking of buying something
together. She pursued that at the same time she lost her job. He didn't say any-
thing, but there was some tension and he disappeared one day when she was at
work. They had a little argument but he couldn't deal with it and plain disap-
peared.
JW: Like escaped?
TH: Yes, like escaped. A month before I saw them walking down the street joy-
ful.
52 Weakland, Johnson, and Morrissette
JW: Well, the picture I get of her ... it's nothing very penetrating, but the picture
I get, and check me on it, that she is in a number of ways a very controlling
sort of woman who on the other side has no give or adjustment at all. She is
very unready to compromise, to adjust to the circumstances, the people she is
dealing with. Am I picking it up right? OK. This would seem to be enough to
account for most of her trouble, simply the way she is behaving. You get into
all kinds of difficulties, one after another, that way. You very easily lose a
series of jobs this way, and I presume, she is not seeing herself in this light.
TH: She sees herself as a total victim. And yet she wants at the same time to do
very deep therapy to find out how she is responsible for all the terrible things
that happen to her.
JW: OK, what have you tried with her?
TH: Nothing sticks, I think I have tried everything, and nothing sticks.
JW: OK, but I need to know what you have tried that has fallen off.
[The consultant subtly models the principle of utilization by mirroring the ther-
apist's metaphor of "stickiness," as well as to ensure that more of the same does
not occur. By learning what has been already tried, the- consultant can avoid
repeating unsuccessful strategies.]
TH: Tried to deal with her in a more behavioral way in terms of getting her life a
little more in order and dealing with issues. That will last only during the time
Strategic Psychotherapy: Mental Research Institute Model S3
we talk. I have tried to talk to her about her behavior, how I see it with me, and
she interprets that as rejecting.
[The therapist sees himself as working hard to help the client change, when the
client appears uninterested in such change.]
JW: If you try to clarify the way she is actually behaving in your observation, you
are attacking her.
[Again, before offering any suggestions the consultant clarifies a previous ther-
apeutic intervention and subsequent client behavioral feedback. Note the thera-
pist has not yet asked for an intervention, and the consultant is waiting for this
invitation. ]
TH: That's right, that's right. It seems like everything I would say, she would find
a kicker to interpret one way why it won't work. She has also gone to groups
of Adult Children of Alcoholics and things of that kind, and she come back to
me with some great insights and that has never taken either. What have I not
tried?
[At this point, the therapist begins to ask for an intervention, perhaps respond-
ing to the consultant's question, "What have you tried?" Up until this point, the
therapist and consultant are in a "complainant" relationship, and now the rela-
tionship has moved toward "customer" status [de Shazer, 1988].]
TH: OK.
JW: What struck you is that you realize you don't see why in the world she
should be coming to you.
S4 Weakland, Johnson, and Morrissette
[As Haley [1987] points out, giving directives is the basis of strategic therapy.
The consultant will not help the therapist understand his contribution to the diffi-
cult relationship with the client, since insight is considered an ineffective inter-
vention. Instead, a directive is given which, when followed, will create a pro-
found change in the relationship. Perhaps following that, the therapist will gain
insight, or perhaps not. But having learned a better way to conduct himself, the
therapist is likely to generalize this one-down intervention to other difficult rela-
tionships. ]
[The consultant works to reduce the anxiety of the therapist through compres-
sion (Stanton, 1984). The therapist has lost his maneuverability, and the consul-
tant works to restore that. Note also the timing suggested by the phrase, "I would
go that far and wait for her response." With this embedded suggestion, the con-
sultant coaches the client on the proper method of intervention with little expla-
nation.]
[The therapist must think through the most likely responses to this interven-
tion, and have a helpful response to each, beginning with the notion that the client
is "totally abandoned." By saying, "She might claim that" the consultant invites
the therapist to reconsider such a response; whereas, taking it at face value had
previously trapped him. Through this therapeutic challenge, the therapist can
begin to empower the client rather than continuing to see her as unresponsive.]
TH: She says that, but she says that at the wrong place.
JW: I know, and I am trying to get her to the right place. If she says it in these cir-
Strategic Psychotherapy: Mental Research Institute Model ss
cumstances, what I would say is that I don't see that at all. It's circumstances,
impinging on you from the outside. I don't see how you are involved in any
way. And I am going to stay with that position, until she proves to me she has
something to do with it. I am not going to believe it unless she sees and dem-
onstrates how she had something to do with it.
[The consultant cautions the therapist against the client giving "lip service" to
the idea of responsibility without a genuine commitment. The purpose of doing
so, is to assist the therapist in avoiding a relapse into his current style of trying
harder to help her than she tries to help herself.]
JW: Otherwise, I am going to stick to the position that she is the unfortunate vic-
tim of the world out there. I feel terrible about that, but I am not in control of
the world out there.
TH: Something stops me from picking up this tack, which I think is absolutely
brilliant and wonderful in many cases like that. In this one something stops me
that you have to help me with.
JW: All right, I don't know if I can, but ...
JW: Well, that certainly is conceivable. But it certainly strikes me that up until
now that although she has devastated herself, she has devastated other peo-
ple considerably more. At considerable cost to herself, she has been giving
other people a hell of a hard time, including the two of you. Beyond that I
can't say much except that fragility is one of the strongest weapons of our
patients. Sort of like fragility is the other end of the rope that goes over the
beam, and it ends in a noose around our neck! If I touch that, she is going to
touch that rope.
JW: I am seeing a family right now.... the girl is 18, gets involved with some
guy, gets pregnant, has an abortion, he washes his hands of her. She says, I
think once, "I don't see any point to go on." And the father has gone around
every day from that one statement thinking, "If I do anything effective to han-
dle that girl, she will commit suicide one minute later." And really, I am
hardly exaggerating his attitude. He is petrified about any form of anything
other than responding to her demands, no matter how outrageous they are.
[In a humorous way, the consultant indirectly restrains the therapist and pro-
vides a therapeutic challenge by suggesting that when faced with challenging
times, an old pattern might overcome him. Therapeutic relapse is predicted and
suggested as a strategy for the therapist.]
DISCUSSANT: It's fascinating. We get stuck in more of the same, and more of
the same isn't working. It's like, when does it sink in?
JW: Well, yea, but this is what I expect, because we have problems, and when we
have problems, they are the same basic shape, in my view, as the problems of
our patients. It's getting stuck with something that's not working, and going
around and around with it. So we may be able to see theirs in this form, but it's
harder to see our own. But it's the same sort of thing.
[In simple terms, the consultant states that the task of therapy is to interrupt
vicious cycles. This view reduces the distance between therapist and client by
suggesting that both share the same human dilemma. Joining the client is not a
technique but rather a position which flows naturally from perceiving this simi-
larity.]
58 Weakland, Johnson, and Morrissette
CONCLUSION
The non-confronting and respectful style of the MRI approach to consultation was
demonstrated in the preceding case example. The consultant was successful in
imparting new information to the therapist without participating in unproductive
power struggles. The ability of the consultant to quickly create a collaborative
context empowered the therapist while reducing his performance-based anxiety.
In strategic therapy there is generally a long period of information gathering
through questioning and clarifying. At the end of the session, an intervention is
made, sometimes after consultation with a team behind the one-way mirror (de
Shazer, 1988; Fisch, Weakland, & Segal, 1984). The consultant modelled that
process by gathering information and formulating a single intervention which he
presented later in consultation. Therapist objections and fear were primarily dealt
with through reframing and metaphors.
The concept of "customer status" (de Shazer, 1988; Segal & Watzlawick,
1985; Fisch, Weakland, & Segal, 1982) was illustrated and the technique of
holding back therapy to help the client create a solvable problem represents a
useful skill for therapists. The client who presents in therapy can be seen as a:
(1) customer, (2) complainant, or (3) guest or visitor. If a client is seen as a
"customer," he or she will express: (1) there is a problem, and (2) there is will-
ingness present to try something different. The "complainant" will complain,
or express problems, but will not demonstrate an effort to do something differ-
ent. The "visitor" will deny there is any problem and therefore, will not
behave differently.
In the case example, the therapist appeared to fit the "complainant" classifica-
tion through much of the consultative process (unwittingly mirroring the relation-
ship he has with the client). In an effort to avoid power struggles and create a
"customer" relationship with the therapist, the consultant effectively maintained
a one-down relationship.
Finally, the consultant predicted and openly discussed possible therapist
responses to the intervention. The notion of being able to predict likely client
reactions and eventual outcomes is a useful tool in helping the therapist maintain
or alter therapeutic directions.
In a follow-up interview two years later, the therapist in the case example,
reported he had not used the intervention offered and the case had continued
along in the same direction. At the present time, the client is still in psychother-
apy with the therapist (who reports satisfaction with progress of therapy).
An obvious drawback of a single consultation is the lack of clinical experi-
ences with a particular model that can effect a conceptual shift. Perhaps, a series
of experiences throughout the course of MRI brief therapy (ten to twelve ses-
sions) would prove more effective. Through such a process, the therapist could
begin to shift perceptions about therapy and alter his or her behavior during ther-
apeutic process.
Strategic Psychotherapy: Mental Research Institute Model S9
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