What Is Strategic Family Therapy?

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What Is Strategic Family Therapy?

Strategic family therapy (SFT) is a short-term family therapy treatment that is often used for families with children or adolescents who are dealing with behavioral issues.

In a safe therapeutic setting, a therapist designs interventions with the family to replicate family interactions and conversations in order to resolve problems specific to the family's structure and create behavioral change. SFT is an active form of therapy. It is designed to be brief, directive, and task-oriented.

Strategic family therapy is based on the premise that the family plays the most important role in the life and development of children. This type of therapy seeks to identify and change the structural interaction patterns that make up the family environment. By addressing family behaviors and interactions that contribute to problem behavior, this approach helps families function better so that kids can overcome issues they are experiencing.

This article discusses how strategic family therapy works, its uses, and its efficacy. It also covers how to get started if you think this approach could be helpful for your family.

Types of Strategic Family Therapy

Brief strategic family therapy (BSFT) is a short-term model that typically consists of 12 to 17 weekly sessions, depending on the severity of the presenting problem. A typical session lasts 60 to 90 minutes.

It is an evidence-based practice that addresses and treats externalizing and internalizing symptoms in children and adolescents ages 7 to 16.

Externalizing symptoms may include rebelliousness, truancy, delinquency, substance use, and association with problematic peers. Internalizing symptoms include depression and anxiety.

Related types of therapy that also focus on treating families include:

Techniques of Strategic Family Therapy

SFT is tailored to each family's unique situation and structure. Listed below are some of the techniques that a strategic family therapist may utilize as they work with families.

Joining

The first step involves creating a therapeutic alliance with the family. This relationship involves mutual respect and consideration.

Joining is a therapeutic stance that allows the therapist to enter the family system, shows the family that the therapist is on their side, and allows family members the opportunity to seek and initiate change.

Tracking and Diagnosing

Once a therapeutic relationship has been established, the therapist will then work to learn more about the family's behavior patterns and problems. In doing so, they can identify strengths and maladaptive patterns of interaction that will allow them to develop a treatment plan.

Restructuring

Restructuring involves different techniques designed to support a family in changing the ways they respond to each other. Some interventions SFT therapists may use include:

  • Enacting transactional patterns: Having family members act out patterns with each other, without describing or verbalizing them
  • Recreating communication channels: Having family members talk directly to each other—not about each other to the therapist or another family member
  • Manipulating space: Noticing who sits where in sessions and moving them
  • Escalating stress: Increasing the family's experience of stress, to see how they manage it and to help them practice more effective coping strategies
  • Assigning tasks: Changing and practicing different communication patterns, such as giving the family homework to change how they are seated at dinner
  • Reframing: Helping the family shift the definition of a problem respectfully and honestly
  • Unbalancing: The therapist briefly joins a subgroup or individual in the family and uses their authority to change relational dynamics

The goal of restructuring is to help practice and support more productive, constructive interactions that promote change.

Recap

A strategic family therapist will utilize techniques including joining, tracking and diagnosing, and restructuring to understand and change problematic family dynamics and behaviors.

Additional Techniques

Some additional techniques of SFT include:

  • Directives: The therapist provides direct instructions on what to change and how.
  • Covert change: The therapist provides more subtle suggestions or indirect feedback to encourage change within the family session (such as praising desired behavior or ignoring non-desired behavior).
  • Pretend techniques/reversals: The family is encouraged to act “as if”—or to imagine another set of circumstances to act differently than they normally would.
  • Hypothesizing: The family is encouraged to ask the question "What would happen if...?"
  • Circular questioning: The therapist asks the same question to multiple family members to illustrate various perspectives of the same issue or problem.

What Strategic Family Therapy Can Help With

Strategic family therapy can be helpful for:

  • Aggressive behaviors
  • Conduct problems
  • Delinquency
  • Noncompliance
  • Substance use problems
  • Risky sexual behavior
  • Violent behavior

This approach is often used in situations where young people have come into the juvenile justice system due to drug use, delinquency, or violent behaviors. It can be helpful for improving family functioning, increasing positive parental interactions and parental involvement, strengthening peer relationships, and improving prosocial behaviors.

Family therapy can also help:

  • Facilitate and improve communication between family members
  • Shift and change inflexible family rules, roles, and coalitions
  • Strengthen the family system
  • Allow the family to understand and handle challenging situations
  • Increase separation and individuation of family members
  • Solve family problems and improve the home environment

Family therapy may be helpful for a child or adolescent with a personality, anxiety, or mood disorder that impairs their family/social functioning, and can also be helpful when a stepfamily is formed or begins having difficulties adjusting to new family life.

Benefits of Strategic Family Therapy

Strategic family therapy can benefit families in a number of different ways. Some of the key benefits of this type of therapy are that it: 

  • Improves communication between family members
  • Helps form, strengthen, or enforce healthy boundaries
  • Improves positive parenting
  • Strengthens conflict resolution skills
  • Builds family cohesion

The basic premise of strategic family therapy is that how the family functions and interacts plays a pivotal role in a child's symptoms. By changing how the family functions, this treatment reduces the risk factors that contribute to behavior problems and helps protect kids from future issues that may arise. 

Flexibility is another important benefit of structural family therapy. Because it is adaptable, it can be utilized in a broad variety of family situations including single-parent households, multigenerational households, and stepfamilies. 

Strategic family therapy can help people from a range of different backgrounds when practiced by a culturally-sensitive therapist. Cultural factors and multigenerational patterns have strong influences on families, so it is important to seek out a culturally responsive therapist who can explore and address these as part of treatment.

Recap

Some of the key benefits of strategic family therapy include improving family cohesiveness, improving communication, and improving parenting behaviors.

Effectiveness

Evidence suggests that strategic family therapy can be effective in treating teens who are experiencing substance use, mental health conditions, and other difficulties.

  • One clinical trial found that a Brief Strategic Family Therapy (BSFT) improved family engagement and retention. It also improved parent-reported family functioning. However, there were no significant differences in self-reported adolescent drug use between the BSFT group and the treatment-as-usual group.
  • Another study found that teens who had mental health problems exhibited fewer internalizing and externalizing symptoms after treatment with strategic family therapy. In post-therapy interviews, parents also reported feeling more effective as parents and engaged in more authoritative parenting practices as opposed to permissive or authoritarian ones. 

Things to Consider

While strategic family therapy can be beneficial and effective, it is important to recognize that there may also be some challenges. While strategic family therapy can be helpful in many cases, it is not always the right choice for every problem or issue.

Participation

It is important for family members to participate in the treatment process. One problem, however, is that the same dynamics that play a part in contributing to behavior problems can often interfere with families working together to get help. It is not uncommon for some family members to be less cooperative or to refuse to attend therapy sessions altogether.

Resistance

How people come into treatment may also have an impact on participation and outcomes. Teens are often referred to strategic family therapy through the criminal justice system. Researchers suggest that those entering treatment often feel hopeless and blame others, including family members, for their problems. This can make initiating and maintaining treatment more challenging.

Difficult Emotions

It is also important to recognize that the treatment process involves talking in-depth about emotional problems, conflicts, and difficult relationships. This can be upsetting for many people and it isn't uncommon to go through a period of feeling worse before the situation improves. Because of this, it is important to work with a skilled professional who can help members of the family deal with strong or difficult emotions.

Ethics of the Therapist

Due to the nature of many of the interventions utilized in SFT, the therapist needs to be extremely careful and mindful about the ethics of their actions. Some of the interventions can be manipulative and may be harmful if not performed carefully, professionally, and mindfully.

Recap

Strategic family therapy isn't right for every situation and there can be challenges that may affect the treatment process. Working with a skilled therapist can help address some of these issues.

How to Get Started

The brief form of strategic family therapy is typically short-term, lasting a period of approximately 12 weeks. However, it may also last longer depending on a family's needs and the problems that are being treated. 

It may involve all members of the family, but in some cases, it may involve those who are able or willing to take part in treatment.

If you think this type of treatment would be helpful for your family, you can start by asking your healthcare provider for a referral to a professional in your area. You may also be referred to a therapist through a social worker or a school counselor.

Another option is to search for a therapist using the online directory provided by the American Association for Marriage and Family Therapy. 

Once you find a potential therapist, ask them about their background, experience, and approach to treatment. Therapists who offer this type of treatment often have a master's or doctorate degree in a field such as psychology, social work, counseling, or marriage and family therapy.

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6 Sources
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