The Therapist Who Told Couples to Fight More

What if the most effective thing a therapist could do was tell a couple to schedule their arguments?

What if a child's panic attacks weren't a problem to fix — but a protection someone needed?

What if the most important thing a family could do was learn to say what they actually mean?

Three questions. Three different visions of what family therapy is for. This week we cover all of them.

In Part 2 of the Licensure Lifeline family systems series we go deep on strategic family therapy and experiential approaches — two of the most distinctive and testable frameworks in family systems work.

Strategic Family Therapy — Haley & Madanes Jay Haley built an entire approach on one belief: insight is optional, change is not. We cover directives and paradoxical directives — including why prescribing the symptom actually works. Ordeal therapy — Haley's most provocative contribution. And Cloe Madanes' extension of the model — the protective function of symptoms, and the pretend technique for working with children.

Experiential Family Therapy — Virginia Satir Satir believed most human suffering came down to one thing: low self-worth. We cover her four communication stances — placater, blamer, computer, and distracter — and the belief underneath each one. Family sculpting — using the body and physical space as primary clinical tools. The temperature reading — a five-component structured communication exercise. And congruent communication as the goal of everything.

We also bring all four family systems theorists together in one comparison — Bowen, Minuchin, Haley, and Satir — so you can stay in the right framework on any exam question.

Four exam-style multiple choice questions at the end.

Want the full picture? This week's newsletter covers three additional strategic techniques and Satir's growth model in depth. Link in the show notes — always free.

SimplePractice:  Get a 7-day free trial + 50% off your first 4 months

Licensure Lifeline Website: Access the newsletter and information about the online community.  

Email Me!!: licensurelifeline@gmail.com

Transcript

SPEAKER_00 0:11

It's the early 1970s. A family comes into therapy. The parents say the problem is their teenage son. He won't listen. He's defiant. He's out of control. Jay Haley looks at the son. Then he looks at the parents. Then he says something that changes the whole conversation. He doesn't ask the son why he's acting out. He asks the parents why they need him to. That question, that subtle, almost provocative reframe, is the heart of strategic family therapy. And it was genuinely radical because it said something most therapists at the time weren't willing to say out loud. The symptoms, the symptom isn't the problem. The symptom is the solution. It's doing something. It's holding something together that the world otherwise that would otherwise fall apart. Haley had trained with Gregory Bateson, worked alongside Milton Erickson, and studied communication theory. He came to the theory with one core belief that people get stuck not because they lack insight, but because the systems around them keep them stuck. And the therapist's job isn't to help people understand that. The therapist's job is to disrupt it. Virginia Satir arrived at the same party from a completely different direction. She wasn't interested in disruption. She was interested in something much older and much simpler. She wanted people to find to feel seen. Satir believed that most human suffering came down to one thing: low self-worth. And low self-worth showed up in how people communicated, not what they said, how they said it. The body, the picture, the way someone shrinks when they speak or puffs up to avoid being vulnerable. Two completely different visions of what therapy should do. Both change the field. Both will be on your exam. Let's get into it. Welcome back to the Leicester Lifeline, the podcast that helps you build the knowledge and confidence to pass the exam and show up well in the room. I'm your host, Matt Lawson, and we're continuing with family systems series today. Um last week we got into Bowen and Minuchin, their differentiation, triangulation, enmeshment, boundaries, just the whole framework. If you missed it, go back. It was a really good one. I really enjoyed that. Um this week we're going to kind of another side of this, um, strategic family therapy. So Haley and Matt Medan's um the approach that uses directive paradox and uh deliberate disruption with uh within the therapy framework. Um, we're also going to look at it at experiential family therapy from Virginia Satir. Um that approach like puts emotion, communication, and self-worth at the center of everything. Also, want to make note if you haven't already, sign up for the Leicester Lifeline newsletter. Um, links in the notes. You can also go to LeicesterLifeline.com and find the link to get the newsletter as well. Um, the whole point of the newsletter is to go deeper into these topics that we talk about. Um, so you know, it's I'm gonna give you a lot of information today through the podcast, and then you're able to go to the newsletter and continue that studying and go to more depth on the topics. That's how it kind of underlines this. Also, check out the circle, uh, Licester Lifeline Circle community. It is up and going. Um, go take a look. Again, uh link in the show notes, as well as um you can find it through the Licester Lifeline. Um, I'm running a kind of a special right now where you can you know try it out for two weeks for free and then decide if it's something that you want to go with. The whole point of this community is to bring people together that are studying for this test, give them a place to communicate and talk and talk by their experiences, but it also has things like quizzes. Um, I have different information just around licensure. Um, I'm putting up videos, it has little cheat sheets in there, and I'm really developing it. I am, you know, I'm I'm wanting I want this to be a really nice community for individuals that just provide support in getting the test done and then also launching their careers as therapists. Also, the Licer Lifeline is now on YouTube. You can now look at the get the podcast through um YouTube as well. I'm also going to be starting what I'm calling the seventh wave series on there as well. This is going to specifically be um content for that channel around technology and mental health, emerging tech, and the way that it's impacting um mental health and um how we can support individuals in this area um through our practices. All right, enough with the announcements. Let's go into the news. First up, a major new study published this week found that mental health disorders are now the leading cause of disability worldwide. Nearly 1.2 billion people were living with mental health disorders in 2023, almost twice as many as was recorded in 1990. So just take a second just to think about how significant that is in that time, the growth of people struggling with mental health issues. And, you know, just the way the world has gone over the last couple of decades, unfortunately, not a huge surprise. But the research points to a combination of factors. Um, better diagnosis, which we see a lot of times when we see upticks in any illness, really, um, less stigma, more people are actually coming to therapy, genuine increase in prevalence in the world that has become measurably harder to navigate. But whatever the cause, the need is real and the need for us is real. So if there's ever any ever any question that you might have around, am I going in the right direction? Um, especially if I'm looking to support people, um, you are going in the right direction. Next up in the news, the Trump administration released sweeping executive orders in June, making it easier to involuntarily commit people who are unhoused and having serious mental health conditions. Mental health advocates and crisis characters have pushed back on this, noting that involuntary commitment can create what they call a revolving door that drains health systems and often harms the individuals going through it. Um, you know, this is something that we we really need to consider and look at. Um, you know, it it on the one hand, you want people to get help, you want people to get support, um, but on the other hand, you know, this does. The fact that it's making easier, making it easier for people to be um committed, you know, it's it does. It's gonna strain the system. And we need some some better guardrails in place. The the data the debate about involuntary commitment is fundamentally a systems question. Um, who decides when someone's autonomy yields to safety? Um, what happens to trust when the mental health system becomes coercive? Um, how do clinicians maintain therapeutic alliances with clients who they know um might be committed? You know, and and it and it does. Like this is the weight that it puts on on clinicians is it puts them in a place where people don't necessarily want to be there, um, but for whatever factor they've been deemed this has been deemed necessary, and you know, just being able to provide them the support they need becomes a whole other topic. So something to consider, something to keep on your radar. Speaking of systems, something about strategic and experiential therapy that nobody mentions in grad school. Both approaches are highly relational. Um, Haley would give a family homework, give a family homework and directive around around when to spend the next session unpacking unpacking what happened with that homework. Satir would have a family do sculpting exercises that took the whole session. All that is clinical work. None of it runs itself. You still have notes to write, sessions to schedule, and insurance to bill. Simple practice handles all of it. Practice management built specifically for mental health clinicians, scheduling, billing, notes, telehealth, and insurance. So you can stay in the clinical work without drowning in the administrative side. You will see how significant it is when you get bogged down on the administrative side. And that is one of the really nice things with simple practice, is it does, it just makes that part of your work that much easier and allows you to focus on being that clinician that shows up for the people that need you. There is a free trial of simple practice available. I will have a link for you in the show notes where you can give it a try, just give it a look. I do highly recommend that. Um, they're there, I've used them in my private practice. It really is a great system. Here's the thing about strategic therapy that makes it different from everything else we've covered in this series. Every other approach we've discussed wants the family to understand something. Bowen wants them to see the multi-generational patterns. Minuchin wants them to feel structure shift. Even CBT wants the client to develop insight into their own thinking. Strategic therapy doesn't care if you necessarily understand anything, it cares if you change. Jay Haley was blunt about this. Insight doesn't produce change, change produces change. And the therapist's job is to design conditions for change to happen, whether the family understands this uh or not. That that's the spirit of strategic therapy. Directive, problem-focused, and deliberately designed. This can be an extremely refreshing approach. Um, there is this idea that I've kind of deemed um kind of therapeutic drift that I see a lot of times um in my own work um that I talk to colleagues about, and it's this place where things stop being as directive as they could be. Um, there's always room for processing, there's always room for creating space for individuals. Um, there's always room for being that witness for that individual that needs to come in and talk. But also, you know, a lot of the times people are coming in with an actual desire to present a problem that they are having, um, a problem in their families that they want to come to a resolution around. And this takes a little bit more of a directive approach. Um, you need to have a little bit more of a point to the therapy that you're doing with these individuals. And these frameworks, this strategic family therapy, um, gives you that framework. The core tool in strategic therapy is the directive, a specific instruction the therapist gives the family to carry out between sessions, not a suggestion, not homework in the general sense, a precise, deliberate prescription for behavior. Directives come in two flavors, and both will be on your exam. The first is the straightforward directive. Do this. A couple who avoids conflict is instructed to have one strategic argument per week. Ten minutes, specific topic, timer goes off, and it ends. The directive creates a context that for the avoided behaviors to happen safely. Um, I have done this with couples before. It's great. Um, schedule a time to argue. It's different when you have to make yourselves argue. And especially given that it's on a timer, it changes the whole frame of the argument. I put that in air quotes. The second is the paradoxical directive. And this is where Haley gets genuinely interesting. A paradoxical directive prescribes the symptom. You tell the family to keep doing the thing they came in to stop doing. A child who throws tantrums is told to have a tantrum every Tuesday at 4 p.m. A couple who fights constantly is instructed to schedule their fights. Why would you do that? Because the symptom is spontaneous, it happens outside of any control. The moment you put it in a schedule, you take it out of that spontaneous concept context. So very similar to that, you know, that the directive piece that I talked to. Um, you know, making people do things that tend to happen spontaneously on a schedule, again, makes them frame it in a different way in their heads. Families can't have an uncontrolled tantrum on Tuesday at 4 p.m. if they were supposed to be having a controlled one. Um, the symptoms lose its power, and the family gets the evidence that they actually have more control than they thought. Because that's what happens a lot of times with these issues that people bring to us is they feel out of control. They feel like this is something that, you know, is a force of nature that they just have to deal with. They don't have a sense of control. And what this aims to do is to give them a better sense of control. Chloe Mundane's Haley's collaborator and equal brought something important to the strategic model. She focused on the function of the symptoms in the power dynamic of the family. Specifically, she noticed that the symptoms often serve to protect a function. A child's anxiety protects the parents from having to confront their marital issues. A teenager's defiance distracts from a father's depression. For mundane's, the question was always, who is the symptom protecting and from what? So the reframe here becomes from the symptoms as a problem to the symptoms as a some uh the symptoms as a protection is both clinically useful and directly testable. And again, like you are going to be blown away by how often people will come in and say, like, this is the problem. Um, my child, the prop, my child's the problem, or my relationship's the problem. And what you come to discover is the focus of that problem is allowing the individual to take away from the actual problem that they're dealing with, the deep-seated depression, the deep-seated anxiety that they're struggling with. Um not to say that those problems aren't happening, um, that the relationship is, you know, maybe maybe not going so great, or the kid is acting out. Um, but the person isn't seeing, is isn't dealing with something that they're struggling with, that's actually contributing to the problem a lot of the times, um, and avoiding it in order in in order to deal with something else. So one exam note before we move on. Strategic therapy questions often present a scenario where the therapist gives an unusual or counterintuitive instruction. The wrong answer is usually the one that says the therapist is being unethical or inappropriate. The right answer recognizes the paradoxical directive as the deliberate strategic intervention. Get that? So on the test, you might see something that makes it sound like the paradoxical directive is inappropriate. Um, it's not. It's it, you know, it it sounds like something that it could be. Um, and you know, the test the test is testing to know if you can see this as a really strategic tool that you can use. Okay, let's go into Virginia Satir. Um, she is a bit different from everyone else who we've covered in the series in general. She actually liked people. Not that the other ones didn't, but you know, she really that that was a her big focus. And that sounds kind of like a bit of a joke, right? Um, it isn't. She brought warmth and genuine belief into human potential to her work that was unusual in a field that sometimes prioritized technique over humanity. She came into therapy during a time when it was, it was, you know, people being very clinical about their approaches and um, you know, looking at the the systems that they can produce and the therapeutic interventions that they can utilize to help people. But, you know, she did. She brought a little bit more of a human, um, a warmer sense of um how we take care of individuals. At the center of her model was one idea. Most human problems come down to low self-esteem and low worth. And low self-worth shows up most clearly in how people communicate. Satir identified four dysfunctional communication patterns. She called them stances. The um these um people would adopt these stances under stress and when their self-worth is threatened. The placater is the first one, agrees with everyone, um, apologizes constantly, takes the blame, does anything to avoid conflict. Underneath, the placating is a belief. My needs don't matter. The second one is the blamer. The blamer criticizes, accuses, points fingers, takes up all the space in the room. Underneath, the blaming is a belief. I have to be in control, or I'm nothing. The next one is the computer, also called the super reasonable. Um this is you know, d detached, intellectual, emotionally flat, uses big words, explains everything, feels nothing. Um at least they show nothing. That's you know, that's how they present. Underneath is a belief of that I must not show any vulnerability. And then finally you have the distractor, um, also called the irrelevant. And this individual will shift topics, makes jokes, can't stay focused, changes the subject whenever anything gets real. Underneath is the belief there's no place for me here. And there's a fifth dance, the one Satir called congruent communication, saying what you mean, feeling what you feel, being present with without defending, attacking, retreating, or distracting. That's the goal of Satir's therapy. She wants to get people around to this dance. Um, she doesn't want insight, not structural recognition, she wants congruence. Family sculpting um was Satir's signature technique, and it's worth knowing for the exam. I I feel like I remember a question around family sculpting from the test. Um, and this involves physically positioning family members in space to represent the emotional relationship in the family. And while I don't quite remember this on the test, I absolutely remember this from grad school. Um, we actually had to do this, like play a mock family in class, and um, we did this uh positioning, positioning, this physical sculpting um of a family system. So someone volunteers to be the sculptor, usually a family member, and arranges everyone in the room the way they experience the family. It's this is fascinating. Um close, far, turned away, reaching, hunched, elevated. What it does is it takes something invisible, the emotional structure of the family and makes it visible. You can see the enmeshment, you can see the cutoff, you can feel the distance between pe two people who are technically in the same room, but as might as well be in different buildings. For the exam, family um family sculpting is satire, it's experiential and uses the body and physical space rather than language. And the purpose is to externalize the family emotional experience so it can be worked with directly. This can be so I I highly recommend you watch videos of this. It is really fascinating to see these different interpretations, how people see their family members, um, and then watching people realize like, oh my gosh, that's how people see me. Um, watching, you know, parents and kids like see how the other members of their family see them. Um it's really, really interesting. Love this, love this topic. So let's like look look at two frameworks before we get into some of the questions here. For strategic therapy questions, look for the directives. If the therapist is going or giving specific the therapist is giving specific instructions for behavior between sessions, that's strategic. If there those instructions seem counterintuitive or prescribe the very behavior the family wants to stop, that's paradoxical. The function is always to disrupt the system, homeostasis, the the system's homeostasis and create conditions for change. For experiential therapy, questions look for the body, emotion, and communication. If the question involves physical positioning, sculpting or communication stances, that's satire. If the question asks about self-worth, congruence in communication patterns under stress, that's also satire. The exam trap in this content area is assuming that a directive is inappropriate or unethical because it seems strange, right? Paradoxical directives are designed to seem strange. That's the intervention. Recognizing the intention behind an unusual instruction is what the question is testing. Okay, that's going to be it for the main body let's get into some questions. Question number one A family therapist working from a strategic framework is treating a couple who argues constantly and cannot seem to stop. The therapist instructs them to schedule a 15-minute argument every evening at 7 p.m to argue about whatever they want, then stop when the timer goes off. This intervention is best identified as a an enactment asking the couple to demonstrate their conflict in a session B a paradoxical directive prescribing the symptoms to disrupt its spontaneous function c a structural intervention reorganizing the couple's interaction hierarchy or B a Bowinian directive helping the couple de-triangulate from the outside parties the answer to this is going to be B paradoxical directive prescribing the symptoms removes it from the spont spontaneity out of control context. The argument can't function as an uncontrollable outburst if it's scheduled the couples the couple gains evidence of control they didn't know they had okay question number two according to Chloe's strategic mo Chloe Modane's strategic model a 10 year old child who develops um severe separation anxiety anxiety whenever the parents discuss divorce is best understood as a demonstrating ammeshment with primary caregiver b exhibiting a symptom that serves a protective function in the family system c showing evidence of low differentiation of self or D developing an anxious attachment style based on an early caregiving experience the answer here is going to be B a symptom that serves to protect function. Medaines extended Halley's model by focusing on protective function as a of symptoms who is the symptom protecting and from what? The child's anxiety reliably interrupts the divorce conversation. It protects the parents or the marriage from the confrontation that might otherwise happen. The symptom is not random it's a function question number three A family therapist observes that one parent speaks in long emotionally flat monologues, avoids eye contact and uses clinical language to describe the family problems never expressing any personal feelings according to Virginia Satir's model this communication pattern is best identified as a placating B blaming c computing or D distracting answer here is going to be C computing or super reasonable stance. The computer stance is a care is characterized by emotional detachment intellectualizing and avoidance and any personal personal avoidance of any personal vulnerability long clinical effect affect free descriptions of problems with no personal feeling visible anywhere. This is classical this is a this is the classical presentation of this question number four a family therapist asks a family member to physically position each person in the room to represent how some experiences the how some experience the emotional relationship in the family placing people close or far turned toward or away elevated or lower this technique is best identified as a enactment b joining c family sculpting or d unbalancing this easy um c family sculpting this is from Virginia Satir and it's one of her signature experiential techniques using physical space and body positioning to externalize the family's emotional structure it makes the invisible visible the emotional emotional distance the cutoff the enmeshment all of it becomes something the family can literally see and feel in the room okay that is going to do it for this episode know your strategic therapy framework Haley and Medaine's directive between use directives between sessions paradoxical directives that prescribes these symptoms symptoms as solutions to something and Medaine's key contribution symptoms as protection who is this symptom protecting and from what next know your satire four communication stances placators blamer computer distractor each one a defense against low self-worth family sculpting as the signature technique physically positioning body and space making the invisible visible congruent communication as the goal number three on the exam watch the signals directives between sessions equals strategic physical positioning equals satire counterintuitive instruction equals paradoxical directive not unethical intention the newsletter this week goes a bit deeper into this um that's kind of how I'm trying to frame all of this is I give you know some of the most salient points in the podcast and then I go deeper and kind of give you guys a deeper cut in the newsletter. So please take a look you know it's it is it's a really nice companion to this podcast. I think it rounds out your week next week we're moving into something completely different. We're going to be looking at some of the marriage and family therapy exam focused stuff. So this makes system systemic questions different from individual therapy questions and exactly how you approach them. If you're sitting for an M MFT exam you'll want to you do you don't want to miss this one. But you know just getting this knowledge and actually looking if this is an area that you're interested in. I have worked with couples off and on over the years. It is a different kind of therapy and you know if this is an area that speaks to you highly recommended there are there's always a need for couples counselor. It is one it is extremely difficult to find a couples counselor um in most areas. And I know that people struggle to find couples counseling in both Denver and Chicago. So keep that in mind. But until next week never stop learning take care everyone