Strategic family therapy

1. Introduction

Version followed: the Haley–Madanes "Washington school" of strategic therapy as set out in Jay Haley, Problem-Solving Therapy (1976; 2nd ed. 1987), Leaving Home (1980) and Ordeal Therapy (1984), and Cloé Madanes, Strategic Family Therapy (1981), Behind the One-Way Mirror (1984) and Sex, Love, and Violence (1990). Haley's last statement of the model, Directive Family Therapy (Haley & Richeport-Haley, 2007; Routledge reissue 2012), is the same approach organised by family life-cycle stage. This is not the MRI Brief Therapy model (Palo Alto: Watzlawick, Weakland, Fisch) and not Szapocznik's licensed Brief Strategic Family Therapy (BSFT); those are separate entries. [source: SAGE Encyclopedia "Directive therapy"; Taylor & Francis page for Directive Family Therapy; iAST Foundations] Basis: the primary books are not drawn on directly. Supported by the cited pages: the scope of Ordeal Therapy (Crown House page), the subject of Leaving Home (Taylor & Francis page), and the components of Madanes's approach to sexual abuse and violence (Erickson Foundation 1990 workshop listing; NCJRS abstract of a 1995 book on a "therapy of social action"). Removed as unsupported: Haley's staged list for paradoxical directives, a step sequence for ordeal therapy, a step-by-step Leaving Home procedure, the order and wording of Madanes's repentance steps, and any typical session count. Where a working procedure is still given for these, it is the editor's [synthesis], not Haley's or Madanes's. Everything else comes from the secondary sources, tagged per claim.

What it is: a directive, problem-focused family therapy developed by Haley after his years with Bateson's project and the Mental Research Institute and a decade (from 1967) with Minuchin and Montalvo at the Philadelphia Child Guidance Clinic, then developed with Madanes at the Family Therapy Institute of Washington, DC, which they founded in 1976. It combines Erickson's directive and paradoxical techniques with a structural view of family hierarchy. [source: SAGE Encyclopedia "Directive therapy"; Family Solutions Institute study guide ch. 4]

Core idea of change: a symptom is a communicative, relational act that fits a recurring sequence of behaviour among at least three people, usually within a confused or "incongruous" hierarchy (e.g. a child whose symptom gives them power over, or protects, a parent). The therapist takes responsibility for change, defines a solvable problem, and gives directives (tasks, inside and between sessions) that change the sequence and reorganise the hierarchy. Insight and interpretation are not needed; change in action comes first. Madanes added that symptoms can be metaphors for another member's difficulty and that children may protect parents through symptoms; her later work (with Haley's) shifted emphasis from control to increasing family members' capacity to love, soothe and repair ("strategic humanism"). [source: iAST Foundations; Family Solutions Institute study guide ch. 4; Carpenter slides]

2. Framework

There is no session-by-session manual. The model is a set of planned stages within each case. [source: iAST Foundations: strategic therapy "a way of thinking, not a fixed set of techniques"]

Stage A. The first interview (one session, whole household). Haley treats the first session as decisive: a therapy that ends well must begin well. Everyone living in the home or closely involved in the problem is asked to attend. Four stages, in order [source: Family Solutions Institute study guide ch. 4; Carpenter slides]:

Social stage: greet each person, put everyone at ease, observe seating, who speaks for whom, who tries to recruit the therapist; form tentative hypotheses only.
Problem stage: say briefly why you are meeting and what you already know, then ask each person's view of the problem, usually starting with the less-involved adults rather than the identified patient; stop interruptions and return to the speaker; draw in quiet members.
Interaction stage: have members talk to each other (not to you) about where they disagree, or enact the problem in the room, so you can see sequences, coalitions and who is in charge.
Goal-setting stage: agree a problem that can be counted, observed or measured, give a first directive and set the next appointment.

Exit criterion: a clearly stated, solvable problem, everyone's agreement to come back, and a first task. [source: as above]

Stage B. Strategy design (between sessions, often with a team). Formulate (i) the sequence the symptom is part of, (ii) the hierarchy and any cross-generational coalition, (iii) the triad involved (symptom bearer, the person most affected, the third person whose involvement maintains the pattern), (iv) the family life-cycle transition in play and, in Madanes's version, (v) what the symptom may be a metaphor for and whom it protects. Choose a directive to fit. [source: iAST Foundations (Haley 1976 triadic analysis); Family Solutions Institute study guide ch. 4]

Stage C. Directive sessions (the middle of therapy). Each session reviews the last task, observes the family's response, then gives the next directive. [source: Family Solutions Institute study guide ch. 4 (directives reviewed in the next session)] The work moves toward a more normal organisation, with the parents (or responsible adults) jointly in charge of the problem, after which any marital issues can be taken up. [source: Family Solutions Institute study guide ch. 4 on strengthening the parental subsystem] Where one parent is peripheral, it can help to give that parent sole charge of one defined part of the problem for a while before asking for joint parenting. [synthesis; not from Haley]

Criteria for moving on: the agreed behavioural goal is shifting; tasks are being carried out (or the family's response to non-performance has been used); the parental hierarchy is functioning on the problem. [synthesis from the sources above]

Stage D. Ending. Therapy ends when the presenting problem is solved; the goal was defined so that therapist and family both know when that is. [source: Family Solutions Institute study guide ch. 4] Giving the family the credit, predicting that some old behaviour may return, and leaving the door open are recommended here as good practice [synthesis]; restraining and relapse prediction are described in the sources mainly for the MRI model [source: Family Solutions Institute study guide ch. 4].

Typical count and format. Brief, problem-focused outpatient therapy, with flexibility about place, length and who attends; whole family at the start, then sub-groups (parents, couple, individual) as the strategy requires. [source: Family Solutions Institute study guide ch. 4] No typical number of sessions is stated in any source, so none is given here [uncertain]. A practical local choice is to agree an initial block of sessions and review it against the agreed goal [synthesis]. Training and supervision classically use a one-way mirror with live supervision and phone-ins from a supervisor or team. [source: iAST Foundations]

Certification and licensing. Not a licensed or trademarked programme: no certification is required to practise it. Historical training was at the Family Therapy Institute of Washington, DC; current private trainings (e.g. iAST) state that their certificates confer no licensure. [source: iAST Foundations; SAGE Encyclopedia "Directive therapy"]

3. Guiding principles

[source for this section unless marked: Family Solutions Institute study guide ch. 4; iAST Foundations; SAGE Encyclopedia "Directive therapy"; Carpenter slides]

The therapist is responsible for change. Plan each case, take charge of the session, and own a failure rather than blaming the family's "resistance".
Start with the presenting problem. Work on what the family brought, defined so it can be counted or observed; that problem is also the ending criterion.
Symptoms are relational acts. Ask "what does this behaviour do between people?" rather than "what is wrong inside this person?"
Think in sequences and triads. Map who does what, then who responds, then what happens next, across at least three people, and target a link in that chain.
Hierarchy matters. Parents should be in charge of children; the more cross-generational coalitions a person is part of, the more disturbed they appear. Practically: put the parents (or the responsible adult) in charge of the problem.
Incongruous hierarchy (Madanes). A child who is overtly helpless can be covertly powerful, e.g. protecting a parent through the symptom. Ask: whom does this symptom help, and how?
Symptoms can be metaphors (Madanes). A child's symptom may stand for a parent's unspoken difficulty; the intervention can work on the metaphor without naming it.
Action, not interpretation. Do not explain the family's interactions to them; change what they do. Insight is not a goal.
Directives are the main tool. They change behaviour, intensify the therapist's involvement, and give information from how the family responds, including non-compliance.
Utilisation (from Erickson). Use the family's own language, values and even the symptom itself as the vehicle for change. [source: iAST Foundations]
Every case gets its own strategy. No fixed protocol; formulaic paradox is a misuse. [source: iAST Foundations]
Respect the family life cycle. Many problems appear at transitions (marriage, birth, child leaving home, retirement); the goal is often to get the family through the stage. [source: iAST Foundations; T&F page for Directive Family Therapy]
Brevity. Change can be quick; do not prolong therapy once the goal is reached.
Give the family the credit. Let improvement belong to the family rather than to the therapist, so the change is theirs to keep. [synthesis; not from Haley]
Include the wider professional system. With hospitalised or medicated young adults, agree early with the other professionals who is in charge of what, so the parents get one consistent message. [synthesis] Haley's Leaving Home (1980) is the book-length treatment of this life stage [source: Taylor & Francis page for Leaving Home], but its specific recommendations are not drawn on. [uncertain]
Love over control (later "strategic humanism"). Aim to increase family members' capacity to love, soothe, protect, repent and forgive, not only to correct power. [source: Family Solutions Institute study guide ch. 4; Carpenter slides]
Tasks must be good for the person. An ordeal must be beneficial as well as harder than the symptom; nothing harmful is prescribed. [source: Family Solutions Institute study guide ch. 4]
Learn through live supervision. Skill is built by supervised work on real cases behind the mirror more than by seminars. [source: iAST Foundations]

4. Intervention inventory

All example therapist language below is the editor's illustrative wording, not quotation from Haley or Madanes. Interventions 4.1–4.6 are the core Haley procedures; 4.7–4.11 add the paradoxical, ordeal and Madanes techniques; 4.12–4.15 are special applications and the supervision format.

4.1 Convening the whole household

Purpose / when: before and at the first session, so the sequence around the symptom can be seen live.
Steps: (1) On the intake call, ask who lives in the home and who else is closely involved (grandparent, ex-partner who shares care). (2) Ask that all of them come to the first meeting; explain that everyone's view helps. (3) If a key adult refuses, say you need their help with the problem rather than that they are to blame; offer a time or place that suits them; be flexible about place, length and fee. [source: Family Solutions Institute study guide ch. 4]
Example language (illustrative): "You know your son best, and so does his dad. I'd like both of you there the first time so I'm not working with half the picture."
Watch for: who decides who comes (a first clue to hierarchy); a missing member is often central to the sequence. Working if: the people who maintain the pattern are in the room.

4.2 Structured first interview (social, problem, interaction, goal-setting)

Purpose / when: session 1, to define a solvable problem and see the sequence.
Steps: follow the four stages in section 2, Stage A. In the problem stage start with the adult who seems least involved and leave the identified patient for later; in the interaction stage ask two members to talk to each other, or to show you what happens ("show me what happens at bedtime"), and keep yourself out of the conversation; in the goal-setting stage turn vague complaints into behaviour you could count. [source: Family Solutions Institute study guide ch. 4; Carpenter slides]
Example language (illustrative): Problem stage: "Dad, what's your view of what brings you here?" Interaction stage: "You two see this differently. Would you talk it over with each other now? I'll listen." Goal stage: "If things were better in a month, what exactly would we see on a school morning?"
Watch for: members talking through the therapist; a child interrupting whenever the parents begin to agree; who rescues whom. Do not interpret these in the session; note them for the strategy. Working if: the family names a concrete target and agrees to return.

4.3 Formulating the strategy (sequence, hierarchy, triad, life cycle, metaphor)

Purpose / when: after session 1 and whenever stuck.
Steps: (1) Write the sequence as a chain: trigger, symptom, who responds, how, what follows. (2) Mark who is in charge of whom, and any cross-generational coalition (e.g. mother and son against father). (3) Name the triad: the symptom bearer, the person most affected, and the third person whose involvement keeps it going. (4) Name the life-cycle transition. (5) Madanes: ask what the symptom might be a metaphor for and whom it protects. (6) Choose the smallest directive that would change one link and move the hierarchy in the right direction. [source: iAST Foundations; Family Solutions Institute study guide ch. 4]
Watch for: formulations that blame one member; the formulation is a working hypothesis, not something you tell the family. Working if: you can predict how the family will respond to a task.

4.4 Straightforward directives ("do something different" / "stop doing something")

Purpose / when: the default intervention when the family is cooperative and the adults have authority they can use.
Steps [synthesis: working procedure; Haley's own chapter on giving directives is not drawn on]: (1) Motivate first: link the task to the family's own goal, and get agreement that what they have already tried has not worked. (2) Design a task that changes one step of the sequence (e.g. the peripheral parent takes over a specific part of the problem; the over-involved parent steps back from it). (3) Give precise instructions: who, what, when, how often, what to do if X happens. Prefer tasks that involve everyone, even with a small role (someone keeps a record). (4) Where possible rehearse it in the session. (5) Ask for a report next time. [source for the types and purposes of directives: Family Solutions Institute study guide ch. 4]
Published example (paraphrased): a father exasperated with a wife he saw as helpless is told to coach her each evening on how to handle the children, which makes her more competent and puts them on a more equal footing as parents. [source: Family Solutions Institute study guide ch. 4]
Example language (illustrative): "For this week, when Sam won't get out of bed, Dad handles it, start to finish. Mum, your job is harder: you stay downstairs and don't step in, even if it takes longer. Sam's sister keeps the score on this sheet."
Watch for: vague tasks ("communicate more") that cannot be checked; tasks that make the weaker parent fail in front of the stronger one. Working if: the sequence changes even once and the family reports it.

4.5 Reviewing the task

Purpose / when: at the start of every session after a directive was given.
Steps [synthesis]: (1) Ask early and specifically what happened. (2) Done: praise the family's effort and ask what they noticed; build the next task on it. (3) Partly done: do not accept it as done; find out precisely what was skipped. (4) Not done: treat it as important rather than letting it pass, and consider whether the task was badly fitted. A repeated failure to carry out straightforward tasks is information that a paradoxical or indirect approach may fit better. [source for reviewing directives in the next session: Family Solutions Institute study guide ch. 4; the rest is synthesis, not from Haley]
Example language (illustrative): "Nobody did it? That's a pity. You've lost a week you could have used. What got in the way, exactly?"
Watch for: shaming, which damages the alliance; the aim is to take tasks seriously, not to punish. [synthesis]

4.6 Putting the parents (or responsible adult) in charge

Purpose / when: child and adolescent problems with a reversed or confused hierarchy; disturbed young adults (see 4.12).
Steps: (1) Address the parents as the experts and decision-makers. (2) Ask them to agree, in the session, on one rule and one consequence for the problem behaviour. (3) Block the child from joining one parent against the other. (4) If one parent is peripheral, give that parent a defined job with the child first, and move to joint parenting later (section 2, Stage C). (5) Once the child's behaviour has changed, turn to the couple's own disagreements, often separately from the child. [source: Family Solutions Institute study guide ch. 4 (parental hierarchy and subsystem); steps (4) and (5) as a sequence are [synthesis]]
Example language (illustrative): "You two are in charge of this house. Before you leave today, agree between you what happens the next time he hits his sister. I'll help, but it's your decision."
Watch for: parents who cannot agree in front of the child (see the parents alone); a parent too depressed, intoxicated or violent to take charge (assess safety first). Working if: parents present a united decision and carry it out.

4.7 Indirect and metaphorical directives

Purpose / when: when a direct instruction would be refused, or when the family cannot talk about the real issue (e.g. sex, a parent's fear) but can act on an analogue. Directives are classed as straightforward, paradoxical and metaphorical. [source: iAST Foundations; Family Solutions Institute study guide ch. 4 (metaphor, Madanes)]
Steps [synthesis: working procedure built on the descriptions of metaphorical directives; Haley's and Erickson's own accounts are not drawn on]: (1) Identify the sensitive area and an everyday activity with a similar structure (e.g. who takes the lead, who waits). (2) Give a task in the analogue area, explained only in its own terms. (3) Do not point out the parallel. (4) Review the task as an ordinary task.
Example language (illustrative): to a couple who cannot discuss closeness: "This week I'd like you to plan one dinner out where each of you chooses half the evening, and neither of you may hurry the other."
Watch for: tasks so obscure the family finds them silly; covert manipulation the family would object to if they knew it (see 5.9). Working if: change in the analogue area spreads to the real one.

4.8 Paradoxical directives

Purpose / when: families who have repeatedly not carried out straightforward tasks, or a symptom that persists because of the struggle around it. Not for crises, violence, abuse, suicidality or other dangerous behaviour (see 5.6). [source: iAST Foundations (Haley holds that well-built paradox leaves every response leading toward improvement); contraindications are [synthesis]]
Steps [synthesis: Haley set out a staged procedure for paradoxical directives in Problem-Solving Therapy (1976), but it is not reproduced; the following is the editor's working procedure]: (1) Make sure the family has agreed to work on change and on a clearly defined problem and goal. (2) Give a rationale for the task that fits the family's own views. (3) Ask for the problem behaviour to continue in a specified, scheduled form (when, where, how long), as a way to learn about it. (4) At the next session, review what happened in detail. (5) If the behaviour changes, respond with mild caution and let the family own the change rather than celebrating. [source for the principle that a well-built paradox makes every response lead toward improvement: iAST Foundations]
Example language (illustrative): "I don't think you should try to stop the arguments yet. We don't understand them well enough. This week, have your usual argument on Tuesday and Thursday at 8 pm, for twenty minutes, at the kitchen table, and notice everything you can."
Watch for: sarcasm or a trick tone (it must be delivered seriously and with a believable rationale); families who feel mocked. Working if: the symptom drops or becomes voluntary and the family takes over control of it. If they "rebel" by stopping, accept it with mild caution, not triumph.

4.9 Ordeal therapy

Purpose / when: an adult who sincerely wants to be rid of a symptom (insomnia, compulsion, binge eating, habit) and has not managed it. Principle: a task more unpleasant than the symptom, but good for the person, is required every time the symptom occurs, so it becomes harder to keep the symptom than to give it up. [source: iAST Foundations; Family Solutions Institute study guide ch. 4]
Steps [synthesis: Ordeal Therapy (1984) covers how to design an ordeal, but the book's sequence is not reproduced; the following is the editor's working procedure built on the criteria]: (1) Agree a clearly defined symptom the adult wants to be rid of. (2) Choose the ordeal together: more aversive than the symptom, beneficial or at least harmless (exercise, chores, study, a donation the person dislikes making), something the person can actually do, and precisely specified [source for these criteria: iAST Foundations; Family Solutions Institute study guide ch. 4]. (3) Explain the reasoning and obtain the person's free agreement; the person can withdraw that agreement at any time. (4) The ordeal is done each time the symptom occurs [source: iAST Foundations; Family Solutions Institute study guide ch. 4], until the problem is resolved. (5) Review regularly, including how the ordeal is affecting the person's relationships.
Published examples (paraphrased): extra scheduled time added to a compulsive hand-washer's washing; a donation to a disliked cause after each binge; a husband required to give a gift to a disliked brother-in-law each time the symptom appeared. [source: iAST Foundations; Family Solutions Institute study guide ch. 4]
Example language (illustrative): "Each night you are still awake at 1 am, you get up and polish the kitchen floor for an hour, then go back to bed. Every night, no exceptions. Shall we agree that before you go, and look at how it went next week?"
Watch for: any ordeal that is physically risky, humiliating, involves food or weight restriction, sleep deprivation in someone vulnerable, or is imposed by a parent on a child (see 5.7). Haley's warning, quoted secondarily: ordeals "do not in themselves have positive effects" [source: Hage PDF quoting Haley 1984]; the therapist's purpose and the person's free agreement are what matter. Working if: the symptom drops; the person chooses to stop the symptom rather than do the ordeal.

4.10 Madanes's pretend techniques

Purpose / when: a child's symptom that protects or helps a parent (incongruous hierarchy), especially in young children; playful enough to use where direct parental control fails. First identify whom the child protects and how. [source: Family Solutions Institute study guide ch. 4 (citing Madanes 1980 Family Process); iAST Foundations]
Variants and steps:
- Dramatisation: the parent asks the child to perform the symptom on purpose, at set times. Because it is now requested, it loses its effect and usually fades; the parent's own difficulty may then surface and can be worked on.
- Pretend symptom, pretend help: the child pretends to have the symptom (e.g. a stomach ache) and the parent or grandparent pretends to care for them, as a daily game for a set period (a week in Madanes's published case). The caring continues; the symptom becomes unnecessary.
- Parent pretends to need help: the parent pretends to be in difficulty (e.g. frightened) and the child pretends to help. Covert, symptom-based helping is replaced with open, playful helping, and the parent is visibly back in charge. In Madanes's night-terror case, the mother re-enacted this play whenever her son woke screaming, and the night terrors stopped.
- Steps for all: (1) Set it up in the session first and coach a run-through. (2) Make it light and game-like. (3) Specify frequency and duration. (4) Have the parent (not the therapist) give the instruction at home. (5) Review next session. [source: Family Solutions Institute study guide ch. 4; iAST Foundations; step list is [synthesis]]
Example language (illustrative): "Every evening after dinner, Jamie, you'll pretend your tummy hurts, really well, like an actor. Grandma, you pretend to look after him: blanket, hot drink, the works. Ten minutes, then it's over."
Watch for: medical symptoms not yet medically assessed (assess first); a parent who cannot play. Working if: the real symptom falls away while affection stays.

4.11 Relabelling (positive reframing)

Purpose / when: to make a directive acceptable, reduce blame, or recast a symptom as protective or loyal. MRI developed reframing most fully; Haley and Madanes use it in service of directives. [source: Family Solutions Institute study guide ch. 4 (MRI section); Carpenter slides ("use language to give new meaning")] [uncertain: the sources attribute reframing mainly to MRI]
Steps: (1) Find an intention the family can accept (protecting, caring, loyalty). (2) State it plainly. (3) Attach a directive to it.
Example language (illustrative): "It looks as if Ella's been keeping an eye on you since Dad left. That's loyal, and it's a heavy job for a twelve-year-old. Let's see how you can take that job back."
Watch for: reframes the family hears as excusing violence or abuse; never reframe harm to others as benign.

4.12 "Leaving Home" procedure for disturbed young adults

Purpose / when: a young adult with severe disturbance who is failing to leave home. Haley's Leaving Home (1980) presents a method of family therapy for the stage when children leave home, for a particular group of troubled young people. [source: Taylor & Francis page for Leaving Home; Taylor & Francis page for Directive Family Therapy (life-cycle framing)] The book itself is not drawn on, so its procedure is not reproduced. [uncertain]
Steps [synthesis: the editor's working procedure, applying the opened principles of parental hierarchy (Family Solutions Institute study guide ch. 4) and life-cycle transitions (iAST Foundations) to this stage; not Haley's published sequence]: (1) Agree with the psychiatrist, hospital and other professionals who is in charge of what, so the family is not split between experts. (2) Meet the parents and young person together and ask the parents to agree specific, time-limited expectations for life at home (daily routine, work or study, behaviour in the house) and what follows if they are not met. (3) Treat the young person as capable of more than has been expected. (4) As the young person moves toward work, study and independence, watch for the parents' own conflict surfacing or for relapse, and keep the parents working together. (5) Support the young person to leave into ordinary adult life and reduce contact. Medication decisions stay with the prescriber.
Example language (illustrative): "While he's living under your roof, you two decide the house rules. He's capable of more than everyone has been expecting."
Watch for: risk to self or others (follow standard risk assessment, never suspend crisis care for the strategy); parents who blame each other. Working if: fewer crises and admissions, and the young person is working or studying.

4.13 Restraining, predicting relapse and ending

Purpose / when: when change is fast, when the family seems ambivalent, and at the end of therapy.
Steps: (1) When improvement appears, express caution ("go slowly") rather than celebration. (2) Predict that some old behaviour may return and say what to do if it does; sometimes ask for a deliberate small relapse to show control. (3) Credit the family for the change. (4) Review gains against the original goal; end when it is met; leave a way back. [source: Family Solutions Institute study guide ch. 4 (restraining and termination, described under MRI)] [uncertain: restraining is documented in the sources for MRI rather than for Haley; step (3) is [synthesis]]
Example language (illustrative): "This has changed faster than I expected. I'd be careful. Something like the old pattern may show up once or twice. If it does, it doesn't mean you're back at square one."
Watch for: families who feel their success is doubted; keep the caution warm.

4.14 Madanes's love–violence model and the repentance procedure for sexual abuse and violence

Purpose / when: Madanes's later work (1990) on violence, sexual abuse and other problems framed as a dilemma between love and violence. [source: Family Solutions Institute study guide ch. 4; DPSP workshop programme]
Assessment step: identify which of four aims dominates the problem: to dominate and control; to be loved; to love and protect; to repent and forgive. Problems in each area produce different kinds of symptom and call for different strategies. [source: Family Solutions Institute study guide ch. 4]
Repentance procedure (components only): Madanes published a staged procedure (variously described as 16 steps; her 2008 workshop taught 15 steps for juvenile and 20 for adult offenders, plus steps for past offences). [source: Family Solutions Institute study guide ch. 4; DPSP workshop programme] The steps themselves are not drawn on, so their order and wording are not given. The cited descriptions name these components: involvement of the whole family; open disclosure rather than secrecy; the offender's acknowledgement of the acts and full responsibility for them; confrontation with the effects on the victim, to build empathy; sincere repentance; amends and longer-term reparation to the victim, decided by the therapist; a protector appointed for the victim, who offers guidance and comfort and watches for further violence; the chance for other family members who were victims or offenders to disclose this; discussion with the offender and adult family members of the consequences of any further violence; finding acceptable alternatives to violence; coordination with the legal and protective systems; and, for teenage offenders, group work to build social responsibility. [source: Erickson Foundation catalogue, Madanes 1990 workshop "Therapy of Sex Offenders and Their Victims"; NCJRS abstract NCJ 161980 (1995 book on a "therapy of social action" for violent men; the title matches The Violence of Men, but the abstract page did not show the author) [uncertain: authorship]]
Steps for the clinician today [synthesis]: report to child protection and police as the law requires before any family work; ensure the victim's safety and separation from the offender as directed by the protecting agency; see the victim separately and never use the victim as an instrument of the offender's treatment; work alongside the statutory offender programme, not instead of it; joint sessions only with the victim's and protective parent's informed agreement and the agency's consent.
Watch for: any pressure on the victim to forgive, reconcile or comfort the offender; ritual apology that substitutes for accountability.

4.15 Live supervision with a one-way mirror and phone-ins

Purpose / when: training and difficult cases; the standard Washington-school format. [source: iAST Foundations]
Steps: (1) Get the family's written consent to observation and recording and introduce the team. (2) Agree with the supervisor in advance when phone-ins or breaks will happen. (3) During the session the supervisor phones or calls the therapist out with a short directive; the therapist delivers it in their own words. (4) Take a mid- or end-session break to design the task with the team. (5) Debrief after. [source: iAST Foundations (live supervision behind the mirror); step detail is [synthesis]]
Example language (illustrative): "My colleagues behind the mirror have been thinking hard about what you said, and I'd like to share what we came up with."
Watch for: the family feeling watched or discussed; keep interruptions few and the therapist clearly in charge in the room.

5. Handling problems

Tags: guidance drawn from the sources is cited; everything marked [synthesis] is the editor's own and is not found in Haley or Madanes.

Key member will not attend. Haley requires those involved to come to the first session [source: Family Solutions Institute study guide ch. 4]. Respond: call the absent member yourself and ask for their help as an expert on the child, not as a culprit; offer a time or place they can manage; if they still refuse, start with those present but treat the absence as part of the sequence and set early tasks that bring them in (e.g. the attending parent asks the absent one to take over one small job). [synthesis]
Tasks not done (non-adherence). Review every task, and do not let a missed task pass as unimportant. Then ask yourself whether the task was too big, unclear, or in conflict with someone's position in the hierarchy; shrink it, rehearse it in session, give each member a role. After two or three failed straightforward tasks, consider an indirect, metaphorical or paradoxical directive (4.7, 4.8). [source for reviewing directives: Family Solutions Institute study guide ch. 4; the rest is [synthesis]]
Stuck: tasks done, no change. The formulation is probably wrong. Re-map the sequence and the triad: who else is involved (grandparent, school, another professional)? Is the symptom protecting someone (Madanes)? Is the family at a life-cycle transition you have missed? Consult the team or watch a recording. Consider staging: give the peripheral parent sole responsibility for a time before asking for joint parenting. [source: iAST Foundations; Family Solutions Institute study guide ch. 4; staging and consultation are [synthesis] built on these]
Resistance and power struggles with the therapist. Do not argue for change. Use restraint ("go slowly"), accept the family's view and build the directive on it (utilisation), or, where safe, prescribe the pattern. [source: iAST Foundations (utilisation, paradox); Family Solutions Institute study guide ch. 4 (restraining, positioning, under MRI)] Haley's stance is that the therapist owns the failure: change your approach, not the label on the family. [source: Family Solutions Institute study guide ch. 4]
Overwhelm, crisis or very chaotic families. Drop to one small, clear, straightforward directive aimed at safety or routine (who gets the children to school; who is called if a fight starts). Do not use paradox or ordeals in a crisis. Meet more often for a short period and coordinate with crisis services. [synthesis]
Paradox in dangerous situations (contraindication). Never prescribe or encourage violence, self-harm, suicidal behaviour, substance misuse, risky eating or unsafe driving, even "in a controlled form". In these situations use a standard risk assessment, safety planning, lethal-means counselling (safe storage and removal) and straightforward directives that put responsible adults in charge of safety. [synthesis, following current risk-assessment practice]
Ordeals and coercion. Ordeals must be beneficial, chosen with the adult's free agreement, and something the person can stop agreeing to. Do not design ordeals involving pain, humiliation, food, fluids, sleep deprivation, isolation or physical restraint, and do not hand ordeals to parents to impose on children. Strategic ideas ("paradoxical" permission, ordeals) have been borrowed into coercive parenting literature for adopted and fostered children, alongside holding and "Z-process" approaches; one such source itself warns ordeals can be abusive in the wrong hands. Red flags: a child confined to a room for hours, food used as a battleground, a parent instructed to "win" every struggle, therapy framed as breaking a child's will. If you see these, they are not Haley–Madanes strategic therapy; refer to evidence-based attachment-informed help and consider safeguarding duties. [source: Hage paradoxical-techniques PDF (cited only as an example of misuse); the rest is [synthesis]]
Ruptures: the family feels manipulated, mocked or blamed. Common after a paradoxical task or a reframe that misses. Respond: acknowledge directly that the task or remark did not fit; restate your aim in plain terms; return to the family's goal and give a straightforward task. Avoid any tone of trickery. [synthesis]
Transparency and consent. Classic strategic work often gave tasks without explaining the reasoning [source: SAGE Encyclopedia "Directive therapy"]. Current ethics codes require informed consent to the general approach. Practical adaptation: at intake explain that you work with families using practical tasks, that some may seem unusual, and that the family may always ask why or decline; obtain written consent to observation, recording and team consultation; do not deceive clients about facts. [synthesis]
Intimate partner violence and abuse. Do not restore "parental hierarchy" or run joint couple sessions in ways that strengthen an abusive partner's control. Screen each partner alone for violence and coercive control before conjoint work; where present, see partners separately, prioritise safety planning and specialist services, and meet reporting duties for children. Madanes's violence work (4.14) presumes statutory protection is in place. [synthesis]
Cultural fit of "hierarchy". Families differ in who legitimately holds authority (grandparents, elder siblings, extended kin, single parents with co-parenting relatives). Ask who is responsible for the child in this family and support that arrangement rather than imposing a nuclear two-parent model. [synthesis]
Parents who cannot play (pretend techniques). Rehearse the game in session with lots of coaching; shorten it; let the more playful adult lead; if a parent is too depressed or angry to play, treat that first or choose a straightforward directive. [synthesis]
Improvement then relapse or parental conflict surfaces. Expected: when the child's symptom recedes, the parents' or couple's issues often emerge (Madanes's dramatisation can bring the parent's problem to the surface). Predict this, normalise it, and move to work with the parents or couple. [source: Family Solutions Institute study guide ch. 4 (dramatisation); the general prediction is [synthesis]]
Other professionals undercut the plan. With a psychiatrist, school or child-protection worker involved, meet or call them early; agree who is in charge of what; give the parents a consistent message. [synthesis]
Medical symptoms. Before using pretend or paradoxical techniques for pain, sleep, eating, toileting or tics, make sure medical assessment has been done. [synthesis]

Sources

Sources:

Further reading (not drawn on; content is used only where a source page describes it, otherwise the relevant guidance is marked [synthesis] or [uncertain]):

Haley, J. (1963). Strategies of Psychotherapy. Grune & Stratton.
Haley, J. (1973). Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. Norton.
Haley, J. (1976; 2nd ed. 1987). Problem-Solving Therapy. Jossey-Bass.
Haley, J. (1980). Leaving Home: The Therapy of Disturbed Young People. McGraw-Hill.
Haley, J. (1984). Ordeal Therapy: Unusual Ways to Change Behavior. Jossey-Bass.
Haley, J., & Richeport-Haley, M. (2007). Directive Family Therapy. Haworth (Routledge reissue 2012).
Madanes, C. (1980). Protection, paradox, and pretending. Family Process, 19, 73–85.
Madanes, C. (1981). Strategic Family Therapy. Jossey-Bass.
Madanes, C. (1984). Behind the One-Way Mirror: Advances in the Practice of Strategic Therapy. Jossey-Bass.
Madanes, C. (1990). Sex, Love, and Violence: Strategies for Transformation. Norton.
Nichols, M. P., & Schwartz, R. C. (1998). Family Therapy: Concepts and Methods (4th ed.). Allyn & Bacon (via the Family Solutions Institute study guide).
The Violence of Men: New Techniques for Working with Abusive Families: A Therapy of Social Action (1995). ISBN 978-0-7879-0117-2. [uncertain: authorship not shown in the cited sources]

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