family therapy concepts process and practice phần 3 potx

104 CENTRAL CONCEPTS IN FAMILY THERAPY specifi ed but are not linked. For example, ‘If I make dinner, I may go sail- ing; if you do the shopping, you may go out with friends’. Graded task assignment. For depressed inactive patients, gradually increasing clients’ activity levels by successively assigning increasingly larger tasks and activities. Love days. In discordant couples, increasing the amount of non-contingent reinforcement within their relationships by inviting couples, on alternate days, to increase the rate with which they engage in behaviours their spouse has identifi ed as enjoyable. Modelling. Learning by observing others. Monitoring. Regularly observing and recording information about spe- cifi c behaviours or events. These include the duration, frequency and in- tensity of problematic or positive behaviours and their antecedents and consequences. Negative reinforcement. Increasing the probable frequency of a response by rewarding it with the removal of an undesired stimulus. For example, increasing the child’s use of the word ‘please’ by stopping things they do not like when they say ‘please’. Operant conditioning. Learning responses as a result of either positive or negative reinforcement. For example, working hard because of praise for doing so in the past, or bullying others because in the past it has stopped them annoying you. Pleasant event scheduling. For depressed clients with constricted life- styles, increasing the frequency with which desired events occur by scheduling their increased frequency. Positive reinforcement. Increasing the probable frequency of a response by rewarding it with a desired stimulus. For example, increasing good behaviour by praising it. Problem-solving skills training. This involves coaching clients through modelling and role play in defi ning large daunting problems as a series of small solvable problems and, for each problem: brain- storming solutions; evaluating the pros and cons of these; selecting one; jointly implementing it; reviewing progress; and modifying the selected solution if it is ineffective or celebrating success if the problem is resolved. Punishment. Temporarily suppressing the frequency of a response by introducing an undesired stimulus every time the response occurs. Pun- ished response recurs once punishment is withdrawn and if aggression is used as a punishment, the punished person may learn to imitate this aggression through modelling. Quid pro quo contract. A contingency contract for couples in which the consequences for both parties of engaging in target positive behaviours are specifi ed and linked. For example, ‘If you make dinner, I’ll wash up’. Reinforcement menu. A list of desired objects or events. THEORIES THAT FOCUS ON BEHAVIOUR PATTERNS 105 Relaxation training. Training clients to reduce physiological arousal and anxiety by systematically tensing and relaxing all major muscle groups and visualising a tranquil scene. Reward system. A systematic routine for the reinforcement of target behaviours. Schemas. Hypothetical complex cognitive structures (involving biases, attributions, beliefs, expectancies, assumptions and standards) through which experience is structured and organised. Selective attention. An automatic (often unconscious) process of pref- erentially directing attention to one class of stimuli rather than others, for example, noting and responding only to negative behaviour in family members. Shaping. The reinforcement of successive approximations to target posi- tive behaviour. Standards. Beliefs about how people generally should behave in family re- lationships, for example family members should be honest with each other. Star chart. A reward system where a child receives a star on a wall chart each time they complete a target behaviour such as not bedwetting. A col- lection of stars may be cashed in for a prize from a reinforcement menu. Systematic desensitisation. A procedure based on classical condition- ing where phobic clients learn to associate relaxation with increasingly anxiety-provoking concrete or imaginal stimuli. Time-out (from reinforcement). A system for extinguishing negative behaviours in children by arranging for them to spend time in solitude away from reinforcing events and situations if they engage in these nega- tive behaviours. Token economy. A reward system where a child or adolescent receives tokens, such as poker chips or points, for completing target behaviours and these may be accumulated and exchanged for items from a reinforce- ment menu. Functional Family Therapy Attributional style. The explanatory style used by family members to account for positive and negative behaviours. Under stress, family mem- bers tend to attribute negative behaviour to personal factors and positive behaviours to situational factors. Education. The second stage of treatment which involves training family members to use routines from behaviour therapy, such as contingency contracts, to replace problematic with non-problematic behaviour pat- terns that fulfi l similar relationship functions. Functions. Problematic and non-problematic behaviour patterns serve relationship functions, including distancing, creating intimacy and regu- lating distance. 106 CENTRAL CONCEPTS IN FAMILY THERAPY Relationship skills. These include clarifying how family members’ emotional responses force them unwittingly into problem-maintaining be- haviour patterns; adopting a non-blaming stance involving the use of relabel- ling fair turn taking in family sessions; using warmth and humour to defuse confl ict; and engaging in suffi cient self-disclosure to promote empathy. Structuring skills. These include directives in maintaining a therapeutic focus, clear communication and self-confi dence. Therapy. The fi rst stage of treatment which involves helping family mem- bers change their attributional styles so that they attribute positive behav- iours to personal factors and negative behaviours to situational factors. FURTHER READING MRI Brief Marital and Family Therapy Cade, B. & O’Hanlon, W. (1993). A Brief Guide to Brief Therapy. New York: Norton. Duncan, B., Miller, S. & Sparks, J. (2003). Interactional and solution-focused brief therapies: Evolving concepts of change. In T. Sexton, G. Weeks & M. Robbins (Eds), Handbook of Family Therapy, pp. 101–124. New York: Brunner-Routledge. Fisch, R. & Schlanger, R. (1999). Brief Therapy with Intimidating Cases. Changing the Unchangeable. San Francisco, CA: Jossey Bass. Fisch, R., Weakland, J. & Segal, L. (1982). The Tactics of Change: Doing Therapy Briefl y. San Francisco, CA: Jossey Bass. Green, S. & Flemons, D. (2004). Quickies: The Handbook of Brief Sex Therapy. New York: Norton Hoyt, M. (2001). Interviews with Brief Therapy Experts. Philadelphia, PA: Brunner- Routledge. Segal, L. (1991). Brief therapy: The MRI Approach. In A. Gurman & D. Kniskern (Eds), Handbook of Family Therapy, Vol. 11, pp. 171–199. New York: Brunner- Mazel. Shoham, V. & Rohbaugh, M. (2002). Brief strategic couple therapy. In A. Gurman & N.Jacobon (Eds), Clinical Hanbook of Couples Therapy, 3rd edn, pp. 5–21. New York: Guilford. Watzlawick, P. Weakland, J. & Fisch, R. (1974). Change. Principles of Problem Formation and Problem Resolution. New York: Norton. Weakland, J. & Fisch, R. (1992). Brief therapy: MRI style. In S. Budman, M. Hoyt & S. Friedman (Eds), The First Session in Brief Therapy, pp. 306–323. New York: Guilford. Weakland, J. & Ray, W. (1995). Propagations: Thirty Years of Infl uence from the Mental Research Institute. Binghampton, NY: Haworth. Strategic Marital and Family Therapy Behar-Mitrani, V. & Perez, M. (2000). Structural-strategic approaches to couple and family therapy. In T. Sexton, G. Weeks & M. Robbins (Eds), Handbook of Family Therapy, pp. 177–200. New York: Brunner-Routledge. THEORIES THAT FOCUS ON BEHAVIOUR PATTERNS 107 Browning, S. & Green, R. (2003). Constructing therapy: From strategic to systemic to narrative models. In G. Sholevar (Ed.), Textbook of Family and Couples Therapy: Clinical Applications, pp. 55–76. Washington, DC: American Psychiatric Press. Grove, D. & Haley, J. (1993). Conversations on Therapy. New York: Norton. Haley, J. & Richeport-Haley, M. (2003). The Art of Strategic Therapy. New York: Brunner-Routledge. Haley, J. (1963). Strategies of Psychotherapy. New York: Grune & Stratton. Haley, J. (1967). Advanced Techniques of Hypnosis and Therapy: Selected Papers of Milton H. Erickson, MD. New York: Grune & Stratton. Haley, J. (1973). Uncommon Therapy. New York: Norton. Haley, J. (1976). Problem Solving Therapy. San Francisco: Jossey Bass. Haley, J. (1984). Ordeal Therapy. San Francisco: Jossey Bass. Haley, J. (1985a). Conversations with Milton H. Erickson, MD: Volume 1. Changing Individuals. New York: Norton. Haley, J. (1985b). Conversations with Milton H. Erickson, MD: Volume 2. Changing Couples. New York: Norton. Haley, J. (1985c). Conversations with Milton H. Erickson, MD: Volume 3. Changing Children and Families. New York: Norton. Haley, J. (1996). Learning and Teaching Therapy. New York: Guilford. Haley, J. (1997). Leaving Home: The Therapy of Disturbed Young People, 2nd edn. Philadelphia, PA: Brunner-Mazel. Keim, J. & Lappin, J. (2002). Structural-strategic marital therapy. In A. Gurman & N. Jacobon (Eds), Clinical Handbook of Couples Therapy, 3rd edn, pp. 86–117. New York: Guilford. Lankton, S. & Lankton, C. (1991). Ericksonian family therapy. In A. Gurman & D. Kniskern (Eds), Handbook of Family Therapy, Vol. 11, pp. 239–283. New York: Brunner Mazel. Madanes, C. (1981). Strategic Family Therapy. San Francisco, CA: Jossey-Bass. Madanes, C. (1984). Behind the One-way Mirror: Advances in the Practice of Strategic Therapy. San Francisco, CA: Jossey Bass. Madanes, C. (1990). Sex, Love and Violence. New York: Norton. Madanes, C. (1994). The Secret Meaning of Money. San Francisco, CA: Jossey-Bass. Madanes, C. Keim, J. & Smelser, D. (1995). The Violence of Men. San Francisco, CA: Jossey-Bass. Madanes, C. (1991). Strategic Family Therapy. In A. Gurman & D. Kniskern (Eds), Handbook of Family Therapy, Vol. 11, pp. 396–416. New York: Brunner-Mazel. Rosen, K. (2003). Strategic family therapy. In L. Hecker & J. Wetchler (Eds), An Introduction to Marital and Family Therapy, pp. 95–122. New York: Haworth. Structural Family Therapy Behar-Mitrani, V. & Perez, M. (2003). Structural-strategic approaches to couple and family therapy. In T. Sexton, G. Weeks & M. Robbins (Eds), Handbook of Family Therapy, pp. 177–200. New York: Brunner-Routledge. Colapinto, J. (1991). Structural family therapy. In A. Gurman & D. Kniskern (Eds), Handbook of Family Therapy, Vol. 11, pp. 417–443. New York: Brunner-Mazel. Elizur, J. & Minuchin, S. (1989). Institutionalising Madness. Families, Therapy and Society. New York: Basic Books. 108 CENTRAL CONCEPTS IN FAMILY THERAPY Fishman, C. & Fishman, T. (2003). Structural family therapy. In G. Sholevar (Ed.), Textbook of Family and Couples Therapy: Clinical Applications, pp. 35–54. Washington, DC: American Psychiatric Press. Fishman, C. (1988). Treating Troubled Adolescents: A Family Therapy Approach. New York: Basic Books. Fishman, C. (1993). Intensive Structural Family Therapy: Treating Families in their Social Context. New York: Basic Books. Keim, J. & Lappin, J. (2002). Structural-strategic marital therapy. In A. Gurman & N. Jacobon (Eds), Clinical Handbook of Couples Therapy, 3rd edn, pp. 86–117. New York: Guilford. Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Cambridge, MA: Harvard University Press. Minuchin, S. & Nichols, M. (1993). Family Healing: Tales of Hope and Renewal from Family Therapy. New York: Free Press. Minuchin, S. (1974). Families and Family Therapy. Cambridge, MA: Harvard University Press. Minuchin, S. (1984). Family Kaleidoscope. Cambridge, MA: Harvard University Press. Minuchin, S., Rosman, B. & Baker, L. (1978). Psychosomatic Families: Anorexia Nervosa in Context. Cambridge, MA: Harvard University Press. Minuchin, S., Lee, W. & Simon, G. (1996). Mastering Family Therapy: Journeys of Growth and Transformation. New York: Wiley. Minuchin, S., Montalvo, B., Guerney, B., Rosman, B. & Schumer, F. (1967). Families of the Slums. New York: Basic Books. Wetchler, J. (2003). Structural family therapy. In L. Hecker & J. Wetchler (Eds), An Introduction to Marital and Family Therapy, pp. 39–62. New York: Haworth. Behavioural Marital and Family Therapy Atkins, D., Dimidhian, S. & Christensen, A. (2003). Behavioural couple therapy: Past, present and future. In T. Sexton, G. Weeks & M. Robbins (Eds), Handbook of Family Therapy, pp. 281–302. New York: Brunner-Routledge. Baucom, D. & Epstein, N. (1990). Cognitive Behavioural Marital Therapy. New York: Brunner-Mazel. Baucom, D., Epstein, N. & LaTaillade, J. (2002). Cognitive behavioural couple therapy. In A. Gurman & N. Jacobon (Eds), Clinical Handbook of Couples Therapy, 3rd edn, pp. 86–117. New York: Guilford. Dattilio, F. & Epstein, N. (2003). Cognitive-behavioural couple and family therapy. In T. Sexton, G. Weeks & M. Robbins (Eds), Handbook of Family Therapy, pp. 147–176. New York: Brunner-Routledge. Dattilio, F. & Padesky, C. (1990). Cognitive Therapy with Couples. Sarasota, FL: Professional Resource Exchange. Dattilio, F. (1997). Integrative Cases in Couples and Family Therapy. Cognitive- Behavioural Perspective. New York: Guilford. Dimidjian, S., Martell, C. & Christensen, A. (2002). Integrative behavioural couple therapy. In A. Gurman & N. Jacobon (Eds), Clinical Handbook of Couples Therapy, 3rd edn, pp. 251–280. New York: Guilford. THEORIES THAT FOCUS ON BEHAVIOUR PATTERNS 109 Epstein, N. (2003). Cognitive behavioural therapies for couples and families. In L. Hecker & J. Wetchler (Eds), An Introduction to Marital and Family Therapy, pp. 203–254. New York: Haworth. Epstein, N., Schlesinger, S. & Dryden, W. (1988). Cognitive Behavioural Therapy with Families. New York: Brunner-Mazel. Falloon, I. (1988). Handbook of Behavioural Family Therapy. New York: Guilford. Falloon, I. (1991). Behavioural family therapy. In A. Gurman & D. Kniskern (Eds), Handbook of Family Therapy, Vol. 11, pp. 65–95. New York: Brunner-Mazel. Falloon, I. (2003). Behavioural family therapy. In G. Sholevar (Ed.), Textbook of Family and Couples Therapy: Clinical Applications, pp. 147–172. Washington, DC: American Psychiatric Press. Falloon, I., Laporta, M., Fadden, G. & Graham-Hole, V. (1993). Managing Stress in Families. London: Routledge. Jacobson, N. & Christensen, A. (1996). Integrative Behavioural Couple Therapy. New York: Norton. Jacobson, N. & Margolin, G. (1979). Marital Therapy; Strategies Based on Social Learning and Behavioural Exchange Principles. New York: Brunner-Mazel. Mueser, K. & Glynn, S. (1995). Behavioural Family Therapy for Psychiatric Disorders. Boston: Allyn & Bacon. Sanders, M. & Dadds, M. (1993). Behavioural Family Intervention. New York: Pergammon Press. Sayers, S. (1998). Special issue on behavioural couples therapy. Clinical Psychology Review, 18(6). Functional Family Therapy Alexander, J., Pugh, C., Parsons, B. & Sexton, T. (2000). Functional Family Therapy, 2nd edn. Golden, CO: Venture. Sexton, T. & Alexander, J. (2003). Functional family therapy: A mature clinical model for working with at-risk adolescents and their families. In T. Sexton, G. Weeks & M. Robbins (Eds), Handbook of Family Therapy, pp. 323–350. New York: Brunner-Routledge. Alexander, J. & Parsons, B. (1982). Functional Family Therapy. Montereny, CA: Brooks Cole. Barton, C. and Alexander, J. (1981). Functional family therapy. In A. Gurman & D. Kniskern (Eds), Handbook of Family Therapy, pp. 403–443. New York: Brunner-Mazel. Morris, S., Alexander, J. & Waldron, H. (1988). Functional family therapy. In I. Falloon (Ed.), Handbook of Behavioural Family Therapy, pp. 130–152. New York: Guilford. Chapter 4 THEORIES THAT FOCUS ON BELIEF SYSTEMS Family therapy schools and traditions, it was noted in Chapter 2, may be classifi ed in terms of their emphasis on problem-maintaining behav- iour patterns; constraining belief systems and narratives; and historical, contextual and constitutional predisposing factors. While Chapter 3 was concerned with traditions that highlight the role of problem-maintaining behaviour patterns, this chapter is primarily concerned with approaches that focus on belief systems and narratives which subserve these in- teraction patterns. Traditions that fall into this category, and which are summarised in Table 4.1, include constructivism; the Milan School; so- cial-constructionist family therapy approaches; solution-focused family therapy; and narrative therapy. These traditions share a rejection of posi- tivism and a commitment to some alternative epistemology, so it is with a consideration of these epistemologies that this chapter opens. EPISTEMOLOGY: POSITIVISM, CONSTRUCTIVISM, SOCIAL CONSTRUCTIONISM, MODERNISM AND POSTMODERNISM Bateson (1972, 1979) was fond of the word epistemology and referred to what he described as an ‘ecosystemic epistemology’. This, for Bateson, was a world view or belief system that entailed the idea that the universe – including non-material mind and material substance – is a single eco- logical system made up of an infi nite number of constituent subsystems. However, in the strictest sense, epistemology is a branch of philosophy concerned with the study of theories of knowledge. Following Bateson’s idiosyncratic use of the term, epistemology within the family therapy fi eld is used more loosely to mean a specifi c theory of knowledge or world view. Using this defi nition, within the family therapy fi eld, distinctions are made between three main epistemologies: positivism, constructivism and social constructionism. Domain Constructivism Milan Social constructionism Solution focused Narrative Key fi gures Harry Procter Rudy Dallos Guillem Feixas Greg and Robert Neimeyer Mara Selvini Palazzoli Gianfranco Cecchin Luigi Boscolo Giuliana Prata Gianfranco Cecchin Luigi Boscolo Karl Tomm Imelda McCarthy Nollaig Byrne Phil Kearney Tom Andersen Harlene Anderson Harry Goolishan Steve deShazer Insoo Kim Berg Michael White David Epston Healthy family functioning Members of healthy families have personal and family construct systems that are suf fi ciently complex, fl exible and congruent to promote adaptation to the changing demands of the family lifecycle and the wider ecological system Each family system develops a unique set of relationships, patterns of interactions and belief systems. In healthy families these are suf fi ciently fl exible to promote adaptation to the changing demands of the family lifecycle and the wider ecological system Healthy families hold belief systems that are suf fi ciently fl exible to promote adaptation to the changing demands of the family lifecycle and the wider ecological system Family members attend to exceptional circumstances in which common problems do not recur and learn to recreate these circumstances when they need to resolve specifi c problems In healthy families, the dominant narratives subserve the liberation of family members and their empowerment Also healthy families open space for creating narratives about personal competence Table 4.1 Key features of family therapy schools and trad itions that emphasise the role of belief systems and narrative (Continued on next page) Table 4.1 (Continued) Domain Constructivism Milan Social constructionism Solution focused Narrative Unhealthy functioning Members of unhealthy families have personal and family construct systems that are too rigid and simple and disparate to allow adaptation to the changing demands of the family lifecycle and the wider ecological system In unhealthy families the relationships, interaction patterns and belief systems are not suf fi ciently fl exible to promote adaptation to the changing demands of the family lifecycle and the wider ecological system Unhealthy families hold belief systems that are not suf fi ciently fl exible to promote adaptation to the changing demands of the family lifecycle and the wider ecological system Family members engage in recursive problem- maintaining behaviour patterns and do not recreate exceptions In unhealthy families, the dominant narratives subserve the entrapment of family members, the equation of people with problems, and the closing down of possibilities for new narratives to emerge Assessment Triadic questioning; constructing perceived element grids; laddering; circular questioning; bow-tie mapping; completing paper and pencil or computer versions of the repertory grid; self- and family characterisation; completing an autobiographical table of contents; and Circular questioning asked from a position of neutrality is used to progressively modify hypotheses about belief systems, interaction patterns (family games), and family relationships Circular questions asked from positions of curiosity and irreverence to bring forth the family’s construction of the problem Clarifying if clients are customers, complainants or visitors Identi fi cation of exceptional circumstances under which the problem does not occur The identi fi cation of the problem and unique outcomes where the problem does not occur defi ning the self and the family through metaphor are used to clarify family members individual and shared construct systems Scope of treatment goals Elaborating personal and family construct systems so they make more accurate predictions Challenging the family belief system that underpins problem- maintaining interaction patterns Co-constructing or bringing forth a new and more adaptive belief system Facilitate the occurrence of exceptional episodes in which the problem does not recur Re-authoring personal narratives so they no longer equate the person with the problem and so they include a view of the self as competent Therapy Use construct articulation and fi xed role therapy to elaborate more complex and fl exible individual and family construct systems Circular questioning within sessions and end of session interventions are used to promote change End of session interventions include positive connotation of family members intentions; split-team messages empathising with beliefs, feelings and Circular questions asked from a position of curiosity and irreverence along with re fl ections of the therapist and team opens up space for co-constructing a new belief system The therapist uses strategising and interventive interviewing to help Goal setting using the miracle question Deconstructing the complaint Exploring differences between problematic and exceptional episodes Use scaling questions, questions about presession change and questions about coping Externalise the problem Enquire about unique outcomes in the past Thicken the plot about competence Extend the story into the future Recruit family members to act as outsider witnesses (Continued on next page) [...]... us turn to a discussion of those family therapy traditions that have looked to constructivist, social constructionist and postmodern ideas as a basis for practice, and which have highlighted the centrality of helping clients construct new belief systems and narratives in family therapy A CONSTRUCTIVIST APPROACH TO FAMILY THERAPY A constructivist approach to family therapy grounded in George Kelly’s... Houston Galveston Institute developed a unique social-constructionist approach to family therapy (Anderson, 1995, 1997, 2000, 2001, 20 03; Anderson & Goolishan, 1988; Anderson & Levine, 1998; Anderson, Goolishan & Windermand, 1986; Goolishian & Anderson, 1987) They abandoned systems theory and cybernetics as explanatory frameworks and replaced these with the extreme social-constructionist notion of collaborative... more than therapy: triadic questioning; laddering; circular questioning; completing paper and pencil or computer versions of the repertory grid; self- and family characterisation; completing an autobiographical table of contents; and defining the self and the family through metaphor 122 CENTRAL CONCEPTS IN FAMILY THERAPY Triadic questioning is the main technique for identifying constructs and it involves... class, ethnicity and culture, must be incorporated into useful models of therapy, because there are no universal principles for good practice or for the perfectly adjusted family Models of good practice and of family functioning are local, not global and take account of salient contextual and cultural factors Postmodernism also has implications for practice (Pocock, 1995) Postmodern therapy rejects... Harry 120 CENTRAL CONCEPTS IN FAMILY THERAPY Procter (1981, 1985a, 1985b, 1995, 20 03) and Rudi Dallos (1991, 1997; Dallos & Aldridge, 1985) in the UK; by Guillem Fexias (1990a, 1990b, 1995a, 1995b; Feixas, Proctor & Neimeyer, 19 93) in Spain; and by Greg and Robert Neimeyer (Alexander & Neimeyer, 1989; Neimeyer, 1985, 1987; Neimeyer & Hudson, 1985; Neimeyer & Neimeyer, 1994) in the USA; and by Vince Kenny... 20 03; Rowan & O’Hanlon, 1999), Eve Lipchik (2002) and a team including Miller, Hubble and Duncan (1996) have made significant contributions to the development of solution-focused brief therapy in North America Solution-focused centres have been established in the UK by Evan George, Chris Iveson and Harvey Ratner (1999), and in Ireland by John Sharry, Brendan Madden and Melissa Darmody (20 03) Brief therapy. .. from oppressing 138 CENTRAL CONCEPTS IN FAMILY THERAPY you?’ Descriptions of these unique outcomes are then elaborated by posing landscape-of-action and landscape-of-consciousness questions The terms for these twin ‘landscapes’ were coined by Bruner (1986, 1987, 1991) Landscape-of-action questions address sequences of events, for example, ‘Give me a step-by-step account of that episode?’ Landscapeof-consciousness... Even if a boat sinks or capsizes, it can always be righted or repaired Similarities and differences between differing metaphors may then be discussed and the implications of this for individual and family construct systems Family Therapy Based on Personal Construct Theory Therapy techniques in personal construct family therapy all hinge on the positioning of the therapist The therapist’s position is... after fixed-role therapy, to construe it as a need to develop selfreliance and bravery Within therapy sessions, where it is clear that family member’s construe each other in ways that are not accurate, they may be invited to listen carefully to other family members’ positions and check the discrepancies between their beliefs and the views expressed by relevant family members For example, family members... challenged Where family members completely opposed the treatment team and engagement was jeopardised, the Milan therapists commonly took a one-down position to mobilise the family to engage in therapy For example, the team would express puzzlement and therapeutic impotence by, for example, noting that the family s problems were so complex and baffling and that they would probably be unresponsive to therapy In . J. (20 03) . Structural family therapy. In L. Hecker & J. Wetchler (Eds), An Introduction to Marital and Family Therapy, pp. 39 –62. New York: Haworth. Behavioural Marital and Family Therapy Atkins,. to Marital and Family Therapy, pp. 95–122. New York: Haworth. Structural Family Therapy Behar-Mitrani, V. & Perez, M. (20 03) . Structural-strategic approaches to couple and family therapy. . (1991). Strategic Family Therapy. In A. Gurman & D. Kniskern (Eds), Handbook of Family Therapy, Vol. 11, pp. 39 6–416. New York: Brunner-Mazel. Rosen, K. (20 03) . Strategic family therapy. In L.