We intend to dive into a description of the thinking that underlies our model and how it differs from other models of family therapy and brief therapy. Most other therapy models can be called ‘normative’: the model provides a structure for human behavior, and a deviation from that structure results in ‘illness’, discomfort, and a need to consult a professional.
In simple terms, the professional working from this model will consequently help the person seeking consultation to calibrate their life to get closer to that ‘just right’ point where problems cease to exist in their life. This way of thinking is based on a physiological medical model. For example: if the appendix is inflamed, it causes discomfort, pain, and fever. If those are the symptoms, a doctor is likely to suggest surgery. In the case of the appendix, there seems to be no negative consequence to not having it, so the surgery should produce an effective improvement in quality of life. However, when we talk about the gallbladder, which can also cause tremendous pain, removing this organ is not as simple. Bile is an essential part of the digestive process, and not having it means either taking a supplement for life or not being able to eat as much fat as desired and still be able to digest it. A similar situation occurs with a thyroid that isn’t functioning properly.
As a consequence of following the medical model, psychoanalysis gives a lot of power to the psychoanalyst: they sit behind the patient and interject one or two statements in the patient’s discourse. Change happens slowly, if at all, and the ‘flight to health’ is a way for the professional to keep the patient on the couch for a long period of time. And yes, back then this was seen as progress and novelty.
Let’s fast forward to Family Therapy, Systemic Therapy, and Interactional Therapy. The biggest difference in this way of thinking is that behavior always occurs in a context and cannot be explained independently of that context. As a consequence of this way of thinking, Don Jackson began inviting the entire family to therapy. Legend has it that in the town of Palo Alto, he would meet his patients at the cinema, in the supermarket, and many other places, and it was inevitable to introduce himself. “Since I’m going to bump into them anyway, he probably thought, I might as well bring them to the office because I’m sure they’ll have a lot to add to the story that brings the patients to see me.”
It was the first time a behavior, a complaint, a problem, or difficulty was seen in the context in which it occurs. The symptoms of a schizophrenic increased when the messages from their mother were unclear. Likewise, a fight between siblings worsened when the father favored one child over the other in their presence. All these situations make more sense in the context in which they occur; they are the foundation of a functional model.
In contrast, for example, the structural model developed by Minuchin describes how a ‘normal’ family should be. It classifies relationships between family members or between subsystems of the family. These classifications represent power dynamics within the system, as well as boundaries between different subsystems. The therapist is called upon to interrupt dysfunctional relationships within the family and help them return to a ‘healthier’ pattern. The explanation of why problems occur in a family or couple is based on the deviation of the system from what is considered its ideal state. Families are either enmeshed (the parental and child systems have unclear boundaries) or disengaged (these same subsystems are extremely detached). When these states become rigid, a family will seek or be referred for help, and the therapist will try to make these subsystems more flexible.
The strategic model developed by Haley—after spending time with Minuchin in Philadelphia—and his wife Madanes, is another example of a normative model. Haley was particularly interested in power struggles and said that a symptom arises when the cost of maintaining it outweighs the gains. Madanes was interested in incongruent hierarchies, where a child uses symptoms to change the father’s behavior. The power imbalance and hierarchies in a family or couple is what defines, from this point of view, how a problem arises. Therefore, the therapist’s attempt is to achieve a new balance. Another key piece in this therapy model is that the symptom or problem serves a function in the system, so that function needs to be explored if one is to find successful change in behaviors. This is achieved by exploring the past.
Both therapy models require the entire family to be present for therapy to take place.
There are many examples of normative therapies, but in contrast, the Brief Problem Resolution Therapy model focuses on what will work for the family, couple, or person who comes seeking help. We don’t have a preconceived idea of what is ‘normal,’ and therefore, each consult is different and unique. In our work with families in marginalized schools, it was very common for the grandmother to ask for help. She was in charge of a group of grandchildren because the mother was addicted, and the father had left, for example. In those situations, it was also very common for one of the older children to take on the role of the absent father, getting a job and leaving school to help financially support the family or help the grandmother discipline the younger siblings. Alternatively, older daughters often didn’t go to school to take care of younger siblings if the grandmother had a medical appointment, for example. It was also common for an older daughter not to go to school the day they needed an interpreter for medical visits because the grandmother didn’t speak English. In our model, we don’t talk about a ‘parentified child’ because that’s not part of our construction of reality/therapy model. Instead, the therapist asks, ‘What is the problem now?’ ‘What hurts now?’ with a focus on promoting a change in behavior that is a problem for the person asking for help.
What is even more important in Brief Problem Resolution Therapy is observing the context in which the undesired behavior occurs and helping to promote different solutions to change it. We assume that once a small change happens, the individuals will have new tools to continue with the new and desired action. This perspective promotes implicit optimism, which in turn creates a virtuous circle of change.
