|
Strategic/Interactional Therapies
- from NIDA
Strategic/interactional therapies attempt to identify
the client's strengths and actively create personal and environmental
situations where success can be achieved. In these therapies, the focus
is on the individual's strengths rather than on pathology, the
relationship to the therapist is essential, and interventions are based
on client self-determination with the community serving as a resource
rather than an obstacle. This model has been widely used and
successfully tested on persons with serious and persistent mental
illnesses (Rapp and Wintersteen, 1989; Saleebey, 1996; Solomon, 1992).
It has also been used with persons who have problems related to
substance abuse (Juhnke and Coker, 1997; Miller and Berg, 1991; Ratner
and Yandoli, 1996; Watzlawick et al., 1967). Although the research to
date on these therapies (using nonexperimental designs) has not focused
exclusively on substance abuse disorders, the use of these therapies in
treating substance abuse disorders is growing.
Many different theoretical approaches have strategic
or interactional roots. They can be distinguished from each other
primarily by the different emphasis and value they place on components
of the change process. Therapists rarely follow a single theoretical
approach strictly; therapists today influence and learn from each other,
incorporating what they find useful into their own work.
All of these models stem in part from the work of
Milton Erikson. He coined the term strategic therapy to describe
an approach in which the therapist takes responsibility for finding new
and effective strategies to help clients in distress. Jay Haley, John
Weakland, and other theorists of the Mental Research Institute (MRI)
consulted with Erikson as they expanded on his theoretical approach.
More recently, Steve De Shazer and his colleagues,
who were influenced by the MRI approach, shifted the focus of treatment
from problems to solutions, calling their modality solution-focused
therapy. Their approach, originally developed to work in brief
marriage and family therapy, has since been used in a variety of
situations for a variety of presenting problems, including substance
abuse disorders. (See Chapter 8 for more information on the application
of all these therapies to the treatment of families.)
Interactional therapy is based on the
assumption that problems can best be understood by examining clients'
(often dysfunctional) interactions with others and their resulting
problems. Strategic therapy is a form of interactional therapy because
it does not focus on the root causes of the client's problems but
instead tries to increase competency and develop problem-solving skills
that will help the client in her interactions with others. For the
purpose of this discussion, however, the combined term strategic/interactional
therapy is used. This broader term allows solution-focused therapy,
which is certainly interactional, to be included in this section.
Although it has a strong kinship with strategic approaches, not all
practitioners consider solution-focused therapy to be "strategic."
The significance of these different approaches can be
found in their presentation of an alternative approach to understanding
how substance abuse disorders evolve and how new innovative solutions
could be generated to assist with the resolution of these problems.
The Consensus Panel believes that these therapeutic
approaches are potentially useful for clients with substance abuse
disorders and should be introduced to offer new knowledge and techniques
for treatment providers to consider. This chapter presents one
strategic/interactional approach, solution-focused therapy, which has
been used in substance abuse treatment. Information on when to use
solution-focused brief therapy with substance abuse clients, a case
study using strategic/interactional approaches with a substance-abusing
client, and the general theories that provide the basis for strategic/interactional
therapies are discussed below.
| back to top
While this chapter covers several strategic and
interactional theories and practices, most of the work currently being
done on substance abuse treatment uses a solution-focused approach.
Solution-focused therapy is always brief, and to date there has not been
a great deal of research comparing it to other models.
Research by Iguchi and colleagues supports some of
the theoretical claims made by solution-focused therapists (Iguchi et
al., 1997). The solution-focused therapist believes that helping clients
with substance abuse disorders to address any life problems they find
significant will help them to reduce their substance use. What is
important is finding a solution to the problems the client identifies as
significant, then reinforcing the client's success in solving those
problems. This procedure helps the client to recognize her own ability
to solve her problems. The study by Iguchi and colleagues compared the
role of urine testing, traditional substance abuse counseling services,
and the reinforcement of nonsubstance-use-related positive life changes
and found that the latter resulted in the most significant reduction in
substance use even after reinforcement contingencies ended.
The solution-focused therapy model has been used to
respond to a range of problems and complaints. Researchers Berg and
Miller were the first to apply the model specifically to the treatment
of alcohol-related problems, but others also have used these techniques
for treating substance abuse disorders (Berg, 1995; Berg and Miller,
1992; Berg and Reuss, 1998; Ratner and Yandoli, 1996). This treatment
model is not necessarily a useful treatment strategy for all clients
with substance abuse disorders; no one model is. However, this model is
a "complex and varied package of strategies that can be applied in an
individualized, eclectic fashion to those seeking treatment" for a
multifaceted and complex problem (Berg and Miller, 1992, p. xix). Berg
and Reuss delve into greater detail regarding the applications of
solution-focused brief therapy to the treatment of substance abuse
disorders (Berg and Reuss, 1998).
One technique of solution-focused therapy is to focus
on the exceptions to the client's problems. For example, in providing
solution-focused brief therapy for a client with a substance abuse
disorder, the therapist should direct the client's attention to periods
when he was substance free. To identify these periods, the therapist
must listen carefully to the client's responses, then ask the client to
discuss those periods. The purpose is to help the client realize that he
can maintain sobriety and has, in fact, done so in the past. The idea of
focusing on the exception to any presenting problem is an aspect of
strategic therapy that has particular relevance to the substance abuser
because, as Berg notes, almost every substance abuser has had some
period of abstinence--in many cases this period may have lasted months
or years (Berg, 1995).
Exceptions to presenting problems may fall into two
categories, deliberate exceptions and random exceptions
(see Figure 5-1 for definitions). The more deliberate the behavior on
the part of the client, the easier it will be for her to repeat it. But
even substance-free periods that seemed to result from outside
influences (i.e., random exceptions) can be used to help the client
realize her own ability to stay sober.
| back to top |
