BASIC CONCEPTS

The BSFT conceptual framework makes two basic assumptions about

the nature of families: the family and its members are a system,

and family interactions occur in typical patterns called struc-

tures. In addition, BSFT uses two general guidelines to govern

therapy: it should be strategic, that is, problem-focused and

pragmatic, and it should be time-limited. Finally, BSFT follows

three therapeutic strategies: the use of joining for entering the

family system, experiential diagnosis to plan restructuring, and performance-based restructuring techniques. These seven elements define BSFT and are discussed below.

Assumptions About Families

The systems perspective in RSFT implies that individuals and indi- vidual behavior can be understood only in terms of their context-- the system (e.g., the family, the community) and subsystems (e.g., the parental unit, the sibling unit) to which the individual

belongs. Additionally, individual behavior is viewed as both

interactive and interdependent. Thus, each family member's

behavior is fundamentally different from what it would be if that individual could act in isolation.

Families in which adolescent drug abuse occurs tend to identify the adolescent as the sick patient. Within a family systems framework, this person is referred to as the family's Identified

Patient (IP). At the time of presentation, the family's typical

expectation of therapy is that the IP needs to be changed. The

BSFT therapist, however, recognizes that, although one of the members manifests drug abuse symptoms, those symptoms are main- tained because the entire family participates in maladaptive

patterns of interaction. Treatment, therefore, targets the family

as a whole.

Because of the systems assumption, BSFT examines interactions between people rather than individual behavior in isolation. Another basic assumption of BSFT is that a family tends to repeat these interactions, forming typical behavior patterns for conduct-

ing business among its members and within its environment. These

typical or habitual patterns of interaction define a family's

structural organization. Dysfunction results from the family

system's attempts to resolve a problem by applying a maladaptive

pattern of interaction. A problem arises and the family responds

is adaptive and will be effective in resolving the problem, but because that particular set of frequently repeated interactions

has become habitual. Thus, the purpose of structural therapy is

to facilitate the emergence of new patterns of interaction (i.e., family structures) that resolve problems effectively.

General Therapeutic Guidelines

In BSFT, therapy is strategically oriented. As part of this stra- tegic orientation, therapy is problem-focused. The problem-focus requires that the family structures (patterns of interaction) tar- geted for change are those that directly affect the drug use or

other symptomatic behavior. In addition, the presenting com-

plaints such as drug abuse are used as the content through which

the family is engaged in therapy. A strategic orientation also

implies a high degree of pragmatism. Thus, BSFT modalities use

whatever techniques lead to the most efficient, permanent, and adaptive structural change in the family system.

Another BSFT characteristic is that it is time-limited. Research and clinical evidence indicate that explicit temporal limitations that are strictly adhered to may facilitate and accelerate the therapeutic process (McGee and Williams 1971, Muench 1965). BSFT's preferred treatment length is 8 to 12 weekly therapy sessions, although a maximum of 15 sessions may be necessary.

Therapeutic Strategies

BSFT uses a joining strategy for entering the family system in a

manner designed to avoid systemic resistance to change. The

therapist joins by initially supporting the family and mimicking

its style, affect, and activity. Once the therapist has found a

way to fit into the family system and formed a positive relation- ship with each of its members, he/she quickly establishes a

leadership position in the system. Thus, as a result of joining,

a new system consisting of the family plus the therapist is formed.

Another element of BSFT is the strategy of developing an experi- ential diagnosis in order to plan how to restructure the family. The therapist diagnoses the family structure based on interactions

occurring in the therapist's presence. In practice, the diagnosis

occurs throughout the joining process. The diagnosis is experien-

tial in two senses: not only is it based on behavioral inter-

actions, but also it is through the joining process that the therapist is able to experience these interactions in the same way

that family members experience them. After the family's structure

is assessed, a series of interventions is strategically designed to restructure dysfunctional patterns of interaction. This planning focuses the therapeutic process, thereby shortening it. Finally, the BSFT conceptual framework uses the strategy of

change in the family's organization so that the family members can

achieve more adaptive patterns of family interaction. The thera-

pist directs or manipulates improved ways of relating that must be performed by family members during therapy. Once more adaptive interaction patterns have been achieved within therapy sessions, the therapist assigns homework so these patterns can be success- fully performed without the therapist's direct assistance. Brief Strategic Family Therapy is present- and future-oriented. Its goal is not the exploration of the past, but rather the manipulation of the present (Minuchin 1974) as a tool for change.

In order to work toward this goal, the therapist examines sets of interactions, diagnoses those that are pathological, and plans strategies to restructure these interaction patterns in order to

implement change. BSFT's cost-effectiveness derives from its use

of strategic interventions, explicit a priori time limitations, and the joining strategy, which gives the therapist access to the family and the ability to maneuver effectively.