STRATEGIC APPROACH TO DRUG ABUSE
This section covers the principal elements of our model.* We use the term "structural—strategic- because we drew
from the predominent practices of both these approaches, in addition to
introducing some distinctive features
of our own.T The general thrust is
strategic, but many of the moment-to-moment or
"micromoves" within sessions are of a more structural
nature. In other words, the broad strokes tend to be strategic and the
brushwork structural, with the single excep-tion of the regular use
throughout of "noble ascriptions- (a description of which follows). More specifically, the
procedure is to (1) apply
Minuchin's structural theory as a guiding paradigm; (2) work struc‑
turally within sessions through the actual
enactment of new patterns, and the application of structural techniques
such as joining, accom-modating, testing boundaries, restructuring, and
so forth; (3) apply Haley's strategic model in terms of its emphasis
on a specific plan,
extrasession events, change in the symptom, collaboration
among treatment systems, and the
This therapy is goal-oriented and short-term. One advantage of a brief therapy model is
that it catalyzes and compresses into a time
Unlike prevalent practices in the drug-abuse
field, we put heavy and continual
emphasis on actively involving the addict's family of origin in therapy, even if he is not living with them. Part of the rationale for this rests on a developmental
framework. As discussed earlier,
these families have commonly gotten stuck at the stage when it is
appropriate for the IP to leave home. They have not been able to traverse this stage and instead become fixed in a
cycle in which the addict either moves
out and then back in, or remains inappropriately and overly tied to the family
in other ways. By convening the whole family,
the therapist can more easily help them to go through this correctly. In a sense, the family is being asked
to return to an earlier stage that
was not successfully negotiated. and to do it -right" this time. Thus parental control is reinstated and then
gradually and appro-priately relaxed.
It should be noted that this process frequently intensifies the whole
experience for the family, as members are brought closer together.
Sometimes the result of this -compression" 162 is a counterreaction in which family members begin to insist on separation with much less of their previous
ambivalence. During this period the
therapist should attempt to prevent the process from running its usual course by slowing it down and
planning the IP's departure
carefully; an example of such a strategy is given in Chapter 7.
It has become clear to us that family treatment
must first deal with the triad
composed of addict and both parents (or parent surrogates) before proceeding further. It is our experience, and that of
some others,152 that if this step is skipped, therapy will falter and possibly fail. In some cases with married addicts
we started with the marital pair and
found that it only served to stress or dissolve the marriage; thus, the addict would end up back with
his parents. However, families differ
in the ease with which the transition from family of origin to family, of procreation can be made. Sometimes the parents can be eased out of the picture (or, as in
Chapter 10, their involvement reduced) within a few sessions, while other cases
may require that they be involved
throughout treatment. The key is to
start with the parent-addict triad and to move away from it in accordance with the parents' readiness to release the addict.
success.
On the other hand, siblings may serve a number of functions
in
the sessions. They may act as allies to the
addict and help to get him to assert himself more appropriately. Or, as in
Chapter 9, they can be rallied to strengthen the position of a parent
who is taking an appropriate stand. Often they provide a useful
alternative focus and prevent exclusive attention from being given to the
addict. It is not unusual to find siblings who are also addicted or
have problems as severe as those of the addict (e.g., the case in Chapter 12).
Finally, siblings always provide additional data on family interactions, which
the therapist may use to advantage.
From the above it may be clear why we place such
inordinate
emphasis on family recruitment and engaging
members in therapy, as outlined in Chapter 3, 4, and 5. Because the
drug taking of the IP is so intimately a part of the interactional
behavior of the whole family, a therapist who does not have direct access to other family members operates at a severe disadvantage. In addition,
efforts by members to control
session attendance are usually attempts to resist change,r1" so decisions as to who should or should not attend
therapy are best made
by the therapist, not the family.
It would not be accurate to view our treatment
approach as
always limited just to the
addict and his immediate family. This may be the primary system
involved, but other interpersonal systems are also engaged, as appropriate.
We deal with them if they are par-ticularly relevant to the case and can serve to facilitate
or hinder therapeutic progress. Such
systems might include friends, important relatives, vocational counselors,
employers, school or legal authorities, and,
of course, the staff of the drug-treatment program itself. The interfaces among these systems are discussed at
greater length later in the chapter.
