BSFT is based on three basic principles. The first is that BSFT is a family
system approach. Family systems means that family members are interdependent:
What affects one family member affects other family members. According to
family systems theory, the drug-using adolescent is a family member who displays
symptoms, including drug use and
related co-occurring problem behaviors. These symptoms are indicative, at
least in part, of what else is going on in the family system. Just as important,
research shows that families are the strongest and most enduring force in the development of children and adolescents.
For this reason, family-based interventions have been studied as treatments for
drug-abusing adolescents and have
been found to be efficacious in treating both the drug abuse and related co-occurring
The role of the BSFT counselor is to identify the patterns of family interaction
that are associated with the adolescent's behaviour
problems. For example, a mother and grandmother who are arguing about establishing
rules and consequences for a problem adolescent never reach an agreement because
the adolescent disrupts their arguments with self-destructive attempts
to get attention.
BSFT appeals to cultural groups that emphasize family and interpersonal
What Are the Goals of Brief Strategic Family Therapy?
In BSFT, whenever possible, preserving the family is
desirable. While family preservation is important, two goals must be set:
to eliminate or reduce the adolescent's use of drugs and associated problem behaviors,
known as "symptom focus," and to change the family interactions that are associated
with the adolescent's drug abuse, know as "system focus." An example of the
latter occurs when families direct their negative feelings toward the drug-abusing
youth. The parents' negativity toward the adolescent directly affects his
or her drug abuse, and the adolescent's drug abuse increases the parents' negativity.
At the family systems level, the counselor intervenes to change the way family members
act toward each other (i.e., patterns of interaction). This will prompt family
members to speak and act in ways that promote more positive
family interaction, which, in turn, will make it possible for the adolescent to
reduce his or her drug abuse and other problematic behaviors.
What Are the Most
Common Problems Facing the Family of a Drug-Abusing
The makeup and dynamics of the family are discussed in terms of the adolescent's
symptoms and the family's problems.
The Family Profile of a Drug-Abusing Adolescent
Research shows that many adolescent behavior problems have
common causes and that families, in particular, play a large role in those problems
in many cases. Some of the family problems that have
been identified as linked to adolescent problem behaviors include:
Some adolescents may have families who had these problems before they began using
drugs. Other families may have developed problems in response to the adolescent's
Because family problems are an integral part of the profile of drug-abusing adolescents
and have been linked to the initiation and maintenance of adolescent drug use, it
is necessary to improve conditions in the youth's most lasting and influential environment:
the family. BSFT targets all of the family problems listed above.
The Behavioral Profile of a Drug-Abusing Adolescent
Adolescents who need drug abuse treatment usually exhibit a variety of externalizing
behavior problems. These may include:
Associating with antisocial peers
Conduct problems at home and/or school
Violent or aggressive behavior
Risky sexual behavior
Negativity in the Family
Families of drug-abusing adolescents exhibit high degrees of negativity.
Very often, this negativity takes the form of family members blaming each other
for both the adolescent's and the family's problems. Examples might include
a parent who refers to her drug-abusing son "no good" or "a lost cause."
Parents or parent figures may blame each other for what they perceive as a failure
in raising the child. For example, one parent may accuse the other of having
been a "bad example," or for not "being there" when the youngster needed him or
her. The adolescent, in turn, may speak about the parent accused of setting
a bad example with disrespect and resentment. The communication among family
members is contaminated with anger, bitterness, and animosity. To the BSFT
counselor, these signs of emotional or affective distress indicate that the work
of changing dysfunctional behaviors must start wit changing
the negative tone of the family members' emotions and the negative content of their
interactions. Research shows that when family negativity is reduced early
in treatment, families are more likely to remain in therapy.
What Is Not the
Focus of Brief Strategic Family Therapy?
BSFT has not been tested with adult addicts. For this reason, BSFT is not
considered a treatment for adult addiction. Instead, when
a parent is found to be using drugs, a counselor needs to decide the severity of
the parent's drug problem. A parent who is moderately involved with drugs
can be helped as part of his or her adolescent's BSFT treatment. However,
if a parent is drug dependent, the BSFT counselor should work to protect and disengage
the adolescent from the drug dependent parent. This is done by creating an
interpersonal wall or boundary that separates the adolescent and non-drug-using
family members from the drug dependent parent(s).
The social influences an individual encounters have an important
impact on his or her behavior. Such influences are particularly powerful during
the critical years of childhood and adolescence. The BSFT approach asserts
that the counselor will not be able to understand the adolescent's drug-abusing
behavior without understanding what is going on in the various contexts in which
he or she lives. Drug-abusing behavior does not happen in a vacuum; it exists
within an environment that includes family, peers, neighborhood, and the cultures
that define the rules, values, and behaviors of the adolescent.
Family as Context
Context, as defined by Urie Bronfenbrenner, includes a number of social contexts. The most immediate are those that include the youth,
such as family, peers, and neighborhoods. Bronfenbrenner recognized the enormous
influence the family has, and he suggested that the family is the primary context
in which the child learns and develops. More recent research has supported Bronfenbrenner's
contention that the family is the primary context for socializing children and
Peers as Context
Considerable research has demonstrated the influences that friends' attitudes,
norms, and behaviors have on adolescent drug abuse. Moreover, drug-using
adolescents often introduce their peers to and supply them with drugs. In
the face of such powerful peer influences, it may seem that parents can do little
to help their adolescents.
However, recent research suggests that, even in the presence of drug-using or
delinquent peers, parents can wield considerable influence over their adolescents.
Most of the critical family issues (e.g., involvement, control, communication,
rules and consequences, monitoring and supervision, bonding, family cohesion,
and family negativity) have an impact on how much influence parents can have in
countering the negative impact peers have on their adolescents' drug use.
Neighborhood as Context
The interactions between the family and the context in which family lives may
also be important to consider. A family functions within a neighborhood context,
family members live in a particular neighborhood, and the children in the family
are students at a particular school. For instance, to effectively manage a
troubled 15-year-old's behavioral problems in a particular neighborhood, families
may have to work against high drug availability, crime, and social isolation.
In contrast, a small town in a semi rural community may have a community network
that includes parents, teachers, grandparents, and civic leaders, all of whom collaborate
in raising the town's children. Neighborhood context, then, can introduce
additional challenges to parenting or resources that should be considered when working
Culture as Context
Bronfenbrenner also suggested that families, peers, and neighborhoods exist within
a wider cultural context that influences the family and its individual members.
Extensive research on culture and the family has demonstrated that the family and
the child are influenced by their cultural contexts. Much of the researchers'
work has examined the ways in which minority families' values and behaviors have
an impact on the relationship between parents and children and affect adolescents'
involvement with drug abuse and its associated problems.
Counseling as Context
The counseling situation itself is a context that is associated with a set of
rules, expectations, and experiences. The cultures of the client (i.e., the
family), the counselor, the agency, and the funding source can all affect the
nature of counseling as can the client's feelings about how responsive the "system"
is to his or her needs.
Systems are a special case of context. A system
is made up of parts that are interdependent and interrelated. Families are
systems that are made up of individuals (parts) who are responsive (interrelated
to each other's behaviors.
A whole Organism
"Systems" implies that the family must be viewed as a whole organism. In
other words, it is much more than merely the sum of the individuals or groups that
it comprises. During the many years that a family is together, family members
develop habitual patterns of behaviour after having repeated them thousands of times.
In this way, each individual member has become accustomed to act, react, and respond
in a specific manner within the family. Each member's actions elicit a certain
reaction from another family member over and over again over time. Their repetitive
sequences give the family its own form and style.
The patterns that develop in a family actually shape the behaviors and styles
of each of its members. Each family member has become accustomed to behaving
in certain ways in the family. Basically, as one family member develops certain
behaviors, such as a responsible, take-control style, this shapes other family members'
behaviors. For example, family members may allow the responsible member to
handle logistics. At the same time, the rest of the family members may rather
than compete with one another. These behaviors have occurred so many times,
often without being thought about, that they have shaped the members to fit together
like pieces of a puzzle--perfect, predictable fit.
Family Systemic Influences
Family influences may be experienced as an "invisible force." Family members'
behavior can vary considerable. They may act much differently when they are
with other family members than when they are with people outside the family.
By its very presence, the family system shapes the behaviors of its members.
The invisible forces (i.e., systemic influences) that govern the behaviors of family
members are at work every time the family is together. These "forces" include
such things as spoken or unspoken expectations, alliances, rules for managing conflicts,
and implicitly or explicitly assigned roles.
In the case of an adolescent with behavior problems, the family's lack of skills
to manage a misbehaving youth can create a force (or pattern of interaction) that
makes the adolescent inappropriately powerful in the family. For example,
when the adolescent dismisses repeated attempts by the parents to discipline him
or her, family members learn that the adolescent generally wins arguments, and they
change their behavior accordingly. Once a situation like this arises in which
family expectations, alliances, rules, and so on have been reinforced repeatedly,
family members may be unable to change these patterns without outside help.
The Principle of Complementarity
The idea that family members are interdependent, influencing and being influenced
by each other, is not unique to BSFT. Using different terminology, the theoretical
approach underlying behaviorally oriented family treatments might explain there
mutual influences as family members both serving as stimuli for and eliciting responses
from one another. The theoretical approach underlying existential family treatments
might describe this influence as family members either supporting or constraining
the growth of other family members. What distinguishes BSFT from behaviorally
oriented and existential family treatments is its focus on the family system rather
than on individual functioning.
BSFT assumes that a drug-abusing adolescent will improve his or her behavior
when the family learns how to behave adaptively. This will happen because
family members, who are "linked" emotionally, are behaviorally responsive to each
other's actions and reactions. In BSFT, the Principle of Complementarity holds that
for every action by a family member there is a corresponding reaction from the rest
of the family. For instance, often children may have learned to coerce parents
into reinforcing their negative behavior--for example, by throwing a temper tantrum
and stopping only when the parents give in. Only when parents change their
behavior and stop reinforcing or "complementing" negative behavior will the child
Structure: Patterns of Family Interaction
An exchange among family members, either through actions or conversations, is
called an interaction. In time, interactions become habitual and repetitive,
and thus are referred to as patterns of interaction. Patterns of family interaction
are habitual and repeated behaviors family members engage in with each other.
More specifically, the patterns of family interaction are comprised of linked chains
of behavior that occur among family members. A simple example can be illustrated
by observing that family members choose to sit at the same place at the dinner table
every day. Where people sit may make it easier for them to speak with each
other and not with others. Consequently, a repetitive pattern of interaction
reflected in a "sitting" pattern is likely to predict the "talking" pattern.
A large number of these patterns of interaction will develop in any system.
In families, this constellation of repetitive patterns of interaction is called
the family "structure."
The repetitive patterns of interaction that make up a family's structure function
like a script for a play that actors have read, memorized, and re-enact constantly.
When one actor says a certain line from the script or performs a certain action,
that is the cue for other actors to recite their particular lines or performs their
particular actions. The family's structure is the script for the family to
Families of drug-abusing adolescents tend to have problems precisely because
they continue to interact in ways that allow the youths to misbehave. BSFT
counselors see the interactions between family members as maintaining or failing
to correct problems, and so they make these interactions the targets of change in
therapy. The adaptiveness of an interaction is defined in terms of the degree
to which it permits the family to respond effectively to changing circumstances.
The Three Ps of Effective Strategy
As its second word suggests, a fundamental concept of Brief Strategic Family
Therapy is strategy. BSFT interventions are strategic in that they are practical,
problem-focused, and planned.
BSFT uses strategies that work quickly and effectively, even though they might
seem unconventional. BSFT may use any technique, approach, or strategy that
will help change the maladaptive interactions that contribute to or maintain the
family's presenting problem. Some interventions used in BSFT may seem "outside
the theory" because they may be borrowed from other treatment modalities, such as
behavior modification. For example, behavioral contracting, in which patients
sign a contract agreeing to do or not to do certain things, is used frequently as
part of BSFT because it is one way to re-establish the parent figures as the family leaders. Frequently, the counselor's greatest challenge is to get the parent(s)
to behave in a measured and predictable fashion. Behavioral contracting may
be an ideal tool to use to accomplish this. The BSFT counselor uses
whatever strategies are most likely to achieve the desired structural (i.e., interactional)
changes with maximum speed, effectiveness, and permanence. Often, rather than
trying to capture every problematic aspect of a family, the BSFT counselor
might emphasize one aspect because it serves to move the counseling in a particular
direction. For example, a counselor might emphasize a mother's permissiveness
because it is related to her daughter's drug abuse and not emphasize the mother's
relationship with her own parents, which may also be problematic.
The BSFT counselor works to change maladaptive interactions or to augment existing
adaptive interactions (i.e., when family members interact effectively with one another)
that are directly related to the presenting problem (e.g., adolescent drug use).
This is way of limiting the scope of treatment to those family dynamics that directly
influence the adolescent's symptoms. The counselor may realize that the family
has other problems. However, if they do not directly affect the adolescent's problem behaviors, these other family problems may not become a part of the BSFT
treatment. It is not that BSFT cannot focus on these other problems.
Rather, the counselor makes a choice about what problems to focus on as part of
a time-limited counseling program. For example, the absence of clear family
rules about appropriate and inappropriate behavior may directly affect the adolescent's
drug-using behavior, but marital problems might not need to be modified to help
the parents increase their involvement, control, monitoring the supervision, rule
setting, and enforcement of rules in the adolescent's life.
Most families of drug-abusing adolescents are likely to experience multiple
problems in addition to the adolescent's symptoms. Frequently,
counselors complain that "this family has so many problems that I don't know
where to start." In there cases, it is important for the counselor to
carefully observe the distinction between "content" and "process".
Normally, families with many different problems (a multitude of contents_ are
unable to tackle one problem at a time and keep working on it until it has been
resolved (process). These families move (process) from one problem to
another (content) without families able to focus on a single problem long enough
to resolve it. This is precisely how they become overwhelmed with a large
number of unresolved problems. It is this process, or how they resolve
problems, that is faulty. The counselor's job
is to help the family keep working on (process) a single problem (content) long
enough to resolve it. In turn, the experience of resolving the problem may
help change the family's process so that family members can apply their newly
acquired resolution skills to other problems they are facing. If the
counselor gets lost in the family's process of shifting from one content/problem
to another, he or she may feel overwhelmed and, thus, be less likely to help the family resolve its conflicts.
In BSFT, the counselor plans the overall counseling strategy and the strategy
for each session. "Planned" means that after the counselor determines what
problematic interactions in the family are contributing to the problem, he or she
then makes a clear and well-organized plan to correct them.
Content Versus Process: A Critical Distinction
In BSFT, the "content" of therapy refers to what family members talk about,
including their explanations for family problems, beliefs about how problems should
be managed, perspectives about who or what causes the problems, and other topics.
In contrast, the "process" of therapy refers to how family members interact,
including the degree to which family members listen to, support, interrupt, undermine,
and express emotion to one another, as well as other ways of interacting.
The distinction between content and process is absolutely critical to BSFT.
To be able to identify repetitive patterns of interaction, it is essential that
the BSFT counselor focus on the process rather than the content of therapy.
Process is identified by the behaviors that are involved in a family interaction.
Nonverbal behavior is usually indicative of process as is the manner in which family
members speak to one another.
Process and content can send contradictory messages. For example, while
an adolescent may say, "Sure Mom, I'll come home early," her sarcastic gesture and
intonation may indicate that she has no intention of following her mother's request
that she be home early. Generally, the process is more reliable that the content
because behaviors or interactions (e.g. disobeying family rules) tend to repeat
over time, while the specific topic involved may change from interaction to interaction
(e.g., coming home late, not doing chores, etc.).
The focus of BSFT is to change the nature of those interactions that constitute
the family's process. The counselor who listens to the content and loses sight
of the process won't be able to make the kinds of changes in the family that are
essential to BSFT work. Frequently, a family member will want to tell the
counselor a story about something that happened with another family member.
Whenever the counselor hears a story about another family member, the counselor
is allowing the family to trap him or her in content. If the counselor wants
to refocus the session from content to process, when Mom says, "Let me tell you
what my son did...," the counselor would say: "Please tell your son directly so that I can hear how you talk about this." When Mom talks to her son directly, the
therapist can observe the processes rather than just hear the content when Mom tells
the therapist can observe therapist what her son did. Observations like
these will help the therapist characterize the problematic interactions in the family.
Source: NIH Pub. No. 03-4751, Printed September 2003