The Tactics of Change: Doing Therapy Briefly

by Richard Fisch, John H. Weakland, Lynn Segal

A best-selling, seminal manual on treating a wide range of clinical problems briefly and effectively. Explores the principles of brief therapy and discusses the basic elements of treatment. Examines common situations in therapy and what therapists can do to initiate change.

Genres: Psychology, Nonfiction, Mental Health

328 pages, Hardcover

First published May 21, 1982

Reviews

[Jeremy · Rating 4 out of 5]

Quotes:

This is, in essence, a nonpathology model.

In psychodynamic [therapy],…the fundamental curative factor…is supposed to be “insight.”

This change exemplifies a general shift in epistemology from a search for linear cause-and-effect change to a cybernetic or systems viewpoint.

We do attach importance to identifying clearly the problem behavior – what it is, in what way it is seen as a problem, and by whom… A problem by our definition is an ongoing difficulty.

What works or fails to work – observable responses – should take precedence over what is abstractly right or logical.

[Therapists] are under no injunction to perform instantly.

“Well I have never met your husband; but judging from what you have told me, I think I would be inclined to agree with you.”

“I have a suggestion to make, but I’m not sure how much it will accomplish. It will depend on your ability to use your imagination and, perhaps, on your readiness to take a step toward improvement.”

Just as the therapist must be able to take a noncommitted or fluid position, the patient must be helped to take committed or nonfluid positions. That is, the maneuverability of the therapist is dependent on the nonmaneuverability of the client.

We hope to interdict the problem-maintaining behavior.

If one regarded an observed tennis rally as an undesirable interaction and therefore wished to end it as rapidly as possible, it would only require that one player not return the ball.

“Who in the family is most interested in resolving the problem?”

A good salesman knows he is not going to make a sale with every customer who enters his shop. But he also knows that he will almost never make a sale to someone who has come into the store just to get out of the rain.

[The therapist must] notice whether the patient is much bothered by the problem.

The commonest mistake is for the therapist to conceal his intimidation.

If the work constraints are as he says, he will be better off if he either learns to live with the problem or finds ways to rearrange his work schedule so that it will permit his planning on treatment.

“I think it only fair to tell you that you are setting up almost impossible odds if you are hoping to work on a problem while never being able to plan appointments ahead of time.”

Who is doing what that presents a problem, to whom, and how does such behavior constitute a problem?

If an answer is not clear and specific, the therapist should not act as if it is, but rather say, “I’m not clear on that,” taking the overt onus on himself (instead of saying, “You’re too vague”).

It is better for a therapist to appear dull and slow than to feign understanding when matters are not really clear.

“How do you see me as being helpful in dealing with that problem? How did you come to call me at the particular time you did, rather than sooner or later?”

In essence, the principal task of therapy is to influence the client to deal differently with his problem or complaint.

If they define someone else as the patient, they will present themselves either as benevolently concerned about a person who is “sick” or as victimized by a person who is “bad.”

1. What is the client’s principal position (attitude, opinion, motivation) in regard to the problem?
2. How can I best boil this down to its basic thrust or value?
3. Since I know what I would like the client to do to resolve his problem, how can I state this so that it will be consistent with that position?

The purpose of brief therapy is to influence the client in such a way that his original complaint is resolved to his satisfaction. This can be done either by interdicting the problem-maintaining behavior of the client or others or, in appropriate cases, by altering the client’s view of the problem so that he no longer feels distressed and in need of further treatment.

Five basic attempted solutions commonly observed in clinical practice[are]:
1. Attempting to force something which can only occur spontaneously
2. Attempting to master a feared event by postponing it
3. Attempting to reach accord through opposition
4. Attempting to obtain compliance through voluntarism
5. Confirming the accuser’s suspicions by attempting to defend oneself.

Interventions are basically a means to interrupt the attempted solution.

The general strategy we often use for dealing with performance problems centers on reversing the patient’s attempt to overcome the problem by providing a rationale and directives that instruct the patient to fail in his performance.

The common thread in strategies of resolving fear/avoidance problems, then, is to expose that patient to the feared task while restraining him from successfully completing it.

In marital problems, the complainant will usually try to wrest consideration from the spouse through complaint rather than request.

“My role here is not to play detective and determine which one of you is right or wrong. My role is limited to aiding both of you in your communication with each other since that has, obviously, broken down.”

The injunction to go slow will often be given very early – quite possibly in the first session – with clients whose main attempted solution is “trying too hard,” or with clients who press the therapist with urgent demands for remedial actions while they remain passive or uncooperative.

“If you are going to lean on your oars, I am going to lean on mine. I cannot do the rowing for both of us.”

Accept what the client offers and consider how it may be utilized, rather than argue about it.

When things have not gone well for a strategically oriented therapist, it is more likely that the therapist has been working too hard rather than not hard enough.

In our view, there are only vicious circles of problem behavior and inappropriate solutions that perpetuate such behavior in the present. Correspondingly, any problem is potentially open to resolution by interdiction of its problem-maintaining solution.

[Patrick · Rating 5 out of 5]

Though several decades old now, this stuff feels very fresh to me. These authors offer such a different perspective on behavior and change that it reinvigorates my work attitude. I take this stuff right to the psychiatric unit where I work. Playful and fun for me to use. Oh, and effective.

[Bailey · Rating 2 out of 5]

Had to read this for school. Definitely don't agree with most of the therapy techniques in this book, but I can see how some things could work and I'm planning on keeping this to reference if I am desperate. Very outdated.

[Bernard · Rating 5 out of 5]

I found fascinating the real case commented scripts at the end of the book