The Brief Strategic Family Therapy® (BSFT®) approach is a short-term family treatment model developed for youth with behavior problems. Developed by a team of clinicians and clinician-scientists over nearly 40 years of research at the University of Miami’s Center for Family Studies, the BSFT approach is based on the premise that families are the strongest and most enduring force in the development of children and adolescents (Gorman-Smith, Tolan, & Henry, 2000; Steinberg, 2001; Szapocznik & Coatsworth, 1999). Families of youth with behavior problems such as drug and alcohol use, delinquency, affiliation with antisocial peers, and unsafe sexual activity tend to interact in ways that permit or promote these problems (Vérroneau & Dishion, 2010). The goal of the BSFT approach, therefore, is to change the patterns of family interactions that allow or encourage problematic adolescent behavior. By working with families, the BSFT intervention not only decreases youth problems, but also creates better functioning families (Santisteban et al., 2003). Because therapists bring about changes in family patterns of interactions, these changes in family functioning are more likely to last after treatment has ended because multiple family members have changed the way they behave with each other.
The BSFT approach is based on an integration of structural (Minuchin & Fishman, 1981) and strategic (Haley, 1976; Madanes, 1981) approaches to family therapy. We proposed such an integration of structural and strategic principles given our early clinical experiences, where (a) adolescent behavior problems were clearly linked to structural problems (i.e., maladaptive patterns of interactions) within the family and (b) a time-limited, strategic approach, targeting only those family processes that are directly associated with the adolescent’s symptoms, appeared to be the most efficacious way to engage and retain families in treatment. Indeed, our own clinical experiences have continued to guide the refinement of the BSFT model. We have used a collaborative, bidirectional approach between clinicians and clinician-scientists in developing the BSFT model and its various modules (e.g., BSFT Engagement).
Based on our early experience with Cuban families, within the BSFT approach, the family is conceptualized as a system that is “greater than the sum of its parts” (Bowen, 1978) – that is, a system in which the behavior and development of each family member is interdependent with the behavior and development of other family members. Changing the adolescent’s behavior, then, requires changing the family system as a whole. Specifically, the BSFT approach aims to modify the repetitive patterns of family interactions that support the adolescent’s drug use and associated negative behavior, and to strengthen adaptive family interactional patterns that promote healthy development.
Specific Techniques Used in the BSFT Model
The BSFT intervention employs four specific theoretically and empirically supported techniques delivered in phases to achieve specific goals at different times during treatment. These techniques were built from the work of master clinicians such as Minuchin, Haley, and Madanes, and from the clinical experience of our clinicians and clinician-scientists in working with our minority families. As will be noted, this work is intended to make the family fully participatory – a full partner – in the change process. Early sessions are characterized by joining interventions that aim to establish a therapeutic alliance with each family member as well as with the family as a whole. The therapist here demonstrates acceptance of and respect toward each individual family member as well as the way in which the family operates as a whole. Early sessions within treatment also include tracking and diagnostic enactment interventions designed to systematically identify family strengths and weaknesses and develop an overall treatment plan. A core feature of tracking and diagnostic enactment interventions includes strategies that encourage the family to behave as they would usually behave if the counselor were not present. Family members are encouraged to speak with each other about the concerns that bring them to therapy, rather than have them direct comments to the therapist. From these observations, the therapist is able to diagnose both family strengths and problematic relations. Reframing techniques are then used to reduce family conflict and create a motivational context (i.e., hope) for change.
Throughout the entirety of treatment, therapists are expected to maintain an effective working relationship with family members (joining), facilitate within-family interactions (tracking and diagnostic enactment), and directly address negative affect/beliefs and family interactions. The focus of treatment, however, shifts to implementing restructuring strategies to transform family relations from problematic to mutually supportive and effective. These interventions include (a) directing, redirecting, or blocking communication; (b) shifting family alliances; (c) helping families develop conflict resolution skills; (d) developing effective behavior management skills; and (e) fostering parenting and parental leadership skills.
Often, the same interactional problems that are linked with the adolescent’s symptoms are also associated with the family’s inability to coming to treatment. Within the BSFT model, specialized engagement techniques have been developed in collaboration with our senior therapists and evaluated by a team of clinical researchers (Coatsworth et al., 2001; Santisteban et al., 1996; Szapocznik et al., 1988). In this context, engagement refers to a set of strategies designed to bring all the relevant family members into treatment. The same intervention domains used in BSFT treatment – joining, tracking and diagnostic enactment, and reframing – are also used to engage families into therapy. The therapist begins to explore the family interactions in a first call by giving the caller a task such as bringing all the members of the family into the first session. Through the caller’s response (e.g. “my husband won’t come to treatment”) the BSFT therapist can begin diagnosing family interactions. In these cases, and with the caller’s approval, the therapist will insert herself into the family’s process by reaching out directly to the family member who either does not want to come to treatment or whom the caller is not eager to bring to treatment, as a way of getting around the interactional patterns that interfere with bringing all family members into treatment.