TACTICS OF CHANGE
The following reviews were published when Tactics of Change was first published in 1983.
1. Frank Pittman, psychiatrist in private practice.
2. William M. Bumberry, Ph.D., Family Therapy Institute of Southern California, LA
3. Dr. Carl Voss is director of adult outpatient psychiatry and director of psychiatric research at Maine Medical Center in Portland. Hospital and Community Psychiatry.
4. Alan Frank, M.D. Assistant Professor of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.
THE TACTICS OF CHANGE: Doing Therapy Briefly
Review by Frank S. Pittman III, M.D.
Psychiatrist in private practice, Atlanta
This is a practical book about the deliberate promotion of useful change in psychotherapy. It's specific focus is on what to do and how to do it in order to help resolve persistent human problems effectively and efficiently. Of course, The Tactics of Change also provides you with the rationale of treatment--especially important since the techniques detailed are often out of the ordinary. The authors, writing of their long and impressive experience, describe their approaches with such exceptional clarity that the technique can readily form a basis on which very professional can build and develop further refinements.
In 1974, three members of Palo Alto's Mental Research institute-Paul Watzlawick, John Weakland, and Richard Fisch wrote book called Change. A brilliant book. it was about theory, for intellectuals, and not easy to read. Now, two of the authors, psychiatrist Fisch, and family therapist Weakland, are joined by clinical social worker Lynn Segal in The Tactics of change.. (Watzlawick is also on hand, as therapist for two of the three cases.) The theory remains the same. but the new book is a guidebook, focusing on techniques for producing change in brief psychotherapy The book is direct, logical, orderly, clinical and fun.
For 15 years, the MRI group has concentrated on a brief psychotherapy project, testing theories and sharpening techniques. What they present in The Tactics of Change with calm assuredness and exhilarating clarity may be the most basic recipe for doing therapy yet available. The therapeutic view here-- if you don't succeed then, you might perhaps try a second time, but if you don't succeed then try something different-- is amplified in the tactics details how therapists can get patients to try something different. You will read about:
The MRI approach, despite its simplicity, is revolutionary The approach is specific to the symptom or problem behavior, rather than to the structure or history of the family. (It uses systems concepts. but may use an individual format.) The authors' clinical ability to identify the 0point of distorted reality is impressive, particularly with such problems as insomnia, impotence, and anxiety.
What we have here is not just another school of family therapy, This volume offers much more than that. It presents a theory of change and a set of techniques for bringing about change. However effective the method in its specific clinical context, certainly the theory and most likely the techniques are applicable in any clinical context and in most interpersonal situations in which change is desired.
Any therapist will be surer after these exercises. Some therapists may even come to view as ineffectual many cherished therapeutic approaches to patients' problems, discovering that they can be as exacerbating as patients' own attempts to solve their problems!
I'm going to have trouble talking about patient problems to an colleague who hasn't yet read The Tactics of Change.
Journal of Sex &Marital Therapy -- Vol. 9, No. 1, Spring 1983
William M. Bumberry, Ph.D., Family Therapy Institute of Southern California, Los Angles, Ca
THE TACTICS OF CHANGE: Doing Therapy Briefly, by Richard Fisch, John H Weakland and Lynn Segal. San Francisco: Jossey-Bass Publishers, 1982, 302pages,
In this volume, Fisch, Weakland and Segal expand upon and operationalize the revolutionary theoretical concepts earlier presented in the book Change (Watzlawick, Weakland and Fisch, 1974). The tactics and techniques of conducting therapy, developed over the course of more than 15 years of clinical research at the Brief Therapy Center of the Mental Research Institute (MRI), compose the real substance of this work. This is a book that focuses on the process of conducting therapy, emphasizing specific techniques and strategies, rather than abstract speculations or post-hoc explanations. Their central theme, an almost vulgar emphasis on problem resolution, is made even more earthy by a near callous disregard for the decades of inferentializing and speculating that have resulted in the elegant clinical vernacular of today's sophisticated depth therapists. For those clinicians capable of transcending therapeutic language in favor of the language of therapy, this book will become a valued colleague. Innovative strategies for approaching a variety of clinical problems, including marital conflicts, sexual dysfunction and family difficulties, are presented.
Following from their theoretical bias of viewing behavior in context and considering "truth" a relative, as opposed to an absolute, concept, this volume introduces the reader to a multitude of new "realities" regarding human problems. By altering the punctuation utilized in viewing human events, the creative therapist can effectively aid families in breaking impasses and initiating more adaptive life styles.
The essential components of the MRI approach are clearly presented in this book, with sufficient explanation and examples to permit the reader to utilize it as a guide to therapy. Central issues skillfully addressed include: 1) the vital importance of the therapist retaining maneuverability; 2) the value of gaining a clear understanding of the "patient position" regarding the problem; 3) the clinical artistry involved in incorporating the language and values of the client into the therapeutic strategy; and 4) the power and leverage for change that can be drawn from the system's natural resistance to change.
One of the more controversial theoretical concepts posited by the MRI perspective is that of the role of the "attempted solution" in maintaining or exacerbating the problem. This notion suggests, that regardless of etiology (an issue more relevant to the curiosity of the therapist, than to change of the system), the persistence of problems is typically embedded within the context of "attempted solutions." Following from this premise, the course therapy must take involves interdicting such well-intended problem-maintaining behaviors and providing sufficient impetus to initiate a more adaptive recalibration of the system. Numerous clinical examples emanating from this perspective are presented, with sufficient clinical impact documented to arouse the interest of all but the most self-righteous variant of depth therapists.
Perhaps the real pleasure of this volume lies in the skillful interweaving of theoretical perspective with clinical application, in a fashion that can expand rather than muddle the reader. Exploring an internally consistent approach to psychotherapy, that provides an alternative to the epidemic of fuzzy thinking (incorrectly considered eclecticism) that permeates our field, is a stimulating and enjoyable adventure.
In addition to being heavily seasoned with case examples and vignettes, three chapter length case studies, accompanied by elucidating explanations, make the journey a lively one.
The excitement of this approach to therapy is contagious and is certain to trigger new synaptic activity in the worn but not too calcified clinician. For those made wary by the rumor of manipulation that occasionally is pinned to the MRI approach, this is required reading. Others may enjoy it at their leisure.
William M. Bumberry, Ph.D., Family Therapy Institute of Southern California, Los Angles, Ca
THE TACTICS OF CHANGE: Doing Therapy Briefly-by Richard Fisch, M.D., John H. Weakland, Lynn Segal; Jossey-Bass, San Francisco, 1982, 302 pages, $16.95.
Dr. Carl Voss is director of adult outpatient psychiatry and director of psychiatric research at the Maine Medical Center in Portland. Hospital and Community Psychiatry, April 1983, Vol. 34, No. 4,365.
The Tactics of Change s a manual describing the authors' methods of doing brief therapy based on their behavioristic, problem-oriented conceptualization and treatment of human problems. Their theory and techniques are based on 15 years of clinical research at the Brief Therapy Center of the Mental Research Institute in Palo Alto. However, the book is purely descriptive, and research methods, statistical analyses, and the like are not included.
Dr. Fisch is director of the center. He, John Weakland (a marriage, family, and child counselor), and Lynn Segal (a clinical social worker) are all research associates of the Mental Research Institute.
Their methods and theories have their origin in the work of Jay Haley, Don Jackson, and Milton Erickson. They focus on the behavioral interactions between client and significant others that are distressing and that are perpetuating the identified problem. Treatment is aimed at altering either the behavior or others' response to it. Psychobiological factors and concerns at the core of other forms of psychotherapy (including brief therapy), such as transference and early unconscious determinants of feelings and behavior, are not recognized in their approach.
The therapists' goal is to relieve the distress in ten sessions or less in the "most effective and efficient" way possible. General principles of their method are well stated and have broad application for psychotherapists with other theoretical backgrounds. A flexible stance by the therapist, detailed evaluation of the presenting problems, attempts at resolution, and attention to client's expectations are emphasized.
Interventions listed as "five basic attempted solutions commonly observed in clinical practice" are clearly described. For example, under "attempting to reach accord through opposition," the discussion of the power struggle and the attempt to be "one up" that commonly brings a couple, or parents and a rebellious teenager, to a therapist is well done. The paradox that to relinquish control can lead (in effect, can control) a relationship toward harmony is demonstrated.
The thrust of many of the authors' interventions is to produce change by effectively directing clients to do the opposite of what they have previously attempted. The subtleties of patients' and families' behavior that unwittingly perpetuate the problem while attempting to resolve it are well presented.
The major limitation of Tactics of Change is that no limitations are recognized. There is no description of patient selection; presumably all clients are dealt with through this one theoretical framework, within the limits of ten therapy sessions. It should be acknowledged that other approaches may be necessary for patients who seek care in the many kinds of psychiatric settings. Would the authors apply only their approach to a profoundly depressed, acutely suicidal individual, or someone in an acute manic.
Brief Therapy would seem insufficient. Their methods, however, may often be useful as part of the overall treatment of such disorders. Aside from that objection " Tactics of Change" should be stimulating to anyone doing psychotherapy,: even--or perhaps especially for those with different theoretical understandings of human behavior. The book is well written, is; clear and enjoyable reading, and is recommended.
THE TACTICS OF CHANGE: Doing Therapy Briefly by Richard Fisch, John H. Weakland, and Lynn Segal, San Francisco: Jossey-Bass, 1982 + 294 pp.
Reviewed by Alan Frank, M.D. (Being a clinician, such books are a treasure house of ideas. I've tried to indicate this in my review of The Tactics of Change., Alan Frank, M.D. is Assistant Professor of Psychiatry at the University of New Mexico School of Medicine, Albuquerque, New Mexico.)
It is something of a relief to find a book that says "this is what we believe and this is what we do and why we do it that way" without hinting at everlasting damnation if one does not happen to believe the particular dogmas expressed. Such a presentation is the Tactics of Change, the fifth in a series of volumes written from the theoretical position being developed by the Brief Therapy Center of the Mental Research Institute, Palo Alto, California.
The first volume, Change: Principles of Problem Formation and Problem Resolution (Watzlawick, Weak-land and Fisch, Norton), presented the theory in its state of development at the time. The subsequent volumes (Watzlawick, How Real is Real? Communication, Disinformation, Confusion. Random House 1976 Watzlawick, The Language Of Change: Elements of Therapeutic Communication. Basic Books 1978; Herr and Weakland, Counseling Elders and Their Families: Practical Techniques for Applied Gerontology. Springer. 1979) lay out both further refinements of theory and, increasingly, their clinical applications.
Each presents the reader with another derivative of the theoretical ideas developed from the work of Milton H. Erickson and Gregory Bateson. And for those psychotherapists (and others) who have discovered they can practice their profession without the concept of predestination psychological or theological, these volumes are a source of ideas and practices indeed.
The Tactics of Change talks directly to the psychotherapist about ways of assisting people to achieve more comfortable, satisfying, enjoyable living with their own assumptions about the nature of human nature---rather than having to share the therapist frame of reference. This in itself is a somewhat new approach. Most therapies have definite ideas about ( what constitutes appropriate, correct, normal, healthy living. But this book says, in essence, it may not necessary to spend large amounts of money or extensive periods of time on therapy, acquire a specialize vocabulary, or learn an esoteric belief system about human behavior.
Instead it is possible that one need only find therapist who knows how to plan appropriate strategy to match one's situation and problem, follow his suggestions to resolve the problem, and then get about the business of living since the suggestions are designed to produce new or different learning leading to the possibility of change rather than starting with changes the patient should make, and are aimed at specific verifiable bits of behavior rather than personality or complexes or other constructs, the patient may come out of the process more "normal" than if treated successfully by any other kind of therapy: the symptom gone and the patient doesn't know why. This is the w most functionally adequate people seem to manage the human, transient symptoms adequately. Despite the foreboding and disbelief of various therapists al theoreticians, this naturalistic way of coping with u wanted symptoms seems to be quite adequate to resolve many problems--even schizophrenia on occasion, has the advantage of not implicitly promising that 1: will hold no further challenges or difficulties in the future.
This is no bible promising psychological salvation for all who believe. It is not even inspirational, although I might conceivably inspire some clinicians to re-examine some of their own patterns of functioning. It does not advertise cures for everyone if only.. It is not a blueprint, a complete and final set of instructions, a roadmap to be followed. (In fact, the authors comment repeater on the development of their ideas and invite participation from the reader in the ongoing process of developing these ideas and practices.) It isn't an academic exercise reviewing the history and development of t ideas and containing an extensive bibliography of similar yet distantly related ideas and practices; there are only 15 references and six pages of index.
It is an exposition--with many examples drawn from cases, explanations, and reasons and comments--about how the authors do therapy briefly. It begins by stating the assumptions about human problems that t therapist uses and then how they are used in interaction with the customer, starting from the initial contact. It discusses the way the therapist goes about gathering the kinds of data s/he needs for understanding the problem, how s/he designs and carries out strategies to bring about its resolution, and how s/he then terminates the therapy. Each step is designed and carried out in such a manner as to enhance the probability of genuine change and its continuation. There are three edited case transcripts with interpolated comments taken from audio recordings of the interviews, and the final chapter discusses the broader uses beyond psychotherapy of their perspective on human behavior and problems.
Since there are different models of human psychological illness, even among the more traditional therapists, one would not expect the kind of rejection that frequently greets the model presented here. It is in large degree pragmatic, but many clinicians dismiss it out of hand, even while complaining themselves that they cannot understand why their patients aren't more compliant. There is something about having spent many years studying a subject from one perspective that makes it rather difficult for most people to consider the same subject from a different perspective. History is strewn with examples, the most obvious being the difference in viewpoint of Ptolemy and Kepler. While the present book does not have quite the theological implications that hung on the planetary orbits, twenty years of observation of clinicians' orbits when confronted with the ideas and tactics used in strategic therapy would lead one to suspect similarities somewhere. With all the complexities being uncovered in neurotransmitters and the endless debate over personality theory it is indeed hard to accept the simple proposition that many human problems are the result of the particular means used in the attempt to resolve some difficulty or other. It follows then that the way to problem resolution is to stop whatever attempts at solution one has been making and try something new and different. Simple, yes; but astonishingly difficult to get a client to try something truly different. That's where the strategies come in.
The strangest thing about such simplicity of concept is that it works--frequently. No need to establish normative baselines; search through mountains of statistics for hidden genetic factors; dig up memories of childhood traumata buried beneath years of repression, postulate "chemical lesions" in the brain. Without such wondrous Explanatory Principles (Cf. Bateson, "What Is An Instinct?'') the busy clinician can get on with his interactions with his patients knowing that he will get very rapid feedback from them on whether his therapy is working or whether he needs to modify or redesign it. The authors claim no omniscience or omnipotence, no infallibility, and not even the use of intuition overtly (although surely it lurks behind the judgments therapists must make). They claim only that they can significantly help a percentage of people who come to them asking for help. Since they don't start from assumption of disease and illness they are unencumbered by need to produce cures. It is enough to remind one that quotation from the Dean at Edinburgh: "the history of a man is a record not so much of the progress discovery of truth as of the gradual emancipation from error.
There are two levels of reservation about this work. The first has to do with the entirely proper use of rationality both in presenting their material a concepts, and also in their discussion of the interaction with patients. The reservation here is a general one applicable to most books in psychiatry and psychology the absence of extensive and serious consideration of place or humor, for example, and emotionality. Granted that the pattern of scientific theories and the personalities of those who survive the training in the healing professions (and, therefore, write the books) is essentially obsessional, the substrate of therapeutic options remains all too human. Simply writing it off vaguely pathological, ("You aren't controlling your feelings." "You're too emotional." "You need to understand ..."), will no longer suffice in a world where the right hemisphere of the brain is gaining recognition
This tradition stretches back through history in an unbroken line to the classic Greeks at least. Rationality is t most important human attribute, the highest good. Such an antiseptic approach not only leaves the wine of 1 stale and flat, as a good many obsessive-compulsive customers have complained to their therapists, but also clarifies humanity among the computers as merely second rate thinking machine. The subjective, the emotion the feeling, the creative, has been left to women, and other "lesser" life forms. It is certainly much harder to deal with than rationality--observe the difficulties in even trying to explain humor in rational terms--but it is more than just the affective accompaniment of thought and it deserves much wider attention as a major dimension of human experience, in and , of therapy.
The second level of reservation is also a general conceptual question. All the psychotherapies Use an explicit or implicit normative approach as if all the variety of human beings could be measured by the same of yardsticks. The result is predictable but not especially therapeutic. Since the norm is taken to be the ration the thinking approach to life, those who have a different orientation are seen as having psychopathology in some degree. Since a number of these people also deriving their immediate experience of self and adequacy from ongoing interactions and relationships with others-condition the rational thinking man describes out of perception as pathological dependency--they are vulnerable to the reflected attitudes toward psychopathology of their therapists. They literally live, through the "therapeutic relationship", the belief that they are somehow" diseased, " just as when they experience supportive, accepting relationships their lives become full and meaningful and rewarding and enjoyable.
The implications of this is that different personality interact in different ways. This is an extension of the ancient clinical observation that some therapist really do work better and produce better results with one kind of patient as contrasted with another kind. As is general in books about physiotherapy there is no consideration given to what kinds of personalities respond more constructively to this particular form of therapy.
All psychotherapists, professionally young and old, should read this book as well as the other volumes in this informal set. Not because they are " better than..." or more "real" than other books about psychotherapy, but because they are different. And the difference throws interesting light on the practice of other psychotherapies, emphasizing aspects of human interaction usually ignored or providing alternative understanding. The whole question of resistance, for example, takes on a different meaning and implications which should invite the serious clinician to review their own behavior.
In the present burgeoning discussion about the efficacy of psychotherapy, which it ominous implication, no therapist who believes he helps others can afford to be rigidly doctrinaire or unaware of the successes achievable through different kinds of psychotherapy.. There isn't one right way any more: the hardest and most creative task still lies ahead to invent ways of matching patients-as-people to the therapist as people, and to match the problem in a particular personality to the particular psychotherapy like to produce the most effective change most quickly.
The tactics of change should be read because it presents an understandable picture of someone else's way of doing therapy from which every therapist can learn something useful to improve his effectiveness. It should not be read by those various schools of therapy whose priestly function is doctrinal or procedural purity. Nor should it be read by the acolytes of such priests, since is almost certain to raise fascinating but heretical questions about human nature, communication, and the nature of psychotherapeutic change.