DIALECTICAL INTERVENTIONS AND THE STRUCTURE OF STRATEGY
HAIM OMER
Tel-Aviv University
Psychotherapy Volume 28/Winter 1991/Number 4 563-71
Strategic thinking is not merely another therapeutic approach, but a practical concern of all approaches. This concern makes itself felt when goals are precise, and when therapy is hemmed in by constraints. Strategies are conceptual maps with three major components: ways of access to the goal, ways of dealing with resistance, and ways of mobilizing cooperation. Dialectical interventions are a strategic family in which two contrary therapeutic moves are coordinated so as to deal best with resistance and cooperation. Because of their dual character they illustrate aptly the elements of strategy that are often mixed in unidirectional interventions. Besides this illustrative role, dialectical strategy gives us an algorithm for dealing with the ubiquitous problem of mutual neutralization between the forces of resistance and cooperation. Ideally, it should be possible to potentiate any unidirectional move by an antithetical counterpart.
"Strategy" and its related concepts suffer from two ills: They are either bandied about as fashionable hazy terms, or made into a specific and exclusive approach to treatment, that of "strategic therapy," yet another school to swell the roll of the more than 400 extant ones (Karasu, 1986). Ifstrategic concepts are to make any real contribution and be saved from these two undesirable uses, they must be well defined and the principles ruling their application in a variety of therapeutic approaches set down. Omer and Alon (1989) pro-posed such a corpus of strategic principles as a common basis for dialogue between different treatment approaches. The present paper, following on this attempt, has a double purpose. To define the functional elements of strategic moves, and to present a family of interventions (the dialectical ones) that aptly illustrates the very structure of strategic thinking.
When Are Strategies Needed?
The term "strategy" is used at three levels of generality: At the lowest level, a strategy is a plan to solve a problem and attain a goal; at the middle level, it is an algorithm, that is, a general formula to create solutions for a given type of problem; at the highest level, it is the discipline, or way of thinking, that rules the creation of such algorithms and plans. In the present paper the word "plan" will be used to indicate the lowest level, and whenever needed we shall specify which of the other levels is intended. To clarify the distinction between a strategy as a specific plan, and a strategy as an algorithm, we may consider a Gestalt therapist treating a client with a decisional conflict. An algorithm for this type of problem might take the form, "decisional conflicts should be approached by the two-chair technique"; the specific plan for the problem would stipulate the roles to be embodied in each chair. Whatever the level of generality, however, the need for strategic considerations becomes greater the more precisely the goals be defined, and the more constrained be their pursuit.
a. Preciseness of goal definition. Hazy goals make clear strategies inapplicable. It is prepos-terous, for instance, to plan in detail for achieving goals such as "getting in touch with oneself", or "increasing self-fulfillment." Any clear plan would be faulted as restricting the scope of these goals and closing possible avenues towards self-contact or self-realization. Furthermore, even if one had a plan, how could one ever know whether the goal was being approached? Plans cannot be re-alized without feedback. In order to decide ra-tionally on pursuing, improving, or relinquishing them, we must know if we are making progress, but determination of progress requires clear definition of goals. Plans for encompassing hazy goals are therefore doomed to be hazy.
b. Constraints on pursuit of goals. Without limitations such as of time, money, acceptability of moves, or logistics, there is little need for planning. One may simply pursue the goals at one's own fumbling pace. Although psychotherapy is always constrained, as any treatment has limitations on what moves are legitimate, it is so to different degrees: An open-ended psychodynamic treatment is, for instance, less constrained (and therefore less in need of strategic planning) than a focused and time-limited one (Mann, 1973).
The foregoing clarifies the relationship between strategic thinking and symptom- or problem-oriented therapies. These therapies are more strategically oriented because they have clearer goals and usually limit themselves to shorter time spans. But strategy can become an issue in a relatively unfocused and open-ended therapy as well, when-ever limitations of money, time, physical capacity, or client availability make themselves felt. Strategic considerations are thus a matter of degree, and under proper circumstances may become prominent in any treatment.
Elements of Strategy
Essentially, strategy can be described as a conceptual map showing a) ways of accessing goals, b) ways for dealing with obstacles, and c) ways for mobilizing resources and help.
Ways of Accessing Goals
Therapy should set itself not a single goal, but a hierarchy of goals that makes for flexibility when progress is blocked (Omer & Alon, 1989). Any strategy requires a map of the territory within which we can move toward the goals. Within the map ways of approach are chosen, linking one's current position to the goals. Both the map and the ways of approach are determined by one's theory and therapy orientation, as well as by one's assessment of the case (according to the dictates of the theory). A behaviorist, for instance, will draw a map with descriptions of present and desired functioning, observations on stimuli, responses and reinforcement contingencies, and a list of potential reinforcers to mediate change. A psychodynamic therapist will draw a map of conflicting motivations, defense mechanisms, object relations, and observations on client—therapist interactions that are to be used in propitiating change. A family therapist's map will consist of coalitions, hierarchical crossings, communicational blocks, inter-personal boundaries, and family myths.