Resistance, dilemmas and crises in family therapy: a framework for positive practice

When clients believe that they have not got the personal resources to cope with the demands of either living with their problems or taking steps towards the resolution of these, stating their therapeutic dilemma may precipitate a therapeutic crisis. A therapeutic dilemma is a concise statement of the disadvantages and difficulties associated with leaving the presenting problem unresolved and the disadvantages and risks entailed by solving the problem. Invariably, therapeutic crises involve some family members doubting an interactional formulation of the family's problems and redefining these as individual difficulties of a specific family member. That is, someone in the family becomes defined as bad, sad, sick or mad. The pressure to collude with the family and other network members in abandoning an interactional construction of the problem and accepting an individual description is usually very intense. When therapists follow this route they become part of the problem maintaining system. In this paper a framework for conceptualizing therapeutic crises and guidelines for their management are described. These guideline allow the therapist to avoid becoming involved in problem maintenance and to retain a position from which to promote problem resolution. The framework and guidelines evolved within the context of a brief integrative approach to consultation with families who require help with child-focused psychosocial difficulties.