Knowing Where to Tap: Using a Structural-Strategic Lens to Locate The Root Cause of a Family’s Trauma
There is an excellent story on the importance of knowing where to tap told by the late family therapist, Virginia Satir:
After listening to the engineer’s description of the problems and asking a few questions, he went to the boiler room. He looked at the maze of twisting pipes, listened to the thump of the boiler and the hiss of the escaping steam for a few minutes, and felt some pipes with his hands. Then he hummed softly to himself, reached into his overalls and took out a small hammer, and tapped a bright red valve one time. Immediately, the entire system began working correctly, and the boilermaker went home.
When the steamship owner received a bill for one thousand dollars, he became outraged and complained that the boilermaker had only been in the engine room for fifteen minutes and requested an itemized bill. So, the boilermaker sent him a bill that reads as follows:
For tapping the valve: $.50
For knowing where to tap: $999.50
TOTAL: $1,000.00 (pp. 239–240)
Like the boilermaker, after eight years of research in 15 states with more than 1,000 families, the children, the parents, and the extended family members showed us where and how to tap. It was their voices and expertise that uncovered the answers to this question to achieve maximum impact with the greatest efficiency. At the Family Trauma Institute, we used what is called a grounded-theory research method to discover and operationalize key concepts and techniques through ethnographic interviews with the families and participant-observations with the therapists and clients using this approach. We replicated the research methods outlined in Chapter 12 in our second book, Treating the Tough Adolescent. The culmination of this 8-year project led to the publication of Treating the Traumatized Child: A Step-by-Step Family Systems Approach and the Family Systems Trauma (FST) Model.
An Unexpected Surprise
We were surprised, contrary to popular belief, when the trauma specialist knew where to tap, trauma could be healed without long hours of therapy, without painful reliving of memories, and without a continuing reliance on medication. Instead, the root causes of the child or family’s trauma symptoms could be quickly identified and healed in the here and now using the correct tools and the right timing.
A Key Breakthrough: Why is Theory So Important?
However, the critical breakthrough to “knowing where to tap” came with the discovery and integration of structural-strategic theory into the FST Model. Salvador Minuchin founded structural theory and Jay Haley founded strategic theory. In sum, structural theory views a family as having either healthy hierarchy with the elder, parent, or caregiver as the leaders or an upside-down hierarchy with the child in charge. A traumatic event or another crisis can act as the catalyst to cause or exacerbate an already upside down hierarchy. Over time, this inverted hierarchy will lead the problem symptoms in the child and/or other family members, a lack of boundaries, coalitions, or a lack of love or limits. FST frames these structural patterns as unhealthy undercurrents (see Figure 1). The strategic theory uses what are called directives to help restructure the family using new interactional patterns or in FST terms, healthy undercurrents (see Figure 2), using what we call trauma playbooks.
Up until now, the structural-strategic theory had not been formally used in family trauma treatment. Therefore, the question remains: “Why is theory so essential to helping the trauma therapist know where to tap to discover the root causes of their client’s trauma quickly?”
Without a solid theoretical foundation, you, the trauma therapist can easily get lost in the complexities, white noise, and bunny trails within the traumatized family.
Good theory is a beacon in the storm. It helps the trauma therapist train his or her eyes to have an ordered search for evidence rather than causal scanning, guesswork, or “fly by the seat of your pants” approach.
This case example will illustrate this important point.
Fifteen-year-old Dan was an only child of Stan and Beth. Besides everyday normal ups and downs, things were going well. This all changed when Dan was slipped a hit of Ecstasy in his drink at a party and was raped by two unknown males. Dan was so ashamed that he kept the incident to himself and told no one. Over time, the secret was too much for Dan’s psyche to handle. He began to skip school, his grades plummeted, and he began to cut on his arm.
The parents responded by getting angry and grounding Dan. In turn, this only made the situation worse and spun out of control further. The parents then overcompensated by setting no limits and letting Dan spend hours and weekends by himself in his room. Stan and Beth’s marriage was also strained. They had different parenting philosophies on how to solve the problem. Before long, Dan made his first unsuccessful suicide attempt and was hospitalized. Dan then went exclusively into individual treatment. He told his therapist about the rape, but the therapist was not trained in family therapy and continued to see Dan individually. Dan stabilized. But after Dan returned home, the same tension and problems remained, and he soon relapsed again.
Structural- Strategic Theory: The “Know Where to Tap” Road Map
Dan likely relapsed for two reasons:
- Family Secrets and Shame- Two Reasons Why The Trauma Could Not Heal– Using a structural lens, the FST Model discovered the technique of undercurrents or core interactional patterns that cause the trauma or in Dan’s case maintain it. As Figure 1 illustrates, undercurrents are labeled as “unhealthy” when they directly prevent an individual, family, or community from healing such as “family secrets” or “shame.” And labeled “healthy” when they are replaced with their unhealthy counterparts. In this case, “revealing secrets” and “the truths of you are not damaged and you are worthy.”
Table 1: Unhealthy and Healthy Undercurrents
In Dan’s case, structural theory would help the trauma therapist cut through the white noise. They would know where to tap by knowing precisely what unhealthy undercurrents were causing Dan’s trauma to heal. One could show Dan this handout and show him how and why “family secrets” and “shame” had thrown his family structure off its axis point (i.e., imbalance, parents out of alignment, lack of boundaries, etc.) Once Dan had this insight and could connect the dots, the stage would be set to begin family trauma treatment.
- No Strategic Directive or Trauma Playbook- Also, from a strategic lens, there was no technique or strategy presented to Dan or the family to bring about the healthy undercurrent (see Table 2). Moreover, there was no sample trauma playbook presented to show what a clear plan of action would look like (see Figure 1). Without a trauma playbook, it would be difficult to realign or restructure Dan’s family by osmosis or talk therapy. In a crisis, it is often a time for action, not more problem exploration.
Table 2 -Sample Techniques to Create Trauma Playbooks for Family Secrets and Shame
Dan and his parents could have been presented Table 2 as a handout and told that it could be modified and customized for their family. The family could have also been told that the technique and trauma playbook were analogous to an antibiotic or prescription a medical doctor may provide to kill the bacterial infection (the unhealthy undercurrent) and bring about full healing. Please read Chapter 8 of Treating the Traumatized Child: A Step-by-Step Family Systems Approach for a complete listing of strategic trauma playbooks and techniques.
Figure 1: The Birth of Dan’s Stronghold of Shame: Arrow to His Heart
During our research, we also discovered two additional reasons why client’s, like Dan, had high rates of relapse:
- Trauma Treatment Was Mostly Individual Therapy, Not Family Therapy– There were many trauma-informed therapy models that treated the individual child but few that worked with the child as part of a traumatized family from a systems theory framework.
What the Families Told Us: Over and over again parents, grandparents, and children told us their entire family had trauma, many over multiple generations. Also, it was the family that we need to tap and heal, not just the child. The child’s problems were merely the entry point or gateway into the family dysfunction, and without a family change, the positive changes in their child would not last. The whole was greater than the sum of its parts, or in this case the individual traumatized child or adolescent.
- Step-by-Step Family Trauma Tools for the Frontline Therapist- At the same traumatized families were telling us where to tap, so were the trauma therapists. Frontline therapists liked theory and general concepts up to a point. But to learn a new approach like family systems trauma, therapists reported that they needed detailed step-by-step procedures that were manualized and had many case examples. This was especially the case when navigating the complexities of treating the traumatized child and the entire family.
What the Therapists Told Us: Privately, therapists told us that they were scared to death to do family therapy. They reported that their graduate schools did not teach high-level family therapy, but instead primarily individual treatment. Also, the books and manuals on trauma-informed treatment were based on how to treat the individual. Even though most therapists acknowledged and intuitively knew that the family was the key, they lack the tools to execute this goal.
Scott P. Sells, PhD, MSW, LCSW, LMFT, is the author of three books, Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide (1998), Parenting Your Out-of-Control Teenager: 7 Steps to Reestablish Authority and Reclaim Love (2001), and Treating the Traumatized Child: A Step-by-Step Family Systems Approach (2017). He can be contacted at firstname.lastname@example.org or through LinkedIn.