Strategic/interactional therapies attempt to identify the client's strengths and actively create personal and environmental situations where success can be achieved. In these therapies, the focus is on the individual's strengths rather than on pathology, the relationship to the therapist is essential, and interventions are based on client self-determination with the community serving as a resource rather than an obstacle. This model has been widely used and successfully tested on persons with serious and persistent mental illnesses (Rapp and Wintersteen, 1989; Saleebey, 1996; Solomon, 1992). It has also been used with persons who have problems related to substance abuse (Juhnke and Coker, 1997; Miller and Berg, 1991; Ratner and Yandoli, 1996; Watzlawick et al., 1967). Although the research to date on these therapies (using nonexperimental designs) has not focused exclusively on substance abuse disorders, the use of these therapies in treating substance abuse disorders is growing.

Many different theoretical approaches have strategic or interactional roots. They can be distinguished from each other primarily by the different emphasis and value they place on components of the change process. Therapists rarely follow a single theoretical approach strictly; therapists today influence and learn from each other, incorporating what they find useful into their own work.

All of these models stem in part from the work of Milton Erikson. He coined the term strategic therapy to describe an approach in which the therapist takes responsibility for finding new and effective strategies to help clients in distress. Jay Haley, John Weakland, and other theorists of the Mental Research Institute (MRI) consulted with Erikson as they expanded on his theoretical approach.

More recently, Steve De Shazer and his colleagues, who were influenced by the MRI approach, shifted the focus of treatment from problems to solutions, calling their modality solution-focused therapy. Their approach, originally developed to work in brief marriage and family therapy, has since been used in a variety of situations for a variety of presenting problems, including substance abuse disorders. (See Chapter 8 for more information on the application of all these therapies to the treatment of families.)

Interactional therapy is based on the assumption that problems can best be understood by examining clients' (often dysfunctional) interactions with others and their resulting problems. Strategic therapy is a form of interactional therapy because it does not focus on the root causes of the client's problems but instead tries to increase competency and develop problem-solving skills that will help the client in her interactions with others. For the purpose of this discussion, however, the combined term strategic/interactional therapy is used. This broader term allows solution-focused therapy, which is certainly interactional, to be included in this section. Although it has a strong kinship with strategic approaches, not all practitioners consider solution-focused therapy to be "strategic."

The significance of these different approaches can be found in their presentation of an alternative approach to understanding how substance abuse disorders evolve and how new innovative solutions could be generated to assist with the resolution of these problems.

The Consensus Panel believes that these therapeutic approaches are potentially useful for clients with substance abuse disorders and should be introduced to offer new knowledge and techniques for treatment providers to consider. This chapter presents one strategic/interactional approach, solution-focused therapy, which has been used in substance abuse treatment. Information on when to use solution-focused brief therapy with substance abuse clients, a case study using strategic/interactional approaches with a substance-abusing client, and the general theories that provide the basis for strategic/interactional therapies are discussed below.

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