Held, B.-S.; Heller, L. (1982): Symptom prescription as metaphor: A systemic approach to the psychosomatic-alcoholic family. Family Therapy, 9(2), 133-145

A case study of a family with a severely psychosomatic child and an alcoholic father is presented to illustrate the integration of various systemic treatment approaches. The primary intervention, a paradoxical symptom prescription task shared by the entire family, functioned both as a solution that interdicted a cycle of ineffective problem-solving efforts, and as a metaphor that transformed the identified patient's problem into a family drama. Other systems concepts illustrated by this case include: (1) establishing clearer generational boundaries through the intervention; (2) using positive connotation with the provision of systemic hypotheses and prescriptions to decrease resistance and enact change; (3) attending to family of origin issues concerning differentiation; (4) the ability of the system to tap its health and discover creative and often serendipitous solutions in a therapeutic context; and (5) the possibilities for initiating systemic change, or upsetting the homeostatic balance, by selecting limited and key target behaviors in a brief, problem-focused approach.