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Fam Proc 37:215-232, 1998

Beyond Bipolar Thinking: Patterns of Conflict as a Focus for Diagnosis

and Intervention
FRITZ B. SIMON, M.D.a
aDirector, Heidelberg Institute for Systemic Research, Kussmaulstrasse 10, D-69120 Heidelberg, Germany; e-mail:
simon@heidelberger-gruppe.com.
Most family typologies in the history of family therapy organized the observation according to bipolar scales. The
implied assumption of such models is that the attribution of the one observational characteristic is inevitably bound to
the negation of its opposite characteristic. This article presents a formal observational schema that has the possibility to
grasp contradictory, conflicting characteristics. Using this schema, one can develop a clinically relevant family
typology, making distinctions between different patterns of interaction by which conflicts and antagonistic tendencies in
families are organized. Clinical observation and experience suggests that one can distinguish families with members
with psychosomatic, manic-depressive, and schizophrenic symptoms by the way they overcome conflicts and
ambivalence.
In his last article in 1971, Nathan Ackerman voiced a still relevant concern in the family therapy field about the issue of
family typologies and diagnosis:

Formal diagnosis of behavior is viewed by many as passé, a waste of time, and by a few it is even deemed
harmful. Or, as others say, within the limits of present-day knowledge, a typology of families is simply not do-able.
Do-able or not, the sheer fact in clinical practice is that therapists inevitably draw judgment on the families they
treat. They compare and contrast them. They draw meaningful clinical distinctions between them. They cannot help
but do so. . . . Let us be very clear, however; there is no way to sidestep the responsibility of conceptualizing and
categorizing family types. [p. 153]

Therapists observing a family are confronted with immense complexities. If they wish to deal with the subject accurately
(therapeutically), they require theoretical models that will enable them to reduce complexities to such a level that they can
judge their own procedure as being more or less useful (measured according to the aim of the therapy), and to make reliable
decisions between various therapeutic options. The purpose of this article is to introduce a typology from which practical
alternatives for therapeutic action can be derived. This typology has been developed over the last 15 years in our
Heidelberg group.* The practical foundation was the therapeutic work with families that had one or more members
diagnosed to be suffering from schizophrenic, manicdepressive, or psychosomatic symptoms (Retzer, 1994; Retzer, Simon,
Weber, et al., 1991; Simon, 1988/93, 1995, 1996; Simon,Weber, Stierlin, et al., 1989; Stierlin, Retzer, Simon, & Weber,
1997; Stierlin, Weber, Schmidt, & Simon, 1985, 1986; Weber, Simon, Stierlin, & Schmidt, 1977). The theoretical basis
contained constructivist concepts and models of self-organization.

A TYPOLOGY OF FAMILY TYPOLOGIES

In the history of family therapy, we have seen the development of varied typologies oriented according to varied
observational systems. If we try to construct a typology of them, they tend to follow two general tendencies. On the one
hand, such diagnostic systems continue the system of categorization propounded by medicine, through which the diagnoses
of the individual patient defines a characteristic difference between the families. For example, families could be categorized
as "families with schizophrenic patients" or "families with psychosomatic patients." The advantage of this classification lies
in the sharing of a common vocabulary with the existing medical care system and its individual-related diagnoses. This
enables mutual communication and cooperation. The disadvantage therein is the lack of any description of characteristic
differences concerning specific system dynamics. Additionally, there exists the danger of logical types being intermixed by
employing concepts that could be useful in the characterization of individual behavior and transferring them to a social
system (for example, in any discussion concerning a "schizophrenic family").
These models, which refer for the most part to individual symptom formation, are confronted with typologies that are
more concerned with family relationships and structures. It then becomes evident that families are mostly assigned qualities
according to a bipolar sliding scale. For example, in the model of Minuchin (1974), families are placed along a continuum
of intrafamilial boundaries spanning the area between enmeshment and disengagement. The model of Kantor and Lehr
(1975) also orients itself along these lines and characterizes families as being closed, open, or random. Stierlin, Levi, and
Savard (1973) described families according to different centripetal and centrifugal relationship patterns. In his description
of familial interaction, Beavers (1981) is also concerned with this form of differentiation, combining it with an assessment

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of adaptability, also according to a bipolar scale. In the Circumplex Model of Olson Sprenkle, and Russell (1979), families
are divided into sixteen different groups, depending on whether (within the dimension "cohesion") they are allocated a
position between the poles "disengaged" and "enmeshed" or (within the dimension "adaptability") between "chaotic" and
"rigid."
Even when such typologies focus the attention of the observer to differing aspects of content with regard to familial
interaction and communication, they hold a formal mutuality: they are each based upon a schema of bipolar description. For
example, in Figure 1, which describes the differentiation between centrifugal and centripetal tendencies within the family,
the implied assumption of such a model is that the centrifugal tendencies decreaseas the centripetal increase, and vice versa.
Any attribution of observational characteristics is inevitably bound to the negation of the antagonistic characteristic. This
premise is however highly questionable as far as the characterization of dynamic systems is concerned.

Figure 1.
The bipolar type of description.

THE LOGIC OF OBSERVATION

As we began to describe families according to bipolar scales, we realized that those of us who had worked often and
successfully together as a team, shared the least agreement when it came to the evaluation of families. After the usual
fruitless discussions about whose observations were "correct," we came to our senses, rejected the question of "right" or
"wrong," and concerned ourselves instead with what was causing these differences. This led us, first, to the hypothesis that
the conflicts arising in our teamwork and the opposing results of our observations mirrored certain aspects of the familial
dynamics; each observer had focused his attention on a different facet of familial interaction. This step led us to reconsider
and modify our systems of observation. It became evident that our main problem was the bipolar scale, which was bound to
a bivalued logic incorporating an either/or model. The scale did not account for ambivalence, contradictory attributions, or
paradox. These were, however, typical of the phenomena, the conflicts and the success or failure of various solutions,
which constantly concerned us in our work with families.
Autopoietic systems as a composite unity can only keep their coherence when they are able to balance perturbations
caused by their environments (Maturana & Varela, 1980; Luhmann, 1984). In order to achieve this, it is necessary that
opposing tendencies and operations become effective simultaneously and, in the best of cases, remain balanced or regain
balance ("principle of systemic antagonism," Morin 1977).
If one attempts to describe the patterns of interaction and communication within a family, it is essential to regard the
effect of the webbed and entangled behavioral patterns of the family members. In doing so, it can be observed how the
actions of the different family members are often contradictory in their effects. Any system of observation that concerns
familial interaction and communication must be able to grasp logically such contradictory characteristics. If for example, a
mother behaves in an intrusive manner toward her child, ignoring the interpersonal boundaries, whereas the father behaves
aloof and extremely reserved, we would need to place this family toward the center of a bipolar scale representing the
interpersonal formation of boundaries. With this however, we would not be able to consider effectively the intensity of the
contradictory tendencies observed simultaneously. For all involved, it may make a difference whether the mutual wishes for
closeness and distance are displayed in a moderate way, or whether two parties send contradictory, mutually excluding
messages.
Wanting to describe familial communication patterns, one inevitably encounters a second difficulty. A neutral observer
has access only to the behavior of the individual family members and the resulting patterns of interaction. The different
behaviors may be observed simultaneously or consecutively. The meaning that each member attributes to his or her actions,
or to the actions of others involved, is not as immediately discernable as the interactional effect of these actions. The
"intrusive behavior" of the mother, as interpreted by an independent observer, may be seen by her to be loving and caring.
The observed "disinterest" of the father may beseen by him to be keeping an appropriate distance from the child as a sign of
respect for his or her independence. The access to the meaning behind the actions of the protagonists is thus only indirectly
possible to an observer. This could be achieved, however, through questioning, by empathy gained through similar cases,
or through interpretation based on the rules of cultural context and common vernacular. In any case, the observer, be it as
therapist or researcher, is obliged to interpret!
Family typologies are therefore always typologies of interpretation or, more exactly, typologies of interpretation (of the
therapist or researcher) of the interpretation (of the family members). This is, however, not an argument against the

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usefulness of such typologies. The whole point of therapeutic thinking is to empower therapists with models of observation
and interpretation in order to aid them in their actions.
Observers create the information they need to guide their behavior, by making "differences that make a difference"
(Bateson, 1979, p. 250). By doing this, they draw a distinction between a "space, state or content" with a certain
characteristic ("marked state"), and a "space, state or content" without this characteristic ("unmarked state")
(Spencer-Brown, 1969, pp. 4-5). This applies not only to family members but also to therapists and researchers.
In order to accommodate both this structure of observation based on differentiation and the antagonistic tendencies of
social systems, it is vital to employ an observation model that allows logically contradictory attributions. In the following
diagram "Pro" represents the actions of certain family members, the effects of which are interpreted by the observer as
being, for example, centripetal. "Contra" represents opposing actions interpreted as being centrifugal. This conflict makes it
necessary to replace our bipolar scale with a model containing four fields (see Figure 2); we refer to it as "Tetralemma."

Figure 2.
The four logical options of the Tetralemma.
The behavior of each family member (in the preceding example centripetal or centrifugal) can now be seen by our
observer to refer to one of the four following positions:
1. Either Pro (centripetal)
2. Or Contra (centrifugal)
3. Both Pro And Contra (centripetal and centrifugal)

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4. Neither Pro Nor Contra (neither centripetal nor centrifugal)

The application of such a system of observation in clinical practice enables us to describe not only the ambivalence and
conflict within families and other social systems, but also the related elements of patterns of interactionbe it the single
actions themselves or the actions of individual protagonistsand the resulting effect within this context.

STRONG AND WEAK CONFLICTS

Every observer required to act is confronted with the necessity to make notonly distinctions but also decisions. In the
simplest of cases he or she has a choice between two possibilities: to act or not to act. Additionally, he or she must assess if
it is wise to take sides with one or the other involved party. The measurements for this assessment are not only aspired
goals, wishes, and desires, but also the avoidance or prevention of something that is feared.
If we accept this definition of conflict, then life can be seen to be a sequence of experienced conflicts. Every action of an
individual or social system presupposes certain value judgments and is, ipso facto, at the mercy of ambivalence and
cost/effect calculations. These calculations do not always lead to unambiguous results, especially when the varied goals
constantly influence the standards of our assessment. Intrapsychically, this is often the case. Within social systems it is the
rule. Due to being autonomous and structurally determined (Luhmann, 1984), interrelating individuals will always pursue
contrasting goals for themselves, their group, or family. The simple fact that constructions of reality are dissimilar will lead
to antagonism. Consensus is the exception.
Generally speaking, there exists within any social order a self-organized system of checks and balances. This controls
antagonistic tendencies within the group because all members will observe and assess any interaction and take opposing
measures if they suspect the group to be moving in a direction that endangers their own interests and values. In order to
analyze this process of conflict and decision, it is useful to make a distinction between "strong" and "weak" conflicts
(Simon, 1995).
Allow me to give an example to illustrate this point. A hiker arrives at a crossing. The decision to choose between
continuing left or right can be described as a "strong conflict," whereas the choice between taking the right path or not the
right path as a "weak conflict." In the first case, we are dealing with two logical distinctions, which are mutually exclusive
(one cannot simultaneously take both paths). A strong conflict of this type defines two spaces, states, or contents of
contradicting qualities defined by opposing concepts ("turning left" vs. "turning right"). A weak conflict, however, defines
only one space, state, or content. The opposing distinction is defined solely through the absence of the conflicting quality
(not-turning right). Through this, further options become available ("going straight-ahead," "turning left," "remaining
stationary," "going back").
To summarize: strong conflicts describe a distinction between "Pro" and "Contra"; both qualities being defined by
characteristics that are logically mutually exclusive. If this conflict involves taking action, the choice lies between two
alternatives of opposing behavioral patterns. A weak conflict, however, describes the respective distinction between "Pro"
and "Not Pro" or "Contra" and "Not Contra." In this case the choice lies between taking action or not taking action. This
model (see Figure 3) enables us to describe both the logic behind the behavior of the participants, as well as the patterns of
their interaction in conflict and nonconflict situations.

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Figure 3.
Interactional differences between weak and strong conflicts.
If we continue with our example of the family, the behavior of a member can be concentrated on either the achievement
of a positive goal (how can my wife be cheered up?) or on the prevention of something negative or feared (my wife is
hopefully not in a bad mood). There exists no conflict between these two goals since the activity of creating a good mood
does not clash with tactics involved in the prevention of a bad one.
In a conflict situation between "Pro" and "Contra," each participant can take four possible positions and risk varying
intensities of conflict. A man, for example, could become active for the "Pro"-Party and clash head-on in a strong conflict
with the "Contra"-Party. The same can be said of a member of "Contra," who will stand in the front line against the

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members of "Pro." Yet he can also take a position supporting neither the "Pro" nor the "Contra"-Party. In this case, he is, at
most, involved in a weak conflict with either "Pro" or "Contra." As a fourth possibility, he can behave inconsistently and
illogically by showing himself to be ambiguous or vacillating (supporting first the "Contra" then the "Pro"-Party). In this
case, due to the difficulty in assigning a clear preference to his behavior, the conflict is neither strong nor weak, but has
evaporated as if by sleight of hand. Where the meaning of behavior cannot be clearly categorized, there can also be no
conflicts.

GUIDANCE FOR THE OBSERVER

The observational logic described above results in the following suggestions and questions for the external observer
wishing to describe a family model of interaction (Simon 1988/93, p. 261):
1. Draw distinctions (this is the general principle for the creation of information).
2. Observe antagonistic tendencies. Are there basic recurring themes of conflict?
For instance, opening or closing boundaries, centrifugal or centripetal tendencies, actions that confirm structures or
challenge themconflicting tendencies are a dynamic principle of self-organizing systems.
3. Are both tendencies presently in balance?
3.1 If they are presently balanced, is it rather a matter of
3.1.1 both "Pro" and "Contra" actions being shown or
3.1.2 neither "Pro" nor "Contra" actions being shown?
3.2 If the tendencies are not balanced, does this imbalance lie rather with
3.2.1 the actions of the one tendency ("Pro") or
3.2.2 of the other tendency ("Contra")?
Observation always takes place within a certain time span. This means that statements concerning the balance within the
interaction process result from descriptions of synchronous patterns, organized in the "here and now." Numerous
protagonists will show behavioral patterns simultaneously. The resulting effect could be classified by the observer as being
contradictory.
However, if the observation can take place over a longer period of time, it then becomes possible to describe the process
of balance between opposing tendencies indiachronic terms (as actions and observations taking place through time). An
imbalance resulting from present actions, which favor one tendency, can be adjusted at a later time through effective actions
of an opposing nature.
If one incorporates long-term observation, one is confronted by questions concerning the chronological organization of
antagonistic tendencies:
4. How can the chronological organization of antagonistically functioning actions be described? Does it occur mainly
4.1 synchronously (simultaneously) or
4.2 diachronicly (consecutively)?
If the occurrence is diachronic, it can be understood to be a type of oscillation of the system between both tendencies.
This results in the following question. Is the rhythm of the change
4.2.1 fast (fast oscillation) or
4.2.2 slow (slow oscillation)?
"Fast" and "slow" are once again value categories that require standardization. "Fast" can be interpreted as change within
seconds, hours, or from day to day. "Slow" can be change occurring over months, years, or even generations. "Fast
oscillation" occurs therefore within a time span that is generally regarded in the West as being the present; whereas "slow
oscillation" refers to a time span conceptualized to be the past and/or the future ("earlier/later").
A further diagnostically relevant aspect is the allocation of protagonistic roles to certain persons. Diverse models allow
the representation of contradictory roles by the same persons (or their actions), or by alternating actors. The resulting
question reads:
5. Which role patterns can be identified? Are the conflicting tendencies represented mainly
5.1. by players with long-term fixed roles, or
5.2. by changing players?
If the case involves changing individual activities, are we dealing with
5.2.1 a fast change (fast oscillation) or
5.2.2 a slow change (slow oscillation)?
All the descriptive possibilities listed here refer to the formal organization of conflicts, that is, the balance or imbalance
between both sides of ambivalences, regardless of the respective dimension of content.

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PATTERNS OF CONFLICT-ORGANIZATION
Since our patients were referred to us within the structure of a university clinic and with traditional psychiatric diagnoses,
we were interested in differences and similarities between families with members diagnosed as psychosomatically ill,
manic-depressive, or schizophrenic. Although such a diagnostic-oriented approach is not very popular in the field of
systemic therapy, it appeared to usand still appears soto be necessary to maintain contact with the school of traditional
medicine.
Our interest lay, therefore, in the connection between familial patterns of interaction and individual symptom formations
(which is not to say that we suspected a causal connection, since the described patterns could have been the "cause" as well
as the "effect" of symptom formation). A central conflict affecting all families was distinguished by various opposing
concepts: a conflict between autonomy and dependence, demarcation and fusion, between binding and expelling, closeness
and distance, individuation and interrelatedness, centripetal and centrifugal tendencies. There are certainly many additional
pairs of concepts that could describe this conflict. They represent not so much theessential but rather the formal conflict.
The important question is where should the boundary be drawn between the individuumthe "complete person"and the
family as a unity? And whose aims and motivesbe they of the individuum or of the social systemhave the greater value
and influence? Should the individual describe the self as a unit of survival or, rather, the family? In the first case, the family
represents for the self only one environment among many. In the second case, individuals are participants of a larger system
whose aims are more important than their own and, thereby, will influence their actions.
Concerning the question as to how a unit of survival is definedas a human individual or a social system, be it a couple
or familythere develop not only psychodynamics but also patterns of interaction that appear to be linked with various
symptom formations. The emphasis with which this question is dealt, is from family to family and from pattern to pattern,
essentially different. One could maintainperhaps a little simplisticallythat each of these formal patterns is linked to a
basic, essential conflict. This must be overcome by the family memberseither together or individuallyand confronted
by the therapist during the therapy work. We will now illustrate a number of these content-related conflicts and their
interactive formation through the following typical examples. A case study will illustrate what, until now, have been very
abstract considerations.

Family Patterns

Psychosomatic Symptoms
Family B is referred by a doctor to family therapy because the 5-year-old daughter suffers from neurodermititis. In the
first interview, it becomes evident that the daughter is not the only family member to exhibit symptoms. The father, a
48-year-old journalist, is admitted every 3-4 weeks to the hospital for his recurring heart attacks (panic attacks, racing
heart, pain in the area of the heart). He remains there in fear of death until he learns the results of his laboratory tests. The
mother, a 40-year-old social worker, is undergoing treatment for depression. The son, 8 years old, is, as the parents explain,
a "source of great concern" because he is "socially disturbed, somewhat autistic."
Closer observation allows the linking of individual symptoms and communication patterns in the following manner. Both
parents are, as a result of their own family histories, very concerned that they do "everything right" in their relations with
one another and with their children. They blame themselves for the skin condition of their daughter and the "social
disturbance" of their son. "If only we knew what goes on in our son, we would be better able to help him. . . . If we were of
more help to him, there would not be any conflict between the two children, and our daughter would not have to scratch
herself so."
When asked for an explanation of the symptoms of their children, it became clear that the parents had differing ideas
about what makes someone "sick." Their attempts to solve the problem by "trying to understand" their son, only made
matters worse. The son presented himself as a "concrete wall." Father: "Even if I were to use the interrogation methods of
the secret service, I would never get anything out of him."
The mother reacts to her perceived "failure" with depression. She feels that she can do no more and wants only to sleep.
Her doctor is of the opinion that she is in a state of "self-hypnosis." Mr. B reacts to the problems in his family with feelings
of guilt and by being active. He becomes increasingly "stressed." Torn between the duties of his profession and family, he
often has the fear that he will have a heartattack. Only in hospital, while awaiting the results of tests, does he have moments
when he does not feel under pressure of having to fulfil some obligation, or to "take responsibility for others."
Seen from the therapist's perspective, one can say that rules of communication in Family B have developed so as to
discourage the expression of wishes that may lead to conflict with the wishes of others, and therefore lessen the likelihood
of interpersonal conflict. This brings us closer to the hypothesis that unavoidable conflict between individual and the family
as unit of survival, can manifest itself only within the individual.
This example may illustrate how a conflict, individually experienced as ambivalence between the wish (or fear) to

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separate and the wish (or fear) to bind, is interpersonally "overcome." Most of the behavior of the interacting family
members appears to be free of conflict, each participant focusing on one side of the amivalence ("Pro" = commitment,
intimacy, care). Behavior or communication that could be interpreted as distancing oneself, as active demarcation or
aggression (= "Contra") are avoided. Only that side of the ambivalence which has a positive value for the family as a unity is
communicated. No one assumes the opposing role; consensus appears complete. Resistance against family values occurs, if
at all, only passively ("Not-Pro").
Figure 4 sketches the "playing field" within which members of the family are able to move. The mother and father move
primarily in the Pro-field when they attempt, seemingly selflessly and at any price, to fight for a harmonious family life. The
children, however, move in the Neither-Nor field. They display no behavior that is actively directed against the family
values. Their differences with their parents are only passive while the parents' active attempts to help miscarry. Only when
the parents themselves produce symptoms do they then allow themselves to adopt a more passive role.

Figure 4.
Choice of position is restricted to only two options: Pro or Neither Pro Nor Contra.
Since there is little room for dissent within such a pattern of communication, there forms the picture of an indivisible
truth, a "hard" construction of "relational reality." The social rules-of-the-game become rigid. Each protagonist has to place
others or the community before the self. This pattern is strengthened by a mainly physical symptom formation; the patient
becomes the center of attention. Whoever is sick receives benefits, closeness, andmost importantthe possibility of
retreat whenever he or she wants. In this way, sickness offers a way to experience both sides of ambivalence. However, the
cost is high. The symptoms can become chronic because the principles or values of the family are not called into question.

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Manic-depressive Symptoms
Families with a psychosomatic member and those with a manic-depressive member share many similarities. This
relationship can be seen in the following example.
The patient, Mrs. D, is 30 years old. She has been referred with a diagnosis of "Manic-depressive Disorder." and been
hospitalized several times with this diagnosis. At present, she displays no acute symptoms. She appears young and
attractive. Although trained as a teacher, she is presently unemployed because her two children (5 and 7 years old) consume
all her energy. She comes from a "harmonious family" in which there were "never conflicts." Her brother suffers from
"depression." (Meetings with her family of origin revealed an organization of conflict that fitted the previously discussed
psychosomatic pattern.)
Her husband, 36 years old, is an official of a Trade Union. He sees himself as a passionate and professional "fighter." He
comes from a family in which there was much fighting, his father being an "alcoholic."
The two met when he was 18 years old, and she 12. From early on, he took on the role of "attorney" for his wife in order
to settle her disputes with her family. Whenever an aggressive dispute threatened between daughter and parents, he jumped
in andto some extent at the behest of the daughtertook on the role of "freedom fighter."
In their relationship, he was always the "big" one and she the "small." In the last few yearsafter the birth of their last
childa new quality appeared in the relationship, which displayed the following recurring pattern. She no longer accepts
the lower position, no longer allows herself to be "locked up at home" and "fixated on the children." Instead, she tries to
"live her own life." This means that she has contact with a large number of peopleincluding other men. He reacts to this
with "blind jealousy." The situation escalates: the more he tries to rule, the more she shows him that this will not work. She
eludes his attempts at control, increases her activities even more, can't sleep at night, goes out only with others, has sexual
contact with other men. The emotional distance from her husband becomes ever greater. Finally she behaves in such a way
that dispassionate observers regard her as "manic." The husband seriously considers divorce. When he takes the first steps
to divorce, the patient becomes "depressive" and has herself admitted to the hospital. Her parents and husband cooperate in
the care of her and the children. After her return from hospital, she is again the unequivocally loving wife and mother as
everyone formerly knew her, and distances herself from everything that she had been doing. But, after a few months, the
entire cycle begins to repeat itself.
This example shows that during the phases where manic symptoms are not so evident, the way of dealing with conflict
coincides significantly with those patterns found in families with a psychosomatic member. The behavioral territory is
limited to areas without strong conflicts ("Pro," or "Neither Pro Nor Contra"), and unity appears to be the most important
family value.
During the phases of manic behavior however, we observe a swing in the opposite direction. This means that the factor
of differentiation, until now excluded from interaction and communication, becomes active ("Contra"). Also, here it is
important to review the question of the smallest unit of survival and of the necessity and possibility of separation and/or
remaining together. From the perspective of an external observer, however, it certainly appears that a further
content-related conflict is influencing the interaction, namely, the conflict between self-control and foreign control. The
question that is relevant to observation in this particular pattern reads: Is the individual family membercapable of governing
his or her own behavior or not?
The behavior of the concerned individual displays an oscillation between two modalities that appear to be consistent and
free of conflict: he or she is either overcontrolled or undercontrolled (see Figure 5). The control system governing
individual behavior in the family is based heavily on negative, deviation-counteracting feedback.

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Figure 5.
Oscillation between two conflict-free interactional styles.
In this family, the patient "normally" articulates only her wish for closeness. In the manic phase, she shows only her wish
to separate. The family can follow this oscillation only up to a point since this side of the conflict now enacted by the patient
is unacceptable. Because she is acting in an "irresponsible" way, the question arises if she has therefore lost her
self-control. The partner is now faced with the decision to deny her autonomy, to label her as being "sick," and to limit her
freedom. The bond, however, is strengthened through the "sickness." This is a classical example of the paradoxical effect of
symptomatic behavior. In a "normal" situation, only the centripetal side is experienced. All disuniting factors are excluded
from communication. If the patient now enters the manic phase and emphasises her wish for separation, her relatives feel
personally and collectively threatened since she is questioning the foundation of the family being the smallest possible unit
of survival. This is confirmed through her irrational behavior. At this point, someone from the family attempts to take over
and regain control of the situation.
There then occurs a dividing-up of roles such that both sides of the conflict are represented by various individuals. The
phases of dissent are periodically replaced by phases of consensus. The role allocation can be abandoned or at least reduced
in its strictness when the patient returns to normal or depressive behavior ("Pro," or "Neither Pro Nor Contra").
On the abstract level there are a number of similarities to the previously described pattern of a family with a
psychosomatic patient, for example, its "hard" construction of reality and its Either-Or pattern in which there seems to be
no place for ambivalence. These form, despite any oscillations, the basis of the family structure. The difference
liesespecially for the patientin the fact that the opposing side of ambivalence can be experienced, at least in the manic

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phase, for short periods of time (for example, the wish to separate, or to get rid of control). This represents a sort of "time
out," which may have a protective effect from the formation of physical symptoms.

Schizophrenic Symptoms
The daughter in Family E is 21 years old. Since age 18, she has been hospitalized three times for
"Schizophrenia-Paranoid Type." Her 23-year-old brother is currently being treated for "Heroin Addiction" (he takes no part
in the family therapy). The father, 65 years old, has recently retired as the director of a school; the mother is housewife. The
parents are"strict Catholics" and their moral standards are very high.
The daughter's symptoms first appeared when she took a Mediterranean holiday together with her mother and, after
excessive alcohol consumption one night, she "got involved" with an attractive young Italian. As a result she saw herself as
a "sinner," imagined she was being followed, heard reproaching voices. Whether or not sexual contact between the two
actually occurred never became clear. Neither the mother nor father knew exactly, and their suspicions oscillated from one
minute to the next. When the father was of the opinion that it happened, then the mother believed it had not; when the
mother believed it true, then the father said it had all been "harmless." The daughter, ambiguously and unclearly, said only
that, under the influence of alcohol, things had happened which she would not normally do. Her answer in a later interview
to the question, "If you would do such things without the influence of alcohol, how would your parents react?" was "They
would blame me, and I would feel guilty." She herself explained away her behavior as "the influence of alcohol on her
transmitters." In daily family life, there are always situations in which unclarity and confusion reigns as to who bears the
responsibility for which behavior of the children, and what the causes are. In contrast to this, the parents, above all the
mother, appear to be ready, to an absurd degree, to blame themselves for the problems of the children. Out of concern not
to do the wrong thing, they are completely disoriented. When they show care and concern for the children, they are accused
of impinging on the children's "independence." Yet, when they treat their children as adults and make grown-up demands of
them, the children behave as patients who demand care; on account of their handicaps, no blame can be laid on them for
anything they may or may not do.
The main conflict appearsagain, seen from the perspective of an external observerto be the question of individual
guilt or innocence. Is the individual responsible for his or her actions and their consequences? Is he or she a perpetrator or a
victim?
Within this pattern, one can avoid strong conflicts by disqualifying the attribution of unambiguous meanings to individual
actions, which could define a party as guilty. There is an oscillation between two contexts of interpretation of the meanings
of the behavior of the family members ("responsible" or "nonresponsible"). If everyone moves between the "Neither
Perpetrator Nor Victim" position and the ambiguous "Both Perpetrator And Victim" position, nobody can be blamed (see
Figure 6).

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Figure 6.
Two possible options: taking an ambiguous (Both Pro And Contra) position, or avoiding (Neither Pro Nor
Contra) any position.
The opposing sides of the ambivalence are experienced synchronously, that is, the meaning attributed to the behavior of
each individual is either ambiguous or it fluctuates within very short intervals betweenPro and Contra. By softening reality
through communication, the fear of accusation is neutralized (a high level of "communication deviance" (Wynne & Singer,
1958)). Since reality is socially always consensually validated, it is sufficient if one does not agree with any dangerous
declarations of guilt.
One of the consequences of this communicational style is the difficulty one would have in acquiring clear definitions of
relationships or forming strong coalitions. Only unreliable relationship structures can be developed. Conceptions of reality
are sometimes thoroughly "softened." Due to this, the capability of the individual, as well as that of the entire system, to
make clear and reliable decisions is impaired.

SOME THERAPEUTIC CONSEQUENCES

When therapists are confronted with one of these patterns of communication (see Table 1), they face the following
problem: On the one hand, they must show an ability to connect; that is, they must adapt to the forms of familial concepts of
reality and their patterns of overcoming conflict so that communication becomes possible. In order to encourage processes
of development, on the other hand, they must encourage diversity not only to disallow the confirmation of these patterns but
also to bring about their "perturbation" (Maturana & Varela, 1980). The goal of the therapy is to perturb the depicted

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patterns so that a new organization of conflicts becomes possible, allowing the minimizing of symptom formation and its
maintenance.

Content of conflict
Conflict-related patterns of
interaction
Time-related patterns
Patterns of relationship, role
allocation
Table 1
Patterns of Communication in Families with Symptomatic Members
Psychosomatic Manic-Depressive Schizophrenic
Binding vs. Separation Self-control vs. Foreign control Guilt vs. Innocence
Apparent consensus and freedom Alternation between apparent Neither consensus nor dissent,
from conflict. Conflicts are consensus and freedom from neither conflict nor freedom from
experienced only individually andconflict, and apparent dissent and conflict since the distinction
are internalized, not staged strong interpersonal conflict. between Pro and Contra has
interpersonally: pseudomutuality. Slow changes in phases between been dissolved. Pseudomutuality
pseudomutuality and and pseudohostility exist
pseudohostility. synchronously.
No noticeable chronological Slow oscillation between Fast oscillation between
differentiation, consistency and antagonistic patterns of antagonistic patterns of
reliability of the rules of interaction. The two sides of interaction. Contradicting
interaction. Freedom from ambivalence are experienced positions are represented
ambivalence as normal diachronically. synchronously. Limited
expectation. predictability and reliability.
Fixed and clear definitions of Fixed and unambiguous Unclear and unstable definitions
relationships, which are subject definitions of relationships, of relationships and roles.
to little change. When which are varied according to the Constant unpredictable
considering the central situation. Central conflict reveals fluctuations of roles and
content-related conflict, no distinct roles which allow their changing coalitions.
differentiated exchanging of carriers to act without
roles. ambivalence.

Family Interventions

Psychosomatic Symptoms
As a therapist who is confronted with such conflict patterns, one is inclined to employ compensatory functions and
intervene correctively, that is, to take up a position which apparently represents the denied separating, Contra-side of the
conflict. The patient or the family "seduces" the therapist into assuming a substituting function that emphasizes the
advantages of independence and self-reliance.
Using psychoanalytical terminology, we mean specifically a transference-countertransference dynamic, which leads to
the therapist taking over missing functions from the patient or family and creating collectively a characteristic pattern of
relationship. Such a procedure is partial toward one side of the conflict and endangers the therapeutic relationship by
representing a value that openly contradicts the individual and social values of the client-system.
The result is almost always a phenomenon generally described as "resistance": the patient or his relatives devalue the
therapist, so that that his or her intervention no longer perturbs the system. The therapeutic dilemma is that the therapist is
always in danger of either confirming the patterns of the family or of deviating too far from the family's expectations.
Through systemic consideration we come however to a third, neutral strategy.
If the therapist adopts the "Both Pro And Contra" position, ambiguity and ambivalence are imported into the
client-system. The therapist does not question the sense of the preferred ways of family behavior but, rather, introduces the
opposing side into the field of perception and incorporates it in the communication.
In the example of family B, on the one hand, the therapist needed to acknowledge and recognize the worth of cohesion
and the parents' readiness to sacrifice themselves. On the other hand, it also exactly portrayed the psychic and physical
price each individual had to pay in daily life. By means of hypothetical questions, the results of conflict were played out. By
this means, it became clear that the parents were both afraid that the present state of affairs would lead to separation. More
concretely, it was clear that both parents were sure of their ability to survive such a separation, but each had doubts that the
other would come through so well.
Our experiences, therefore, suggest that the therapist should take an ambivalent not-only-but-also position in the face of
the presumed conflict"presumed" because it is usually not clearly discernable in the communication. Of grave importance

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here are the questions of separation and demarcation and of the individual as opposed to the family.

Manic-Depressive Symptoms
Since only one side of the conflict is enacted, therapists are tempted to take the opposing side and accept responsibility
for its realization. If the depressive-psychosomatic side (the suppression and "overcontrol" of individual impulses) is being
shown, then therapists tend to use their own vitality as a counterbalance. trying to inject vitality into the client-system, to
bring the suppressed areas back to life, to encourage, and to animate. If the manic, "undercontrolled" side is being shown,
then therapists are tempted to take over the responsibility for the control of extreme activity and energy: that is, to dampen
and restrain.
A useful systemic strategy for intervention would be an attempt to change thediachronic organization of conflict into a
synchronous one. Our experience shows that this strategy works best when two therapists work together: by splitting the
roles, each therapist can assume one of the two ambivalent sides ("Pro" or "Contra").
The case of Family D will illustrate this. The treatment was carried through by a pair of co-therapists. One of these took
the position that Mrs. D suffered from an organic illness, and therefore had no self-control during the symptomatic phases.
The other focused his attention on the effects of the relationship on the patient's behavior, and cautiously took the view there
might be grounds for seeing the relationship as the cause of the symptoms. Both therapists discussed their views in the
presence of the couple. They agreed on the fact that they could not agree on whether the appearance of the symptoms could
better be attributed to reasons of biology or of partnership. Furthermore, they agreed that the question was not important in
terms of the further treatment of the pair since it came down to the fact that all possible influences should be investigated in
order to find out which factors lead to mania, depression, or "health"from medication to the patient's extramarital
relationships, and the dominant behavior of the husband.
By using this strategy within the team, the "Both the Pro And Contra" position is actualized. The team as a whole is
neutral because the two team members are taking opposite sides. If both can demonstrate that they mutually accept the
differing views of the other as legitimate and there is no adverse effect on their cooperation, then the idea that consensus is
a prerequisite for the survival of a relationship can be called into doubt. In addition, the premise of a "correct" strategy for
life and the "hardness" of an indivisible reality within a relationship is softened. The beliefs that have held the system stable
and caused it to oscillate in the face of an ambivalent conflict are implicitly challenged without being explicitly attacked.

Schizophrenic Symptoms
When confronted with chaos, therapists are inclined to take the side of order. They often become advocates of a "hard"
construction of reality, a representative of authority, demanding adaptation and submission. Attempts to enforce order,
however, are often boycotted by the patient or family. Yet, therapists are also impelled to remove the question of guilt, to
deny that the patient alone is responsible, and to redefine the actions of all participants (patient and family) that could lead
to feelings of guilt, as being symptoms of the sickness or reactions against it.
We use a therapeutic strategy by which the therapist tries to deconstruct the idea of guilt. An excerpt from a session with
Family E will clarify this. The context is that, during the therapy of the drug-dependent son, accusations were made against
the parents. The daughter explained that she and her brother were of the opinion that the parents were to blame for the
problem. The following dialogue took place (Th = therapist, D = daughter):
Th: How does your brother see that his mother is to blame?
D: That he has become addicted to drugs!
Th: And which behavior of your mother does he see as worthy of blame?
D: That she is always overmothering him, that she asks him, "Do you want some more buttered bread?" And
when he says no, she brings him more anyway.
Th: And how does he see that buttered bread and drug addiction have anything to do with each other?
D: (laughs heartily) Oh, hm! Perhaps that he has never become independent.
Th: Does he consider that your mother has hindered his becoming independent?
D: Yes, she has been a hindrance!
Th: And how has she done that? By buttering his bread?
D: (laughs again; sighs) Yes, that he can't decide for himself when he is hungry and when to butter his own
bread.
Th: Does he have to eat the bread when she has buttered it?
D: Well, she brings it to him and he doesn't eat it anyway.
Th: Aha! Is he not then very independent when he doesn't do what she has in mind for him?
D: But it annoys him when she runs around after him.
Th: Let's suppose for a moment that your brother didn't think that your mother or your father were to blame.
How would he see things then? Would that make any difference to the way in which he saw himself?

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D: Yes, then he would see himself as more independent.

Th: Would he then be to blame?
D: Then he'd be to blame.
Th: And would that be all right for him?
D: No. He is actually quite happy to be able to blame someone else.
Th: That's the same then as with the buttered bread. He lets his mother not only butter his bread, but also
carry the blame.
D: Yes, yes.
In the further course of the conversation, the question was asked as to where the blame for the daughter's psychosis lay.
The therapist had first attempted in an analogous manner to take an imaginary picture of blame as a direct cause-and- effect
relationship to an absurd extent. Instead of that, he now attempted to plant the idea that everyone can have influence over
things, even though no one can have complete control over the situation.The therapist demonstrates clearly, that
unambiguitywhere guilt is concerned, or anything else for that mattercannot exist. He makes the over-valued,
existential Either-Or Question of guilt tangible by observing short sequences of interaction that could lead to a result
charged with guilt. He implicitly attributes to each individual some influence over the behavior of all the other family
members. If everyone is responsible in some respect, and if everyone can consider himself or herself a perpetrator and
victim at the same time, then the Either-Or Alternative evaporates.The three strategies of intervention discussed above
share a common ground. They question the conceptions of reality displayed by the family members and propose new,
alternative ideas. They refer to the fundamental, bipolar logical model in which ambivalence, contradictory evaluations that
are dependent on context, and the antagonistic tendencies of living systems have no place.

POSTSCRIPT
Let me emphasize that the sketched typologies in this article do not present an attempt to describe characteristics of
families but, rather, patterns of interaction and communication. These patterns may alter during family history and
sometimes during the process of therapy. From a theoretical point of view, the described patterns cannot be considered to
cause the specific formation of symptoms. The relationship between communicational patterns and psychological
phenomena can be seen as between a system and its environment. The environment (that is, the type of organization of
conflicts) limits the options for the development of the structures of the system (the psyche), but it does not determine its
structure. However, our clinical experience has shown that these patterns do at leastretard the process of rehabilitation
since the above discussed strategies of intervention, which aim to alter these patterns, have proved to be successful in our
followup studies (Retzer et al. 1991; Retzer 1994).The discussed patterns follow a tradition of observation and description
which is well-known in the history of family therapy. Noteworthy are Wynne and colleagues' distinction between
"Pseudomutuality" and "Pseudohostility" (1958), and Reiss's distinction between "Distance sensitivity" and "Consensus
sensitivity" (1981). Also the "Collusion" model of couples dynamic by Dicks (1967) and Willi (1984) show similarities that
cannot be overlooked: namely, a shared conflict is divided between two ambivalence-free positions and protagonists.The
advantage of the model presented above, is that it describes an interactive and communicative frame that lays social
behavioral constraints upon the freedom of the individual participants. Within these borders, there are many varied
possibilities to develop psychodynamic patterns that could be "viable" (Glasersfeld, 1984). The described patterns should
not be seen as determining the development of the individual. They are simply borders that influence the probability of
individual development. It must be underlined that there may be other communicational patterns to be observed in families
with patients with psychosomatic, manic-depressive, and schizophrenic symptoms. In addition, the presented case
examples show that different kinds of symptoms can emerge within the same pattern.Such patterns are not to be considered
as pathological. They have simply different consequences for the participant who is involved in the interaction and
communication, as well as for the system as a whole. These schema can be used to describe not only families, but also
organizations, institutions, and even cultures. An example of this was presented by Ruesch and Bateson (1951) when they
described how conflicts in the European and American political systems are organized in different ways (in Europe,
between the parties/in the U.S., within the parties).

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Manuscript received August 14, 1997; Revisions submitted August 14, 1997; Accepted February 23, 1998.
*Helm Stierlin, Gunthard Weber, Gunter Schmidt, Arnold Retzer, and Fritz B. Simon.

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