t Planning

If you flew over a flock of penguins,you might imagine that this

was a con-
vention of butlers-'so_precisea patterning of black *hit" and such stateli-
nessof movementcould berongto no other group. But "ia as soon as you
courd
get a real look at your subject, that hypothesis would be discard"j.
B.,tl"r,
have arms, not flip_pers;they are human, and these creatures clearly
are not.
But what are they? As you saw one dive into the waier to swirn
effbrtlessly
away, you might decide that penguinswere fish. only closer u"qouirrt
rr.
would lead you to discard this secondhypothesis,ani move toward
the cor-
rect solution.

It is always a mistake, sherlock Holmes warned, to theorize ahead

of
one'sdata. Planning tlgatm activity that can be engagedin,r only
vruJ
with an awareness.oflrtgFhitqtionslasthe fable of the p""soi" cautions.
Family therapists leaYri,in ett'eltlto theorize ahead of their data about
a
family, but always with awarenessthat a family's structure is never
im-
mediately available to a therapist. only in the processof joining a fam-
ily, probing its interactionsand experiencingits governingstructure,
can
a therapist get to know the transactionsof thaffamily. Any initial
hy-
potheseswill have to be tested in joining, and they *uy
uu be quickly
discarded.
Nevertheless,an initial hypothesis can be invaluable to a therapist.
Families come with different shapesand structures, and since form
will
affect function, families will respond to stressesin certain ways that
are

50

)aJ
 51 Planning

necessital.db{.r-heirshap,eu\ir shapewill indicatepossible

functional
€r$)ano possrblevt:ea$/i9r\id their structural arrangem.nt.\'
The therapistformsaht'deaorgp4ryyEs a whore
uponfirst exami_
basicaspects r'ro- thesimprest
infor-
11':::'j::1"T @g4\.
mationgatheredonaphonecalhE'ffiefirstappointment,orre-
sheer, rh; iherapist can devetop some
:::.1:1,:l _u,.tili:,theTruk:
about
sisqyrptions famir)-,F or instance,ho* *urrv p"oil;; in the
family and where do they live? what ih" agesof the family mem-
bers?Is one of the normal transitional"r* points thlt stressevery farnily a
L+gt-oI-be1q? T! e .Pre$,c4[Ig.grB]fe,e m'ay be ano,fJeerclue tr-,- t *,, gg**
areas of possible strength and weaknessin each "Fro*
client family.
these simple elements,the therapist will develop
some hunches about
the family to guide her first probes into the famiiy
organization.
The most immediate clue is family cornposition.Certain
eombinations
indicate certain areas for exproration. The most commonly
encountered.
family shapesare the pas de deux, three generation,
shoe, accordion,
fluctuating, and foster.

PAS DE DEUX FAMILIES

suppose that a family consistsof only two people.The
therapist can
guessthat these two gqg{e probably rely on
each other a great deat.If
they are mother a"d child -uy .purrd much time in the com-
@the
pany of adults. She rnafhave advancedverbal
skills, and becauseof a
. high percentageof interaction with adults,she may becomeinterested
in
.r;"tadultissuesbefore her peers and appear more mature. she may spend
o less time with peers than the usual child, having ressin common with
them, and she may be at a disadvantagein physical play.
Th_ ;;
free, if she chooses,to give the child *or* indiviiuai uit.hon
than
would be possibleif there were a husband or other children
to be con-
cerned with. As a result, she may be very good at reading
the child,s
moods,satisfyingher needs,and answerirr!her questions.
she rnay, in_
deed,have a tendency to over-readthe child, as she has
no one else on
whom.to cojrygntsate*rphe may have no one with whom to checkher ob-
servationt.Qs-I"t"!&n be an intense style of relatins which fosters

exampleof the pasil" aeu* ramilils the oider couplewhose

children have left home. They are sometimessaid to suffer
from the
empt{46s!,ayndrome.still another exampleis the parent and
adult pin"
gle
gle chilt6ho
child-\\ryho
have livert
have lived fooefhor. oll +]-o
together aI the ^L.irr'^
.hitd', rir^
lif".
r

It,o
 52 Family Therapy Techniques

Every family structure, no matter how viable in somecases,has

areas
of possibledifficulty, or weak rinks in the chain. The two-person
struc-
ture has the possibility of a lichen-like formation, in which the individu-
als becomealmost symbioticany dependenton each other. This
is a pos-
sibility that the therapist will probe. If her observationsindicate
that
overinvolvement is curtailing each mernber'spotential functioning,
the
therapist will plan interventions to delineate the boundury between
the dyad memberswhile openingout the boundariesthat keep each
,, in_
, dividual closed off from other relatio s. The therapist may explore
-the { ppo r interest in order to chal-
lenge ale an view of mily reality.
THREE.GENERATIONFAMILIES
The extendedfamily with the variousgenerationsliving closetogether
is probably the most typical family shape,worldwide. Many therapists
have emphasizedthe importance of working with three generations,re-
gardlessof possible geographicdistancing. In the western urban con-
text, however, the multigeneration family tends to be more typical of
Iower middle classand low socioeconomicgroups.Therefore, the thera-
pist may tend to look at this family shapein terms of its deficits,instead
of searchingout the form's sourcesof adaptational strength.
The extended family shape contains within its multiple generations
the possibility of specializationof function. The organizationof supporr
and cooperationin family tasks can be managedwith an inherent flexi-
bility, and often a true expertise.This type of organizationrequires a
context in which the family and extrafamilial are continuousand harmo-
nious. Like any family shape,the extendedfamily needsa societal con-
text that complementsits operations.
In working with three-generationfamilies, family therapists should
guard against their penchant for separation.Therapists tend to want to
delineate the boundaries of the nuclear family. In a family with a
mother, grandmother,and a child, the family therapist'sfirst question is
often, "who is parenting the child?" If the parenting functions are rele-
gated to the grandmother,the map-maker inside of the therapist begins
to devise strategies to reorganize the family shape so that the .,real
mother" takes over the major responsibility for parenting the child and
t'he grandmother moves into the background. This adherence of the
family therapist to the cultural norms should be shakenup a bit, sinceit
may be that what is therapeutic for that three-generationfamily is to

AI,\
 53 Planning

work within the cooperative system toward a differentiation of

functions
rather than to push for a structure that corresponds to the
cultural
norm.
It is important for the therapist to find out what is the idiosyngatic
affangement for this particular family. It may be that the gran;nother
is living with the daughter and grandchild.gut it is also por.ibl*
that the
grandmother is the head of the house and that the mother
and.child
function under her care. Is there a clearly delineated structure,
with
both adults living as equalsand one acting as the child's primary parent?
-Arg,fh e=edrrlf e.conpererirl$,,tla es
tions and expertise,or are the two adutts struggling for positions;i;;;_
macy?And in this last situation, is the child in coatition with one woman
against the other?
There are rnany forms of three-generation families, ranging from the
single parent, grandparent,and child combination,to the conrplexnet-
work of entire kin systemswho neednot live in the samehouseto wield
great influence.It may be necessaryfor the therapist to find out
who
"the family" really is, how many membersit has, and what is their level
of contact with the extended network. The influence of the extend.ed
family on nuclear family functions should never be underrated.l
A possibleweak link ih the multigeneration family is the hierarchical
organization.When an extendedthree-generationfamily comesto ther-
apy with one of its members as the symptom bearer, the therapist will
explore cross-generational coalitionsthat may be scapegoatingone farn-
ily member or rendering certain holons dysfunctional.
In some disorganizedextendedfamilies,adults may function in a dis-
engaged,centrifugal way. In such cases,executivefunctions, including
child @atingr may remain underdefinedand "fall between the cracks.,,
?hfs problem is often seenin poor, overburdenedfamilies living in slums
without societalsystemsof support. Clarifying boundaries**s holons
can help differentiate functions and facilitate cooperatidn.2

SHOE FAMILIES
The large family is not as common as it once was in this culture. At
one time, having many children was the norm. Children were considered
a family asset. Times have changed, but the structural relationship
found in most large families has not. Whenever institutions becorne
large, authority must be delegated.with many children in a household,
usually one and perhapsseveralof the older children are given parental

al)-
 54 Family Therapy Techniques

responsibilities.These parental children take over child-rearing func-

tions as the representativesof the parents.
This arrangementworks well as long as the parental child's responsi-
bilities are clearly defined by the parents and fall within the capabilities
of the child, given her level of maturity. The parental child is put in a
position in which she is excludedfrom the sibling subsystemand kicked
upward to the parental subsystem.This-nosition has sorne attractive
features,since the child has d the parents, and it can in-
creasethe child's executiygskill* T,herelationship has worked well for
millennia. Many theraot+ts.aietorm-erBarental children. But the struc-
ture of a largil't'ai'iurycbnbreak down at thrs porntl and a therapist must
be aware of this possibility.
The potential exists that parental children will becomesymptomatic
when they a1egiven responsibilitiesthat they cannot handle, or are not
given the authority to carry out their responsibilities.Parental childt

cluded from the sibling context and the parental

holon. The important socializationcontex . the sibling subsystemis
handicapped.Furthermore, the nurturanc tunctions that the younger
children need from the parents may e,b{ocked)bythe parental child.
In therapy, it can be usefi,rlto em oy boundary-making techniques
tfrat.leorganizethe parental subsystemwithout the parental child, and
1iduct sessionsamong the siblings alone in which the. position of
the parental child in the sibling subsystembeconresreorganized.Or if
the parental subsystemis already overloaded,t sponsibility for sup-
porting the parental subsystemmay be distributed more fairly among
the other siblings.

ACCORDIONFAMILIES
In some families one for long periods of Militarv
families are the classicalexample.Whe spouseleaves,the spouse
who stays must take on additional nurturant, executive, and guiding
functions or the children will go without. The parental functions are
concentratedinto one personfor part of each cycle.Familiesmay crys-
tallize in the shapeof a one-parentfamily. The spouseat horneassumes
additional functions at the expenseof spousecollaboration.The children
may function to further the separationof the parents,evento crystallize
them in the roles of "good father and bad, desertingmother" in an orga-
nization that tends to evict the peripheral parent.

a5
 Planning

Accordion families may cometo therapy if the job of the traveling par-
ent changesand she becomesa permanentfigure in the,family organiza-
tion. At this point, there needsto be a shift in the way in which the fam-
ily organizesits functions, for the old program handicapsthe evolution
of new functions that include the absentspouse.The peripheral parent
must be reincluded in a meaningfulposition.
In thesesituations,as in other transitional situations,therapy will in-
clude not only restructuring maneuversbut also educationalones.The
family must come to understand that, in effectfihey are a "nevfGffi
'-**+i*arneW*te,8ffi 'aee€F#ia+€+"##*.gar+t-ffi
family have beentogether for a long time; oniy the shapeof the family is
new.
-: ': l'' -'-, - .., 'urtt,iti,
FLUCTUATING FAMILIES
Some families move constantly from one place to another, like thb
ghetto family who leave when the rent is too Iong overdue, or the cor-
poration executive who is transferred aga!: apaftr.py the parent
company.In other families, it is the family bompositiontlat fluctuates.
This occurs most frequently when a single dalent+as-sedal love affairs.
A father may pass from girl friend to gful friend, each one a potential
spouseand parent. This configuration may not be apparent to the thera-
pist on initial contact, but it will becomeclear as she works with the farn-
ily over time.
If the shifting context involves significant adults, it is irnportant for
the therapist to get a history, to determine if what seemsto be a stable
organization is in effect transitional. Part of the therapist's function will
then be to help the family defineit+organizational structure clearly. If
the shifting context involvesQoc:atiowlahereis a loss of gypJergsof sup-
port, both family and community. The family is berettl Chrtdren who
have lost their peer network and must enter a new school context may
find themselvesdysfunctional.If the family becomesthe only context of
support in a shifting world, its ability to contact the extrafamilial may
suffer.
The therapist must realize that when the family loses its context by
relocation, its members will enter into crisis and tend to function at a
lower level of competencethan in circumstanceswhere the extrafarnilial
context is supportive. Therefore, asr
both of the family as an organism
comesa relevant issue.It is essentir
' -.,'i iai'

t\h
 Family Therapy Techniques

product of pathology in the family. The family holon is alwaysa part of a

larger context. With the larger context in disruption, the family will evi-
dencedisruption.

FOSTERFAMILIES
A foster child is by definition a temporary family mernber. Agency
workers make it clear that the foster family is not to becomeattached to
the child; a parent-child relationship is to be avoided.Neverbheless, par-
ent-child bondsoften do becomeestablished,only to be broken when the
child moves to a new foster home or back to her family of origin.
A potential problem with this family shapeis that sometimesthe fam-
ily organizeslike a nonfoster family. The child is incorporated into the
family system.If she then developssymptoms,they may be the result of
Ftressqqwithin the family organism. But the therapist and family may
'assum6
that the child's symptoms are the product of her
prior to her entrance into this family, or that they are the product 9f in-
ternalized pathqlqg.y, since she is a foster child and technically not a
tam ember.
The relationship of the symptom to the family organizationshould be
assessed.If1he symptomatology is the product of the child's entrance
into a new system, then the system is functioning as if in a transitional
crisis. On the contrary, if the child is already fully integrated into the
family, her symptoms are family organized and related to the stresses
that other family members expressin other ways.
In the latter situation, an additional complexity of the foster family
, shapeis the presenceof the agency. Fosterfamily agencies,which invest
a lot of time and effort in developinggoodfoster parents,tend to be verv
protective of them. They may operatein a way that hinders rhe posslbrl-
ity of accommodationbetween the child and the host family. In these
casesthe therapist must consider bringing the agepcy worker into the
therapeutic context and working with the agencyworker as a cotherapist
to help the total family organism,including the child.

Intake information often tells somethingnot only about thesekinds of

family composition, but also about the family's developnnentalstage.
Family developmentimplies transitions.Families changein adapting to
different circumstances. Occurrencesin the family's developmental
stagemay therefore be threatening the family equilibrium. Many farni-
lies come to therapy preciselybecausethey are in a transitional period,
in which demandsfor changeand the counterdeviationmechanismsac-

{rr
 57 Planning

tivated by those demands are handicapping family function. These

problems of discontinuity are found in stepparentfamilies and families
. '''with a ghost.

}: STEPPARENTFAMILTES
'',".
When
1$gqgglgq|is actdedto a family unit, she must go through a
"'iprocessoKQtefration,)hich will prove to be more or lesssuccessful.She
may make les-Fthaneftrll commitment to the new family, or the original
unit may keep her peripheral.The children may increasetheir demands
'an-@,exaee*b*i*g, hie,pf€b+e* q:ith d*dde$-sl3kisg.
In caseswhere the children lived away from their natural parent until
his remaniage, they must now accommodateto both their own parent
and their stepparent.
Crises in this family shape are comparable to problems in a U_e._W farn-
ily organism; they should be seenas normal. Western culture postulates
instant family formation. After the ritual, whether legal or paralegal,
the membersof a "blended" family rush into family holons.But tirne has
not yet given them functional legitimacy. A therapist may have to help
the family by introducing dresignsfor gqgdu_a! In some cases,it
_e_vqlrrfisn.
may be useful in the beginninjfor thJmeffia;.'dft'filtwo original farni-
. Iies to maintain their functional boundaries,meeting as two cooperating
'..i' -halvesto resolve issues as the family moves toward a one-organism
shape.

A family which has experienceddeath or desertion may have prob.

-4emsreassigningthe tasks of the missing member. Sometimesa family
. ' will establish the attit,ude that if the mother had lived, she would have
'
known what to do. Taking roverthe mother's functions becomesan act of
disloyalty to her memory"-Old coalitions may be respected,as if the
mother were still alive-
Problems rn'tnesefamilies may be experiencedby family membersas
issuesof incomplete mourrring.But if the therapist operateson this as-
sumption, she may crystallize the family instead of helping them move
toward a new organization.From the therapeutic point of view, this is a
family in transition. Previousshapesare handicappingthe development
of new structures.

As the therapist thinks over all of the initial information on a family, a

speculativefamily structure takes shape.It acknowledgesthe configura-

u6
 58 Family Therapy Techniques

tion that the family report-sas basic. It includes elements of the farnily's
developmentalstageand the possibleproblems inherent in that stage.If
the family's r nn, econoaic status, or ethnic background are known,
this information is included. Finally, the picture incorporates the pre-
senting problem. If an infant is failing to thrive, the therapist will probe
for dysfunction in the mother-child interactions.If a child "won't mindo"
the therapist will probe for an alliance within the family hierarchy that
is giving the child adult support for disobedience.
Certain symptoms are a clear indication of certain family structural
arranggments.Therefore, the "presentingproblem" triggers any trained
therapist's imagination. It immediately evokesthe page of sornebook of
psychology,the face of some child seenpreviously, or the shape of an-
other family with similar problems. These images are usefi.rlin forrning
the initial set of hypotheses with which the therapist will approach the
family.

FAMILIES
OUT-OF.CONTROL
In families where one of the mernberspresentss5rmptomsrelated to
control, the therapist assumesthat there are problems in one or all of
celtain areas:the hierarchical organizationof the family, the implemen-
tation of executivefunctions in the parental subsystem,and the proxim-
ity of family members.
Issuesof control vary, dependingon the'developmentalstageof family
members. In families with young children, one of the most cornmon
problems to appear in a child guidance clinic is the preschooler de-
scribedby the parents as a "monster" who will not obey any rules. When
a fifty-pound tyrant terrorizesan entire family, it must be assumedthat
she has an accomplice.For a three-foot tyrant to be taller than the rest
of the family members,she has to be standing on the shouldersof one of
the adults. In all cases,the therapist may safely assumethat the spouses
disqualify each other, which Ieavesthe triangulated tyrant in a position
of power that is frightening to her as well as to the family.
The therapeutic goal in this situation is the reorganizationof the farn-
ily, with the parents cooperatingand the child appropriately demoted.
The developmentof a clear hierarchy, in which the parentshave control
of the executivesubsystem,requiresa therapeutic input that affectsthe
entire parental holon.
In families with adolescents,the issuesof control may be related to
the inability of the parents to move from the stageof concemedparents

A4-
 59 Planning

of young children to respe,ctfulparentsof young adolescents.In this situ-

ation, old programs that served well for the family when the children
were young interfere in the development of a new farnily shape. The
children may feel more comfortablewith changesin their development,
whereasthe parents have not yet evolvednew alternativesfor their own
stagein life.
An adolescentchild may also be so overinvolvedwith a hovering par-
ent that no action of the child remains unnoticed. In these situations,
blocking the overinvolved.transaction may increasethe encountersbe-
-ffi
enffi 6'-FaF€htaf h'oh and the etrild, #riefr rrray.hretpjn r,fueexpfure.
tion of alternatives.
In general,the best route for the therapist when dealingwith families
of adolescentsin conflict is to travel the middle of the road. She will
support the parents"rights;to make certain demandsand requestrespect
for their position. She will also support the adolescents'demands for
change.
In families with delinquentchildrery the parents' control is dependent
on their presence.Rules exist only as long as the parents are there to
implement them. The chitd learns that in one context there are certain
rules, but these rules do not operate in others. In this organization,the
parents tend to make a high number of controlling responses,which are
often ineffective.The parent makesa controlling dernand,the child does
not obey, the parent makesanother demand,and so on. There is a mu-
tual agreement that after a certain number of parental demands, the
child wiII respond.
Communication patterrrstend to be chaotic in these families. People
do not expectto be heard,and relationship messages are more important
than the content. Communicationsseemto be organizedaround srnall,
disconnected,affect-carryingbits or transactions.
When these families have severalchildren, the sibling subsystemcan
be an important contextfor beginningto organizea new family shapeand
for creating meaningful boundaries.Other therapeutic techniques for
these families have been rlescribedelsewhereby Minuchin and others.3
In families with child abuse,the systerncannot control the parents'
destructiveresponsesto children. Usually the parentsare devoid of sup-
portive systems.They respond to the children as if they were only a
continuation of themselves.Every action of the child is felt by the parent
to be a personalresponse.Parentsin this situation do not have their own
adult context in which they are competent. The family becornestoo
much the only field in which the parent expressespower and compe-

)\t
 60 Family Therapy Techniques

tence, which emergeas aggression.Just as people hit each other only in

clinches,only overinvolvedsqbsystemstend to produceabusingparents.
Sometimesthe child abusefamily is organizedaround an overinvolved
dyad, one parent and child. Usually this is the mother and child, with
the father attacking them indiscriminately, as an enemy alliance. In
these families, abusebetweenthe parents is overflowingto the child.
The family of the infant who fails to thrive is sometimesput in the
same category as the allused child family, becausethe effect in both
casesis to endangerthe child. However,the characteristicsof the family
are different. Failure to thrive involves not a situation of proximity but,
on the contrary, an inability of the parents to respond to the child's
needs. In effect, this is a disengagedorganization. The rnother is not
feeding the child as much as she needs.She is being distractedwhen the
child is at the breast or bottle. In thesesituations therapeutic techniques
involve engaging the parents, instead of the boundary rnaking tech-
niques that are indicateclin child abusesituations.
There are two types of families in which children have schoolphobias.
In one,the schoolphobia is a manifestationof a delinquentlike organiza-
tion. In the other group,the situation is similar to families who have psy-
chosomatic children. There is an overinvolvement between the child
and some family member which hooks the child into rernaining at horne
as a companion.

PSYCHOSOMATICFAMILIES
When the presentingcomplaint is a psychosomaticproblem in one of
the family members,the structure of the family is one that includes an
overemphasison nurturing roles. The family seems to function best
when someoneis sick. The characteristicsof such families include over-
protection, enmeshment,or overinvolvement of family mernbers with
each other, an inability to resolveconflicts,a tremendousconcernfor the
maintenanceof peaceor avoidanceof conflict, and an extrernerigidity.
This is not the rigidity of the challenge,but rather the rigidity of water,
which lets itself be graspedonly to return to its original form. These
families look like the normal, all-American family. They are benign
neighbors.They do not fight. They are very loyal and very protective-
the ideal family.
One of the problemsthat thesefamilies presentto the therapist is that
they are so likeable.They seemeagerto respond.The therapist may feel
that they are cooperatingwith her, only to find herself frustrated again

alq
 Planning

and again by the problennsof these families, as well as by her easy in-
duction into the molassesof their attitude of peaceat any price.

READING STRUCTUREFROM EARLY TRANSACTIONS

The skeletal information that can be gatheredfrorn an intake sheetor
a phone conversationevokesthe possibility of certain farnily shapesand
problem areas.This cognitive schemais useful in helping the therapist
organizeher initial contact \,niththe family. But only in the formation of
I
I the therapeutic systemcan the information to buttress,clarify, or refute
*T*I 4hs-irieia* ffiesis be gat&ered, tk"easst$at ffi '#moadrate
how to read structure from early transactions.
In the Malcolm family the identified patient is Michael, age 23. While
away at college,Michael had a psychotic break during his senior year.
He and his wife of four months came back to the city, where Michael was
hospitalized. Coming to the initial session are Michael and his wife
Cathi, Michael's parents,and his youngerbrother Doug, who is a college
freshman.
Readingthis information on the intake sheet,the therapist notes that
during one year this family has experiencedthe marriage of one child
and the loss of the other to college. Questionsimmediately corne to
mind. Is this a family that has difficulty separating? Has the vacuurn
created by the absenceof the younger brother causedinstability in Mi
chael's family? If Michael has had difficulties separating frorn his par-
ents, have these exacerbatedthe problems of forming his own marriage
relationship?
As the Malcolm family enters the room, Mr.and Mrs. Malcolm sit on
one side of the room. Michael's wife sits down opposite them. Michael
walks in and, looking at no one in particular, says,"Where shall I sit?"
His mother folds her arms, then extendsa hand, pointing to a chair. "I
guessyou sit next to your wife," she says.Michael responds,"I think I'll
sit next to my wife."
Michael's question was not directed to one person.TLrefact that his
mother answeredsuggeststhat there is a great deal of proximity be-
tween Michael and his mother. If the position of the two spouseunits
were more clearly defined,Michael might have directed the question to
his wife, or his wife might have answered.More likely, Michael would
not have asked the quesbionin the first place; he would automatically
have sat next to his wife. The wording of the mother's reply also suggests
a closenesswith her son, or at least an ambivalenceabout Michael's
marriage.
 Family Therapy Techniques

Much more information is needed, to verify this speculation. The

therapist cannot decide on a definition of the family structure and prob-
lems until he has seenmany more such transactions.Furthermore, there
are other relationshipshe must find out about. What is the relationship
of the mother and father? If this mother is overly closeto her son, per-
haps there is distance,or even conflict, in her relationship with her hus-
band. What is the position of the younger son?Was he a stabilizerin the
family until he left for college,and did his absencegeneratean instabil-
ity which contributed to Michael's breakdown?Or did Michael, in spite
of absenceand maniage, remain closelyinvolved in his parents'transac-
tions, leaving Doug in a more distant position? How successfulhave Mi-
chael and Cathi been in forming a marriage (according to the intake
sheet, their relationship already has "problems")? What about Cathi's
side of the family?
Nevertheless, the therapist already has a structural hypothesis to
guide his first probes. His hunch is that the mother and Michael form an
overinvolved dyad which keepsthe father and Cathi peripheral.
This kind of hunch gives the therapist a working blueprint. In the
course of therapy the blueprint will be expanded,modified, or perhaps
scrapped altogether. But the therapist has a framework for his early
contacts with the family. He will probe the hypothesizedclosenessof
Michael to his mother. The relationships of Michael and Cathi, and of
Mr. and Mrs. Malcolm, wil be analyzed.If the hypothesis is borne out
by further data, the therapist will work to strengthen both spousesub-
systems,not only by working to delineate the boundary between them,
but also by helping to increasethe rewards of participation in the indi-
vidual subsystems.The structural hypothesis from the intake sheet
data, apparently supported by the early therapeutic contact, has given
the therapist a working idea of where he is, and even where he may be
going.
In the Jacksonfamily, four children, aged 14,!7,1g, and 20, areliving
at home with their mother. The intake sheet notes that five older chil-
dren have left home, though one of the older daughtersand her infant
are living with the Jacksonsuntil the daughter can find a job. The iden-
tffied patient is Joanne, a1a17. She has been referred by the school for
low gradesand difficulty getting along with peers.
From this intake information, the therapist notes that the family is in
the stage when the children separate.All of the children remaining at
home are adolescents,presumably involved in building their own lives
independent of the family-a processalready begun some years before

l(t
 63 Planning

by the older children. The therapist hypothesizesthat Joanne is having

difficulty separating.
The family enters the room with a great deal of joking and kidding.
One of the sons is carrying a radio tuned loud. Everyone talks at once.
The mother, who seemsolder than her 48 years,sits in the corner,saying
very little. Joanne appearsto function as the family's executive head,
grving her siblings various orders and seeing that they are followed.
Looking at the 14-year-old-boy,the therapist says,"What's your name?"
The child is-silent: Joanne looks at her brother and says, "Answer the
'rffi*tTe-ffdes:'ffibffrET-ffiiltregfrBi'6-g=6-f i.Thethatrytst
6'ffiE'6effu-65fr
says,"Sure, go ahead.""Don't forget to.comeback," Joannewarns him.
Later, the therapist askswhat the grandson'sname is. Joanne rises and
picks up the child. "This is Tyrone," she replies.
From these transactions, it is clear that the therapist's intake sheet
hypothesis must be radically expanded. It now appears that Joanne
functions as the head of a large, disorganizedfamily, taking over from a
depressedparent. The therapist hypothesizesthat Joanne's numerous
duties at home, as parental child in a disorganizedfamily, are interfering
with her age-appropriateactivities, such as attending school.
If this hypothesis is correct, the therapist knows what the treatment
plan must be. Joanne has to be relieved of some of the burdens of the
parental child. The therapist must work with the mother to help her
resolve some of her difficulties and becomemore forcefuI in organizing
the family. Some of the executive functioning must be divided among
the other children. Probably all the children living at home will need
help with the processof separation.
From a systems point of view, the concept of family shape in these
caseshas limited usefulness.The therapist must never forget that in ac-
tually gathering data, she is inside the system she is studying. Further-
more, the family is never a static entity. Formulating the family shape
from initial data is a useful first step, but it is only a first step. The
therapist must move beyond it almost immediately,to the actual dance
of therapy.

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