Professional Documents
Culture Documents
Family Narratives 64
Gender 65
Culture 66
SUMMARY 67
Family Life-Cycle Stage Emotional Process of Second-Order Changes in Family Status Required
Transition: Key Principles to Proceed Developmentally
Leaving home: single Accepting emotional and a. Differentiation of self in relation to family of origin
young adults financial responsibility b. Development of intimate peer relationships
for self c. Establishment of self in respect to work and financial
independence
The joining of families Commitment to new a. Formation of marital system
through marriage: the system b. Realignment of relationships with extended families
new couple and friends to include spouse
Families with young Accepting new members a. Adjusting marital system to make space for children
children into the system b. Joining in childrearing, financial and household tasks
c. Realignment of relationships with extended family to
include parenting and grandparenting roles
Families with adolescents Increasing flexibility of a. Shifting of parent–child relationships to permit ado-
family boundaries to lescent to move into and out of system
permit children’s b. Refocus on midlife marital and career issues
independence and c. Beginning shift toward caring for older generation
grandparents’ frailties
Launching children and Accepting a multitude of a. Renegotiation of marital system as a dyad
moving on exits from and entries b. Development of adult-to-adult relationships
into the family system c. Realignment of relationships to include in-laws and
grandchildren
d. Dealing with disabilities and death of parents (grand-
parents)
Families in later life Accepting the shifting a. Maintaining own and/or couple functioning and
generational roles interests in face of physiological decline: exploration
of new familial and social role options
b. Support for more central role of middle generation
c. Making room in the system for the wisdom and expe-
rience of the elderly, supporting the older generation
without overfunctioning for them
d. Dealing with loss of spouse, siblings, and other peers
and preparation for death
xiii
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Major Events in the History
of Family Therapy
(continued)
xv
xvi Major Events in the History of Family Therapy
(continued)
xviii Major Events in the History of Family Therapy
In this volume, Mike Nichols tells the story of family functioning of all human collectives. A major broad-
therapy—and tells it very well. It’s hard to imagine a side came from feminists who questioned the absence
more readable and informative guide to the field. of concepts of gender and power in systems thinking
Born in the late 1950s, family therapy seemed to and pointed to the distorting consequences of gender-
spring fully formed out of the heads of a group of less theory when focusing on family violence. The
seminal thinkers. Over six decades later, both theory other challenge concerned the connection between
and practice show the uncertainties and doubts that theory and practice: a challenge to the imposition of
define maturity. But in the beginning—as the story- systems theory as the basis for therapeutic practice.
tellers say—there was Gregory Bateson on the West The very techniques that once defined the field were
Coast, a tall, clean-shaven, angular intellectual, who called into question. Inevitably, the field began to re-
saw families as systems, carriers of ideas. On the East open for examination of its old taboos: the individual,
Coast was Nathan Ackerman, short, bearded, portly, intrapsychic life, emotions, biology, the past, and the
the quintessential charismatic healer, who saw fam- particular place of the family in culture and society.
ilies as collections of individuals struggling to bal- As is always characteristic of an official science,
ance feelings, irrationalities, and desires. Bateson and the field tried to preserve established concepts while
Ackerman complemented each other perfectly, the
a pragmatic attention to specific cases was demand-
Don Quixote and Sancho Panza of the family systems ing new and specific responses. As a result, today we
revolution. have an official family therapy that claims direct de-
For all the diversity of the 1960s that saw the new scendance from Bateson and a multitude of excellent
clinical practice called family therapy take a variety practitioners doing sensitive and effective work that is
of names—systemic, strategic, structural, Bowenian, frequently quite different from what systems theory
experiential—there was also a remarkable solidarity prescribes.
in the shared beliefs that defined the field. I see the therapeutic process as an encounter between
As family therapy succeeded and expanded, it distinct interpersonal cultures. Real respect for clients
was extended to encompass different client popula- and their integrity can allow therapists to be other than
tions, with specific interventions for various special fearfully cautious, can encourage them to be direct and
groups—clients with drug addictions, hospitalized authentic—respectful and compassionate—but also at
psychiatric patients, the welfare population, violent times honest and challenging.
families, and so on. All posed their own complexities. This conception of the therapist as an active
Practitioners responded to this expanded family ther- knower—of himself or herself and of the different
apy with an array of new approaches, some of which family members—is very different from the neutral
even questioned the fundamental allegiance to sys- therapist of the constructivists. But, of course, these
tems thinking. two prototypes are entirely too simplified. Most prac-
The challenges to systems theory (the official sci- titioners fall somewhere between these two poles of
ence of the time) took two forms. One was purely the- neutrality and decisiveness.
oretical: a challenge to the assumption that systemic The choice between action and interventionism,
thinking was a universal framework, applicable to the on the one hand, and meaning and conversation,
xxi
xxii Foreword
on the other, is but one of the questions the field is ideas and techniques that make family therapy such
grappling with today; there are many others. Are the an exciting enterprise. Dr. Nichols has managed to
norms of human behavior universal, or are they cultur- be comprehensive without becoming tedious. Per-
ally constructed products of political and ideological haps the secret is the engaging style of his writing,
constraint? How do we become experts? How do we or perhaps it is how he avoids getting lost in abstrac-
know what we know? Can we influence people? Can tion while keeping a clear focus on clinical practice.
we not influence them? How do we know that we are In any case, this superb book has long set the standard
not simply agents of social control? How do we know of excellence as the best introduction and guide to the
that we are accomplishing anything at all? practice of family therapy.
These questions and the rich history and contem-
porary practice of family therapy are explored in
Family Therapy: Concepts and Methods. It is a thor- Salvador Minuchin, M.D.
ough and thoughtful, fair and balanced guide to the Boca Raton, Florida
Preface
One thing that sometimes gets lost in academic dis- they click on the icon and the quiz appears. The
cussions of family therapy is the feeling of accom- first one prompts them to test their knowledge of
plishment that comes from sitting down with an chapter concepts by taking a multiple-choice quiz.
unhappy family and being able to help them. Begin-
The second quiz icon prompts them to apply their
ning therapists are understandably anxious and not
knowledge of chapter concepts by responding to
sure they’ll know how to proceed. (“How do you
open-ended questions by typing their response and
get all of them to come in?”) Veterans often speak
submitting it for immediate feedback. These self-
in abstractions. They have opinions and discuss big
assessments can reinforce understanding of key
issues—postmodernism, managed care, second-order
chapter concepts and support application of newly
cybernetics. While it’s tempting to use this space to
learned content.
say Important Things, I prefer to be a little more per-
sonal. Treating troubled families has given me the
greatest satisfaction imaginable, and I hope that the
same is or will be true for you. Content Changes in the
New Edition
♦ New section on the impact of the Affordable Care Act
New to This Edition ♦ Recommendations for establishing a fee-for-service
private practice
In this eleventh edition of Family Therapy: Concepts ♦ Revised and expanded section on attachment
and Methods, I’ve tried to describe the full scope of theory
family therapy—its rich history, the classic schools, ♦ Questions to ask when doing a genogram
the latest developments—but with increasing empha- ♦ More specific interventions from the MRI
sis on clinical practice. There are a lot of changes in approach
this edition: ♦ Detailed guidelines for making a structural family
therapy assessment
New Digital Enhancements ♦ New section with guidelines on using family
sculpting
in the Pearson eText ♦ More specific techniques used in object relations
family therapy
♦ Videos: Links to video clips of therapists have
♦ Expanded section on spirituality and religion
been embedded for students to view throughout
♦ Expanded and updated section on families and
the chapters of the Pearson eText. Students are
technology
prompted to reflect on and analyze the videos via
♦ Guidelines for therapeutic letter writing
an accompanying question.
♦ New research chapter including a discussion of
♦ Chapter Quizzes: At the end of each chapter why research has failed to influence practice and
Summary, students will find two self-assessments suggestions for bridging the research-practice gap
marked by a checkmark icon. In the Pearson eText, ♦ New case studies
xxiii
xxiv Preface
Instructor Supplements who went out of their way to help me prepare this
eleventh edition were Yvonne Dolan, Jerome Price,
An instructor’s manual, test bank, and PowerPoint Deborah Luepnitz, William Madsen, Frank Dattilio,
slides are available to accompany this text. They can be Vicki Dickerson, Douglas Breunlin, and Salvador
downloaded at www.pearsonhighered.com/educator. Minuchin. And I owe a huge debt of gratitude to Sean
Davis for his extensive and thoughtful contributions
to this edition. Sean has the rare combination of ac-
Acknowledgments ademic smarts and clinical sophistication that makes
his perspective so valuable. To paraphrase John, Paul,
Albert Einstein once said, “If you want to learn about George, and Ringo, I get by with a lot of help from my
physics, pay attention to what physicists do, not what friends—and I thank them one and all. I am especially
they say they do.” When you read about therapy, it can grateful to Julie Peters at Pearson for making a hard
be hard to see past the jargon and political packaging job easier.
to the essential ideas and practices. So in preparing Finally, I would like to thank my postgraduate
this edition, I’ve traveled widely to visit and observe instructors in family life: my wife, Melody, and my
actual sessions of the leading practitioners. I’ve also children, Sandy and Paul. In the brief span of forty-five
invited several master therapists to share some of their years, Melody has seen me grow from a shy young
best case studies with you. The result is a more prag- man, totally ignorant of how to be a husband and
matic, clinical focus. I hope you like it. father, to a shy middle-aged man, still bewildered and
So many people have contributed to my develop- still trying. My children never cease to amaze me. If
ment as a family therapist and to the writing of this in my wildest dreams I had imagined children to love
book that it is impossible to thank them all. But I would and be proud of, I wouldn’t even have come close to
like to single out a few. To the people who taught me children as fine as Sandy and Paul.
family therapy—Lyman Wynne, Murray Bowen, and
Salvador Minuchin—thank you. Some of the people M. P. N.
I n t r o d u c t i o n
T
here wasn’t much information on the
intake sheet. Just a name, Holly Roberts,
the fact that she was a senior in college, The
Foundations
and her presenting complaint: “trouble making
decisions.”
The first thing Holly said when she sat down
was, “I’m not sure I need to be here. You prob- of Family
ably have a lot of people who need help more
than I do.” Then she started to cry.
Therapy
It was springtime. The tulips were up, the
trees were turning leafy green, and purple Leaving Home
clumps of lilacs perfumed the air. Life and all its
possibilities stretched out before her, but Holly
was naggingly, unaccountably depressed.
The decision Holly was having trouble making
was what to do after graduation. The more she
tried to figure it out, the less able she was to
concentrate. She started sleeping late, missing
classes. Finally, her roommate talked her into
going to the counseling center. “I wouldn’t have
come,” Holly said. “I can take care of my own
problems.”
I was into cathartic therapy back then. Most
people have stories to tell and tears to shed.
Some of the stories, I suspected, were dramatized
to elicit sympathy. We seem to give ourselves
permission to cry only with some very accept-
able excuse. Of all the human emotions we’re
ashamed of, feeling sorry for yourself tops the list.
I didn’t know what was behind Holly’s depres-
sion, but I was sure I could help. I felt comforta-
ble with depression. Ever since my senior year in
high school when my friend Alex died, I’d been
a little depressed myself.
♦ ♦ ♦
After Alex died, the rest of the summer was a
dark blur. I cried a lot. And I got mad whenever any-
body suggested that life goes on. Alex’s minister said
that his death wasn’t really a tragedy because now
“Alex was with God in heaven.” I wanted to scream,
1
2 Part One: The Context of Family Therapy
but I numbed myself instead. In the fall, I went off Looking back, I don’t remember much that was
to college, and, even though it seemed disloyal to said in that first meeting. Both parents were worried
Alex, life did go on. I still cried from time to time, about Holly. “We’ll do whatever you think best,”
but with the tears came a painful discovery. Not all of Mrs. Roberts said. Holly’s stepfather, Mr. Morgan,
my grief was for Alex. Yes, I loved him. Yes, I missed said they could arrange for a good psychiatrist “to
him. But his death provided me the justification help Holly over this crisis.” But, Holly didn’t want to
to cry about the everyday sorrows of my own life. go home, and she said so with more energy than I’d
Maybe grief is always like that. At the time, though, heard from her in a long time. That was on Saturday.
it struck me as a betrayal. I was using Alex’s death to I said that there was no need to rush into a decision,
feel sorry for myself. so we arranged to meet again on Monday.
When Holly and her parents sat down in my
♦ ♦ ♦ office on Monday morning, it was obvious that some-
thing had happened. Mrs. Roberts’s eyes were red
What, I wondered, was making Holly so sad? In from crying. Holly glared at her and looked away.
fact, Holly didn’t have a dramatic story. Her feelings Mr. Morgan turned to me. “We’ve been fighting all
weren’t focused. After those first moments in my of- weekend. Holly heaps abuse on me, and when I try to
fice, she rarely cried. When she did, it was more an respond, Lena takes her side. That’s the way it’s been
involuntary tearing up than a sobbing release. She since day one of this marriage.”
talked about the future and not knowing what she The story that emerged was one of those sad his-
wanted to do with her life. She talked about not hav- tories of jealousy and resentment that turn ordinary
ing a boyfriend, but she didn’t say much about her love into bitter, injured feelings and, all too often, tear
family. If the truth be told, I wasn’t much interested. families apart. Lena Roberts was thirty-four when she
Back then, I thought home was a place you left in or- met Tom Morgan. He was a robust fifty-six. The sec-
der to grow up. ond obvious difference between them was money. He
Holly was hurting and needed someone to lean on, was a stockbroker who’d retired to run a horse farm.
but something made her hold back, as though she didn’t She was waitressing to support herself and her daugh-
quite trust me. It was frustrating. I wanted to help. ter. It was a second marriage for both of them.
A month went by, and Holly’s depression got Lena thought Tom could be the missing father fig-
worse. I started seeing her twice a week, but we ure in Holly’s life. Unfortunately, Lena couldn’t ac-
weren’t getting anywhere. One Friday afternoon, cept all the rules Tom wanted to enforce, and so he
Holly was feeling so despondent that I didn’t think became the wicked stepfather. He made the mistake
she should go back to her dorm alone. I asked her in- of trying to take over and, when the predictable ar-
stead to lie down on the couch in my office and, with guments ensued, Lena sided with her daughter. There
her permission, I called her parents. were tears and midnight shouting matches. Twice
Mrs. Roberts answered the phone. I told her that I Holly ran away for a few days. This triangle nearly
thought she and her husband should come to Rochester proved the marriage’s undoing, but things calmed
and meet with me and Holly to discuss the advis- down after Holly left for college.
ability of Holly taking a medical leave of absence. Holly expected to leave home and not look back.
Unsure as I was of my authority back then, I steeled She would make new friends. She would study hard
myself for an argument. Mrs. Roberts surprised me by and choose a career. She would never depend on a
agreeing to come at once. man to support her. Unfortunately, she left home
The first thing that struck me about Holly’s parents with unfinished business. She hated Tom for the way
was the disparity in their ages. Mrs. Roberts looked he treated her mother. He was always demanding
like a slightly older version of Holly; she couldn’t to know where her mother was going, who she was
have been much over thirty-five. Her husband looked going with, and when she would be back. If she was
sixty. It turned out that he was Holly’s stepfather. the least bit late, there would be a scene. Why did her
They had married when Holly was sixteen. mother put up with it?
Introduction The Foundations of Family Therapy 3
Blaming her stepfather was simple and satisfying. of techniques; it’s a whole new approach to under-
But another set of feelings, harder to face, was eat- standing human behavior—as fundamentally shaped
ing at Holly. She hated her mother for marrying Tom by its social context.
and for letting him be so mean to her. What had her
mother seen in him? Had she sold out for a big house
and a fancy car? Holly didn’t have answers to these The Myth of the Hero
questions; she didn’t even allow them into full aware-
ness. Unfortunately, repression doesn’t work like put- Ours is a culture that celebrates the uniqueness of
ting something away in a closet and forgetting about the individual and the search for an autonomous self.
it. It takes a lot of energy to keep unwelcome emo- Holly’s story could be told as a coming-of-age drama:
tions at bay. a young person’s struggle to break away from child-
Holly found excuses not to go home during col- hood and provincialism, to take hold of adulthood and
lege. It didn’t even feel like home anymore. She promise and the future. If she fails, we’re tempted to
buried herself in her studies. But rage and bitterness look inside the young adult, the failed hero.
gnawed at her until, in her senior year, facing an While the unbounded individualism of the hero
uncertain future, knowing only that she couldn’t go may once have been encouraged more for men than
home again, she gave in to hopelessness. No wonder women, as a cultural ideal it casts its shadow on us
she was depressed. all. Even if Holly cared about connection as well
I found the whole story sad. Not knowing about much as autonomy, she may be judged by the prevail-
family dynamics and never having lived in a step- ing image of accomplishment.
family, I wondered why they couldn’t just try to get We were raised on the myth of the hero: the Lone
along. Why did they have so little sympathy for each Ranger, Robin Hood, Wonder Woman. When we got
other? Why couldn’t Holly accept her mother’s right older, we searched for real-life heroes: Eleanor Roosevelt,
to find love a second time around? Why couldn’t Tom Martin Luther King Jr., Nelson Mandela. These men and
respect the priority of his wife’s relationship with her women stood for something. If only we could be a little
daughter? And why couldn’t Lena listen to her daugh- more like these larger-than-life individuals who seemed to
ter’s adolescent anger without getting so defensive? rise above their circumstances.
That session with Holly and her parents was my Only later did we realize that the circumstances we
first lesson in family therapy. Family members in wanted to rise above were part of the human condition—
therapy talk not about actual events but about re- our inescapable connection to our families. The roman
constructed memories that resemble the original ex- tic image of the hero is based on the illusion that
periences only in certain ways. Holly’s memories authentic selfhood can be achieved as an autonomous
resembled her mother’s memories very little, and individual. We do many things alone, including some of
her stepfather’s not at all. In the gaps between their our most heroic acts, but we are defined and sustained
truths, there was little room for reason and no desire by a network of human relationships. Our need to wor-
to pursue it. ship heroes is partly a need to rise above littleness and
Although that meeting may not have been terribly self-doubt, but it is perhaps equally a product of imag-
productive, it did put Holly’s unhappiness in perspec- ining a life unfettered by all those pesky relationships
tive. No longer did I think of her as a tragic young that somehow never quite go the way we want them to.
woman all alone in the world. She was that, of course, When we do think about families, it’s often in
but she was also a daughter torn between running negative terms—as burdens holding us back or as de-
away from a home she no longer felt part of and being structive elements in the lives of our patients. What
afraid to leave her mother alone with a man she didn’t catches our attention are differences and discord. The
trust. I think that’s when I became a family therapist. harmonies of family life—loyalty, tolerance, solace,
To say that I didn’t know much about families, and support—often slide by unnoticed, part of the
much less about how to help them, would be an un- taken-for-granted background of life. If we would be
derstatement. But family therapy isn’t just a new set heroes, then we must have villains.
4 Part One: The Context of Family Therapy
These days there’s a lot of talk about dysfunctional It’s possible to look back on the days before fam-
families. Unfortunately, much of this amounts to lit- ily therapy and see those who insisted on segregating
tle more than parent bashing. People suffer because of patients from their families as exponents of a fos-
what their parents did: their mother’s career, their fa- silized view of mental disorder, according to which
ther’s unreasonable expectations—these are the causes psychiatric maladies are firmly embedded inside
of their unhappiness. Perhaps this is an advance on the heads of individuals. Considering that clinicians
stewing in guilt and shame, but it’s a long way from didn’t begin treating families together until the mid-
understanding what really goes on in families. 1950s, it’s tempting to ask, “What took them so
One reason for blaming family sorrows on the long?” In fact, there were good reasons for conducting
personal failings of parents is that it’s hard for the av- therapy in private.
erage person to see past individual personalities to the The two most influential approaches to psycho-
structural patterns that make them a family—a system therapy in the twentieth century, Freud’s psycho-
of interconnected lives governed by strict but unspo- analysis and Rogers’s client-centered therapy, were
ken rules. both predicated on the assumption that psychological
People feel controlled and helpless not because problems arise from unhealthy interactions with oth-
they are victims of parental folly and deceit but be- ers and can best be alleviated in a private relationship
cause they don’t understand the forces that tie hus- between therapist and patient.
bands and wives and parents and children together. Freud’s discoveries indicted the family, first as a
Plagued by anxiety and depression, or merely trou- breeding ground of childhood seduction and later as
bled and uncertain, some people turn to psychother- the agent of cultural repression. If people grew up a lit-
apy for help. In the process, they turn away from the tle bit neurotic—afraid of their own natural instincts—
irritants that propel them into therapy. Chief among who should we blame but their parents?
these are unhappy relationships—with friends and Given that neurotic conflicts were spawned in the
lovers, and with our families. Our disorders are pri- family, it seemed natural to assume that the best way to
vate ailments. When we retreat to the safety of a undo the family’s influence was to isolate relatives from
synthetic relationship, the last thing we want is to treatment, to bar their contaminating influence from the
take our families with us. Is it any wonder, then, that psychoanalytic operating room. Because psychoanaly-
when Freud ventured to explore the dark forces of sis focused on the patient’s memories and fantasies, the
the mind, he locked the family outside the consulting family’s presence would only obscure the subjective
room? truth of the past. Freud wasn’t interested in the living
family; he was interested in the family-as-remembered.
Psychotherapeutic Sanctuary
Psychotherapy was once a private enterprise. The con-
sulting room was a place of healing, yes, but it was
equally a sanctuary, a refuge from a troubled and trou-
bling world.
Buffeted about in love and work, unable to find
World History Archive/Newscom
By conducting treatment in private, Freud safe- understanding human behavior. Both have their
guarded patients’ trust in the sanctity of the therapeu- virtues. Individual therapy provides the concentrated
tic relationship and thus maximized the likelihood focus to help people face their fears and learn to
that they would repeat, in relation to the analyst, the become more fully themselves. Individual therapists
understandings and misunderstandings of childhood. have always recognized the importance of family life
in shaping personality, but they have assumed that
♦ ♦ ♦ these influences are internalized and that intrapsychic
dynamics become the dominant forces controlling
Carl Rogers also believed that psychological prob- behavior. Treatment can and should, therefore, be di-
lems stemmed from destructive family relations. Each rected at the person and his or her personal makeup.
of us, Rogers said, is born with an innate tendency Family therapists, on the other hand, believe that the
toward self-actualization. Left to our own devices, we dominant forces in our lives are located externally, in
tend to follow our own best interests. Unhappily, said the family. Therapy, in this framework, is directed at
Rogers, our instinct for actualization gets subverted by changing the organization of the family. When family
our craving for approval. We learn to do what we think organization is transformed, the life of every family
others want, even though it may not be what’s best member is altered accordingly.
for us. This last point—that changing a family changes
Gradually, this conflict between self-fulfillment the lives of its members—is important enough to
and need for approval leads to denial of our authen- elaborate. Family therapy isn’t predicated merely
tic selves—and even the feelings that signal them. We on changing the individual patient in context. Fam-
swallow our anger, stifle our exuberance, and bury ily therapy exerts change on the entire family; there-
our lives under a mountain of expectations. fore, improvement can be lasting because each family
The therapy Rogers developed was designed to member is changed and continues to exert synchro-
help patients uncover their real feelings. The Rogerian nous change on other family members.
therapist listens sympathetically, offering compassion Almost any human difficulty can be treated with
and understanding. In the presence of such an accept- either individual or family therapy, but certain prob-
ing listener, patients gradually get in touch with their lems are especially suited to a family approach,
own inner promptings. among them problems with children (who must, re-
Like the psychoanalyst, the client-centered ther- gardless of what happens in therapy, return home to
apist maintains absolute privacy in the therapeutic their parents), complaints about a marriage or other
relationship to avoid any possibility that patients’ intimate relationship, family feuds, and symptoms
feelings might be subverted to win approval. Only an that develop in an individual at the time of a major
objective outsider could be counted on to provide the family transition.
unconditional acceptance to help patients rediscover If problems that arise around family transitions
their real selves. That’s why family members had no make a therapist think first about the role of the
place in the process of client-centered therapy. family, individual therapy may be especially useful
when people identify something about themselves
that they’ve tried in vain to change while their so-
Family versus Individual cial environment remains stable. Thus, if a woman
Therapy gets depressed during her first year at college, a
therapist might wonder if her sadness is related to
As you can see, there were valid reasons for conduct- leaving home and leaving her parents alone with
ing psychotherapy in private. Although a strong claim each other. But if the same woman were to become
can be made for individual psychotherapy, equally depressed in her thirties, during a long period of sta-
strong claims can be made for family therapy. bility in her life, we might wonder if there was some-
Individual psychotherapy and family therapy thing about her approach to life that wasn’t working
each offer an approach to treatment and a way of for her. Examining her life in private—away from
6 Part One: The Context of Family Therapy
troubled relationships—doesn’t, however, mean that work with what’s going on in the present. Although the
she should believe she can fulfill herself in isolation mother in the earlier example may only have started
from other people. reproaching her daughter when she started avoiding
The view of persons as separate entities, with fam- social activities, her continuing attempts to motivate
ilies acting on them, is consistent with the way we the girl with criticism may only serve to perpetuate a
experience ourselves. We recognize the influence of circular pattern of withdrawal-and-criticism.
others—especially as obligation and constraint—but When things go wrong in relationships, most of us
it’s hard to see that we are embedded in a network are generous in giving credit to other people. Because
of relationships, that we are part of something larger we look at the world from inside our own skins, it’s
than ourselves. easy to see other people’s contributions to our mutual
problems. Blaming is only natural. The illusion of
unilateral influence tempts therapists too, especially
when they hear only one side of a story. But once we
Thinking in Lines, Thinking understand that reciprocity is the governing principle
in Circles of relationships, we can begin to get past thinking in
terms of villains and victims.
Mental illness has traditionally been explained in Suppose that a father complains about his teenage
linear terms—medical or psychological. Both para- son’s behavior.
digms treat emotional distress as a symptom of inter-
Father: It’s my son. He’s rude and defiant.
nal dysfunction with historical causes.
Linear explanations take the form of A causes Therapist: Who taught him that?
B. This works fine for some things. If you’re driv- Instead of accepting the father’s perspective that
ing along and your car suddenly sputters to a stop, he’s a victim of his son’s villainy, the therapist’s ques-
go ahead and look for a simple explanation. Maybe tion invites him to look for patterns of mutual influ-
you’re out of gas. If so, there’s a simple solution. Hu- ence. The point isn’t to shift blame from one person
man problems are usually a bit more complicated. to another but to get away from blame altogether. As
Individual therapists think in terms of linear cau- long as he sees the problem as his son’s doing, the fa-
sality when they explore what happened to make in- ther has little choice but to hope the boy will change.
dividuals behave the way they do. If a young woman (Waiting for other people to change is like planning
has low self-esteem, perhaps it’s because her mother your future around winning the lottery.) Learning to
constantly criticizes her. Family therapists prefer to think in circles rather than lines empowers us to look
think in terms of circular causality and consider peo- at the half of the equation we can control.
ple’s mutual influence on each other. Thus, the young
woman’s moping around the house might be a re-
sponse to her mother’s fault-finding—and the moth-
er’s finding fault might be a response to the young The Power of Family Therapy
woman’s moping around the house. The more the
mother criticizes, the more the young woman with- The power of family therapy derives from bringing
draws, and the more the young woman withdraws, parents and children together to transform their in-
the more the mother criticizes. teractions. Instead of isolating individuals from the
The term circular causality calls attention to the cy- emotional origins of their conflict, problems are ad-
cles of interaction in relationships. But in fact the term dressed at their source.
is somewhat of a misnomer, because the focus is not on What keeps people stuck is their inability to see
causality—how something got started—but on the on- their own participation in the problems that plague
going transactions that sustain it. In some cases, maybe them. With eyes fixed firmly on what recalcitrant oth-
something in the past did trigger an unhappy pattern ers are doing, it’s hard for most people to see the pat-
of interaction. But the past is over; therapists can only terns that bind them together. The family therapist’s
Introduction The Foundations of Family Therapy 7
job is to give them a wake-up call. When a husband Bob tried to shift responsibility back to Shirley.
complains that his wife nags, and the therapist asks “Doesn’t she have to kiss me first?”
how he contributes to her doing that, the therapist is “No,” the therapist said. “In real life, you have to
challenging the husband to see the hyphenated him- earn that.”
and-her of their interactions.
♦ ♦ ♦
♦ ♦ ♦
In the opening of Anna Karenina, Tolstoy wrote:
When Bob and Shirley came for help with marital “All happy families resemble one another; each un-
problems, her complaint was that he never shared his happy family is unhappy in its own way.” Every un-
feelings; his was that she always criticized him. This happy family may be unhappy in its own way, but
is a classic trading of complaints that keeps couples everyone stumbles over the same familiar challenges
stuck as long as they fail to see the reciprocal pattern of family life. It’s no secret what those challenges
in which each partner provokes in the other precisely are—learning to live together, dealing with difficult
the behavior he or she can’t stand. So the therapist relatives, chasing after children, coping with ado-
said to Bob, “If you were a frog, what would you be lescence, and so on. What not everyone realizes,
like if Shirley changed you into a prince?” When Bob however, is that a relatively small number of sys-
countered that he doesn’t talk with her because she’s tems dynamics, once understood, illuminate those
so critical, it seemed to the couple like the same old ar- challenges and enable families to move successfully
gument—but the therapist saw this as the beginning of through the predictable dilemmas of life. Like all
change—Bob starting to speak up. One way to create healers, family therapists sometimes deal with bizarre
an opening for change in rigid families is to support the and baffling cases, but much of their work is with or-
blamed person and help bring him back into the fray. dinary human beings learning life’s painful lessons.
When Shirley criticized Bob for complaining, he Their stories, and the stories of the men and women
tried to retreat, but the therapist said, “No, continue. of family therapy who have undertaken to help them,
You’re still a frog.” are the inspiration for this book.
c h a p t e r 1
I
n this chapter, we explore the antecedents and
early years of family therapy. There are two
The Evolution compelling stories here: one of personalities,
of Family
one of ideas. The first story revolves around
the pioneers—visionary iconoclasts who broke
Learning Outcomes
♦♦ Describe the circumstances that led to The Undeclared War
the birth of family therapy.
Although we came to think of asylums as places of
♦♦ List the founders of family therapy and
cruelty and detention, they were originally built to
where they practiced.
rescue the insane from being locked away in family
♦♦ List the first family therapy theories and attics. Accordingly, except for purposes of footing
when they were popular. the bill, hospital psychiatrists kept families at arm’s
♦♦ Describe early family therapy theoretical length. In the 1950s, however, two puzzling devel-
concepts. opments forced therapists to recognize the family’s
power to alter the course of treatment.
Therapists began to notice that often when a pa-
tient got better, someone else in the family got worse,
almost as though the family needed a symptomatic
member. As in the game of hide-and-seek, it didn’t
seem to matter who “It” was as long as someone
played the part. In one case, Don Jackson (1954)
was treating a woman for depression. When she be-
gan to improve, her husband complained that she was
8
Chapter 1 The Evolution of Family Therapy 9
getting worse. When she continued to improve, the What this case dramatizes is how parents use
husband lost his job. Eventually, when the woman their children as a buffer to protect them from in-
was completely well, the husband killed himself. Ap- timacy. To the would-be Oedipus, Minuchin said,
parently this man’s stability was predicated on having “You’re scratching your eyes for your mother, so
a sick wife. that she’ll have something to worry about. You’re
a good boy. Good children sacrifice themselves for
Another strange story of shifting disturbance was
their parents.”
that patients often improved in the hospital only to get
worse when they went home.
Families are made of strange glue—they stretch
Case Study but never let go. Few blamed the family for outright
In a bizarre case of Oedipus revisited, Salvador malevolence, yet there was an invidious undercurrent
Minuchin treated a young man hospitalized for trying to these observations. The official story of family
to scratch out his eyes. The man functioned normally therapy is one of respect for the family, but maybe
in Bellevue but returned to self-mutilation each time none of us ever quite gets over the adolescent idea
he went home. He could be sane, it seemed, only in that families are the enemy of freedom.
an insane world.
It turned out that the young man was extremely Small Group Dynamics
close to his mother, a bond that grew even tighter
during the seven years of his father’s mysterious ab- Those who first sought to understand and treat fam-
sence. The father was a compulsive gambler who ilies found a ready parallel in small groups. Group
disappeared shortly after being declared legally dynamics were applicable to family therapy because
incompetent. The rumor was that the Mafia had group life is a complex blend of individual personali-
kidnapped him. When, just as mysteriously, the fa- ties and properties of the group.
ther returned, his son began his bizarre attempts at In 1920, the pioneering social psychologist
self-mutilation. Perhaps he wanted to blind himself
William McDougall published The Group Mind, in
so as not to see his obsession with his mother and
hatred of his father. which he described how a group’s continuity depends
But this family was neither ancient nor Greek, on boundaries for differentiation of function and on
and Minuchin was more pragmatist than poet. So customs and habits to make relationships predict-
he challenged the father to protect his son by be- able. A more scientific approach to group dynamics
ginning to deal directly with his wife, and then he was developed in the 1940s by Kurt Lewin, whose
challenged the man’s demeaning attitude toward field theory (Lewin, 1951) guided a generation of re-
her, which had driven her to seek her son’s protec- searchers. Drawing on the Gestalt school of percep-
tion. The therapy was a challenge to the family’s tion, Lewin developed the notion that a group is more
structure and, in Bellevue, working with the psychi- than the sum of its parts. The transcendent property of
atric staff to ease the young man back into the fam-
groups has obvious relevance to family therapists, who
ily, into the lion’s den.
must work not only with individuals but also with fam-
Minuchin confronted the father, saying, “As a
father of a child in danger, what you’re doing isn’t ily systems—and their famous resistance to change.
enough.” Analyzing what he called quasi-stationary social
“What should I do?” asked the man. equilibrium, Lewin pointed out that changing group
“I don’t know,” Minuchin replied. “Ask your behavior requires “unfreezing.” Only after something
son.” Then, for the first time in years, father and shakes up a group’s beliefs will its members be pre-
son began talking. Just as they were about to run pared to change. In individual therapy this process is
out of things to say, Dr. Minuchin commented to initiated by the unhappy experiences that lead people
the parents: “In a strange way, he’s telling you that to seek help. When someone decides to meet with a
he prefers to be treated like a child. When he was therapist, that person has already begun to unfreeze
in the hospital he was twenty-three. Now that he’s
old habits. When families come for treatment, it’s a
returned home again, he’s six.”
different story.
10 Part One: The Context of Family Therapy
Richard T. Nowitz/Corbis
The first people to practice family therapy turned to group therapy for a model.
Family members may not be sufficiently unsettled Dependency masquerades as therapy when fami-
by one member’s problems to consider changing their lies allow therapists to subvert their autonomy in the
ways. Furthermore, family members bring their own name of problem solving. Pairing is seen in families
reference group with them, with all its traditions and when one parent colludes with the children to under-
habits. Consequently, more effort is required to un- mine the other parent.
freeze, or shake up, families before real change can The process/content distinction in group dy-
take place. The need for unfreezing foreshadowed namics had a major impact on family treatment.
early family therapists’ concern about disrupting fam- Experienced therapists learn to attend as much to
ily homeostasis, a notion that dominated family ther- how people talk as to the content of their discus-
apy for decades. sions. For example, a mother might tell her daugh-
Wilfred Bion was another student of group func- ter that she shouldn’t play with Barbie dolls because
tioning who emphasized the group as a whole, with she shouldn’t aspire to an image of bubble-headed
its own dynamics and structure. According to Bion beauty. The content of the mother’s message is,
(1948), most groups become diverted from their pri- “Respect yourself as a person.” But if the mother
mary tasks by engaging in patterns of fight–flight, expresses her point of view by disparaging the
dependency, and pairing. Bion’s basic assumptions daughter’s wishes, then the process of her message
are easily extrapolated to family therapy: Some is, “Your feelings don’t count.”
families skirt around hot issues like a cat circling a Unfortunately, the content of some discussions is
snake. Others use therapy to bicker endlessly, never so compelling that therapists get sidetracked from the
really contemplating compromise, much less change. process. Suppose that a therapist invites a teenager
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.