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Contributors

Donald H. Baucom? PhD, is Distinguished Professor of Psychology and

director of the Clinical Psychology Program at the University of North
Carolina, Chapel Hill. His research has included controlled outcome studies
of cognitive-behavioral marital therapy, as well as the development of
instruments for assessing couples' standards, attributions, and other cogni-
tions. He has collaborated extensively with Norman B. Epstein on empirical
studies of couples' cognitions, as well as on workshops, many book
chapters, and the text Cognitive-Behavioral Marital Therapy (1990). Dr.
Baucom also has won several awards for excellence in undergraduate
teaching, and he maintains an active clinical practice.
Insoo Kim Berg, MSSW, is director and cofounder (with Steve de
Shaver) of the Brief Family Therapy Center in Milwaukee, Wisconsin.
Many of her papers and books have been translated into eight different
languages. Her most recent publications include Family-Based Services: A
Solution-Focused Approach (1994); Working with the Problem Drinker
(with coauthor S. Miller, 1992); Interviewing for Solutions (with coauthor,
P. Dejong, 1997); and Brief Treatment Manual for Substance Abuse (with
coauthor N. Reuss, 1997).
Norman B. Epstein, PhD, is a professor of family studies at the
University of Maryland, College Park. He is a fellow of the American
Psychological Association and a clinical member of the American Associa-
tion for Marriage and Family Therapy. A major portion of his teaching,
research, scholarly writing, and clinical practice is focused on the assess-
ment and treatment of couple and family problems. His collaboration with
Donald H. Baucom has included empirical studies of couple relationships,
professional workshops, numerous book chapters, and their book Cogni-
tive-Behavioral Marital Therapy (1990).
Joseph B. Eron, PsyD, is founder (1981) and codirector of the Catskill
Family Institute (CFI) with offices in New York's Hudson Valley region. In
the late 1970s and early 1980s, he wrote several book chapters that contrib-
uted to the integration of core concepts and techniques in brief family therapy.
In recent years, he has published numerous articles and chapters on CFPs
unique narrative solutions approach, and has presented and trained in the
United States and Canada. Eron's recent book with coauthor Thomas W.

vii
viii Contributors

Lund, Narrative Solutions in Brief Therapy (1996), focuses on what works

to generate helpful conversations inside and outside the therapy session; it
has allowed their approach to reach a broad audience.
Marion S. Forgatch, PhD, is a research scientist at the Oregon Social
Learning Center, where she is principal Investigator of a 5-year study with
Gerald R. Patterson to test an intervention designed to help single mothers
prevent and ameliorate their children's conduct problems. Her professional
life is divided between basic research and clinical application. She has
published numerous journal articles and book chapters in the areas of single
parenting, family process, prevention, and therapy process and outcome.
Her intervention publications include books, audiotapes, and videotapes
that teach principles involved in effective family living.
Paula Hanson~Kalm? MBS? MA, CP3 received her legal education in
her native Singapore, where she was admitted as advocate and solicitor to
the Singapore Supreme Court. After years as a missionary in the Philippines
and Taiwan, she moved to the United States (with her husband and
daughter) to attend Trinity Evangelical Divinity School, where she obtained
a master of arts degree in counseling psychology. She Is a licensed profes-
sional counselor and has been a senior resident in marriage and family
therapy at Cross Keys Counseling Center in Atlanta, Georgia, since 1994,
where she works closely with Luciano L9 Abate.
Harville Hendrix, PhD, is the president and founder of the Institute
for Imago Relationship Therapy in Winter Park, Florida. He is the author
of Getting the Love 'You Want: A Guide for Couples (1988) and Keeping
the Love You Find: A Guide for Singles (1992), and coauthor of Giving
the Love That Heals: A Guide for Parents (with Helen Hunt, 1997).
Michael E Hoyt, PhD, is senior staff psychologist and former director
of adult psychiatric services at the Kaiser Perrnanente Medical Center in
Hayward, California; and a clinical faculty member of the University of
California School of Medicine, San Francisco. He is the author of Brief
Therapy and Managed Care: Readings for Contemporary Practice (1995);
the editor of Constructive Therapies, Volumes 1 and 2 (1994 and 1996)
and The Handbook of Constructive Therapies (1998); and coeditor of The
First Session in Brief Therapy (with S. H. Budman and S. Friedman, 1992).
Susan Johnson, EdD, is a professor of psychology and psychiatry at
the University of Ottawa. She Is also director of the Marital and Family
Clinic at the Ottawa Civic Hospital, where she supervises a multidiscipli-
nary team within the Department of Psychiatry and conducts a yearly
summer externship in emotionally focused therapy. She is an approved
clinical supervisor for the American Association for Marriage and Family
Therapy and maintains a small private practice. She is actively involved in
conference and workshop presentations across North America, most re-
cently at the American Psychological Association conference and the
Contributors ix

International Society for Traumatic Stress Studies, where she gave presen-
tations on creating healing relationships for trauma survivors dealing with
marital distress. Her most recent publications include The Heart of the
Matter: Perspectives on Emotion in Marital Therapy (with coeditor L. S.
Greenberg, 1994} and The Practice of Emotionally Focused Marital Ther-
apy: Creating Connection (1996). She lives in Ottawa with her husband
and two children.
James Keim? MSW, LCSW-C, is director of training at the Family
Therapy Institute of Washington, D.C., in Rockville, Maryland. He is also
founder and director of the Community Health Project, which collaborates
with the National Institutes of Health to provide continuing education to
public health professionals. He has worked closely with Cloe JVladanes and
Jay Haley; he is coauthor (with Cloe Madanes and Dinah Smelser) of the
book The Violence of Men (1996), and has written or contributed to
numerous other publications on strategic family therapy.
David V. Keith, MD,, is an associate professor of psychiatry, family
medicine, and pediatrics, and the director of family therapy, at the State
University of New York Health Science Center in Syracuse. He was
formerly with the Family Therapy Center in St. Paul, Minnesota and the
University of Wisconsin Department of Psychiatry in Madison. Dr. Keith is
the author and coauthor (with Carl Whitaker) of numerous journal articles
and book chapters in the field of family therapy. Dr. Keith is one of the
leading figures of experiential family therapy and for years was a close
colleague and cotherapist with Carl Whitaker.
Luciano L3Abate, PhD, ABPP, was educated in his native Italy until
moving to the United States as an exchange student. He received his
doctorate in clinical psychology from Duke University. He has retired from
Georgia State University as professor emeritus, and has been consultant at
Cross Keys Counseling Center in Atlanta, Georgia, for the past 18 years,
and director of multicultural services at Cross Keys for the last 3 years. He
is a diplomate of the American Board of Professional Psychology and an
approved supervisor of the American Association for Marriage and Family
Therapy. In 1994, he received the "Family Psychologist of the Year" award
from Division 43 (Family Psychology) of the American Psychological
Association. He is widely published, and his many works have been
translated into several languages.
Thomas W. Lund, PsyD, has been a child and family psychologist for
23 years. For the past 11 years, he has been codirector of the Catskill
Family Institute (CFI), providing direct services to individuals, couples, and
families. During this time, he worked at developing CFPs narrative solu-
tions approach and has published numerous articles on its principles and
practices. Over the past 7 years, he has trained psychotherapists in the
United States and Canada in the CFI approach, and recently coauthored a
x Contributors

book with Joseph B. Eron entitled Narrative Solutions in Brief Therapy

(1996). Dr. Lund also teaches clergy, caseworkers in children's services,
family specialists in family-based treatment programs, and other nonthera-
pists the principles of the narrative solutions approach as they apply to the
task of having helpful conversations.
Wade Liiquet, ACSW5 is on the faculty of the Institute for Imago
Relationship Therapy and has worked closely with Harville Hendrix. He
is the author of Short-Term Couples Therapy: The Imago Model in Action
(1996) and coeditor of Healing in the Relational Paradigm: The Imago
Relationship Therapy Casebook (1998). Luquet maintains a private prac-
tice with his wife, Marianne, in North Wales, Pennsylvania.

Terry MacCormack, PhD (candidate)., currently teaches with the De-

partment of Health Studies at the University of New England in Armidale,
Australia. A former doctoral student in clinical psychology at the University
of Ottawa, he completed his internship in the Family Therapy Program at
the University of Calgary School of Medicine. His work with Karl Tomm
is part of a larger qualitative study comparing the experiences of couples
and therapists working from either a narrative or an emotion-focused
approach. His interests also include working with individuals, couples, and
families coping with life-threatening illness, and what this is like both for
clients and for those who counsel them.

Salvador Minucfain, MD5 has been at the forefront of family therapy

since the early 1960s. He first developed his structural model while working
at the Wiltwyck School for Boys, and in 1965 he was invited to become
the director of the Philadelphia Child Guidance Clinic. In 1981 Minuchin
moved to New York and founded Family Studies, Inc., where he pursued
his dedication to teaching family therapists from all over the world and his
commitment to social justice by working with the foster care system. His
1974 book Families and Family Therapy is the most popular volume ever
written in family therapy; his 1993 book with coauthor Michael P. Nichols,
Family Healing, features moving descriptions of his clinical artistry. His
latest book, Mastering Family Therapy (with W. Y. Lee and G. M. Simon,
1996), is a complex study of the supervision and learning process. Dr.
Minuchin retired in 1996 and now lives with his wife, Patricia, in Boston.
Michael P. Nichols, PhD, has been practicing and teaching family
therapy since 1973. In addition to his psychoanalytic training. Dr. Nichols
studied with Murray Bo wen and Salvador Minuchin. Among his many
books are Family Therapy: Concepts and Methods, fourth edition (with
coauthor Richard C. Schwartz, 1998), which has been one of the most
widely read textbooks in family therapy; The Self in the System; No Place
to Hide; The Lost Art of Listening; and Family Healing (with Salvador
Minuchin, 1993). After 17 years at Albany Medical College, Dr. Nichols
Contributors xi

recently resettled in Virginia and now teaches psychology and family

therapy at the College of William and Mary.
William C. Nichols, EdD5 ABPP? is a fellow of the American Psycho-
logical Association, the American Psychological Society, and the American
Association for Marriage and Family Therapy (AAMFT), He is also a
diplomate of the American Board of Professional Psychology. Currently an
adjunct professor of child and family development and a member of the
graduate faculty at the University of Georgia, he is also a consultant with
The Nichols Group. A former president of both the AAMFT and the
National Council of Family Relations and president-elect of the Interna-
tional Family Therapy Association, he is currently editor of the journal
Contemporary Family Therapy and the International Family Therapy
Association's International Connection. Dr. Nichols is also the author of
numerous articles and book chapters, as well as two books—Marital
Therapy: An Integrative Approach (1988) and Treating People in Families:
An Integrative Approach (1996).
Gerald R. Patterson, PhD, is a research psychologist at the Oregon
Social Learning Center (OSLC), Eugene, Oregon, and one of the foremost
behavioral family therapists in the world. He received his doctorate from
the University of Minnesota; prior to the establishment of OSLC, he was
a research scientist at the Oregon Research Institute and served in various
professional capacities at the University of Oregon for 13 years. He founded
OSLC in 1977 to focus upon the family interaction process as it relates to
aggressive children, marital conflict, and parent training therapy with
antisocial youths. Dr. Patterson has authored and coauthored numerous
professional articles and book chapters; he is also the sole author of the
book Families: Applications of Social Learning to Life (1971). Dr. Patterson
is a past president of Association for the Advancement of Behavior Therapy.
He is the recipient of the Distinguished Professional Contribution Award
from the Division of Clinical Child Psychology of the American Psycholog-
ical Association (APA); the Distinguished Scientist Award from the Division
of Clinical Psychology of the APA; the Distinguished Scientist Award for
the Applications of Psychology from the APA, and the award for Distin-
guished Scientific Contributions to Developmental Psychology from the
Society for Research in Child Development.
Cheryl Rampage, PhD, is a clinical psychologist and senior therapist
at the Family Institute at Northwestern University, Evanston, Illinois, where
she provides psychotherapy to individuals and couples; supervises family
therapy trainees; and teaches courses on family therapy, ethics, and gender
issues. She has previously served as the director of graduate education at
the Family Institute, and also spent 11 years on the faculty of the University
of Houston-Clear Lake. Dr. Rampage is a graduate of Marquette Univer-
sity, and received her doctorate from Loyola University of Chicago. She is
the coauthor (with T. J. Goodrich, B. Ellman, and K. Halstead) of Feminist
xii Contributors

Family Therapy: A Casebook (1988), as well as numerous articles and book

chapters on gender and family therapy. She is a frequent presenter at
national conferences.
Laura Giat Roberto, PsyD, (now Laura Roberto Forman), is professor
of psychiatry and behavioral sciences at Eastern Virginia Medical School.
She has also served on the psychology faculties of the Eastern Virginia
Family Therapy Institute, Old Dominion University, and the College of
William and Mary. She is the founder of the Center for Eating Disorders
in Norfolk, Virginia. She is a graduate of the University of Connecticut,
received her doctorate from the University of Illinois, and served her
internship., residency, and postdoctoral fellowships in family research at the
University of Wisconsin School of Medicine. She is the author of Transgen-
erational Family Therapies (1992). Dr. Roberto is a member of several
journal editorial boards, and is an approved supervisor and a site visitor
for postgraduate training programs for the American Association for
Marriage and Family Therapy. She was book review editor for the Journal
of Feminist Family Therapy from 1993 through 1996. She maintains an
active practice of marital, family, and individual psychotherapy, and has
written extensively on women in families.
Fred M. Sander, MD3 is associate clinical professor of psychiatry at
the Mount Sinai School of Medicine in New York. He received his
psychiatric training at the Albert Einstein College of Medicine in New York,
and he is a graduate of the New York Psychoanalytic Institute. In addition
to his 1979 book Individual and Family Therapy: Toward an Integration,
he has written extensively on the integration of psychoanalytic theory and
family therapy, and has taught on this topic for several years. In "off
hours," Dr. Sander leads audience discussions after theater productions in
New York.
Richard C. Schwartz, PhD, received his doctorate in marriage and
family therapy from Purdue University; he then worked for the Institute for
Juvenile Research in the Department of Psychiatry, University of Illinois at
Chicago, for 16 years. In 1996, he moved to the Family Institute of
Northwestern University. In addition, to writing numerous articles on a
variety of topics related to psychotherapy, he is author of the book Internal
Family Systems Therapy (1994) and coauthor of the books Mosaic Mind:
Empowering the Tormented Selves of Child Abuse Survivors (with R.
Goulding, 1995); Family Therapy: Concepts and Methods, fourth edition
(with Michael P. Nichols, in press); and Metaframeworks: Transcending the
Models of Family Therapy (with D. Breunlin and B. MacKune-Karrer,
1992). He is also coeditor of the Handbook of Family Therapy Training
and Supervision (with H. A. Liddle and D. Breunlin, 1988). He is on the
editorial board of five professional journals, including the Journal of
Marital and Family Therapy, and is a fellow of the American Association
for Marriage and Family Therapy.
Contributors xlii

Karl Tomm? MD, is a professor of psychiatry and director of the

Family Therapy Program at the University of Calgary Faculty of Medicine.
He has published and presented widely, and over the years has introduced
a number of influential ideas and approaches to the family therapy field.
He is currently developing and refining his ideas about psychiatric assess-
ment with his "pathologizing interpersonal patterns" (PIPs) and "healing
interpersonal patterns5' (HIPs) approach. Chapter 13 is his first published
work on his use of the Internalized Other Interview.
David N. Ulrich, PhD, ABPP, received his doctorate in clinical psychol-
ogy from Harvard University in 1956. He is a diplomate of the American
Board of Professional Psychology, and is also a charter member of the
American Family Therapy Academy. Between 1956 and 1982, he served as
a staff member of Judge Baker Guidance Center, Boston, and the Child
Guidance Center of Southwestern Connecticut, in Stamford. Dr. Ulrich
currently maintains a staff position with the Northeast Center for Trauma
Recovery, Greenwich, Connecticut, and also maintains a private practice in
Stamford, Connecticut. He has authored and coauthored numerous publi-
cations on contextual family therapy, one of which is a chapter with I.
Boszormenyi-Nagy and J. Grunebaum in the Handbook of Family Therapy,
Volume 2, edited by A. Gurman and B. Kniskern (1991).
Acknowledgments

I owe much to my early mentors, Joseph Wolpe and Aaron T. Beck, who
have taught me most of what I know about cognitive-behavioral therapy.
I am also indebted to Thomas A. Seay, who taught me a great deal about
psychotherapy integration as well as couple and family therapy during my
early graduate school training. Additional thanks goes to Wallace E. Crider
for his supervision of my early work with couples and families. Along the
way in the development of my work, personal conversations with noted
figures such as Harry Aponte, Norman B. Epstein, Janies Framo, Cloe
Madanes, Donald Meichenbaum, John C. Norcross, Arnold A. Lazarus,
and Peggy Papp have also helped me tremendously in understanding the
potential role of cognitive-behavioral techniques in couple and family
therapy. I also thank the many couples and families who have served as the
pioneering samples for my early work in the refinement of the cognitive-
behavioral approach,
Compiling a major casebook such as this is not possible without the
aid of many talented contributors. The chapters in this book have been
written by some of the finest couple and family therapists in the world. In
addition, a tremendous debt of gratitude is owed to the series editor,
Michael P. Nichols, who has provided tireless effort and superb editorial
suggestions that helped to shape this text into what is (in my opinion) one
of the finest collection of case studies in the couple and family therapy
literature. Staff members at The Guilford Press who deserve acknowl-
edgment are Jodi Creditor and Anna Nelson for their outstanding work as
the production editors, and Seymour Weingarten, the editor-in-chief, who
has been extremely supportive and patient with rny ideas. It is because of
Seymour's open-mindedness and flexibility that this project has become a
reality.
I also profusely thank my personal secretary, Carol "Fingers" Jaskolka,
for her long hours of typing and her excellent computer skills. Her expertise
in coordinating all of the details with this book is appreciated more than
she will ever know. Her patience in enduring the stressful periods during
this project was remarkable and has also earned her the guarantee of a
lifetime supply of Prozac.
Finally, I owe the greatest acknowledgment to my children, Roseamie,
Tara, and Michael, as well as my wife, Maryann, who endured my many
absences during the preparation of this text. They have also taught me the
true meaning and beauty of being a father and husband.

xiv
Foreword

From its very inception a century ago, the field of psychotherapy has
resembled a dysfunctional family-—with covert and overt antagonism
among those representing different orientations, and few if any attempts
made to comprehend or value the points of view held by others. It has
operated on a win-lose basis, and the real losers have unfortunately been
our clients. However, there is nothing like an attack from the outside—tak-
ing the form of third-party payments, biological psychiatry, and pressures
for accountability—to facilitate cooperation within the system. This attack
may very well have helped facilitate the interest in integration among
therapists of different orientations and modalities. Other forces that have
caused the long-term latent interest in psychotherapy integration to evolve
into a more visible movement have been the proliferation of different
schools of therapy; the realization that no one approach is capable of
dealing with everything that therapists encounter clinically; and the forma-
tion in 1983 of the Society for the Exploration of Psychotherapy Integration
(SEPI), an interdisciplinary organization dedicated to the development of
clinically meaningful and empirically informed interventions that are not
necessarily constrained by theoretical schools.
Although most of the attention of the psychotherapy movement has
been paid to the integration of different schools of thought associated with
individual therapy, a small but energetic group of clinicians has been
interested in applying integrative thinking to family and couple therapy.
Contributions by Alan Gurrnan, Jay Lebow, and William Pinsof have dealt
with the integration of different theoretical approaches, and work by Larry
Feldman, Ellen Wachtel, and Paul Wachtel has focused on the conjoint use
of different modalities, such as individual along with couple/family inter-
ventions. The present casebook, edited by Frank M. Dattilio, is a very clear
illustration of how an integrative stance can be used when couple/family
work is approached from within a cognitive-behavioral orientation.
In commenting on the developmental status of behavior therapy in the
early 1980s, Philip Kendall observed that as a result of years of industry
and hard work, the behavioral approach—-including cognitive-behavior
therapy—had finally achieved its own personal identity. With this sense of
security, he went on to add, it was now ready to become more intimate
with other orientations. Even the very fact that Kendall, a behavior
therapist, used this Eriksonian metaphor in his formulation attested to the
readiness of behavior therapy for psychotherapy integration.

xv
xvl Foreword

Kendall's characterization of the developmental status of behavior

therapy is very much in accord with my own personal experience. Indeed,
behavior therapy and I grew up together. Although originally trained within
a psychodynamic orientation, I arrived at the State University of New York
at Stony Brook in the mid-1960s, shortly after the birth of behavior therapy.
I was both a participant in and an observer of its development over the
years, with my clinical writings focusing on behavioral assessment and case
formulation; the incorporation of cognitive factors into behavioral inter-
ventions; the conception of cognitive-behavior therapy as training in coping
skills; and the incorporation into cognitive-behavior therapy of contribu-
tions from other orientations. The openness of cognitive-behavior therapy
to what therapists from other schools of thought might have to say can be
seen in Gerald C. Davison's and my book. Clinical Behavior Therapy,
originally published in the mid-1970s. In retrospect, it was probably the
incorporation of cognition into behavior therapy that provided a bridge to
other orientations, and many behavior therapists who championed the
cause of cognitive-behavior therapy (e.g., myself, Gerald C. Davison,
Arnold A. Lazarus, Michael J. Mahoney, and Donald Meichenbaum) have
since moved on to develop an interest in psychotherapy integration.
In their earlier conception of how cognition might be integrated into
behavior therapy, behavior therapists found the contributions of Albert Ellis
and Aaron T. Beck to be particularly significant. As more clinical attempts
were made to make use of cognitive variables, it became evident that clients
were not always able to articulate the "self-statements" that were at the
root of their problematic emotional reactions and behavior. More often, it
was "as if" they were saying certain things to themselves. The recognition
that the meaning clients attributed to events was often implicit soon led to
the incorporation of concepts developed in cognitive science, such as the
"schema" construct. Of particular significance for psychotherapy integra-
tion is the fact that cognitive-behavior therapists began attending to those
very same clinical phenomena that had long been of interest to their
psychodynamic colleagues (e.g., clients* distorted perceptions of others).
The fact that psychodynamic therapists were independently drawing on the
cognitive sciences—similarly using the notion of "schema"-—even further
facilitated a link between the two orientations. In light of this, it is not at
all surprising that many of the contributions to this volume make use of
the schema concept.
The possibility that clients' views of themselves and others might
mediate their clinical problem and constitute a focus for change has
provided a common ground among psychodynamic, behavioral, cognitive,
and experiential therapists. Although the means by which such change
can be brought about are believed to vary—-with behavioral approaches
emphasizing action, psychodynamic and cognitive orientations stressing
thinking, and experiential interventions focusing on emotion—it is none-
Foreword xvii

theless possible to Induce a common set of change principles. Thus, in the

context of a positive therapeutic alliance consisting of a good interper-
sonal bond, with therapists and clients agreeing on the goals of therapy
and how they may be approached, therapists attempt to increase clients'
awareness of themselves and others in regard to factors that may be
creating difficulties in their lives. By becoming better aware of what they
are thinking and not thinking, doing and not doing, and feeling and not
feeling, clients are in a better position to take risks that can change their
maladaptive patterns of thinking, behaving, and feeling. This risk taking,
which we can refer to as the "corrective experience," is at the very heart
of the change process.
The corrective experience begins with clients having certain expecta-
tions about themselves and the impact that they are likely to have on their
world and on others. These expectations are typically schema-driven, based
on early ways they may have learned for dealing with others. By now,
however, these methods of coping are maladaptive. For example, clients
with a history of parental abuse may approach current interactions with
their significant others with this expectation: "If I tell my partner what I
really feel or want, something bad will happen." This expectation, be it
explicit or implicit, typically occurs with accompanying affect, such as fear,
guilt, or anger, Within the context of a good therapeutic alliance, and once
the clients have become more fully aware of the anachronistic nature of
this perception of intimate relationships in their current life situation, they
are in a better position to take the risk and recognize the invalidity of this
"if-then" expectation.
In the case of clients who have experienced parental abuse, the risk
may involve expressing their feelings or needs in a close interpersonal
interaction, even though at some level the clients may still perceive this as
being somewhat dangerous—hence the "risk." Telling their partners that
they would prefer not to spend the weekend doing something they don't
want to do, or expressing displeasure or disappointment about something
without any major negative consequence occurring, provides the clients
with a corrective experience containing cognitive, affective, and behavioral
evidence that goes counter to their maladaptive schema. In the context of
individual psychodynamk therapy, the corrective experience typically in-
volves interaction with the therapist. In cognitive-behavior therapy carried
out individually, this is more likely to occur between sessions, as in a
homework assignment to assert oneself to a spouse. As so vividly illustrated
in many of the cases described in this book, couple or family therapy allows
the corrective experience to take place within the session itself and with
the very individuals with whom clients' interactions, attitudes, and feelings
have been problematic. Regardless of where this cognitive-affective-behav-
ioral risk takes place, or how it is brought about, the corrective experience
is at the core of therapeutic change.
xviii Foreword

In this collection of cases, Dattilio and his contributors have demon-

strated in a direct clinical way how change occurs and how psychotherapy
integration may be implemented. When therapists actually show rather than
say what they do, it is far easier to draw out the points of similarity among
the different schools of thought and to see how one approach can comple-
ment another. In editing this volume of cases, in providing commentary for
each, and in obtaining the authors' responses to this commentary,, Dattilio
has taken an important step in this process of psychotherapy integration.

MARVIN R. GOLDFRIED, PHD

State University of New York at Stony Brook
Preface

In-te-grate (inti grat): To bring together or incorporate into a unified,

harmonious, or interrelated whole.

This book is the result of almost 10 years of contemplation, reflection, and

debate on integrating various approaches to couple and family therapy. The
contents contain most of the major theories along with a number of
innovative and nontraditional approaches to working with couples and
families, including the cognitive-behavioral modality.
As a young doctoral student in the early 1980s, I received my formal
training in behavior therapy at Temple University from Joseph Wolpe, who
is now regarded as the father of behavior therapy. It was through him that
I was introduced to the application of behavioral principles in the treatment
of individual and marital problems. At that time, very little was known
about the true efficacy of behavior therapy with couples and families.
During my training, I was always struck by how little emphasis the
behavioral strategies received in my courses in family therapy, particularly
in light of how effective some of the strategies proved to be. Much of the
general thinking in the field at that time was that behaviorists were naive
about couple and family dynamics, and that their techniques were only
effective when a family presented with an acting-out child or adolescent.
In my opinion, much of the fine work done by such individuals as Gerald
Patterson (1971), Richard Stuart (1969), and Robert Liberman (1970) in
the late 1960s and early 1970s got little attention from many in the field
of marriage and family therapy, even as an ancillary mode of treatment.
As the 1980s came to a close, I began to read more about psychother-
apy integration. I read works by such individuals as Arnold A. Lazarus,
Marvin R. Goldfried, and John C. Norcross, who promoted a distinct
model of psychotherapy integration (e.g., Norcross & Goldfried, 1992}, I
also become keenly interested in writings by James Coyne and Howard
Liddle, who spoke specifically about a technical eclecticism in the field of
couple and family therapy (e.g., Coyne & Liddle, 1992).
I had always agreed with the notion that cognitive-behavioral therapy
fell somewhat short of being a comprehensive mode of treatment for
couples and families. As I began to read works by Donald H. Baucom

xix
JO" Preface

(1981) and Norman B. Epstein (1982), I began to see how effective

cognitive-behavioral techniques could be when used within a systems
framework or in combination with other modalities. By the rnid-1980s, I
also had the honor of working with Aaron T. Beck at the University of
Pennsylvania School of Medicine on the development of his theories of
cognitive therapy and the application to distressed couples. This effort
subsequently spawned his popular book Love Is Never Enough (Beck,
1988), as well as my coauthored text Cognitive Therapy with Couples
(Dattilio & Padesky, 1990).
By the 1990s I, like many psychotherapists, was feeling overwhelmed by
the bewildering array of therapeutic approaches that had become available
to couple and family therapists. This therapeutic morass was both a cause
and consequence of the often-repeated research finding that no one modality
was ideal or superior in addressing the broad range of couple and family
dysfunctions. A summer lecture tour to southern Italy came at about the right
time during this period. At one point, I had the good fortune to be invited on
an outing to a Sicilian farm that had several hundred acres of vineyards. An
Italian farmer was explaining to me in his native tongue how he combined
the use of hybrid vines or meritage blends to produce an extraordinarily
robust wine. It struck me that his thoughtful hybrids were analogous to the
integration of psychotherapy models and to the blending of techniques to
achieve a common goal—unique and robust results.
As I continued my European travels, this notion of blending various
therapies sparked more thought on the idea of using cognitive-behavioral
techniques as an integrative component with other models of couple and
family therapy. This idea of integration was particularly intriguing, since
Aaron Beck had always taught me how cognitive therapy was one of the
most "integratable" of therapeutic modalities. Beck drew from various
schools of thought in developing cognitive therapy, which rendered it
compatible with many other psychotherapies.
In the past decade, cognitive-behavioral therapy with couples and
families has gained tremendous popularity worldwide (Dattilio, 1990,
1992; Dattilio & Padesky, 1995, 1996). Many fine researchers and
clinicians have been making an indelible impact throughout the world
on practitioners of couple and family therapy. This comes primarily as
a result of its adaptability to other modalities as well as to other
cultures.
The early 1990s witnessed the beginning of a strong movement toward
psychotherapy integration, which has led practitioners to explore various
schools of thought that were once viewed as incompatible.
The primary focus of this book is theoretical integration. Previously,
structural therapy and strategic therapy, the primary influences in the early
development of couple and family therapy, have been combined in an
attempt to maximize the effective components of both theories (Coyne &
Liddle, 1992; Haley, 1976; Stanton, 1981). This theoretical melding has
Preface xxi

also been the case with concepts and techniques of the psychodynamic
orientation (Norcross & Prochaska, 1988; Pitta, 1997), as well as those of
other schools of thought (Kirschner & Kirschner, 1993; Lazarus, 1992;
Christensen, Jacobson, & Babcock, 1995). Such hybrid forms of interven-
tion appear to be on the increase, as practitioners become more aware of
their potential effectiveness with individuals as well as with couples and
families. In fact, the modal orientation of family therapists is now eclecti-
cism/integration (Prochaska & Norcross, 1994). Within systemic therapy
alone, there has been a decided breakdown of schoolism and a movement
toward integration. In a survey of 900 family therapists, nearly one-third
described their theoretical orientation as eclectic (Rait, 1988).
One of the beauties of integrating theories is that the essential frame-
work of the primary theory need not be abandoned in order to integrate
other techniques or strategies. These techniques may be augmented in
various fashions and forms, depending on the vitality of the basic therapy
model. Cognitive-behavioral therapy has received increasing support in the
professional literature as a highly "integratable" theory in work with
couples and families (Beck, 1988; Dattilio & Padesky, 1990; Dattilio, 1989,
1990, 1994, 1997; Lombana & Frazier, 1994). In fact, two recent articles
addressed the question of whether or not all therapies are cognitive (Alford
& Norcross, 1991; Persons, 1995), particularly since cognitive components
appear to be part of the fabric of most modalities. Clinicians may selectively
choose various cognitive-behavioral techniques to incorporate into their
primary approach as the need arises. (This integration is particularly
important in short-term treatment, due to the effective results achieved with
cognitive-behavioral techniques,) Interestingly, this phenomenon was often
mentioned during the process of choosing contributors for this book. After
I explained to authors my idea for the work, many of them spontaneously
said, "Oh, I use cognitive-behavioral strategies in my work all the time."
In addition to the concept of integration, this book also provides detailed
case analysis from more than 16 different perspectives of couple and family
therapy, with elaborate commentary by both the authors and the editor.
Laurence Sterne, the 18th-century novelist, said that writing is just a
different name for conversation-—a conversation that takes place between the
author and the reader. The present book transcends this definition by provid-
ing a conversation among the authors, the editor, and (in a tacit sense) the
reader. In this text, the symbol " t" denotes rny comments as the editor, and these.
are highlighted in italics. The author or authors of each chapter were also invited
to submit a follow-up commentary after receiving a copy of my editorial com-
ments.1 The primary intention was to create a dialogue that would help
readers draw their own conclusions regarding the integration of cognitive-
behavioral strategies with other therapies as presented in this book.

FRANK M. DATTILIO
September 1997
xxii Preface

NOTE

1. The author or authors of each chapter were provided with a copy of Cognitive
Therapy ivith Couples (Dattilio & Padesky, 1990), which contains the basic
philosophy and theory of cognitive-behavioral therapy with couples and families.
They were also provided with a uniform list of questions to answer when composing
their "authors' reply to the editor's comments," along with a guideline for disguising
case material to ensure confidentiality.

REFERENCES

Alford, B. A., & Norcross, J. C. (1991). Cognitive therapy as integrative therapy,

Journal of Psychotherapy Integration, 1(3), 175-190.
Beck, A. T. (1988). Love is never enough. New York: Harper & Row.
Coyne, J. C., & Liddle, H. A. (1992). The future systems therapy: Shedding myths
and facing opportunities Psychotherapy* 29(1), 44-50,
Christensen, A., Jacobson, N. S., & Babcock, J. C. (1995). Integrative behavioral
couple therapy. In N. S. Jacobson & A. S. Gurman (Eds.), Clinical handbook
of couples therapy (pp. 31-64). New York: Guilford Press.
Dattilio, E M. (1989). A guide to cognitive .marital therapy. In P. A. Keller & S. R.
Heyman (Eds.), Innovations in clinical practice: A source book (Vol. 8, pp.
27-42). Sarasota, FL: Professional Resource Exchange.
Dattilio, E M. (1994). Families in crisis. In E M. Dattilio & A. Freeman (Eds.),
Cognitive-behavioral strategies in crisis intervention (pp. 278-301). New York:
Guilford Press,
Dattilio, E M. (1997). Family therapy. In R. Leahy (Ed.), Practicing cognitive
therapy: A guide to interventions (pp. 409-450). Northvale, NJ: Jason Arori-
son.
Dattilio, E M., & Padesky, C. A. (1990). Cognitive therapy with couples. Sarasota,
FL: Professional Resource Exchange.
Haley, J. (1976). Problem-solving therapy: New strategies for effective family
therapy, San Francisco: Jossey-Bass.
Kirschner, S., & Kirschner, D. A. (1993). Couples and families. In G. Strieker & J.
R. Gold (Eds.), Comprehensive handbook of psychotherapy integration (pp.
401-412). New York: Plenum Press.
Lazarus, A. A. (1992). When is couples therapy necessary and sufficient? Psycho-
logical Reports, 703 787-790.
Liberman, R, P. (1970), Behavioral approaches to couples and family therapy.
American Journal of Orthopsychiatry, 40, 106-118.
Lombana, J. H.5 & Frazier, F. B. (1994). Cognitive-systems therapy: A case excerpt.
Journal of Mental Health Counseling, 16(4), 434-444.
Norcross, J. C., & Goldfried, M, R. (Eds.). (1992). Handbook of psychotherapy
integration. New York: Basic Books.
Norcross, J. C., & Newman, C. E (1992). Psychotherapy integrations: Setting the
context. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psycho-
therapy integration (pp. 3-45). New York: Basic Books.
Norcross, J. C, & Prochaska, J. O. (1988). A study of eclectic (and integrative)
views revisited. Professional Psychology: Research and Practice,, 19, 170-174.
Preface xxlii

Patterson, G. R. (1971). Families: Applications of social learning to life. Champaign,

IL: Research Press.
Persons, J. (1.995). Are all psychotherapies cognitive? Journal of Cognitive Psycho-
therapy, 9(3), 185-194.
Pitta, P. (1997). Marital therapy: A systemic psychodynamic integrated approach:
A case study. Psychotherapy Bulletin, 32(1), 45-48.
Prochaska, J. O.? & Norcross, J. C. (1994). Systems of psychotherapy: A
transtheoretical analysis (3rd ed.). Pacific Grove, CA: Brooks/Cole.
Rait, D. (1988). Survey results. The 'Family Networker, 12, 52-56.
Stanton, M. (1981). An integrated structural/strategic approach to family therapy,
Journal of Marital and Family Therapy, 7, 427-439.
Stuart, R. B. (1969). Operant-interpersonal treatment of marital discord. Journal
of Consulting and Clinical Psychology, 33, 675—682.
Contents

Chapter 1. An Introduction to Cognitive-Behavioral 1

Therapy with Couples and Families
Frank M. Dattilio, Norman B. Epstein, and
Donald H. Baucom

Chapter 2. Cognitive-Behavioral Couple Therapy 37

Norman B. Epstein and Donald H. Baucom

Chapter 3. Cognitive-Behavioral Family Therapy 62

Frank M. Dattilio

Chapter 4. Behavioral Family Therapy 85

Marion S. Forgatcb and Gerald R. Patterson

Chapter 5. Structural Family Therapy 108

Salvador Minuchin and Michael P. Nichols

Chapter 6. Strategic Family Therapy 132

James Keim

Chapter 7. Contextual Family Therapy 158

David N. Ulrich

Chapter 8. Symbolic-Experiential Family Therapy 179

for Chemical Imbalance
David V. Keith

Chapter 9. Solution-Focused Couple Therapy: 203

Helping Clients Construct Self-Fulfilling
Realities
Michael F. Hoyt and Insoo Kim Berg
xxiv
Contents XXV

Chapter 10. Integrative Marital Therapy 233

William C. Nichols

Chapter 11. Transgenerational Family Therapy 257

Laura Giat Roberto

Chapter 12. Cross-Cultural Couple Therapy 278

Paula Hanson-Kahn and Luciano L'Abate

Chapter 13. Social Constructionist/Narrative 303

Couple Therapy
Terry MacCormack and Karl Tomm

Chapter 14. Internal Family Systems 331

Family Therapy
Richard C. Schwartz

Chapter 15. Feminist Couple Therapy 353

Cheryl Rampage

Chapter 16. Narrative Solutions Couple Therapy 371

Joseph B. Eron and Thomas W. Lund

Chapter 17. Imago Relationship Therapy 401

Wade Luquet and Harville Hendrix

Chapter 18. Psychoanalytic Couple Therapy 427

Fred M. Sander

Chapter 19. Emotionally Focused Couple Therapy 450

Susan Johnson

Chapter 20. Epilogue 473

Frank M. Dattilio

Index 480
 Marriages and families
are not as they are made,
but as they turn out.
—Italian proverb
 Chapter 1

An Introduction to
Cognitive-Behavioral Therapy
with Couples and Families
FRANK M. DATTILIO
NORMAN B. EPSTEIN
DONALD H. BAUCOM

Cognitive-behavioral therapy has now gained recognition among mental

health theorists, researchers, and practitioners as a mainstream approach
to psychotherapy. Even though the various forms of cognitive-behavioral
therapy are in their infancy as compared to some other schools, they have
generated more empirical research and resulted in more outcome studies
than any other psychotherapeutic modality (Beck, 1991a).
Albert Ellis was among the first to publish descriptions of the appli-
cation of cognitive-behavioral therapy to problems in intimate relation-
ships. Ellis applied his A-B-C theory1 of rational-emotive therapy (RET) to
distressed couples (Ellis, 1977; Ellis & Harper, 1961), in an attempt to
modify their thoughts and subsequently their emotions and behaviors. Ellis
contended that marital dysfunction occurs when partners hold unrealistic
beliefs about their relationship and make extreme negative evaluations once
dissatisfied. He further proposed that disturbed feelings in a relationship
are not caused merely by partners' actions or other adverse events, but by
their particular views of each other's actions and other life stressors (Ellis,
Sichel, Yeager, DiMattia, & DiGiuseppe, 1989). Ellis introduced the notion
of "irrational beliefs" and defined them as highly exaggerated, inappropri-

1
2 CASE STUDIES IN COUPLE AND FAMILY THERAPY

ately rigid, and illogical contentions that produce disappointment and

frustration. In an individual, these negative cognitions and emotions then
lead to negative behavior toward another person, causing a vicious cycle
of disturbance, Ellis (1995) has recently renamed his approach rational-
emotive behavior therapy (REBT) in order to acknowledge more fully the
role of behavioral responses in individuals' interpersonal problems. This
suggests that he places equal emphasis on the role of such responses in
couple and family relationships.
Unfortunately, the RET model of relationship dysfunction may have
been perceived as simplistic when it first appeared in the literature, and
consequently there was little discussion of it in the literature until much
later. Moreover, at the time that Ellis first introduced his model, the systems
theory approaches to marriage and family therapy had already gained
substantial popularity; thus, they overshadowed the RET approach. Fur-
thermore, because the RET model tended to emphasize linear, intrapsychic
causation, it had limited appeal among family therapists, who focused on
circular interaction processes with family members.
At about the same time, during the 1960s, modern behaviorists were
utilizing principles of learning theory to assess and treat adults and children
who displayed behavioral problems. Behavior therapists9 work with chil-
dren led them to observe parent-child interaction patterns and to train
parents in principles of behavior modification to alter their children's
negative actions (Berkowitz &c Graziano, 1972; Patterson & Hops, 1972).
Similarly, Richard Stuart (1969) described the use of operant learning
strategies to produce more satisfying interactions in distressed couples.
Observations of parents and their children with behavioral problems also
led behavior therapists to begin to address issues in the parents' own
relationships, as they began to realize how marital discord contributes to
inconsistent parenting (Gordon & Davidson, 1981). The movement toward
applying principles of operant conditioning and social learning developed
into a more comprehensive theory of marital and family discord and
therapy (e.g., Liberrnan, 1970; Patterson, 1971). Initially, behavioral treat-
ment approaches placed emphasis on the components of operant condition-
ing, social exchange theory, and contingency contracting with couples and
parent-child relationships (Gordon & Davidson, 1981; Stuart, 1969); they
later included an increased focus on communication and problem-solving
skills (Falloon, 1991; Jacobson, 1981; Jacobson & Margolin, 1979).
Even though nonbehavioral marital and family therapists long ago
recognized the importance of intervention with cognitive factors, such as
family members* interpretations of one another's behavior (Dicks, 1953;
Satir, 1964; Haley & Hoffman, 1968), only in the late 1970s did clinical
researchers begin to add cognitive components to behavioral treatment in
controlled outcome studies. Initially, aspects of cognition were introduced
as auxiliary components of treatment within the behavioral approach
(Margolin, Christensen, & Weiss, 1975). A study by Margolin and Weiss
An Introduction to Cognitive-Behavioral Therapy 3

(1978) compared behavioral marital therapy with a treatment in which

behavioral marital therapy was supplemented with cognitive restructuring
techniques. The results suggested that the cognitive restructuring signifi-
cantly enhanced the effectiveness of traditional behavioral marital therapy
on several outcome measures. During the 1980s, cognitive factors became
more of a focus in the couple research and therapy literature (e.g., Baucom,
1987; Baucom, Epstein, Sayers, & Sher, 1989; Beck, 1988; Dattilio, 1989;
Doherty, 1981a, 1981b; Eidelson & Epstein, 1982; Epstein, 1982; Epstein
& Eidelson, 1981; Fincham, Beach, & Nelson, 1987; Fincham & O'Leary,
1983; Jacobson, 1984; Jacobson, McDonald, Follette, & Beriey, 1985;
Margolin, 1983; Schindler & Vollmer, 1984; Weiss, 1980, 1984). This
movement underscored the need for couple treatment procedures to include
a focus on the partners' cognitions regarding each other's actions, and led
to the application of established cognitive interventions in conjoint couple
therapy (Baucom & Epstein, 1990; Dattilio & Padesky, 1990; Epstein,
1992; Epstein & Baucom, 1989).
Similarly, cognitive-behavioral family therapy evolved from behavioral
approaches to research and intervention with families. Whereas early work
by Patterson and his associates (e.g., Patterson, 1971, 1982; Patterson,,
McNeal, Hawkins, & Phelps, 1967) emphasized contingency contracting
and operant learning procedures, the theoretical, research, and clinical
literature broadened to include family members' cognitions about one
another. Once again, Albert Ellis was one of the first to introduce a
cognitive approach to family therapy, in an article that discussed the
significant difference between RET and systems-oriented therapy (Ellis,
1982). At about the same time, a chapter by Richard Bedrosian (1983)
addressed the notion of cognition in family dynamics. Subsequently, the
1980s and 1990s saw a rapid growth in the literature on cognitive-behav-
ioral approaches to therapy with families (Alexander, 1988; Dattilio, 1993,
1994, 1996a, 1997; Epstein & Schlesinger, 1995; Epstein, Schlesinger, &
Dryden, 1988; Falloon, Boyd, & McGill, 1984; Huber & Baruth, 1989;
Robin & Foster, 1989; Schwebel & Fine, 1994; Teichman, 1981, 1992).

BEHAVIORAL FACTORS IN COUPLE

AND FAMILY PROBLEMS

A basic tenet of the cognitive-behavioral model of couple and family

dysfunction is that relationship distress and conflict are directly influenced
by an interaction of cognitive, behavioral, and affective factors (Epstein et
al., 1988). Considerable evidence suggests that exchanges of negative
behavior among family members are associated with relationship distress,
and that members5 use of aversive control is associated with a variety of
dysfunctional outcomes for children, such as school, work, and interper-
sonal problems (Biglan, Lewin, &£ Hops, 1990). Consequently, traditional
4 CASE STUDIES IN COUPLE AND FAMILY THERAPY

behavioral family therapy methods of assessment and modification of

behavioral interactions remain important components of the cognitive-
behavioral approach. In particular, the cognitive-behavioral family therapist
pays attention to family members' (1) frequencies and patterns of antago-
nistic/discordant behavior exchanges, (2) expressive and listening skills for
communicating thoughts and feelings,, and (3) problem-solving skills (Bau~
com & Epstein, 1990; Epstein et al, 1988; Robin & Foster, 1989).
Concerning exchanges of aversive behavior, evidence that distressed couples
and families engage in circular, escalating antagonistic/discordant interac-
tion patterns (e.g., Patterson, 1982; Revenstorf, Hahlweg, Schindler, &:
Vogel, 1984) is consistent with a systems theory conceptualization of
reciprocal influences among family members. Similar to other family
therapists who focus on the "process" of family interactions, cognitive-
behavioral therapists carefully observe sequences of behavior and interac-
tion among family members during conjoint sessions, noting how each
person's behavior is a response to others' actions and serves as a stimulus
that elicits further responses from other members. Concerning communica-
tion skills, cognitive-behavioral therapists assume that effective communi-
cation is the mutual responsibility of the speaker, who intends to express
his or her thoughts and feelings, and the listener, whose role is to
understand what is being expressed (Guerney, 1977). In addition, it is
assumed that in order to resolve the problems of daily living (ranging from
relatively trivial matters to major issues), family members require skills for
defining problems clearly, identifying mutually acceptable and appropriate
re-solutions or problem-solving strategies, and implementing these solutions
effectively. These assumptions of cognitive-behavioral therapy are sup-
ported by empirical findings that couples and families referred for relation-
ship distress exhibit more dysfunctional communication and less construc-
tive problem-solving behavior than do satisfied couples and families
(Baucorn & Epstein, 1990; Robin & Foster, 1989; Weiss & Heyrnan, 1990).

COGNITIVE FACTORS IN COUPLE AND FAMILY PROBLEMS

Cognitive factors involved in couple and family distress have been concep-
tualized in varying ways by cognitive-behavioral theorists and therapists.
The central principle, however, is that family members' appraisals and
interpretations of one another's behavior influence the nature and extent
of their emotional and behavioral responses to one another.

Beck's Cognitive Model

Beck's cognitive model (Beck, 1991b; Beck, Rush, Shaw, & Emery, 1979)
has been expanded to focus on cognitive variables that shape an individual's
reactions to life events, in order to provide a better understanding of
,4ft Introduction to Cognitive-Behavioral Therapy 5

cognitive mediation in interpersonal relationships. Those who have applied

Beck's model to couple and family interaction (Beck, 1988; Bedrosian,
1983; Bedrosian & Bozicas, 1994; Dattilio, 1989, 1990, 1997; Dattilio &
Padesky, 1990; Epstein, 1982, 1986} have described the assessment and
modification of "automatic thoughts'9 and "cognitive distortions" that are
involved in faulty information processing, as well as of unrealistic, extreme,
or inappropriate "schemas."

Automatic Thoughts
"Automatic thoughts" are defined as stream-of-consciousness ideas, beliefs,
or images that individuals have from moment to moment, often elicited by
specific situations (e.g., "My wife is late again—she doesn't care about my
feelings," or "My parents are setting a curfew for me because they like
hassling me"). The word "automatic" indicates the spontaneous quality of
these cognitions, and cognitive therapists (e.g.. Beck et al., 1979) have noted
how individuals commonly accept them as plausible rather than questioning
their validity. A perfect example of this is portrayed by an incident that
occurred with a newly married couple. During working hours, a gentleman
had received a call from a distant relative who had arrived in town
unexpectedly. She asked if he and his wife were available for lunch. The
gentleman attempted to call his wife at home, but since it was short notice,
she was not available for lunch. However, he made plans to meet the
relative for lunch by himself. Ironically, the gentleman's wife had been out
shopping and saw him leaving a restaurant with his relative, who happened
to be an attractive young female. Upon seeing her husband with another
woman, the wife immediately flew into a rage. She began catastrophizing
that her husband was having an affair, and she became emotionally
distraught. After she confronted her husband, he informed her of the
situation and arranged for an opportunity to introduce his wife to his
relative later that same day. This is a clear example of a woman engaging
in the distortion of "jumping to conclusions," which led to the automatic
erroneous belief that her husband was being unfaithful.

Cognitive Distortions In Automatic Thoughts

The same cognitive distortions contributing to depression that were iden-
tified in early writings on cognitive therapy (Beck et al., 1979) are likely
to contribute to distorted automatic thoughts and thus to be sources of
relationship discord. Below is a list of eight common cognitive distortions
(many others could be described), with examples of how they may occur
in couple or family interaction:

1. Arbitrary inference. A conclusion is drawn from an event, in the

absence of supporting substantiating evidence. For example, a man whose
£ CASE STUDIES IN COUPLE AND FAMILY THERAPY

wife arrives home 30 minutes late from work concludes, "She must be
having an affair/' or parents whose son or daughter was 15 minutes late
for curfew conclude that the child is engaging in inappropriate activities
with friends.
2. Selective abstraction. Information is perceived out of context;
certain details are noticed or highlighted, while other important informa-
tion is ignored. For example, an individual may focus on the negative
behavior of other family members., but fail to notice their positive actions.
In distressed families, it's common to hear the members whose positive acts
go unnoticed complaining, "You never notice the good things that I do!"
3. Over generalization. An isolated incident or two is allowed to serve
as a representation of similar situations, whether or not they are truly
related. For example, after her husband fails to complete one household
chore, a woman concludes, "He is totally unreliable."
4. Magnification and minimization. A case or circumstance is per-
ceived as having greater or lesser significance than is appropriate. For
example, an angry husband becomes enraged upon discovering that his wife
has overspent the weekly budget for groceries, and magnifies this event by
concluding, "We're doomed financially." In contrast, he may engage in
minimization when his wife spends less than the budgeted amount the next
time she does the grocery shopping, as he concludes, "That hardly saved
us any money/'
5. Personalization, This is a form of arbitrary inference, in which
external events are attributed to oneself when insufficient evidence exists
to render a conclusion. For example, a woman finds her husband remaking
the bed after she previously spent time making it herself and concludes,
"He is dissatisfied with the way I did it."
6. Dichotomous thinking. Experiences are classified as either all or
nothing—as complete successes or total failures. This is otherwise known
as "all-or-nothing" or "polarized thinking." For example, a mother who
states to her son who is cleaning his room, "There is still dust on your
bureau," elicits this reaction from her son: "She's never satisfied with
anything I do."
7. Labeling and mislabeling. Behaviors such as mistakes made in the
past are generalized as traits to define oneself or another family member.
For example, subsequent to making repeated errors in balancing the
checkbook, a partner states, "I'm really stupid," as opposed to recognizing
the errors as situational behavior (perhaps influenced by fatigue). Similarly,
a parent who observes a child dragging along in the morning as he or she
gets ready for school concludes, "This kid is really lazy."
8. Mind reading. This is another special case of arbitrary inference, in
which an individual believes that he or she is able to know what another
family member is thinking or will do in the near or distant future, without
the aid of direct verbal communication between the parties. Members of
distressed couples and families often make negative predictions about each
An Introduction to Cognitive-Behavioral Therapy 7

other. For example, a woman says to herself, "I know what Tom is going
to say when he hears that I'll be working late tomorrow." Although such
predictions may be accurate, based on past experiences with the other
person, mind reading involves going beyond the available data and risking
erroneous conclusions.

Schema®
Research on human cognition (Fiske & Taylor, 1991) supports the premise
that moment-to-moment automatic thoughts and the cognitive distortions
on which they are based tend to be shaped by the individual's "schemas,"
which are underlying core beliefs that the person has developed about
characteristics of the world and how it functions. Schemas are relatively
stable cognitive structures that may become inflexible and unconditional in
character. Many schemas about relationships and the nature of family
members' interactions are learned early in life from primary sources, such
as family of origin, cultural mores, the mass media, and early dating
experiences (Dattilio, 1993, 1994). These schemas or dysfunctional beliefs
about relationships are often not articulated clearly in an individual's mind,
but exist as vague concepts of what "should be" (Beck, 1988). For example,
some men believe that holding a door open for a woman is a way of being
polite or showing courtesy—-something that has been taught in many
American households. A woman who was brought up in a different
environment, however, may interpret this gesture as not respecting her
independence, particularly if it is overdone.
These kinds of schemas are the basis for coding, categorizing, and
evaluating experiences during the course of one's life. Central to Beck's
cognitive theory of depression is the concept of the "negative triad"—pes-
simistic schemas about the self, world, and future, Schemas that have been
previously developed influence how an individual subsequently processes
information in new situations. A basic tenet of cognitive-behavioral family
therapy is that each individual family member maintains schemas about
every member of the family unit (including himself or herself), in addition
to schemata about family interaction in general. These schemas are some-
times conscious and overtly expressed, but more often individuals aren't
fully aware of the basic beliefs that guide their responses to family
interactions.
When a couple forms a relationship, each partner brings some schemas
from his or her family of origin and other life experiences (e.g., schemas
about the characteristics that each individual assumes are typical of an
intimate relationship). Although these schemas influence each partner's
perceptions and inferences about events in the current relationship, events
in the current relationship can also modify preexisting schemas (Epstein &:
Rauconi, 1993). For example, even though an individual who grew up with
abusive parents may have developed a schema involving danger in family
8 CASE STUDIES IN COUPLE AND FAMILY THERAPY

interaction, and years later this schema may lead the individual to make
arbitrary inferences about malevolent intent by his or her adult partner,
current experiences with a safe and supportive partner may alter the
negative schema. However, preexisting schemas may be difficult to modify,
particularly if they are associated with strong feelings.
In addition to the schemas that partners or mates bring to their
relationship, each member of a couple develops schemas specific to the
current partner and relationship. Consistent with empirical findings con-
cerning schemas as templates according to which individuals process new
information. Beck (1988) describes how each partner develops a "frame"
or stable schema concerning the other's characteristics, and how subsequent
perceptions and interpretations of the other's behavior tend to be shaped
by the frame. For example, when a woman's observations of her partner
produce a schema in which he is viewed as "selfish," the woman is likely
to notice future partner behaviors that seem consistent with the schema, to
ignore actions that are inconsistent with the schema, and to attribute other
negative partner behavior to the trait of "selfishness."
Members of a couple are also likely to develop schemas about
themselves as a couple (e.g., "We share a lot of interests," "We're from two
different worlds," "Our goal is to raise children with high moral stan-
dards"). The couple dyad is modified with the birth of any offspring and
the development of a triad or larger family unit. Here the development of
"triangles" becomes important, because they contribute profoundly to the
development of family members' cognitions (Procter, 1985; Guerin, Fogarty,
Fay, & Kautto, 1996). For example, consistent with systems theory, when
family members form coalitions against other members, each individual
develops schemas concerning the conflict and power dynamics involved in
such coalitions. Moreover, cognitive-behavioral therapists are particularly
interested in helping individuals link such schemas to experiences in their
families of origin (Dattilio, 1997). As a result of years of integrated
interaction among family members, the individuals develop jointly held
beliefs, which constitute the "family schema" (Dattilio, 1994). To the extent
that the family schema involves cognitive distortions, it may result in
dysfunctional interaction (e.g., when all members of a family view a
particular child as irresponsible and therefore behave in ways that constrain
the child's development of autonomy). Figure 1.1 depicts the evolution of
a family schema from the schemas the partners bring from their families of
origin, and the blending of their life experiences and beliefs.

Battcom and Epstein's Typology of Cognitions

Baucom and Epstein (1990; Baucom et aL, 1989) have presented a typology
of cognitions that have been implicated in relationship conflict and distress:
(1) "selective attention," in which each member of a relationship tends to
notice some aspects of the events occurring in their interactions but not
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

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.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN