Mastering Family TherapyJourneys of Growth and Transformation

Second Edition

Salvador Minuchin

Wai-Yung LeeGeorge M. Simon

John Wiley & Sons, Inc.

File AttachmentC1.jpg

Mastering Family Therapy

Other Books by Salvador Minuchin

Families and Family Therapy

Family Healing: Tales of Hope and Renewal from Family Therapy(with Michael P. Nichols)

Family Kaleidoscope: Images of Violence and Healing

Family Therapy Techniques(with H. Charles Fishman)

Institutionalizing Madness(with Joel Elizur)

Psychosomatic Families: Anorexia Nervosa in Context(with Bernice L. Rosman and Lester Baker)

Families of the Slums(with Braulio Montalvo, Bernard G. Guerney, Bernice L. Rosman,and Florence Schumer)

Working with Families of the Poor(with Patricia Minuchin and Jorge Colapinto)

Assessing Families and Couples: From Symptom to System(with Michael P. Nichols and Wai-Yung Lee)

Mastering Family TherapyJourneys of Growth and Transformation

Second Edition

Salvador Minuchin

Wai-Yung LeeGeorge M. Simon

John Wiley & Sons, Inc.

This book is printed on acid-free paper.

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To Andy Schauer (1946–1994), a friend who was openand lovable, lived his life without grudges, and

left us long before his time.

vii

Foreword

This book is a bottomless bag of tools. Part I is a pathbreaking contri-bution, in which Salvador Minuchin offers his unique perspective onthe major ideas of the field’s luminaries, selecting some of the most ex-citing conceptual and clinical tools for helping troubled families.

In Part II, we hear the individual voices of eight therapist-supervisees as they struggle to transform themselves and the fami-lies in their care, under their supervisor’s masterful guidance. Wewatch them improve the complexity and accuracy of their interven-tions, and we observe them learning to abandon unworkable goals.We see how they use Minuchin’s catalyzing reactions, and we sharetheir pain and joy as they sharpen their skills and enhance theirstyles.

The manner in which each therapist’s story is told, as well asMinuchin’s ongoing comments on their work, make reading this bookbecome, in effect, like sitting in on a master class. We follow both theteacher’s and students’ perspectives and see how they intersect andhow those perspectives affect the therapy. This work is especially im-pressive in light of the examples presented: a formidable gallery of Di-agnostic and Statistical Manual casualties of high difficulty levels.

For the beginner searching for new approaches to problems that atfirst appear to be inside the individual only, Mastering Family Therapy isa remarkably rich resource. For the experienced therapist seeking tocultivate fresh ways of unbalancing pathologic systems, to amplify di-vergences, and to challenge the usual, the harvest has never been soabundant. This book is particularly valuable in stimulating the super-visor’s imagination. All of us who have found ourselves in conflictwith a supervisee’s chosen direction will learn from the ingeniousways Minuchin finds to resolve clashes and promote growth. He showshow a supervisor can thrive on the differences between himself andthe supervisees, and the supervisee and the family he or she workswith, turning those differences into productive conflict, unexpectedproblem solving, and healing. He teaches how to make efficient use ofthe supervisor’s most fundamental instrument: the ability to join thesupervisee in a tough and honest dialogue in which both search avidlyfor ways of anticipating and creating scenarios.

These ideas do not fit in a field inclined to sacrifice the use of theevocative and probing conversation in the planning and carrying out of

viii FOREWORD

therapeutic interventions. These ideas do not accommodate the quickand automated protocol as a principal means of training. They do be-long, however, in any professional setting that employs a family-basedtherapy, delivered by providers who value the relevance and usefulnessof interventions above all. These clinicians will heartily embrace thebook’s main point: discovering feasible goals and improvising a flexi-ble trajectory for therapy by gaining a systemic understanding of fam-ilies. Minuchin’s guidance in achieving such an undertaking cultivatesand releases the therapist’s protean imagination—the endless capacityto shape new options. He teaches how to assume different forms de-pending on what the case requires.

In the future, when the field of family therapy is examined and thetools in its workshop are inventoried, Mastering Family Therapy will becounted as more than the work of a brilliant craftsman from whoseforge came an extraordinary collection of tools that go on shaping thestructure of family therapy. It will be remembered as the source bookon inspiring therapists to fire their own imaginations and forge theirown tools to better serve the families they work with.

BRAULIO MONTALVO

xv

Contents

FOREWORD viiBraulio Montalvo

PREFACE ixSalvador Minuchin

ACKNOWLEDGMENTS xiii

PART I FAMILIES AND FAMILY THERAPY

1 Family Therapy: A Theoretical Dichotomy 3

2Family Particulars: All Families Are Different 17

3 Family Universals: All Families Are Alike 33

4Family Therapies: Clinical Practiceand Supervision 41

5 Contemporary Trends: Whatever Happenedto Family Therapy? 61

6 The Therapeutic Encounter 75

PART II STORIES OF SUPERVISION

7 Supervision of the Therapeutic Encounter 99

8The Feminist and the Hierarchical Teacher 107Margaret Ann Meskill

9One Head, Many Hats 123Hannah Levin

10The Poet and the Drummer 137Adam Price

11“The Oedipal Son” Revisited 159Gil Tunnell

12Into the Crucible 177Israela Meyerstein

13Men and Dependency: The Treatment of a Same-Sex Couple 195David E. Greenan

14The Shit-Painter 215Wai-Yung Lee

15Filling the Empty Vessel: Andy Schauer’s Story 243Wai-Yung Lee

EPILOGUE 261Salvador Minuchin

REFERENCES 267

INDEX 271

xvi CONTENTS

xiii

Acknowledgments

To begin with, we owe a deep debt of gratitude to the therapists whosechapters constitute Part II of this book. Were it not for their courageouswillingness to expose their clinical work to mass perusal, this bookwould have become a dry, academic affair, with lessened utility forthose who are involved in the flesh-and-blood work of doing and su-pervising family therapy.

We would like to acknowledge the contributions of Richard Holm,our fellow faculty member at the Minuchin Center for the Family.Richard is present everywhere in this book, albeit invisibly. His contri-butions ranged from the sublime to the meticulous—from helping uscrystallize some of the theoretical ideas to working with the analysis ofvideotapes.

Authors can count themselves blessed if they find an editor who canunderstand their material and make it better. In writing this book, wewere fortunate; we had four such editors. Frances Hitchcock worked thebasic transformations when the material first emerged from our wordprocessors. Nina Gunzenhauser alerted us to the flaws in the manu-script when we believed it was already flawless. Jo Ann Miller, the exec-utive editor at John Wiley while the first edition was being written,brought an understanding of the field and an ability to integrate thework of many writers into a coherent volume. And Patricia Rossi, oureditor at Wiley for this second edition, managed to infect us with her en-thusiasm for a project of revision and rewriting that we would neverhave undertaken on our own.

Our profound thanks also to Lori Mitchell, Jenny Hill, and GailElia. They labored tirelessly and with tactful patience to type the nu-merous revisions through which the manuscript passed.

Finally, we would like to thank our spouses: Patricia Minuchin,Gail Elia, and Ching Chi Kwan. They accompanied us through thisbook, and they represent the best of complementarity in work andmarriage.

ix

Preface

Once upon a time, a wise old rabbi listened fondly as his two brighteststudents engaged in a polemical discussion. The first presented his argu-ment with passionate conviction. The rabbi smiled approval. “That iscorrect.”

The other student argued the opposite, cogently and clearly. Therabbi smiled again. “That is correct.”

Dumbfounded, the students protested. “Rabbi, we can’t both beright!”

“That is correct,” said the wise old man.

Like the wise old rabbi, the authors are of two minds concerning themaking of a family therapist. Meyer Maskin, a brilliant and caustictraining analyst at the William Alanson White Institute, used to tellhis supervisees how once, when he wanted to build a summer house,he asked an architect to show him the plans of homes he had previ-ously designed. Then he went to see how they looked when they werefinished. Here Maskin would pause for dramatic effect. “Shouldn’t wetake an equally rigorous approach when we are searching for an ana-lyst? In other words, before we start the arduous psychological trek to-gether, shouldn’t we look at how a potential analyst has constructedher life? How well does she understand herself? What kind of spouseis she? Even more important, how well did she parent her children?”

An equally critical observer of clinicians, the family therapist JayHaley, would disagree with this point of view. Haley says that heknows many good people and excellent parents who are mediocre ormiserable therapists; he also knows good family therapists who havemade a mess of their personal lives. Neither life skills nor self-knowledge via psychoanalysis or psychotherapy improves the capacityof therapists to become better clinicians. Clinical skill, he would ob-serve, requires specific training in the art of therapy: how to plan, howto give directions, how to rearrange hierarchies. It can be achieved, hewould say, only via supervision of therapy itself. For Haley, to knowhow good a family therapist is, one would need to interview her previ-ous patients. Even a therapist’s written work, he would say, tells usonly about her writing skills, not about her therapeutic skills.

So here we find ourselves in a quandary because, as in the rabbi’sstory, the two sides absolutely disagree, and we agree with both of them. In previous writings, I (SM) have indicated how I respond tothe specific needs of patients by using different facets of myself. My

x PREFACE

experiential understanding of the pulls that the family exerts on meshapes my responses to them. This aspect of therapy certainly requiresself-knowledge. But Haley is right when he says that therapeutic re-sponses are not guided by self-knowledge but by knowledge of theprocesses of family functioning and the interventions directed towardchanging them.

To escape this paradox, a number of schools of family therapy re-quire their trainees to undergo psychotherapy while they are trainedin family therapy. In fact, this is a licensing requirement in some Eu-ropean countries. We remember the early strategies of Virginia Satiron family reconstruction and Murray Bowen sending his students tochange their relationships with their families of origin. Carl Whitakerused to have his students and their spouses in therapy as part of theirtraining. More recently, Harry Aponte, Maurizio Andolfi, and RussellHaber have developed supervisory techniques that aim at self-knowledge as therapists.

The supervision strategy with which we confront this paradox is tofocus on the therapist’s preferred style—that is, his or her use of a nar-row set of predictable responses under a variety of diverse circum-stances. One therapist may be very involved with content; another mayperceive behavior in the light of a particular ideology, such as femi-nism. Sometimes style relates to the therapist’s basic characterologicalresponses, such as conflict avoidance, a hierarchical stance, fear of con-frontation, an exclusive focus on emotions or on logic, or a preferencefor happy endings. But for the most part, the therapist’s style manifestsitself in elements that are less visible to the therapist himself, like fo-cusing on small details, remaining aloof, being indirect, talking toomuch, lecturing, or not owning one’s ideas.

Thus, two therapists with a similar understanding of a family situ-ation and the same therapeutic goal will respond to the family in twodifferent, idiosyncratic ways. This difference in style may have consid-erable effect on the course of therapy; some responses are better thanothers. Our approach to supervision therefore is to begin by workingwith the therapist to understand her preferred style. Which responsesin her repertoire does she use most frequently? We accept them. Theyare okay. Then we declare them wanting. The therapist’s style is allright as far as it goes, but it can be expanded. The therapist who focuseson content can learn to direct her attention to the transactions occur-ring between family members; the therapist who is captivated by thestory line can learn the art of discontinuous intervention.

Whatever we identify in the beginning becomes the point of depar-ture. We challenge the therapist to expand her repertoire, to be able torespond from a variety of perspectives in ways that are complementary

Preface xi

to the family’s needs. The goal is a clinician who can manipulate her-self on behalf of therapeutic change and nonetheless be spontaneous.

Carl Whitaker, who was a colorful, idiosyncratic therapist, commu-nicated in his teaching the need to take a variety of universal role func-tions while working with a family. He enjoyed telling stories aboutwhen he was a little “girl.” It is this freedom to be protean while re-maining true to yourself that we try to impart to our students.

Successful supervision results in a therapist who is different fromthe supervisor but also different from the person he was before the su-pervision. The trick is to respect the boundaries of the supervisee’sprivate life during the process of self-transformation.

About the Second Edition

While the overall organization of this edition of the book has changedlittle from that of the first edition, we have made substantial changes incontent, mostly in the form of additional new material.

Part I provides an overview of theories of family functioning andtherapy, including our own model of working with families, whichserves as the basis of our supervision of practicing therapists. In thissecond edition, we have included new case material in Chapter 2,which we believe better illustrates the impact of poverty and ethnicityon family functioning than did the material included in the first edi-tion. Chapter 5 is brand new, surveying developments in the field offamily therapy during the decade that has passed since the publicationof the first edition. The bulk of this chapter is devoted to the burgeon-ing trend toward evidence-based models of family treatment. Chapter6, which summarizes our own approach to family therapy, includes anew section detailing Minuchin’s recently developed Four-Step Modelfor family assessment.

The first part of the book was written jointly by the three authorslisted on the title page. The authorial voice throughout most of Part I is“we,” and refers to all three. However, from time to time, and especiallyin Chapter 6, the discussion focuses on the individual therapeutic or su-pervisory work done by Minuchin. Here, the authorial “I” refers to him.

Part II of the book represents a response to Haley’s suggestion thatthe way to know whether a therapist is successful is to ask the clientfamilies. Since this book is about supervision, we have solicited reac-tions not from families, but from supervisees. In an advanced trainingcourse with Minuchin, we asked eight supervisees to describe their ex-periences in supervision. The supervisees began their stories by de-scribing themselves as members of their families of origin. (Such anaccount was not part of their training course; it was assigned only for

xii PREFACE

the pupose of this book.) The supervisees then go on to talk about whatthey experienced as they presented cases to Minuchin and the traininggroup for supervision. The italic passages in this portion of the bookreflect Minuchin’s commentary on the supervisory process.

Since 10 years have elapsed since the supervisees wrote their orig-inal stories for this book, we have asked them to write postscripts forthis second edition, detailing how their reaction to the supervisory ex-perience might have changed over time, and how their current clinicalwork is, or is not, being influenced by the experience. In the Epilogue,Minuchin responds to these postscripts in epistolary form.

We hope that the two parts of this book—the theoretical and theexperiential—will convey the complex and rewarding process of mas-tering family therapy.

SALVADOR MINUCHIN

PART I

Families andFamily Therapy

3

Chapter 1

Family TherapyA Theoretical Dichotomy

MOTHER (eagerly): Do you want to tell him what you did?DAVID: Oh, yeah, my eye, I rubbed it a little. I didn’t have to. The urge

didn’t last that long.GIL (softly): David, where were your parents, just before the urge?

What were they doing?

The Wednesday class, behind the one-way mirror, is attentivelywatching Gil struggle with David’s family. David, 24 years old, hasspent the last year of his life on a psychiatric ward. When the compul-sive rubbing of his eye threatened to leave him blind, there seemed tobe no alternative to hospitalization. Gil was, at first, his individualtherapist, but for the past 4 months he has been working with Davidand his parents.

During these 4 months, Gil has been presenting videotapes of thetherapy to the group. Today for the first time we are observing the fam-ily session “live.” We feel as if we know these people well. We are fa-miliar with the parents’ hovering attention to David. Every detail of hisbehavior becomes invested with meaning and is a matter of concern tothem. He cannot hide.

The father, a figure in gray, seems hesitant, pleading to be useful.The mother’s round and jovial face seems always closer to David’sthan we, the group members, think necessary. David’s stumbling ex-planations are divided evenly between them; he tries first to satisfy hismother, then his father. It is clear his mission is to please.

Gil, a psychologist born and raised in the South, tends to relate topeople from a respectful distance. As a therapist, he has a preferencefor low-key interpretations delivered in a soft voice.

MINUCHIN (the supervisor, to the group): I think that Gil is telling themthat David’s rubbing of his eyes is triggered by the mother’s prox-imity. He is so respectful of the power of words that he thinks they

4 FAMILIES AND FAMILY THERAPY

got it. But they are on a different wavelength. Gil will need to learnto shout before they can hear him.

I have been working with Gil on his style with this family since thebeginning of the year, and while he has recognized the limitations ofhis style and seems invested in expanding his way of working, he haskept his narrow cognitive focus and his reliance on softly delivered in-terpretations. I decide to join Gil on the other side of the mirror and towork with him as a supervisor/cotherapist for a short while.

As I enter, Gil says simply “Dr. Minuchin.” I sit down. The familyknows that I have been supervising the therapy for the last few months.

MINUCHIN (to the father): If you want to help your son, you must keepyour wife from dealing with him like that. Talk to your wife.

FATHER: I can’t. There’s no talking to her.MINUCHIN (to David): Then you should continue blinding yourself.DAVID: I’m not going to blind myself.MINUCHIN: Why not? Good children do nice things like that for their

parents. Your father has decided that he cannot handle yourmother. She feels lonely and alone. You have decided to be a healer.So you will blind yourself to give her a job in life, to be a mother.

Later, in Chapter 11, Gil describes in detail his experience of beingsupervised by me in this case. In my introduction to Gil’s chapter, andin my comments on his narrative, I describe the thinking that led me tointervene in the consultation session in the way that was just de-scribed. The case of David and his family is such a fascinating one thatit would be tempting at this point to delve into the details of my super-vision of the case. Before beginning this exploration of family therapysupervision, however, a more general point must be made.

The way in which I intervened during the consultation session—infact, the way in which I supervise in general—is rooted in my vision ofthe therapeutic encounter. It is based on a particular understanding ofpeople and why they behave in the way that they do, how they change,and what kind of context invites change. This intimate connection be-tween one’s therapeutic vision and one’s way of doing supervision andtraining is not peculiar to structural family therapy. Since the field offamily therapy began, in every one of the so-called “schools” of familytherapy, how one supervises has been driven by how one sees therapy.

Thus, an exploration of family therapy supervision must beginwith a look at how family therapy is done. It must, however, be a lookthat sees through the welter of techniques in use in the field. Toground an exploration of supervision in a solid understanding of what

Family Therapy 5

happens in family therapy, we must penetrate to the thinking that un-derlies the techniques and discern the fundamental assumptions andvalues that give birth to techniques. When we look at the practice offamily therapy in this way, many of the apparent differences among the“schools” of family therapy disappear. As will soon be clear, however,what differences remain are crucial ones.

Going back to my supervision of Gil’s work with David’s family, itis important to note that my focus as a supervisor was based not somuch on family dynamics as it was on Gil’s therapeutic style. We thinkthat this focus on the person of the therapist is essential. Unfortu-nately, the literature of family therapy has all too often displayed amuch greater interest in therapeutic technique than it has in the thera-pist himself as an instrument of change. This division between thera-peutic techniques and the therapist’s use of self began to occur quiteearly in the development of the field. In part, this was simply an unin-tended by-product of family therapy’s historical need to differentiateitself from psychodynamic theories. Consider, for example, the psycho-dynamic concepts of transference and countertransference, conceptsthat very much involve the person of the therapist. The early theoristsof family therapy dismissed these concepts as irrelevant. Since the pa-tient’s parents and other family members were right there in the ther-apy room, it did not seem necessary to consider how the patient mightbe projecting feelings and fantasies associated with family membersonto the therapist. But with the dismissal of these concepts, the thera-pist as a person began to become invisible in the writings of the familytherapy pioneers. As the therapist disappeared, all that was left behindwas his or her techniques.

As the field developed, family therapists accepted, copied, andmodified techniques innovated by other practitioners. For example, JayHaley’s restraint of change reappeared in the Milan school’s notion ofparadox and counterparadox. Virginia Satir’s sculpting was taken overand modified in Peggy Papp’s technique of choreography. And thegenogram, developed by Bowen and Satir, became a common way foralmost all family therapists to map families.

Of course, in practice, the way in which therapists applied tech-niques was of concern for families, therapists, and supervisors. For themost part, however, this concern was not reflected in the literature ofthe field; at most it was an afterthought. For instance, in Families of theSlums (Minuchin, Montalvo, Guerney, Rosman, & Schumer, 1967) Iwrote:

The therapist’s choice of intervention is decidedly limited because hemust operate under the organizational demands of the family system.

6 FAMILIES AND FAMILY THERAPY

But this has the advantage that awareness of himself in the midst of these“system pulls” allows him to identify the areas of interaction which re-quire modification and the ways he may participate in them to changetheir outcome. . . . The therapist loses distance and is fully in when he en-ters the role of reciprocating the family members with complementaryresponses which tend to duplicate what they usually elicit from eachother. (p. 295)

This is a rather complex description of the process by which the thera-pist experiences and knows the family by using his awareness of self inthe therapeutic context. Nonetheless, the major focus of my early bookswas not on the therapist’s self, but on the techniques of influencingfamilies. As I focused on them (the families) rather than us (the thera-pists), the therapist as the carrier of techniques became universal,while families became increasingly idiosyncratic.

Another example of this process of the disappearance of the thera-pist can be seen in the way my concept of joining reappeared in modi-fied ways in the Milan school’s concept of positive connotation. InFamily Therapy Techniques (Minuchin & Fishman, 1981), I describedjoining in the following way:

The therapist is in the same boat with the family, but he must be thehelmsman. . . . What qualifications must he have? What can he use toguide the craft? . . . [He] brings an idiosyncratic style of contacting and atheoretical set. The family will need to accommodate to this package insome fashion or other and the therapist will need to accommodate tothem. (p. 29)

The overriding concept in joining had to do with two idiosyncraticsocial systems (the family and the therapist) accommodating to eachother.

When joining was transformed into positive connotation, it simplybecame a technique of responding to families:

The best known of these attempted solutions was undoubtedly the tacticwe called positive connotation, which implied not only abstaining fromcriticizing anyone in the family but also pointedly playing up everyone’scommendable behavior. . . . As we think back on it today, we note that theidea of positive connotation, originally designed as a means of guardingthe therapist against both counterproductive clashes with the family anddropouts . . . was a strategically f limsy device. . . . (Selvini-Palazzoli, Cirillo,Selvini, & Sorrentino, 1989, pp. 236–237; emphasis added)

The difference between these two concepts is not primarily at thelevel of content. A large part of joining does have to do with positively

Family Therapy 7

connoting family members’ way of being, though it is not limited tothat. But while joining acknowledges the therapist as an active, idio-syncratic therapeutic instrument, positive connotation sees her only asa passive, universal carrier of meaning and technique.

As we have noted, the disappearance of the person of the therapistfrom the family therapy literature can be partly attributed to the his-torical context in which family therapy developed. For a large segmentof the field, however, the disappearance of the therapist has been inten-tional rather than accidental, the result of deliberate theoretical choice.It is, in fact, one of the central contentions of this book that the field offamily therapy has organized itself over time into two camps, charac-terized by two very different views of the role that the therapist shouldplay as an instigator of change. We discuss later in the chapter the the-oretical concerns that have led some family therapists deliberately toseek a kind of invisibility in the therapy room. First, however, let us seewhat family therapy looks like when it is done by a member of thatgroup of practitioners who, in their practice if not always in their writ-ings, see the person of the therapist as the primary instrument ofchange in the therapeutic encounter. This kind of family therapy is ex-emplified in the following description of a session conducted by Vir-ginia Satir.

Activist Family Therapy

In the 1970s, the Philadelphia Child Guidance Clinic sponsored severalextremely interesting workshops in which two therapists would sepa-rately interview the same family on successive days. The sessions wereobserved from behind a one-way mirror and videotaped. (The secrecythat characterized psychoanalysis was one of the concepts againstwhich family therapy was in full revolt at the time.) The idea behindthe format was that since each therapist’s interventions would beguided by his theoretical premises, the audience could observe the waythese concepts about the nature of families and the process of changetook shape in the therapist’s style.

One of the first participants was Virginia Satir, who interviewed ablended family. The father and his 18-year-old daughter by his firstmarriage lived with his second wife and her 16-year-old daughter. His10-year-old son of the first marriage lived with his first wife. Bothfamilies had been in treatment for about a year because of disagree-ments about the boy. The father felt that his first wife was an unfitmother, and he had taken her to court to fight for custody. Their legalbattles were reflected in bitter and acrimonious arguments between

8 FAMILIES AND FAMILY THERAPY

the families. The daughter had not spoken to her mother in a year, andthe boy was having severe problems in school.

Satir was tall and blond, a goddess of a woman who filled a roomwith her presence. As she entered the interview room, she shook eachperson’s hand, seated herself comfortably, and asked the boy to go tothe blackboard and draw a genogram of the family. She chatted easily,asking questions and making personal comments: “I don’t know why Ican’t remember that name.” “When I feel this way . . . .” Within min-utes she had created an atmosphere of openness in which both sidesfelt free to talk. Clearly pro-everybody, Satir proceeded to engage eachfamily member, tracking the content of each exchange and punctuatingeverything with friendly comments.

Her remarks seemed random, but she had soon organized the fam-ily’s information into a unified narrative. She got the husband and hissecond wife to describe their style of resolving conflicts and askedthem to act out a fight for her. Then she created two family sculptures.She asked the boy to sit on his mother’s lap and asked his sister to siton his lap. She seated the other subsystem mirror-fashion, putting thesecond wife on her husband’s lap and her daughter on top of her. Thenshe asked the son to move out, leaving the 18-year-old daughter aloneon her mother’s lap. She moved a chair very close to the mother andasked the daughter to sit in it. Then, kneeling on the floor next to them,she encouraged the mother and daughter to describe their resentment,betrayal, loving, and longing. Through sympathy, teaching, and direc-tion, she moved the two women to express how much they missed eachother. Then she asked the ex-husband to sit with them. The sessionended with the possibility that these two families could reconnect inlove instead of conflict.

There is no way that a narrative can convey the very warm qualityof the session or the process by which Satir moved from what seemed arandom involvement with each individual to the reconciliation ofdaughter and mother. It was clear that her goal was connection. Shetargeted the areas of contact, using herself with such emotional prox-imity that it would have been quite difficult for the family members toresist her direction. Stylistically, one could argue that her level ofinvolvement was smothering and that her push for positive emotion in-appropriately overrode and suppressed the honest expression of con-flict. Nonetheless, in the space of 1 hour, she was able to help thefamily move away from a year of destructive interactions and begin aprocess of more cooperative parenting.

The therapy of Virginia Satir was nothing if not highly idiosyn-cratic. But in its very idiosyncrasy, it serves as a worthy exemplar of thework of the activist group of family therapists.

Family Therapy 9

A Dissenting View of Family Therapy

At the same time that Satir was developing her approach to family ther-apy, very different ideas were also being explored in the field. GregoryBateson, at the Mental Research Institute (MRI) in Palo Alto, wasbringing the combined sensibilities of an anthropologist and a cyber-netician to the endeavor of helping families. As an anthropologist, Bate-son was deeply and correctly concerned with the dangers of imposingone’s cultural values on another. He knew from history as well as fromtheory that in this domain, it is impossible to predict the direction ofchange; introduce any perturbation into a culture, however minute andwell intentioned, and from then on you have a bear by the tail. Bateson’sstrong aesthetic preference for letting things be is given endearing ex-pression in his “Metalogue: Why Do Things Get in a Muddle?”

DAUGHTER: Daddy, why do things get in a muddle?FATHER: What do you mean? Things? Muddle?DAUGHTER: Well, people spend a lot of time tidying things, but they

never seem to spend time muddling them. Things just seem to getin a muddle by themselves. And then people have to tidy them upagain.

FATHER: But do your things get in a muddle if you don’t touch them?DAUGHTER: No—not if nobody touches them. But if you touch them—

or if anybody touches them—they get in a muddle and it’s a worsemuddle if it isn’t me.

FATHER: Yes—that’s why I try to keep you from touching the thingson my desk. Because my things get in a worse muddle if they aretouched by somebody who isn’t me.

DAUGHTER: But do people always muddle other people’s things? Whydo they, Daddy? (Bateson, 1972, p. 3)

As a cybernetician, Bateson carried an epistemological outlookthat reinforced and amplified his aesthetic preference for lettingthings be. When cybernetics seeks to explain an event, it does notsearch for positive explanations of the event. Rather, it considers all thealternative events that could have happened and then asks, “Whydidn’t they happen?”

In cybernetic language, the course of events is said to be subject to re-straints, and it is assumed that, apart from such restraints, the pathwaysof change would be governed only by equality of probability . . . . The cy-bernetic method of negative explanation raises the question: Is there adifference between “being right” and “not being wrong”? (Bateson, 1972,pp. 399, 405)

10 FAMILIES AND FAMILY THERAPY

When Bateson’s aesthetic and intellectual sensibilities werebrought to bear on the task of helping families, the predictable resultwas an extreme concern on his part about introducing any change thatmight distort family balance in unpredictable ways. He rejected psy-choanalytic theory, but his posture during family interviews, as thedata-collecting anthropologist, mirrored the psychoanalytic concernfor avoiding intrusion into the patient’s psychological field. Thus,Bateson introduced a very different tradition into the field of familytherapy, a tradition of a cautious, restrained interviewer, who overtime became more focused on what not to do in therapy (“not beingwrong”) than on what should be done (“being right”).

The work of the MRI group, which included Virginia Satir amongits founders, started with the interventionist fervor of the time. Butlater, especially under the influence of Paul Watzlawick, the concernsraised by Bateson about the potentially disruptive aspects of interven-tion grew. Watzlawick taught that attempts at solutions are preciselywhat create human problems in the first place. Thus, therapy should bebrief and minimally interventive.

Bateson’s introduction of a neutral, reflective therapeutic stanceinstantly posed a conundrum for those family therapists who wishedto pursue this approach to doing therapy. How could the influence ofthe therapist in the session be controlled?

For the psychoanalyst, the tool for controlling countertransferen-tial responses was the self-awareness developed via the training analy-sis. No equivalent to the training analysis was available to the familytherapist. So those in the field who wished to pursue Bateson’s re-strained therapeutic posture had no choice but to create external con-trols on the therapist’s interventions. In this effort, the most ingeniousgroup was the Milan School, whose methods will be described in moredetail in Chapter 4. To control the therapist’s intrusiveness, they cre-ated the “therapeutic team” of observers behind the one-way mirror, towhom the therapist in the session was responsible. They changed the“I” of the therapist to the “we” of the team and worked to activate aprocess of change in family members when they were away from thesession and the therapist’s influence. The therapists saw themselves asobjective interveners at a distance, tossing psychological pebbles thatwould create ripples in the family.

Interventionist versus Restrained Therapy

Our look at how family therapy is done has revealed that throughoutits brief history, the field has been populated by two kinds of thera-pists. The difference between the groups involves the extent to which

Family Therapy 11

they advocate the therapist’s use of self as an instrument for producingchange. On one side is the interventionist therapist, who practices the“try, try again” active therapy of self-commitment that is a product ofthe 1960s, with all its optimism and energy, experimentalism, creativ-ity, and naivete:

FATHER: Jimmy is very, very wild. I can’t control him.THERAPIST: Ask Jimmy to bring his chair over here, and talk to him.

Jimmy, I would like you to listen to him. Then tell him what youthink. And Mother, don’t interrupt!

The therapist creates a transaction between father and son that allowsher to observe how they interact, in her presence, without themother’s monitoring. Her next intervention will be organized by whatshe observes.

On the other side is the restrained therapist:

FATHER: Jimmy is very, very wild. I can’t control him.THERAPIST: Why do you think that is?

The therapist may ask other questions, encouraging the explo-ration of meaning. She will be attentive and respectful, careful not toimpose her own biases on father and son. It is a therapy of minimalism.

The restrained therapist has sought intellectual justification for aminimalist therapeutic style from a number of sources. During the1980s, Bateson’s founding intellectual contribution was supple-mented with ideas imported from the work of the Chilean scientistsHumberto Maturana and Francisco Varela (1980). Their research haddemonstrated that an organism’s perception of the outside world islargely determined by its internal structure. Much was made in somecircles of an experiment in which a newt’s eye was rotated 180 de-grees. When a moving insect was placed in front of the newt, the newtjumped around and tried to pick it up as though the insect were be-hind the newt (Hoffman, 1985). The trifling objections on biologicalgrounds—that the mammalian eye, and brain for that matter, are of adifferent order than the reptilian—and on human grounds—thathuman beings and their interactions are not confined to questions ofneurobiology—did not deter some restrained therapists from theirtriumphal march to the logical conclusion: There is no objectivelyknowable “reality.” If each organism is primarily responsive to itsown internal structure, then no organism can directly bring aboutany given state of affairs in another. To practitioners of restrainedtherapy, a therapeutic corollary seemed self-evident: It is impossiblefor a therapist to produce specific targeted changes in a family. Thus,

12 FAMILIES AND FAMILY THERAPY

therapy should be noninterventionist, a simple conversation amongpeople.

In the 1990s, the restrained therapist turned to social construction-ism (Gergen, 1985) and to the postmodernism of Michel Foucault(1980) for support and inspiration. Social constructionism highlightsthe fact that knowledge is not a representation of external reality but aconsensus constructed by individuals who are “in language” together.Foucault’s postmodernism adds the observation that local conversa-tions are governed by larger sociocultural discourses that privilegecertain perspectives while submerging and marginalizing others.Under the influence of these schools of thought, the restrained thera-pist has come to focus on language and narrative. The therapist asks hisclients questions that provide them with the opportunity to reconsidermeanings and values that up until then they had considered as “given”and normative. The therapist thus creates a context in which clients areinvited to “re-story” their lives, throwing off, in the process, the op-pression of constraining cultural discourses.

We do not question the importance of social constructionism andpostmodernism for understanding social phenomena, but in our view,therapy should not be primarily an exercise in understanding, espe-cially the kind of abstract, academic understanding that is produced bypostmodernist analysis. Instead, therapy should be oriented toward ac-tion. It is a relatively brief, ad hoc arrangement between a family and atherapist, with the explicit goal of alleviating stress. To apply construc-tionist and postmodernist ideas in an unmodified fashion to such anarrangement appears to us to be an instance of what Bateson would calla category error, a misapplication of a concept from one level of abstrac-tion to another.

Nonetheless, the restrained therapist of today remains wary of ourbrand of therapeutic interventionism. Emphasizing the ways people aregoverned by, and limited to, the stories that they have coconstructed inconversation with others, the restrained therapist continues to call boththerapeutic expertise and norms into question. Harlene Anderson(1994) has described the shifting in the theoretical basis of therapy thataccompanies a constructionist practice:

From

Knowledge as objective andfixed—knower and knowledge asindependent

Language as representational,accurate picture of reality

To

Knowledge as socially createdand generative—interdependent

Language as the way weexperience reality, the way wegive meaning to it