Harvard university press, cambridge, massachusetts




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Fig. 41 -~- becomes -

M D2 D1 D2

Accordingly, he follows the strategy of concentrating on the step­mother, eliciting her comments, responding respectfully to her meager inputs, and stating that she is the key to change in the family. This reinforces and increases her activity in the sessions. The therapist forms a coalition with her, saying that her acceptance of the man's children is vital to the family and a meaningful thing for the marriage. But he questions her acceptance of the ghost of the first wife her husband is bringing into their household. The second wife must help her husband exorcise this ghost. The father is attacked for failing to recognize that his daughter is a teenager, not a peer with whom it is appropriate to enter into power struggles. He is also told to realize that she is a person in her own right, not an extension of her mother. The coalition of therapist, wife, and children transforms the family, transitionally making the husband the deviant and freeing the daugh­ter.

This kind of treatment, which focuses on how people can affect and help each other, characterizes the therapist who regards the family as the matrix of healing. The goal is mutual accommodation and support. The stepmother, a wife who has always been afraid to challenge her

The Family in Therapy

husband, learns from her young stepdaughter. And while the step­mother is learning from the girl how to challenge, the girl is learning from her stepmother how to retreat.

MOVEMENT IN THERAPY

People's experiences change as their positions relative to one another are transformed. But the question arises as to why family members accept repositioning, and why the transformations are maintained when the therapist is no longer part of the unit. The family comes into therapy asking the therapist only to alleviate the presenting problem. The wonder is that its members then allow and assimilate the therapist's probes, his challenges, and his insistence on change.

Like all therapists, the family therapist challenges people's percep­tions of reality. He conveys to a family member that his experiences are questionable, because the therapist knows that reality is more complex. He erodes each family member's certainty of the validity of his experience. This is not a confrontation technique. Rather, the therapist supports the family members, but suggests that there is something beyond what they have perceived. In effect, he is saying "yes, but..." or "yes, and ..."

He must convince the family members that his "yes, but" or "yes, and" suggestions are derived from their own natures. His position of doubt must be supported by statements that the family members find correct on the basis of their own previous experiences. Although he challenges them on grounds that he can see beyond what they can, he must be able to hook in to alternative possibilities of experience, or alternative codes, already available to family members. What he poses must be a part of the family member's existing repertory.

For example, a wife makes an appointment for therapy because her husband has personal problems and also has great difficulty relating to their two sons. In the first session, the therapist sees the spouses alone. The husband says that he is the member of the family who has the problems. He describes himself as intellectual and logical. Because he is logical, he is sure that he is right; therefore, he tends to be authoritarian.

The therapist interrupts to say that a man who is so concerned with logic and correctness must often be frustrated in life. He criticizes the man for never allowing his wife to perceive the depression he must feel and never allowing her to help him. By this means the therapist is blocking a well-oiled but dysfunctional relationship in terms of an

Families and Family Therapy

expanded reality. His observation feels right to the man, who acknowl­edges his depression, and also fits the woman's never-expressed wish for an opportunity to support her husband. Both spouses experience the therapist's challenging, change-requiring input as familiar and welcome, because it recognizes the woman's felt needs and suggests some alternatives that are available to the man. The therapist then assigns a task based on his "yes, but." Under specified circumstances, when the wife feels her husband is wrong, she is nevertheless to side with him against the children.

The parents bring the children to the next session. The adults have performed the assigned task and feel closer. The husband believes that his wife supports him, and she is gratified by the increased sensitivity and decreased authoritarianism he has displayed in response to her support.

When the entire family is seen in therapy, it becomes clear that the children and mother are in a coalition which has isolated the father, making him peripheral and leaving too much of the socialization process to the mother. The children act as a rescue squad. When father sets rules, he does so in a pompous, ex cathedra manner, which makes the mother feel frustrated and helpless. The children begin to misbehave in ways that deflect their father's wrath to them. The younger child is particularly expert at this, and the relationship between him and his father is particularly tense.

The therapist's tactics are to break up the coalition of mother and children, clarifying the boundary around the spouse subsystem and increasing the proximity of husband and wife and of father and children. Accordingly, his strategems must support the father, even though he disagrees with him. He therefore assigns a task that will bring the father and younger son together, excluding the mother. This task also confirms the father in his evident skills of logical thinking and detached observation of behavior, but now directs these skills positively toward a son whom he has always regarded as irritating. The father is to meet with the son at least three times during the week for a period of no longer than one hour. During this period, he is to use his capacity for clear observation and analysis by studying his son, so that during the next session he can describe the son's particular characteristics to the therapist. In this way, the therapist is brought into the contact between father and son as a distant observer. The father, who has always related to this child with impulsive, deroga­tory, controlling movements, will feel the therapist encouraging him

The Family in Therapy

to use his logical skills in relating to his son, inhibiting his impulsive­ness. The mother, who has been stressed by her exclusion from this interaction, will nevertheless feel supported in an important area—her wish that her husband become a good father.

The father, mother, and son are all repositioned by the therapist's interventions. Originally they accepted these position changes because the therapist offered them alternatives within their range and held out a promise of more satisfactory arrangements. The family transforma­tion is maintained when the therapist is not there because new dynamics among the family members have been activated by the transformation, and the new transactional patterns are supported by them. The new transactional patterns thus tend toward self-mainten­ance.

Patients move for three reasons. First, they are challenged in their perception of their reality. Second, they are given alternative possi­bilities that make sense to them. And third, once they have tried out the alternative transactional patterns, new relationships appear that are self-reinforcing.

THE ROAD IS HOW YOU WALK IT

The concept of transformation deals with large movements in therapy, which take place over time. The therapist must know how to map his goals. But he must also know how to facilitate the small movements that carry the family toward those goals. He must help them in such a way that they are not threatened by major disloca­tions. A person's ability to move from one circumstance to another depends on the support he receives; he will not move toward the unknown in a situation of danger. Therefore, it is vital to provide systems of support within the family to facilitate the movement from one position to another.

Therapeutic contact occurs on a level of interpersonal immediacy within a specific context. As the poet Jimenez wrote, "the road is not the road, the road is how you walk it." The content of a session is dependent on many idiosyncratic factors, such as the family's own transactional style and the therapist's personality. It is not surprising, therefore, that therapeutic descriptions, seeking to generalize, discuss techniques of treatment in isolation. But therapeutic content relates closely to the current life experience of a family. The family dynamics and structure are conveyed by the content of the communications among its members as well as by the order of those communications.

Families and Family Therapy

The content of a session is also influenced by the therapist's input. Two therapists might arrive at basically the same goals and tactics for a family, but the means to those goals would differ markedly because the therapists' styles, as the product of their own life experiences, are different.

For example, my style is partly a product of a childhood spent in an enmeshed family with forty aunts and uncles and roughly two hundred cousins, all of whom formed, to one degree or another, a close family network. My home town in rural Argentina, with only one main street, called "Main Street Number Eleven," had a popula­tion of four thousand. My grandparents, two uncles, a cousin, and their families lived on our block. Like an inhabitant of Chinatown, when I walked the street, I felt a hundred cousins were watching me.2 Thus, I had to learn as a child to feel comfortable in situations of proximity, yet to disengage sufficiently to protect my individuality.

As a young professional, I tended to empathize with children and to blame their parents. After I was married, had children of my own, and was making the mistakes that parents inevitably make, I began to understand parents and to sympathize with them. My life both in Israel, where I worked with Jewish children from many cultural backgrounds, and in the United States, where I worked with black and Puerto Rican families, sensitized me to the universality of human phenomena, as well as to the different ways in which specific cultures prescribe a person's response to these phenomena. I became particular­ly aware of the manner in which societies coerce their underdogs.

Through the years, I have had a number of successes and made innumerable blunders, which have given me a sense of competence and authority. In my worst moments, this sense of achievement expresses itself in an authoritarian stance, and at other times it allows me to operate as an expert. In the measure to which I have learned to accept myself and to recognize areas in which I will never change, I have developed a sense of respect for the diversity of people's approaches to human problems.

My therapeutic style is organized along two parameters: how to preserve individuation and how to support mutuality. I am always concerned with preserving the boundaries that define individual identity. I do not let one family member talk about others who are present in a session. This rule can be brought alive by telling a family member, "He is taking your voice." I often separate people who are sitting together, and may gesture like a traffic policeman to block

The Family in Therapy

interruptions or inappropriate requests for confirmation. I tend to discourage the use of one family member as the repository for others' memories. I approve descriptions of competence and encourage family members to reward any competence that is displayed in a session. I am generous with positive statements about individual characteristics, clothing, a well-turned phrase, or a creative perception. I encourage and join family underdogs, supporting them so that they can win acceptance and change their position. In particular, I support the struggle of growing children for age-appropriate independence. It is often possible to state a problem in this area in terms of comparative ages: "Sometimes you act like a six-year-old, and sometimes you act like a real seventeen-year-old." This formulation becomes a tool for encouraging the development of "seventeen-year-old" behavior.

In encouraging mutuality, my best technique is to display a sense of humor and a general acceptance of the foibles of humans. I tend to challenge the existence of an "I" without a "you." Instead of telling a family member to change, I tell another member, who has a significant complementary relationship with the first, to help the first to change because the first cannot do it alone. This tactic utilizes the power of the family's own system of mutual constraints, which make it difficult for one individual to move without support and complementarity from the others. In effect, I turn other family members into my cotherapists, making of the larger unit the matrix for healing. I avoid making individual interpretations. When a husband is overcontroiling, for example, I may challenge the wife for encouraging her husband's dominance.

I approach family conflicts through sequential interpretations, so that the same pattern is highlighted from different points of view. For instance, in a situation in which a fourteen-year-old child is having difficulties in school and his parents are in conflict about how to deal with this, I might make three interventions. Joining the husband, I would say, "A coalition between your wife and your son is making you helpless." Joining the wife, I would say, "The inability of your husband and son to resolve conflicts is overburdening you, making you responsible for taking care of both of them." Joining the son, I would say, "Your father and mother are arguing about your difficul­ties in school without giving you any chance to participate. They are keeping you younger than you are." I then ask them to enact a change in the session.

In general, instead of letting people talk about past events, I tend to

Families and Family Therapy

give situations immediacy by bringing them right into the session. For instance, if I am working with an anorectic patient, I eat with the family. If spouses talk about a conflict, I ask them to enact it. I use space to express proximity and distance, asking people to move about as a way of facilitating or blocking communication and affect.

I have learned to disengage myself and to direct the family members to play out their own drama while I am observing. I am spontaneous with interventions, having learned to trust my responses to families. But I continuously observe the order and rhythm of family com­munications, making conscious decisions about when to talk to whom.

As a therapist, I tend to act like a distant relative. I like to tell anecdotes about my own experiences and thinking, and to include things I have read or heard that are relevant to the particular family. I try to assimilate the family's language and to build metaphors using the family's language and myths. These methods telescope time, investing an encounter between strangers with the affect of an encounter between old acquaintances. They are accommodation tech­niques, which are vital to the process of joining.

Forming the Therapeutic System

The therapist's methods of creating a therapeutic system and positioning himself as its leader are known as joining operations. These are the underpinnings of therapy. Unless the therapist can join the family and establish a therapeutic system, restructuring cannot occur, and any attempt to achieve the therapeutic goals will fail.

JOINING AND ACCOMMODATION

Joining and accommodation are two ways of describing the same process. Joining is used when emphasizing actions of the therapist aimed directly at relating to family members or the family system. Accommodation is used when the emphasis is on the therapist's adjustments of himself in order to achieve joining. To join a family system, the therapist must accept the family's organization and style and blend with them. He must experience the family's transactional patterns and the strength of those patterns. That is, he should feel a family member's pain at being excluded or scapegoated, and his pleasure at being loved, depended on, or otherwise confirmed within the family. The therapist recognizes the predominance of certain family themes and participates with family members in their explora­tion. He has to follow their path of communication, discovering which ones are open, which are partly closed, and which are entirely blocked. When he pushes beyond the family thresholds, he will be
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