Directive Family Therapy

Jay Haley, Madeleine Richeport-Haley

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136867378
• Edition: 1
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

Directive family therapy pioneer Jay Haley and Madeleine Richeport-Haley explain their innovative techniques for solving problems Directive Family Therapy is the final work of a widely recognized giant in the international family therapy field. This text is the pre-eminent state-of-the-art sourcebook on practical, innovative techniques to effectively solve problems throughout the life cycle stages. Directive family therapy pioneer Jay Haley, PhD(who passed away in 2007), and, Madeleine Richeport-Haley, PhD provide practitioners with creative directives to clearly identify problems, formulate well-designed treatment plans, and then successfully carry them out to achieve lasting therapeutic change. This essential text explores fascinating case studies illustrating the powerful, highly effective problem solving directives. The work is extensively referenced, and includes a full and complete bibliography of Haley's published works and a list of the authors' collaborative films. Directive Family Therapy presents highly instructive, revelatory stories about working with real life clients and provides dynamic, innovative, and oftentimes surprising solutions to a wide range of specifically detailed problems and clinical issues. All stages and issues in the life cycle are addressed, including birth, child development, raising children, problems in adolescence, becoming a couple, aging, and retirement. Also included is a detailed appendix containing a variety of poignant, insightful interviews featuring Haley's reflections on the early years of practice and the development of directive family therapy. Problem areas addressed in Directive Family Therapy include:

• firesetting
• bedwetting
• fear of dogs
• violent behavior
• teenage rebellion
• incest
• drugs
• panic attacks
• abuse
• fights within couple relationship
• eating disorders
• alcohol abuse
• affairs
• sexual shyness within a couple relationship
• shoplifting
• and more

Directive Family Therapy is invaluable for mental health professionals of every experience level, and is a useful family therapy resource for educators and students in MFT programs and psychology—and a fitting and poignant memoir to the work of a profoundly gifted family therapist.

Chapter 1

How to Be a Wise Child

Witnessing an infant waving an arm, one recognizes that he or she must learn this action. A child begins life as a helpless being. An infant who comes into the world has surprises waiting. Children are wise. They have to learn many complicated aspects of becoming human.

This is a more complex process than people realize, unless they find an infant who will teach them. As we learn from Dr. Milton H. Erickson, infants have the beginnings of sex drives, but they are not apprehensive about it. This chapter explores aspects of infant and adolescent biological and sexual development for the purpose of illustrating the process humans go through to learn to become fully functioning adults. It will also be useful in cases with men and women who are apprehensive about sex and want to do something about any malfunctioning. I (J. H.) was a student of Dr. Erickson before he was famous. These ideas were expressed in one of our audiotaped conversations (Haley & Richeport, 1991a). At the time and to this day I have never seen a better presentation of the infancy and development of human beings and the people involved with them. I memorized it and told it to many clients. It is unique because it is presented from the point of view of the infant. The original sequences and phrasing of Dr. Erickson's conversational style have been retained to demonstrate his ability to work on many therapeutic levels at once. Subheads have been added for clarity and the text of the monologue presented here is an abridged version of the original.

DEVELOPMENT OF THE CHILD

How are you going to have a normal, well-adjusted person, unless they can look at you, and at other things, with that same sense of self-confidence that the little baby does? The little baby knows that it's a nice baby, a good baby, a bright baby, an intelligent baby, a competent baby, isn't that right? And therefore it has a good opinion of itself. It knows it can pick up that toy and rattle it. Too many adults do not know that they can pick up that toy and rattle it. They're thinking what will other people think, what will they say, how do they feel about it. When a baby picks it up it rattles because it knows it's a good baby and it can make a good noise.

Now what I have to tell you already know—and yet you haven't organized it. In the first place, how does one learn things? The baby starts life in a certain position, arms flexed, hands closed, and it has to start from scratch to learn every possible thing. It's got no background, memory, or experience. So the baby flexes its arm; it does not extend its arm—it's quite a job to learn how to extend its arm. The flexor muscles get tired, and the extensor muscles take over and extend the arm, just to relieve the fatigue of the flexor muscles. The baby learns to extend its arm, to move the shoulder; it learns the elbow movements, shoulder movements first. Then it learns eventually by trial and error to open the hand. It can close it reflexively, but to open the hand deliberately. The last movement learned in the arm is of course the wrist movement. It learns the pronation and supination movements of the arm later as a deliberate thing. But that's a function of the use of the hand. The same way with the matter of eyesight. The baby has to look at this, look at that, and there is countless repetition of its looks. No matter how good a retina it has, it has to look at red and blue and green and yellow many times before it acquires the experience of yellowness or greenness. And it has to make many errors in the process of learning colors accurately. In all of its sensory experience, all of its motor experience, there's endless repetition. But the baby is under a handicap because its body is changing in size all the time. The mere fact that you've got a full complement of muscles, joints, bones, nerves, and organs doesn't mean anything. A perfectly developed person who sits down to a computer the first time doesn't know how to type, because they know nothing about the sequences and patterns of finger movements. Furthermore, they don't know finger sensations in typing. They have to learn that the little finger has to hit a key relatively harder than the four fingers in order to get an even touch. They learn an even touch on a typewriter by measuring the unevenness of the touch of the individual fingers, because there's different strength in the fingers. And so they use muscles to varying degrees to get that even touch. If you tried to learn typing and one day the typewriter keyboard was one size, and the next day it was another size, the next day it was another, it would be a fearful handicap. And any expert stenographer who sits down to a keyboard twice the usual size is an amateur. And yet the growing child has to learn how to put its hand to its mouth.

Now I think you probably know this matter of increment in stimulation. A baby learns to put its hand into its mouth. The arm grows longer, and when there is sufficient extension in the growth of the arm, then the baby can't put his hand in his mouth, the increment is so great. So he has to learn it all over again. And all the learning is in that pattern. People recognize that exercise is good for the muscles. Actually exercise is good for all forms of body behavior. It's tremendously important to hear a distant sound, a near sound, a sound up above, a sound below, behind, just to exercise the ears. The same is true of vision. One needs to exercise the eyes. When you actually recognize that, then you can recognize the tremendous importance of exercising the genitals, too. The little baby is exercising the eyes by looking at red, blue, yellow, and green repetitiously. And it needs to do it in a repetitious fashion. The baby is learning to recognize eyes, ears, nose, mouth, hair, but the parents throw a fit if it touches its genitals. Yet the genitals are as important as the eyes, and ears, and nose. You couldn't very well learn to type if, every time you touched the letter A or the letter B you got a frowning look and were made to feel guilty. You've got to learn the entire body if you're going to live in a normal way. The learning of the body means the learning of all parts of the body. You can't really learn to write with your right hand without learning in part how to write with your left hand. Nobody is ever trained to write with their feet, and yet any normal adult can put a pencil between his toes and scrawl his name better than he could the first time he tried to write his name with his right hand. Because there is a transfer of learning from one part of the body to another, certain parts of the body become dominant, but it's so tremendously important when you learn to write to learn something with your feet at the same time, a part of that writing. And you'll see the little child trying to write twist its mouth, wiggle its hand, squirm with its entire body, shuffle its feet, until it has learned to localize writing movements in the hand and the arm.

Learning Body Parts

Now a little baby hasn't learned where its ear is until it can reach up with its right hand and touch its right ear, reach up with its left hand and touch its left ear. But it still hasn't learned until it can take its left hand and touch its right hand, and then touch the left ear with the right hand. But it still hasn't learned where its ears are, and how the ears feel, until it can touch the opposite ear by reaching behind its head. Then and only then does a child really know where its ears are. And it has to learn the body in that particular fashion. By discovering all parts of its body.

How Does the Child Learn to Say “Mama”?

It accidentally makes the “Mama” noise and receives approval, but it's a chance thing. It utters more sounds and accidentally says “Mama” again. It gets rewarded by attention, but the child hasn't learned to say “Mama” until it says “Mama” in the bedroom, in the crib, on the floor, on top of the big bed, in the closet, in the hall, in the living room, in the kitchen, out on the front porch, out in the front yard, in every conceivable place. And the child says “Mama” indiscriminately to Mother, Father, Brother, Sister. It hasn't learned to say “Mama” until it says “Mama” to Mother and Mother alone. And then it has an utterly bewildering experience. The neighbor woman comes over with a baby the same age. They recognize each other as infants do. Each has learned to say “Mama” to Mother. And then they have the horrifyingly shocking experience to see this other good citizen saying “Mama” to the wrong person, and not until then have they really learned to whom to say “Mama.” And they've got to have control of the utterance “Mama” no matter where they are. And so it's a learning process, a repetitious process.

Now the child has to learn to urinate.

Toilet Training

Mother wants to toilet train the baby. What experience does the baby have? It doesn't even know what urination is; it doesn't even know what part of the body. Because a pat on the belly to a baby feels the same as a pat on the back, pat on the thigh, pat on the head. It hasn't got the experiential background to say “That was a pat on my abdomen.” When it gets a full bladder, reflexively it releases the sphincter. And the baby gets an experience of a warm, wet feeling without knowing what a warm, wet feeling is. But through repetition the child discovers that sooner or later, without a concept of time, that that warm, wet feeling is going to be followed by a cold wet feeling. Mother's tried to teach the baby toilet habits, but that's too soon. Because Baby can't really learn toilet habits until it completes that concept of learning. And when Baby is really ready to learn toilet habits, Baby's sitting on the living room floor. And all of a sudden Baby looks around with a wondering, questioning look. It has suddenly become aware of pelvic pressure. The intelligent mother says Baby is ready to wet and she rushes the baby into the bathroom. And the baby is ready to learn toilet habits. But not until the child learns that unlocated sensation of pelvic pressure can the child learn toilet habits. All right. Now all of this learning, whether it's visual, auditory, urinary, whatever it is, takes place in small fragments here and there in a mixed-up fashion. I'm trying to present it to you one idea at a time. Has the child learned to urinate by being placed on the toilet? It really hasn't. The child has the difficult task of learning to urinate by itself. So Mother has to teach it when it gets that pelvic pressure to pick up one foot and put it down, pick up the other foot and put it down, headed for the bathroom. And eventually the child learns that. At first the child does not allow sufficient time to get from the living room to the bathroom. Finally it learns that. Then it goes to the kitchen. It has to learn geography all over again; the kitchen is further away than the living room. But the child finally masters that, then it goes out in the backyard and arrives at the bathroom too late; it wets its pants—it didn't know about geographical distance and the time involved. Finally it learns to allow sufficient time to get to the bathroom. And it rushes from the backyard into the bathroom in adequate time, and some confounded adult is in there. And the child wets its pants not because it resents the adult being there, but because the allowance of time is insufficient. And so the child wets its pants. It's had a tremendously important elementary lesson, and we all have to learn things at an elementary level. The child discovers the adult is in the bathroom, wets its pants, has received an elementary lesson, a profoundly important elementary lesson, that is, in your own physiological functioning you've got to respect the physiological functioning of other people. It's utterly, completely necessary for that fundamental lesson to be learned. And yet what do mothers do? They spank the child because it wets its pants, and interfere with the learning of that lesson. And yet the child eventually learns to allow for the bathroom to be occupied. And then it really has a consideration, but not an intellectually formulated conception of the rights and privileges and needs of others. One item I omitted concerns the little boy who has learned toilet habits; he allows plenty of time for distance, for the bathroom being occupied, and Sunday morning his mother dresses him up in a brand-new suit. And then she hurriedly dresses, and the son wets his pants. And the reason is not anger toward the mother or anything of that sort; he doesn't know where his penis is in relationship to his new suit. It's the first time he's had it on. And he's as helpless as you are when you borrow a friend's car, different model, different make, different dashboard, and you're driving along, and finally you discover it's time to turn on the lights. Now where, where is that light button? You hunt and hunt and hunt. Not because you want to drive recklessly without lights, but because you don't know where the light button is. The little boy in a brand-new suit has not explored it, and his mother doesn't want wet pants. She'd better send him to the toilet right away and tell him to try to urinate, and thus he discovers relative positions, and then when he has to urinate he's already explored it, and he doesn't wet his pants. And the spanking he got for wetting his pants was his mother's oversight, not his antagonism because she's taken away his old suit and forced him into a new suit; he's just unfamiliar. But the child hasn't really learned to urinate because urination is something that's not only going to occur in the bathroom, it's got to occur in other parts of the world. At first the little boy—and I use a little boy because that's easier to visualize and to understand—has been toilet trained; he wants to stand up and make bubbles like Daddy. He stands up there bravely and sprays the bathroom. Until he learns to direct the stream of urine into the toilet bowl, then he can make bubbles like Daddy, but there's more involved there. He's learned a fundamental, elementary lesson in controlling the direction and the use of his penis. And it's a very simple, elementary level, but he'd better learn how to direct the use of his penis at that simple level that he can understand. When he can direct it into the toilet bowl and use it for the pleasurable purpose of creating bubbles like Daddy. Then the next step the child has to learn is, you urinate in the toilet bowl—but the boy if he is ever going to mature has got to be able to urinate out in the backyard, he's got to urinate on the tree, the flower bed, the lawn mower, the dog, the cat, through a hole in the fence. In other words, as far as he can conceive of the world he's got to be able to urinate—in any part of the world where he needs to. And so he tries it out, just as the baby tries out saying “Mama” in the closet, under the bed, on top of a chair, behind the davenport, in order to have control of the utterance of “Mama.” The little boy explores the external world. But that fundamental learning that's so important. What does a boy have to do? He has to be able to use his penis in the outside world, not just in the parental home. He's got to have a sense of freedom, a sense of mastery, a sense of confidence in his penis.

SEXUAL PLEASURE

All right. The little boy ought to be proud of his penis when he urinates on the dog, on the tree, on the lawn mower, the flower bed; he can really use that organ of his. And to put it through a hole in the fence and urinate through it. He doesn't really know what he's doing, but at a very elementary level he's learning to put his penis someplace and derive satisfaction, comfort, and pleasure. He can put it in a bottle, he can put it in a tin can, there's no way of explaining anything to him at his age, anything at all about ejaculation or a vagina. That's way beyond his powers of comprehension, just as much as you do not teach cube root to the kindergarten child who's trying to master one plus one. It's just plain idiotic to teach that child struggling with one and one and two and two, what cube root is.

All right. I had a delightful experience on one occasion with one of my sons. He was being undressed to go to bed, and in the nude he started racing around the room. And in doing so he happened in swinging his arms to strike himself on the buttocks. And he stopped and looked around to see who was behind him, who had hit him. He looked puzzled, but with the short attention span of infancy, he soon lost interest in that and continued racing. So every night I had him in the nude racing around. He slapped his fanny again and stopped to look. Then one night it happened again and he sat down and examined the back of his calves. He looked at the front of his legs, then he twisted his body so he could see the back of his calves, then he felt on the back of his thighs, and tried to see them. The next night—it was a rather orderly progression—he slapped his fanny, he sat down, he examined the calves, the front of his legs, the front of his thighs, the back of his thighs, his fanny, and he felt the lumbar region of his back. Lost interest. The next night he did the same thing, and reached up in back of his shoulders and happened to touch the back of his head. A dawning comprehension. He had known for a long time that he had a back of his head, that the back of his head was behind his eyes, that he couldn't see, therefore this was a part of his body he could feel but not see, and then he felt of his shoulders, felt of his back, felt of his fanny, and then looked at the back of his calves again. Then he knew that this body of his was not only a body he could see and feel, but also a body he could feel and not see. And that dawning comprehension, and he really felt of his body, front and back, then he went and got his footstool, put it in the middle of the room, went to the other side of the room and backed up. He knew where his fanny was and he sat squarely on the stool, instead of sitting on it too soon, off to one side, or too far over. He knew where his fanny was, he could aim it. One of the most beautiful demonstrations of the verification that he knew where that part of his body that he could feel and not see but still could use accurately. And you watch little children as they learn how to sit on a stool, and how they feel of their bottom, and try to recognize it as the part you feel but don't see, and it differs so much from the part you feel and see. And a little bit later we gave Robert a taste of a new food. He didn't know whether he liked it. So he took another taste—and stood up to taste it. Took another, and lay down on the floor to taste it. Then he shut one eye and tasted it, went out to the living room and tasted it there. Went out on the back porch and tasted it there. He tasted it in all conceivable situations and wound up by deciding he really liked it. But it was such a laborious, but comprehensive way of learning to like it. Lying on his belly, lying on his back, eyes shut, one eye shut, and tasting it, a thoroughly searching way of tasting a food.

Self-Touching

Now when it comes to becoming aware of the genitals, the child plays with his genitals and his big toes and his ear and his nose indiscriminately. I like to simplify it for patients by stating that there are three sets of nerves to the penis, then I illustrate that they have one kind of feeling in their scalp, and they test it this way (with a pencil), not with their fingertips because then they get confused with the fingertips and the scalp feeling, then they touch the eyeball, another sensation, they touch the tongue, or the lip. It's all touch, it's different sensations. They can look at red, that's one sensation, yellow, that's another sensation, the paper is identical. But the quality of the color is different. That there are three sets of nerves to the penis, one set for the skin, one set for the shaft, and one for the glans penis. And of course neurologically speaking that is correct. But it's much more involved than that; that's only a simplification. The child better learn all the sensations of the skin of the penis, because the pronouncement “I now pronounce you man and wife” doesn't tell him anything at all about the skin of the penis sensations. “I pronounce you graduate, therefore you can take this computer, you've got a full complement of nerves and muscles and joints, and you can type.” No. It doesn't work. You have to learn. So the child plays with his penis. He plays with his big toe in order to find out where it really is, and to tell the difference between the right big toe and the left big toe. He has to learn how to get an erection, how to lose it, just as the newlywed had to learn when and how to get an erection. So the little boy plays with his penis. Little children can be born with an erection, it serves no use. The little boy in the boy's camp, he's a pain in the neck to the counselor, he gets a full bladder, he gets an erection, he can't urinate. And the counselor wearily puts him back to bed and wishes the little boy would grow up. The boy has to learn the skin of the penis, he has to learn the shaft, the head of the penis. And go through as much exploratory activity with his genitals as he does with his eyes and ears. Then he has to learn that he can get an erection, he's got to learn how to lose it, his span of attention is short, he starts it and doesn't finish it, but he has to keep on repeating that behavior until finally he can actually get an erection and then lose interest and lose it, and then get it back, and then lose it again. He's got to learn the difference between a flaccid penis and the skin sensations then, a semi-erect penis and the skin sensations at that stage, and the skin sensations at full erection. And the sensations of the shaft of the penis, very similarly. Because what does the psychiatrist get in his office: the man who is impotent, psychologically impotent, and he doesn't know the feeling of the skin of the penis, he doesn't know the feelings of the shaft, he doesn't know the feeling of the head of the penis. Is he trying to spite his mother, has he...