Family-Of-Origin Therapy
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Family-Of-Origin Therapy

An Intergenerational Approach

James L. Framo

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eBook - ePub

Family-Of-Origin Therapy

An Intergenerational Approach

James L. Framo

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About This Book

Considers the family-of-origin approach to the psychiatric counselling of adults in marital, family and individual therapy. The text discusses theoretical and clinical implications and provides three case studies to illustrate the application of this method.

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Information

Publisher
Routledge
Year
2013
ISBN
9781134851690

1

Introduction: An Overview

In this volume I will discuss what I consider to be the most important aspect of my work—involvement of the family of origin in the therapy I do with adults in marital, family, and individual therapy. My 35 years of experience in working with couples and families has led me in that direction, and since first publishing on this subject (Framo, 1976), I have conducted many more family-of-origin sessions. This family-of-origin procedure, which has been fine-tuned and has undergone important modifications over the years, will be described in such detail that others who wish to try this method will have adequate guidelines. In response to the many inquiries I have received about my intergenerational method, I will present as clearly as possible, with clinical examples, what I usually do in working with adults and their families of origin.
Repeated experience with this family-of-origin method has convinced me of the power of the approach in producing change, although I have a more sober appreciation of the limitations of the method, the precautions that must be taken, and the formidable technical difficulties involved. It is not an easy kind of procedure to do and it certainly does not always work. On the other hand, I believe that one session of an adult with his/her parents and brothers and sisters, conducted in this special kind of way, can have more beneficial therapeutic effects than the benefits derived from the entire length of a course of psychotherapy. Aside from the clinical validity of this intergenerational approach, a systematic research study on a follow-up of partners and their families of origin whom I had seen in the past presented data-based evidence of the effectiveness of this method (Baker, 1982). The method is considered a general one, not just applicable to people in marital and family therapy, but to those in individual therapy as well—indeed to all adults who need to sort out mixed feelings about parents and siblings.
This family-of-origin method is foundational and basic to all other therapies I do—individual, family (Framo, 1965a), marital (Framo 1978b, 1980, 1981), couples groups (Framo, 1973), and divorce therapy (Framo, 1978a). My book of” collected papers contains the foregoing papers (Framo, 1982).
Even though I have the reputation for doing long-term therapy, family-of-origin therapy could be regarded as the ultimate brief therapy, in that the method involves approximately four clinical hours with the family. Ideally, the family-of-origin sessions are most generative when integrated with ongoing psychotherapy, but the family-of-origin work can stand on its own as a meaningful therapeutic experience.
Utilizing family of origin as a resource in marital, family, and individual therapy is the logical outcome and clinical application of the conceptual formulation that hidden transgenerational forces exercise critical influence on present-day intimate relationships (Framo, 1970). That is, current marital, parenting, and personal difficulties are viewed, basically, as reparative efforts to correct, master, defend against, live through, or cancel out old, disturbing relationship paradigms from the original family. In their choices of intimate relationships people attempt to make interpersonal resolutions of intrapsychic conflicts.
Most people do not see their spouses, children, or intimate partners as they really are since old ghosts stand in the way; the current significant others are shadowy representatives of past figures and are responded to as if they were split-off aspects of the self. When clients are prepared to deal face-to-face with the critical, heretofore avoided issues with parents and brothers and sisters, taking the problems back to where they began, they can clear away some of the filters and cobwebs that exist between them and their intimate others. Most people, for years, have been telling friends, therapists, spouses, and Dear Abby all the things they should have been telling their parents and siblings, the people most concerned. Furthermore, in family-of-origin sessions past bitterness toward parents and siblings can be dissipated, and mothers and fathers can be perceived as real people. By having the opportunity to come to terms with parents before they die, these clients do not have to spend their lives expiating guilt.

CATEGORIES OF CLIENTS WHO HAVE FAMILY-OF-ORIGIN SESSIONS

There are two general categories of clients for whom I conduct family-of-origin sessions: those clients who are engaged in ongoing therapy with me, and those who are not regular clients. Those clients who are engaged in ongoing therapy with me fall into one of four therapy contexts: (1) family therapy; (2) marital or divorce therapy; (3) couples group therapy; and (4) individual therapy. Although it is only individuals who have sessions with their families of origin, the therapy contract in this first general category begins as marital, family, or individual therapy.

Clients in Ongoing Therapy with Me

The family therapy context. When the family presents a child as the problem, I work with the whole family, or subgroups of the family, until the symptomatic child has been defocused and the symptoms have either disappeared or have been alleviated. Then, if the parents are motivated, I will work with their marital relationship, since I view most children's symptoms as a metaphor for the parent's marriage (Framo, 1975). Some of these parents, who originally came to therapy out of concern for a child, become interested in working out some of their own internal issues with their family of origin, especially when they recognize that they are repeating with their own children their parents’ templates of parenting.
The marital or divorce therapy context. The couples that I see who request help for marital problems either do not have children or do not present their children as the problem.* I almost always treat partners together, and only under rare circumstances will I work with one person who has marital problems (for example, when one partner absolutely refuses to come to therapy and the motivated partner wants help in dealing with the marital situation). Consistent with my conceptual view that internalized conflicts from past family relationships are being lived through the present marital relationship (Framo, 1970), the large majority of my clients who have family-of-origin sessions arise out of initial work with the partners seen conjointly. That is, most family-of-origin sessions originate from the marital therapy context.
Some partners who originally present for marital therapy come to recognize that they are emotionally allergic to each other, and at that point, the therapy goals shift to that of divorce therapy—ending the relationship constructively so that the destructive consequences and pain of divorce are minimized and fairness for all is maximized.* Family-of-origin sessions with this population can help the partners discover, among other things, whether their divorce represents the completion of an old, incomplete divorce from the parents. These meetings also give the family of origin the opportunity to attend to the fallout from the divorce (e.g., concern of grandparents that they might be cut off from their grandchildren).
Couples group therapy. Perhaps the best context for motivating clients to bring in their parents and siblings for sessions is a couples group. The group process and sharing that occur in these groups eases the dread most people have about having family-of-origin sessions. (The family-of-origin sessions are held separately from the group, of course.) Couples group therapy is a powerful form of treatment in its own right for couples’ relationship problems, but it is especially productive as a means of preparing clients for the family-of-origin sessions. The particular method I use for conducting couples groups is described in more detail in the chapter on Early Stages of Family-of-Origin Therapy and in a prior publication (Framo, 1973).
Individual therapy. Although early in my career as a psychotherapist I did a lot of individual therapy (and group therapy), after I became a family therapist I stopped seeing individuals and only dealt with relationships in vivo. In recent years I have begun again to see individuals; having had experience treating couples and families, however, I work with individuals differently than I did before the family therapy experience—that is, I do family-oriented individual therapy. Some individuals, usually single adults, start therapy because they have insoluble intrapsychic conflicts and are symptomatic (suffering from depression, anxiety attacks, psychosomatic disorders, addictions, etc). Others begin individual therapy for a variety of relationship problems and are unable or unwilling to involve their intimates in treatment. I convert most individual cases into family cases, orienting the therapy toward exploration of their family-of-origin experiences, which usually leads to actually having sessions with the original family.

Clients Not in Ongoing Therapy with Me

The second general category of clients for whom family-of-origin consultations are indicated are those who are not in ongoing therapy with me. These clients come from three sources: (1) consultations done at the behest of out-of-town individuals; (2) parents who request sessions with their adult children; and (3) clients referred for consultations by other therapists.
Consultations done at the behest oj out-of-town individuals. After my family-of-origin work became known, I began to get requests from individuals all around the country, mostly family therapists, for family-of-origin consultations. These individuals are strongly motivated to work on the important issues with their original family; they go to great lengths to gather family members together and bring them in, sometimes from long distances. They usually have overt and secret agendas, often having to do with saving themselves or others.
Parents who request sessions with their adult children. Although most requests by individuals for family-of-origin consultations are initiated by adult children who want to resolve contlicts with parents and siblings (or wish to get closer or more distant), occasionally a request comes from the older generation. Sometimes mothers or fathers, or even both parents, have gotten to a stage in their lives where they want to settle important matters with their adult children before they (the parents) die.
Clients referred for consultation by other therapists. There are numerous instances where psychotherapists, working with a particular client, think, “This client really has to work something out directly with his/her mother (father, brother, sister) if there's going to be any progress in this case.” Some of these therapists, being familiar with my specialization in this modality, have referred such clients to me for a one-shot family-of-origin consultation. Most of these clients are in individual therapy, but some are in other forms of therapy. These clients are seen for a preparation session (getting a family history, coming up with an agenda), are seen with their family of origin for two 2-hour sessions, are seen for a follow-up session, and are then returned to the referring therapist. These consultations usually help overcome impasses and move forward their ongoing therapy. Some of these clients, with the family's permission, play the tapes of the family-of-origin sessions for their therapists.

IS THIS INTERGENERATIONAL PROCEDURE THERAPY?

Throughout this book I use the expression “family-of-origin therapy,” but I do not consider the intergenerational method described herein as a form of psychotherapy in the usual sense of the word, although the procedure certainly has therapeutic effects. Conventional psychotherapy implies that a client (couple, family) voluntarily enters into an implicit contract in order to get help for a problem, whereas when a family of origin agrees to a client's invitation to attend sessions, they do not typically come in as patients consciously seeking help. There are, to be sure, therapeutic consequences of family-of-origin work, beginning when clients get past their inherent fear and ask their parents and siblings to come in for sessions, continuing throughout the preparation process, proceeding through the two 2-hour family-of-origin sessions proper, and lasting long after the sessions are over.
Consider this aspect of the innate nature of family life: Families can provide the deepest satisfactions of living: unreserved and unconditional love; gratifying bonding; measureless sacrifice; enduring dependability; compassionate belonging; the joys and warmth of family holidays, dinners and vacations; the fun and play; the give and take; and knowing your family is always there when needed. Still, the hurts and damage that family members can inflict upon one another are infinite: scapegoating; humiliation and shaming; parentif ication; crazy-making; physical, sexual, and psychological abuse; cruel rejections; lies and deceit; and the manifold outrages against the human spirit.
During family-of-origin sessions, as the old family ways are reex-perienced, as the family stories unfold (Stone, 1989), and as the positive and negative memories and feelings are stimulated, the family members start to deal with the foregoing life-and-death relationship issues, and they eventually tell each other what is in their hearts. The coming together of parents and adult children in this special context allows the truth to be told—often for the first time. The ensuing passionate exchanges, embarrassment, and intense anxiety is contained by the safe, holding environment of trust created by the cotherapists, which makes it all right to confront the people one needs. No matter how enraged people are at their parents and siblings, the deepest part of themselves yearns to love and to be loved by these irreplaceable figures. In this context positive feelings can emerge such that mothers, fathers, sons, daughters, brothers, and sisters can understand, reconnect, come to terms with and, finally, forgive each other. How to increase the chances of getting to these auspicious outcomes is what this book is all about. Although not “therapy” in the formal sense, these intergenerational encounters are usually unique healing experiences.

FAMILY OF ORIGIN AS HANDLED IN TRADITIONAL INDIVIDUAL PSYCHOTHERAPY

Most traditional psychotherapists, particularly those who treat individuals psychodynamically, subscribe to the philosophy that adult clients should work out past or current problems with parents and other relatives via the relationship with the therapist. In other words, the professional, utilizing his or her skills and personhood, should provide a corrective and therapeutic experience that will free the patient of crippling parental influences or, in cases of severely emotionally deprived people, should provide the caring and concern that the parents would not or could not give. Most traditional individual therapists regard the family of origin of their clients as the enemy, as noxious, and as undermining their therapeutic efforts. This attitude is epitomized by the book Toxic Parents (Forward, 1989). In the process of trying to help their clients become independent and free of their families, they see keeping the family at bay as part of their task. I have heard therapists speak of having to hang up on “destructive” parents who telephone; in this connection one of them said, “Never try to rescue a maiden who comes from a dragon ranch.” These therapists believe they should undo the family madness and thereby save the client.
The usual therapeutic strategy for handling of the actual parents consists of encouraging clients to stand up to their parents (as in assertiveness training procedures), “working through” the conflicts with the therapist, or advising clients to avoid their crazy family and have minimal contact with parents who are considered to be “hopeless.” One client I saw with her family of origin had been cut off from them for 15 years. She had taken the advice of a previous therapist to stay away from her family because they were “a bunch of cannibals.” Sometimes the message is implicitly given that because the parents are “too old to change” and do not have much more time left, the patient should go along with the family myths for the sake of peace.
Typically, the communication is given that patients should stop trying to get from “bankrupt” parents that which can never be obtained. The therapist, never having seen the parents, has relied on the patient's description of what they are like—that they are “cold, rejecting, overwhelming, exploitative, double-binding, disappointing, too loving and possessive, undependable, irresponsible,” and so on. Instead, the patient is led to the conclusion that the real satisfactions in life are available from other relationships, from one's mate and children, from friends, or from work. In short, most therapists write off the family of origin as a therapeutic resource.
Perhaps the primary reason for this state of affairs is that most individual therapists do not know what to do with the family of origin of adults they are treating. Until family transactional theory and therapy came on the scene, there was no conceptual basis or body of techniques for dealing with relatives. Indeed, the creative leap of family therapy was to take what was ordinarily regarded as an interference and to use it therapeutically.
To be sure, a rationale exists behind the decision of individual therapists to involve themselves as little as possible with family members of clients. While to some extent this policy, which was based largely on Freud's pronouncements regarding avoidance of family, was unrealistically rigid at times, it made sense, given the basic premises of individual therapy. The reasons given by psychoanalysts, for example, for...

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