Family Healing

Strategies for Hope and Understanding

Salvador Minuchin, Michael P. Nichols

• Publisher: Free Press
• Year: 1998
• Print ISBN: 9780684855738
• eBook ISBN: 9781439107898
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

At the center of people's lives is the family, which can be and should be a haven from the harshness of the outside world. Unfortunately, the source of people's greatest hope for happiness often turns out to be the source of their worst disappointments. Now, the family therapist, Salvador Minuchin unravels the knots of family dynamics against the background of his own odyssey from an extended Argentinian Jewish family to his innovative treatment of troubled families. Through the stories of families who have sought his help, the reader is taken inside the consulting room to see how families struggle with self-defeating patterns of behavior. Through his confrontational style of therapy, Dr Minuchin demonstrates the strict but unseen rules that trap family members in stifling roles, and illuminates methods for helping families untangle systems of disharmony. In Dr Minuchin's therapy there are no villains and no victims, only people trying to deal with various problems at each stage of the family life cycle. Minuchin understands the family as a system of interconnected lives, not as a "dysfunctional" group. Each story of a therapeutic encounter brings a new understanding of familiar dilemmas and classic mistakes, and recounts Dr Minuchin's creative solutions.

PART THREE

PARENTS AND CHILDREN

N obody taught me how to parent. Pat didn’t have lessons either. We’re supposed to know, instinctively, as a bird knows the right time to encourage its young to fly, or a bear knows how to teach its young to fish. Nobody teaches them—at least we don’t think so.

I have seen films about chimpanzees and admired the patience of the mother with her young. They cling to her belly, then scamper off, detaching themselves a few steps but remaining close to her, ready to take refuge again. There are forays of independence, playing with older siblings, tentative jumps into space. Then they return to cling to Mother.

If it’s instinctive to them, it should be so with us. There is a natural affinity between mothers and babies; milk flows in the mother’s breast when it’s needed by her young. Parent and child teach each other how to communicate. Baby talk—those repetitive, nonsensical sounds that parents universally make—seems to come instinctively as part of the natural system of signals exchanged by parents and children. But as time goes on, things become more complex. The world makes many demands on us, and we don’t have time to accommodate with ease to each other’s needs. If we had only to fish or fly or look for food, if we could concentrate on learning to be proficient at survival, our lives would be simpler. But the demands of socialization become more and more difficult. Parenting turns into a lifelong endeavor, and a variety of people and institutions become involved in doing the job, with varying degrees of success.

All in all parenting is an almost impossible task, and all parents fall short in some ways. I suppose, though, that for many parents this knowledge will not be sufficiently reassuring, and they will still look at friends or relatives whose children seem perfect. Let me tell you, it is an illusion.

What is useful to know, however, is that if conflicts and problems are unavoidable, solutions are usually available. Parents often find ways of getting out of difficult situations with their children, but sometimes they get stuck and repeat the same useless solutions again and again, with the same useless results, until everybody is exhausted. It is in these situations that a family therapist can be helpful.

Experts usually agree on certain basic premises—the behavior of a child is maintained by the combined effort of all family members. While this may not seem like a revelation, it is nonetheless an important perspective when looking at a child’s behavior. Most parents, in their efforts to help their child, focus so much of their attention on decoding the child’s behavior that they become experts on the child but blind to their own contribution. I don’t mean that the child is nothing but a product of parental treatment—which would ignore the complex reality of the child and contribute to the legion of parent bashers. It means simply acknowledging that children are actors and reactors and often more adaptable than we realize.

Let me give an example: A couple in their mid-forties comes to consult with me about their three-and-a-half-year old youngster. He clings to them and cries whenever they try to leave him. The boy, who has been in nursery school since he was two, plays in my office with toys the parents brought, while I talk with them. He seems well coordinated, bright, and quite independent in his play. I notice the disparity between the parents’ report and the child’s behavior, and I gently ask the mother to leave the room. She smiles and leaves. The child continues playing. I then ask the father to leave. He does so, and the child continues making a hangar for his plane, quite absorbed and seemingly unconcerned. When I ask him if he wants his parents to return, he shakes his head and says no. I nonetheless ask him to bring his parents from the waiting room. They now tell me that he is sometimes, as on this occasion, quite independent.

I tell the parents that their observation of the child was correct. He is in effect a clinging child—something they have seen many times. What they don’t see is their contribution to his behavior. Mother cries; Father fidgets uncomfortably. They acknowledge that as older parents of a young child they have made him the center of their pleasure, concern, and control. We chat; we consider alternatives. I suggest some tasks. Three sessions later we finish our encounters. Treatment is usually more complicated, but in cases that work like this, there is a great sense of clarity and pleasure. I feel wise, the parents feel grateful, and the child does not know that he has been “in therapy.”

I will talk later about more complicated cases, but in every case, success comes with a change in perspective—when family members, parents and siblings, begin to see and change their way of connecting to the child; when one spouse doesn’t recruit the child in a coalition against the other; when children stop protecting parents from each other or from grandparents.

In treatment the focus frequently shifts from a child’s symptoms to conflict between the parents. When this happens I continue to concentrate on the child’s problems but expand the focus to include the marital problems—that is, I ask the spouses to look at how their conflict is being played out in the child’s symptoms. Once again, we have a kaleidoscopic shift. I don’t deny the child’s symptoms; I don’t minimize the spouses’ conflict. I simply suggest that they are both part of a family grappling with difficulties and getting stuck with narrow “solutions.”

This systemic way of looking is not the way people feel things themselves. Pain is always an individual experience. But when family members learn to look at problems in an interrelated way, they see anew. Novel and more sensitive ways of being emerge. For example, spouses in conflict may be more willing to postpone their game of “You did”—“No, you did” once they begin to understand that when marital conflict becomes parental conflict, the ones who pay are the children.

7

A Crutch to Move Away

I was leafing through the mail in my office at the Philadelphia Child Guidance Clinic when my secretary buzzed. Joseph Pasquariello, a retired high school teacher from North Philadelphia, wanted to talk to me about his eleven-year-old granddaughter, who lived in Venezuela because her father’s work had taken the family there. Jill suffered from hysterical paralysis. Her father’s company had agreed to send the family to Philadelphia and pay their expenses for one month so she could seek treatment. Would I take the case?

I dislike measuring therapy in terms of time. I much prefer to work until we’ve done what needs to be done, rather than constrain the process of change to some arbitrary number of sessions. Who’s to say how long it will take to change the life of a family? If I took this case, I would have one month to treat a family I had never met, with a symptom I had never seen. Finally I decided to see them; I never could say no to a challenge.

Nevertheless, after accepting the case, my reaction was mostly excitement. Hysterical paralysis. Very few people still select this nineteenth-century European way of expressing conflict, and very few living therapists have seen it.

The last time hysterical paralysis was anything but anomalous was during World War I, when hundreds of soldiers, caught between the terror of suicidal assaults and the fear of cowardice and disgrace, found an unconscious solution in the form of somnambulistic trances, catalepsy, and hysterical paralyses. Few things show the power of the mind more vividly than a patient struck blind, or suddenly unable to walk, for no organic reason. These strange and puzzling disorders have baffled healers since ancient times.

The Greeks believed that hysteria was due to a wandering uterus. Ancient physicians attempted to coax these migratory uteruses back to where they belonged by applying foul-smelling substances to the afflicted body parts and aromatic herbs to the area of the womb. That these remedies sometimes worked proved, to the satisfaction of those who employed them, that the wandering uterus theory was correct.

In the dark days of the Middle Ages, hysteria was believed to be brought about by witchcraft and sorcery. This theory, too, produced many cures. The fact that few sufferers survived the cure only proved the gravity of the disorder and the inadvisability of alliance with unholy powers. Freud too believed that hysterics were possessed, but by unconscious longings rather than supernatural forces.

Invariably Freud found hidden sexual fantasies at the root of the problem. Fräulein Rosalia H. was a gifted pianist whose hands became palsied because, Freud discovered, she had been forced to massage her brutish uncle’s back when she was a girl. And of course there was Dora, the girl Freud tried to bully into believing that her disgust at the advances of a middle-aged neighbor was evidence of repressed desire. According to Freud, she protested so much because she was only defending against her real feelings. But what if Dora didn’t protest too much? Was it possible that her parents didn’t protest enough?

Already I was thinking like a family therapist. Hysterical paralysis? The very term seemed an anachronism in a time of sexual revolution. The nineteenth-century hysteric had been an isolated creature, a specimen plucked from her surroundings and treated as though she had a past but no present. What would hysterical paralysis look like in the twentieth century, in a young girl seen in the context of her family?

The family I met in the waiting room two weeks later seemed out of place in the clinic. Most of our clients were poor, many of them black or Hispanic. These people were not only white and well dressed, but all of them, even the six-year-old, were reading. As I approached the mother consulted her watch.

I introduced myself, and an intellectual-looking bald man with snow-white, shaggy eyebrows stood up and said he was Joseph Pasquariello, He introduced me to his wife, Rose; his daughter, Janet Slater; his granddaughter, Jill; and her brother, Davey. Jill’s father was detained on business and would arrive in a few days.

As the family entered the office, Jill clutched her mother’s arm. One leg dragged, and her arm on that side was rigid against her body. She sat down heavily and sank into a slouch. Were her hunched shoulders an attempt to hide her budding adolescence? I thought of Freud again. Was the symptom in any way related to the fear of becoming an adolescent, to the clear signs that a little girl was becoming a young woman?

Mr. and Mrs, Pasquariello appeared to be in their late seventies. He wore a tweed suit, which—with his bushy, white eyebrows poking over dark-rimmed glasses—gave him a venerable appearance. They were glad to come, he said: “Anything we can do to help.” She was short and round, with no neck, like one of those Russian dolls that nest one inside the other. She was colorfully dressed in white slacks and a bright paisley blouse. She looked at Jill and her eyes glistened. I recognized the anxious love of protective grandparents.

Mrs. Slater, a handsome woman with thick, auburn hair, settled Jill and sat down next to her. She told me about the accident that had paralyzed her daughter.

They were at the country club by the pool. It was a hot, cloudless day, and Mrs. Slater was stretched out on a chaise longue next to her husband when suddenly she heard a scream. Jill was thrashing in the water, screaming for her father. “Very funny,” he said, assuming it was a game. Then he realized it was serious, and he jumped in to get her. When he carried Jill out of the pool, she could not stand.

Apparently Jill had been playing with some boys who had pushed her into the pool. Rushed to the emergency room, she was admitted to the hospital for observation. Test after test turned up normal results, yet she could not move her left leg or arm.’ Then Jill spent a couple of months working with a physiotherapist in the rehabilitation department. After that she had six months of psychotherapy. There was still no improvement.

Jill listened intently to this story she’d heard a dozen times, her brown eyes shuttling anxiously between her mother and her grandparents. Nothing about the incident or subsequent tests gave any clue as to why a healthy eleven-year-old had suddenly become unable to move her leg and arm.

I asked how long they had been in Caracas. Mrs. Slater explained that her husband was a geological engineer for an international oil company. Because of his job they had always lived abroad, assigned for two or three years at a time to oil-producing countries in the Middle East and Central and South America. His previous assignment had been to Houston, where they’d had a beautiful house, and she’d found a wonderful teaching job at a private school. But it was only a two-year tour, and a transfer to Caracas had ended it. It had been hard to leave that job and all her friends. And the first few months in Venezuela had been especially trying. Their furniture hadn’t arrived for weeks, and workmen were still finishing the interior of their house.

I wondered if Mrs. Slater had dragged her feet on the move from Houston to Caracas, and if Jill was dragging half her body as a symbolic expression of that reluctance. A few minutes into the session, I had a working hypothesis: Perhaps the child’s paralysis was an expression of her mother’s resentment at moving. First hypotheses will change many times as an exploration continues, but they are useful—in fact, necessary—in organizing the gathering of information. I kept watching as well as listening as the family talked.

Chatty and unrestrained, Rose, the grandmother, laughed easily, spoke rapidly and boldly, and analyzed with restless force. “Well, if you want my opinion, doctor, I don’t think all this traipsing all over the world is a healthy environment for the children.”

Mrs. Slater complained of the burden of having to do everything for Jill. “Richard’s never home. He’s always working.”

Rose Pasquariello said what her daughter implied: “Richard should think more about his ...

Table of contents

• Cover Page
• Title Page
• Contents
• Preface
• I. THE MAKING OF A FAMILY THERAPIST
• II. COUPLES
• III. PARENTS AND CHILDREN
• IV. REMARRIAGE
• V. AGING
• Epilogue: The Silent Song
• Related Works by The Authors