Family Therapy in Focus

Mark Rivett, Eddy Street

• Publisher: SAGE Publications Ltd
• Year: 2002
• Print ISBN: 9780761962366, 9780761962359
• eBook ISBN: 9781446235874
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychothérapie

Drawing on many years? experience in practice, teaching and research, Mark Rivett and Eddy Street present philosophical, sociological and empirical views of family therapy. Balancing the perceived benefits against the potential limitations, they pose questions, which challenge those within the profession to think hard about their role.

} does family therapy work?

} can those most in need really be helped?

} is family therapy a means of social control?

} who does professionalization help?

While most texts offer a straightforward and uncritical perspective, in contrast Family Therapy in Focus aims to stimulate debate among practitioners and to help trainees adopt a more reflective and critical attitude towards their own professional development and the development of their profession.

Chapter 1

Beginning at a beginning: family therapy as critique

There is no first cause. There is a circular cause, in which the beginning, which does not exist, meets the end, which is impossible.

Maurice Maeterlinck

To begin at a beginning …

The treatment of an entire family, interviewed together regularly as a group, is a new procedure in psychiatry. Just when Family Therapy originated is difficult to estimate because the movement has been largely a secret one. Until recently, therapists who treat whole families have not published on their methods, and their papers are still quite rare – although we may soon expect a deluge. The secrecy about Family Therapy has two sources: those using this method have been too uncertain about their techniques and results to commit themselves to print (therapists of individuals have not let this dissuade them), and there has apparently been a fear of charges of heresy because the influence of family members has been considered irrelevant to the nature and cure of psychopathology in a patient. As a result, since the late 1940’s one could attend psychiatric meetings and hear nothing about Family Therapy unless, in a quiet hotel room, one happened to confess that he treated whole families. Then another therapist would put down his drink and reveal that he too had attempted this type of therapy. These furtive conversations ultimately led to an underground movement of therapists devoted to this most challenging of all types of psychotherapy and this movement is now appearing on the surface. (Haley, 1962)

So wrote Jay Haley in the first edition of the pre-eminent journal of the field – Family Process. In these opening remarks Haley alludes to a number of features of the family therapy endeavour. Firstly, its origins lie in the developments of the practice of psychiatric psychotherapeutic treatment; secondly, it is a practice utilised by clinicians; thirdly, it is presented as being one thing with a unity of purpose; fourthly, in meeting a resistance from professional hegemony and dogma it has a critical almost delinquent stance. It is on this critical stance that we wish to base our analysis of family therapy.

From its outset family therapy or perhaps more accurately family therapists have seen themselves looking on the world of psychotherapy and mental health provision with a healthy and at time disrespectful scepticism. In this book we wish to use similar critical skills to examine the theory and practice of family therapy itself. We shall examine how family therapy has responded to the critiques of itself and how it has used its own critiques of others to develop itself. Such a self-reflexive examination is necessary if family therapy is to maintain its claim to criticality. More crucially, as ‘archaeologists’ of family therapy itself (Foucault, 1965) we will seek to highlight particular paths of development that family therapists chose to follow and those they chose not to. In such a telling we are hoping that our reflections on the field do not lead to a view there is only one line of practical and theoretical development that was possible and that is possible. We are hoping that our examination leads simply to a process of continual re-examination.

Typically at this juncture authors would define their terms and set a boundary around their field of interest; however, we need to be cautious about this as in adopting our critical stance it could prove counterproductive. If we are to understand how family therapy has dealt with critiques and developed further we should not prescribe a history. If we are to examine how its clinical methods operate in practice and how its practitioners conduct themselves in the world of clients and professions we cannot strictly limit our definitions of those practices. If we are to assume some unity of purpose in the field we cannot examine that integrity by the field’s own concepts; we must move outside its conceptual frame in order to offer a varying perspective. Definition and delineation, if they are appropriate, may come later but only when we have completed our investigations. In a task such as this, of a field as wide as family therapy, we cannot hope to cover every aspect; we can only hope to illustrate and elucidate a reflective, and sometimes reflexive, critical method. We are aware that in order to do this we cannot and indeed should not attempt to provide comprehensive descriptive accounts of many of the positions that we will come to examine, in this we must rest on the reader’s appreciation of the subject matter. But we hope that our methodology and the conclusions we arrive at through our examination will cast a different illumination on the family therapy field.

So where do we start? In an examination of any field in which philosophical, sociological, psychological, empirical and practical applications are all dimensions that have relevance, it is not possible to identify a beginning that leads on in some ‘logical’ manner to all the other points. In a field that well understands the concept of circular causality, we can alight at any point on the circle and begin our journey there. The quote from Haley above illustrates how family therapy began to see itself as a separate therapeutic method in its early days and we will take this as our first access point to examine the field. Each of the characteristics we identified in the quote – the development of a psychotherapeutic practice, a clinical method, a unity of purpose and a critical stance – all carry with them implications for how the field has regarded itself particularly in its development and we can develop our critical methodology here. Let us examine each of these in turn.

Developments in psychotherapy

The standard way of presenting family therapy’s historical story is to begin in some way with the emergence of the ‘new epistemology’ of the application of cybernetic theory to human relationships. Cybernetics began in the work of a mathematician, Norbert Wiener who invented the phrase ‘cybernetics’ to describe the science of feedback mechanisms in machines and later of communication in human systems. The ideas of cybernetics became fashionable within a certain intellectual circle (just as those of post-modernism have today). Such was the impact of these ideas that there was a series of international conferences between leading scientists called the Macy Conferences in which the breadth of representation was profound. Indeed one crucial member (for the story of family therapy) was Gregory Bateson. He, similar to others, held a cybernetic view that the organisation of events, whether neurological, psychological, behavioural or social, could only be understood in terms of pattern, and information, rather than energy or matter. Wiener and Bateson, as well as others, made the jump from the paradigm of things to the paradigm of pattern and connection. Bateson took these ideas into his anthropological work and in the late 1960s went on to study schizophrenia not as an intrapsychic phenomenon but as an interactional one. His work produced some of the essential papers in the field (1972; 1979). Also because of his status, a group of researchers formed around him who later collectively and independently led the family therapy field. Interestingly when family therapists discuss Bateson’s foundational theoretical position there is a tendency to refer only to his work Steps to an ecology of mind, whereas his position is clearer and fuller in the work Mind and nature. This work is a reflection of his scientific view, an argument intended to unmuddle so much of the muddled thought he saw around him. Yet these ideas have a difficult nature – they seem to turn in on themselves, sometimes to infinitely regress becoming examples of the types of arguments he opposes. Although Bateson was never in any active professional sense a part of family therapy itself, his work is credited by some to have established the field:

One of the groups with the strongest claim to originating family therapy was Gregory Bateson’s schizophrenia project in Palo Alto. (Nichols & Schwartz, 1995: 27)

Although the family was only one of many different types of natural systems that interested Bateson, he is credited as providing the intellectual foundation for the field because of his ideas and studies of patterns and communications. (Dallos & Draper, 2000: 19)

Indeed, what we notice immediately from this account is that the focus is not on the nature of psychotherapeutic practice but on the way that social events in general are considered. So this beginning point of family therapy presents a view of a field that is interested in ideas rather than psychotherapeutic practice. So if we are to suggest another possible starting point for our history where can we begin? What if we begin with the psychotherapeutic origin to which Haley alludes?

In the history of psychotherapy it is easy to see that if one takes Freud as the point of birth for psychotherapeutic practice (which one always does) then one of the main paths of development has been from the intrapsychic/individual focus to an interest in the inter-psychic/social processes. This is a line of thought that has been continually present in the history of psychotherapy (see Ackerman, 1958; Brown, 1961). The clinical precursor to much of early family therapy practice was Harry Stack Sullivan. It is through his professional link (a supervisor–supervisee relationship) with Don Jackson that his work had its primary influence on family therapy. Sullivan is best known for his social psychologically based critique of Sigmund Freud’s psychoanalytic drive theory. He and his colleagues (including Frieda Fromm-Reichmann, Erik Erikson, Karin Horney, Edward Sapir, Claire Thompson and Harold Lasswell) offered an alternative definition of psychiatry as

the study of processes that involve or go on between people, the field of interpersonal relations, under any and all circumstances in which these relations exist. It seems a personality can never be isolated from the complex of interpersonal relations in which the person lives and has his being. (Sullivan, 1954: 4–5)

Sullivan challenged the central role of infantile sexual drives in psychological development. Rather he emphasised the role of culture and social context in the determinants of human behaviour and action. Sullivan was critiqued by psychoanalysis and was taken to task for showing an over-concentration on external factors. However, Sullivan pointed out that human experience is a dynamically unfolding interaction between interpersonal, environmental influences and internal (i.e. intrapsychic) meaning. Here the ‘self’ modifies perceptions and behaviour in response to those external experiences. For Sullivan, understanding an individual’s interpersonal relationships involved understanding the way a person interprets his or her experience. This in turn is influenced by the ways the person comes to know the world through the formation of a set of internal assumptions, ideas and fantasies about people and the self. These internal assumptions are based on developmental experiences. (There are many links with these formulations to the writings of the British object-relation theorists, Fairburn, Guntrip and Winnicott, and the Self Psychology of Kohut and Eriksson’s psychosocial developmental theory.) Sullivan’s journal, Psychiatry, reflected his deep-felt belief that psychiatry itself should not emphasise psychopathology but instead focus on the study of interpersonal living and its difficulties. Sullivan’s ‘interpersonal psychotherapy’ was a treatment approach, which focused on the understanding of interpersonal relations and the inner representation of these relations. Learning was the key process for psychotherapeutic change. He introduced the method of obtaining ‘collateral data’ from families and significant others in the treatment of schizophrenic clients in which the therapist discussed relationships with family members. This clearly presages the future development of family therapy. It needs to be recognised that Sullivan represents a flux of ideas that came from a social understanding. At the time that he was writing there were movements against psychoanalytic orthodoxy and hegemony. Many of Sullivan’s theoretical ideas appear well represented and well supported in modern social science including the social construction of reality (see Berger & Luckmann, 1966).

Working at the same time as Sullivan, Otto Rank introduced innovations in therapeutic methods that are also more familiar to family therapists than traditional techniques will have been. He focused more on what was happening in the session itself and less on what had happened in client lives. He introduced his own feelings into sessions rather that remaining detached. An interesting aspect of Rank’s contribution was that it provided an important foundational element for the work of Carl Rogers who discussed ‘relationship therapy’ with regard to the therapy of parents with a child with problems in 1939. Barrett-Lennard (1998) has noted that Rogers’ exposition of relationship therapy directly foreshadowed most of the therapeutic principles he set forth and elaborated over the following years. This tradition that encapsulated a social understanding of the development of psychological difficulties and their treatment resulted in a profession led by psychology and counselling. This is opposed to the more medically dominated psychiatric origins of family therapy. It is also worth noting here that the clinical originators of family therapy wished to distinguish themselves not only from psychoanalysis but also from the developing Rogerian field (Haley, 1963).

As we have seen, it was via his link with Sullivan that Jackson developed his foundational ideas and thoughts that were his contribution to the Palo Alto group. From these influences Jackson followed on from Sullivan and his Interactional Theory places emphasis on what is transpiring in the present between people as the primary data relevant to understanding human behaviour. Context and relationship are the focus of attention with little or no emphasis placed on the past, genetic or biochemical explanations of behaviour.

So we can see that a small change of focus provides us with a different history. If we offer a view of family therapy history that privileges the Sullivan lineage as a primary origin then our interest becomes more focused on the processes of psychotherapy and our field’s development would not necessarily be seen as a delinquent offshoot that suddenly appeared. It may well have been, and indeed in terms of its clinical practice may just represent, a natural development of a way of thinking that had been slowly developing within psychotherapy’s intellectual environment.

A clinical method

To some extent our quote of Haley’s suggests more interest in a clinical method than a set of intellectual ideas and it is worth considering the core ideas of clinical practice that were present initially. Sullivan was a clinician rather than a theorist and he refused to be impressed with any theory that could not be demonstrated in practical work with clients. This is an attitude that clearly infiltrated the early family therapists:

Without doubt this disposition to trust one’s experience instead of the reigning dogma characterizes the founders of all the movements (involved in the development of family therapy). (Broderick & Schrader, 1981)

Jackson was the first clinician to uncompromisingly maintain a higher-order cybernetic and constructivist position in the actual practice of therapy. The essence of this model is that the client is seen as a ‘family-surrounded individual with real problems in the present day’ (Jackson, 1965). Brief in orientation, the primary focus of the model, the questions asked, assignments and tasks given, were always on the relationship between members of the family. Conjoint Family Therapy was a term coined by Jackson to characterise therapy in which two or more people who are vitally important to one another were seen simultaneously in psychotherapy. The family therapist treats the family, not the individual. There are a number of clear statements about this within past and recent literature. In the first British text Walrond-Skinner (1976) begins with the following definition:

family therapy can be defined as the psychotherapeutic treatment of a natural social system, the family, using as its basic medium, conjoint interpersonal interviews. (1976: 1)

In 1984 Speed asserted that:

one belief which is shared by family therapists is that the focus of concern should be mainly on what occurs between people rather than on what occurs inside an individual. (1984: 2)

Burnham continues to echo this definition:

family therapy … looks at problems within the system of relationships in which they occur, and aims to promote change by intervening in the broader system rather than in the individual alone. (1986: 1).

Lastly, Nichols and Schwatz (1998) comment that:

the animating idea of family therapy is that because most human behavior is interactive, problems can often best be addressed by helping people change the way they interact. (1998: 9)

The clinical method was therefore an uncompromising one in which family members were seen together – hence the name. Even though this interactional, contextual and ‘group’-based therapeutic work clearly initially defined the field, we should again note the way that ideas about the origins of problems have dominated f...

Table of contents

• Cover Page
• Title Page
• Copyright
• Dedication
• Contents
• Foreword by Andy Treacher
• Preface
• 1 Beginning at a beginning: family therapy as critique
• 2 A troubled legacy? Systems theory and family therapy
• 3 Family therapy’s affair with post-modernism
• 4 Freedom or control? The sociological critique of family therapy
• 5 Who are the family therapists?
• 6 Social policy, social justice and family therapy
• 7 Where is the individual?
• 8 Does it work?
• 9 How does it all go together?
• 10 Beginning at an ending: beyond ‘both/and’
• References
• Index