The postmodernists accused the modernists of believing in “totalizing truths” and “grand narratives.” The modernists declared their opponents to be relativists without values. The quarrel spilled over from the academy into other fields, including family therapy, where it created much argument but also an explosion of new energy and ideas. (Page 0)
This seemed like a good time to assess the family therapy field. As it evolved, it resembled a version of the scissors, stone, paper game of my childhood, except that it kept marching up a set of stairs. Family therapy trumped individual therapy, systemic therapy trumped family therapy, feminist therapy trumped systemic therapy, multicultural therapy trumped feminist therapy, and so on. But this formulation implied an upward and onward progression, which I distrusted. Also, each of these models pointed to a different location for distress, as well as a different recipe for how to handle it, and each had enough good points to make it hard to choose between them. (Page 0)
Perhaps the real biggest hit of the family therapy movement was its power to fold back upon itself and change. (Page 0)
What particularly interested me about the idea of family therapy as a braid was that, in its self-revising journey, it had become able to critique itself at the level of its own premises. I have always been impressed by the number of family therapists who have used the insights of each new development to rethink their theories and practices rather than getting fixed in one particular school. (Page 0)
In the history of large-scale literate frameworks, Western culture has had at least three: Augustine’s City of God, which defined the place of humans in the heavenly order; the Enlightenment framework, which followed the assumptions of the natural sciences; and now the postmodern view, according to which reality is constantly woven and rewoven on social and linguistic looms. Each framework is true within its own boundaries. Each allows things to be seen that are outside the purview of the others, and one can move back and forth between them, just as one can choose to speak another language. (Page 0)
From Plato’s idea that we must learn to “carve nature at the joints,” we moved on to seeing that our conceptual systems create the joints we erroneously think we carve. As a result, the objectivist, one-way approaches of modernism began to be challenged by an interest in self-reflexive, open-ended processes that included therapists as well as clients in the loop. (Page 0)
During the first part of the 20th century, she observes, the treatment of emotional illness moved from a rehabilitative framework based on the work of German psychologist Adolf Meyer to an etiological or causative one based on Freudian psychodynamics and developmental theory. This shift, according to Singer, had unfortunate consequences. Freudian theory had fostered an emphasis on the family as a source of psychic injury, and this view, backed up by developmental research on children, created a hostile environment for parents. In time, we began to see what Singer (1997) and others have called the “blame and change game.” In other words, if you can find somebody in your family to blame, you can change. This idea was key for many individual therapies, but it was often disastrous in family therapy, as a host of humbled parents can attest. (Page 0)
The Mental Research Institute’s interactional view (Watzlawick, Weakland, & Fisch, 1974) was a happy exception to this blaming bias. From the beginning, the MRI emphasized a rhetorical rather than an etiological stance. If you believe that reality is constructed in the eye of the observer, you will naturally try to alter perceptions. As a result, instead of looking for causation and cure, they used language and suggestion to shape a different world of meaning. This approach was a welcome corrective to the blame and change game. For one thing, not only did you avoid pathologizing your customers but you liked them better too. (Page 0)
The downside of this rhetorical strand was the way the customer was perceived. Family therapy was compared by theorists like Paul Watzlawick to a game of chess. The therapist, who knew the rules of the game, was the master player, while the family members were the pieces on the board. (Page 0)
Then came the narrative approach, which placed privilege itself under the microscope. The originators of this approach, Michael White and David (1990; White, 1995), exchanged the metaphor of systems for the metaphor of stories. Taking their cue from the ideas of Foucault (Rabinow, 1984), they redefined therapy as helping people “re-author” their lives. Foucault had identified some of the institutional and cultural discourses that invisibly constrain and oppress people. White and Epston saw these as discourses of entitlement: the belief of whites that they are superior to non-whites; the belief of men that they have the right to dominate women; the belief of heterosexuals that homosexuals are abnormal; and so forth. Training in narrative therapy began to serve as a re-education movement for professionals who wanted to move out of the solipsism of culture, race, and class. Dismaying in some ways, this proactive stance was a relief after the neutrality of the systemic years. (Page 0)
Another strand now appeared that tucked itself under a postmodern banner and called itself a collaborative approach. Led by the late Harold Goolishian and Harlene Anderson (Anderson, 1997; Anderson & Goolishian, 1988), this group turned for support to the constructionist framework proposed by social theorists like Kenneth Gergen (1994) and John Shotter (1993b). Following Lyotard’s dictum of “incredulity toward meta-narratives” (1984), these therapists also began to question the assumptions that underlay the practice of present-day professionals: the idea of the expert, the idea of objectivity, the idea of control. If you watch collaborative therapists at work, you will see that they do not seem to care about goals and methods. The not-knowing stance of Anderson and Goolishian (1988), the reflecting team process of Tom Andersen (1991), and the poetic activism of Peggy Penn (Penn & Frankfurt, 1994) are examples of a style that prefers to follow openings as they surface rather than imposing a predetermined scheme. (Page 0)
In a recent paper, social performance therapist Fred Newman (2000) describes postmodern therapy as a study of the unknowable, meaning the domain of things that cannot be “discovered” in the same way that things in the physical universe can. For this reason, he states that storytelling should be seen as “a non-explanatory mode of understanding the activity of human life.” I like that idea. I want to continue to be not-knowing at the level of the road map while still exploring the road. (Page 0)
Satir came from a humanist psychology background, and the feelings-oriented language of that world conflicted with the language of the MRI, which was drawn from General Systems Theory, communication theory, and cybernetics (Buckley, 1968). (Page 6)
Up to that time, I had assumed that there was such a thing as mental illness and that it was just like any other disorder or disease. In talking with the inhabitants of the MRI and reading the many articles produced by the Bateson group, I found that they did not believe this. The “identified patient,” as the child with a problem was called, was not so much sick as unable to communicate directly. There were many secrets in these families, and many hidden rules that kept these secrets from surfacing. This explained the peculiar use of language and gesture that characterized the so-called schizophrenic. These strange behaviors were like messages sent by semaphore. (Page 6)
At the MRI, as I discovered, there was a presumed link between the communication style of the family and the problem of the child. Research was being done comparing “schizophrenic” families to “delinquent” families, “normal” families to “abnormal” ones. If you analyzed the conversation between a pair of parents, you supposedly could tell whether a new baby would become schizophrenic by the age of twenty. This idea led to attempts to create a typology of families that would predict for various kinds of symptoms in children. Research on this idea was suggestive but never proved, and it had pejorative implications. Just think of the “alcoholic family” and its list of losers: the “addict,” the “lost” child, the “parentified child,” the “codependent spouse,” the “enabler,” and so forth. At the time, however, I saw only a rescue operation. (Page 6)
I once saw Satir interview the family of a disturbed boy who made a “cocktail” out of condiments he found on the table in a restaurant: ketchup, salt, worcester sauce, and so forth. Satir connected this odd behavior to the feelings about drinking in the family. It turned out that the father drank, and the mother disapproved, and that this disagreement festered even though the parents never brought it up. Satir suggested that the boy’s cocktails were a message, not only about the hidden conflict but about what she saw as the prohibition in the family against joy of any kind. (Page 7)
The intention was noble: to rescue the family’s problem member from being stigmatized. Unfortunately, the opprobrium merely shifted to the family. Jackson (1957) and his colleagues had been trying to study “family homeostasis,” under the assumption that the family was like an aquarium, with fish and weeds and water operating as a self-maintaining whole. When someone in the family was symptomatic, this meant that some event was threatening the balance of this world. If an older girl were about to go off to college, and if she were indispensable to the mother, a younger brother might develop symptoms. The older girl might then drop back from college to help the mother out. The implication was that the family (for which read “mother”) was to blame for the problems of the child. (Page 7)
There was a famous story about Satir’s response to a man who had chased his wife around the kitchen with a hatchet. She had said to him, “You are really trying to tell your wife that you want to be closer to her, but you don’t know how.” Satir refused to admit that such statements had anything strategic about them. All she would say was, “You catch more flies with honey than with vinegar.” (Page 8)
Most early family therapy had been aimed at locating a cause for the problem, but Satir went in a different direction from the start. She gave all her attention to leading families out of the shadow of blame, coming as close as anyone did in those days to inventing a no-fault type of practice. She also showed me what a therapy that created possibilities rather than correcting pathologies might be like. She was a skillful weaver who asked the family to join her in making handsome, useful textiles from the most unlikely threads. (Page 9)
Pragmatics of Human Communication (1967), which Jackson co-authored with Paul Watzlawick and Janet Beavin (now Bavelas), summarized much of the original thinking and research that had come out of the years of the Bateson group. (Page 10)
Bateson was interested in messages that were delivered on two levels—one consisting of a statement and the other indicating how the statement was to be understood. Examples of such double-level messages could be found in areas like play, paradox, and animal communication. In the case of otters, a creature Bateson would watch at the San Francisco Zoo, the message “This is play” was embedded in gestures that resembled an attack but then did no harm. The bite would be a play bite, so that both animals would know what was going on. But what happened in cases where the qualifying cue was self-contradictory or confusing and an important relationship was at stake? Bateson surmised that there might be a breakdown and peculiar behavior might result. This was why he and some of his younger researchers began to visit the Palo Alto V.A. Hospital to study what they called “schizophrenic communication.” (Page 12)
Stories about Milton Erickson were another staple of our conversations. If Virginia’s accent on the positive was astounding, Erickson’s was even more so. Erickson’s work modeled for Haley a new kind of therapy based on a directive, strategic stance. This was part of Haley’s war against the psychoanalytic establishment. Where analytically-influenced therapists sat back and said little (and, according to Haley did less), Erickson busily sought out a person’s area of resourcefulness and put it to work. I particularly remember the story of the elderly woman who was illiterate but wished to learn to read. Erickson helped her to read by using analogies from carpentry, because that was one thing she could do very well. (Page 13)
Erickson’s most famous device was to give people paradoxical tasks. He would tell them to fight on purpose, stay awake on purpose, and stutter on purpose. When these directives worked, they worked with extraordinary swiftness. Clinicians who had spent a lifetime helping people gain insight into symptoms that stubbornly refused to disappear tried paradox and they suddenly vanished. (Page 13)
After years of thought, I have come to a simpler conclusion. A therapist who encourages a symptom promotes a habit of acceptance, which is in itself helpful. In Virginia’s work, and also I suspect in Erickson’s, a key element lay in preventing everyone, especially the therapist, from pulling any tighter on the Gordian knot. (Page 14)
the rhetorical emphasis of the Ericksonians was a clean break with the etiological bias of most other psychotherapy schools. It was also a great step forward. In return for giving up the comforts of causality, you increased the chances that therapy would be a blamefree environment. (Page 14)
I have always thought that this interview, which is called “A Family of Angels,” is one of the best portraits of Satir at work that I know. (Page 15)
I found Ackerman to be a sturdy, cigar-chomping little man who didn’t waste his time on useless politeness. When I explained about our interview book, he told me that he and Haley had long been at odds and that there was a long-standing feud between the “warmhearted clinicians” of the East Coast and the “coldhearted researchers” of the West Coast. They certainly came from different worlds. Ackerman used the more insight-oriented language of psychodynamics in working with a family. Haley, as I have said before, openly ridiculed psychoanalysis, and his approach was more that of a social engineer. (Page 15)
During the late sixties, there was a growing sentiment against conventional psychiatry on the grounds that, by diagnosing mental illness, doctors created it. Haley had once said, “There is no such thing as a schizophrenic in the wild, untouched by the hand of a helper.” (Page 17)
I went out of that store weeping with frustration. It wasn’t until I accidentally stumbled onto Walter Buckley’s Modern Systems Research for the Behavioral Scientist (1968) that I realized that what I had caught by the tail in Palo Alto was not a new comet; it was just one that had not yet appeared in New York skies. (Page 19)
In the course of my search for “systems” people, an acquaintance introduced me to the late Edgar H. Auerswald, who was starting an Applied Behavioral Sciences Program at Gouverneur Heath Services on the Lower East Side. Auerswald, a child analyst turned community psychiatrist, had been working with the families of poor, minority children at the Wiltwyck School for Boys in New York state. The signature book that came out of that work was Families of the Slums (1968), written by a team that included family therapy researcher and psychiatrist Salvador Minuchin and psychologist Braulio Montalvo. Auerswald would have been one of the authors if he had not left Wiltwyck to go to Gouverneur. I began to think that Wiltwyck had been the East Coast equivalent of the Palo Alto group. When Auerswald asked me to join his program as staff historian, I jumped at the chance. (Page 19)
Related to the Crisis Unit was Auerswald’s Family Health Team, a pilot project in which families in a given district were assigned to a team of medical and behavioral professionals who acted as a collective general practitioner. As all family members would be seen by the same group, there would be a shared knowledge of the connections between the health events of family members and other factors in a family’s life. In an important paper, Auerswald (1968) compared the usual “interdisciplinary team,” in which each specialist works in an isolated manner with a person or a bodypart, with an “ecosystemic team,” where information is exchanged across disciplinary lines and across the conceptual boundaries that isolate the individual. In the team’s weekly meetings, the interplay between a child’s hearing problem, a mother’s depression, and a father’s job loss could be laid out and understood in a holistic way. (Page 20)
In general, Auerswald acted more as a presiding genius than a clinician. On the rare occasions when I saw him interview a family, I noticed that his work had certain trademarks. The most notable one, aside from his reluctance to use medication, was his war against diagnostic labeling. He foresaw the inexorable creep of the system of nomenclature that has now captured the institution of psychiatry and did what he could to undermine it. If he could find any environmental or cultural reason for someone’s unwanted behavior, no matter how far the reach, he was a happy man. He would gladly accept a cognitive disability if it got a child off the hook of being “bad.” (Page 21)
In Auerswald’s view, it wasn’t enough to see the child in the context of the family. For him, children’s cognitive territories were shaped not only by their intimate relationships but by the environment they grew up in. I am always reminded here of writer Annie Dillard’s phrase, “The river fits and shapes its banks as the mind fits and shapes its world” (1994). (Page 21)
It was interesting to me to see how Rabkin zeroed in on the emotional connections between people, pushing them in a more positive direction, where Auerswald focused on changing perceptions and beliefs. Both had the same goal, to take the pressure off the little boy, but they used different modalities for their interventions. This was the first time I had seen such a vivid clash of practices in a family therapy session. The odd thing was that when the two psychiatrists conversed theoretically, they sounded as if they were coming from the same page. (Page 26)
When I finally looked up the etymology of the word “ecology” in Webster’s, I found that it came from the Greek “oikos,” or house, and that “ecology” was “the study of the relationships between living organisms and their environment.” (Page 27)
At last Mrs. Klosky came out with the real hurt. After the move, she had gone in to see Miss Sadie, and Miss Sadie had accused her of “going over to the enemy.” Always ready with a tart answer, Mrs. Klosky said, “Well, if I’m the enemy, perhaps you don’t want me to bring the groceries.” Miss Sadie quickly said that wasn’t what she meant, but the barb had stuck. Mrs. Klosky ended the conversation with a remark that startled Hetrick. She said she had run into an acquaintance who had asked her about the young psychiatrist from Gouverneur that everybody had been talking about. Mrs. Klosky said, “I told her I didn’t know him.” This was a curious and sobering reaction. It led the members of the Crisis Unit to realize that what for them was an occasion for rejoicing, namely, Miss Sadie’s move, was not necessarily the same for everyone else. In a network where some are caretakers and others are taken care of, a move toward independence on the part of the one who is taken care of affects the relationship with the other, whose life is just as surely changed. (Page 33)
As I look back on my experiences at Gouverneur, I ask myself which of them have passed the test of time. Auerswald gets star credit for applying an ecosystemic view to community psychiatry. Owing to his influence, notions like the “interdisciplinary” approach to public health, or the “person-in-environment” of social work, seem narrow and dated. One has only to look at Auerswald’s insistence on working with the cultural ring around the family to see how much his work foreshadowed the current multicultural trend. For family therapy to be useful in a broad sense, it had to add a wider template to the narrow family one, and it had to begin looking at the implications of issues like environment, economics, ethnicity, race, and class. And so it was that instead of working with bounded units like the individual or the family, relational therapists began increasingly to experiment with shifting, looser forms like assemblages and nets. (Page 34)
So it was Harry Aponte, not Haley or Minuchin, with whom I worked during the Philadelphia years. Aponte was younger than I, very intelligent, very reserved, and he bore with conscious dignity the mandate that came with being a Black Puerto Rican professional. His work with poor families (the only families we ever saw in that satellite clinic) was filled, with a generosity that was rare by any standards. Haley’s strategic approach, based as it was on the extravagant genius of Milton Erickson, attracted me by its inventiveness, but it seemed to work overtime to avoid heart. Aponte’s style was the direct opposite. When he listened to the stories of the families that came our way, he did so with an empathic quietness that impressed me greatly. Although I would not know this for many years, he made the most lasting imprint on my style of any of my teachers. (Page 41)
Every time I watched this tape, I was struck all over again by the humanity of Aponte’s manner. As his former supervisee, I remembered how often he would insist that the therapist check in with her own feelings—or what we might now call “inner voices”—as a way of determining direction. It was as though he had a gyroscope inside, a touchstone that told him if he were hot or cold, connected or losing ground. Using this process as a sort of feedback instrument, he took tremendous care to stay close to what Michael White calls the “lived experience” of people, moving together with them against the forces that diminished them. I was later to speak of a “different voice” for therapy, but I think my early exposure to Aponte’s thought and practice laid the groundwork for this idea. (Page 49)
This was particularly welcome because Peggy Papp and Olga Silverstein, redoubtable stars in what had by now become a performance field, were striking into new territory. In their work at the Brief Therapy Project at Ackerman, these two pioneers merged Palo Alto’s paradoxes with their Bowenian interest in the family of origin. They had also been influenced by the work of a research team in Milan headed by child psychiatrist Mara Selvini Palazzoli. This group’s seminal book, Paradox and Counterparadox (Palazzoli et al., 1978) had been translated from the Italian by Gillian Walker, one of our team members, and I read it with intense interest and admiration. (Page 53)
I was glad I had a team to back me up, and welcomed the paradoxical messages so pungently described by the Milan team as “bombs.” This work reminded of a TV program I once saw on opal mining. The miners lived in man-made tunnels underground, and every once in a while they set off small blasts of dynamite at the end of their burrows, hoping to dislodge precious stones. But this is too violent an image. Papp and Silverstein added a softening influence by linking the presenting problem to the thematic metaphors of the family’s history. Their work had a quality of poetic resonance that appealed to me. (Page 54)
With tactics like these, Harry wiped me out in the first round. I could hardly ask a question without his making some idiotic wisecrack that broke everybody up, including me. But, as you can imagine, the audience I was really concerned about was the one behind the screen. One feature of our strategic teams was the freedom to express ourselves backstage, sometimes at the family’s expense. The therapist was not exempt either. At times I was sure that I heard, despite the one-way glass, the sound of laughter. Hiding my discomfort, I steeled myself to endure what felt like an initiation rite. (Page 55)
The parents did not want to bring Michael and Laura back in, but we had insisted on this for the first session, and we insisted on it again. One of the guiding rules at this stage of the family therapy movement was that the whole unit should be seen. We assumed, you see, that the family was benefiting from the problem because it served some important function, and if everyone wasn’t there, we couldn’t find out what this function was. (Page 56)
I myself was pondering how to understand Harry’s extreme behavior. Many factors obviously fed into it—the adoption, the learning impairments, Harry’s life stage, the new school—but I was convinced that it acted as a coded message that pointed to some feared event. My rationale was that if a therapist could figure out this message and find a more direct way to transmit it, the anxiety behavior would calm down. I had a bit of time in which to do this, as it was the spring break. So what I did during the following two weeks was to ask myself: “How is this problem a metaphor for something else?” (Page 56)
While Harry was sitting there, muttering to himself, I complimented the parents on being a “good team.” They looked a bit insulted and said they had always been a good team. I remarked that Harry was certainly giving them the chance to demonstrate it. The mother smiled and said, “We were a team before Harry came along. When he’s away at camp, we’re still a good team.” I confess that part of my plan was to expose the way the problem influenced the family and then uncover the ways the family kept it going. White and Epston (1990) were to employ a version of this technique some years later in their “relative influence questioning,” but here I went in paradoxically, complimenting Harry for his bad behavior and implying that the family should be grateful to him. I turned to him and said, “You know, Harry, if you became an angel overnight, I don’t think that would be so good.” Harry started up in exaggerated shock and said, “Angel! Are you sick?” I said, “No, I really think the family would miss you.” He snorted. Then I pushed my luck. I said, “You’re an ugly duckling and an ugly duckling implies swans. And I think that what your family did just now was extremely graceful, they looked like swans.” Michael rushed in to disagree, saying, “No, it’s ugly, it’s not graceful at all,” but the mother, who knew what I was doing, said, “If you mean that we need that to look good, I think you’re wrong.” I pointed out that I wasn’t talking about things they consciously did. For example, when Harry was acting up just then, Harry looked bad and Michael looked good. I added that Michael would have looked even better if he had given up his seat to Harry, and that I was surprised that he didn’t. There was a general family murmur against this idea, but Michael looked quizzically at me and began to smile. (Page 57)
What was interesting to me and the team about this jail analogy was the way everybody chimed in to comment on it. Unlike the kind of interpretation that “points things out,” which often alienates people, this sort of metaphor gets them thinking. (Page 59)
Into the general blackness of my mind came a ray of light. I had been rereading Paradox and Counterparadox, and had been transfixed by the paradoxical letters the Milan team sent to their families. These messages seemed to have a powerful effect in depriving symptoms of the oxygen they needed to grow. (Page 62)
At the bottom of this mutual concern is a secret that may be painful but keeps the family together. Under no account do we believe that this secret should be revealed. (Page 62)
As for the metaphor of the fault, I had used it before in writing about the position of the “identified patient.” I believed that this person was literally standing on a fault or split in the family, but that the practical effect on the other family members was to make them feel that the fault was within him. (Page 65)
Interesante la disposición a tomar partido para compensar inequidades presentes en el contexto cultural.
The mother began to look confused and turned to me, explaining, “Well, that’s the problem. I want to do the harsher thing and he wants to do the softer thing, and I feel that I’m wrong, so I give in.” I confess that I had a feeling of sympathy for this mother, knowing from my own experience how easy it is to “give in.” If we had seen this case in a stronger feminist environment, 1990 instead of 1980, we might well have supported the mother more openly, but at that time we believed that taking sides would jeopardize our effectiveness. In this particular situation, I think that, if I had sided with the mother, the family would have swung to the father’s defense and the “differences” we were trying to get at would have vanished. (Page 65)
The mother wanted to try to convince the father to commit himself to therapy. She said that she was now a true believer and hoped he would want to continue too. The team got nervous and called me out to discuss how we might get the father out of his bad position. Here were two females, both favoring family therapy, ganging up against him. So they told me to go back in and tell the father that I valued his skepticism much more than his support because I too was a family therapy doubter (which was true). (Page 66)
True to our theory that the family “needs” its symptom, the team had already stated that if Harry ever did vacate his position of troublemaker, Michael might very well take his place. The mother had called around mid-August, saying that the crystal ball had worked again and that they were now worrying about Michael. (Page 67)
At Michael’s request, I saw him a couple of times. He was worried about himself, felt quite depressed, and had lost interest in school. I tried to normalize this state of affairs and to point out that it had been topsy-turvy for his younger brother to be a rebellious teenager before he was. After all, he needed a chance to rebel too. I hoped that this way of prescribing the problem would work. At any rate, something did. His grades had gone from good to failing that fall, but he made such a quick recovery that by spring he was accepted in the college of his choice. (Page 67)
In our last session, we asked a question of each family member except Michael, who was away at college: “What would each of you have to do to bring the situation back to where it was when you first came into this room?” This was a strategic intervention based on the idea was that if you prescribed a relapse, it was less likely to happen. It was also a way of obtaining evidence of change, and the answers were interesting in that respect. (Page 68)
So much for brief therapy. The Milan team was now describing its work as a kind of long brief therapy, with separations of two weeks to a month between sessions. If the family was indeed a many-layered kinship system (as it certainly was in Italy), an intervention would take a much longer time to percolate through it than conventional therapies allowed for (Selvini et al., 1980b). (Page 69)
I think it was Selvini who first used Bateson’s word “systemic” to describe their work, but I picked it up and pushed it, just as I had done with Minuchin’s use of the word “structural.” Systemic therapy went on to become a huge influence on family therapy worldwide. (Page 73)
The Milan team felt that a child’s symptoms arose from a pathological tangle that resembled the Bateson group’s double bind. In one of her presentations, Selvini described this syndrome as an “imbroglio,” and gave an unforgettable illustration. When she was a young woman in Italy, just after the war, there was a black market in cigarettes. She went to buy a pack from a street dealer and gave him a large bill, which he went off to change. When he came back, he only returned part of what he owed her. Seeing a policeman nearby, Selvini ran up to him and informed him of the dealer’s attempt to cheat her. The policeman told her that it was she who was guilty of criminal behavior, by buying cigarettes on the black market, and threatened her with a fine. As she stood there, shocked, she watched the dealer and policeman walking away arm in arm. Selvini and her team assumed that some version of this confusing relationship pattern could be found in families with a symptomatic child. The job of the interviewer was to ask questions that would cast some light on how the symptom protected the relationship system. After a discussion, the group would deliver a “counterparadox” that positively connoted and/ or prescribed the problem but would touch all members of the group. For instance, the family might be given a ritual to be carried out at supper in which each person ceremoniously thanked the person with the problem. Mother would say, “Thank you, Anthony, for refusing to go to school because that insures that your grandmother will remain close to me.” Father would say, “Thank you, Anthony, for refusing to go to school, because that keeps me and your mother from fighting.” The brother would say, “Thank you, Anthony, for refusing to go to school because then nobody notices what I do.” The family might be very upset at such a directive, and might not carry it out, but often the boy would go back to school. (Page 74)
At this time, Penn and I were moving from the idea of changing behaviors to the idea of changing meanings. In this we were following Luigi Boscolo and Gianfranco Cecchin, who had separated from the original Milan team. They were exploring the idea of a family myth (Boscolo et al., 1987), which, if it became too rigid, might require crazy behavior to keep it going. Penn and I were taking a similar view, but used the word “premise.” If you said that a family was operating in the service of an outmoded premise rather than playing a psychotic game, it seemed less pejorative. The problem was that we were still using a reified language. We were talking as if a premise sat inside a family the way a message sits inside a fortune cookie. In the grip of what I now think of as a modernist persuasion, we spent endless hours trying to find patterns in our families that matched those that were operating in our minds. (Page 76)
For us systemic thinkers, with our belief that disturbed behavior in a child was tied to a multigenerational struggle, it was an amazing scene, as if the inner politics of the family had been unfurled before us. Penn’s question seemed to hit at the heart of the “imbroglio,” to use Selvini’s term, and lay it out for all to see. (Page 76)
Family theory at that time suggested that obsessions like these might be connected to incomplete mourning, so we decided to give the family a paradoxical ritual. We explained that the obsessions rose from Delia’s belief that she must divert attention from the deaths in the family that had not been properly mourned. To help her with this important task, we asked the family to sit together every Friday evening during the next month and pass around photos of the people who had died. If Delia noticed anyone looking sad or upset, she was to offer one of her obsessions. Our theory was that the obsessions served a diversionary function in the family, and we hoped that if this function were made overt, the obsessions would die down. We also wanted to honor the prohibited feelings of grief. (Page 78)
In the fourth session, the father chided us for this interpretation and stated that Delia still had obsessions even though she didn’t talk about them. However, even though our messages might be experienced as strange or sarcastic, we felt their shock value was worth it if they produced a change. And there was one. Delia told us that she was now seeking a “new image” by throwing out everything in her room. She had gone back to her classes at college and she was dating. At least the obsessions were no longer getting in her way. (Page 79)
This was a premonition we ignored at the time; we were so focused on the past that we didn’t worry about the future. It was only later that we realized that we should have picked it up. (Page 79)
word of explanation. The Milan group often asked children how they perceived their parents’ sex lives. The group was not so attached to the content of the children’s answers as to what it could tell them about alliances. If a husband and wife were not close, they might hypothesize about a “marriage” between the mother and sister that excluded the husband. Or they might find that such a marriage existed between a father and a child. In their eyes, such ties had less to do with sexuality than with family politics. An odd wrinkle came in here. Trying to escape these politics themselves, the group aspired to a “neutral” stance. This stance was seen by the growing feminist presence in family therapy to be immoral if not worse, but systemic principles prevented Milan-style therapists from aligning themselves too directly with any person or side. As a result, they came in for much criticism during the eighties and nineties, when families were being scrutinized for child sexual abuse and therapists were being scrutinized for any kind of boundary violation at all. (Page 80)
The session seemed to become stalled in trivia, and the team called John and myself out, instructing us to tell the family that the team felt we were failing to help them. This was another Milan maneuver. In response to such an accusation, the family would usually side with the therapists against the team and produce evidence of progress. (Page 82)
The moral of the story was a sobering one. I began to wonder whether our elaborate system of hypothesizing served any purpose other than to entertain ourselves. Our interventions, too, were at times questionable, even when they seemed to work. Other objections arose: was our team reacting too mildly to conditions that in other settings would have attracted a serious diagnosis like anorexia? Perhaps we should have taken conventional precautions like hospitalizing Delia or setting up a suicide watch. All I can say is that the family never felt that Delia’s threats were that serious, and our own bias made us reluctant to push her in the direction of a promising mental illness career. (Page 87)
So what did this family teach us? As I have said, we were enamored with the “sacrifice intervention,” which meant putting the person with the problem in the service of other people in the family. This sometimes produced a backlash, but was just as often taken as sarcasm by the family or dismissed. Worse yet, such messages kept putting the family in the wrong. When we connected Delia’s obsessions to the father’s refusal to mourn, we put the father in the wrong. When we made the daughters into caretakers of the parents’ marriage, we put the parents in the wrong. Our messages were full of humiliating implications: that the parents “needed” a homebound child, or that a daughter might have to stay home to be a parent’s therapist. This father, at least, had no trouble disagreeing with us to our faces; in other cases, families simply left. I was left with an enormous appreciation of this family’s tolerance and good will. (Page 87)
That said, let me underline what we did accomplish. The task our team undertook, to positively connote a constantly changing situation in session after session, and to apply this effort to family after family, was in retrospect a most important education. Long after I no longer believed that a symptom served any kind of function in a family, one habit stuck. I had learned how to open my arms wide enough to encompass whatever came at me and to find meaning in it. For years I had talked about the “presenting edge,” because the problem had seemed to rotate from session to session, always facing up a different way. The task was to find a way to describe this moving edge, and then to find a larger universe in which all the contradictions would make sense. (Page 88)
Here, then, was a stellar example of the reflexive impact of practice on theory. It was this family that helped our team to move away from the belief that the behavior of the troubled person serves a protective function in the family. In the next chapter, you will hear how we began to see through another myth: the linear causal bias of the models most therapists are trained in. This was also the beginning of an acknowledgment that while we might try to influence families, the families no less surely influenced us. (Page 88)
 At the beginning of 1981, a family was assigned to our team that challenged one of my core beliefs. Up to then, I had automatically assumed that therapies were all about change and that the primary weapon of change was the intervention. For example, in Haley’s training video, “A Modern Little Hans,” issued in 1976, a little boy who was afraid of dogs was told to adopt a puppy who was afraid of humans. His father, who was a postman of course, was to help him find a dog that was suitably afraid, and then to help him cure it of its fear. Of course, in so doing, the little boy would have cured himself. For structural, strategic, and systemic therapists, the word “change” was the signature of their work. (Page 91)
we had stopped asking at the beginning of a first session, “What is the problem?” because that would imply that we were looking for some kind of objectively knowable condition, and we were moving away from the “essentialist” position of modernism (see Chapter 8). Instead we asked, “What is your idea of the problem?” (Page 91)
But here I was in 1982, awkwardly attempting to insert circular questions into my clinical toolbox. I confess I was not entirely comfortable with them. They seemed designed to hunt out evidence for a hypothesis that the therapists already knew, and they channeled the conversation into a narrow path. As a result, I felt I was standing on a cusp, not comfortable with our current approach but not sure what direction to go in next. (Page 92)