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The New Wave in Psychiatry

Techniques of Family Therapy

by Jay Haley, by Lynn Hoffman
Basic Books, 480 pp., $4.95 (paper)

I Think It’s Me—Difference Display as a Contextual Event, A Family With a Little Fire, The Open Door: A Structural Approach to a Family with an Anorectic Child

Films available from the Philadelphia Child Guidance Clinic

Some psychiatric patients (most notably, young adult schizophrenics) seem unable to get better because of the pressures their families exert on them. This common clinical observation gave rise, some fifteen years ago, to attempts to treat families as a whole. The number of clinicians treating families has since multiplied (there were several thousand at the last government count, with training programs at a dozen major city teaching hospitals), and they would describe themselves as the Family Therapy movement. There are two main schools within family therapy. One derives from psychoanalysis, and is interested in how the inner lives of family members interlock. The other school, more controversial though increasingly influential, is interested in families as “systems.”The instructions of a systems-minded supervisor to a beginning family therapist might run like this:

Assemble the family in one room. Ask them to pick out one of their problems and to try to negotiate a solution. Sit back and follow the structure of their conversation—the form, not the content—the sequences of “transactions” that take place. A transaction might take the form of people blaming each other, or of a child raising his demands each time the parents are about to agree, or of one person “invalidating” another’s perceptions. See what you can learn about the family by watching the patterns of their communication. Ask yourself: What alliances are formed in this family, and when? Why do their arguments never reach “closure” and what keeps happening to prevent a resolution? Where does the child’s “symptom” (for example, withdrawal or provocative courting of danger) appear in this sequence of transactions?

Making observations of this kind is clearly a persuasive experience, especially as it soon becomes apparent that every unhappy family does indeed have certain sequences of “transactions” which seem to recur automatically. It is doubtful whether a young psychiatrist or social worker who tries this experiment could ever think about the problems of therapy exactly as he did before. However, to carry it out, a different sort of attention from that of a psychoanalyst is required. The psychoanalyst, deliberately using his own empathy as a tool, pays close attention to the emotional “content” of what people say. While it is true that he observes the style of communication in order to detect “defenses,” he asks himself a rather different question: What form of relationship is this patient trying to re-create with me? Family therapy shifts the emphasis to the family as a whole and to the transactions within it as they take place in the present.

Many in the family therapy movement prefer to think of themselves as anthropologist-consultants to very small tribes in distress rather than as doctors who cure individual “cases” of psychological illness. Their new style of thinking was shaped by the work of the anthropologist Gregory Bateson1 and in fact all the books under review derive in part from the Palo Alto research group that, under Bateson’s leadership in the mid-Fifties, produced the “double-bind theory of schizophrenia.” This hypothesis has since become (to borrow Auden’s words on Freud’s death) a whole climate of opinion, not least through its influence on R.D. Laing.

Jay Haley, family movement spokesman, was a member of the Palo Alto group, as were John Weakland and the late Don Jackson, who appears in the book by Haley and Hoffman, and to whom Change is dedicated. Salvador Minuchin’s style of therapy was shaped by his work with Oriental immigrant families in Israel and with the families of black and Puerto Rican delinquent boys at the Wiltwyck School; but he has also been much influenced by Haley, whom he invited to join the Philadelphia Child Guidance Clinic.2 These books thus offer an opportunity to re-examine double-bind theory and some therapeutic techniques that have emerged from it during the last twenty years.

What the double-bind hypothesis did was to translate the relationship between the schizophrenia-producing mother and her child into communications theory. The hypothesis starts from the observation that the talk of schizophrenics leaves out—or leaves ambiguous—the signals or “metamessages” which tell us whether a message is serious or playful, real or imaginary, ironic or direct, literal or metaphoric. As Haley first suggested, schizophrenics cannot distinguish among different kinds of logical discourse; he and Bateson drew on Whitehead and Russell’s demonstration that confusion of “logical types” creates paradox. Why do schizophrenics apparently refuse all relationships by refusing to qualify their own messages? What could such schizophrenic communication be an adaptation to? It was, as Bateson put it, a response to a mother who continually puts her child in a paradoxical bind by a) giving him mutually contradictory messages, while b) implicitly forbidding him to recognize or point out what she is doing. If he could blame her he would be out of the bind; but such children sacrifice themselves in order to maintain the fiction that their parent’s “mystifications” (as Laing later called them) make sense.

Bateson specified what sort of mother this was: one who is made anxious and hostile by closeness to her child but finds it intolerable to acknowledge this. When the child approaches she withdraws, but when the child then moves away she becomes pseudo-affectionate and accuses him of being unloving. Such phenomena are readily observable, and Bateson’s description of them was simple and elegant.

Psychoanalysis doesn’t contradict the double-bind hypothesis. Bateson’s work meant that there were now two ways of describing the same phenomena. You could talk in psychoanalytic language about a highly ambivalent mother who projected her own hostility, an infant who lacked experiences of mutuality and so developed a weak ego, etc., or you could talk about the same behavior as a “dysfunctional relationship” which shows itself in disturbed communication. But if you do the latter, the emphasis shifts from past to present, from inner dynamics to communication, from pathology to a peculiar adaptation. Haley, in his Strategies of Psychotherapy, published in 1963, spelled out one version of the implications of double-bind theory. Unfortunately, Haley’s notoriously sardonic style has made it nearly impossible for anyone educated in psychoanalysis to give him attention.

Every communication, Haley wrote, functions both as a report and a command; and as a command each communication can be seen as redefining the nature of the relationship one is having with the partner. If I discuss the weather I may be defining our relationship as one in which we will only talk about conventional matters. If you then ask me why I am talking about the weather, you have redefined our relationship as more intimate. (Try observing this. It can be unnerving.) Every relationship (marriage, therapy) can be seen, Haley says, as an implicit power struggle over who defines the nature of the relationship. In the above example, if it is a psychoanalyst who asks why I talk about the weather, he has thereby taken control of the context: my pleasantries are now something to be examined. All symptoms of “disturbance,” according to Haley, should be looked at as strategies that control relationships that cannot be controlled by other means. (Part of the strategy is the claim that the symptom is involuntary.)

Haley also suggested that we look at all situations in which one person sets out to change another, whether by hypnosis, religious conversion, psychoanalysis, behavior therapy, family therapy, or whatever, and ask what formal characteristics they have in common. He found that they all contained “benign” double-binds, i.e., they make it impossible for the patient to re-create the kinds of relationships he has formed in the past.

Minuchin, Haley, and their colleagues command our attention, moreover, because they represent one of the first concerted attempts to apply systems-theory concepts to the practice of psychotherapy. Their defenders say they are trying to give us a grammar of situations rather than a grammar of individual motives. As such, their work appeals to the loyalty of those who sympathize with Bateson’s plea that we need to think “ecologically,” in terms of patterns and relationships, rather than in linear fashion, in terms of cause and effect, individual vs. environment, etc. (Minuchin, for example, calls himself a “context-oriented” therapist, in contrast to those who are “individually oriented.”) Their clinical methods, however, can strike outsiders as unpleasantly manipulative and authoritarian. And their style suggests that something of Bateson’s vision has been lost in translation.

Family therapy is best defined as what a number of family therapists are doing,” write Haley and Hoffman in the introduction to their book, which combines interviews with noted family therapists and transcripts of representative sessions. “To learn what it is they do, one must watch them at work and inquire about their actions…. From such queries we learn what a therapist’s beliefs are about his work. If these be rationalizations, that is what all clinical writing is.” This calculated ingenuousness and mistrust of explanatory concepts are characteristic of Haley, but they also reflect the state of the art. When C. Christian Beels and Andrew Ferber, who are more ecumenical teachers of family therapy, set out to survey their field, they too watched therapists at work through one-way screens, studied video tapes, and interviewed colleagues. Their report3 sounded a similar note:

It was pointless to try to abstract “the technique” from these many approaches, since the personal stamp of the therapist was so clearly the first thing we had to understand…. We avoided the evaluation of theory because we believed that in many cases the theory advanced was a rationalization for the practice….

Indeed, at first view all that the various forms of family therapy may seem to have in common is that the whole family is usually in the clinic or the consulting room at once, and that the setting is somehow public; the tape recorders, video cameras, and one-way screens suggest an audience. Therapists may have co-therapists, and the one-way screen may harbor behind it a supervisor, armed with a microphone that he may use to intervene. The therapist himself may disappear behind the screen, emerging like a deus ex machina when the plot gets too thick.

Family therapy, like some family quarrels, needs witnesses, to keep track. The watchers often prefer to be watched too, to guard against their being drawn in to take sides in a way that would perpetuate the family’s patterns. Family members, also, may be taken behind the screen, to show them how the family gets on without them (for example, to show an intrusive grandmother that her daughter can cope with the children). The invisible drama of the transference has been replaced by what has been described as a kind of Brechtian theater. The therapist functions as stage director, and some (Minuchin is one) double as actors too.

Despite their shyness of concepts, the systems-theory therapists, as I’ll call them, do have some. Following Don Jackson, they try to look at families as systems that are kept together, or kept within certain limits of behavior, by homeostatic mechanisms which continually re-establish the status quo. (Examples might be: whenever this wife shows a certain degree of resentment, her husband deprecates himself; whenever these parents quarrel, their child diverts them by becoming troublesome; whenever another child shows a certain degree of independence, his mother labels it as dangerous or disturbed.) They are not interested in the history or causes of a symptom, but in how it serves to regulate present behavior.

The identified patient’s symptoms can be assumed to be a system-maintaining or a system-maintained device,” Minuchin asserts. He allows that a symptom may arise because of the individual’s “particular life circumstances,” but he believes it then always gets “supported” by the system. This is a useful assumption for opening one’s eyes to such phenomena, and a difficult one to falsify in any given instance. (The authors of Change, however, lose my confidence when they reveal their cavalier assumption that the origin of most symptoms is essentially trivial, e.g., that a phobia about going out to shop starts from an accidental fit of dizziness at a department store door.)

In contrast to psychoanalysts, and to the more psychoanalytic family therapists, the systems-theory therapists place little reliance on insight as an agent of change. “I believe that insight is a by-product of change,” Carl Whitaker said in an interview. “You have to go past it to see what it is.” Moreover they assume, arguing from cybernetics, that if one family member does try to change, the rest of the “system” will respond so as to minimize or eliminate that change. So they feel they have to interfere actively in the pattern of the family’s functioning in order to make it possible for something new to happen. “In order to transform the system, the therapist has to intervene so as to unbalance the system,” says Minuchin, who may do so by taking sides, in various tacit but obvious ways. (Scholastic attention is given to how and when Minuchin changes his seat.) Don Jackson says, “You don’t really point it [the system] out, you disturb it first. Otherwise they’ll never see it…” because each person will simply blame the other for starting the system in the first place.

The family therapists may have the family “enact” new ways of behaving in the session. (Example: having the children sit with their backs turned while their parents get on with a quarrel.) They may assign homework “tasks” (shutting a bedroom door two hours daily, so as to establish privacy). They may deliberately stage a crisis (as Minuchin does when he tells the parents of an anorectic girl to try to force her to eat) or they may give instructions that will exacerbate the situation. Don Jackson, asked how he might try to produce insight, if he ever wanted to, replied, “I would tell them to treat [this] daughter the way they are already treating her, and let them discover how they’re treating her. In other words, try to produce a ‘runaway’ in the system. That would produce more ‘insight’ than just telling them what I think they’re doing…. Prescribing the symptom is more likely to produce insight than telling people how the mind works.”

But while systems-theory therapists don’t value insight, they do use all manner of persuasion to convert the family to their way of seeing its communications as strategies. They will, for example, ask each person what he or she could do that would upset or please the others. Their initial sessions seem to be devoted to propagandizing the family, more or less skillfully, into the view that it is the whole family that is “hurting,” as Virginia Satir, in Techniques of Family Therapy, puts it.

In Families and Family Therapy, Mr. Smith, an anxious and paranoidseeming middle-aged husband, is on the verge of returning to a mental hospital:

Smith: I think it’s my problem. I’m the one who has the problem.

Minuchin: Don’t be so sure. Never be sure.

Smith: Well, it seems to be. I’m the one that was in the hospital and everything…. I don’t know if it’s caused by anybody, but I’m the one that has the problem.

Minuchin: Mm. If…let’s follow your line of thinking. If it would be caused by somebody or something outside of yourself, what would you say the problem is?

But Smith continues deferring to his wife’s complaints. And when Minuchin mentions the wife’s bad temper, Smith shows more anxiety: “Are we on television?” Finally, Minuchin himself has to bring up the fact, known from a previous psychiatrist, that the wife is frigid. Smith acknowledges that his “condition” could relate to this; the wife “accepts the label of sick” and Smith is told he needs to help his wife overcome her difficulty. The hospital is avoided; marital therapy with sex counseling ensues.

The film made of this session is entitled I Think It’s Me—Difference Display as a Contextual Event. This last phrase is so splendid a flourish of systems rhetoric that it seems almost self-parody. Family therapists value “difference” since it is difference that makes the world go round, as everyone knows who remembers Bateson’s lovely definition of “information” as “a difference that makes a difference.” But the difference referred to here is simply Mr. Smith’s tendency to behave in a bizarre way under stress, particularly the tic-like scrabbling of his hand on his chair; the camera zooms in on this to show that it occurs whenever Mrs. Smith implies he is sick, and subsides whenever Minuchin redefines him as normal by making a point of how much he, Minuchin, resembles Smith.

In his treatment sessions, Salvador Minuchin comes across as a showman; he loves to play the expert or the duffer, whichever he thinks will work. He seems canny, cheerfully domineering, anti-intellectual, and genuinely sympathetic toward poor families. According to Minuchin, every unhappy family is unhappy in one of two ways: they are either too “enmeshed” or too “disengaged.” The cure is to “restructure,” by putting “boundaries” around “subsystems,” and his book is full of diagrams, which look a bit like football plays, and which he uses to point out where the realignments should take place. The psychoanalytic family therapists I’ve talked with feel he deserves credit for trying to present a comprehensive theory in a field which had none.

He has recently received much attention for his research project in which young adolescents suffering from anorexia—rejection of food—are treated by family therapy. Anorexia can be fatal; it is difficult to handle. It astonishes many that it should be amenable to family treatment. Does Minuchin’s success imply that even so grave and seemingly “psychotic” a disturbance is best described as merely a “contextual event”?

What follows is Minuchin’s typical procedure in treating an anorectic patient, abstracted from several transcripts and video tapes. We see the family in the hospital where the emaciated daughter has continued to lose weight. Lunch is brought in for everyone. Minuchin tells each parent in turn to try to get the daughter to eat. This part is usually agonizing to watch: the parents are awful, the girl stubborn and desperate. The parents always fail, and Minuchin calls a halt once the scene reaches some appalling if ludicrous climax, such as the enraged father trying to stuff a hot dog down his daughter’s throat. You have failed, he tells the parents. And you will always fail so long as you fight your battles through the girl, and undercut each other’s efforts, as you just did. You must learn to work together if she is to live.

Minuchin then tells the girl that she has been fighting for her independence in a family where the only remaining opportunity to rebel was in not eating. She has won; she has humiliated and defeated her parents in front of the doctor. And as she gets stronger, she will be able to do battle in other matters. Meanwhile, of course, she must eat, but now she is offered a choice, chicken or hamburger? and so on down the menu. By the end of the session she is unobtrusively eating, and is discharged within a week.

Minuchin may continue to take charge of the girl’s eating, perhaps by having her phone him whenever she wants to eat anything (paradoxical tactics). Meanwhile the parents are encouraged to apply “behavior modification”: the girl must stay in bed unless she gains her weekly quota. Since anorectics are hyperactive, this is strong punishment. Family therapy will continue, and will also deal with the “behavior problems” some ex-anorectics develop.

It is an ingenious therapy: half ritual drama, half behaviorism. As Sir William Gull said in the nineteenth century, when he named the syndrome anorexia nervosa, “The treatment required is obviously that…the patients should be fed at regular intervals, and surrounded by persons who would have moral control over them….” It is clear that Minuchin mobilizes the parents to exert a degree of “moral control.” It is interesting also that ritual drama works. The staged crisis is at least a temporary exorcism of the girl’s negativity, and Minuchin construes it for her as a rite of passage: she has “defeated” her parents. I do not think it necessarily proves anything new about the supposed causes of anorexia, or that anorexia isn’t part of a larger disturbance of personality which may later persist as struggle with “internal” parents. But the scene does make powerfully visible the hidden binds the parents have been imposing on the girl.

We learn much about the ethos of family therapists by watching one of their most favored and most fascinating techniques, which is called “relabeling” or “reframing.” They consider it to be highly effective. As Haley himself might have observed, one of the first things which gurus, shamans, and psychotherapists do when they set out to change someone is to convey to them that the world is not what it seems, and that their habitual categories may not apply. Magical feats will serve to do this, and so will interpretations of the unconscious, and so too, the family therapists believe, will “relabeling.”

Relabeling has distinguished ancestry in Bateson’s application of the “Theory of Logical Types” to the study of communication. Every message is qualified by the label given to it by the “meta-message.” The significance of anything changes according to what class or set you assign it to—reward or punishment, praise or blame, the playful or the earnest, etc. Change the context and you can modify the facts, or everybody’s attitude to the facts. The relabelers are engaged, so they believe, in changing the context. They hope that this will free everybody to behave differently in the next context.

Thus in family therapy patients are to be relabeled as normal; symptoms are to be relabeled as rational tactics; and wherever possible what looks negative is to be relabeled as positive. (Probably the boldest example of this was the husband who had chased his wife with an axe, and was told he was trying to get close to her.) Candide was clearly a talented relabeler, and so too was Tom Sawyer, whose “reframing” of the task of whitewashing a fence is quoted as exemplary by the authors of Change. Here are some examples of relabeling in practice:

  1. The family of an anorectic is asked, “How long have you had this fasting problem?”

  2. A young schizophrenic, barely managing to survive as a failing student, is brought to the therapist by his mother, who claims he is headed for another breakdown. The boy complains that his parents dole him a weekly allowance on the basis of how “sick” or “good” he seems. Watzlawick et al. write, “In the presence of the mother it was pointed out to the son that he had every right to defend himself by threatening to cause a far greater expenditure by suffering another psychotic break. The therapist then made some concrete suggestions as to how the son should behave in order to give the impression of impending doom—these suggestions being mostly reformulations of the some-what weird behavior the son was engaging in anyway.”

This is relabeling the symptom as a voluntary tactic. Result: the mother felt free to get angry at the son; she settled an adequate allowance on him so that he could “sink or swim”; the son saved up and got a car, becoming more independent.

  1. In Techniques of Family Therapy, two cold upper-class parents—collusive in their attitude that all-things-must-be-bright-and-beautiful—are confronted with their college-age daughter, who has just had an acute schizophrenic episode. The mother, who plays the martyr, starts to cry.

Father: I certainly am [sighs] sorry to see, ah, Mrs. Starbuck hurt by, ah, things that Sue was saying.

Sue: Oh, I don’t mean to hurt her….

Therapist (Don Jackson): I wonder that she was crying necessarily because she was hurt. Has that been established?… [To mother] …because you responded to your daughter with I think a rather touching closeness, I don’t think it was just a hurt….

Jackson explains his technique: “This is simply taking the motivation that has been labeled in a negative way and labeling it in a positive way…. If they have been defining what they are doing in one way for many many years, and if I can suddenly define it another way, it shocks them a little out of believing that they’re always right….”

  1. A session in Minuchin’s book (and in the film A Family With a Little Fire) is an act of relabeling from start to finish: A hard-working black mother of four, more relieved than sorry that her ex-husband no longer visits the family, comes to the clinic because her seven-year-old daughter has, for the second time, set fire to the mother’s bed. The therapist, Braulio Montalvo, praises the children for their competence in putting out the fire. He notes silently that the mother tends to use as a scapegoat the fire-setting child, Mandy, who had been the father’s favorite. Mandy hides behind a book, whereupon the mother reprimands her. Montalvo deliberately misunderstands, and asks Mandy to read aloud: “She was reading O.K.” Prescription: Mother is to spend ten minutes a day teaching Mandy to light matches safely. Also her teacher is to encourage her good reading. Throughout, Montalvo is reassuringly low-key. Fire-setting doesn’t recur.

Throughout this session the fire has, by implication, been “labeled” an accident. Because of the taboo on interpretation, particularly of anything negative, no one told Mandy that it was natural she missed her father, or explored whether she blamed her mother for his disappearance. Perhaps the mother did get the message to appreciate Mandy more. But perhaps what also happened was that the clinic provided Mandy with an authority figure, Montalvo, who said she wasn’t so bad after all, just as her father used to do. Psychoanalysts used to call this a “transference cure”; they still could.

The interpretations psychoanalysts make, of course, are also a form of relabeling. They too relabel the patient’s irrationality as understandable and acceptably human. Reflection on this raises provocative questions. Doesn’t all therapy provide a change of context? Does all anxiety signal loss of context? I am dubious about some family therapists not because they relabel but because they do so in so facile and Pollyannaish a way.

Another contribution of Bateson’s, although it is no longer acknowledged as such and seems to have been somewhat oversimplified, has to do with the notion of complementarity. During his work in Bali with Margaret Mead, Bateson became interested in what kept cultures together or drove them apart (he called these latter factors “schismogenic”). He described two basic forms of relationship between groups in a culture as symmetrical and complementary. In a symmetrical relation the same behavior is exchanged; more of it in A is answered by more of it in B. Examples would be boasting, or ritual gift exchanges, or commercial rivalry. Such relations tend to be ones of rising competition, as in armament races.

In complementary relations, opposite and mutually dependent behaviors are exchanged, e.g., nurturance/dependency; exhibition/spectatorship; dominance/submission. Complementary relations may tend to increase cohesion. However, Bateson also saw from the beginning that complementary relations could become increasingly polarized if they lead “to a progressive unilateral distortion of the personalities of the members of both groups, which results in mutual hostility.” Family therapists look for ways to change symmetrical relations into complementary ones, and often seem to sentimentalize the “complementary.”

Therapist (Carl Whitaker): Come on, Dad. Do you solve the problem of Mom coming on so strong by sort of being nice and quiet?

Mr. Dodds: Yes, I think we are quite opposite in personality. She is, like you say, quite fiery.

Whitaker: Do you appreciate that? Do you like it?

Mr. Dodds: Yes, I guess in a way it’s good.

Whitaker: I sort of feel like that’s the way we marry. I married a wife with fire because I was kind of soft and easy.

Minuchin’s commentary: “The therapist makes an interpretation of complementarity…. Again the terms emphasize positives: the mother is strong, the father is nice. Another therapist, more concerned with pathology, might call her controlling and him passive.”

What about the clinical success of the family therapists? They seem to be good at doing certain things: at getting very disturbed adolescents some freedom from very disturbing families; at teaching families how to manage a symptom (such as asthma—another Philadelphia project) without reacting to it in ways that make it worse; and at keeping schizophrenics out of hospitals. Beyond that, it is hard to judge their work because they publish only the early sessions, not later stages of treatment which may go on for two years. Nor do some of them worry much over the number of families who walk out after one meeting. They happen to work mainly with a lower-middle-and working-class clinic population, and their faith in the power of genial persuasion may reflect their clients’ diffidence toward professionals.

Minuchin’s underlying assumption, which he states humanely, is that most people cannot change very much. Haley has always inveighed against the kinds of questions psychoanalysts ask about whether deeper changes in personality take place. He believes we can tell only whether behavior has changed. Watzlawick et al. believe that most contemporary therapy creates more problems than it cures by implying “utopian” goals of personality change, and that it is cruel to view a symptom as just the “tip of an iceberg.” The art of therapy, in their eyes, is to define a problem as narrowly and pragmatically as possible, and then to deal with it.

The authors of Change take a conservative political position; they find most social welfare programs “utopian” too. They are, however, training probation officers in the use of paradoxical techniques, e.g., to gain the trust of the probationers in their charge, the officers are advised to say, “You should never fully trust me or tell me everything.”

Jay Haley once remarked in Families and Family Therapy that he suspected the essence of therapeutic technique was in the “mixture of forcing people to behave differently but phrasing it in such a way that they can’t resist because you’re on their side.” The authors of Change have much in common with Haley, and even include one of his old examples of such technique (suggesting a dearth of canonical anecdotes in Palo Alto). The example: If a frigid wife is, according to psychiatric theory, hostile to her husband, then she should be told that she is trying to protect him from the full force of her sexuality. Because of her hostility, she will decide to stop protecting him.

Young family therapists are gratefully reading Change because it tells them how to look at situations of conflict as feedback systems. Moreover, it spells out the mysteries of their tradition: elementary set theory, the theory of logical types, the notion of logical paradox (double-binds). Change is deliberately and provocatively obnoxious, but its clumsiness is, I suppose, inadvertent. Important ideas reappear in it as snappy formulas. (Bateson shows that cybernetics implies a new notion of what constitutes an explanation: Cybernetic explanation is a-causal, because it deals with form, not substance, relationships, not things. Watzlawick, Weakland, and Fisch just tell you to ask “What is happening?” rather than “Why?”) Change uses the cybernetic definition of change to rationalize an exceedingly manipulative approach to patients—an approach which is more properly justified by cynicism, not cybernetics.

As I trace it, this notion of change first appears, innocently enough, in Bateson’s thoughts about a porpoise: the experimenters were trying to teach the porpoise to produce new behavior. Each time it did something new accidentally, they would reward it. The porpoise would begin each show by displaying its latest “new” trick, but it wouldn’t get a reward unless it did something still newer, by chance. The porpoise grew understandably moody. But finally it caught on: it went into a state of creative agitation, and at its next performance produced four pieces of behavior never before observed in the species. It had learned to learn.

This corresponds with the cybernetic notion of change. There is “first order” change: this is merely substituting one item of data (or behavior) for another. Then there is second order change: this is a change in the kind of operation that is carried out—“a change in its [the computer’s] way of behaving.” Second order change means a shift to a “meta-level” of programming.

Change was written to expound the rationale that implicitly had been guiding the authors’ eight years of “problem solving” at their Brief Therapy Center in Palo Alto. What they’d been doing, it seems, is looking at situations and asking: What in this could be seen as an analogy to a logical paradox—or to a closed positive feedback circuit (where A=go to B, and B=go to A)? What could they then suggest that would resolve the problem at a meta-level? Their examples are uninspiring: a teenager stays out late; his parents become more restrictive; conflict mounts. Moral: The attempted countermeasure is often part of the problem. Solution: Tell the parents to play helpless and unconcerned; the teenager will become responsible.

The problem solvers have, they confess, only one problem, which is how to get people to do what they tell them to do. For this too there is a strategy, which they devised especially for those patients who are just too “cautious,” for example, to “risk” looking for a job or a mate. They call it the “Devil’s Pact.” We have a plan, they say, which is likely to succeed, but you will probably think it is too absurd or inconvenient or risky, and turn it down. Therefore we will not tell you what it is unless you promise in advance to do it. Go home and decide: if you don’t agree, don’t come back.

Well, yes, of course. The issue in all therapy is how to produce commitment or willingness to change, how to create what psychoanalysis calls the “therapeutic alliance.” I do not mean to condone their use of this ultimate little gimmick when I point out that it could also be seen as a coarse version of a formula which is found in many therapeutic contracts. The formula is, roughly: I will ask you to do something which requires that you surrender your ordinary rationality for a while and so trust in me or in something larger which I may represent. The psychoanalyst’s rule that the patient at least try to free-associate also fits this formula, as do some tasks set by shamans and gurus to beginners.

Accepting the irrational task, letting go of one’s usual means of controlling the world, is, of course, already a first step in changing—and it also establishes one’s commitment to the therapist and the therapy. And yes, Watzlawick, Weakland, and Fisch’s “Pact” might impel a certain kind of patient to “put himself blindly into the hands of another person,” as they themselves describe it. And for some this might represent a small but significant step toward change. The offer of the “Pact” might drive some others to suicide, but this too could be edifyingly discussed as an example of “second order change.”

The epistemology of cybernetics, Bateson has informed us, is anti-Aristotelian. Cybernetics, in his view, suggests that we are all prisoners of seeing things in pairs of opposites. The way out of conflict (or “oscillation,” in computer terms) is to realize that we are neither one nor the other pole, neither A nor B, but something which contains both. This is what Bateson’s extraordinary analysis of Alcoholics Anonymous as a therapy is all about. The alcoholic must “surrender” (to God, in the AA scheme) and stop pitting his “sober” self against his “drunken” one, i.e., he must acknowledge that both his sober ego and his drunken irrationality are part of a larger system.

Bateson proposed the AA procedure as a typical example of therapeutic change. Similarly, to venture an example suggested by this model: a schizoid person could be seen as oscillating between the need to be special and a sense of being worthless; the more he needs to be special, the more worthless he will feel, and vice versa. Therefore to change he will need to stop seeing the world in terms of special vs. worthless. The authors of Change are also in effect proposing that we use this model in looking at situations of conflict, both outer and inner. But their notions of inner conflict are decidedly sketchy. And their raffish problem-solving is not, I think, what Bateson meant at all.

The systems therapists announce they are working with a new paradigm, or model of thinking, one which, they are the first to tell us, is discontinuous with the psychoanalytic one. When one paradigm arises to rival another, as Thomas Kuhn has suggested, there may be a longish interregnum, during which people will decide their allegiance on all sorts of grounds. They may prefer the cultural style of the adherents of the new paradigm. Many family therapists, for example, consider themselves less “elitist” than psychoanalysts (partly because they deliberately put themselves on an equal footing with patients by revealing their own personalities, instead of remaining a blank screen for transference. Meanwhile, without acknowledging that it is the patient’s transference which has invested them with authority, they use that authority). If the new paradigm solves problems which the old one failed to solve, that often convinces people that it is the only one that makes sense. These books do not assure me that the solutions of family therapy are as yet so convincing.

Letters

Family Therapy: An Exchange May 29, 1975

  1. 1

    See Gregory Bateson, Steps to an Ecology of Mind (Chandler, 1972; Ballantine, paper).

  2. 2

    Another major influence on the Palo Alto group was the imaginative work of Milton H. Erickson, the doyen of medical hypnotism, who wrote the foreword to Change. Erickson advised Bateson and Mead on their work on trance in Bali. From his work comes the understanding that trance can be seen not just as an inner state but as a form of relationship, and that inducing trances typically proceeds by double-bind communications. See also Jay Haley, Uncommon Therapy (Norton, 1973; Ballantine, 1974, paper), which is about Erickson’s work.

  3. 3

    What Family Therapists Do,” in The Book of Family Therapy, edited by Andrew Ferber, Marilyn Mendelsohn, and Augustus Napier (Aronson, 1972; Houghton Mifflin, 1973, paper).

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