The New Wave in Psychiatry

Techniques of Family Therapy

by Jay Haley and 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…

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