Multi-generational Family Therapy

Tools and resources for the therapist

Maurizio Andolfi

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781134812165
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Multi-generational Family Therapy reveals the limits of the medical model in treating mental and relational problems. It instead provides a toolkit for therapists, observing family functioning over at least three generations to explore the developmental history of the family in order to discover links between past trauma and broken emotional bonds, and current problems experienced by family members. Maurizio Andolfi honours the voices of children in therapy and enlists them as the key to unlocking unresolved family issues.

The book provides an experiential model of intervention that centres on creativity and humanity as the best way to build an alliance and work with a family in crisis. Demonstrating with case examples, Andolfi outlines the relational skills and inner self of the therapist, focusing on the ability to be direct, authentic and emphatic. The use of relational questioning, silence, body language, physical contact and movement in therapy are explored in depth.

Multi-generational Family Therapy will be of interest to anyone working with individuals, couples and families including child, adolescent and adult psychotherapists, psychiatrists, psychologists and counsellors. It will also prove useful to private practitioners, social workers, doctors, paediatricians and educators

1

THE ROOTS OF RELATIONAL PSYCHOLOGY

The origins of Systems Theory

Relational Psychology finds its roots in the American culture of the 1950s, characterized by an attempt to overcome the fragmentation of isolated studies and interventions with the introduction of a holistic model to deal with people’s problems. Such a new interdisciplinary approach provided fertile ground for the development of social sciences like anthropology and sociology, which offered a significant contribution to the understanding of the socio-cultural contexts in the individual’s life cycle, as well as the influence of family dynamics on personality development. In particular, in the field of psychology, Neo-Freudian theories brought about a radical shift from observing mostly intra-psychic factors, to exploring inter-personal phenomena and the cultural and social contexts in which they take place. In the opening session of an outstanding International Conference on The Pioneers of Family Therapy, held in Rome in 2000, Minuchin stated that the Neo-Freudian group formed by Sullivan, Fromm, Horney and Thompson were the real precursors of the incipient movement of family therapy.

From this theoretical framework, Systems Theory emerged. It represents the structure that connects (Bateson, 1979) the various fields of understanding (from mathematics to natural history to humanities), and is based upon such concepts as systems, organization, self-regulation, totality and circular causality. The General Systems Theory, introduced by the biologist Von Bertalanffy, was systematically organized in 1968. The focus of interest for the observer changed from isolated phenomena to “organized wholes”. Such a vision of reality introduced a new language and an innovative scientific lexicon applicable to the study of any system: live organisms, social organizations, computers and human systems. The systemic perspective adopted a wide-angle lens: it looked at the world in terms of the inter-dependence and inter-relationship of all observed phenomena and this integrated reference scheme, whose properties cannot be reduced to those of its parts, was designated a system (Capra, 1982). In this sense, this model allowed the observer to isolate the characteristics common to all systems, understood as whole, intelligent units interacting amongst themselves (Miller, 1978).

The introduction of a systemic-cybernetic perspective to family studies is due to Palo Alto’s Mental Research Institute, represented by Watzlawick, Jackson, Haley and Weakland, among others. These authors were the direct followers of the Batesonian ideas and borrowed concepts and language from communication theories in animals and machines (input and output, feedback, etc.). The access key to the family, seen as a self-correcting system with stable connections tending to homeostasis, is provided by the psychic discomfort in the individual, which in turn translates into a distortion in communication. They were responsible for theorizing that families are organized by a tendency to maintain the status quo (homeostasis), with particular rules of communication and more or less rigid sets of interactions. The model proposed by the group focused on observable aspects of behaviour/communication in the here and now, that is to say, on the interactive dimension. They attempted to connect a particular type of communication with a specific symptomatology, which led them to develop ways of assisting people to communicate better.

In the mid-1950s, the Double-bind Theory (Bateson, Jackson, Haley & Weakland, 1956) provided a theoretical framework for understanding and treating dysfunctional forms of communication typical of dyadic relationships. Such a concept derived from an attempt at explaining major psychiatric dysfunctions, primarily schizophrenia, in terms of causal circularity and therefore connected to particular types of interaction between different family members. Various authors criticized this idea for remaining trapped in mechanistic concepts of linear causality, in a search for the ultimate causes of symptoms (Minuchin, 1974, 2002; Ugazio, 1985; Telfener, 2002; Andolfi & Mascellani, 2013). In effect, even though they worked in collaboration with Bateson and shared with him an ambitious research project on various forms of communication, the group did not understand the complexity of his concept, and were unable to free themselves from the mechanistic model they were attempting to overcome. Aetiology (the search for the cause), typical of the Medical Model, continued to guide family studies. This gave rise to the dyadic theory that dysfunctional communication between two individuals who are emotionally bonded leads inevitably to the manifestation of pathology, when one person is unable to decipher the contradictory messages given by the other. An example of double bind is highlighted by the dysfunctional communication between a mother and child, where the mother tells the child, “I love you”, whilst her intonation and body language demonstrate the opposite, and the child is unable to make sense of the contradiction. In reality, the Double-bind Theory, as an explanation of major psychiatric disorders, was an interesting research idea, but when applied to clinical practice it resulted in total failure and was strongly opposed by the families associated with the National Alliance on Mental Illness (NAMI) in the United States, because it was considered judgemental and accusatory towards the parents of schizophrenic patients. The decline of this theoretic model was highlighted in 1978 during a conference held in New York, entitled “Beyond the Double Bind Theory”. A book by the same title was published later that year (Berger, 1978).

The axioms of human communication, including a thorough exploration of verbal and non-verbal language, and the difference between content and context are described in the well-known book, Pragmatics of Human Communication (Watzlavick, Beavin & Jackson, 1967). This book provides very useful guidelines to orient therapists in working with clients. The adoption of a systemic-cybernetic perspective opened a critical debate on the monadic vision of the individual, a prisoner of his inner world, contrasting it with the view of an individual as a social being, whose behaviour can be understood within the context of the relational system he inhabits. The communicational features of every event and action, including symptomatic behaviour, are highlighted by this approach. An individual’s problem is viewed also as a signal of the relational discomfort in the family, and communicates the existence of conflict between homeostasis and change.

To summarize, Systems Theory is based on looking at the family as an organized system. Every behaviour is understood as a function of the relationship according to the context within which interactions take place. The focus of interest shifts from the idea of an artificially isolated individual to the relationships between the dynamics of the larger family system. The idea of context in the study of family relationships is a key point of the model proposed by Watzlawick et al. (1967). Devoid of context, words and actions have no meaning. Context is defined not only by the words that are spoken, but also by the non-verbal communication, which are mutually reinforcing and constantly evolving. The presenting issue can thus be viewed in another light, in that it is no longer considered solely as the manifestation of individual discomfort or illness, but highlights the dysfunction within the family system. Haley (1976) made another significant contribution. He proposed the triad as the basic unit of observation of relational phenomena, an innovative idea that allowed the therapist to look at family interactions through a new lens and to adopt different ways of gathering information, which later was described as “circular questioning”. His finding of perverse triads in the presence of severe individual symptoms led him, in the late 1960s, to open himself up to new influences, firstly through the strategic approach of hypnosis by Milton Erickson and later through Minuchin’s Structural Theory (1972).

Systems and Multi-generational Theories: two models compared

The development of Systems Theory did not lead to the definition of a common conceptual and operative model to look at family functioning and individual psychopathology. Since the 1960s, two different schools of thought in the area of family studies began to take shape and confront each other. On the west coast of the United States, the Palo Alto group studied the first axioms of human communication (which would culminate in the Double-bind Theory). On the east coast, another group formed that came from a psychodynamic tradition. Principally represented by Bowen, Boszormenyi-Nagy, Framo, Whitaker and, at some level, by Minuchin and his structural school, their work was fundamental in orienting the focus towards a developmental perspective that took into account the individual’s development within the family’s life cycle.

Pragmatics of human communication

The theoretical formulations of the systemic movement (Watzlawick et al., 1967; Selvini Palazzoli, Boscolo, Cecchin & Prata, 1978; Haley & Hoffman, 1981) were focused mainly on the observable communications and interactions in the family system taking place in the here and now, without connecting them to the developmental process of which they are a part. The observed reality was imprisoned in a static way: the natural formulation of a system and its development over time was reduced to a single dimension, the present. The limitation in such a vision was to consider the individual’s subjectivity as a “black box” that trapped his thoughts, emotions, motivations, expectations, imagination and meaning. This reduced observation exclusively to pragmatic aspects, ignoring temporal aspects made up of a past, a present and a future and a whole world of meaning. In spite of the limiting exclusion of the family’s historical and subjective aspects, the communicational theory gave the opportunity to contrast the dominant ideas of that period, and acquired an autonomous identity in relation to a strong psychoanalytic tradition that was based on verbal discourse and on the intra-psychic dynamics in the individual.

It is important to note that the group comprising Watzlawick, Beavin, Fish and Weakland, who worked for almost 30 years at the Mental Research Institute in Palo Alto, was mainly interested in brief individual interventions with a strategic orientation. In spite of this, Pragmatics of Human Communication (Watzlawick et al., 1967) became the family therapist’s bible for at least two decades, particularly in Europe, perhaps because of its strong opposition to a firmly rooted and dominant psychoanalytic tradition. During the 1970s, the group, headed by Selvini Palazzoli in Milan, was inspired by Watzlawick’s work and by the so-called “system purists,” who insisted that the therapist had to maintain a neutral stance, with no emotional response to the clients’ problems. Influenced by this, Selvini Palazzoli and her group wrote a classic article on how to conduct a session, which was based on three principal guidelines: the therapist’s neutrality, the formulation of relational hypotheses and the use of circular questioning, devoid of any personal involvement of the therapist (Selvini Palazzoli, Boscolo, Cecchin & Prata, 1980).

The individual in the family

Multi-generational family therapy transforms ideas about the individual from the psychoanalytic approach and “the whole” from the systemic perspectives, to propose a new model that focuses on the individual within the larger system of the family and community. The foundation of multi-generational family therapy married ideas from several pioneers of the field – Bowen’s concepts of the differentiation of self from the family of origin and the transmission of inter-generational immaturity (Bowen, 1978); Boszormenyi-Nagy and Spark’s (1973) notion of invisible loyalties and inter-generational debits and credits; Framo’s inter-generational approach to couple work (Framo, 1992; Framo, Weber & Levine, 2003); Whitaker’s (1989) study of family myths and temporal jumps. Significantly, Whitaker became the most coherent and creative interpreter of the widening of relational interventions to include at least three generations. Minuchin’s (1974) descriptions of enmeshed and disengaged families, which became fundamental in understanding child development in terms of history and boundaries between generations, were also included. Particular mention is due to the pioneering work of Ackerman (1958), who provided the most original relational interpretation of childhood symptoms and his idea of the symptomatic child as the scapegoat in family conflicts, using the primary triad as a model of observation and intervention in family dynamics.

None of these master therapists would define themselves purely as systemic, even though all had a knowledge of Von Bertalanffy’s (1968) Systems Theory, Bateson’s interdisciplinary approach (1979), and Watzlawick et al.’s (1967) axioms of human communication. Minuchin (2002) wrote an article published in the book I Pionieri della Terapia Familiare (Andolfi, 2002) regarding the importance of paying attention to people’s cultural background. In this, he offered a critique on the systemic-cybernetic perspective. He said that Bateson’s work, which inspired the systems theorists, oriented the clinician towards description rather than prescription, and towards ideas and away from people and their emotions. The seminal volume Intensive Family Therapy, edited by Boszormenyi-Nagy and Framo (1965), became a manifesto of multi-generational family therapy. These pioneers and their followers, even though they differed in many ways in terms of both theory and intervention, were aware that working with families meant meeting different family configurations, but always with a fundamental attention to the study of the individual in his growth process within the family. The family genogram introduced by Bowen (1978) became the tri-generational map, still used by therapists all over the world, by which to formulate a relational assessment of the family, noting significant events such as births, deaths, marriages and separations, useful in structuring treatment plans. For these authors, the individual would never be neglected or underestimated. Rather, the individual was encouraged either to repair emotional disconnections and to reconnect or to differentiate from inter-generational over-dependence. Above all, the goal of these pioneers was not merely to fix presenting problems, but more to understand the relational value of individual symptoms and, together with the family, to look for pathways to healing.

The system purists and the conductors

The outlining of such perspectives in family studies allowe...