Evolution Of Psychotherapy

The 1st Conference

Jeffrey K. Zeig

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317736660
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

First published in 1987. The Milton H. Erickson Foundation, Inc. is a federal non-profit corporation. It was formed to promote and advance the contributions made to the health sciences by the late Milton H. Erickson, M.D., during his long and distinguished career. This volume is a collection of the papers from video-taped sessions at first Evolution of Psychotherapy Conference.

Section I
Family Therapists

My Many Voices

Salvador Minuchin, M.D.

Salvador Minuchin, M.D.

Salvador Minuchin received his M.D. from the University of Cordoba in Argentina in 1947. For ten years, he served as Director of the Philadelphia Child Guidance Clinic.

Currently, he is Clinical Professor of Child Psychiatry at the University of Pennsylvania School of Medicine; research professor of Psychiatry at New York University; and resides in New York where he teaches and practices family therapy.

Minuchin has developed the structural approach to family therapy which is one of the major models in the field. He has authored two books and co-authored three, and there is also a volume about his approach. Additionally, he has over 30 original papers and journal contributions. He is recipient of the Distinguished Family Therapy Award from the American Association of Marriage and Family Therapy.

In presenting the evolution of his own approach to treating families, Minuchin discusses how other seminal family theorists and practitioners influenced him. He does not merely describe their impact; he also summarizes their essential positions, including strengths and shortcomings. If the family therapy approach can be seen as a quilt, this chapter is an artfully integrated patchwork. In viewing the quilt, one can see the particular patches, how they were embroidered by their designer, and how they comprise a significant part of the whole.

History, or “the past,” is by definition a construction. There are facts, which are more or less objective; but their grouping, the way they are highlighted, and the shadows that are left are the product of the historian’s present position. The mores of his time, the ideologies fashionable at the moment, and current constraints all contribute to the framing of the “proper” interpretation of recorded events— “proper” meaning, in this context, “correct at this historical juncture.”

The field of family therapy, at least in its labeled version, is so new that my own experience as a child psychiatrist, analyst and family therapist very nearly encompasses it. Therefore, I am using myself as the “framer” of the memories I will recall for you. Perhaps my collection of framed memories, or (as I like to call it) my collection of “voices,” can serve as a contribution to the oral history of family therapy.

Family therapy officially began in 1954 with John Elderkin Bell’s monograph. For my own personal reasons, however, I would suggest that family therapy began in 1925 with the first case seen at the Philadelphia Child Guidance Clinic^* under the auspices of Dr. Frederick Allen. The patient was a ten-year-old boy who lived in one of Philadelphia’s ethnic neighborhoods with his mother, stepfather and a three-year-old half sister. The case started with a letter from the mother stating that her son was not doing well in school, misbehaved at home, and was getting beyond her.

A social worker was assigned to prepare the social history as an initial step in treatment. She interviewed all the family members at home, meeting with them separately and together. Her several home visits included contact with the neighbors. She visited the school with a social worker “patron” and the hospital where the mother was currently under medical care. As part of the study, the boy had psychological tests and two appointments with Dr. Allen, director of the clinic at the time. There was also a thorough physical examination at Children’s Hospital. (By the way, there was no charge for the clinic’s services.)

Allen, who became one of the leading child psychiatrists in the United States, reported that he found the child to be open with him. Although he thought the child was somewhat more impulsive and irresponsible in his behavior than the average ten-year-old, Allen did not consider him a seriously disturbed child. The boy spoke affectionately of his father, mother and aunt. He acknowledged that he ought to be a better boy, but he also thought that the grown-ups could stand improvement. It was hard to know what they expected, he said, because grown-ups, especially his mother, sometimes said contradictory things, or said one thing and did another.

The developmental history taken by the social worker revealed that the mother had been rather promiscuous as a girl, and that the boy was illegitimate. He had been reared by his aunt until the mother married. She and her husband then took the child, but the aunt continued in the picture as an active and very critical member of the extended family.

The staffing conference decided that the problem resided primarily in the family. The treatment plan covered a wide span. The social worker, for instance, was to encourage the parents to have the boy’s teeth treated and to have him seen by a pediatrician to treat a mild anemia revealed by the physical examination. The parents were to be helped to be more consistent in their expectations and their discipline. The school was to be encouraged to coordinate its expectations with those of the parents. The mother and aunt were to be helped to resolve their differences in relation to the child.

Accordingly, the social worker worked with the family for about a year. She saw the mother and aunt in the clinic and had occasional appointments at the home with the stepfather and child. During the second year, contact with the family was reduced and more widely spaced. The case was closed at the end of two years on the basis of an improved relationship between the mother and aunt and the improved behavior of the boy. The referring social worker in this case continued occasional follow-up contacts for the next 20 years. The last entry, dated 1944, reports that the client, now happily married, had just been promoted to captain’s rank in the U.S. Army.

This was a remarkable case, treated by a procedure that would seem radically modern today. First, the clinic considered the child’s problems to be supported by the conflicts between the parenting members of his family, that is, the mother and the aunt. Therapy included coordinating the parents’ and the school’s approach to the child. There was close cooperation with a pediatrician. The psychiatrist elicited the child’s ideas about himself and about the world in which he lived. There were no references to fears or anxieties. The concern was with integration and competence.

What view of a child organized this kind of treatment? In 1925, a child was seen as a victim—primarily as done to rather than doing. The family, the school, or other aspects of a child’s environment were the context to which a child responded. What was the view of parents? Here an interesting contradiction arises. Parents were presumed to have caused a child’s problems. Nevertheless, it was expected that parents would be able to modify their relationship with a child once they understood the meaning of their input. Clearly this was an optimistic period, in which educational procedures directed toward the social context were considered necessary for helping children, and in many cases, sufficient. A brochure published by the clinic in 1930 stated, “Each individual child is part of the group setting, and to treat and help a child readjust his mental outlook he must be considered in terms of the whole family. It would hardly be wise,” the pamphlet concluded, “to concentrate on the child alone. Our real philosophy is that both the parents and child are reacting to the given situation, and it is this interaction of each of them with the situation that generates the difficulty.”

When I began working in the field of child psychiatry, 25 years after the initiation of this case, there was a very different focus. In my training, the emphasis was on the child’s internalized pathology. The first DSM was a few years in the future, but I recall that our chief interest in the 1950s was diagnosis. Diagnostic categories were expanding, and the richness of labels was in itself entrancing and seductive. Services, on the other hand, were fragmented at best. In my training at Bellevue with Lauretta Bender, where I interviewed and diagnosed psychotic children, contact with the parents was not a significant part of the treatment. We saw the parents mostly as visitors, coming (probably unwillingly) to see their children on weekends. Occasionally we did observe their relationship to their children. We described it as “detached.”

Some years later I worked in a residential institution for juvenile delinquents. Hawthorne Cedar Knolls School, part of the Jewish Board of Guardians, emphasized the youngster’s individual dynamics and the creation of a therapeutic milieu. Parents were considered frankly destructive to the children. If they were seen at all, they were seen individually, in the “main office.” During this time, Bettelheim, at the Orthogenic School in Chicago, was writing about the pathogenic influence of parents. His recommendation for very disturbed youngsters was “parentectomy”—for life.

It is clear that over these years, the profession’s views of parents and families were changing along with the enormous social, economic, and cultural shifts of those decades. New understandings of the complexity of the human condition developed new therapeutic procedures. But the view of humans as somehow innately pathological and pathogenic gained more and more salience. In the 1940s David Levy discovered the overprotective mother. In the 1950s Frieda Fromm-Reich-man’s “schizophrenogenic mother” was popularized in a number of antifeminine forms, like Philip Wylie’s “Momism” (the direct cause of the United States’ withdrawal from Korea and the triumph of communism on that archipelago). In 1953 Johnson and Szurek described the superego lacunae in which children’s acting out is a projection of parents’ deficient superego.

It was about this time that family therapy began its entrance to the field. And consistent with its time, its first interventions followed constructs that looked at families in order to protect patients from them. Ronald Laing’s organization of Kingsley Hall followed these premises. The purpose was the organization of an institution where adults could repair the damage they had sustained in their families. Murray Bowen’s theories encouraged people to differentiate themselves from the undifferentiated family ego mass—a kind of psychological quicksand in which family members seemed to lose their capacity for individual movement. Nathan Ackerman’s early papers dealt with the child as the family scapegoat. Bateson’s double bind theories obviously contain the period’s mistrust of families, even though systems theory should have prevented such linearity. It took a number of years for the family therapy movement to free itself from this ideology.

I began to work with the families of institutionalized children in the late 1950s. Juvenile delinquency was hitting the headlines in those years, along with the opening guns in what was to become one of the shorter wars in American history— the “War on Poverty.” I came from an intense political commitment as a Socialist Zionist, having worked with displaced children from a wide variety of ethnic backgrounds in Israel. This oriented me to both cultural and social issues, so that when I began to work with black and Puerto Rican children and their families in the lower socioeconomic groups of New York City, my sense of their pathology was framed by my broader view of their lack of power within a social context that disorganized their lives. In some way, I think my own experience closed the circle, returning me to the concepts of Frederick Allen in 1925—the context of the child and of the family emerged once more as a significant component of both individual and family behavior.

At the time this was the stuff of Young Turks. Don Jackson’s article, around 1954, gave us the theoretical rationale, as well as a rallying cry, for a frontal attack on the mental health establishment, with its overwhelming concern with internalized pathology.

By the late 1950s, we were doing family therapy at the Wiltwyck School for Boys. At the time we were using a three-stage interview, exploring how different family subsystems change when they interact alone and with other subsystems. In the course of each session we first saw the family together, then the parents in one subgroup and the sibling subsystem in another, and then the family regrouped once more. We wanted to see whether the relationship of family members changed in different contexts. But as we saw families in these contexts, the importance of authority—of hierarchy and power—became evident. We learned to look for the alliances and coalitions formed within the family and to explore the characteristics of the family’s affective range and the way family members negotiated control. At the same time, a host of techniques evolved as a necessary analog to working with a number of people in a number of different contexts.

There were five of us on the Wiltwyck team: Dick Auerswald, Charlie King, Braulio Montalvo, Clara Rabinowitz, and myself. Braulio Montalvo is a voice I still hear from that time. He has a rare capacity for managing a combination of holistic thinking and a search for precision. During the Wiltwyck years, he was dreaming of a family therapy that would have specific, discrete interventions—an alphabet of skills. We used to study each other’s work with this implausible goal in mind. His voice, as I hear it today, maintains its capacity for complexity. But it has softened over the years, melding with Carl Whitaker’s voice in bringing me more acceptance of human frailty.

Dick Auerswald’s is the other voice that still speaks urgently to me today. Whenever I use the words “epistemology” and “ecology,” that is Dick talking. He used to play with this concept, giving “ecology” such resonance that finally it took meaning for us all. He also lived by it. In the 1960s he was dreaming strategies to change the way New York City politicians thought, as the only way to change mental health services for poor families. He wrote a classic paper on multiple agency impact on welfare families and the destruction caused by it. In the 1970s he left for Maui, where he has worked for 15 years on the mental health of a whole island, thereby giving ecology a real visibility in the field of family therapy.

In 1962 Dick Auerswald and I made a pilgrimage to the centers of family therapy. We traveled to Palo Alto to see Bateson, Satir, Jackson and Haley. In New Haven we met Lidz, Fletch and Cornelison, and we went to Washington to see Lyman Wynne’s work. We knew of no one other than Nathan Ackerman doing family therapy at that time.

In Palo Alto we wanted to see a session with Bateson, but we were detoured by Jay Haley. He suggested we attend a class of Virginia Satir’s instead, since Bateson’s anthropological cast made his therapeutic sessions more a matter of gathering information than attempting change. Bateson was leery of change. His concern had a clear theoretical bias: When you focus on one corner of an ecological system, your perspective of the total system will distort and your intervention, which will be skewed, will chop the ecology.

I worked with Jay Haley for many years, and I also learned a lot from many other people who had worked with Bateson. Although I met Bateson personally only once, in a conference in 1982, in Topeka, clearly his voice has become part of my thinking, and the thinking of all family therapists. It is therefore with a sense of respect for his contributions that I want to focus on the constraints they introduced in the field. I myself have always felt uncomfortable with the cybernetic language that he used: ‘The family is a system.” “The family therapist is caught in the feedback loops of the family.” “The therapist cannot control a system of which he forms a part.”

The descriptive language of cybernetics is demonstrably poor. Excluded are the sweat and tears and pain, the hopes, confusion, ambiguity, boredom, passion, and weariness that characterize human encounters. The world of systems thinking is a world of ideas. Ideas are organized at different levels. They can be reversible. Wrapped in language, they can be manipulated without breaking. They can deal with ideal types; they can conflict and cancel without bloodshed. They exist on infinite axes of time and space. Humans do not.

I think that when Bateson lent family therapy the cloak of systems thinking, we lost in the exchange. We lost drama. We lost understanding of the human being’s emotional world. Storytelling became too predictable because the idiosyncratic gave way to the generic. We gained in understanding patterns, in seeing truth as perspective, in the ability to manipulate reality. But 30 years later, some family therapists are speaking with a dry, dehumanized, predictable babble all too similar to the language analysts used to speak (which is why I decided to leave the field of psychoanalysis). As a clinician I feel uncomfortable with the complexity of cybernetic language and the concomitant simplicity of its view of human beings. In focusing on logical systems, Bateson’s thinking, as reflected in the field, eschews affect, doesn’t give enough significance to the family as a complex system with subsystems with different agendas, and somehow makes the individual disappear. Its concern with the wholeness of systems also dismisses power in family dynamics because when what you are studying is a system, you see people as the way they participate in maintaining that system.

Let me return to 1962 and our meeting with Virginia Satir, the first family therapist I ever met in action. She was teaching then with a strictly communicational bias. In effect, the idea was that if a woman offers a cup of tea to her husband and the husband says, “I like the tea,” and by that he means that he likes the tea, not that he loves her, a lot of the disharmony in t...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• About The Milton H. Erickson Foundation
• Acknowledgments
• Table of Contents
• Introduction: The Evolution of Psychotherapy—Fundamental Issues
• Convocation
• SECTION I. FAMILY THERAPISTS
• SECTION II. COGNITIVE/BEHAVIORAL APPROACHES
• SECTION III. HUMANISTIC/EXISTENTIAL THERAPIES
• SECTION IV. PSYCHOANALYTIC THERAPISTS
• SECTION V. GROUP APPROACHES: TA, GESTALT, PSYCHODRAMA
• SECTION VI. ERICKSONIAN APPROACHES
• SECTION VII. COUNTERPOINT
• Name Index
• Subject Index