Handbook Of Family Therapy

Alan S. Gurman, David P. Kniskern, Alan S. Gurman, David P. Kniskern

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317772217
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This volume reflects the achievements in developing new concepts and models of family therapy and new approaches to special clinical issues and problems during the 1980s. Chapters by experts such as Boszormenyi-Nagy, Everett, Guttman, Lankton, Liddle, McGoldrick, Madanes, and Walsh offer insight into a variety of areas including systems theory, cybernetics, and epistemology; contextual therapy; Ericksonian therapy; strategic family therapy; treating divorce in family therapy practice; ethnicity and family therapy; and training and supervision in family therapy.

Part I

Historical and Conceptual Foundations

Chapter 1

The History of Professional Marriage and Family Therapy*

Carlfred B. Broderick, Ph.D.,
and Sandra S. Schrader, Ph.D.

It seems likely that people have been listening to each other’s family problems and responding with commiseration and advice as long as there have been families. It seems equally likely that as soon as humankind became prosperous enough to develop specialized professions (the chief, the priest, the physician, the prostitute), many of these worthies included giving advice on family matters among their duties and prerogatives. Only in our own century and our own culture, however, has a profession developed whose sole purpose is to deal with problems between family members. Doubtless it was an inevitable development. The temper of the times had become such as to encourage attempts to intervene in every social problem. From Prohibition to Social Security, from the community mental health movement to the women’s rights movement, we have been a nation boldly (if not always wisely) committed to finding cures for new and old social ills. The family received particular attention as the divorce and juvenile delinquency rates rose dramatically decade after decade. Indeed, as we shall see, marital therapy and family therapy are only two of the many related movements that grew up in response to evident social needs. The social-hygiene movement, the family-life-education movement, the child-guidance and parent-education movements, and an array of new psychotherapeutic modalities such as group, brief, and behavioral approaches all emerged within a narrow span of decades in response to the same compelling historic currents.

The present cluster of cross-borrowing, overlapping professions that deal with the relationships among family members began as at least four largely independent movements.¹ The oldest of these is the marriage-counseling movement. It grew out of the attempts of many in the various helping professions (medicine, psychology, education, social work, the ministry, law) to address the widely acknowledged increase in marital and sexual problems of the post-World War I era. The new movement was pragmatic and eclectic. In nearly every case, marriage counseling was the auxiliary activity of a professional whose primary commitment was elsewhere.

The sex-therapy movement is the youngest of the four in that the document that may be thought of as the movement’s founding chapter (Human Sexual Inadequacy by William Masters and Virginia Johnson) was published only in 1970. Yet its roots reach back as early as any of the others, and many of the key figures in the development of marriage counseling were also forerunners of the sex-therapy movement.

The other two movements, marital therapy and family therapy, both trace their origins to the development of social psychiatry in America after World War II. The pioneers were mostly psychiatrists who dared to break the rules requiring a therapist to see no more than one member of a family at a time.

In this chapter, we shall attempt to trace the evolution of each of these four movements and their progressive amalgamation into contemporary training and practice. Before doing so, however, it may be helpful to sketch some of the closely related historical developments.

The Social-Work Movement

The history of social work has been inextricably interwoven from the beginning with the history of interventions into marriages and families. Social workers have by turns been the most daring pioneers and the most passive “Johnny come lately ‘s” in the whole parade of professionals.

Social historians date the beginning of social work in this country to the founding of the first citywide charity organization in Buffalo, N.Y., in 1877 (Rich, 1956). Modeling themselves after similar organizations in Great Britain, early American societies concerned themselves primarily with aiding the poor at a time when there was little government investment in what has since come to be called “welfare.” From the beginning, it was observed, however, that the proper unit of concern for these societies was not the single client but the family. “Work with families” was the phrase used in the earliest descriptions of the casework activities of these organizations (Rich, 1956, p. 13). As Robert Treat Paine (1899), president of the Boston Associated Charities, put it in his first annual report, “Each one of the 7,716 cases reported is a human family with human lives, cares, and woes” (p. 355).

One of the early pioneers in the conversion of a volunteer service into a profession requiring advanced training was Zilpha D. Smith. In 1890 she wrote of her colleagues, “Most of you deal with poor persons or defective individuals, removed from family relationships. We deal with the family as a whole, usually working to keep it together, but sometimes helping to break it up into units and to place them in your care.”

But perhaps the greatest champion of looking at the whole family and its need was Mary Richmond, originally the general secretary of the Baltimore Charity Organization Society, and eventually one of the main organizers of the profession at the national level. Her 1908 publication of a case record of a widow and four children followed over nine years (she entitled it A Real Story of a Real Family) set a new standard of family-oriented case record keeping among social workers (Rich, 1956). In her influential book Social Diagnosis (Richmond, 1917), she quoted the Swiss neuropathologist Paul Dubois as referring “to this necessity of not confining one’s therapeutic efforts to the patient alone, but extending it to those who live with them. This is often the one way to obtain complete and lasting results” (Dubois, 1907). Then she elaborated, “In some forms of social work, notably family rebuilding, a client’s social relations are so likely to be all important that family case workers welcome the opportunity to see at the very beginning of intercourse several of the members of the family assembled in their own home environment, acting and reacting upon one another, each taking a share in the development of the client’s story, each revealing in ways other than words social facts of real significance” (Richmond, 1917, p. 137). In 1928 she wrote a paper, “Concern of the Community with Marriage” (Richmond, 1928), that further stressed the importance of dealing with relationships as well as individual problems.

As early as 1911, enough social-work agencies had begun to specialize in the treatment of marriages and families that a group of them formed the alliance that has come to be known as the Family Service Associations of America (Barker, 1984, p. 11). This was the agency that in 1943 produced the first volume entirely devoted to marriage counseling. Titled Report of the FSAA Committee on Marriage Counseling, it was a substantial handbook for training social workers in counseling with couples. The report considered both psychoanalytic and sociological constructs and insights in addition to many practical guidelines on how to proceed clinically. As an in-house publication, it was not widely read outside of the agency that produced it, but it is a testimony to the fact that the field of social work never abandoned its involvement with families.

Indeed, the case could be made that both marriage counseling and family therapy had their origins as subspecialties within the broader field of social casework. That this is not the prevailing view is probably the result of at least two historical realities. First, traditionally the field of social work has not packaged its intellectual and clinical wares for export into the broader community. Its practitioners have been less likely to write books for general consumption (e.g., the 1943 Report cited earlier), to give widely advertised workshops, or to seek leadership positions in multiprofessional organizations.

The second factor was the establishment in the 1920s of the orthopsychiatry movement, which gave shape and legitimacy to the status structure of the clinical professions. Psychiatrists with their M.D. degrees were in charge, clinical psychologists with their Ph. D.s were in the middle, and social workers with their B.S.W.s and M.S.W.s were on the bottom, with little or no influence. Moreover, the orthopsychiatric thrust was focused on the psychodynamics of the individual, not on the relationships among family members. Without doubt, this movement set back the development of whole-family therapy within the social-work profession several decades. The proceedings of the first roundtable discussions of the American Orthopsychiatric Association in 1930 were a harbinger of the decades to follow. In their discussion of that occasion, John Spiegel and Norman Bell (1959, p. 116) have written:

A psychiatrist, a social worker and a clinical psychologist spoke in this panel discussion, about treatment of behavior and personality problems in children. Alone among the three discussants, the social worker, Charlotte Towle, dealt with the problems and the family in dynamic fashion. She was articulate and direct concerning the family, saying in part “Treatment cannot be given to any member of the family without affecting the entire group. In some cases the entire family must be drawn into treatment. Approach to this or that member or centering treatment on a certain individual cannot be a random thing” (Towle, 1948).

The prolonged discussion that followed dealt largely in whether notes should be made in front of the patient. No reference to Towle’s ideas was made at all. The whole issue of the dynamic formulation and handling of family relationships simply dropped out of sight.

The point may be further documented by Florence T. Waite’s summary of 50 years of casework practice published in 1941. As she pointed out:

Family casework had moved beyond the older emphasis on trying to know and be in touch with several family members. It had developed a clinical orientation and tended to concentrate on the individual because: (1) competitiveness and jealousy existed among family members; (2) seeing the whole family blurred the autonomy of the individual and the worker was apt to take over the family too completely and overpoweringly; (3) society has increased its emphasis on the individual even at the expense of his membership in the family and society at large. (As summarized in Sherman, 1961, pp. 19–20)

While that view doubtless overstates the retreat of social workers from relationship counseling for this period, it does appear to be true that from the decades of the ’30s forward, they have never, as a profession, taken the lead in the marriage- and family-therapy movement. They have, however, at every point, provided a substantial part of the professional cadre actually seeing couples and families in the various pioneering programs that we shall describe later. It seems likely that their actual contribution is much greater than present accounts give them credit for (cf. Guerin, 1976; Kaslow, 1979).

Although, as we have seen, the potential existed for the field to grow out of social-casework experience, the evidence is that two quite separate social movements provided the actual historical roots of both the early marriage-counseling movement and the more recent sex-therapy movement. One was the sexual-reform movement that flourished in Europe in the post-World War I era. The other was the family-life-education movement that developed in the ’30s and ’40s in the United States.

The Sexual-Reform Movement of the Post–World War I Era

A number of Europeans and Americans participated in the movement to establish human sexuality as a scientific field and to free men and women from disabling sexual ignorance, fear, and inhibition. Preeminent among these were Havelock Ellis of Great Britain and Magnus Hirschfeld of Germany. More than any others, they paved the way for working with couples in a practical way on the sexual problems of everyday life.

Havelock Ellis was a remarkable man. He was a physician who also produced some of the most widely acclaimed translations of the Greek dramatic poets. Raised in Victorian prudery, largely without a father’s influence, he vowed to do all within his power to spare others the ignorance of and discomfort in sexual matters he had experienced as a young man. In all, he produced seven volumes covering almost every imaginable aspect of sexual behavior. His writing was literate, well reasoned, and well documented, but beyond that he was remarkably free from the moralizing that previous sexual scholars had indulged in, and he livened up his text with literally hundreds of excerpts from sexual histories he had collected over the years. Decades in advance of his time, he worked personally with individuals (mostly women) in helping them overcome their sexual fears.

Ellis saw himself as something of a secular high priest of sex and refused to charge for consultations. Yet he saw scores of sexually unhappy people and was in correspondence with hundreds more. His approach varied from patient to patient, but two elements were common to most of his encounters: (1) he listened with acceptance and personal supportiveness, reassuring the individual that his or her personal experiences and fears were not unique; and (2) he recommended reading (usually of his own published work) to help further allay anxiety and to be exposed to a scientific and informed perspective on the matter.

Because he wrote the first major work on homosexuality (or sexual inversion as he preferred to call it), many of his clients were homosexuals of both sexes. Among his heterosexual clientele, most were women who were attracted, apparently, not only by his scientific scholarship and liberated views, but also by his striking leonine appearance coupled with a gentle personal style. When he felt it would be accepted, he sometimes personally introduced these women into his own version of nondemand sexual pleasuring. He considered himself impotent through most of his adult life and this awareness contributed to his confidence that these approaches would not be misconstrued as mere seduction. It is curious by contemporary standards that he never saw couples as clients, nor did he, so far as is recorded, instruct husbands and wives in how to enlarge their mutual repertoire of sexual approaches. (See his biography, The Sage of Sex, by Calder-Marshall [1959], especially pp. 173–174 and 238–243, for a fuller description of his approach.)

His German counterpart, Magnus Hirschfeld, founded the Institute of Sexual Science in Berlin in 1918 and together with Ellis and August Forel founded the World League for Sexual Reform. Between 1921 and 1932, this group convened five meetings of the International Congress for Sexual Reform on a Scientific Basis. Literally thousands of physicians from all over the world visited his center in the 15 years of its existence. He culminated his career with a five-volume work, Geschlechtskunde (Sex Education) (1930), which reported his conclusions based on analyzing 10,000 questionnaires filled out by men and women who came to him for advic...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Contents
• About the Editors
• Contributors
• Preface
• PART 1 Historical and Conceptual Foundations
• 2 Models of Family Therapy
• 3 Special Issues and Applications
• Name Index
• Subject Index