Family Therapy After Twenty Years

Family
Therapy After Twenty Years
Murray Bowen
e-Book 2015 International Psychotherapy Institute
From American Handbook of Psychiatry: Volume 5 edited by Silvano Arieti, Daniel X. Freedman, Jarl E.
Dyrud
Copyright © 1975 by Basic Books
All Rights Reserved
Created in the United States of America

Table of Contents
Family Therapy After Twenty Years
History of the Family Movement
Common Differences Between Individual and Family Theory and Therapy
The Spectrum of Methods and Techniques in Family Therapy
Specific Methods and Techniques of Family Therapy
Experiential and Structured Family Therapy
A Systems Theory of Emotional Functioning
Family-Systems Therapy
Systems Theory and Societal Problems
Conclusion
Bibliography
Family Therapy After Twenty Years
Family therapy came on the psychiatric scene in the mid-1950s. It had
been developing in the private work of a few investigators for some years
prior to that. The growth and development of family therapy has paralleled
the ferment and change in psychiatry during the same period. There are
psychiatrists who consider family therapy to be a superficial counseling
method. A majority think of family therapy as a treatment method based on
conventional psychiatric theory. A small percentage of family therapists think

of family research as providing new dimensions for thinking about human
adaptation and family therapy as pointing the way toward more effective
ways of dealing with human problems. All three views are probably accurate,
depending on the way the person thinks about the nature and origin of
human mal- adaptation. In this chapter the author will present his view of
how the family movement began, how it has developed during its first two
decades of existence, and how this has been related to the changing
psychiatric scene. There are many differences in method and technique in

family therapy, based on a variety of theoretical premises. Each therapist is
emotionally invested in his own approach and therefore has some degree of
bias in the way he views the total field. With awareness of the differences, the
author will present one version of the way the field has evolved in the past
two decades. The author was one of the originators of the family movement
and has continued to be active in the field. He began his family explorations in
American Handbook of Psychiatry Vol 5 5

the late 1940s from a psychoanalytic orientation. He has moved from
psychoanalytic thinking toward a systems theory and systems therapy.
History of the Family Movement
The family movement in psychiatry began in the late 1940s and early
1950s with several widely separated investigators who worked privately
without knowledge of each other. The movement suddenly erupted into the
open in the 1955-56 period when the investigators began to hear about each
other, and they began to communicate and to meet together. Growth and
development was rapid after the family idea had come to the surface. After
family therapy was well known, there were those who said it was not new
and that it had developed from what child psychiatrists, or social workers, or
marriage counselors had been doing for several decades. There is some
evidence to support the thesis that the family focus evolved slowly as early
psychoanalytic theory was put into practice. Freud’s treatment of Little Hans
in 1909, through work with the father, was consistent with methods later
developed from family therapy. Flügel’s 1921 book, The Psycho-Analytic Study
of the Family (1960), conveyed an awareness of the family, but the focus was
on the psychopathology of each family member. The child-guidance
movement passed close to some current family concepts without seeing them.
The focus on pathology in the child prevented a view of the family. Psychiatric
social workers came on the scene in the 1930s and 1940s, but their work with
http://www.freepsychotherapybooks.org 6
families was oriented around the illness in the patient. Sociologists and
anthropologists were studying families and contributing to the literature, but
their work had no direct application to psychiatry. Marriage counseling began
its growth in the 1930s, but the dynamic formulations came from
conventional psychiatry. Also, general-systems theory had its beginning in the
1930s before there was a recognizable connection between it and psychiatric
theory. There is little evidence that these forces played more than an indirect
role in ushering in the family movement.
Most of the evidence favors the thesis that the family movement
developed within psychiatry, that it was an outgrowth of psychoanalytic
theory, and that it was part of the sequence of events after World War II.
Psychoanalysis had finally become the most accepted of the psychological

theories. It had theoretical postulations about the full range of emotional
problems, but psychoanalytic treatment was not clearly defined for the more
severe emotional problems. After World War II, psychiatry suddenly became
popular as a medical specialty and hundreds of young psychiatrists began
experimenting in an effort to extend psychoanalytic treatment to the full
range of emotional problems. This includes those who began experimenting
with families. A psychoanalytic principle may have accounted for the family
movement remaining underground for some years. There were rules to
safeguard the personal privacy of the patient-therapist relationship and to
prevent contamination of the transference by contact with the patient’s

relatives. Some hospitals had a therapist to deal with the carefully protected
intrapsychic process, another psychiatrist to handle reality matters and
administrative procedures, and a social worker to talk to relatives. In those
years this principle was a cornerstone of good psychotherapy. Failure to

observe the principle was considered inept psychotherapy. Finally, it became
acceptable to see families together in the context of "research."
The investigators who started family research with schizophrenia were
prominent in starting the family movement. This included Lidz in Baltimore
and New Haven (1965), Jackson in Palo Alto (1969), and Bowen in Topeka
and Bethesda (1960). Family therapy was so associated with schizophrenia in
the early years that some did not think of it as separate from schizophrenia
until the early 1960s. Ackerman (1958) developed his early family ideas from
work with psychiatric social workers. Satir (1964), a psychiatric social
worker, had developed her family thinking through work with psychiatrists in
a state hospital. Bell (1961) and Midelfort (1957) were examples of people
who started their work very early and who did not write about it until the
family movement was well under way. The pattern suggests there were
others who never reported their work and who were not identified with the
family movement. The formation of the Committee on the Family, Group for
the Advancement of Psychiatry, provides other evidence about the early years
of the family movement. The committee was formed in 1950 at the suggestion
of William C. Menninger who considered the family to be important for
psychiatric study. The committee was not able to find psychiatrists working
in the field until the family investigators began to hear about each other in the
1955-1956 period (Spiegel, verbal).
Spiegel, Chairman of the Committee on the Family, helped organize the
first national meeting for psychiatrists doing family research. It was a section
meeting at the annual meeting of the American Orthopsychiatric Association
in March 1957. It was a quiet meeting. All the papers were on family research,
but the notion of "family therapy" or "family psychotherapy" was discussed.
Some investigators had been working toward methods of family therapy for
several years, but I believe this was the first time it was discussed as a
definite method at a national meeting. That was the beginning of family
therapy on a national level. Dozens of new people, attracted by the promise of

therapy, and with little knowledge of the family research that had led to the
development of family therapy, rushed into the field and began their own
versions of family therapy. Another section meeting for family papers at the
American Psychiatric Association annual meeting in May 1957 helped amplify
the process set in motion two months before. All the papers were on research,
but the meeting was crowded and there was more audience urgency to talk
about family therapy. The national meetings in the spring of 1958 were
dominated by new therapists eager to report experiences with family
therapy. Family research and theoretical thinking that had given birth to
family therapy was lost in the new rush to do therapy. New therapists entered

the field in numbers. Many dropped out after initial therapeutic failure, but
there was a rapid net gain in the total field. The 1957-58 period was
important in determining the future course of the family movement. In that
year family research became known nationally, and in the same year the new
family therapists began what the author has called the "healthy unstructured
state of chaos." It was considered healthy on the premise that clinical
experience would bring an awareness of the theoretical dilemma implicit in

family therapy, and awareness would result in efforts to clarify the dilemma.
This has not evolved to the degree it was predicted. Some of the newer
generations of family therapists have worked toward establishing some
theoretical order and structure to the field. A majority of family therapists see
family therapy as a method based on conventional, individual theory or as an
intuitive, experiential method conducted by therapists who are guided by

their own feelings and subjective awareness toward the "use of self’ in
therapy. Others fall between the two extremes. The range of clinical methods
and techniques will be discussed later.
There is suggestive evidence that family therapists come largely from
childhood situations in which they had more than average awareness of
discord among relatives, some ability to see both sides of an issue, and some
motivation to modify the situation. The author uses the term "family
movement" in psychiatry to include the theoretical thinking, the family
research, and family therapy as they have evolved together and as continue to
grow in psychiatric thinking and practice. This is in contrast to the more
popular use of the term "family therapy" as it is used to connote a treatment
method.
Common Differences Between Individual and Family Theory and Therapy
The one main difference between an individual and a family approach is
a shift of focus from the individual to the family. The nuances of difference
between the two approaches are more subtle and far reaching than is evident
on the surface. The total fabric of society, as it pertains to human illness,

dysfunction, and misbehavior, is organized around the concept of man as an
autonomous individual who controls his own destiny. When the observing
lens is opened to include the entire family field, there is increasing evidence
that man is not as separate from his family, from those about him, and from
his multigenerational past as he has fancied himself to be. This in no way
changes what man is or has always been. He is as autonomous as he has
always been, and he is as "locked in" to those about him as he has always
been. The family focus merely points to ways that his life is governed by those
about him. It is simple enough to say that the family therapist considers the
illness in the patient to be a product of a total family problem, but when this
simple concept is extended to its ultimate, then all mankind becomes
responsible for the ills of all mankind. It is easy to say this in a philosophical,
detached kind of way, but man becomes anxious about the notion of changing

himself to help modify the ills of mankind. It is easier for man to fight his
wars, inflation, social ills, and pay his money for non-effective corrective
action, than to contemplate changing himself. From family therapy, we know
it is relatively easy for family members to modify their part in the creation of
emotional illness once they clearly see what has to be done, but this does not
decrease initial anxiety and evasive action at the mere contemplation of it.
This section of the chapter is not designed as a theoretical treatise on the

ultimate implications of family theory, but it is to indicate that the deeper
implications are there, and they are more far reaching than is easily realized.
The following differences between individual and family theory point up a
few of the more obvious examples of the differences.
The Medical Model
This cornerstone of sound medical practice requires the physician to
examine, diagnose, and treat the pathology in the patient. The medical model
also applies to conventional psychiatry and the social institutions that deal
with human dysfunction, including the courts, social agencies, and insurance
companies. There is an emotional process in the family through which the
family helps to create and maintain the "illness" in the "patient." The process
is more intense when anxiety is high. The process also operates in the family-
therapy sessions. The family members point to the sickness in the patient and
try to confirm this by getting the therapist to label the patient the sick one.
The therapist tries to avoid diagnosing the patient, and to focus on the family
emotional process that creates the patient. The family problem is intensified
when the medical records and insurance companies require a diagnosis to
comply with the medical model. Each therapist has to find his own way to
oppose, neutralize, or deflect the intensity of the family emotional process.
The situation is usually less dramatic than presented here, but this illustrates
the counterforces as the therapist tries to change the family process and also
meet the minimal requirements of the institutions. Some therapists explain
the situation to the family that medical-model principles are necessary for
records, but a different orientation is used for the therapy. Also, the
institutions are a bit less strict in requiring adherence to the medical model.
Therapists have come to use the terms "designated patient" or "identified
patient" to refer to the symptomatic family member. The mere use of the term
implies an awareness of the basic process in the family, in the therapy, and in
society. The issues that go around the medical model have ramifications that
involve the lives of all the people connected with the problem.
Clinical Responsibility
Members of the mental-health professions have second-nature

awareness of the nuances of clinical responsibility for a single "patient." The
welfare of the patient comes first and the welfare of the family is outside the
realm of direct responsibility. The principles of medical responsibility are

changed when the focus is on the entire family instead of the patient. There
are situations in which an improvement in the former patient is followed by
serious symptoms in another family member. A conventional therapist might
send the second family member to another therapist. A family therapist

would operate with the premise that the best interests of the family would be
served with a single therapist who could deal with the total family problem.
There are other similar situations. A conventional therapist could more easily
conclude that the patient should be separated from the family, which he
considers inately pathogenic to the patient. A family therapist would believe
the total family situation would be advanced if the patient were kept at home
while he attempted to deal with the overall family anxiety. Family therapists
are less likely to consider family members hurtful to each other. They have
experience to support the premise that family members want to be

responsible and helpful to each other and that it often requires very little help
to shift the family climate from a hurtful to a helpful one. The general
direction of family therapy is toward helping the family to be responsible for
its own, including the "sick" one. It is far more difficult for the impaired family
member to begin to assume responsibility than it is for healthier family
members. In an effort to more quickly work toward family responsibility, the

author developed an approach to work with the "healthiest family member"
and to exclude the "sick" family member from the therapy. It has been
possible to do an entire course of family therapy with the focus on family
health without ever seeing the "sick" family member.
Confidentiality and Secrets
A basic principle of medicine and individual psychotherapy requires
that the physician and psychotherapist not divulge confidential information.
Family therapists are forced to reevaluate this principle. There are situations
in which keeping the confidence of one family member can be detrimental to

the total family. From family research we have learned that the higher the
level of anxiety and symptoms in a family, the more the family members are
emotionally isolated from each other. The greater the isolation, the lower the
level of responsible communication between family members, and the higher

the level of irresponsible underground gossip about each other in the family
and the confiding of secrets to those outside the family. Through pledging a
confidence, a person becomes part of the emotional network around the

family problem. The basic problem is the relationship pattern in the family
rather than the subject matter of the secrets and confidences. A goal in family
therapy is to reduce the level of anxiety, to improve the level of responsible,

open communication within the family, and to reduce the irresponsible,
underground communication of secrets and gossip to others. When a family
therapist becomes entangled in the secrets and confidences, he becomes part
of the emotional web-work and his effectiveness as a therapist is lost. Each

family therapist has to find his own way of dealing with confidences within

the family without becoming part of the emotional entanglements. Most
family therapists employ some kind of working rule about not keeping
secrets, and they find ways to communicate secrets in the family sessions,
rather than err on the side of becoming a part of the family intrigue. From
family-therapy experience, we know it can be as detrimental on one side to
blindly keep individual secrets as it is detrimental on the other side for the
therapist to gossip to outsiders about private matters in a family. The goal of a

family therapist is to be a responsible person who knows the difference
between underground secrets and valid, responsible, private communication
and who respects the difference.
From family therapy we have learned much about the function of secret
communication in situations that range from the avowed privacy of the

individual psychotherapy hour to the function of secrets and gossip in society.
The higher the avowed intent of secrecy in individual psychotherapy, the
greater the chance the patient will gossip to others about the therapist, or the
therapist will gossip to others about the patient, all done in strictest
confidence. In larger social systems, a gossip is one who came from an
anxious, gossipy family. The higher the level of anxiety in a social system, the
lower the level of responsible communication, and the higher the level of
irresponsible gossip and the keeping of irresponsible secret files about
individual members. Family-therapy research, with its emphasis on open
communication within the family, has been the most observed, audiotaped,
filmed, and videotaped of all the psychotherapies. The research points up the
emotional problems that result from rigid adherence to conventional rules
about confidentiality.
The Spectrum of Methods and Techniques in Family Therapy
The best survey of the family field thus far is The Field of Family
Therapy, a report by the Committee on the Family, Group for the
Advancement of Psychiatry, published in March 1970. It was based on the
analysis of a detailed questionnaire completed by some 300 family therapists

from all the professional disciplines and all levels of experience. Experience
since 1970 indicates that the basic pattern of theory and practice is still very
much as it was then. The questionnaire responses represented such wide

diversity in theory and practice that it was difficult to find a format to report
the results. Finally, a scheme was devised to characterize therapists on a scale
from A to Z.
Therapists toward the A end of the scale are those whose theory and
practice is the same as individual psychotherapists. They use family therapy
as a technique to supplement individual psychotherapy or as the main

technique for a few families. The A therapists are usually young or they have
just started experimenting with family techniques. The overwhelming
majority of family therapists are toward the A end of the scale. The A

therapist thinks in terms of individual psychopathology, and he views the
therapeutic relationship between the therapist and patient as the modality for
emotional growth. He sees family therapy as a technique to facilitate his
psychotherapy with the patient, and he speaks of indications and

contraindications for family therapy. It is impossible to know how many
individual therapists now do occasional family interviews. They
characteristically do not make formal reports about their work.
Therapists toward the Z end of the scale use theory and techniques that
are quite different. They think in terms of systems, relationships, emotional
fields, and breakdown in communication. They tend to "think family" for all
emotional problems, and they usually end up seeing a number of family
members even if the initial problem in the patient is one for which others
would clearly recommend individual psychotherapy. The therapy of a Z-scale
therapist is directed toward restoring communication, improving
relationships in the family, and toward helping family members toward

higher levels of differentiation. There are few therapists toward the Z end of
the scale. They are the ones more oriented to research and theory or who
have been in practice a long time.
Between the two extremes are therapists with theoretical orientations
made up of a mixture of individual and family concepts, and with a wide

variety of techniques. The place of therapists on the scale seems to be
determined by the therapist’s motivation for theory and research, and the
professional environment in which he works. The research- oriented
therapist is guided more by theory than approval from the professional
environment. He usually moves steadily toward the Z end of the scale. The
therapy-oriented therapist is more sensitive to the approval of colleagues. He
is guided toward a philosophy of treatment that includes a mix of individual
and family concepts. When he finds the best "fit" between himself and the
professional environment, and between himself and the clinical problem,

there is little movement on the scale. The therapy-oriented therapist tends
more to try to "sell" his viewpoint and to be critical of others with another
viewpoint.
Popular terminology in the field is determined by the usage of terms by

a majority of therapists. Most therapists are toward the A end of the scale.
They tend to think of family therapy as a method and technique for the
application of individual theory. Designations of the type of therapy are

determined more by the configuration of family members who attend the
sessions than by the theory. The term "family therapy" popularly refers to any
psychotherapy session attended by multiple family members. The terms
"couples therapy" or "marital therapy" are used when most sessions are
attended by both spouses. The term "individual therapy" is used to designate
sessions with only one family member. Some use the term "conjoint family
therapy" for psychotherapy sessions attended by family members from two

or more generations. It often refers to parents and child together. From this
orientation it would be possible for a single family to have individual therapy
for the patient, couples therapy for the two parents, and conjoint therapy for
parents and patient. The author is at the extreme Z end of the scale. For him
the terminology is based on the theory. The term "family therapy" is used for
the effort to modify the family-relationship system, whether that effort is with
one or with multiple family members. Since 1960 he has spoken of "family
therapy with one family member," which is consistent with his orientation
but can be considered inaccurate by most family therapists. The author
objected to the title The Field of Family Therapy, for the 1970 survey of the
family field on the grounds that it did not recognize the thinking and research
that helped create the field. A majority of the committee members insisted on
this title on the grounds that it best represented the field as it exists.
Specific Methods and Techniques of Family Therapy
The following is a brief summary of some of the most prominent,
different methods of family therapy. The list is designed to communicate the
author’s view of the overall pattern to the growth and development of family
therapy. It is not designed to present the work of any one therapist or any
group of therapists. Most therapists tend to use a combination of the
methods.
Family Group Therapy
A high percentage of family therapy should more accurately be called
family-group therapy since many of the basic principles were adapted from
group psychotherapy. It is noteworthy that specialists in group
psychotherapy have had no more than a secondary interest in family therapy.
There were no group psychotherapists among the originators of the family

movement. Some group therapists became interested in developing family
therapy a few years after family therapy was introduced. That group has
grown gradually, but it has been relatively separated from the main body of
family therapists. The group therapists doing family therapy attend the
group-therapy meetings and they publish in group-therapy journals with
relatively little overlap between the groups. If one can consider this as a fact
without value judgment about why it came to be, it can say something about
the nature of the family movement.
Most of the influence of group psychotherapy on family therapy has

come from people who had some early professional training in group
psychotherapy, but who did not consider themselves to be group therapists.

In 1957 when new therapists began developing their own version of family
therapy, without much knowledge of family research, the already defined

methods of group psychotherapy offered more guidelines than any of the
other existing methods. In addition, the psychodynamic formulations of group

psychotherapy were reasonably consistent with training in individual
psychotherapy. I believe this may account for the strong influence of group
psychotherapy on family therapy.
Methods of family-group therapy vary from therapist to therapist, but
there are some common denominators. The basic theory, the psychodynamic
formulations, and the interpretations are reasonably consistent with
individual therapy and also with group therapy. The therapeutic method and
encouraging family members to talk to each other come from principles of
group therapy. Family-group therapy comes closer to the popular stereotype

of family therapy than any other. This involves all the family meeting together
to discuss problems. Family-group therapy is one of the easiest of the
methods for the relatively inexperienced therapist. It requires that the

therapist develop some facility for relating to people in a group without
taking sides and without becoming too entangled in the family emotional
system. Beyond this, most professional people can operate with skills learned
in training. As a method it yields very high initial results with comparatively
little effort by the therapist. Most families with symptoms are out of
emotional contact and are not aware of what each is thinking and feeling. The
higher the level of anxiety, the more family members are isolated from each
other. With a family therapist acting as chairman of the group and the
facilitator of calm communication, much can be accomplished in a short time.
Parents can profit from hearing the thoughts and feelings of each other.
Children can be fascinated at hearing the parental side of issues and learning
that parents are human, too. Parents can be amazed at the astute
observations of their children about the family, and the child is grateful for an
opportunity to say what he thinks and for the forum that values his ideas. The
family can eagerly look forward to such sessions, which they cannot manage
at home because of emotions and communication blocks. The process can
reach a point of pleasant exhilaration, with parents increasingly aware of

each other and the children increasingly able to accept the foibles in the
parents. When communication improves, family symptoms subside and the
family can report much more fun and togetherness. Of course, there are
situations where the process is not as smooth as described here. These are
the very impaired, chaotic families and those in which it is difficult to bring
family members together without emotional explosions. However, if the

therapist is able to keep the communication calm for the volatile family and if
he is able to stimulate communication for the more silent family, the net
result is on the favorable side.
The main advantage in family-group therapy is the striking, short-term
result. The main disadvantage develops when the family-group therapy
becomes a longer-term process. At this point, the family begins to act out the
same problems they had at home. The parents begin to expect the children to
assume more responsibility in the family. The more adequate children
become bored by the repetition of issues and they look for reasons not to

attend. If forced to attend, the formerly talkative children can become silent.
The maximum results with short-term family-group therapy come within
about ten to twenty sessions, depending on the intensity of the problem and
the skill of the therapist.
A fair percentage of families tend to terminate at the point of feeling

good about the family. If they terminate before they reach the impasse of
underlying problems, the family feels confident it has learned to solve its own
problems, the family praises the magic of family therapy, and the therapist is
positive about his accomplishment. This may account for the use of family-
group therapy as a short-term method. Some therapists terminate at this
point and arrange follow-up visits for the future. If the family goes into the
emotional impasse of longer-term therapy, they may terminate feeling that

little was accomplished. It is usually not possible for parents and children to
continue together beyond a certain point. It often results in the parents and
one child or the two parents continuing without the others.
Family-group therapy is not as effective for long-term family therapy as
some of the other methods. The continuation of it as a long-term method, to a
reasonable resolution of the underlying problem, depends on the intensity of

the problem and the skill of the therapist. Very impaired families may
continue for a long time, using the therapy much as an individual

psychotherapy patient uses therapy, for support. Therapists tend to develop
other methods and techniques if the goal is to get through the emotional
impasses.
Couples Therapy—Marital Therapy
These terms help to point up the ambiguity in the field and specifically
imply that the spouses are in some kind of therapy in which the focus is on
two people and their relationship. The terms convey nothing about the
problem for which the therapy is used, or the theory or method of therapy.
Some therapists restrict use of the terms to problems in the marital
relationship, such as marital conflict or marital disharmony. A high
percentage of marriages have some degree of conflict or disharmony. Other
therapists have a broader view of marital problems and use marital therapy
for an additional range of problems, such as impotence and frigidity. From
experience, the focus on the relationship aspects of such problems can more
quickly resolve the problems than focusing on the individual aspects of the
problems. Others use marital therapy for problems outside the marital
relationship, such as problems in a child. Such considerations say nothing
about the theory, the method, or the technique of therapy. In general, theory
is determined by the way the therapist thinks about the nature of the family
problem; method is determined by broad principles for implementing the
theory into a therapeutic approach; and techniques are the specific ways or
strategies for implementing the method. Therapists trained in individual

theory, and who accept the assumptions of individual theory as fact, are
usually not much aware of theory. Terms such as theory, hypothesis,
assumption, formulation, and concept are used loosely and inaccurately. It is
not uncommon to hear someone say, "I have a theory," when it would be
more accurate to say, "I have an idea." It would be improbable that anyone
could have a theory about marital relationships that is not part of a larger
theory. Marital therapy might accurately apply to a method if it is based on a

theory about the nature of the problem to be modified. The general use of the
terms, couples therapy or marital therapy, implies merely that both spouses
attend the sessions together. The use of the terms is a good example of the
wide divergence of practice in the family field.
Psychoanalytic Marital Therapy
This term has not been used widely. If it were generally used, it would
be one of the more specific terms in the family field. The theory would be
consistent with psychoanalytic theory, the method would be reasonably
consistent with the theory, and therapy techniques would have a reasonable
resemblance to psychoanalytic techniques. This is a method used frequently
by family therapists who formerly practiced psychoanalysis. One of the main

differences in techniques would be the analysis of the relationship between
the spouses rather than the transference relationship with the therapist. This
method involves the process of learning more about the intrapsychic process
in each spouse, in the presence of the other spouse, with access to the
emotional reactiveness of each spouse to the other. The approach provides
access to the unconscious through the use of dreams. A new dimension is
added when spouses can analyze the dreams of each other. Readings on the
intrapsychic process in each are obtained through simultaneous dreams. This
is one of the most effective long-term methods of family therapy. It works
best when the initial problem was in one spouse or the marital relationship.
The author used it a number of years before moving to a systems approach to
the entire family-relationship system.
Child-Focused Family
This term refers to a well-defined family problem rather than a therapy
approach, but it is used frequently enough to warrant discussion here. The

child-focused family is one in which sufficient family anxiety is focused on one
or more children to result in serious impairment in a child. The child-focused

energy is deeply imbedded, and it includes the full range of emotional
involvements from the most positive to the most negative. The higher the
anxiety in the parents, the more intense the process. For instance, a mother in
her calmer periods can know that nagging makes the child’s problem worse.
She may resolve to stop the nagging, only to have it recur automatically when
anxiety rises. The usual approach in family therapy is to soften the intensity
of the focus on the child and to gradually shift the emotional focus to the

parents, or between parents and families of origin. This might be relatively
easy if the problem is not intense, or it can be so intense that little is
accomplished beyond symptomatic relief and easing the pressure for the
child. There are differences about what to do with the child. Child
psychiatrists tend to focus major attention on the child and supportive
attention on the parents. Family therapists tend to focus on the emotional
process in the family with parents and child together. This approach may
bring good initial results, but there are difficulties when it becomes a long-
term process. Some family therapists will see the child separately or have
someone else see the child. This can result in parents becoming complacent,
expecting the problem to be solved in the child’s "therapy." There is no single
highroad to success in these families. Finding a way through the problem
depends on the therapist’s concept of the problem and his skill in keeping the
family motivated. My own approach is to remove the focus from the child as
quickly as possible, remove the child from the therapy sessions as early as
possible, and give technical priority to getting the focus on the relationship
between the parents, at the risk of a temporary increase in the child’s

symptoms. This broad spectrum of differences around a single clinical
problem conveys some idea of the differences in the field, and this does not
even touch the differences about what goes on in the individual sessions.
Transactional Analysis, Games Theory, Gestalt Theory
These three theoretical concepts are grouped together because all three,
though each different in its own right, occupy similar positions in the total
scheme of family therapy as it is practiced. These concepts and the
therapeutic approaches that go with them were either developed before
family therapy or they were developed independent of family therapy. These
approaches are not incompatible with individual theory, they provide
ingenious ways of conceptualizing relationship systems, and they represent a

step toward systems theory. For the therapist attempting to extend his
knowledge of family process, these concepts provide ready-made concepts
that are more precise for understanding the family and for improvements in
therapy. Success with these therapy methods, as with most other methods,
depends on the skill of the therapist.
Behavior-Modification Therapy
Almost every experienced family therapist has done some version of
behavior-modification therapy, which has now become a well- defined
method. The family presents a near-perfect model of a "system" in operation.

The family is a system in that each member of the system, on cue, says his
assigned lines, takes his assigned posture, and plays his assigned role in the
family drama as it repeats itself hour by hour and day by day. This process
operates without intellectual awareness. When any principal member of the

family can observe and come to know his own part in the family and

purposely change his part, the others will immediately change in relation to it.
Family members who can become adept at knowing their roles can bring
about predictable change in the action-behavior patterns in others. The
disadvantage is in the short-term nature of the change. There are two main
variables that limit the long-term result. First, the other family members
rather quickly catch on and they start their own versions of adapting to it, or
they initiate their own changes. Then the process can become "game playing."
Secondly, the whole system of reacting and counter-reacting is imbedded in
the emotional system, and the initiator has to keep on consciously and
purposely initiating the change. When there is a lapse, the family system
returns to its former level. Long-term change requires a modification in the
intensity of the emotional level, at which time such changes can become
permanent.
Cotherapist Therapy
The use of two therapists, or several therapists, began very early in the
family movement. A high percentage of family therapists have had some
experience with it. Originally, it was used to help the therapist become aware
of his own emotional overinvolvement with family members. Whitaker

(1967) routinely used a cotherapist in psychotherapy with schizophrenia
long before he started family therapy. He also has become well known for
using co-therapists in his long career in family therapy. Others have
developed it as a method for including both male and female therapists who
serve as a model for the family. Boszormenyi-Nagy (1973) is one who has
been prominent in perfecting this model in his method of therapy. Still
another use of co-therapists is the team approach in which several therapists,

representing the various members of the mental-health professions, work
together as a team. MacGregor (1964) and his group made a major effort to
perfect this during his work in Galveston in the early 1960s. He now teaches
and trains family therapists with the team approach. Some version of the
family-therapy, team approach is now used in most centers that do family
therapy. In the broad spectrum of family therapy, cotherapist therapy exists
as one of the major innovations and developments in family therapy. It is used
both as a method and technique.
Sculpting and Simulated Families
These two innovations are the modern-day descendants of drama

therapy. Sculpting is listed first because it has more application to therapy.
The simulated family was developed in the early 1960s, more for teaching
than for therapy. In teaching, it involves professional people who playact
hypothetical family situations. Role playing helps family process become

more real to the participants. In therapy, one or more members of a real
family have outside people role play the parts of absent family members.
People who participate in simulated families discover an uncanny sense of

realness to the role-played situation. Sculpting was developed in the late
1960s to help family members become more aware of self in relation to their
own families. The therapist helps the family members decide on the
functioning position of each family member in relation to the others,

following which the family members are put into physical apposition. The
sculpting sessions in which family members debate the position of each, plus
the living sculpture in which they assume positions such as bossy, meek,
clinging, and distant provide both a cognitive and feeling experience that is
one of the more rapid ways of helping family members become aware of each
other. The sculpting may be repeated during therapy for awareness of change
and progress. These two methods are examples of other innovative
developments in the field.
Multiple-Family Therapy
The most popular version of this was developed by Laqueur (1964) for
members of several families who meet together in a form of family- group
therapy for discussion of individual and shared family problems. It is most
useful for severely impaired or fragmented families. Multiple-family groups
have been started around groups of inpatients and families on visiting days at
mental hospitals, around families and patients attached to mental-health
centers, and families and patients discharged from mental hospitals. This
method provides a unique and effective method of support and a relationship
system that enables patients to be discharged earlier and to be maintained at
home and in the community. New families can replace those who discontinue,
while the group continues to serve as an ongoing resource for former families
who wish to return. This method has also been used successfully with less
impaired people. It is least effective in helping individual family members
toward defining a self. The author has devised a method of multiple-family
therapy specifically designed to help individual family members toward

higher levels of functioning. The therapist works with each family separately,
dividing the time between the three or four families and avoiding
communication or emotional exchange between the families. The focus on the
family emotional process in each family can permit beginning individuation in
that family. Emotional exchange between the families encourages group
process, which overshadows family process, and individuation is impaired or

blocked. Advantages of the method are faster progress in each family from
observing the others and a net saving in time. Disadvantages are additional
work in scheduling and the energy required of the therapist in maintaining
structure.
Network Therapy
This method was devised by Speck (1973) in the mid-1960s. It was
designed to help "create" families for fragmented, disorganized families. The
goal is to include people from the friendship network in addition to relatives.

The isolated family may have few available relatives and few close friends.
The therapist encourages the family to invite relatives and close friends, and
friends of friends, and friends of friends, etc. The meetings often include
fifteen to forty people, but Speck has had meetings with up to 200 people.
Meetings are held in homes or in other appropriate places in the
neighborhood. The therapist begins with discussion about the problem in the
central family for which the network was assembled. Discussions soon shift to
other problems in the network. Theoretical premises about networks are that
people have distorted ideas about problems of others, that distortions are
often worse than reality, that friends become distant during stress, and open
discussion of problems can stimulate more real relationship activity and
helpfulness to network members. Experience with networks tends to support
the premises. Some remain to talk for hours after meetings have ended, some
do become more helpful around the central problem, and network attitudes
about the central problem are modified. When regular network meetings
continue, a fair percentage lose interest, attendance at meetings dwindles,
and continuation requires enthusiasm by the therapist and those who

organize the network. On the negative side, the logistical problems of
organizing time-consuming, evening meetings, and the clinical expertise

necessary for managing large meetings with divergent emotional forces,
makes this a difficult therapeutic method. The network idea has a potential
both for the understanding of social networks and the development of
therapeutic methods. In practice, the network has come to be a short-term
method, or one to achieve a specific goal. One successful application has been
for new admissions to mental hospitals. One or two meetings are held to
include the family, friends, and people who had contact with the patient
before admission (Kelly, 1971). Meetings ease the impact of admission and
facilitate discharge. Additional meetings may be called at nodal points during
hospitalization.
Encounters, Marathons, Sensitivity Groups
These methods are examples of a trend that has increased in the past
decade. Therapists who practice the method are usually not members of the
family movement, and the method lends itself to unstructured use by people
with little training. The methods are short-term and are based on partial
theoretical notions that suppressed feelings are responsible for symptoms,

and that the awareness of feelings and the expression of feelings in relation to
others is therapeutic. For some, such methods can result in temporary
periods of feeling good and exhilaration, which is called growth. For others,
the sessions are followed by an increase in anxiety and symptoms. This
movement is antithetical to the efforts of the majority of family therapists.
Experiential and Structured Family Therapy

An increasing number of family therapists are beginning to classify the
various family-therapy methods into experiential and structured methods.
This is a modification of the A to Z scale in The Field of Family Therapy. The
experiential approaches put a high premium on becoming aware of feelings,
in being able to express feelings directly to others, and in becoming more
spontaneous in relationship systems. Most therapists agree that a
spontaneous, open relationship system is a desirable result for family

therapy, but there is disagreement about the best way to help families achieve
this. The structured approach uses theoretical concepts about the nature of
the family problem and a therapeutic method that is based on the theory. The
method contains a built-in blueprint to guide the course of the therapy. The
method knows the problems to be encountered during therapy; it has a
methodology for getting through the difficult areas; and it knows when it
approaches its goal. This is in contrast to the experiential approaches that

emphasize the subjective experience of therapy, that rely on the subjective
awareness and intuition of the therapist to guide the therapy, and that
consider the development of more open spontaneity in relationships to be the

goal. A structure-oriented therapist makes decisions based on theory, and he
stays on course in spite of any feelings of his against it. An experiential
therapist uses feelings and intuitive, subjective awareness to make his
decisions. If all approaches are put on a continuum, the encounter-marathon

approaches would be at one end of the continuum. Farther along the
continuum would be approaches that offer more and more structure, with
less and less emphasis on the expression of feelings as a guiding principle.

There is no such thing as an all-feeling situation, or an all-structured situation.
The human animal is a feeling being and any approach has to somehow deal
with feelings and, also, the realities of relationships with others. The type of
approach is not a positive index of success in therapy. There are Indian scouts
better qualified to lead an expedition through the wilderness than
inexperienced novices with scientific instruments. The structure-oriented
therapists believe that knowledge and structure, in addition to experience,
will eventually produce a better result. To summarize this point, the

experiential orientation says, "Know and express your feelings and the
process will break down the unhealthy structure that interferes with your
life." The structured orientation says, "Problems are the result of a poorly
structured life. The surest approach is the modification of the structure,
which will automatically result in free and spontaneous relationships."
The following are some examples of therapists who have worked

toward theoretical structures that are different from conventional individual
theory. Jackson (1969) began working on communication theory in the
1950s. Before his death he had extended his thinking into well-defined
systems concepts that clustered around his communication model. His
therapy reflected his theoretical thinking. In more recent years, Minuchin

(1974), in association with J. Haley who formerly worked with Jackson, has

developed a structured approach with theoretical concepts so well-
formulated that he has automatic therapeutic moves for any clinical situation.
His theoretical concepts view man, and his intrapsychic self, in the context of
the relationship system around him. Through his relationships man

influences those about him and man, in turn, is influenced by those about him.
His therapeutic approach, consistent with his theory, is designed to modify
the feedback system of the relationship system through which the whole
family is modified. His therapy specifically avoids a focus on the intrapsychic
forces. The author has worked toward a family-systems theory of human
adaptation and a method of therapy designed to modify the relationship
system by modifying the part the individual plays in the relationship system.
The therapy also avoids focus on the intrapsychic forces. No one is ever really
accurate in describing the work of another. The author’s approach will be

presented in more detail later.
Conclusions
This survey represents one view of the diversity in theory and practice
as it has evolved in the family field during the past two decades. In i960, the
author used the analogy of the six blind men and the elephant to describe a
similar situation in the family field. Each blind man felt a different part of the
elephant and the assumption of each was accurate within his own frame of
reference. The same analogy is accurate today as different family therapists
view the family through different frames of reference. The family is a complex
organization that remains relatively constant no matter who observes and
defines it. At the same time, there can be a wide variety of different concepts
that accurately describe the family. Early in the family movement most
therapists viewed the family through familiar theories about intrapsychic
forces within the individual. This was accurate within limits, but the theory
was awkward and inaccurate for conceptualizing the relationship patterns

through which the intrapsychic forces in one person were interlocked with
the intrapsychic forces in others. Family therapists began using a variety of
different concepts to account for the interpersonal forces. This resulted in one
theory for the intrapsychic forces and another for the interpersonal forces. A
majority of therapists still use this combination of theories, each finding the
most compatible combination for himself. There are problems in using two
different kinds of theories for the same overall phenomenon. Most of the
relationship theories used the functional concepts of systems theory. In the

past decade, the term "systems" has been misused to the point of simplistic
meaninglessness, but the trend toward systems thinking points to a definite

direction. The world of systems thinking has sent men to the moon and back,
but systems concepts are poorly defined in areas that apply to man and his
functioning. Systems thinking has a tremendous potential for the future, but
the "elephant" of systems thinking is far bigger and more complex than the
"elephants" of the past. The author’s effort at developing a systems theory

represents the serious effort of another "blind man." It is presented in the
following sections of this chapter.
A Systems Theory of Emotional Functioning
The main problem in defining a systems theory is in finding a workable

collection of functions that can be integrated into a functional whole. The
number of choices in the selection of pieces for such a theory is almost
infinite. Selection is governed by some overall framework. It is easier to do a

theory about a small area of functioning than a large area. Without a
framework one can emerge with multiple concepts, each accurate within
itself, that do not fit together. The universe is our largest conceptualized
system. From a systems model we know there are logical connections
between the atom and the organization of the universe and between the
smallest cell and the largest known collection of cells, but the development of
workable theories are still far in the future. Large areas of specific knowledge
are lacking. The conceptual integration of new knowledge can take longer
than the original scientific discovery. Into the far distant future man must be
content with his lack of knowledge and discrepant, partial theories.
The following are some of the basic notions about the nature of man
that guided the selection of the various concepts in this systems theory. Man
is conceived as the most complex form of life that evolved from the lower
forms and is intimately connected with all living things. The most important
difference between man and the lower forms is his cerebral cortex and his
ability to think and reason. Intellectual functioning is regarded as distinctly
different from emotional functioning, which man shares with the lower forms.
Emotional functioning includes the automatic forces that govern
protoplasmic life. It includes the force that biology defines as instinct,
reproduction, the automatic activity controlled by the autonomic nervous
system, subjective emotional and feeling states, and the forces that govern
relationship systems. There are varying degrees of overlap between
emotional and intellectual functioning. In broad terms, the emotional system
governs the "dance of life" in all living things. It is deep in the phylogenetic
past and is much older than the intellectual system. A "feeling" is considered
the derivative of a deeper emotional state as it is registered on a screen
within the intellectual system. The theory postulates that far more human
activity is governed by man’s emotional system than he has been willing to

admit, and there is far more similarity than dissimilarity between the dance of
life in lower forms and the dance of life in human forms. Emotional illness is
postulated as a dysfunction of the emotional system. In the more severe forms
of emotional illness, the emotions can flood the intellect and impair
intellectual functioning, but the intellect is not primarily involved in
emotional dysfunction. There are varying degrees of fusion between the
emotional and intellectual systems in the human being. The greater the

fusion, the more the life is governed by automatic emotional forces, despite
man’s intellectual verbalization to the contrary. The greater the fusion
between the emotion and intellect, the more the individual is fused into the
emotional fusions of people around him. The greater the fusion, the more man
is vulnerable to the emotional forces around him. The greater the fusion, the
more man is vulnerable to physical illness, emotional illness, and social
illness, and the less he is able to consciously control his own life. It is possible
for man to discriminate between the emotions and the intellect and to slowly
gain more conscious control of emotional functioning. The biofeedback
phenomenon is an example of conscious control over autonomic functioning.
A major concept in this systems theory is developed around the notion
of fusion between the emotions and the intellect. The degree of fusion in
people is variable and discernible. The amount of fusion in a person can be
used as a predictor of the pattern of life in that person. In developing any

systems theory it is not possible to develop concepts to cover each piece of
the total puzzle. In developing this theory an effort has been made to make
each concept harmonious with the overall view of man described here and,
above all, to avoid concepts that are discrepant with the overall view.
The Theoretical Concepts
The theory is made up of a number of interlocking concepts. A theory of
behavior is an abstract version of what has been observed. If it is accurate, it
should be able to predict what will be observed in other similar situations. It
should be able to account for discrepancies not included in the formulations.
Each concept describes a separate facet of the total system. One may have as
many different concepts as desired to describe smaller facets of the system.
These concepts describe some overall characteristics of human relationships,
the functioning within the nuclear family system (parents and children), the
way emotional problems are transmitted to the next generation, and the
transmission patterns over multiple generations. Other concepts about
details in the extended family and the ways family patterns are interlinked
with larger social systems will be added to the theory at a later time. Since the
total theory has been described in other publications (Bowen, 1966; Bowen,
1971), the concepts will not be described in detail here.
Differentiation of Self Scale
This concept is a cornerstone of the theory. It includes principles for

estimating the degree of fusion between the intellect and emotions. The term
"scale" conveys the notion that people are different from each other and that
this difference can be estimated from clinical information. It is not a scale to

be used as a psychological instrument by people not familiar with the theory
and the variables in a relationship system. The scale refers to the level of solid
self that is within self, which is stable under stress and which remains

uninfluenced by the relationship system. The solid self is easily confused by
the pseudo-self that is determined by the relationship system and can
fluctuate from day to day or year to year. The pseudo-self can be increased by
a congenial relationship and emotional approval and decreased by a negative

relationship or disapproval. An index of the pseudo-self is the degree to which
people act, pretend, and use external appearances to influence others and to
feign postures that make them appear more or less adequate or important
than they really are. The degree of pseudo-self varies so much that it is not
possible to make a valid estimate of solid self except from estimating the life
patterns over long periods of time. Some people are able to maintain fairly
even levels of pseudo-self for several decades. With all the variables, it is
possible to do a reasonably accurate estimate of the degree of differentiation
of self from the fusion patterns in past generations and from the overall
course of a life in the present. Estimates of scale levels provide important
clues for family therapy and for predicting, within broad limits, the future
adaptive patterns of family members.
Triangles
This concept describes the way any three people relate to each other
and involve others in the emotional issues between them. The triangle
appears so basic that it probably also operates in animal societies. The

concept postulates the triangle or three-person system as the molecule or
building block of any relationship system. A two-person system is basically
unstable. In a tension field the two people predictably involve a third person
to make a triangle. If it involves four or more people, the system becomes a
series of interlocking triangles. In a multiple-person system, the emotional

issues may be acted out between three people, with the others relatively
uninvolved, or multiple people clump themselves on the poles of the
emotional triangle. Psychoanalytic theory, without specifically naming it,
postulates the oedipal triangle between parents and child, but the concept
deals primarily with sexual issues, and it is awkward and inaccurate to extend
this narrow concept. There are two important variables in triangles. One
deals with the level of "differentiation of self"; the other with the level of
anxiety or emotional tension in the system. The higher the anxiety, the more
intense the automatic triangling in the system. The lower the level of
differentiation in the involved people, the more intense the triangling. The
higher the level of differentiation, the more the people have control over the
emotional process. In periods of low anxiety, the triangling may be so toned
down that it is not clinically present. In calm periods, the triangle consists of a
two-person togetherness and an outsider. The togetherness is the preferred
position. The triangle is rarely in a state of optimum emotional comfort for all
three. The most uncomfortable one makes a move to improve his optimum
level of emotional closeness-distance. This upsets the equilibrium of another
who attempts to adjust his optimum level. The triangle is in a constant state of

motion. In tension states the outside position is preferred, and the triangle
moves are directed at escaping the tension field and achieving and holding
the outside position. The predictable moves in a triangle have been used to
develop a system of therapy designed to modify the triangular emotional
system. The moves in a triangle are automatic and without intellectual
awareness. The therapy focuses on the most important triangle in the family.
It is designed to help one or more family members to become aware of the

part that self plays in the automatic emotional responsiveness, to control the
part that self plays, and to avoid participation in the triangle moves. When
one person in the triangle can control self while still remaining in emotional
contact with the other two, the tension between the other two subsides.
When it is possible to modify the central triangle in a family, the other family
triangles are automatically modified without involving other family members
in therapy. The therapy also involves a slow process of differentiation

between emotional and intellectual functioning and slowly increasing
intellectual control over automatic emotional processes.
Nuclear Family Emotional System
This concept describes the range of relationship patterns in the system
between parents and children. Depending on the relationship patterns each
spouse developed in their families of origin and the patterns they continue in
marriage, the adaptive patterns in the nuclear family will go toward marital
conflict, toward physical or emotional or social dysfunction in one spouse,
toward projection of the parental problems to one or more children, or to a
combination of all three patterns.
Family Projection Process
This concept describes the patterns through which parents project their
problems to their children. This is part of the nuclear family process, but it is
so important that an entire concept is devoted to it. The family projection
process exists to some degree in all families.
Multiple-generation
Transmission Process
This concept describes the overall pattern of the family projection

process as it involves certain children and avoids others and as it proceeds
over multiple generations.
Sibling Position
This concept is an extension and modification of sibling-position
profiles as originally defined by Toman (1969). The original profiles were
developed from the study of "normal" families. They are remarkably close to
the observations in this research except that Toman did not include the
predictable ways that profiles are skewed by the family-projection process.

Knowledge gained from Toman, as modified in this concept, provides
important clues in predicting areas of family strength and weakness for
family therapy. This is so important that it has been included in a separate
concept.
Family-Systems Therapy
This method of therapy evolved as the theoretical concepts were
developed and extended. During the late 1950s, the term "family therapy"
was used for the method when two or more family members were present.
The deciding factor revolved around the therapeutic relationship when only
one family member was present. In the years prior to family research, the
author had operated on the premise that the most reliable method for
emotional growth was the working out of psychopathology as it was

expressed in the relationship with the therapist. Now this basic premise was
changed. The new effort was to work out problems in the already existing,
intense relationships within the family and to specifically avoid actions and
techniques that facilitate and encourage the therapeutic relationship. A

change of this magnitude, for one trained in psychoanalysis, is so great that
many say it is impossible. The first few years it was difficult to avoid a
therapeutic relationship with only one family member and the designation
"individual therapy" was accurate for that situation. Gradually, it became
impossible to see one family member without automatically thinking about
the part played by other family members in this person’s life. Transference
issues, formerly considered critical for the resolution of problems, were
avoided until more family members could join the sessions. By 1960, the
technique of working with one family member was sufficiently refined so that
it was accurate to begin to talk about family therapy with one family member.
Family therapy for both parents and one child together illustrates
another nodal point in the development of this theory and method. These are
families faced with school and adolescent-behavior problems in the
youngster. Most of the parental anxiety is focused on the symptom in the

child. In the family-therapy sessions, in the physical presence of the child, it is
difficult to get the parents to focus on themselves. The average good outcome
of such therapy would come in about twenty-five to forty appointments

covering about a year, with the aggressive mother becoming less aggressive,
the passive father less passive, and the child’s symptoms much improved. The
family would terminate with high praise for family therapy, but with no basic
change in the family problem. This experience led to rethinking the theory
and developing new techniques to get the focus on the hypothesized problem
between the spouses. The triangle concept was partially developed. Now
parents were asked to accept the premise that the basic problem was
between them, to leave the child out of the sessions, and to try to focus on
themselves. The results were excellent and this technique has been continued
since 1960. Some of the best results have been achieved when the

symptomatic child was never seen by the therapist. In other situations the
child is seen occasionally to get the child’s view of the family, but not for
"therapy." The child’s symptoms subside faster when the child is not present
in the therapy, and parents are better motivated to work on their own
problems. This experience led to the present standard method of family
therapy in the triangle consisting of the two parents and the therapist.
Another effort began early in the family movement. This was directed at
neutralizing the family emotional process to create the "sick patient" and to
make the therapist responsible for treating the patient. Terms such as,
"people," "person," and "family member" replaced the term "patient."
Diagnoses were avoided, even in the therapist’s private thinking. It has been
more difficult to replace the concepts of "treatment," "therapy," and

"therapist" and to modify the omnipotent position of the therapist to the
patient. Most of these changes have to occur within the therapist. Changing
the terms does not change the situation, but it is a step. When the therapist
has changed himself, the old terms begin to seem odd and out of place. There
is the continuing problem of using an appropriate mix of old terms and new
terms both in relating to the medical and social institutions and in writing. It
has been most difficult to find concepts to replace "therapy" and "therapist" in
work with the families and to keep them in the profession. I have found terms
such as "supervisor," "teacher," and "coach" helpful. The term coach is
probably the best at conveying the connotation of an active expert coaching
both individual players and the team to the utmost of their abilities.
One of the most difficult changes has been in finding ways to relate to
the healthy side of the family instead of the weak side. It is a slow, laborious
task to improve the functioning of the weakest family member. It is many
times more effective to work through the healthy side of the family. Opposing
this are the family forces to create the patient and the popular notion that
psychiatrists are to treat mental illness. One example from a period in the
early 1960s will illustrate the point. This came from therapy with conflictual
marriages in which each spouse would continue the cyclical, nonproductive

report about what was wrong with the other, each trying to prove it was the
other who needed to see a psychiatrist. It was effective for the therapist to say
he would not continue the cyclical process, that they should decide who was
healthiest and he would do the next sessions with the healthiest alone. The
focus on both parents, no matter the location of the problem in the family, is a
step toward work with the healthy side of the family. The search for the most
responsible, most resourceful, and most motivated part of the family can be
elusive. It is best determined from knowledge of the family emotional process
and the functioning patterns in the past and present generations, in
collaboration with the family. The potential source of family strength can be
lost in an emotional impasse with a nonproductive family member.
More details about working with a single, motivated family member will

be presented later.
With this theoretical, therapeutic system, the term "family therapy" is

derived from the way the therapist thinks about the family. It refers to the
effort to modify the family-relationship system, whether the effort is with
multiple family members, the two spouses together, or only one family
member. The term "family-systems therapy" began after the theoretical

concepts were better defined. It is more accurate than previous terms, but it
is not well understood by those not familiar with systems concepts. The term
"systems therapy" is now used more often to refer to the process either in the
family or in social systems.
Family-Systems Therapy with Two People
This method is a standard approach for therapists who use this

theoretical-therapeutic system. The concept about modifying the entire
family in the triangle of the two most important family members and the
therapist was well formulated by the mid-1960s. The method has been used
with several thousand families by the staff and trainees in a large family
training center. It has been used alongside other methods in the effort to find
the most productive therapy requiring the least professional time. The major
changes since the mid-1960s have been in a better understanding of triangles,

clearer definition of the therapist’s function in the triangle, and minor
changes in techniques. The method was designed as one that would be
effective for short-term therapy and that could also go on to longterm
therapy. It works best for people who are capable of calm reflection. It is for
two people in the same generation with a life commitment to each other. For
practical purposes this means husbands and wives. Other twosomes, such as
parent and child, two siblings living together, a man and woman living
together, or homosexual pairs, are not motivated for significant change in the
relationship.
Theoretical Issues
A relationship system is kept in equilibrium by two powerful emotional
forces that balance each other. In periods of calm the forces operate as a
friendly team, largely out of sight. One is the force for togetherness powered
by the universal need for emotional closeness, love, and approval. The other
is the force for individuality powered by the drive to be a productive,
autonomous individual as determined by self rather than the dictates of the

group. People have varying degrees of need for togetherness, which
constitutes the life style (level of differentiation of self) for that person. The
greater the need for togetherness, the less the drive for individuality. The mix
of togetherness and individuality into which the person was programmed in
early life becomes a "norm" for that person. People marry spouses who have
identical life styles in terms of togetherness-individuality.

People with lower levels of differentiation of self have greater needs for
togetherness and less drive for individuality. The greater the need for
togetherness, the harder it is to keep togetherness forces in equilibrium
without depriving certain family members. Discomfort and symptoms
develop when togetherness needs are not met. The automatic response to
anxiety and discomfort is to strive for more togetherness. When this effort
fails repeatedly, the family member reacts in ways characteristic to that

person. The reactions include dependent clinging, seductiveness, pleading,
acting helpless, denial of need, acting strong, dictatorial postures, arguing,
fighting, conflict, sexual acting out, rejection of others, drug and alcohol abuse,
running away from the family, involving children in the problem, and other
reactions to the failure to achieve togetherness.
When a family seeks psychiatric help, they have already exhausted their
own automatic mechanisms for achieving more togetherness. Most family-

therapy methods put emphasis on the family need for understanding and
togetherness. The therapist tries to help the family toward more love,
consideration, and togetherness by discarding counterproductive, automatic
mechanisms in favor of calmer and more productive mechanisms. These
methods are effective in achieving symptom relief and a more comfortable life
adjustment, but they are less effective in modifying the life style of family
members.
This method is designed to help the family move as rapidly as possible
toward better levels of differentiation. It proceeds on the assumption that the
forces for individuality are present beneath the emotional reactiveness
around togetherness, that the individuality forces will slowly emerge in the
favorable emotional climate of the therapy triangle, and that togetherness
forces will automatically readjust on a higher level of adaptation with each
new gain in individuality.
Method
The method was developed from experience with emotional forces in a
triangle. Emotional tension in a two-person system immediately results in the
twosome involving a vulnerable third person in the emotional issues of the

twosome. From earlier family therapy with three family members present,
the emotional issues cycled between the family members and evaded the
therapist’s efforts to interrupt the cycles. This method is designed to put the
two most important family members into therapy with the therapist, which
makes the therapist a target for family efforts to involve a third person.
Progress in therapy depends on the therapist’s ability to relate meaningfully

to the family without becoming emotionally entangled in the family system.
At the beginning of therapy the two family members are involved in an

emotional fusion manifested by a "we," "us," and "our" clinging together, or by

an opposite version of the same thing, which is an antagonistic posture
against the other. If the therapist can relate to the family over time, without
becoming too entangled in emotional issues, and if he can recognize and deal
with his entanglements when they do occur, it is possible for two separate
selfs to slowly emerge from the emotional fusion. As this occurs, the
emotional closeness in the marriage automatically occurs, and the entire
family system begins to change in relation to the change in the spouses.
Technique
The most important aspect of the therapy depends on the therapist’s

ability to stay neutral in an emotional field, and his knowledge of triangles.
Each therapist has to find his own way to maintain emotional neutrality in the
therapy situation. My best operating, emotional distance from the family,
even when sitting physically close, is at the point where I can "see" the
emotional process flowing back and forth between them. The human
phenomenon is usually as humorous and comical as it is serious and tragic.
The right distance is the point at which it is possible to see either the serious
or the humorous side of things. If the family becomes too serious, I have an
appropriate humorous remark to defuse the seriousness. If the family starts
to kid and joke, I have an appropriate serious remark to restore neutrality. An

example was a wife going into detail about her critical, nagging, bossy mother.
The husband was indicating his agreement. If the therapist permitted them to
believe he also agreed, he would be in the emotional process with them. His
comment, "I thought you appreciated your mother’s devotion to you," was
enough to change the seriousness to a chuckle and defuse the emotional
tension. A calm tone of voice and a focus on facts rather than feelings is
helpful in keeping an even, emotional climate. Moves toward differentiation
of self are usually not possible in a tense situation.
It is necessary for the therapist to keep his focus on the process
between the two. If he finds himself focusing on the content of what is being
said, it is evidence that he has lost sight of the process and he is emotionally
entangled on a content issue. It is necessary to listen to content in order to
follow process, but to keep the focus on process. The greater the tension in
the family, the more it is necessary for the therapist to stay constantly active
to affirm his neutral position. If he cannot think of anything to say, he is
emotionally entangled. Within narrow limits, the therapist may use learned
comments for emotional situations. If he is only moderately involved, the

comment may be effective. Over the years the "reversal" or "paradoxical
comment" has come into use to defuse emotional situations. The reversal is a
technique of picking up the opposite side of the emotional issue for a
neutralizing comment. If the therapist is deeply involved in the family

emotional system, the reversal is heard as sarcasm or hostility and the effort
fails.

The principal technique of this method is a structure for each spouse
talking directly to the therapist in a factual, calm voice. It is talking about
emotional process rather than the communication of emotional process. The
therapist avoids a structure in which family members talk directly to each
other. Even when the emotional climate is calm, direct communication can
increase the emotional tension. This one technique is a major change from
earlier methods in which emotionally distant family members were

encouraged to talk directly to each other.
A typical session might begin with a comment from the husband to the
therapist. To respond directly to the husband involves risk in triangling with
the husband. Instead, the therapist asks the wife what she was thinking when
she heard this. Then he turns to the husband and asks what was going
through his thoughts while the wife was talking. This kind of interchange
might go back and forth for an entire session. More frequently, the husband’s
comment is too minimal for the clear presentation of an idea. The therapist
then asks the husband as many questions as necessary to elaborate his

thinking into a clearer presentation. Then the therapist turns to the wife for
her thoughts while the husband was talking. If her comments are minimal, the
therapist might ask a series of questions to more clearly express the wife’s
views. Then he turns to the husband for his response to the wife’s comments.
There are numerous other techniques for getting to the private thinking
world of each and getting it expressed to the therapist in the presence of the
other spouse. For instance, the therapist might ask for a summary of private
thoughts about the family situation since the last session, or ask for the most
recent thinking about a particular family situation. The therapist asks for
thoughts, ideas, and opinions, and avoids asking for feelings or subjective
responses. In my opinion, this process of externalizing the thinking of each
spouse in the presence of the other is the epitome of the "magic of family
therapy." Therapists accustomed to emotional exchanges can find these

sessions dull and uninteresting, but the families are interested, and motivated
to attend the sessions. It is common for spouses to say how much they look
forward to the sessions and how they are fascinated to hear how the other
thinks. When asked how they could live with one another so many years
without knowing what each thinks, they say they can listen and hear when
one of them talks to the therapist in a way they could never listen when
talking to each other. It is common to hear these comments about increasing
fascination at discovering what goes on in the other after having been in the
dark so long. Spouses experience a challenge in being as expressive and
articulate as possible. People who have formerly been non-talkers gradually

become talkers. Expressions of emotional closeness and increasing affection
for each other occur at home. This occurs faster than when the effort is
directed at emotional expression in the sessions. Other reports include the
ability to deal calmly with children, the ability to listen to others for the first
time, and new experiences about being able to work together calmly.

When tears or emotion erupts suddenly in a session, the therapist stays
calmly on course, asking what was the thought that stimulated the tears, or
asking the other what they were thinking when the feeling started. If feeling
mounts and the other spouse responds directly to the first spouse, it is
evidence of building emotional tension. The therapist increases the calm
questions to defuse the emotion and to bring the issue back to him. The
therapist is always in control of the sessions, asking hundreds of questions

and avoiding interpretations. By considering each new family as a research
project, the therapist always has so many questions there is never time to ask
more than a fraction of them. The therapist avoids acting like a wise man who
knows the answers. He asks questions and he listens. His ideas about the
family are no more than educated guesses. He might tell the family about his
guesses and ask for their ideas that support it or refute it. He might tell the
family he thinks a particular area of investigation might be helpful, as a way of

telling the family what he is thinking and a way of enlisting their effort in the
exploration.
A fair percentage of the therapist’s time may go to keeping himself
disentangled from the family emotional process. The families use their
automatic mechanisms in the effort to involve a third person in the triangle.

This is more intense early in the therapy and at periods when anxiety is
higher than usual. When the therapist knows the characteristics of triangles,
and he is alert, he can often anticipate the triangling move before it occurs.
There are situations in which a spouse erroneously assumes the therapist has
taken sides on an issue. The process of keeping the therapist emotionally
neutral gets first priority in the therapy. The goal of the therapist is to keep
active and to make statements or take actions that affirm his neutrality and to
avoid transference-type interpretations to the family about it. Systems theory
assumes that the triangling move is an automatic emotional response of the
people involved, and not personally directed, as it might be interpreted to be

in individual-relationship therapy. The casual comment or a calm reversal is
effective in helping the therapist maintain his neutral position.
After the family anxiety subsides and the spouses are more capable of
calm reflection, individuality forces begin to surface in one spouse. This
occurs as the spouse begins to focus more on the part that self plays in the
relationship problems, to decrease blaming of the other for one’s own
discomfort and unhappiness, and to accept responsibility for changing self.
The other spouse increases the pressure on togetherness demands, which

commonly results in the first spouse falling back into the old togetherness.
This process proceeds through a number of false starts, with the
differentiating one gradually gaining more strength and the other increasing
the tempo of the togetherness pleas. The togetherness pressure includes

accusations of lack of love, indifference, not caring, and lack of appreciation.
When the differentiating one is sure enough of self to proceed calmly on
course, in spite of the togetherness pleading of the other, without defending

self or counterattacking, and without withdrawing, the attack subsides and
the differentiating process passes through its first major nodal point. It may
require a year or two for the first spouse to reach this point. This is followed
by a period of calm and a new, higher level of adjustment in both. Then the
second spouse begins a similar differentiating effort to change self, and the
first spouse becomes the promoter of togetherness. New cycles usually take
less time and the steps are not as clearly defined as in the first step.
The individuality force emerges slowly at first and it takes very little
togetherness force to drive it back underground for fairly long periods. An

average life course of people is one that keeps the togetherness-individuality
forces in neutralizing balance. The therapist can facilitate the differentiating
process by focusing questions on this new area of family issues, by focusing

on responsibility for self, and by avoiding any connotation that he is siding
with the more righteous-sounding, togetherness pleading.
Teaching in Family-Systems Therapy
Some kind of didactic teaching is necessary for families who go on to
long-term therapy with this method. This kind of knowledge provides the
family with a way of understanding the problem, an awareness they are
responsible for progress, and a framework in which they can direct their
energy on their behalf. A very anxious family is unable to "hear" didactic
explanations, and the therapist who attempts such explanations becomes
deeply entangled in the family emotional system, with inevitable distortions
and impasses in the therapy. Teaching statements are used cautiously until
after the family is calm. This applies to the rationale for sending spouses
home for frequent visits with their families of origin, which is part of the
effort of encouraging them to "differentiate a self" in their extended families.
In the later stages of therapy, all kinds of conferences and didactic sessions
can be helpful.
Conclusions
This method is effective as a short-term, midterm, or long-term process.
The length of the therapy is determined by the family. There have been a fair
percentage of striking "cures" in five to ten sessions, usually for symptoms
that erupted from an overintense relationship. An example was a seven-
session "cure" of severe frigidity in a young wife. Mid-term, good results often
come in twenty to forty sessions when symptoms have subsided and the
togetherness-oriented spouse exerts pressure to discontinue. No other
approach has been as effective as this in producing good, long-term results. In
1966, this method was adapted for multiple-family therapy. The therapist
does thirty-minute sessions with each of four families while the other families
are nonparticipant observers. In these half-hour sessions the average family
makes a little faster progress than in one-hour sessions for single families.

The difference appears related to the ability to "hear" and learn from the
other families without reacting emotionally. When the differentiation of self is
the goal, it appears to take a certain amount of time for motivated people to
modify their life styles. There have been experiments to spread a given
amount of therapy time over longer periods of time with less frequent
appointments. A majority of multiple- family-therapy sessions are now held
monthly, with results as good, or better, than with more frequent sessions.
The families are better able to accept responsibility for their own progress
and to use the sessions for the therapist to supervise their efforts. Long-term
families continue for an average of five years, which includes about sixty
multiple-family sessions and about thirty hours of direct time with the
therapist.
Toward the Differentiation of Self in One’s Own Family
The turning point in the method came in 1967 after an anonymous

paper on the differentiation of self in one’s own family was read at a national
meeting (Framo, 1972). The method involved a detailed family history for
multiple generations in the past and the developing of a personal relationship
with all important living relatives. This activates old family relationships
grown latent with neglect. Then, with the advantage of objectivity and the
knowledge of triangles, the task is to disentangle themselves from old family
triangles as they come to life.
In the spring of 1967, I began using material presented at that
conference in teaching family therapy to psychiatric residents and other
mental-health professionals. They began to see themselves in their own
families and to go home to secretly try out the knowledge on their families.
This was followed by reports of inevitable emotional impasses and further
conference discussion to help understand the problem and make suggestions
for the next trip home.
Also in 1967, the residents were better than previous residents as
clinicians in family therapy. At first I thought this was related to the quality of
residents that year, but according to them, it was experience with their own
families that made the difference. There were comments, such as, "Family
theory is just another theory until you see it work with your own family. It is
easier to help other families with experience from your own family."
The next awareness came in 1968. The residents were doing so well in
their clinical work that no attention had been devoted to personal problems
with their spouses and children. The effort had been directed toward the
training of family therapists. There had been no mention of problems in their

nuclear families. In 1968, I discovered that these residents had made as much
progress with spouses and children as similar residents in formal weekly
family therapy with their spouses. There was a good sample for comparison.
Since the early 1960s, I had been suggesting family therapy for residents and

their spouses instead of individual psychotherapy or psychoanalysis for
personal problems. There was a volume of clinical experience with formal
weekly family therapy for psychiatric residents to compare with residents
who were going home to visit their families of origin and who were not in any
type of formal psychotherapy. This professional experience with psychiatric
residents and other mental-health professionals was the beginning of a new
era in my own professional orientation.
There is some speculation about the more rapid change in working with
the extended families than with the nuclear family. It is easier to "see" self and
modify one’s self in triangles a bit outside the immediate living situation than
in the nuclear family in which one lives. In the years since 1968, this method
of work with the extended family has been used in all kinds of conferences
and teaching situations and also in private practice type "coaching." A person
working actively can utilize coaching sessions about once a month. Some who
have access to teaching sessions do not need private sessions, or they need
them less often. Some who live at a distance are seen three or four times a
year or as infrequently as once a year. This approach is so different, it is hard

to compare results with other approaches. It bypasses the nuclear family and
the infinite emotional detail in close-up relationships. It appears to produce

better results than the more conventional family therapies.
This method has been used largely for those in training to be family
therapists, but it has been used with a growing number of others who hear
about it and request it. The results are the same, except that there are few
people who seek family therapy until they have symptoms. Once a family
starts formal family- therapy sessions, it is harder to find motivation for

serious work with the families of origin.
The method of defining a self in the extended family has been used as
the only method of therapy for a broad spectrum of mental-health
professionals, and for nonprofessional people who hear about the method
and request it. Work with the extended family is urged for all families in other
types of family therapy, but extended family concepts make little sense when
people are anxious. After symptoms subside, it is harder for people to find
motivation for serious work with their extended families. Any gain from the
extended family is immediately translated into automatic gain with spouses
and children. Success in working toward defining self in the family of origin
depends on motivation and the family situation. It is easiest with highly

motivated people with intact families that have drifted apart. At the other
extreme are those who are repulsed by the idea of contacting an extended
family and those whose families are extremely negative. In between are
different levels of motivation and families with varying degrees of

fragmentation and distance. It is not a serious problem when parents are
dead if there are other surviving relatives. Reasonable results are possible
with those who believe they have no living relatives.

Unique experiences with change in extended families are commonplace.
This is in addition to change in the nuclear family. In a course in family
therapy for freshman medical students and their spouses, there was a student
whose father had been in a state hospital for about twenty years. The hospital
was near his home town several hundred miles away. The family had been
visiting the father about once a year. I suggested that the student visit his
father alone, any time he was home, and that he try to relate through the
psychosis to the man beneath the symptoms. I was guessing that the father
might be able to leave the hospital by the time the son graduated from
medical school. He visited the father about four times that year. The following
year, about nine months after the course started, the father visited the son
while on a furlough from the hospital. Exactly twelve months after the course
started, as the son was starting his sophomore year, the father had been
discharged from the hospital and was visiting the son. The father attended the
twenty-second meeting of that class in family therapy. After having been in a
state institution from the age of thirty to about fifty, he was having
adjustment and employment problems, but the son, the father, and the family
had come far in only one year.
Systems Theory and Societal Problems
The emotional forces in a triangle operate in the same way in society as
in the family. Family therapists have been aware of this for a number of years,
but the specific mechanisms involved in this have been elusive and hard to
define. The author has made one serious effort at this.* The larger societal
field, with its multiple emotional forces, is a challenge for the concepts of
systems theory.
Conclusion
This chapter presents an overall view of family therapy as it began
almost twenty years ago and as it has developed as part of the changing
psychiatric scene. An effort has been made to identify some of the forces that
gave rise to the study of the family and other forces that seem to have
determined the direction of the growth of family therapy. Family therapists
represent such a diversity in theory and therapeutic method that it is difficult

to find a frame of reference for either the common denominators or
differences in the field. An effort has been made to focus on the broad
direction rather than attempting to categorize the work of well-known people
in the field. It is factual that the greatest number of family therapists operate
from psychiatric theory learned in training, and that they use family therapy
as a technique. Another large group of family therapists uses conventional

theory for thinking about emotional forces in the individual but another
theoretical scheme for thinking about the relationship system between family
members. A smaller group of family therapists has moved into completely

different theories for conceptualizing and working with families. These

differences in theory do not have common denominators in the clinical
practice of family therapy. There are skillful therapists who would be masters
with any therapeutic method. In this sense, family therapy is still more of an
art than a science.
Presented here is the thesis that the study of the family opened the door
for the study of relationships between people. There was no ready-made,
conceptual scheme for understanding relationships. We are living in the
computer age in which systems thinking influences the world about us, but
systems concepts are poorly developed in thinking about man and his
functioning. Most of the family therapists who have worked on relationships
have developed systems concepts for understanding the subtle and powerful
ways that people are influenced by their own families, by society, and by their
past generations. Those who have developed the most complete systems
concepts have developed therapeutic methods that bypass individual theory
and practice, not because one is considered better than the other but to
experiment with possible new potentials. The author is among those who
have worked toward developing systems concepts for understanding
emotional illness in the broader family framework. He has presented his
theoretical, therapeutic system as one of the many ways that family and social
systems may be conceptualized, and to provide the reader with the broadest
possible view of the diversity in the practice of family therapy. If the present
trend in systems thinking continues, we can reasonably expect even more
striking developments in the field in the next decade.
Bibliography
Ackerman, N. W. The Psychodynamics of Family Life. New York: Basic Books, 1958.
Bateson, G., D. Jackson, J. Haley et al. "Toward a Theory of Schizophrenia," Behav. Sci., 1 (1956),
251-264.
Bell, J. E. Family Group Therapy, Public Health Monogr., 64. Washington: Department of Health,
Education, and Welfare, 1961.
Boszormenyi-Nagy, I. and G. Spark. Invisible Loyalties. New York: Harper & Row, 1973.
Bowen, M. "A Family Concept of Schizophrenia," in D. Jackson, ed., The Etiology of Schizophrenia,
p. 346. New York: Basic Books, 1960.
----. "The Use of Family Theory in Clinical Practice," Compr. Psychiatry, 7 (1966, 345-374.
----. "Family Therapy and Family Group Therapy," in H. Kaplan and B. Sadock, eds., Comprehensive
Group Psychotherapy, pp. 384-421. Baltimore: Williams & Wilkins, 1971.
----. Societal Regression as Viewed through Family Systems Theory. Paper presented at the Nathan
W. Ackerman Memorial Conf., Venezuela, Feb. 1974.
Flügel, J. C. The Psycho-Analytic Study of the Family. London: Hogarth, 1960.
Framo, J., ed. (author of article anonymous) "Differentiation of Self in One’s Family," in Family
Interaction, pp. 111-173. New York: Springer, 1972.
Freud, S. (1909) "Analysis of a Phobia in a Five-Year-Old Boy," in J. Strachey, ed., Standard Edition,
Vol. 10, pp. 5-147. London: Hogarth Press, 1955.
Group for the Advancement of Psychiatry. The Field of Family Therapy. Report No. 78. New York:
Group for the Advancement of Psychiatry, 1970.

Jackson, D. and W. Lederer. The Mirages of Marriage. New York: Norton, 1969.
Kelly, V. and M. Hollister. "The Application of Family Principles in a Community Mental Health
Center," in J. Bradt and C. Moynihan, eds., Systems Therapy, pp. 117— 127.
Washington: The Groome Center, 1971.
Laqueur, H. P., H. A. LaBurt, and E. Morong. "Multiple Family Therapy," in J. Masserman, ed.,
Current Psychiatric Therapies, Vol. 4, pp. 150-154. New York: Grune & Stratton,
1964.
Lidz, T., S. Fleck, and A. Cornelison. Schizophrenia and the Family. New York: International
Universities Press, 1965.
MacGregor, R., A. Ritchie, A. Serrano et al. Multiple Impact Therapy with Families. New York:
McGraw-Hill, 1964.
Midelfort, C. F. The Family in Psychotherapy. New York: McGraw-Hill, 1957.
Minuchin, S. Families and Family Therapy. Cambridge: Harvard University Press, 1974.
Satir, V. Conjoint Family Therapy. Palo Alto, Calif.: Science Behavior Books, 1964.
Speck, R. and C. Attneave. Family Networks. New York: Pantheon, 1973.
Spiegel, J. Verbal communication.
Toman, W. Family Constellation. New York: Springer, 1969.
Whitaker, C. A. "The Growing Edge in Techniques of Family Therapy," in J. Haley and L. Hoffman,
eds., Techniques of Family Therapy, pp. 265-360. New York: Basic Books, 1967.

Family Therapy After Twenty Years

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Family Therapy After Twenty Years

Uploaded by

Copyright:

Available Formats

Family

Therapy After Twenty Years

Copyright © 1975 by Basic Books

All Rights Reserved

Created in the United States of America

Family Therapy After Twenty Years

History of the Family Movement

Common Differences Between Individual and Family Theory and Therapy

The Spectrum of Methods and Techniques in Family Therapy

Specific Methods and Techniques of Family Therapy

Experiential and Structured Family Therapy

A Systems Theory of Emotional Functioning

Systems Theory and Societal Problems

method. A majority think of family therapy as a treatment method based on

conventional psychiatric theory. A small percentage of family therapists think

psychiatric scene. There are many differences in method and technique in

American Handbook of Psychiatry Vol 5 5

psychoanalytic thinking toward a systems theory and systems therapy.

History of the Family Movement

anthropologists were studying families and contributing to the literature, but

their work had no direct application to psychiatry. Marriage counseling began

1930s before there was a recognizable connection between it and psychiatric

Psychoanalysis had finally become the most accepted of the psychological

experimenting in an effort to extend psychoanalytic treatment to the full

range of emotional problems. This includes those who began experimenting

safeguard the personal privacy of the patient-therapist relationship and to

prevent contamination of the transference by contact with the patient’s

American Handbook of Psychiatry Vol 5 7

intrapsychic process, another psychiatrist to handle reality matters and

administrative procedures, and a social worker to talk to relatives. In those

years this principle was a cornerstone of good psychotherapy. Failure to

acceptable to see families together in the context of "research."

The investigators who started family research with schizophrenia were

prominent in starting the family movement. This included Lidz in Baltimore

of William C. Menninger who considered the family to be important for

1955-1956 period (Spiegel, verbal).

Spiegel, Chairman of the Committee on the Family, helped organize the

but the notion of "family therapy" or "family psychotherapy" was discussed.

definite method at a national meeting. That was the beginning of family

therapy on a national level. Dozens of new people, attracted by the promise of

American Handbook of Psychiatry Vol 5 9

important in determining the future course of the family movement. In that

state of chaos." It was considered healthy on the premise that clinical

experience would bring an awareness of the theoretical dilemma implicit in

generations of family therapists have worked toward establishing some

family therapy as a method based on conventional, individual theory or as an

intuitive, experiential method conducted by therapists who are guided by

There is suggestive evidence that family therapists come largely from

childhood situations in which they had more than average awareness of

movement" in psychiatry to include the theoretical thinking, the family

popular use of the term "family therapy" as it is used to connote a treatment

Common Differences Between Individual and Family Theory and Therapy

The one main difference between an individual and a family approach is

on the surface. The total fabric of society, as it pertains to human illness,

changes what man is or has always been. He is as autonomous as he has

simple concept is extended to its ultimate, then all mankind becomes

American Handbook of Psychiatry Vol 5 11

action, than to contemplate changing himself. From family therapy, we know

This section of the chapter is not designed as a theoretical treatise on the

The following differences between individual and family theory point up a

few of the more obvious examples of the differences.

The Medical Model

This cornerstone of sound medical practice requires the physician to