Family Therapy in Focus

Books

Mark Rivett & Eddy Street

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  • Counselling & Psychotherapy in Focus

    Series Editor: Windy Dryden, Goldsmiths College, University of London

    Counselling & Psychotherapy in Focus is a series of books which examines the criticisms directed at different forms of counselling and psychotherapy. Each book in the series reviews the critiques of a particular approach, presents counter-arguments to the criticisms and examines the influence that the debates have had in shaping the approach in question. The books in this series are:

    Psychoanalysis in Focus

    David Livingstone Smith

    Family Therapy in Focus

    Mark Rivett & Eddy Street

    Person-Centred Therapy in Focus

    Paul Wilkins

    Copyright

    View Copyright Page

    Dedication

    to

    Jean & Leonard

    Eddie & Laura

    who gave us our appreciation of families

    and to

    Jan, Joseph & Alex

    Anna, Tesni, Jenny & Joe

    who remind us of and develop that appreciation

    The Manuscript

    Gregory Bateson Esalen, October 5, 1978

    So there it is in words

    Precise

    And if you read between the lines

    You will find nothing there

    For that is the discipline I ask

    Not more, not less.

    Not the world as it is

    Nor ought to be –

    Only the precision

    The skeleton of truth

    I do not dabble in emotion

    Hint at implications

    Evoke the ghosts of old forgotten creeds.

    All that is for the preacher

    The hypnotist, therapist and missionary

    They will come after me

    And use the little that I said

    To bait more traps

    For those who cannot bear

    The lonely

    Skeleton

    of Truth

    ‘The Manuscript’, quoted from Gregory Bateson and Mary Catherine Bateson (1988) Angels fear: toward an epistemology of the sacred, New York: Bantam Books. The poem is also printed on page 12 of the January 1981 Esalen catalogue. Reprinted by permission of the Institute for Intercultural Studies.

    Foreword

    Family therapy, as an alternative and distinctive way of helping clients, is approximately fifty years old. The oldest family therapy journal, Family Process, dates from 1962, but family therapy as an underground movement had started a decade earlier. Sue Walrond-Skinner, an important pioneer, who produced the first British Family Therapy text (Family therapy: the treatment of natural systems), recounts the story of how, in 1951, John Bell, who worked at the Mental Research Institute, Palo Alto, visited the Tavistock Clinic while he was in England. He got into discussion with John Sutherland about how John Bowlby was exploring, from a theoretical point of view, the significance of seeing whole families rather than individual clients. According to Sue, Bell misunderstood the convening technique being used by Bowlby, who was not actually seeing families conjointly at that time. He went back to America and was prompted to begin experimenting with convening whole families to family group meetings, thinking that Bowlby had already pioneered such work (Walrond-Skinner, 1976).

    I rather like this story about the origins of family therapy. No doubt there are other equally intriguing stories involving other pioneers and how they came to start, but the story does prompt some thoughts about the role of serendipity in developing new ideas. I am reminded of the apple falling on Newton's head and of Fleming's petri dish becoming contaminated with Penicillium (a penicillin-producing organism). There is also a certain poignancy in the punctuation created by the story. The Tavistock influences the MRI, which influences the wider growth of family therapy in America and beyond. Obviously, that is a different story from one that takes the MRI as the first point of punctuation.

    Sue's historical anecdote prompts other thoughts too – for example, why is it that British family therapists have been so heavily influenced by American theorists? If I think of my own career, which roughly spans the last twenty five years of family therapy's history, then I think of successive waves of American influence: Haley and strategic family therapy, Minuchin and structural family therapy, the MRI and brief therapy, de Shazer and solution-focused therapy. I would also include (paradoxically) the Milan school, because I would argue that Palazzoli and her colleagues did not primarily draw on Italian or even European traditions to develop their model. Their inspiration was primarily the work of Bateson and the MRI. In many ways they took American cybernetic ideas more seriously than any other theorists, but (as I have argued elsewhere (Treacher, 1986; 1995)), in doing so, they created an anti-humanist, expert-driven model (Palazzoli, Boscolo, Cecchin & Prata, 1978), which probably has the most dubious ethical stance of all the multitude of family models that are available to us.

    Twenty years on, it is remarkable to look back and remember the popularity of the Palazzoli group. I suspect that their key text, Paradox and counterparadox, must still hold the record as the most cited book in the family therapy literature. But do beginning family therapists ever think of reading it now? The seminal work of Boscolo and Cecchin (in their post-Milan phase), and the radical impact of post-modern ideas have effectively erased the original Milan model – an apparently dialectical process which almost makes me believe in the truth of Hegelianism. Unfortunately the third element of Hegel's triad – synthesis, said to arise from the collision of the thesis with the antithesis – has not shown any signs of emerging. Contemporary British family therapy just does not fit such a format. For example, the two most fashionable current models – narrative therapy and solution-focused therapy – are strikingly both non-systemic and both equally antagonistic to the original Palazzoli model.

    My concerns about the coherence of family therapy and the problems that arise from shifting paradigms are partly the reflection of my role as a family therapy trainer. Since 1991 I have been involved in co-directing the Diploma in Family and Marital Therapy at the University of Exeter. I have been involved with four cohorts of course members during this time, but, if I am honest with myself, I have to admit that the task of teaching the course has become increasingly difficult for me because I no longer have a firm idea of what should be taught. As I have mentioned elsewhere (Treacher, 1998), I feel like a dinosaur who has been rendered extinct by the rapid conceptual changes that have occurred.

    When Eddy and Mark asked me to write the foreword to their book, I was at first not convinced that I should do so. The last thing a book needs is a dinosaur to introduce it! But on reading the manuscript some of my doubts about family therapy's present and future evaporated. Their book is part of a series that will look at all the major forms of psychotherapy from a questioning standpoint. I think Mark and Eddy are very brave to take on the daunting task of putting family therapy under a critical microscope. The task is a huge one because of the complexity of the subject matter. Family therapy is a very diverse field and the conceptual changes that have occurred are, as I have already documented, bewildering. Quite rightly (given the size of the task) they have not attempted to write a definitive text but have instead opted for a less exhaustive approach that deals with selected facets of family therapy. The choices they have made are interesting ones and I am prompted to think what I would have included if I had attempted to write a similar book. In contrasting the so-called first-order approach of general systems theory with the second-order post-modern approaches in the opening chapters of the book is very thought provoking. In reading these chapters I find I drift into a kind of mourning response: I think of the lost opportunities and, above all else, the major problem that family therapy has always confronted – the lack of a major, convincing theory which enables us to have a working understanding of how different types of family function. Thinking along these lines reminds me of the work of Arlene Vetere and Tony Gale whose book Ecological studies of family life (Vetere & Gale, 1987) was such a brave attempt to launch such a project. Such a project would not, I think, mesh well with the post-modern ideas that dominate family therapy today, but I resolutely insist on continuing my mourning. Family therapy as a solely hermeneutic tradition does not appeal to me because I have always valued empirical research as a knowledge base that can contribute to the therapy I undertake.

    In their next two chapters Eddy and Mark change stance and adopt a sociological lens, looking first at critiques of family therapy and then exploring the rather thin literature which has attempted to answer the question: who are the family therapists?In my book with Sigurd Reimers, Introducing user-friendly family therapy, I have explored what I see as a major weakness of family therapy – the failure to explore family members’ experiences of being in therapy. It occurs to me (as I read Mark and Eddy's chapter) that family therapists are curiously unvoiced as well. Actually this is not at all surprising – the original general systems theory ideas that were so important in creating the field of family therapy were very dehumanising. On the one hand they rendered individual family members invisible, but on the other they enabled therapists to escape scrutiny because therapists remained experts outside the system they were viewing. Murray Bowen is correctly celebrated for breaking out of this tradition by insisting that the therapist is a vibrant and crucial participant in the process of therapy. More recently second-order theories and the narrative school have encouraged family therapists to recover their voices and examine their role in therapy, but I nevertheless find it significant that Mark and Eddy have so few studies to explore. Narcissism is clearly not a problem we suffer from.

    Chapter 7 is an intriguing chapter. Eddy's grounding in Rogerian psychotherapy has always played an important role in his approach to therapy but it is surprising how little attention has been paid to Rogers’ approach. Some of the early pioneers of family therapy, and especially Haley, had a mind-set that meant that they rejected other psychotherapy traditions. Paying attention to the nature of selfhood opens the door to asking the almost heretical question: why can family therapy not be undertaken with individuals? Bowen and other transgenerational family therapists were, of course, never bothered by this issue, but it is interesting to see how it has now become a mainstream topic. And there is even some evidence that working individually can be efficacious.

    The question of efficacy in family therapy (Mark and Eddy's next topic) is a curious one – for many post-modern theorists such a crude positivist question is anathema. However, throughout my professional career I have always been haunted by the guilty knowledge that the model of family therapy I had espoused really did not possess a substantial efficacy literature. I would have felt much happier if I had felt that the method I was using was tried and tested. The ethical question posed by this chapter is quite clear to me – is it justifiable to practise forms of family therapy that have no clear efficacy? (Narrative therapists may not like the word ‘efficacy’ but efficacy can be translated into narrative terms quite easily; for example, for ‘efficacy’ read convincing changes in the stories that the participants tell about being involved in therapy.) Diplomatically, Mark and Eddy do not conclude their chapter with this question but their last chapter does take up this theme.

    Chapter 9 is a very ambitious chapter: it attempts to identify core features or dimensions that are responsible for achieving therapeutic change. Much of the work reviewed here is new to me but I am a little bit disappointed that Mark and Eddy do not attempt to make more of what they discover. For instance, what are the training implications of their discoveries?

    This same chapter argues towards a conclusion of integration. I'm particularly sympathetic to this chapter because as a therapist I am squirrel-like – I like to hoard everything I have learnt from being exposed (willingly) to a very wide range of models. Intuitively I feel it is impossible for any one model to suit all clients (unless the model is itself an integrative one). I have always worked generically (rather than having a specialised client group) so I always felt that it is necessary to continually expand the repertoire of ideas and techniques (to use a word unfashionable in family therapy) that I can offer my clients. Mark and Eddy comment in the chapter on the work that Sigurd Reimers and myself undertook under the rubric of ‘user- friendly family therapy’. Obviously I can't be very objective about this part of the book but personally I am glad that this work is getting a second airing. Writing the book with Sigurd solved something of a professional crisis for myself – I was becoming lost as a family therapist and needed to find a firmer and more personally owned basis that I could use as a springboard for developing my work.

    Reading Mark and Eddy's book at the point of retiring has (as I have already hinted) not been an easy task. The retired part of me just wants (among other things) to walk in the Cotswold hills which I have so rapidly got to love (after moving from Devon). The non- retired intellectual part of me has enjoyed the challenges of the book – at times I have agreed and at other times I have disagreed with what they have to say. But overall the book has helped me revisit important issues that I feel remain largely unresolved. I am sure other readers will have a similar experience when reading the book – this is a book that is designed to provoke and stimulate. At times it is elusive and at other times very grounded. That is as it should be since it genuinely reflects many of the puzzling and enriching ideas that family therapy has spawned during its roller- coaster history. Whether the unfolding history will ever be less of a roller-coaster I do not know, but I have a clear preference. I would want to see family therapy based on firmer theoretical and empirical foundations than is currently the case. In other words I take an attachment theory approach to theories – I would prefer to have securer theories to be attached to. And, to wave a (solution-focused) magic wand for a moment, I would have preferred family therapy to place the work of John Bowlby and other attachment theorists (including Allan Schore, 1994) at the centre of its stage. Building therapy on shifting sands may be exciting and energising but I would personally settle for a quieter, less challenging and more professionally secure life.

    AndyTreacher

    Stroud, Gloucestershire January 2002

    References
    Palazzoli, M.S., Boscolo, L., Cecchin, G. & Prata, G. (1978). Paradox and counterparadox: a new model in the therapy of the family in schizophrenic transaction. Northvale, NJ: Aronson.
    Reimers, S. & Treacher, A. (1995). Introducing user-friendly family therapy. London: Routledge.
    Schore, A. (1994). Affect regulation and the origin of the self. The neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum Associates.
    Treacher, A. (1986). Invisible patients, invisible families. Journal of Family Therapy, 8, 267-306. http://dx.doi.org/10.1046/j..1986.00722.x
    Treacher, A. (1995). Steps towards a user-friendly approach. In S.Reimers & A. Treacher, Introducing user-friendly family therapy. London: Routledge.
    Treacher, A. (1998). Psychotherapy and research: a cause for concern?Context, 39, 13-15.
    Vetere, A. & Gale, A. (1987). Ecological studies of family life. Chichester: John Wiley.
    Walrond-Skinner, S. (1976). Family therapy. The treatment of natural systems. London: Routledge & Kegan Paul.

    Preface

    Just prior to the turn of the last century a number of celebrations and ‘reflections’ occurred in the world of family therapy. At its twenty-first birthday celebrations in 1996 there was an ‘orgy of reminiscences’ (Cooklin, 1996) for the Association for Family Therapy and Systemic Practice (AFT). In 1997 the Association published a magazine ‘celebrating British family therapy’ (Rivett & Smith, 1997). Whilst, the following year, the Journal of Family Therapy invited authors who had contributed articles to its very first edition twenty years before, to reflect upon their earlier ideas in the light of contemporary theory and practice (see Speed & Carpenter, 1998). The metaphor that was most frequently used during these celebrations was one of the life cycle. The 1996 conference was sub-titled ‘Coming of Age’: the talk was of ‘maturing’, whilst elsewhere references were made to ‘first’- and ‘second’-generation therapists. When family therapists looked back at the progress of their practice they naturally thought about growth, evolution and maturation. Indeed, one of the most recent historical reviews written from the standpoint of the ‘third generation’ of the field has argued that the concept of ‘abandoning our parents and grandparents’ is a possibility (Dallos & Urry, 1999).

    Within this context, this book seeks to ask ‘how has family therapy got to where it is now?’ and also ‘what is it that exists now that is called family therapy?’ In one sense we simply here reproduce the circular questions that family therapists use. The difference is that the subject in question is not a problematic interaction, a piece of behaviour, or an emotion. The subject is family therapy itself.

    In a field in which metaphors abound, for us the metaphor of evolution or maturation does not quite describe the subject of this book. Certainly, here we have once more both interacted with our professional ancestors and considered future developments. But from the perspective of the different voices that have occupied our minds whilst writing, family therapy's development has seemed to us to involve a complex process of disjunctions, dilemmas and cyclical returns rather than maturation. Understandably, we have therefore wondered about other metaphors that could guide us. In line with Bateson's poem, reproduced here, we certainly have felt that we have attempted to ‘read between the lines’ and identified the ‘baited traps’ of others. We have certainly wondered whether ‘the lonely Skeleton of Truth’ would put in an appearance!

    In the end we have realised that we can most clearly describe the process of writing this book by remembering a very simple meditation technique: ‘Back to one’. In this method when the meditator loses awareness of the present moment he or she simply returns to the beginning – but a new moment for that beginning. This is how it has seemed writing this book: ‘Back to one’. Each perspective from which we have assessed family therapy has led us not to increasing complexity, nor to new revelations, but back to the original insights and practices as well as a development and growth of those insights. These remain at the heart of our passion for family therapy. This passion has been re-awoken in the writing of a book, a book that proposes a critical, and sometimes sceptical, summary of the field. We hope that readers will also experience something of this paradoxical event: doubt serves to stimulate new conviction that is often shorn of its intellectual trimmings. To borrow another Eastern metaphor: this book is a koan (or an intellectually unanswerable riddle).

    Here we need to comment upon our contexts that constitute the particularities of this book. We undertook our professional training at different times and have differing backgrounds. Eddy is a clinical psychologist with an initial training in individual psychotherapy working in the NHS. Mark, initially a social worker, earns his living both as a family therapist and as a systemic therapist within a national children's charity and teaches family therapy at a university. This unique combination of perspectives has certainly contributed to the product of this book. We each took responsibility for different chapters but the way our drafts were passed back and forth makes all elements of the writing a joint process. A very British book has resulted. By this we mean that the practicality and scepticism of the British is apparent in a way that it might not have been if the book had been written somewhere else in the world. Indeed, again context contributes to this point: family therapy in Britain has all too often seemed to be driven by gurus from other nations. At one time they were American; at another time they were Italian. Currently, it appears to be the turn of Australians and New Zealanders!

    Our aim has been to offer a presentation of family therapy in its intellectual and psychotherapeutic context; to try to step over the boundaries that have been used to define our field and in so doing to investigate ideas that are in juxtaposition to ours. All along definitions of family therapy emerge. In the process of doing this we have realised that what at first we saw as being a straightforward task is much more complex. The field itself is of considerable breadth and if, as we have done, one attempts to deal with ideas that are in the academic arena that surrounds us then the task is indeed a mammoth one. We have found that issues that we have only been able to deal with in a paragraph would deserve a chapter in themselves and chapters could have been books! We hope, however, that the critique we offer here will serve as a benchmark for those that follow us. Indeed we now view our text as a benchmarking exercise with all the failings and limitations of such a pursuit.

    We begin with an historical perspective in our opening chapter (Chapter 1) which considers both the origins of family therapy and its critique of previous therapies. Following our introduction we consider philosophical critiques which we have separated into chapters exploring systems theory (Chapter 2) and post-modern philosophical developments (Chapter 3) – chapters which, due to family therapy's over-focus on philosophy, also bear something of an historical perspective. These theoretical issues are followed by chapters that consider family therapy from that of sociological (Chapter 4) and social justice critiques (Chapter 6). Interweaved is our version of the sociology of family therapists (Chapter 5). The problems of ‘self’ are discussed in a chapter on the ‘individual’ (Chapter 7), which includes a section on the personal development of the therapist. Because of the importance of evidence-based practice, we follow the theoretical chapters with two that consider both the traditional ‘outcome’ research (Chapter 8) and ways in which research is arguing for ‘integration’ (Chapter 9). Our final chapter (Chapter 10) draws together our understanding of where our review has alighted from its own journey.

    We have written this book with a number of audiences in mind. It is first and foremost intended to stimulate reflection and debate amongst family therapists about their own practice and the place of their inherited theory in that practice. But it is also designed to meet the requirements of family therapy trainees who need to develop a reflective and critical view of their professional literature. All too often professions train their students within an hermetically sealed bubble. In order to prevent this we have drawn on varied sources, some totally unrelated to the closed world of family therapy theory, in order to create an appropriate context for a critical examination of family therapy theory and practice. However, we must assert that the interpretations and analyses in these pages are our own.

    We hope that authors who we quote will be generous in allowing us to interpret their words. We also hope that readers will understand that we are not here asserting any certainties. We are contributing to a debate; sometimes asking questions that have not been asked before, or perhaps not in quite this way. Whatever the value of postmodernism to the psychotherapeutic theories of family therapy, we do agree that deconstruction can give valuable insights into texts: this ‘family therapy’ one in particular. Thus like Don Cupitt we would argue that ‘truth is the state of the argument’ (1991: 20). If this book stimulates that argument and the enquiry that goes with it, then our hopes will be fulfilled.

    EddyStreetMarkRivett

    Cardiff

    December 2001

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