The present family systems theories emerged out of the ideas and debates in the social and physical sciences after World War II. The specific ideas that led to the development of a systems approach to counseling and psychotherapy are outlined next.
Gregory Bateson is acknowledged by many as the pioneer in applying cybernetic systems thinking to human interaction (Imber-Black, 2004). Bateson saw that cybernetics provided a powerful alternative language for explaining behavior, specifically, a language that did not resort to instinct or descriptions of the internal workings of the mind (Segal, 1991). He began to use these ideas to understand social interaction (G. Bateson, 1951). For instance, he applied cybernetic principles to the study of families of schizophrenics (Haley, 1976). Bateson considered pattern, process, and communication as the fundamental elements of description and explanation. He believed that by observing human systems he could formulate the rules governing human interaction.
The Palo Alto Group
In 1952, while based in Palo Alto, California, Bateson received a grant from the Rockefeller Foundation to investigate the general nature of communication. He was joined on this project by Jay Haley, John Weakland, William Fry, and Don D. Jackson. This research team defined the family as a cybernetic, homeostatic system whose parts (i.e., family members) covary with each other to maintain equilibrium by means of error-activated negative feedback loops (Jackson, 1957). For example, whenever deviation-amplifying information is introduced (e.g., an argument between two family members or the challenge of a new stage in the family life cycle), a designated family member initiates a counterdeviation action (e.g., a family member exhibits symptomatic behavior) so that the family's existing equilibrium is restored (i.e., threatened changes are defeated). The emphasis on homeostasis prevailed in family therapy theory into the 1980s.
The recognition of the symptomatic double bind as a homeostatic maneuver regulating family patterns of relationship is considered the definitive contribution of the Palo Alto Group. The symptomatic double bind most often cited is Bateson's classic example of the interaction between a mother and her son who had "fairly well recovered from an acute schizophrenic episode." Bateson described this interaction as follows:
[The son] was glad to see her and impulsively put his arm around her shoulders, whereupon she stiffened. He withdrew his arm and she asked, "Don't you love me any more?"
He then blushed, and she said, "Dear, you must not be so easily embarrassed and afraid of your feelings." The patient was able to stay with her only a few minutes more, and following her departure, he assaulted an aide and was put in the tubs. (G. Bateson, Jackson, Haley, & Weakland, 1976, pp. 14-15)
The Palo Alto Group noted both the incongruence of the mother's message and the fact that the son could not clearly and directly comment on it. They concluded that the son's craziness was his commentary on his mother's contradictory behavior. Bateson's work in the 1950s spawned the development of many family therapy models, including the strategic model of Haley (1991) and Madanes (1991). An examination of this model follows our discussion of the ideas of another Palo Altoan – Virginia Satir.
Virginia Satir is among the best-loved of all theorists in the field of family therapy and, arguably, beyond. After leaving a career as a schoolteacher, she first practiced as a psychiatric social worker, then engaged in private practice work with families. In 1959, she joined the Mental Research Institute in Palo Alto. Satir gained international recognition with the publication of her first book, Conjoint Family Therapy, in 1964 (Satir, 1964/1983).
Satir acknowledged the impact of a diverse group of theorists on her life's work (Satir & Bitter, 1991). These included Fritz Peris (Gestalt therapy), Eric Beme (transactional analysis), J. J. Moreno (psychodrama), Ida Rolf (life-posturing reintegration), Alex Lowen (bioenergetics), and Milton Erickson (hypnosis). Her family therapy model reflects a growth perspective rather than a medical model for assessing and working with families. In her frame, illness is seen as an appropriate communicative response to a dysfunctional system or family context. Health, therefore, is developed when the system is changed so as to permit healthy communication and responses.
Like other communication theorists, such as Bateson, Satir defined congruence as the use of words that accurately match personal feelings. Thus, congruence is where direct communication and the meta-communication are the same. When using congruent communication, the person is alert, balanced, and responsive to any question or topic without needing to hold back. In contrast, incongruence is seen as communication in which the nonverbal and verbal components do not match. Examples of incongruent communication include double messages, assumptions, ambiguous messages, and incomplete communication. Satir saw self-esteem as the basis for family emotional health. Her perspective was that there is a correlation between self-esteem and communication. Low self-esteem is associated with poor communication because low self-esteem affects behavior and interactions among the members of the system. She also held that maladaptive communication can be both learned and unlearned.
To demonstrate concretely to a family how incongruence occurs and is a source of pain and poor self-esteem, Satir would ask them to join in a game. The communication game would typically be used to work with two members. She observed that when a person delivers an incongruent or mixed message, there is little skin or eye contact. It is as though the sender is "out of touch" with the other person. In the communication game, Satir taught families to improve their communication through a series of interactions that concretely show people what happens when they do not look, touch, or speak congruently. Satir (1964/1983) outlined these steps as follows:
1. Place two persons back to back and ask them to talk.
2. Turn them around and have them "eyeball" each other without touching or talking.
3. Then they "eyeball" and touch without talking.
4. Then they are asked to touch with eyes closed and without talking.
5. They "eyeball" each other without touching.
6. Finally the two talk and touch and "eyeball" and try to argue with each other.
By the last stage of the game, the couple usually finds it impossible to argue with one another. The problem of delivering an incongruent message is dear to the family when one is touching, talking, and looking at the listener.
Besides the humor of this process, the provocative nature of this game encourages a deeper examination of the ways family members suffer and feel inadequate or devalued when engaged in incongruent communication patterns. These revelations are supported through steps toward increasing self-esteem and communication as the family moves from a closed to a more open system. Satir believed that a functional family is an open system in which there is a clear exchange of information and resources both within the system and with others outside the family. In contrast, a closed system is rigid and maladaptive.
Satir observed that family pain is symptomatic of dysfunction. She did not feel that the problems the family brought to her were the real difficulty. Rather she saw that methods of coping within the family and rules for behavior that were fixed, arbitrary, and inconsistent decreased the family's ability to cope over time. Her approach involves the following treatment stages:
1. Establish trust.
2. Develop awareness through experience.
3. Create new understanding of members and dynamics.
4. Have the family express and apply their new understandings with each other.
5. Have the family use their new behaviors outside therapy.
As the family moves through this cycle of change, they feel less anxious and more fully valued and valuing of each other (Satir & Bitter, 1991). In this way, self-esteem, communication, and caring are raised and pain is decreased.
Jay Haley left Palo Alto in 1966 and joined Salvador Minuchin in Philadelphia to pursue his growing interest in family hierarchy, power, and structure. In 1974, he established the
Washington Institute of Family Therapy, where he was joined by Cloe Madanes. Their family therapy model has three roots: the strategic therapy of Milton Erickson, the theories of the Palo Alto Group, and the structural therapy of Minuchin.
Haley (1991) and Madanes (1981) asserted that a family's current problematic relational patterns were at some point useful because they organized family members in a concerted way to solve an existing problem. These patterns persisted because they protected the family from the threat of disintegration. Haley held that therapeutic change occurs when a family's dysfunctional protective patterns are interrupted. He noted that the role of family therapists, through the use of directives, is to provoke such interruptions. Haley offered therapist provocations such as the following:
• A husband and wife with sexual problems may be required to have sexual relations only on the living room floor for a period of time. This task changes the context and so the struggle.
• A man who is afraid to apply for a job may be asked to go for a job interview at a place where he would not take the job if he got it, thereby practicing in a safe way.
For Haley (1990), therapist directives served three purposes: to facilitate change and make things happen; to keep the therapist's influence alive during the week; and to stimulate family reactions that give the therapist more information about family structure, rules, and system. Haley held that the goal of therapy was not client insight; in fact, the family need not understand the actual mechanisms of change. Furthermore, the therapist should act without trying to convince the family that the set of hypotheses guiding the therapy is valid. Haley commented, "the goal is not to teach the family about their malfunctioning system but to change the family sequences so that the presenting problems are resolved" (p. 135).
Haley's ideas have direct consequences for the family therapist wishing to practice a strategic approach. First, a strategic family therapist attends to what is defined by the family members experiencing the problem as the "nature of the problem." Second, the therapist focuses on how the family is responding in attempting to resolve the problem. The assumption here is that it is often the very ways in which families are defining a problem and responding to it that may "keep it going" in a vicious problem-solution cycle.
Structural family therapists do not "sit on the sidelines" during therapy. Rather, they become involved with family members, pushing and being pushed. Minuchin put a strong emphasis on action in his own work as a family therapist. His justification for this emphasis was his belief that "if both I and the family take risks within the constraints of the therapeutic system, we will find alternatives for change" (Minuchin & Fishman, 1981, p. 7). He commented that observers of his structural family therapy work would notice (a) his concern with bringing the family transactions into the room, (b) his alternation between participation and observation as a way of unbalancing the system by supporting one family member against another, and (c) his many types of response to family members' intrusion into each other's psychological space (Minuchin & Fishman, 1981).
Minuchin's therapeutic maneuvers were based on his theoretical schema about family structure and family transformation. He carried out his vision by being uniquely himself. He stated:
In families that are too close, I artificially create boundaries between members by gestures, body postures, movement of chairs, or seating changes. My challenging maneuvers frequently include a supportive statement: a kick and a stroke are delivered simultaneously. My metaphors are concrete: "You are sometimes sixteen and sometimes four"; "Your father stole your voice"; "You have two left hands and ten thumbs." I ask a child and a parent to stand and see who is taller, or I compare the combined weight of the parents with the child's weight. I rarely remain in my chair for a whole session. I move closer when I want intimacy, kneel to reduce my size with children, or spring to my feet when I want to challenge or show indignation. These operations occur spontaneously; they represent my psychological fingerprint. (Minuchin & Fishman, 1981, p. 7)
For Minuchin, family therapy techniques are uniquely integrated in the person of the counselor or therapist who goes "beyond technique" to wisdom, specifically, wisdom concerning "knowledge of the larger interactive system – that system which, if disturbed, is likely to generate exponential curves of change" (M. C. Bateson, 1972, p. 439).
Murray Bowen's (1978) approach to family therapy, like Haley's, had many roots. Specifically, Bowen merged concepts such as Freud's unconscious id and Darwin's theory of evolution with his own observations of schizophrenics at the Menninger Clinic and the National Institute of Mental Health. His core idea was the concept of the differentiation of self. It was through this concept that Bowen addressed "how people differ from one another in terms of their sensitivity to one another and their varying abilities to preserve a degree of autonomy in the face of pressures for togetherness" (Papero, 1990, p. 45).
Bowen also posited that there are two different systems of human functioning: (a) an emotional and reactive system that humans share with lower forms of life and (b) an intellectual and rational system that is a more recent evolutionary development. The degree to which these two systems are fused or undifferentiated is the degree to which the individual is vulnerable to the impulses of his or her emotional system and less attentive to his or her intellectual and rational system. For example, people are more likely to react emotionally rather than rationally when they are anxious. Bowen asserted that the extent to which people have differentiated their thinking system from their emotional system will determine how able they are to maintain a sense of self in relationships with others, particularly members of their family.
Bowen believed that emotional illness was passed from one generation to another through the family projection process (FPP). FPP theory suggests that the ego differentiation achieved by children will generally approximate that of their parents. However, FPP often distributes the capacity for differentiation unevenly among family members. For example, one child may grow up with a high level of ego differentiation, whereas a sibling may grow up with a low level of differentiation. The hallmark of a high level is a well- defined sense of self and low emotional reactivity, whereas a low level is characterized by a poorly defined sense of self and high emotional reactivity.
Low levels of ego differentiation occur when parents "triangulate" a child into their conflicts to dissipate the stresses of their relationship. Bowen (1978) held that "triangles" are the natural consequence of two poorly differentiated people who are overwhelmed by anxiety and seek relief by involving a third party. Triangulation is how parents' low level of differentiation is passed on to the next generation. Klever (2005) presented empirical evidence supporting Bowen's theory of multigenerational transmission family unit functioning.
Bowen's work has influenced many of the present family therapy theorists. One of the best examples of the extension of Bowen's ideas is McGoldrick et al.'s (1999) work on geno- grams. This work was discussed earlier in the chapter.
The major constructs discussed in this section were developed by clinicians to understand how families function. Family theorists conceptualized the communication patterns, structures, and relationship dynamics of their client families. The concepts they developed reflected their own therapeutic interventions. In this way, family theory is a rich resource to students and family practitioners. Table 13.1 provides an overview and comparison of these major theoretical constructs.
Table 13.1. Major Family Therapy Theoretical Constructs