Family Processes: An Interactional View by Rudi Dallos and Harry Procter (1984)

Harry Procter; Rudi Dallos

In this unit we will introduce a challenging approach to the study of the family which has developed outside the traditional disciplines of psychology and sociology. The interactional approach provides a framework for considering the family and any ongoing social group. What makes this approach different from more traditional social psychological explanations is that it treats the interactional processes of the family as an entity and as central rather than as peripheral to the behaviour of individuals.

z iiNfi OHV i imn DNI1V1U3 1X3018 01HOM1VI30S V Nl HnOIAVHH ONV HNUUUX]'IMWdOlMN :A3010H3ASd 1VI30S /OEO mm UAH OUIHI v0 AIISUJAINH NUO m I & I CONTENTS Study guide 55 Set reading 56 Objectives 56 1 An introduction to the interactional view 1.1 Using the 'systems' model to observe family processes 1.2 Homeostasis and rules 57 58 65 2 The study of dyads 2.1 Symmetrical and complementary interactions 2.2 Hierarchy 2.3 Psychological distance 2.4 Psychological boundaries 2.5 The limitations of dyadic analysis 67 67 68 70 71 71 3 The study of triads 3.1 Alliances and coalitions 3.2 Triads and hierarchy 3.3 Boundaries and subsystems 72 72 73 75 4 The family life-cycle 4.1 Transitions in the life-cycle of the family 4.2 Ceremony and ritual 76 76 78 5 Construing and change 5.1 Family constructs 5.2 Reflexivity 5.3 Change in families 5.3.1 First and second order changes 5.3.2 Natural and therapeutic change 5.4 Summary 79 80 82 82 82 83 84 6 Interactional family therapy 6.1 'Problems'versus'difficulties' 6.2 Investigation: the first stages 6.3 The therapeutic process as scientific hypothesizing 6.4 Reframing and positive connotation 6.5 The question of'insight' 6.6 Restructuring 6.7 Paradoxical intervention 6.8 Live supervision 6.9 Public versus private 6.10 A case study 85 85 86 86 88 89 90 90 91 92 92 7 94 Conclusions Further reading 96 References 96 Acknowledgements 97 Index of concepts 98 Study guide In this unit we will introduce a challenging approach to the study of the family which has developed outside the traditional disciplines of psychology and sociology. The interactional approach provides a framework for considering the family and any ongoing social group. What makes this approach different from more traditional social psychological explanations is that it treats the interactional processes of the family as an entity and as central rather than as peripheral to the behaviour of individuals. In Unit 1 we have considered the wider cultural constraints that affect how people organize their social relationships. We have seen how in a given culture there are similarities in the way a family is organized, but the interactional approach emphasizes the fact that, despite such similarities, people actively create their social worlds. We will see that people behave in an interdependent way. The members of a family continually influence and are influenced by each other. This will raise some important questions concerning individual freedom and autonomy which are taken up again later in the course. We will see too that the interactional approach promises to be of major importance, not only in practical therapeutic terms but for the new way of thinking that it provides. levels of analysis The theoretical approach that we are introducing in this unit is very much concerned with levels of analysis. Unit 1 differentiated individual and societal levels of analysis and explanation; but the idea that phenomena can be explored and understood at different 'levels' goes much further. For instance, in the biological sciences we can study a species in its ecological context. We can also study the anatomy and physiology of individuals. This may be at the level of circulatory or digestive systems. Or we can look at the cells that make up the organs, such as the heart, the liver, the brain and so on. We may seek for explanations in terms of cellular structure or at an even 'finer' level of biochemistry - which in turn can eventually be reduced (if we choose) to molecular chemistry and to particle physics. By focusing in turn on these different levels of analysis, 'reality' is structured by our approach; and structured, inevitably, in a hierarchical way. The different levels of analysis complement each other but are distinct, and to confuse or mix concepts at different levels leads to errors in understanding. Levels of analysis are discussed in the Metablock, Part III, paper 3. In the same way, when studying social processes, distinctions are made between levels, such as culture or society, large formal groupings or organizations, small groups such as the family, work and friendship networks and, of course, individual people. Unit 2 will be 'homing in' on the family as a unit. The emphasis will not be on the individuals in the family but rather on that which the inter-psychic level of individuals create 'together' during their interactions. This is called the interanalysis psychic level of analysis. We shall be looking at how the individuals interact, thus creating and maintaining the family in certain configurations. In contrast to Unit 1, where we looked at various forms of family organization and the 'functions' of families in society, here we concentrate on what actually happens in families. Unit 2 also makes a more general contribution to your study of social psychology: First, it will lay the foundations for future blocks by defining some of the terms that are basic to social psychology. Often this involves words like 'behaviour' which are part of natural language but also have specific or technical meanings. Second, Unit 2 will provide a way of conceptualizing dynamic processes, by using the model of mechanical and biological systems. This will also be a useful building block for later units. Third, by studying family processes, i.e. something essentially social and essentially complex, early in the course, you will be forced to think about some of the major conceptual and methodological problems in social psychology. Most of 55 intra-psychic psychology the 'hard work' that goes on to maintain family processes is neither easily observed by outsiders nor (very often) in the forefront of awareness for the participants themselves. Often, interacting family members, if asked, cannot explain what is happening. How can a social psychologist 'know' and come to 'understand' such interactions? Furthermore, it is rare for a social scientist to have access to 'real' groups of interacting individuals. By 'real' we mean groups which exist as dynamic entities over a considerable period of time, and where the members have emotional involvements and habitual patterns of interactive behaviour. Such an opportunity does occur in the practice of family therapy. The interactional view has been developed in this clinical area rather than in the psychological laboratory. Family therapists could be thought of as relating to the study of an interactional level of analysis in a way analogous to the relation between the classical psychoanalyst and the study of individuals and their intrapsychic psychology. The family therapist has the opportunity not only to observe families but also to make active interventions in ongoing family processes. Such intervention is designed on the basis of hypotheses about what is happening in the family and with the intention of bringing about observable and beneficial change. In this sense the family therapist is not only a privileged observer but equivalent to a trusted experimenter. Experiments and research are an integral part of the process of therapy. Thus, by discussing family therapy, Unit 2 will raise practical and ethical as well as methodological issues. Finally, Unit 2 should be treated as an introduction to your own practical projects. It is closely associated with the first project, Family Observation, You won't be able to do the project until you have read the unit. Because the project and the unit complement each other, you should find that carrying out the project enhances your understanding of the unit. Likewise, the unit should be consulted again when you write up the report, to illuminate and clarify what you have observed. You are strongly advised to treat Unit 2 and the Family Observation Project together as two weeks' work. The subject matter of this unit will, of course, be very familiar to you - from actual experience. We have all grown up in families of one kind or another. But we shall be looking at the familiar through new lenses. We shall be talking about the regulation of closeness and distance between family members, about hierarchy, about the boundaries between the generations and between the nuclear and the extended family, about alliances, coalitions and so on. Like the proverbial area in front of our noses, these things are often so familiar we don't see them. This highlights the difficulty of teaching this material: as students you are likely, initially, to be puzzled by its obviousness. However, this obviousness is more apparent than real, and it would be an error to make hasty conclusions at this point. Set reading There are two set readings associated with this unit. The first, 'Towards a theory of pathological systems' (Haley, 1967), is reprinted in the Course Reader. You will be asked to read the first few pages of the article at the appropriate point during section 1.1. The remainder should be read at the end of the unit. The second article, 'Hypothesizing - circularity - neutrality: three guidelines for the conductor of the session' (Selvini-Palazzoli et ai, 1980) should be read at the end of section 6.3. This paper is reprinted in the Offprints Booklet. Objectives After reading this unit you should be able to: 1 Understand and describe the significance of an interactional approach to the social behaviour of individuals. 2 Use the idea of a 'system' to help your understanding of the processes that occur in families and other groups of people. 56 3 Understand and appreciate the problems associated with distinctions such as behaviour versus action; awareness versus unawareness of one's social interactions; inter-psychic versus intra-psychic levels of analysis; and studying social behaviour essentially from an 'outside perspective' in contrast with questioning and collecting people's 'insider' accounts of what they are doing and why. 4 Understand the role of the therapist in interpreting psychological data whilst being an integral part of it. 5 Use the approach described to study interaction patterns. This unit, together with your Family Observation Project, should enable you to conduct an analysis of an interaction: (a) between a pair of people in terms of complementary and symmetrical processes, hierarchy and distance. (b) between three or more people in terms of coalitions, alliances and subsystems. 6 Discuss a family in terms of the unfolding of its natural life-cycle stages. 7 Understand psychological problems and symptoms as interactional phenomena, and how they are often associated with a difficulty of transition from one stage of the family life-cycle to another. 8 Describe the major forms of therapeutic intervention used in interactional family therapy. 9 Relate such therapeutic interventions to methodological and ethical problems in social psychology. 1 AN INTRODUCTION TO THE INTERACTIONAL VIEW In 1965 the psychiatrist and family therapist Don Jackson said: .. . our present knowledge of individual theory is quite exhaustive when contrasted with the paucity of systematic knowledge of relationship per se. In our traditional conceptual framework, the individual is held by the boundaries of his skin, and whatever transpires between two such captives that which is neither clearly T nor 'thou' - is a mystery for which we have no language or understanding. Our thoughts, research efforts, and even . .. our 'view of the cosmos' are limited . . . we must first have a language which enables, even forces, us to think interactionatly. The necessity for a language with which to study interaction may lead to the abandonment of terms which belong to the study of the individual in favour of terms which focus on the relationship.. . The observation of family interaction makes obvious certain redundancies, typical and repetitive patterns of interaction which characterise the family as a supraindividual entity. (Don Jackson; cited in Watzlawick and Weakland, 1977, p. 23; italics added) What is exciting and challenging about the interactional approach is that it makes us think about our everyday social world in a new way. Many of the styles of thinking that exist in modern psychology can be traced back hundreds or even thousands of years. For example, many of the core concepts of cognitive psychology can be found in the writings of philosophers such as Kant, Plato and Aristotle. But much of the interactional view is radically new, having been given 57 explicit form only after the Second World War when writers such as Bateson, Wiener and Von Neumann started applying the new science of cybernetics to human relationships. Before we introduce some of the basic concepts we shall outline the work of some of the more important theorists who have contributed to the development of the interactional view. It is often difficult to pinpoint whom should be given most credit in the development of any new science, but Gregory Bateson (1904^1980) stands out as being one of the most original and influential figures. Bateson's father, William, was an important geneticist in the early years of the century. Gregory Bateson grew up in a cultural atmosphere devoted to the ideas of natural science. As a child he collected fossils and insects, classifying varieties of species he found. It was not unusual for the Batesons to spend weekends with the Darwin family. But later, much against his father's wishes, Gregory turned his interests to anthropology. In the 1930s, he made field trips to New Guinea and Bali and married the American anthropologist Margaret Mead. However, throughout his working life he was to return again and again to the theoretical problems of evolution, form and pattern in biology, learning, genetics, and the new science of ecology (Bateson, 1979). During the 1950s, he directed a research project examining communication and interaction. His co-workers, Don Jackson, Jay Haley and John Weakland, have all gone on to make important contributions. They studied interaction in a number of different areas: play, humour, fantasy, and they became particularly interested in the interaction of families of schizophrenic patients. During the 1930s, Bateson and Mead had consulted the American hypnotherapist Milton H. Erickson to gain more understanding of the films they had made of Balinese trance phenomena. Erickson's work on hypnosis was an inspiration to interactional theorists. He convincingly demonstrated that phenomena previously seen as merely states within individuals (for example, hypnoticallyinduced hallucinations, paralysis and amnesia) depend upon interactional processes no different from those that ordinarily go on between people much of the time. This has contributed to a new view of psychopathology as interactional rather than as individual and intra-psychic in origin. In the 1950s, Haley and Weakland also turned to Erickson's work to make a detailed study of hypnotic processes. After the Bateson communication research project, Haley, in particular, was a crucial influence on the development of family therapy, which has become a very large discipline containing many different approaches. The psychiatrists Don Jackson, Salvador Minuchin and Mara Selvini-Palazzoli have all made important contributions to theory, although they are chiefly known as family therapists. The name of each is associated with a well-known centre for family therapy, each with its own distinct approach. Jackson, joined by Weakland and later by Paul Watzlawick, founded the Mental Research Institute in Palo Alto, California. Minuchin works in Philadelphia and Selvini-Palazzoli in Milan, Italy, It is difficult to decide whom to include in a list of this kind. These names stand out among a large number of innovators. It is important to understand that the people mentioned fall within the general approach but have formed independent schools of thought. 1.1 Using the 'systems' model to observe family processes In his work as a practising psychiatrist, Don Jackson noted a surprising phenomenon. Often when one of his patients started to change or improve in some way, there was an accompanying deterioration in one or some of the people around him, such as members of his family. Frequently, instead of relief and delight, a husband, parent or wife would show depression, anguish or even anger. Naturally, these reactions had an effect on the patient, typically leading to a deterioration or relapse in his condition. Rather like a seesaw, these actions and 58 reactions in a patient's family operated to maintain the current situation, including the psychiatric symptoms shown by the patient. The concept of inertia or resistance to change was not new to psychiatry. But the idea that 'resistance' was based in the family interactions rather than 'within' the individual represented a radical departure. As Jackson pointed out in his quotation at the start of section 1, a new set of concepts was needed to help describe and to construct a framework for understanding the patterns of behaviour which people create between them. In 1957, in a seminal paper entitled 'The question of family homeostasis', Jackson proposed that families show important characteristics in common with cybernetic systems. Of course, he did not propose that families are merely cybernetic systems, but that the systems model could be usefully applied to throw light on what happens in families, Box 1 describes the basic concepts of the systems model; you should read Box 1 now, and refer to it again later if necessary. Box 1 Basic concepts of the systems model system dynamic equilibrium homeostasis boundary subsystem In order for us to describe something as a 'system' we require it to show certain characteristics. Briefly, a system is seen to consist of a number of constituent parts. These parts must be linked together so that change in any one part of the system will eventually affect all the other parts. Most importantly, the parts act in a concerted way so that, over a period of time, they display regularity. Over time a system functions so as to maintain a dynamic equilibrium; deviations from equilibrium are continually corrected. This whole process is called homeostasis. Now you may already be asking how we decide what to include in a particular system? The concept of a system requires that we draw a boundary between what is 'inside' and what is 'outside', However, this boundary is merely a conceptual one, since a particular system always interacts with, and is a part of, larger systems. As you will see, the drawing of the boundaries is reasonably simple in the case of mechanical systems. But when we look at natural systems, such as biological or social ones, we have to make complex choices about 'where to draw the line'; choices which are based upon our purposes and requirements as observers. For instance, if our particular interest is in the children in a family, we may focus on them as a system, but one which is part of, or a subsystem of, the whole family. In turn we might be interested, as anthropologists, in a tribe or clan system and consider a particular family as a subsystem of the larger unit. It is easier to explain 'systems thinking' if we start with a simple mechanical example. In such cases the boundary between what is inside and outside the system is reasonably clear, although in more complex systems this is often not so. In the example of a central heating system (see Figure 1), it is easy to define the boundaries of the whole system or to Radiator (on = hotter) (off = cooler) Room temperature (high or low) Figure 1 A central heating system 59 split the system into subsystems where each room has its own thermostat. The boiler provides energy which is given off into the room by radiators. The temperature of the room will gradually rise until the preordained point of equilibrium is reached. The thermostat then acts to maintain this chosen temperature within acceptable limits. If the room gets too hot the thermostat cuts off an electrical current and this signal directs the boiler, which turns off. The radiators cool, room temperature drops and the thermostat cuts back in, thus reactivating the boiler, and so o n . . . The system behaves, as if in accord with a set of rules, to maintain homeostasis. We can contrast the central heating system with a simple coal fire (see Figure 2). The latter would not qualify as a system, although, of course, it would be feasible to have someone constantly monitoring room temperature and stoking the fire or opening the windows in an attempt to create homeostasis. Many more examples of systems could be given, each exemplifying one or more aspects of what a system is, in essence. Coal fire -»-Room temperature Figure 2 A commonly used example is the 'governor' on a steam engine. This is a mechanically simple but beautifully effective means of providing feedback (of information) to the boiler. The idea of feedback is crucial to systems. Monitors (such as a thermostat) must be able to collect information about the operation of parts of the system in such a way that the operation of the system as a whole can be maintained at its equilibrium point. In a properly functioning system, homeostasis is maintained by error-correcting feedback. This simply means that any tendency of the system to move away from equilibrium is corrected (the technical name for this is negative feedback). James Watt's 'governor' reduces the amount of steam coming from a boiler when the boiler is producing too much, and increases the steam production when more is required. As an instance of a biological system we can cite the regulation of body temperature. Various means are available: shivering if too cold; sweating if too hot; or the exercise of deliberate human choices, such as putting on more clothes or taking a cool bath (see Figure 3). feedback error-correcting feedback Metabolic activity increased or decreased Body activity such as shivering, more exercise, running, work,etc. i.e. a means of getting hotter or cooler) Body temperature (high or low) Central nervous system (which sets (requires) body temperature to remain within an acceptable range) Figure 3 The regulation of body temperature Whilst error-correcting feedback is a means to correct 'errors', erroramplifying feedback is not normally part of the design of a system; it is a malfunctioning which makes an error in the system worse (technically called positive feedback). For instance, in the example in Figure 1 the thermostat might be faulty and, as room temperature increases, the thermostat might signal the boiler to produce more heat. In any system, error-amplifying feedback leads to escalation - or a 'run away' - with potentially disastrous consequences. error-amplifying feedback escalation Another characteristic of systems is that the optimum functioning of the system is usually 'set', either once and for all or for long periods without 60 first order change second order change adjustment. For example, body temperature is set within certain fixed limits. The thermostat in a room is usually set once, but perhaps altered in summer months. The important point to appreciate is that the normal operation of a system deals with change continuously - in the service of maintaining equilibrium. These are called first order changes. But if the nature or the function of the system alters, then a different order of change has to be brought about. Some systems (e.g. biological ones) can evolve the means to create these second order changes. An example might be a child with a high fever. Her illness requires higher metabolism and higher body temperature than normal. But the fever must not be too great: body temperature is above normal but still maintained within limits. Mechanical systems usually need external intervention to produce second order change (e.g. higher setting of a thermostat). Or we can think of hierarchies of control systems (as in a nuclear power station), each level monitoring and 'setting' the operating conditions for the level below. Here we have the possibility of second, or even third, order changes. As we indicated at the beginning of section 1, the interactional view involves new ways of thinking. For instance, it requires us to think in a new way about cause and effect relationships. If you look back to Figure 2, it is easy to see that there is a simple relation between the coal fire (cause of heat) and room temperature linear causality (effect of heat). This type of simple, direct cause and effect is often called linear causality. In contrast, as we can see from our examples of systems, the cause and effect relationship begins to look more like a circle, rather like a snake starting to circular causality bite its own tail. This is often called circular causality (although more properly it is like a spiral, because time elapses with each turn of the circle). Since each part of a system continually influences all the other parts, 'systems thinking' forces us to focus on the overall pattern that is being maintained rather than dividing up the process into simple, linear cause and effect relations. Such segmentation of complicated events into simple 'chunks' of cause and effect in an effort to 'punctuation' understand what is happening is called punctuation. For example, I might say that I became angry because someone annoyed me or that I am sad because someone else's depression upset me. But, with a circular view of causality, these explanations are only partly true, since they ignore the contribution that I myself have made to the interaction, and also the manner in which the outcomes of the interactions are produced mutually. The effort to understand our interactions with others requires us to punctuate events into meaningful chunks. However, our cognitive abilities and, more importantly, the influences of our culture, tend to constrain how we do this, leading to restricted and narrow forms of punctuation. If you think about how you understand your own interactions you might see that it is all too easy to take a 'restricted' view. For example, how often have you reacted by withdrawing emotionally because the other person appears to be doing so? This kind of reaction is based on linear thinking and a restricted view. Instead, you could try to take a wider and longer-term perspective on what is happening. Sometimes we may try to do this, but it is not at all easy. Even for a therapist, there is a great tendency to be drawn into making simple punctuations rather than maintaining a systemic view. The immense significance for the social sciences, and psychology in particular, of these systemic views of causality is discussed by Haley in his article reproduced in the Reader. Set reading At this point, read the first few pages of the Reader article by Haley, 'Towards a theory of pathological systems'. Stop when you reach the section headed 'The perverse triangle'. 61 Although we must be prepared to modify some of the elegance of systems thinking when applying the model to families, we still have a powerful conceptual tool for understanding family processes. For example, first order change occurs continually within families; second order change may arise naturally in the course of life-cycle developments. But a family in trouble may have failed to evolve second order change to deal with some new function (within itself or in the environment). In such cases the family may be going round and round the same, but now inappropriate, circuit, trapped inescapably in error-correcting feedback - or escalating to crisis in error-amplifying feedback. An effective solution, i.e. a second order change, may require professional help. In Box 2 you will find a simple example of a family system. Box 2 A family system A mother is in the bathroom preparing her reluctant six-year old daughter for bed, and their argument gets louder and louder. Grandmother in the next room has a certain type of stomach sensation in response to the noise and her leg muscles become tense in direct relation to the volume of noise. At a certain point in the argument she suddenly rises to her feet and intervenes in the situation. The child quietens down and tells grandmother not to worry. This very simple example illustrates a number of important points. The contribution of each member of this threesome is continuous. In describing it, we are forced to 'punctuate' it, to arbitrarily break it up into behaviours occurring in a sequence. But in reality there is no point at which any member ceases to behave. Bateson says 'it is impossible not to communicate'. Even when someone is silent she is reacting in minimal ways and family members learn to detect the minute signals given out, with great sensitivity. And the absence of a response also constitutes a meaningful message. Even when one of them is not physically present, he or she is still taking part in the drama. Mother and daughter may not be able directly to detect grandmother's rising impatience, but they know her well enough, through many repetitions of this situation, to anticipate that it will not be long before she intervenes. The whole process is circular and, as with the central heating system, each part is connected to the others and is monitored and activated by the others. Furthermore, again like the heating system, there is a regulation of equilibrium. The behaviours in the family are kept within certain limits. If the noise level gets too high, someone eventually intervenes to correct it. If grandmother had not intervened and had remained quiet for a prolonged period, eventually mother or daughter would have gone to see her to find out why she had not intervened in her usual manner. Likewise, if mother and daughter were unusually quiet, grandmother might have come to find out why. It is possible to draw a diagram to illustrate this process (see Figure 4). Child and mother interact and create noise level Grandmother intervenes (in effect, readjusts the noise level. Grandmother is behaving like the control mechanism) Grandmother's perceptions and feelings, which embody a setting of acceptable noise too high or too low Figure 4 62 Level of noise (too high or too low) In the above example, we have focused on the behaviours of the people involved. Our analysis has been concerned with what they did and with physical properties, such as the noise level. In this sense we have been interpreting, in terms of systems thinking, what any outsider might observe. But we have also made inferences about the grandmother's perceptions and feelings. Again, these are inferences made from outside: no-one has actually asked the grandmother how she feels. However, an interactional analysis is not necessarily restricted to analysis of behaviours and inferences about behaviour. We shall see later that gaining information about how the participants themselves think and talk about the interactions can be an important source of data. And the example given in Box 3 shows how the interactional approach can even be applied to physiological changes which affect the participants in an interaction. Box 3 Family processes and emotional arousal in the Collins family System-like processes can be seen at work in research on a family containing two children suffering from diabetes. In this study by Minuchin (1974), a psychophysiological measure of emotional arousal was used the Free Fatty Acid (FFA) level in the bloodstream. The measure of FFA is frequently employed in experiments on stress or anxiety, since it provides a sensitive and reliable measure of emotional arousal. Changes in FFA levels have been found to relate closely to (correlate with) other measures, such as self-reports and behavioural evidence. It was used in this experiment because it provides a reliable and sensitive measure; it is not a measure specific to diabetes. The influence of the family on its members was demonstrated experimentally by an investigation of childhood psychosomatic illness .. . The research findings provided experimental grounding for the basic tenet of family therapy, namely, that the child responds to stresses affecting the family. We developed a method of measuring individual physiological responses to family stress. During a structured family interview designed for this purpose, blood samples are drawn from each family member in such a way that obtaining the samples does not interfere with ongoing interactions. The level of plasma-free fatty acids in the samples is later analysed. Free fatty acid (FFA) is a biochemical indicator of emotional arousal - the concentration rises within five to fifteen minutes of emotional stress. By comparing the FFA levels at different times during the structured interview, the individual's response to family stress can be physiologically documented. The FFA results of the Collins family are a good example (see Figure 5). Both children were diabetics. Dede, 17, had had diabetes for three years; her sister Violet, 12, had been diabetic since infancy. Studies of the children's 'physiological lability' showed that there was no obvious difference in their individual responsivity to stress. Yet these two children, with the same metabolic defect, having much of the same genetic endowment, and living in the same household with the same parents, presented very different clinical problems. Dede was a 'superlabile diabetic'; that is, her diabetes was affected by psychosomatic problems. She was subject to bouts of ketoacidosis that did not respond to insulin administered at home. In three years, she had been admitted to the hospital for emergency treatment twenty-three times. Violet had some behavioural problems that her parents complained of, but her diabetes was under good medical control. During the interview designed to measure the children's response to stress, lasting from 9 to 10 a.m., the parents were subjected to two* different stress conditions, while the children watched them through a one-way mirror. Although the children could not take part in the conflict situation, their FFA levels rose as they observed 63 Dede Mother Father ~ - Violet Sam 9am 10 am 11am 12 noon Figure 5 Change in Free Fatty Acid (FFA), the Collins family their stressed parents. The cumulative impact of current psychological stress was powerful enough to cause marked physiological changes even in children not directly involved. At 10 o'clock the children were brought into the room with their parents. It then became clear that they played very different roles in this family. Dede was trapped between her parents. Each parent tried to get her support in the fight with the other parent, so that Dede could not respond to one parent's demands without seeming to side against the other. Violet's allegiance was not sought. She could therefore react to her parents' conflict without being caught in the middle. The effects of these two roles can be seen in the FFA results. Both children showed significant increments during the interview, between 9 and 10, and even higher increments between 10 and 10.30, when they were with their parents. After the end of the interview at 10.30, however, Violet's FFA returned to baseline promptly. Dede's remained elevated for the next hour and a half. In both spouses, the FFA levels increased from 9.30 to 10, indicating stress in the interspouse transactions. But their FFA decreased after the children had come into the room and the spouses had assumed parental functions. In this family, interspouse conflict was reduced or detoured when the spouses assumed parental functions. The children functioned as conflict-detouring mechanisms. The price they paid is shown by both the increase in their FFA levels and Dede's inability to return to baseline. The interdependence between the individual and his family... is poignantly demonstrated in the experimental situation, in which behavioural events among family members can be measured in the bloodstream of other family members. (Minuchin, 1974, pp. 7-8) *A typical way in which Minuchin stimulates such stress conditions is by prompting two parents to discuss an issue of conflict beyond the length of time that they would normally do so. In order to do th'is he will prevent the normal avoidance manoeuvres, such as, for example, changing the subject to the issue of how to deal with the child's problems. Minuchin proposes that each person in this family occupies a unique position and performs a certain function. Dede plays a special part (a sort of referee position) in relation to^er parents' dialogue that her sister Violet does not. However, in 64 families, people demonstrate the possibility of interchangeability of positions. For example, it could be that in this family, if Dede were absent, Violet might take over her sister's position; if the mother were absent, one of the sisters might start to occupy her position. In clinical work with families, this interchangeability of positions is often observed. According to Minuchin, the important point is that organization of the family shows a constancy. Once you have grasped this kind of thinking and this way of analysing everyday situations, you will begin to realize how some of the more traditional ways of thinking about ordinary interactions resort to linear thinking. For example, we might have said that, in the family described in Box 2, the daughter was naughty because her mother had not taught her adequate discipline. We might have said that the noise made grandmother angry. In the Minuchin example (Box 3), we might have said that the conflict between the parents caused Dede to be more anxious or emotionally agitated. From an interactional perspective, these statements would be only partly true: they would only be arbitrary punctuation of an ongoing interactional process. From the interactional viewpoint, it is necessary to 'complete the circle': for example, to note how the daughter's emotional distress in turn 'causes' the parental conflict. To use the word 'cause' at all still tends to make us think in a simple linear way. But here we come up against the limitations of language itself in describing the circularity, reciprocity and continuity of these processes. The Selvini-Palazzoli group have written most clearly about the limitations of language and the difficulty of trying to describe circular processes. They propose, for example, that it may be more appropriate to talk about how family members show each other anger, sadness, distrust rather than how they are angry, sad or distrustful. To talk of showing implies that these 'states' are interpersonal- as opposed to individual and consequently unrelated to the actions of the others in the family. 1.2 Homeostasis and rules The process of homeostasis can help to make sense of the repetitive and predictable aspects of family interaction. We have seen this already in Boxes 2 and 3. Almost anyone, whether a trained family therapist or a perceptive observer, can easily extract, from watching and listening to families interacting, patterns of circularities regularity in their behaviour. These repeated patterns are called circularities. To take a simple example, we can think of a couple who show a repeated sequence of nagging and withdrawing. The wife tells her husband that she expects him to have painted the kitchen ceiling, which she has mentioned to him on a number of occasions. The husband feels an immediate sense of fatigue and retires to the lounge to watch television. Soon the wife is stimulated to make fresh demands: the children need putting to bed, she has been working all day and the washing^ machine is leaking. The couple show the same complementary pattern of demanding and withdrawing. In other words, their behaviour is very predictable. redundancy Such predictability has been termed redundancy. When we talk about redundant information, we mean that it carries no new information since we can already predict what will be said or done. It is possible to predict how the couple might interact in a variety of situations. The circularity is always the same whether they are preparing food, dealing with the children, planning a weekend away. The presence of these regularities in behaviour make it look, to an outsider, as if the couple are following a set of rules which seem to be necessary to maintain the family in some form of equilibrium. Some theorists, especially Jackson (1965), have proposed that homeostasis in a family can be treated as the operation of a set of rules. What kind of equilibrium might a family be trying to maintain, and why? Let us consider some typical examples from family life. The Jones family are sitting around the kitchen table eating breakfast. Nine-year old Dennis has just joined his parents at the table and is in a boisterous mood. He tilts his chair back and insistently clatters and bangs his cutlery. Over a period of 65 several minutes, the father can be seen to rustle his newspaper in an irritable way. The mother meekly tells Dennis to sit properly. But the noise continues, until finally the father says to his wife, 'Why don't you tell Dennis to keep quiet?' She then says, 'Go on Dennis, be quiet'. With variations, this sequence may be repeated at nearly every mealtime. Another example might be: a daughter goes out of the house and mother shouts, 'Shut the back door'. This may be repeated fifteen times a day. Because these sequences are repeated over and over again, they are predictable and therefore appear to follow or be generated by a set of rules. In the first example, there seems to be a rule operating whereby the son draws attention to himself, and father responds irritably to goad the mother into dealing with the child. In the second example, there seems to be a rule whereby the girl always leaves the back door open, her mother tells her to close it, she then closes it. However, the idea of rules has to be treated with caution. In a sense, rules are a natural extension of using the systems model to describe family interaction. Where an observer can see regularities in behaviour that lead to a predictable equilibrium state, then the next step is to try to specify what rules might give rise rules to the regularities. But such rules are inferences in the minds of the observers. We can only say that such rules exist with certainty when, as in mechanical systems, they have been built into the blueprint design conceived by the engineer. When trying to understand family interaction, one has to decide whether or not it is helpful to assume that the family members themselves are behaving in accordance with rules. In so far as they are behaving in a rule-governed way, these rules need not necessarily be the same as the inferred rules of the observer, explicit rulings nor do they need to be the rare kind of explicit rulings that the members can articulate and appeal to. In the examples above, there may be some explicit rulings, such as 'You may not lean back on your chair', 'Don't eat with your mouth open', 'Always shut the door when you go out', However, there is unlikely to be an explicit family ruling which states that 'Father should get cross at his son and tell his wife to keep him quiet' or 'The girl must leave the door open every implicit family rules time she goes out until reminded by mother'. Instead, these are implicit rules which affect the behaviour of family members, and are usually below the level of conscious awareness during the normal course of their interactions. Such implicit rules may be so deeply buried in the history of the family and the members' individual unconsciousness that the rules cannot be described or discussed by the members even if the therapist tries to point out the regularities in behaviour. You will find that the idea of social behaviour being guided and prescribed by rules, norms, roles and 'scripts' will recur throughout the course. In Unit 1 you saw how cultural expectations operate as norms or rules for family configurjton and for particular roles - that is, expected behaviours associated wTO a particular position in a family or any other social organization. In Block 3 the idea of roles and scripts will be dealt with from a slightly different theoretical perspective - closer to that of self-presentation, as in a 'drama'. In many respects the idea of rule-governed behaviour can be a useful way to conceptualize the dynamics of families and other social groups. The danger is that it is all too easy to think of such rules as clear-cut, conscious sets of behavioural prescriptions which determine what people do. But implicit family rules do not necessarily determine what happens: families can and do change. You may in fact already be asking where people's understandings and perceptions come into a systems model. Certainly, our emphasis so far has been on the patterns of what people do to each other rather than on their insights and understandings. You must realize that much of our everyday behaviour, from the skills of driving a car to engaging in repartee or 'weighing up' a new acquaintance, is done without us being fully aware, at the time, of what we are doing. We are faced with similar questions about awareness, and about the psychodynamic role of the unconscious, when we study families. To what extent are people aware of 66 the patterned behaviours they produce together in their interactions? To what extent, if any, do they try to understand what is happening? Do people have sufficient awareness and self-insight to produce change? It will become increasinglyclear that a large proportion of the interactional process takes place outside awareness. In Section 5 we shall return to the question of how people construe and understand their interactions. We shall show that a systems model can be compatible with a view of people constructing new rules and negotiating changes in the existing ones - at various levels of conscious awareness of what they are doing. 2 THE STUDY OF DYADS The interactional processes that occur in families can be extremely complex, and become increasingly so as the number of people involved increases. Therefore, we will begin by looking in detail at some of the common interactional processes that can be observed between two people: for example, two parents, a parent and a child, or any dyad. 2.1 Symmetrical and complementary interactions Whilst working in New Guinea as an anthropologist in the 1930s, Bateson proposed a way of classifying the behaviours of pairs of people (dyads) which has continued to be useful up to the present day. He proposed that if we observe two people together, it is possible to classify their interaction according to whether it symmetrical interaction is showing a symmetrical or a complementary process. Watzlawick describes Bateson's distinction as follows: dyad In the first pattern the emphasis lies on attempts to establish and maintain equality. It is, therefore, called symmetrical. (The other pattern is based on the acceptance and enjoyment of difference. It is referred to as complementary. . .) In (this) context . . . the term equality refers to the fact that the partners exchange the same sort of behaviour, or, in other words, they demand equality through the message character of their behaviour. In th|£ connection, it is quite irrelevant what precisely they are doing; what does matter is that as A relates to B, so B relates to A. If A offers to give, B also offers to give; if A wants to receive, B also wants to receive. If one occupies a position of strength, so does the other, and if one claims helplessness, so does the other... complementary interaction In a complementary interaction, on the other hand, people exchange behaviour which together forms the same sort of Gestalt as day and night, inside and outside, mountain and valley, etc. What this means is that in a complementary relationship, B's behaviour presupposes A's while at the same time it provides reasons and purposes for A's behaviour and vice versa. . . (Watzlawick, 1964, pp. 7-8) So, in a symmetrical relationship, the contribution of each participant is of a similar type, whereas in a complementary relationship the actions of each are contrasted and complement each other: for example, teaching/listening, blaming/apologizing, exhibiting/observing. Exactly how these similarities and differences are defined is, of course, unique to the particular pair in a particular 67 relationship. Nevertheless, there are a number of common dimensions which seem to be universally relevant in a consideration of dyadic processes and which cross-cut the basic symmetrical versus complementary pattern. Here we shall focus on three such dimensions: hierarchy, distance (or intimacy), and boundary. 2.2 Hierarchy UP/DOWN What does it mean to describe one person as UP and the other as DOWN in a relationship at any given time? We are familiar with the expression 'a put DOWN' or 'one-UPmanship' in our everyday language, but here we want to be specific about the interactional processes involved in UP/DOWN. We use this dichotomy to indicate who tends to initiate or give direction, and who follows and allows the other to take the initiative. It is possible to observe a symmetrical interchange, with both parties going into the DOWN position for brief moments, when two people both try to take responsibility for some mishap: 'I'm sorry, it's my fault', 'No, no, not at all, I should have. , .', etc. A symmetrical competition for the UP position may commonly be seen among children competing for portions of cake. Likewise, nations may symmetrically acquire new weaponry for their arsenals. Watzlawick has described complementary UP/DOWN interaction in general in terms of the definition of the relationship itself: These positions have been variously described as primary, superior or 'oneup' on the one hand, and secondary, inferior or 'one-down' on the other. .. They shall be used here with this understanding: primary, superior or 'oneup' refer to the position of that partner in a complementary relationship who defines the nature of this relationship, while secondary, inferior or 'onedown' refer to the other partner who accepts and goes along with this definition. As can be seen, this has nothing to do with the respective strength or weakness of the partners per se. Indeed, one partner's weakness can easily be the very element by which he defines the relationship as one in which the other is to protect him. (Watzlawick, 1964, p. 8; italics added) On a shorter time-scale, an example of complementary interactions which involve temporary acceptance of UP or DOWN positions might be when person A makes a proposal and person B willingly accepts: such as when a child asks its mother to tie up its shoelace - and the mother kneels down and does it. It is important to take account of the time-scale in all the processes we are descrying. The typical interaction between any two people may show regular, and pffiaps relatively short-term, fluctuation from complementary to symmetrical, and within the complementary pattern the partners may alternate in taking UP and DOWN positions. Or, a relationship may be characterized by a great deal of rigidity, never showing any variation, perhaps over years. Examples of this would be marital relationships where the partners seem to be in a continual symmetrical competition or where one partner always takes the initiative while the other complies doggedly. Many professional role relationships are examples of the complementary UP/DOWN type: doctor-patient, salesman-customer, teacher-pupil. However, on closer inspection, there will often be instances of a symmetrical process also going on in these interactions: for example, when a patient argues with her doctor about a diagnosis or when a customer points out defects in a car that a salesman is trying to sell to her/him. A clear example of the two interactional patterns is in the area of conflict and violence. It is possible to classify quarrels according to whether they are symmetrical (UP/UP) or complementary. In a symmetrical quarrel, the two participants are likely to mirror each other in body posture, to accuse each other 68 and blame each other. In a complementary quarrel, one may accuse the other, who responds with passivity, inciting the first to further accusations. And, of course, such patterns of escalation may also be found in more positive examples of interactions, such as friendship formation and falling in love. As a summary, we can now note that interactional processes involving UP/DOWN can be categorized as: Symmetrical UP/UP or DOWN/DOWN Complementary UP/DOWN Symmetrical and complementary sequences tend to show the phenomenon of error-amplifying feedback leading to escalation. You will recall the earlier example of the central heating system. If it is wrongly connected, so that as the room heats up the thermostat switches the boiler on, then the room will get hotter and hotter and tend to go into 'runaway' until the occupants, wet with perspiration, go to find out what is wrong. Correction of the fault requires a second order change. Similarly, escalation can occur in a dyad, and again change may well come from 'outside' the pair. A quarrel may stimulate a third party to intervene, as when other relatives, a neighbour or even the police, intervene in a fight between two family members. Quarrels of both types (symmetrical UP/UP, or complementary UP/DOWN) tend to escalate. A symmetrical example might be in child abuse, where both parents and child escalate to more and more shouting and screaming until physical violence occurs. A complementary example occurs when a parent gets more and more annoyed at a passive and uncooperative child. The more the parent starts complaining, the more the child withdraws and cowers. When a sequence of either type (symmetrical UP/UP or DOWN/DOWN; or complementary UP/DOWN) escalates, it tends to transform itself suddenly into the other. A very clear example of this occurs in the animal kingdom. With two dogs in symmetrical struggle, at a certain point one will typically roll over on to its back. The winner may briefly put its teeth around the other's throat, but then walks away without harming it. It is easy to imagine an analogous human situation: for example, two children fighting in the school playground. Here symmetry is transformed into complementarity. The opposite process is exemplified by a passive boy, teased by his elder sister, who suddenly flares up and attacks her. As a final example, those of you who have studied DS262 may remember TV programme 5, Family Therapy, in which a family are planning their summer holiday. The interaction given here can be nicely summarized as an example of a complementary relationship between the mother and elder boy. Mother No, not camping or in a hotel? PAUSE. It would give me a break if it was in a hotel wouldn't it? Child Suppose so, yeah. Mother Yeah, all right how abroad? Child I don't really mind. MUMBLING. Mother Where do you fancy going abroad? Child Anywhere. Mother Well, usual tourist track or somewhere out of the ordinary. 69 Child Depends what you call the usual tourist track. Mother Well, sort of Spain and Italy, Greece. A Laker, a Laker? Child Yeah. Mother Travelling around or using a base? Child Using a base, I should think. In the initial stages of this interaction we might hypothesize that the son was UP in relation to his mother. We can see this in her first communication, which is almost a pleading with him for permission to have 'a break'. However, when we consider their behaviour as a sequence, we can see that it is she who is invariably initiating by proposing alternatives and asking that he be involved in making choices. For the son's part, his cursory and reluctant replies stimulate her into pursuing him further. It is important to note that although one person may be UP, he or she is not necessarily 'in control' or 'more powerful'; this would imply that one person can influence the other's behaviour without himself being influenced. In ongoing relationships, a person can only be 'one-up' in the sense that the person in the 'one-down' position allows them to be; in other words, these are truly interactional concepts. Both are 'choosing' to maintain the interaction and both have 'responsibility' for it. This is in spite of the point that both of them may have denned the other to be in charge or in control. hierarchy The whole issue of hierarchy is of central importance in considering families. It is worth pointing out, however, that hierarchy is an inherent characteristic of families in which people of different ages and generations live together (Haley, 1959; Minuchin, 1974). Denial of, or confusion about, the hierarchy in families is a common stumbling-block in therapy. This is not to say, however, that people lower in the hierarchy are in any sense passive. Even new-born babies can adopt an active role (see Unit 7). In interactions with their parents, they may already be taking the UP position - for example, by activating parents to pick them up through a certain type of crying. 2.3 Psychological distance Just as dyads can vary on the dimension of UP/DOWN, so they can be seen to psychological distance vary on the dimension of psychological distance or closeness or intimacy. Again, NEAR/FAR as with the UP/DOWN distinction, such NEAR/FAR interactions can be classified as symmetrical or complementary. A mother may move towards her son to put her arm round him, he may respond symmetrically and reciprocate or he may push her off. Relationships may stabilize at any level of intimacy or, more likely, there will be regular variations. The distance between a husband and wife may remain relatively constant, even though the couple take turns attempting to get close or more distant. The therapist Richard Fisch has jokingly characterized this situation as one where there is a 'ten-foot pole' between the partners; as one approaches, the other retreats and vice versa. This is a good example of a form of equilibrium. Whilst we are talking here about psychological closeness and distance, it will usually be mirrored by literal movement in physical space. In practice, there is likely to be a crossover effect between the UP/DOWN and NEAR/FAR processes. For example, when a husband and wife are close one may assume the 'one-up' position, but when they are distant the positions may be reversed. In one case reported in the literature, a couple oscillated between the husband being dominant and the wife in the DOWN position and the wife being 70 T dominant and the husband DOWN. In the first phase they were distant, but in the second they could become much closer and, for example, sexual relations occurred only in this phase (Bannister and Bott, 1974). 2.4 Psychological boundaries rigid boundary disengagement Minuchin introduced into the family therapy literature the idea of psychological boundaries. These are somewhat related to psychological distance, since psychological distance can also be considered in terms of the nature of the boundary between the two people. If there is a rigid boundary, this will be evidenced by a lack of communication between the pair; perhaps they literally sit a distance apart, avoiding eye contact. Attempts to encourage them to communicate may be met by reluctance on both their parts. In a family therapy session, it is almost as if there were literally a wall between them. This can be termed disengagement. diffuse boundary At the opposite extreme is the situation where a diffuse boundary exists between enmeshment two people. This is also known as enmeshment. In extreme cases, the two hardly seem to function as separate individuals at all. They may sit very close; help each other excessively in getting a coat on; one may talk for the other and get upset when the other gets upset, and so on. You may recall from Box 1 that a boundary is an essential part of a system, i.e. that which differentiates the system from its environment. When the systems model is applied to families the idea of boundaries proves illuminating. A family can be, in effect, defined as such by the boundary that separates it from other people: other relatives or friends, for example. And families vary in the diffuseness or rigidity of this boundary. Some families communicate more with other people, some keep to themselves. The nature of the boundary, and indeed the definition of 'family', will vary from one subculture to another. Boundaries may also exist within a family, dividing it into subsystems. This idea will be developed later. clear boundary The notions of boundary and psychological distance are somewhat different but each add to our understanding of dyadic processes. The fact that they are not identical is evidenced by the situation in which two people are very close and intimate and yet their psychological functions remain distinct and there is no enmeshment. This would be a situation which Minuchin would call a clear boundary. With a clear boundary, flexibility in distance is permitted. For example, a couple may do things together and also function as separate individuals. Boundaries vary along a dimension with clear boundaries occupying a middle position: rigid. boundary .clear boundary .diffuse boundary 2.5 The limitations of a dyadic analysis Although dyads can show homeostasis or dynamic equilibrium, they are prone to instability - escalating and oscillating in the ways that we have described. What is particularly interesting is that, more often than not, if there is stability in distance or hierarchy in a pair it is because the dyad is stabilized by another member of the family system. More generally, restricting our analysis to dyads imposes an artificial limitation on our analysis. Only relatively infrequently do pairs of people exist in isolation from others. This will become clearer in our consideration of interactional processes in triads. 71 3 THE STUDY OF TRIADS triad In the late 1950s, Haley was responsible for introducing perhaps one of the most important innovations in the study of the family. This was the idea of analysing family situations in terms of three people or triads: When therapists observed that what one spouse did provoked the other, who provoked the first in turn, they began to see that a dyad was unstable and it required a third person to prevent a 'runaway'. For example, if two spouses competed over who was most ill, total collapse could only be prevented by pulling in a third party. Rivalrous quarrels that amplified in intensity required someone outside the dyad to intervene and stabilise it. If a third person is regularly activated to stabilise a dyad, the unit is in fact not dyadic but is at least a triad. With this view, the unit becomes a unit of three people. Similarly, if a husband and wife regularly communicate to each other through a third person, the unit is three people instead of a married 'couple'. The observation that a child with a problem stabilises a marital dyad led to the idea that the basic unit of family therapy should be parents and child. (Haley, 1976, p. 153) It will become clearer later how problems in families often involve three people in an unsatisfactory but stable triad. However, before looking at this, let us think carefully about the interactional possibilities open to three people. In examining triads, we shall use the same dimensions of analysis that were used in Section 2, with the addition of some further ones. 3.1 Alliances and coalitions In the case of dyads, patterns of agreeing and disagreeing may be important but the possibilities are relatively limited; in the case of triads, the potential complexity is much greater. Looking at triads in terms of agreement and disagreement, if two people disagree about some issue, a third person entering the scene may tend to 'take sides'; may tend to agree with one or both or disagree with one or both. The different possibilities where there may well be more than one topic at issue are as shown in Figure 6. When a triad is unstable it tends to revert to a stable configuration. We can illustrate this with the example of a therapist (B) working with a couple (A and C) who are warring partners (see Figure 6d). The therapist may experience tremendous pressure to take sides (i.e. to create the stable configuration in Figure 6b). Another possibility (see Figure 6c) is where all three, the therapist and the couple, are in disagreement. Here there is a tendency for two (e.g. the couple) to unite and turn against the therapist, forming what is known as a coalition against him (another version of 6b), Hopefully, of course, the situation in Figure 6a eventually results. A similar situation can occur within the family when, instead of the therapist, we consider a child or an in-law who has become involved in marital conflicts. alliance coalition Haley has made a useful distinction between what he calls alliances and coalitions. An alliance means simply that two people are in agreement or share a common interest. This is a two-person phenomenon. A coalition occurs when the two people are united through their criticism or concern for a third party. Such coalitions may be overt, as when two people openly criticize a third. But an important pattern that sometimes occurs in families where one member has psychopathological symptoms is the covert or secret coalition. Here the pair criticize the third behind closed doors, and when together with the third person they exchange guarded glances. All may deny that any such coalition exists. 72 STABLE CONFIGURATIONS: (a) agreement disagreement A A situation in which all three people are in agreement, as we might expect, is a stable arrangement. A situation where just one pair is in agreement and each of this pair disagrees with the third person tends to be a stable configuration. UNSTABLE CONFIGURATIONS: (c) Not surprisingly, when all three are in disagreement or conflict the triad is likely to be unstable In order to maintain this triad some agreement is usually attempted. Finally, we can have another unstable arrangement when one pair (here A and C) \s in conflict, whilst these two each agree with a third person. Here B's agreement with C threatens his agreement with A. Figure 6 Representations of stable and unstable triads 3.2 Triads and hierarchy As was said earlier, the UP/DOWN dimension is extremely important in understanding family processes. When looking at hierarchy in relation to triads, the obvious starting point is two-generation and three-generation families. We can, of course, also consider the situation of all three people being within one generation: for example, three siblings. Even here, hierarchy will be very much in evidence: usually, of course, some kind of pecking-order mirrors their chronological ages. We may also find two elder siblings uniting against the youngest, or one elder sibling attempting to keep two boisterous younger ones in order. Problems can arise when one sibling has taken over an excessive amount of parenting of the younger siblings. This can lead to what Minuchin refers to as the 'parental child' position. Another area of potential discord occurs when the hierarchy has become skewed and a younger child is acting in an executive position over an older child. According to Haley, if a secret coalition occurs across a generation line (or in fact between any two levels of a hierarchical organization), then undesirable consequences will follow - distress, violence or psychopathological symptoms. Stated in this way, it could be mistaken for a simple linear process of cause and effect. The 'perverse triangle', as Haley calls it, is perpetuated by such symptoms, since the co-allied pair attempt unsuccessfully to solve the problem or respond to it by further connivance. It is easy to think of examples of covert coalitions in any type of organization. A hospital patient may complain to the nursing sister on one shift about her colleague on the other shift. It may be tempting for the sister to form a secret coalition with the patient against her colleague, and if she does problems are likely to occur. Similarly, a teacher may form a coalition with one pupil against another pupil, or a pupil may form a coalition with the headmaster against a junior teacher. In the family, an obvious example is when a child sides with one 73 parent against the other. This family structure may be associated with a variety of problems and symptoms, for example: Mother 1 >• Alcoholic father Daughter J Mother and daughter may co-ally to complain of father's excessive drinking. His sense of exclusion from the coalition leads to further drinking. In another example: Father 1 >• Mother (migraine sufferer) Son J father and son become irritated with wife's/mother's prolonged migraine attacks. Further attacks are then encouraged by her sense of isolation. In each case, a self-perpetuating vicious circle can be set up. It is worth noting at this point that it is easy to confuse a secret coalition, where two people have united across a generation line against a third person, with a benign alliance. A mother and daughter, for example, may secretly plan a birthday surprise for the father. This will not be problematic since the hierarchy is not challenged. A more complex example can be seen where shifting coalitions occur: for example, a child may take sides alternately with each parent against the other. Such a pattern is common in adolescents suffering severe disorders, such as anorexia nervosa or schizophrenia. In the case of the schizophrenic boy who makes some bizarre utterance, or says that he can hear voices instructing him to harm himself, one parent who attempts to tell him to be reasonable may be undermined by the other parent smiling and laughing with the boy. Then the parents may reverse the positions and the sequence is repeated in a never-ending manner. Another example is the following: 1 Grandmother takes care of grandchild while protesting that mother is irresponsible and does not take care of the child properly. In this way grandmother is siding with the child against the mother in a coalition across generation lines. 2 Mother withdraws, letting grandmother care for the child. 3 The child misbehaves or expresses symptomatic behaviour. 4 Grandmother protests that she should not have to take care of the child and discipline him. She has raised her children and mother should take care of her own child. 5 Mother begins to take care of her own child. 6 Grandmother protests that mother does not know how to take care of the child properly and is being irresponsible. She takes over the care of the grandchild to save the child from the mother. 7 Mother withdraws, letting grandmother care for the child. 8 The child misbehaves or expresses symptomatic behaviour. At a certain point, grandmother protests that mother should take care of her own child, and the cycle continues, for ever and ever. Included in the cycle, of course, is sufficient misbehaviour or distress by the child to provoke the adults to continue the cycle. (Haley, 1976) It is worth pointing out that there is a great deal of cultural variation in how family systems tend to be structured hierarchically. Even within western society, there is wide variation in whether the grandparents' generation is treated as above or below the parents' system. What is deemed to be 'correct' is very specific to the subculture or even the individual family. 74 In our society, there is a typical expectation that husband and wife will be in an executive position over the children. Secret coalitions between a parent and a child may be problematic but only in this cultural context. In many Asian societies, the father and the eldest son tend to be the executive dyad. In Hindu society, it can be the mother and son who form the executive pair. Interference with this may be a possible source of distress to the family and is generally discouraged: If she (wife) was attractive enough to elicit her husband's support, her position became even more difficult. If he sided with her, the delicate balance of family relationships was upset, and tensions created which might react back on her. Her supervision was not given over to her husband for this might have developed a warm personal relationship between them, which again might have caused strain in the joint family system. (AileenRoss; cited in Hoffman, 1981, p, 123) 3.3 Boundaries and subsystems When a system is made up of three or more people, then the possibility exists of a subsystem: i.e. a system within a system. In everyday family life, tasks need to be differentiated and allocated to different subsystems. Minuchin distinguishes between the marital subsystem, the executive subsystem and the sibling subsystem. He argues that some clarity in the boundaries separating these is necessary, and that problems arise if the boundaries are too diffuse. For example, a husband and wife need to be able to negotiate marital and sexual issues together without others becoming excessively involved. Likewise, it is necessary for siblings to be able to conduct a certain amount of 'business' without always having a parent intervening. What Minuchin is saying here may well be restricted to the western nuclear family. A commonly occurring pattern can be found in families where a child is presenting difficulties: for example, out of control behaviours, psychosomatic symptoms such as certain types of asthma, eczema or enuresis. In such cases, it is common to find that the two parents do not complete a cycle of negotiating any differences that exist. Instead, the problems are detoured through a child. This is known as a conflict detouring conflict detouring process (an example was given earlier in Box 3: the Collins process family). From the child's point of view, the rising tension between the parents stimulates the symptomatic behaviour, but in true spiralling fashion the conflict is further fuelled by the child's symptom itself. An adolescent daughter may be refusing to eat, and the parents may disagree on how this should be handled: father wants to take a soft persuasive line, whereas mother wants to be firm and strict. Neither strategy is ever conducted for long enough to lead to success, since the parents never get together on pursuing a particular line. The daughter responds and in a sense saves the situation by drawing their attention to herself. Minuchin, who conducts therapy in a very 'directive' way with families, might work on this problem by helping the parents to regain a clear boundary around their own executive subsystem. He may help them to face their own conflict and negotiate a joint plan of action, whilst blocking the tendency of the daughter to become involved in their negotiation process. In the therapy session, he might gesture to the daughter to make her keep quiet or he might arrange for the parents to have some time together each evening without the daughter being present. 75 4 THE FAMILY LIFE-CYCLE So far, we have been analysing family processes as though the family situation is static. Obviously this is not so. Families are dynamic entities which change and family life-cycle develop over time; there is such a thing as a family life-cycle. Whilst no two families can be identical, and we must again acknowledge wide cultural differences, there are some generalizations which can be usefully made. 4.1 Transitions in the life-cycle of the family So far we have built up a picture of the family as a system which seems to develop a 'dynamic equilibrium'. Now we need to put this into a developmental perspective. Obviously life goes on; people grow older, people join the system and people leave it. When these natural changes occur the system inevitably has to work out new structures, new ways of behaving, and new rules. Problems can arise at the 'points of transition'. Minuchin discusses the issues surrounding the transition of marriage and the birth of the first child: The couple also faces the task of separating from each family of origin and negotiating a different relationship with parents, siblings and in-laws. Loyalties must shift, for the new spouses' primary commitments are to their marriage. The families of origin must accept and support this break. In the same way, encounters with the extrafamilial - work, duties, and pleasures - must be reorganized and newly regulated. Decisions must be reached as to how the demands of the outside world will be allowed to intrude on the life of the new family. Each spouse must meet the other's friends and select those who are to become the couple's friends. Each spouse may gain new friends and lose touch with old ones. The birth of a child marks a radical change in the family organization. The spouses' functions must differentiate to meet the infant's demands for care and nurturance and to handle the constraints thus imposed on the parents' time. The physical and emotional commitment to the child usually requires a change in the spouses' transactional patterns. A new set of subsystems appears in the family organization, with children and parents having different functions. (Minuchin, 1974, p. 17) We are all familiar with such transitions, though of course they are not usually labelled as such by the people involved in them. For most people transitions occur reasonably smoothly, and perhaps it is only later that the couple or the grandparents become conscious of some of the adjustments they have made. However, the complexity and importance of these transitions becomes vividlyapparent when things go wrong, such as when a young adult finds it very difficult to leave home or when new parents don't know how to cope with a wellintentioned but painfully interfering grandparent. Haley (1973) has noted that families undergo a continual process of change. This is the result of both external inputs to the family system (such as new friends, changing demands at work, school, environmental and even cultural changes) and internal changes (like the natural development of abilities, skills, or new demands made by the children as they grow older). The family system is continually evolving and adapting, but like a plant it can be seen to embody certain stages of growth. Haley has introduced the concept of the 'family life-cycle' to outline a number of important phases or transitional points in this process: (a) The courtship period (b) Early marriage 76 (c) Childbirth and dealing with the young (d) Middle-marriage - children at school (e) Children leaving home (f) Retirement and old-age (g) Death and bereavement The way that we actually divide the cycle up is relatively arbitrary; we could add the transition of separation and forming step-families, as well as the transition of changing job, moving geographically and so on. The important thing is to understand that these changes are something that all the members in the system go through. This is a very important concept and it puts into a fresh interactional perspective many ideas that have been derived from concentrating on how individuals go through life-stages (e.g. Freud's stages of sexual development (Unit 4 and chapter 4 of the Set Book, Freud and Psychoanalysis), Piaget's cognitive stages (Unit 4) and Erikson's stages of ego development (Unit 14). When the family goes through a developmental transition the nature of the relationships within the system has to be renegotiated. Psychiatric and other problems typically arise from failure to make these transitions properly. An example might be a middle-aged woman who comes to the clinic complaining of depression and sleeplessness. Merely considering her in terms of her individual life-cycle may lead us to a hypothesis that menopausal changes are contributing to her difficulties. This hypothesis may be sufficient in certain instances, but a wider lens may well uncover a much more important process. Possibly her last child is leaving home, and at this point it is necessary for the family system of which she is a part to make radical readjustments. The couple may now have to spend much more time together, time and energy that had been invested in parenting will need to be redirected. At this point potential marital tensions maydevelop, especially if the marital boundary is diffuse and the youngest child is drawn into their negotiation process. For example, the young daughter mayrespond to the mother's depression by sacrificing the time she spends with her own friends or by taking over much of her mother's role. The mother's depression fits into this self-perpetuating pattern and the whole system, as a result, may fail to change appropriately. Another example of the importance of the family life-cycle as opposed to the individual life-cycle is post-natal depression - psychiatric problems experienced by a mother after the birth of a child. It is possible to look to hormonal changes as an explanation, but again this is rarely a sufficient analysis. The birth of a child has great implications for the marriage, in that the couple have to negotiate new ways of relating to each other and allocating their time. Not only the nuclear family is involved, the couple's parents have to become grandparents, and postnatal depression often uncovers issues from the earlier transition of the couple themselves from their families or origin. Typically, a grandmother steps in to help the young mother who might then find herself displaced somewhat from the maternal role. Her husband and the grandmother might form a new parenting executive subsystem, erecting a rigid boundary to exclude the wife. The wife thus loses her position in the hierarchy. She may go 'down', becoming depressed, or she may attempt to regain control through angry or indignant behaviour. If this structure becomes stabilized, what had been a brief transitory problem, i.e. the 'post-birth blues', may become established and maintained (see Figure 7). Grandmother ———— Father Wife Child 5z~^ affiliation clear boundary rigid boundary Figure 7 77 ACTIVITY 1 It may be useful for you to think about the kind of systemic changes that need to occur alongside other transitions. Think about the way in which problems can arise at these points in situations that may be familiar to you: for example, children starting school, an elderly person being admitted to an old people's home, bereavement, loss of income through unemployment, wife going out to work, family changing neighbourhood, becoming an Open University student. Draw a diagram like the one in Figure 7 for one such situation that you can think of. 4.2 Ceremony and ritual In most societies the transitions involved in life-cycle stages are demarcated and assisted by various forms of ceremonies and rituals: the end of courtship and entry into marriage by the wedding ceremony; the first child by christening; bereavement through the funeral ceremony; not to mention graduation ceremonies, confirmations, retirement presentations and so on. Ceremonies and rituals play an important part in signalling change, perhaps erecting boundaries around a newly married couple or restarting the relationship between the nuclear family and other parts of the extended family. The congregation of all family members at ceremonies and rituals allows these redefinitions to be announced to all the members at one time, hence making it easier for them to become established. Selvini-Palazzoli et al. (1978) make the point that ceremonies and rituals are a very powerful form of implicit communication. For example, those who stand closest to the couple in the wedding pictures may at the same time be implicitly displaying and reaffirming for all to see the new nature of the family organization. Haley (1980) has pointed out that in western society the decline of ceremonies and rituals has recently led to a realization of their importance in facilitating transition between life-cycle stages. Greater freedom from formalities has produced greater confusion about the position of grandparents, parents and so on. Likewise, we can speculate that perhaps the lack of a 'divorce ceremony' to mark the end of marriage explains in part the difficulty and pain experienced. With those ideas in mind, the Milan team (Selvini-Palazzoli et al., 1978) have developed the 'family ritual' as a therapeutic tool. In one example, to help a family through an unresolved bereavement, it was suggested to the family that they should meet together in the garden on the next Saturday afternoon, dig a hole, and plant a tree in memory of an unmourned child. In another example, a family was instructed to congregate around a toilet at a particular time and throw the anorexic daughter's tablets into the pan one at a time, whilst chanting 'She is not ill, she is naughty'. These kinds of procedures, sensitively devised, can stimulate the family to reorganize in an extremely effective way. We can note, before we turn to the next section, that the idea of the family as a system has shed considerable light on the processes and dynamics of family life and has led us to many new insights into the way problems may arise. However, as Haley (1980) and others have recently pointed out, the systems view has primarily been employed as a theory of stability: that is, a theory about the processes that maintain the status quo rather than those that assist change. This tends to leave a certain bias in the picture we have of family processes, and particularly in the discussion of the family life-cycle. The emphasis has tended to be on the difficulties involved in change, rather than on how families so often successfully negotiate these transitions. But the systems model has as much to offer in understanding how changes occur in families, both naturally and in a therapeutic context. The idea of helping people to change is taken up in the next section. It is treated primarily from the interactive, systems approach but contrasted with more individual methods. 78 First, however, an important change in perspective must be made, and the next section provides this by focusing on the perceptions and understandings of family members. 5 CONSTRUING AND CHANGE So far we have built up quite a detailed picture of how families operate. We have treated families as systems, more or less parallel with the idea of a mechanical system. But so far we have taken what is essentially an 'outside' perspective, observing people's behaviour: that is, the interdependent and often predictable patterns of their bodily movements and their non-verbal and verbal communications. We discussed the idea of implicit family rules, which might be thought of as guiding these repeated sequences of interaction, but stressed that it would be a mistake to take the idea of such rules too literally. People have perceptions, understandings and choices, and what they do is not necessarily determined by a set of prescriptions analogous to the blueprint of a mechanical system. However, once an observer or a family therapist starts to make inferences about the meanings for the participants of the behaviours that make up family interaction, then it becomes necessary to change tack; and in this section we shall explore a different way of explaining what looks like 'rule-governed' behaviour. behaviour Thus far we have used the term 'behaviour' in a general way to include anything and everything that a person might do. However, once we turn our attention to the meaningfulness of what people do and what they intend by their behaviour, action then we need to use the term action rather than behaviour. This distinction, which is crucial in psychology, is discussed further in the Metablock, Part III, paper 4. The major proposition in this section is that, just as the behaviours of family members are interdependent (and system-like), so too are their perceptions and understandings. In other words, their meaningful actions can also be clarified through a systems approach. social reality Families are the major social settings in which we learn about ourselves, others and relationships. Through shared learning experiences family members evolve and negotiate shared perceptions and understandings about the world, themselves and their relationships. The interactions in a family, over time, create and sustain an experience of reality for that particular family and its members; and in turn this is communicated to outsiders and to the community in general. It is reasonable to suppose that this kind of process within the family directly parallels the construction of social reality in a more general sense through social interactions and the direct and indirect influences of society and culture, such as work, friendship networks, schools and the media. But the family (in some form) is the first social group to which most people belong and, depending upon the strength of its boundaries and its relation to outside influences, it does have the potential to create and maintain a kind of reality that may be maladaptive for the family itself and for the family in respect to the wider community. Of course, the community (or its agents, such as social workers, doctors, psychiatrists) may reinforce or even create the circularities that are causing problems in families. However, before looking more closely at families in trouble, we shall introduce a theory (construct theory) which describes one possible way in which people construct models of the world to guide their perceptions and understandings. Although this theory began with personal constructions of reality, here we shall show that it can also account for family constructions. In this form, construct theory provides a basis for predictable patterns of family interaction which is less deterministic than the idea of family rules. 79 One of the recurring themes of this course is whether people are determined or whether they are autonomous. By determined we mean that what people do individually, how they interact, how they structure their experience, what they become, etc., is fixed by factors such as their genetic inheritance, their physical and social environment, and, hence, their accumulated learning and rules of autonomy conduct. By autonomous we mean that people are free to choose what to do and versus determination free to become what they will. 'Autonomy versus determinism' will be considered in some way or another in many units in the course, and it is the subject of paper 9 of Part III of theMetablock. 5.1 personal construct Family constructs Later in this course (Block 3), you will be introduced to George Kelly's personal construct theory. As it is quite an involved theory, it may be worth your while returning to this section later when you have covered Kelly's approach. Kelly (1955) proposed that each person develops a unique set of personal constructs. A construct is a bipolar dimension, such as tidy-untidy, happy-sad, noisy-quiet, and so on. We develop constructs to deal with all areas of our lives. For example, a botanist will group trees according to deciduous-coniferous, whereas psychiatrists may construe illnesses according to whether they are organic or functional. Over time, we develop a highly complex network or system of constructs in order to anticipate events and make decisions in accordance with these anticipations. Kelly's personal construct theory has, in practice, paid most attention to the individual. Each person is seen as having a unique set of ways of discriminating. One of us (Procter, 1980) has used the notion of constructs to try to throw light on why families (as opposed to individuals) seem to act in predictable and systemlike ways. shared construct system social construct Consider the earlier example of the nagging wife and withdrawing husband. Her perception of him may be: 'He is lazy and inactive and he needs prodding into action'. He may see her as: 'She is always nagging me, why doesn't she wait and let me make my own mind up and stop rushing around?'. Each has a perception of the other that governs their actions, each anticipates the other and acts in accordance with these anticipations. The message that each gets from the other validates and confirms the perception that each holds. What develops over time is a shared construct system. In this particular example, the basis of the couple's interaction seems to be a shared or family construct, which may be 'lazy, withdrawing' versus 'busy, nagging'. A shared or a social construct describes an interpersonal process, not just a personal one as Kelly originally proposed. It describes events at two levels of analysis simultaneously: the level of construing and the level of acting (see Figure 8). Constructs, Lazy Withdrawn Busy Nagging Sits Withdraws Prods "Complains Nags Actions: Waits Figure 8 These two levels maintain each other in a spiral of cause and effect. The husband's and wife's perceptions guide and govern their actions, and the actions in their turn validate and confirm the perceptions. Furthermore, each position is defined by contrast to the other. The idea of contrast - or similarity versus difference - is fundamental to Kelly's theory. It is common in families to hear people say 'He takes after his father' or 'She is just like her Aunt Susan'. People 80 define each other by similarity and contrast. Typically we identify with our parents in the earlier phases of our childhood. We may then go through a period of defining ourselves by contrast with our parents during adolescence. This may eventually come full circle and we may end up seeing ourselves as more similar again in adulthood. Kelly said that our psychological processes are 'channelized' by our constructs so that we have a relatively limited set of alternatives to choose from at any one time. We can extend this notion to the family as a whole: each family has a relatively limited number of avenues or slots. In this model, 'Slots' are occupied by family members in a contingent way: mother tidies up to the extent that her son is untidy. He remains untidy in anticipation that his mum will clear his room for him. Here we have examples of people making choices which are patterned and predictable in a particular social context. So far we have used an example of a dyad, but even in systems of three or more members it is usually possible to reduce the positions of the members in anyparticular circularity down to two contrasting positions, i.e. one family construct. We can see in Figure 9 the basic triangle in which A and B are contrasted with C. For example, mother and father may see themselves as 'tidy' as opposed to the child who is 'untidy', or 'well' as opposed to 'ill', and so on. (Mother) (Father) B C (Child) similar -- different Figure 9 Constructs operating in a triad Incidentally, we can note that it is at the basis of Kelly's definition of a construct that at least three elements are considered, the two things are similar to the extent that they are different from a third. Even if we add more people, we can see that the outcome can only be two positions or groups. Take, for instance, an extreme example where one person has been defined by contrast to the other five in the family (see Figure 10). This one person might be a 'delinquent' adolescent, the 'black sheep' of the family. He is blamed for any misdemeanor that happens and the others attempt to correct his behaviour by giving him lots of good advice. They define him as bad in contrast with themselves who are good. His impatience with their approach leads him to reject their advice and to commit further misdemeanours. Here we can see an interactional circularity governed and maintained by shared family constructs. •" (the 'black sheep') Figure 10 A family configuration showing a single deviant Source: Hoffman, 1981 family construct system We have been considering examples with just one social construct. Any family will develop a set of social constructs which we may call the family construct system. This will consist of a network or web of bipolar alternatives governing the family's interactions in many different areas. Rather than seeing interaction in a 81 deterministic way as implied by rules, this view sees the family members as having avenues of free choice, although the members' choices are 'interdependent'. This explains why family members can move within this set of avenues and it is common to see them swop positions. 5.2 Reflexivity Kelly stated that it is important for any psychologist to be able to account for his psychological activity in terms of his own theory. This is called the principle of principle of reflexivity reflexivity. Construct theory is a reflexive theory. It proposes that all people are in the business of construing and anticipating, and therefore they are, in a sense, like scientists or psychologists. Construct theory can therefore help to overcome the difficulties posed by the potentially mechanistic aspects of a systems approach to families and family therapy. To this end, the therapist needs a set of meta-constructs (i.e. constructs about constructs) to understand and aid meta-constructs the therapeutic process of helping families. We have already proposed a set of such meta-constructs: UP/DOWN, NEAR/FAR, CLEAR/DIFFUSE. There is potentially an infinite variety of ways of construing family constructs and processes; the most useful being those which are open enough to be used to construe the family in any possible cultural or societal variation. In this sense, the approach has an anthropological outlook. Within the construct theory approach, the activities of the observers, therapists and the family members themselves are not seen as fundamentally different. This leads to a compassionate and accepting stance in therapy. All concerned are seen as trying to make sense out of events and as trying in their own ways to get the best outcomes according to their own criteria. 5.3 Change in families So far the systems approach, in considering circularities, rules and family constructs, has tended to emphasize the stability of families as systems. But, as noted earlier, the systems model can also help to illuminate change. You might like to re-read Box 1 in section 1.1 of the unit, especially the part on first and second order change in mechanical systems. 5.3.1 First and second order changes Looking at a simple central heating system, a change, such as occurs when someone opens a door or puts on a gas fire, is always dealt with in the same way: either the boiler goes on or off. If some more permanent eventuality comes up, such as where someone breaks a window, then this set of alternatives won't do. A change at a higher level, including such possibilities as resetting the thermostat or repairing the window, will be necessary. This higher set of possibilities subsumes the set of alternatives possible at the lower levels. Higher order changes may make use of the means of change in the original system (i.e. resetting the thermostat), but they may also involve either an extension of the understanding of the original system (some form of re-design) or an intervention from outside the original system (i.e. someone coming along to repair the window). The types of change possible in families can also be considered in terms of levels. At any given time, it may appear that the people in the family are acting on the basis of a limited set of alternatives open to them. Within this framework, a change from one alternative to the other has been described as first order change (Watzlawick et a/., 1974). On the other hand, a more fundamental change in the framework itself is known as second order change. Take the example of a 'delinquent' adolescent who is seen as the black sheep of the family. Those attempting to correct him may have tried a number of different 82 solutions to the problem, such as punishing him, trying to understand him or ignoring him. All of these are attempts at first order change. They are based on an all-embracing construction of what 'delinquent' and 'normal' people do. This way of construing generates and guides all the solutions that are attempted, i.e. all the solutions are in terms of the definition or design of the original family system. The 'design' and boundaries of the system result in the consequence that only certain solutions are attempted, and others, which might be more helpful, are excluded. If such a family enters therapy, the therapist may attempt to move them from their original framework by offering an alternative one. For example, it may be suggested that another way of construing the delinquency is that the boy is acting in this way in order to help with an underlying marital conflict, and that if he were to stop acting in this way the marriage might break up. They may accept this new framework, which essentially classifies the boy's actions as helpful rather than delinquent or bad. This may help them to start seeing their son and themselves in new ways, leading to new and more productive solutions to their problems. One can summarize the task of therapy as being essentially that of helping the family to make a second order change. It is as though the family has been trapped in one 'gear' and failing to get up a hill, no matter how much the accelerator is used. The therapist can point this out and suggest a more appropriate gear - the problem has then been re-defined. A shift in the family construct system occurs or new constructs may be assimilated. 5.3.2 Natural and therapeutic change Families make second order changes quite naturally in the course of the family life-cycle: normally new ways of construing will emerge. The interactional therapist assumes that people have the potential and the creativity for change, but that this natural potential can sometimes become 'stuck' as a result of their joint actions so that they are therefore repeatedly using the same attempted solutions despite the fact that these are not working. The task of therapy is to help free them so that they can start the natural process of solving their problems effectively once more. We can add here that the techniques of therapy in this are not fundamentally different from those that occur naturally. This point is made strongly by Watzlawick et al. (1974), who describe their approach as essentially pragmatic: that is, they examine many situations in which change was brought about 'naturally' and try to understand what had been done. They cite an interesting anecdote illustrating a second order change in a situation of civil unrest: During one of the many nineteenth century riots in Paris the commander of an army detachment received orders to clear a city square by firing at the canaille (rabble). He commanded his soldiers to take up firing positions, their rifles levelled at the crowd, and as a ghastly silence descended he drew his sword and shouted at the top of his lungs: 'Mesdames, M'sieurs, I have orders to fire at the canaille. But as I see a great number of honest respectable citizens before me, I request that they leave so that I can safely shoot the canaille'. The square was empty in a few minutes. (Watzlawick et al., 1974, p. 81) Here the situation becomes redefined as one in which the detachment basically has the interest of the crowd at heart and want to 'protect' rather than 'intimidate' them. Furthermore, this crowd was no longer defined as a 'rabble', but only as possibly containing rabble-like elements. So both parties, the soldiers and the people in the square, were redefined as 'people' with both friendly and threatening aspects, not just threatening ones as previously. This allowed a new set of choices and attempted solutions. We can see examples of such natural changes in families. The parents of a sixyear old girl may become embarrassed and worried about her interest in sexual 83 matters. One of them may discuss this with a friend, overhear a conversation, or even see a television programme which reinterprets (often referred to as a 'reframe') such actions as evidence of normal 'healthy' development, rather than morbid and dangerous habits. Similarly, an uncle, grandparent or friend with adult children may have a powerful effect on parents worried that an adolescent child is going 'off the rails'. He may recount how one of his children acted in 'just that way' but after a period of 'sowing his wild oats' settled down to work and rearing a family. 5.4 Summary Until this section we have looked at family systems from the outside as observers who are not concerned with the perceptions and understandings of the family members. The emphasis has been on how the behaviour of people in families can be viewed as circularly determined mechanisms. In section 5, however, we have moved to an orientation which permits us to include in our analysis the perceptions and understandings of people in families. We have done this by using Kelly's personal construct theory which proposes that people have the potential to act on the basis of 'free choices'. As such this view might represent a contradiction of what we said earlier about the essential interdependence of people's actions. But, by extending Kelly's theory to develop the idea of shared family constructs, we have described how people's perceptions, like their actions, are interdependent. A fundamental point here is that, no matter what our intent, we cannot ever 'know' how people understand their situation and actions. By looking at family constructs we can take account of what people say and do, and their stated reasons for what they do. However, ultimately we are still left to make inferences about how they see things. In this sense, a rule-governed view or a construct theory view both make clear that our understanding is at best a description of what the family system is like and how it is operating. The development of a construct theory approach, though, has important advantages over a rule-governed model in the area of therapy. Essentially it enables the therapy to be directed not merely at the family's behaviour but at their understandings. Once the therapist has a hypothesis as to what the shared construings are, then interventions can be specifically focused on family constructs which appear to be maintaining the problem. Finally, you should note that a construct theory view does not imply that family constructs are necessarily conscious. From a construct theory view, people are able to make choices, but the extent to which alternatives are consciously scanned is a different matter. Clearly this is a difficult point: it centres on just exactly what we mean when we use the term 'choice'. As an analogy we can consider the 'choices' we make when we drive a car. These are not necessarily conscious. We negotiate hazards, emergencies and a variety of unpredicted situations, only realizing later the complexity and risks that were involved. You should also note that 'conscious-unconscious' and 'aware-not aware' are not allor-none concepts. In the car-driving example, some behaviours seem to be completely automatic (below awareness), others are consciously attended to, but many seem to fall between these extremes: we seem to be partially aware or aware just some of the time. Levels of consciousness are further explored in the sections of the course that are concerned with psychodynamic theory and in Block 4. Attention and awareness come within the realm of cognitive psychology and are covered in DS262 and D309. 84 6 INTERACTIONAL FAMILY THERAPY It is difficult to summarize adequately the developments that have been made within the interactional approach to therapy. There has been a terrific burgeoning of different approaches, with much heated disagreement between the various schools. However, we can start by outlining some of the basic principles that the various interactional approaches have in common: (a) Problems typically presented as residing in one individual in the family are looked at within the whole family system. The actions of any one member are seen as a function of the total interlocking system. Hence, it is usual for the whole family, or all the people who are significantly involved (this may include friends, extended family and so on) to be seen together. In some cases a 'patient' may be seen alone, or only part of a family seen, but an overall appraisal of the system is still made, and any interventions are made with this in mind. (b) The therapeutic process consists of broadly three stages: investigation, which leads to hypotheses regarding how the system is functioning to maintain a problem, which in turn leads to interventions. It is in the area of interventions that the greatest differences between the schools are evident. Nevertheless, all approaches aim to change the overall system, not merely the individual. (c) The therapy is typically conducted by a team in which one person is usually the therapist working with the family. The rest of the team supervise the work by observing through a screen or closed-circuit television. The therapist periodically leaves the family to consult with the team to develop the therapeutic plan. This is a very broad outline with many variations in practice, but the emphasis on the interactional nature of problems is fundamental. The different schools disagree predominantly on the focus and means of achieving change. In general, there are two emphases that can be seen. These reflect the themes of the unit so far. The emphasis of Salvador Minuchin, for example, is on changing behaviours and the structures within families. Typically he does this by powerful confrontations and deliberate alliances with some members in order to promote new familystructures. Mara Selvini-Palazzoli and her team, on the other hand, concentrate on changing the perceptions (constructs) of families by a variety of subtle communications. In practice, of course, both approaches come into play. Haley (1976) and Madanes (1981), for example, emphasize the importance of reorganizing power structures, but do so by subtle prescriptions, tasks, reframes and paradoxes. Before we turn to a discussion of some of the techniques, we need to consider in further detail the nature of the problems that people have and how they can be seen in the family setting. 6.1 'Problems' versus 'difficulties' As we saw in the section on the family life-cycle, changes usually occur naturally. This doesn't necessarily mean that all has been plain sailing for the family. They will have had difficulties to face but will have made the necessary adaptation. Watzlawick et al. (1974) have contributed a clear and elegant theory of the nature of problems within the interactional approach. They distinguish between 'difficulties' 'problems' 'difficulties' and 'problems'. Difficulties are faced by nearly everybody: illnesses, unemployment, bereavements, work problems, brief loss of sexual interest, and the adjustments that have to be made during any transition in the life-cycle. Such difficulties typically stimulate our creative processes, and possible solutions present themselves. Our previous experience of what is appropriate and the 85 constraints of the particular situation are normally sufficient. We apply the solutions to the difficulties and solve them. Sometimes, however, a solution is repeatedly applied, even when it is consistently failing. The failed attempted solution may lead to further difficulties and a typically systemic circular process is set up. This entire circular process itself becomes the problem (see Figure 11). Many of the examples we have given already illustrate this process. For example, in the case of the 'alcoholic' husband, daughter and mother may get together to try to solve father's difficulty; father might try going out more to get away from things; mother might try telling him how much his daughter is upset by his drinking; and of course father might just go and have another drink to ease his mind. THE PROBLEM Difficu'ty v Attempted solution Figure 11 Difficulties and attempted solutions Watzlawick et al.'s (1974) analysis of problems leads to a very neat definition of what the task of problem-solving in therapy is: namely to help the individual or the family to stop applying attempted solutions that are failing and to try some new solutions which will undermine the sort of vicious circles described above. 6.2 Investigation: the first stages Some of the therapeutic approaches typically start with detailed questioning, in which problems are defined in terms of what actually happens. Questioning is designed to elucidate the interpersonal sequences of action that occur when the problem is present. Thus, if it is found that a man has become depressed, the therapist may ask for typical examples, and then begin to ask what his wife says and does when he becomes depressed. The therapist will focus her search on evidence of circularities, coalitions, diffuse and clear boundaries, inappropriate hierarchies and so on, depending on which processes her particular school of therapy regards as being of paramount importance. Some will place emphasis on the behavioural level, some will spend more time in searching for constructs and perceived similarities and differences between the family members. Other therapists may spend more time in giving the family tasks in the sessions: for example, by encouraging two members to talk to each other whilst keeping someone else quiet. Great stress, however, is placed on observing what happens between the members in the sessions as well as listening to the family's account of what happens outside the sessions. For example, the wife and husband may differ in their accounts of how an argument at home develops between them. Sometimes they then start to have a 'meta-argument' (that is an argument about an argument) in the session about their argument outside. Considerable emphasis is devoted to ascertaining whether what the family is demonstrating in the session is consistent with their reports of what happens at home. 6.3 The therapeutic process as scientific hypothesizing To the more academically inclined psychologist, it may be hard at first to see that the process involved in such therapy can be rigorous and scientific. Clearly all forms of therapy involve creativity, basic human understanding, and clinical experience, but the interactional approach shows that it is possible to place these within a very precise scientific framework. Mara Selvini-Palazzoli and her therapy team in Milan have particularly stressed the importance of approaching 86 any new case with a hypothesis about how a particular family is operating as a system. This hypothesis guides the interventions by the therapist, which in turn provoke new responses from the family, which allow the team to elaborate or revise their original hypothesis. In a family that one of us (R.D.) had seen in therapy, it first appeared that the problems were being 'caused' by a rebellious, drunken, teenage girl. The parents protested that 'everything would be all right if only she would stop drinking herself so senseless that she has to be carried home'. Our observations of the way mother and father and daughter behaved together suggested that they were in disagreement about what to do. Father saw the daughter as bored, lonely and depressed, whereas the mother said she needed a 'firm-hand'. Daughter and father spent considerable time together. He had been made redundant and she was unemployed. The wife was out all day at work. The father was repeatedly mocked by the daughter and mother did nothing to support him when this happened. At this point, the investigators paused to formulate a hypothesis to describe what had been shown by the family so far. ACTIVITY 2 Pause for a moment and try to draw up some possible hypotheses which could account, in an interactive way, for the actions of all members mentioned (mother, father and daughter). We considered three possibilities, though of course there are bound to be others: (a) It may be that the daughter's drinking is functioning to create a close relationship between herself and the father, thus postponing the need to face the issues of her leaving home and her father making readjustments in his life following redundancy. This also allows the mother to continue in her position of family breadwinner. (b) A conflict detouring mechanism may be operating here. Mother and father represent a weak subsystem, since they are in conflict and do not make decisions in a united way. They find it easier to detour their conflict by being able to disagree about their daughter's drinking. The boundary around the parents is weak since she comes between them in their preoccupation with and disagreement over her. At the same time, a temporary boundary around the parental subsystem is drawn when they unite in this concern for their daughter. The daughter, on the other hand, receives attention and sees her parents united in response to her behaviour. (c) A third possibility is that the power structure in the family is disturbed. Mother is the breadwinner, which may have the consequence of making father feel a loss of his authority. The daughter's mockery of her father suggests that she does in fact see him in this way. The daughter, by virtue of her symptoms, in turn exerts tremendous control in the family and consequently occupies a very powerful position. However, the whole issue of power is avoided in the focus on her 'symptoms'. Subsequently-gathered information seemed to favour the first hypothesis. It transpired that the father's younger brother had likewise experienced alcoholic problems and father had been quite closely involved in caring for him. Any drinking by his daughter may have been seized upon as relevant. The daughter would then discover her father's unique sensitivity in this area, finding that she could stimulate his concerns, worry and attention by choosing to act in this way. This led the therapist to focus particularly on the father's attempted solutions, helping him to form constructs which clearly distinguished his brother from his daughter, instead of making them seem similar. As new information becomes available, the systemic hypothesis (or hypotheses) guiding the investigative part of the therapeutic process is refined or revised. 87 T Because each family situation is unique, a hypothesis has to be constructed which accounts for all the facts known about that one single case. This is a very different enterprise from much of social psychology, which attempts to derive general principles which will apply to large numbers of people under fairly narrowly defined conditions. In the therapeutic session, generalizations are sought - these are the apparent 'rules' of the family system, or the family constructs - but they are usually generalizations which apply only to how these particular people behave (and construe) over time. Sometimes, of course, these regularities will be common to other families too. Although the hypotheses that are generated are within the systems approach, they are regarded as a subset of the many possible 'working hypotheses'. They are tested in the ensuing relationship between the family and therapist(s) and may subsequently be revised. (The role of generalization in social psychology is discussed in the Metablock, Part III, paper 8.) Set reading This idea of hypothesis-testing and revision is built into the Family Observation Project. You should now read the article by Selvini-Palazzoli et al., 'Hypothesizing - circularity - neutrality: three guidelines for the conductor of the session', which is in the Offprints Booklet. 6.4 refraining Refraining and positive connotation An approach that is used in most schools of family therapy is that of'reframing'. Once the interactional sequences that the family members are engaged in have been established, a new way of viewing these sequences is offered to the family; usually a way which puts the family members in a sympathetic light. This apparently simple technique can lead to major changes relatively quickly, even in quite extreme problems. We gave an example of this earlier when we discussed a delinquent son who was reframed as helping his parents' marriage. This kind of intervention tends to work by interrupting the circularities in which the family may have been engaged. Typically, a way of putting each person's behaviour in a positive light (i.e. giving it a 'positive connotation') will be sought. Superficially, this looks a rather artificial process, but in fact it often uncovers a more profound truth about the family. A husband and wife fighting to the point of dangerous violence may be reframed as making 'manifest attempts to get close to the other despite the hurt involved'. There is a basic tendency in this approach to view human motivation in a positive light and people will often acknowledge with relief that they have been understood. Watzlawick et al. (1974) refer to reframing as a 'gentle art', and in therapy it soon becomes obvious that clumsy or inappropriate reframes are harshly dealt with by the family. The reframing is a negotiational process whereby the reframe is typically generated from already existing but perhaps submerged perceptions held by the family. Rather than offering something totally new, it is more often a question of emphasizing something that is already present. A certain element of humour and feeling for the absurd is also often employed in reframing, as can be seen in one approach Watzlawick et al. suggest to reframe the example already discussed of nagging-withdrawing: Her behaviour can be re-labelled as one which, on the one hand, is fully understandable in view of his punitive silence, but which, on the other hand, has the disadvantage of making him look very good to any outsider. This is because the outsider would naively compare his behaviour to hers and would only see his quiet, kind endurance, his forgiveness, the fact that he seems to function so well in spite of the very trying home situation to which he has to return every evening, etc. It is the very inanity of this 88 redefinition of her behaviour which will motivate her to stop 'building him up' in the eyes of others at her expense, but the moment she does less of the same, he is likely to withdraw less, and nothing ultimately convinces like success. (Watzlawick et al, 1974, p. 103) 6.5 The question of 'insight' More traditional schools of therapy, particularly those deriving from psychoanalysis, rely heavily on trying to help the clients to understand their problems and to take an intellectual and verbal stance towards them. In other words, the therapy is aimed at insight. It is very common for new therapists using an interactional approach to start to explain to the family that their problem is systemic: for example, due to a coalition across generations, and so on. However, it is very rarely an effective approach and the family usually argue vigorously, or disqualify such observations, for instance, by joking. As we have repeatedly pointed out, systemic processes usually occur below the level of awareness, and insight leading to a preoccupation with one's own interactional network can often become a problem in itself. This is not to say that insight is necessarily inappropriate. Again, we can distinguish between individualistic approaches which try to help the patient understand himself and his family and an insight-orientated approach where the insights are presented to the whole family. In the former case, as in many 'humanistic' therapies and psychotherapies, there is a great danger that the insights will be rejected by the other family members. If it's the parents who have been led to these insights, then the children may simply reject them as Mum and Dad telling us what to do again. On the other hand, if it's the children who have been taught some degree of insight, then the parents may reject this as threatening their authority and position of wisdom. A more interesting approach is psychoanalytic family therapy. Here conflicts may be detected between, say, father and son, mother and daughter. The approach is then to make these conscious and to work them through further emotionally so that a new state of awareness is found. The insights offered here, though, concern not so much what goes on between the people in the family as a system, but rather how they feel about each other and what events or traumas might have caused such feelings. Again, such insights are potentially troublesome, since the family may simply be embarrassed by 'strange' psychoanalytic notions. But, more importantly, the therapist's pronunciations may threaten the parents' positions or make them feel 'responsible', say, for a daughter's anorexia. In other words, such approaches typically imply a linear rather than a systemic view of problem-causation. From an interactional perspective, insights, especially those based on a linear causal model where one person is seen as causing another's difficulties or their own, should be avoided. Haley (1976) refers to interactional therapy as essentially being 'courteous', in that it should provide a 'face-saving' way out rather than create a situation where people's mistakes are rammed down their throats. For example, to carry the burden for an anorexic daughter's state is awesome; and in fact agonized searching for 'where did we go wrong?' may be what the family has been doing for years. This search is itself probably part of the problem, and a move to 'where they went right' rather than insights about mistakes is usually seen to be more productive. So reframing, as we have seen, does not imply 'insight' in the sense of the therapists having views about the family's difficulties. Instead, the therapists seek to utilize the family's existing understandings in order to generate understandings which put everyone in a positive light and show how each person is functioning to maintain the situation. It is this positive understanding, based upon a position of neutrality, that the therapists share with the family. 89 6.6 Restructuring restructuring In restructuring approaches, the focus is on the boundaries, coalitions and other dyadic and triadic patterns in the family system. Take a case where a mother has become very over-involved with her anorexic daughter and the father has 'disengaged' or becomes remote. The father might be given the task of dealing with or supervising his daughter's mealtimes while the mother takes the younger daughter out for a walk. Restructuring a family sounds easy in principle, but it is a great art in practice. If the changes suggested are large, the natural homeostasis of the system will operate and the task will not be performed. The therapist has to learn ways of anticipating this and helping the family members to be successful in their ventures. It is most important for the therapist to accept the family's view of their difficulty and to use their understanding. It is very easy for the therapist to become just another advice-giver and merely act to maintain the interactional processes as they have been. One way to avoid this is to use 'live supervision', which will be mentioned later. 6.7 paradoxical intervention Paradoxical intervention A particularly interesting and powerful set of techniques has evolved into the approach known as paradoxical intervention. Here the family may be instructed not to try to make any changes for one reason or another but to continue doing what they have been doing. This is paradoxical, in that the person is coming to see the therapist in order to change, but within this framework she is being requested not to change. A couple who have not been sleeping together may be requested to avoid all physical contact. The family of a boy who has been stealing money from his parents may be told that he should do his best to steal money from his mother without her noticing. A mother and daughter in a secret coalition may be asked to spend half an hour together each evening planning methods to deal with the husband's alcoholism. When used appropriately, such interventions can have powerful effects on the family organization. What was essentially 'spontaneous' behaviour is now being required by the therapist to be performed 'deliberately'. However, the paradox is not a piece of manipulation; rather it is a question of the therapist communicating in a way that matches the family's. When a family comes to therapy they are implicitly saying that they want to change, but their refusal to follow directives contradicts this first message. Paradox in communication rests on the idea that one part of a communication can define the meaning of another part. What is said at a given moment may be a meta-communication meta-communication (that is a communication about a communication) with reference to what was said earlier. A meta-communication can therefore give the earlier communication a new twist or meaning. When two such parts of a message or communication are contradictory, then a paradox is generated. In a therapeutic context, paradox can be employed, as we have indicated, in a positive way. The effects on the family system may be quite dramatic. The couple being told not to have sexual contact are thereby freed from their own continued attempts to have contact: spontaneity may return. In the family with the boy who steals, the issue must now change since the boy is being asked (openly in their presence) to do the stealing. Now they may be able to shift their attention and focus on the other issues which need to be dealt with. Again, a secret coalition is subtly but profoundly changed when the mother and daughter are asked to set aside time to discuss the father's alcoholism 'secretly'. In each case, the opposite of the obvious solution is tried: many people will have told the couple how important it is to be close sexually, told the parents and the boy how wicked stealing is, or perhaps hinted to the wife and daughter that father needs help. Another very important paradox employs the eastern technique of turning no action into action. The couple, for example, are by implication now 'choosing' or 90 acting deliberately not to have sex, whereas previously not having sex was seen as something that was out of their control. So from the viewpoint of our earlier construct theory analysis, the paradox makes apparent the two poles of any action: to have sex or to abstain, to steal or refrain from stealing, to confer secretly or openly. When such interventions go well, the family reports, usually at the next session, that there has been some improvement but they don't know why. The kind of change that occurs resembles 'natural change', in that there is little conscious awareness of how it has occurred. You may like to re-read this section after you have read Unit 10/11, section 7. 6.8 Live supervision An integral part of the interactional approach to therapy is that therapy is conducted as a team. This means that a team of therapists works together to plan the therapeutic strategy and to monitor its progress. Typically only one or two of this team actually work face-to-face with the family. The role of the team is to observe and guide the therapists. Usually the therapy room has an adjoining observation room where the team observes and listens to the therapist and the family through a one-way screen. The team are able to communicate with the therapist by means of a telephone or a hearing device. As therapy progresses, the team may send in suggestions to the therapist and at times call her out for consultation and development of the overall therapeutic strategy. live supervision Such 'live supervision', however, is not merely an addition but is fundamental to the interactional approach. The family as a system is considered to be extremely complex and powerful. New therapists find themselves very quickly caught up in this system, and this is typically indicated by their being 'sucked in' or by their taking sides. For example, in the case described of the alcoholic father, it may be very tempting for one therapist to feel sympathy for him and perhaps to blame the wife and daughter. However, the team is one step removed from the direct influence of the family and can usually see the system in an impartial way. Such neutrality is a vital feature of the systems approach, but without help from the team it may be very difficult to achieve (Selvini-Palazzoli et al, 1978). Some therapists, such as Minuchin, may deliberately take sides with one member, but this is very different from unwittingly taking sides, or ignoring someone. However, the function of the team is not to produce 'robot therapists' but, by being aware, to utilize the therapist's relationships with the family. Another way of viewing this is to see that in the therapy situation a new system comes into being: the family/therapist (therapy team) system. All too often, professional helpers working with families are unable to see how they are unwittingly maintaining a problem. For example, by taking on parenting or the wife/husband position in a family, a therapist may be unaware of the way that he/she has become involved in or a part of a new system: the family/professional helper system. Therapists using the interactional approach develop new skills, or, as Bateson terms it, there is a form of learning how to learn in such situations. The importance of live supervision is indicated by the fact that even 'master therapists' can make quite elementary mistakes. The important point is that 'mistakes' are to be expected and the therapist and the whole team often gain important information from them and continually learn and improve their approach. This does not mean that families are treated as 'guinea pigs'. In fact the opposite is the case, since the supervision team may detect and remedy errors early rather than allow them to continue. In any case, the family's permission is always sought and, from their point of view, the therapeutic process is open and public rather than private and closed to criticism as is common in individual and unsupervised therapy. 91 6.9 Public versus private The interactional approach, as was indicated above, is public. The actions of the therapist are observed by a supervising team. This, of course, is always with the family's permission. Again, this is radically different from most other approaches where the therapist typically has a one-to-one relationship with the patient, as in psychoanalysis. Even group therapies maintain a privacy whereby outsiders do not observe in a non-involved way. This openness of interactive therapies means that the therapist's interventions are open to discussion, the therapeutic process is less subjective and the outcomes are more open to continual evaluation. An analogy can be drawn here with surgery, where operations are typicallycarried out by a team, and most people are reassured rather than threatened by this fact. However, a convention has arisen that what a therapist does, which is in fact infinitely more complex than the most advanced surgery, should be private and no-one else should watch and assist the process. An interesting historical note is made by Haley (1980), who points out that in fact our oldest form of therapy, hypnotherapy, was taught and practised in a public manner (not including, of course, stage hypnotists); it was only with psychoanalysis that the process between patient and therapist became private. In section 6.10 we shall illustrate the application of some of the concepts we have been considering in the context of therapy with a family. As you read the case study you should attempt to consider how it exemplifies the theoretical aspects of the interactional approach. You should also think back to the course DS262 Introduction to Psychology (if you have studied it) and consider what alternative therapeutic approaches you think may have been appropriate. See especially Units 2 (Psychodynamics) and 3 (Learning and Conditioning) and TV 1 and 2. Even if you have not studied DS262, take a critical stance and note how the approach described runs counter to 'common-sense' suggestions. 6.10 A case study A mother and father were seen after their son, John, had been admitted to the psychiatric hospital. He had been behaving in a rather bizarre and provocative manner ever since his visit to Nepal where he reported having experienced some kind of vision. The psychiatrist at the hospital, using a medical understanding of the problem, suspected that he was suffering from early signs of schizophrenia. The parents were very worried because the parents of John's ex-girlfriend had complained to them about various letters that she had received from him which they regarded as 'most objectionable'. It was suggested that the whole familyshould be seen by a team of family therapists. The first interview suggested a secret coalition between mother and John against father. The father, a professional scientist, was rather pompous and long-winded, and mother 'glowered' at him as he spoke. At this stage the therapist and the team formulated a hypothesis that the family was entering a crisis because the close relationship between mother and son was threatened by his leaving home, thereby leaving behind a couple who had grown far apart over the years. This was further exacerbated by the forthcoming marriage of an elder brother Malcolm. (There was also a younger sister in the house whose function we will discuss later.) The team met to discuss the situation and formulated the following intervention: (a) The family was told that John's problems were related to the difficulties that any boy of his age has in leaving home: learning to be more independent and forming intimate relationships. This is a difficult time for any family and it is extremely common for an adolescent to become interested in such things as Buddhism, experimenting with drugs and developing a philosophy that is deliberately in contrast with that of his parents. 92 (b) It was explained that a child at this age needs both a mother and a father to help him negotiate the difficulties of this stage. A mother provides emotional closeness and also space for the child to be free to experiment with new things, albeit sometimes in rather bizarre ways. A father, on the other hand, works at more of a distance and provides his son with a model of success. These two approaches should be kept distinct, but fit together very well. They were urged to continue with this work, and their efforts would pay dividends. (These two interventions are reframes.) They serve to normalize the situation by distracting the family from the potentially fruitless attempted solutions associated with the label schizophrenia. They deal with coalition between mother and son and reframe the marital differences as being valuable. They also support father's somewhat distant position and mother's over-involvement. (c) The therapist asked the parents to make no further contact with the girlfriend's family. The therapist would contact them personally. A telephone call was made the next day in which a detailed investigation of the situation between John and their daughter was made. An explanation somewhat similar to (a) above was given and a request made that any further trouble should be reported to the therapist. (This served to disrupt a complex, circular communication line: John - girlfriend - her parents - his parents - John.) At the next session there was reported to have been 'very little trouble', although the parents were worried about John's life-style: he was living a 'hippy' existence in a squat in Birmingham. Mother had visited him there and attempted to tidy up. An important transition had been made, the older brother had married and they were most amused to recall an incident in which John had 'leapt into the room wearing red tights', and it was subsequently revealed that mother had given John these tights. In the intervention phase, the supportive constructs provided in the first session were reiterated by the therapists with a warning to the family that, in developing through such difficulties, relapses tend to occur and they would feel they were back to square one if this happened. If they were to get 'stuck' in one of these they should get back in contact for another appointment. (The prescription of warning of a relapse is a common technique in this approach. It allows the therapeutic context to be maintained in the event of a relapse and changes the kind of responses that tend to exacerbate such a relapse: excessive anxiety, pessimism, dismay. It often serves in fact to prevent a relapse.) A year later, the mother telephoned requesting an appointment. The parents were asked to attend with John and his younger sister Beryl. John had returned home and had recently become progressively tired and inactive, unable to concentrate, and they were again worrying about schizophrenia. Beryl reported that her brother often seemed to change into a five-year old boy, putting a certain mischievous expression on his face. John demonstrated a certain 'cheeky' smile while his sister was talking. The mother was demonstrating great concern about the sexual aspects of John's relationships with girls. During this and the following session the family all laughed and joked throughout, especially in response to the father's sarcastic criticisms of the therapist and the one-way screen. It was in fact very difficult to conduct the investigation, since the family made disqualifying remarks about each of the questions rather than answering them. This is a common pattern in families demonstrating a schizophrenic member and can make this kind of problem extremely difficult to work with. Before further work could be done, an intervention was felt to be necessary to deal with this problem. After discussion with the team, the therapist went back to the family to say that there was something that he wanted to praise the family for: their sense of humour. They were told that a sense of humour is a very important thing to maintain in any situation and it is particularly important during a period of painful readjustment, such as where a family goes through the time when the children are leaving the nest. This proved to be another important turning point in the therapy. The family was seen on four more occasions, during which time John gradually became more active and started going out more with friends, working in a 93 voluntary capacity and seeking full-time employment. At the next session the family had lost the tendency to disqualify with their humour, and were willing to get down to business in a realistic way. During this time the therapist saw the family in various combinations, tending to spend more and more time interviewing John separately, thus helping to form a clearer generation boundary and beginning to discuss some marital issues with the parents. At the time of writing (three months later) John continues to make satisfactory progress. (The intervention had allowed the therapy to proceed effectively and also prepared the way for Beryl's eventual leaving.) This case is an example of the kind of work that may be done using the interactional approach outlined in this unit. The approach can be applied to a wide variety of problems, not just psychiatric, but also social problems, such as delinquency and child abuse, problems with the elderly, bereavement, and divorce. It even has a part to play in the management of physical illness. It remains an open question as to whether schizophrenia, such as in the case above, should be construed according to an organic or biochemical hypothesis (as is favoured by the majority of psychiatrists) or whether it should be understood according to the interactional explanation favoured by such writers as Haley, Bateson and Palazzoli. In either case, interactional therapy offers a very promising way of handling such problems, in the absence of which most families would receive an explanation that their child was suffering from an incurable mental illness and would always remain dependent upon them or an institution. He would be given major tranquillizing drugs, with their disadvantageous side effects as well as their implicit message that one person in the system is ill and the others are well. Such an understanding can stabilize a family system in its circularities, thus maintaining the idea of illness that has become attached to the construct schizophrenia. 7 CONCLUSIONS In the final sections of the unit we have been considering the therapeutic implications of the interactional approach. This, as we stated at the beginning of the unit, was what provided the impetus for developing this theoretical approach. Yet it is also the area which is problematic for the theory. The systems approach that we outlined in section 1 is essentially a theory of stability rather than change and growth. It is not a sufficient answer to this problem to say that the systems view applies to 'disturbed' as opposed to 'normal' family processes. In therapy the task is to help people to return to their natural process of change. A number of important questions regarding the interactive approach may now be usefully reviewed. As we explore these you should try to consider to what extent these have already been taken into account by the shared construct view that we developed alongside the systems one. An important aspect of such an integrated approach was the attempt to link an analysis of people's behaviours in families with an analysis, made by the therapist, of the ways the families share their constructs about the world. A key concept we introduced in section 1 was that of homeostasis. This proposes that the family members somehow behave in ways which are resistant to changes instigated by the environment, so that their actions return to some prior 'setting'. But how and why does such resistance occur? In the case of a mechanical system, we know that this occurs because it was designed to be so by the manufacturers. In biological systems we know that homeostatic processes, such as maintenance of body temperature in the human body, have developed through evolutionary 94 processes. Here we have evoked a historical explanation in terms of evolutionary processes to account for how the system came into being. The issue of development, however, has been problematic for a systems theory view. Recently, family theorists have emphasized Bateson's ideas (1972) that families ecosystems can be compared to ecosystems (Dell, 1982; Keeney, 1979). Ecosystems are seen as continually changing and evolving but at the same time maintaining a coherence so that the changes in various parts 'fit' into an overall organization. Within such a perspective, a family coming for therapy is seen as an organized whole whose particular coherence includes a 'symptom': for example, anorexia in a daughter. The coherence and the symptom contained within it have survived or resisted all the attempts by the environment to produce change. A family with a schizophrenic son, for example, may have resisted pressures to change, such as those occasioned by children leaving home. Such a system can be seen to display regularities when we focus on a particular part (for example, the symptoms) which may be described metaphorically as maintaining homeostasis. But, when we look at the overall system, it is possible to see any pattern as fitting into a wider framework of change. Dell makes the point that when we focus on the constancy in one part of the total system we run the risk of ignoring change in the rest of the system: For example, an alcoholic or a heroin addict introduces certain constancies into his or her physiology by keeping constant the level of drug in his or her system. As a result the rest of the addict's physiology adjusts to come in line with the constancy. The longer the constancy is maintained, the more the rest of the system shifts. (Dell, 1982) This view implies a set of multiple, interlocking systems. We described earlier how families can be seen to exist within an environment which is continually changing. Rather like the rowers in a boat on a river, people in families have to paddle, sometimes quite hard, in order to stay in the same place. At times, as we described in the family life-cycle, strong pressures for change are demanded of the family. In focusing on stability in one part of the family it is also necessary to consider at the same time how the rest of the system is changing or contorting itself in order to maintain this stability. We have also employed a construct theory approach, which considers the family as operating in terms of a coherent system, organized around a set of shared constructs. This allows for a number of possible forms of homeostasis, between which the family can choose to move. The possible solutions attempted are constrained by the shared construct systems. Within such a view, the task of therapy is a creative process wherein some new inputs are given to the family so that a new reorganization can occur which does not embody the symptoms. This is a different objective from that of many other approaches, which tend to propose a particular direction of change. For example, behaviour therapy may seek to give people new skills or to remove certain types of behaviour which are seen as problematic. The emphasis in the unit has been to regard systems and the associated concepts as metaphors. Homeostasis is a metaphor which can be used to explain certain observed regularities in a system. We have also considered how regularities in behaviour can be seen to revolve around shared construings. This is a novel approach to the understanding of families, and you should challenge our ideas and compare them with what you read as you work through the rest of the course. Finally, although we have concentrated here on family processes, the systems model can be applied to any social situation. Later in the course you will read about group processes and organizations, and you should compare the theories you meet there with the systems model. Systems models have been applied to management, industry and various organizations, but you should be careful not to confuse these with the developments that have come from the family 95 literature. An important recent development has been Mara Selvini-Palazzoli's research into the problems faced by psychologists attempting to stimulate change in organizations such as schools and industry. Set reading Now read the remainder of the Reader article by Haley, 'Towards a theory of pathological symptoms' (i.e. read from the section headed 'The perverse triangle'). FURTHER READING BATESON, G. (1972) Steps to an Ecology of Mind, New York, Ballantine. HALEY, J. (1973) Uncommon Therapy: The Psychiatric Techniques of M. H. Erickson, New York and London, Norton, HALEY, J.( 1976) Problem Solving Therapy, San Francisco, Jossey Bass. HOFFMAN, L. (1981) Foundations of Family Therapy, New York, Basic Books. MINUCHIN, S. (1974) Families and Family Therapy, Harvard, Harvard University Press. SELVINI-PALAZZOLI, M. (1978) Self-starvation, New York, Jason Aronson. SELVINI-PALAZZOLI, M., BOSCOLO, L., CECCHIN, G. and PRATA, J. (1978) Paradox and Counter-paradox, New York, Jason Aronson. WATZLAWICK, P., WEAKLAND, J. and FISCH, R. (1974) Change, New York and London, Norton. REFERENCES BANNISTER, D. and BOTT, M. (1974) 'Evaluating the person', in Kline, P. (ed.) Mew Approaches to Psychological Measurement, Wiley, London. BATESON, G. (1972) Steps to an Ecology of Mind, New York, Ballantine. BATESON, G. (1979) Mind and Nature, New York, Button. DELL, P. F. (1982) 'Beyond homeostasis: toward a concept of coherence', Family Process, vol. 21, no. 1, pp. 21-41. HALEY, J. (1959) 'The family of the schizophrenic: a model system', Journal of Nervous and Mental Disorders, vol. 129, pp. 357-74. HALEY, J. (1973) Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, New York and London, Norton. HALEY, J. (1976) Problem Solving Therapy, San Francisco, Jossey Bass. 96 HALEY, J. (1967) 'Towards a theory of pathological systems', in Zuk, G. N. and Boszormenyi-Nagi, I. (eds) Family therapy and Disturbed Families, Palo Alto, California, Science and Behaviour Books. (This article is also in the Course Reader.) HALEY, J. (1980) Leaving Home, New York, McGraw-Hill. HOFFMAN, L. (1981) Foundations of Family Therapy, New York, Basic Books. JACKSON, D. (1957) 'The question of family homeostasis', Psychiatry, Quarterly Supplement, vol. 31, pp. 79-90. JACKSON, D. (1965) 'Family rules: marital quid pro quo', Archives of General Psychiatry, vol. 12, pp. 589-94. MURPHY, J., JOHN, M. and BROWN, H. (eds) (1984) Dialogues and Debates in Social Psychology, London, Lawrence Erlbaum (Course Reader). KEENEY, B. (1979) 'Ecosystemic epistemology: an alternative paradigm for diagnosis', Family Process, vol. 18, no. 2, pp. 117-29. KELLY G. A. (1955) The Psychology of Personal Constructs, vols 1-2. New York and London, Norton. MADANES, C. (1981) Strategic Family Therapy, San Francisco, Jossey Bass. MINUCHIN, S. (1974) Families and Family Therapy, Harvard, Harvard University Press. PROCTER, H. G. (1980) 'Family construct psychology: an approach to understanding and treating the family', in Walrond-Skinner, S. (ed.) Developments in Family Therapy, London, Routledge and Kegan Paul. SELVINI-PALAZZOLI, M., BOSCOLO, L., CECCHIN, G. and PRATA, J. (1978) Paradox and Counter-paradox, Now York, Jason Aronson. SELVINI-PALAZZOLI, M., BOSCOLO, L., CECCHIN, G. and PRATA, J. (1980) 'Hypothesizing - circularity - neutrality: three guidelines for the conductor of the session', Family Process, vol. 19, no. 1, pp. 3-12. (This article is in the Offprints Booklet.) STEVENS, R. (1983) Freud and Psychoanalysis, Milton Keynes, The Open University Press. WATZLAWICK, P. (1964) An Anthology of Human Communication, Palo Alto, California, Science and Behaviour Books. WATZLAWICK, P. and WEAKLAND, J. (1977) The Interactional View, New York and London, Norton. WATZLAWICK, P., WEAKLAND, J. and FISCH, R. (1974) Change, New York and London, Norton. Acknowledgements Grateful acknowledgement is made to the following sources for material used in this unit: Text S. Minuchin, Families and Family Therapy, Harvard University Press, 1974. Copyright the President and Fellows of Harvard College. Figures Figure 10 from L. Hoffman, Foundations of Family Therapy, Basic Books, 1981. 97 Index of concepts action (5) alliance (3.1) autonomy versus determinism (5) behaviour (5) boundary (1.1, Box 1) circularities (1.2) circular causality (1.1) clear boundary (2.4) coalition (3.1) complementary interaction (2.1) conflict detouring process (3.3) 'difficulties'(6.1) diffuse boundary (2.4) disengagement (2.4) dyad (2.1) dynamic equilibrium (1.1, Box 1) ecosystems (7) enmeshment (2.4) error-amplifying feedback (1.1, Box 1) error-correcting feedback (1.1, Box 1) escalation (1.1, Box 1) explicit rulings (1.2) family construct system (5.1) family life-cycle (4.1) feedback (1.1, Box 1) first order change (1.1, Box 1) hierarchy (2.2) homeostasis (1.1, Box 1) implicit family rules (1.2) inter-psychic level of analysis (Study guide) intra-psychic psychology (Study guide) levels of analysis (Study guide) linear causality (1.1) live supervision (6.8) meta-communication (6.7) meta-constructs (5.2) NEAR/FAR (2.3) paradoxical intervention (6.7) personal construct (5.1) principle of reflexivity (5.2) 'problems' (6.1) psychological distance (2.3) 'punctuation' (1.1) redundancy (1.2) refraining (6.4) restructuring (6.6) 98 rigid boundary (2.4) rules (1.2) second order change (1.1, Box 1) shared construct system (5.1) social construct (5.1) social reality (5) subsystem (1.1, Box 1) symmetrical interaction (2.1) system (1.1, Box 1) triad (3) UP/DOWN (2.2) SaiBaiBJlS diaqi PUB SlUaiUSAOW |BI30S ZZ l!Ufl 39IWH9 QNV 3Uf11in3 'A13I30S L H3018 LZ/OZ/6lim(l SdnOH9NI31d03d 9)10018 jnoiABqaqpUBsapmmi/ 9 Limn sapnmiB diaiji PUB sienpiAipui gi nun NU3QOIAI QNV 1N3I3NV :S3IU03H1 3Qnililtf 9 M0018 9j!l leuosjad in aBueqa PUB luauidoiaAao 1 1 ljun aouauadxa gnuoGfqns jo asuas BUJHCIAI Clliun uostiad B fiuiaq jo aouauadxa am 21 imn sdmsuopiaj BujdoiaAao u/oumn Ajoam uopqi JUB jo qoBO udde am :il sjaiiio BuipuBis uapun 6 liun lunoooe Ajoaqi jonjisuoa iBuosjad e :isjaqioBmpuBisjapun 81!U(l SdlHSI\IOIlV13U 9Nld013A3Q QNV 31d83da3Hi09NiaNtflSa3QNn 8)10818 Bwpueis japun jo luaiudoiaAap am L liun Aiiiuapi iBmos PUB afienfiuBi g imn afiBnfiuBijo UiaiudoiaAap am :pooisuapun Buiuioogg g jiun 9NI381VI30SV9NIIAI0338 ZM3018 uo!iBZ!|B|30S uo S8A| jaads jad fr liun ajIMBjOOSOlSJOJGBJ iBaiBoioiq PUB djiaiiaB 10 aouBAaia u am g imn iwam leuoiiGEuaiu! 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