5 cnunse

i
I,{,

All family therapists agree on the need to challenge the dysfunctional

aspectsof family homeostasis.The degreeto which the challengeshould
.be taken is a moot point,
however, and the methods and targets of the
challenge vary depending on the therapist's theoretical worldview.
Technique is the pathway to change,but it is the therapist's conceptualization of the family dynamics and the processof changethat gives the
way its direction. The effectivenessof a particular technique cannot be
evaluatedwithout an understandingof the therapist's goal. The way in
which theory prescribestherapeutic techniques is illustrated by three
positions in family therapy-the existential framework as represented
by Carl Whitaker, the strategicschool as representedby Jay Haley and
.ChloeMadanes,and the structural position.t
It
Whitaker seesthe family as a systemin which eachmember is equally
I:,1
tl - -Qqificant.
Each member must be individually changedto change the
rr,'
4 ' , tfi6re. Consequently,he challengeseach family member,und.ermining
"each person'scomfortable allegianceto the family's way of apprehend.ing life. Each individual is madeto experiencethe absurdity of accepting
the family's idiosyncratic worldview as valid.
Whitaker's sessionsseem undirected, becausehe acceptsand tracks
any family member's communication.He rarely challengesthe content
of a communication, but he does not accept it either. Any statement
tl

&)

65

presentedas completeis turned into a fragment;like James Joyce,Whitaker createsa revolution in the grammar of life. He brings up an association with his own life, an anecdoteabout his brother, a slightly different
commentanotherfamily mernbermade,or a joke: "What would he do if
God retired?" Though seemingly random, his interventions all are
directedto challengingthe meaningthat peoplegive to events.
Whitaker's assumptionseemsto be that out of his challengeto form,
creative processesin individual members as well as in the farnily as a
whole can arise. Out of this experientialsoup, a better arrangement
among family memberscan result.
Whitaker is a destroyer of crystallized forms. If a family rnember
enters a dialog,it is not long beforeWhitaker asksa third persona question that is related to the theme tangentially, if at all. The content of
family members' communicationsis stretched to touch areas that are
human universals,but which people own uneasily:rage, killing, seducing, paranoid fears,incest.All of it is presentedcasually,amid commonplace statements.
Whitaker will commenl;himself on an issue,relating a comrnunication
to another person, fantasy, or memory. He also links family members
again and again, while at the same time destroying their connections,
like a sculptor carving a wax statue with tools that are white hot.
Whitaker's therapy is dazzlingby the range of his interventions. He
uses humor, indirection, seduction,indignation, primary process,boredom, and even falling asleepas equally powerful instruments of contact
and challenge.By the end of therapy every family member has been
touched by Whitaker's distorting magic.Each member feels challg4gec!._.
misunderstood,accepted,rejected,or insulted.But he has been put in
contact with a less familiar part of himself.
Whitaker's techniques,makesenseonly within his theoretical scherna.
In this existentialformulation, the therapist is not responsiblefor monitoring the developmentof new structures,and it is not his responslbility

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Change

,/ The stra
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on represented by Haley and Madanes differs

res are goal oriented--directed toward alleviation of specificdysfunctional aspectsof the family. It is very much the
therapist'sresponsibility to monitor developmentand produceimprovement.
The strategic school seesthe family as a comp,lex.system, differentiated into hierarchically arranged subsystems.A dysfunction in one
TTIZTfKOTttV-

,4

66

Family Therapy Techniques

subsystemcan be expressedanalogicallyin another;in particular, the organizationof family membersaround the symptom is taken to be an analogical statement of dysfunctional structures.By reananging the organization around the symptom, the therapist can release isomorphic
changesin the entire rsystem.
In this strategic forrnulation, the identified patient is seenas carrying
the symptom to protect the family. At the same time, the syrnptom is
maintained by a family organization in which the family mernbers occupy incongruoushierarchies.For instance,the identified patient is in an
inferior position in relation to the family memberswho take care of him,
but he is in a superior:position by not improving under their care. The
therapeutic techniquesare directed to challengingthe heart of the dysfunctional structure: the organizationof the symptom.
The strategicschoolhas made the supervisoryholon the focu.sof their
exploration in theratrly.In their work with severely disturbed young
adults, the cornerstoneof their techniquesis the redistribution of clearly
allocated power in the family. By organizrngfamily holons so that each
one has a defined hierarchy, and by putting the heads of the executive
holons in control, they create a field in which autonomy, responsibility,
and cooperationare trilayedout.
To challengethe restrictive ways in which crystallizedfarnily systems
prescribe a view of reality to the family members,Haley and Madanes
suggestthat the patients pretend that the world is different. A depressed
husbandis to pretend he feels depressed.His wife is to judge whether he
is pretending. The control that the husband has kept over the wife, by
not improving while remaining in a powerlessposition, is changeclto a
game in which the spousesplay different power arrangements"
In a casein which a child developssymptomsof being afraid, a fearful
mother becomescon:tpetent,protecting the child from his symptom,
while in effect the child is protecting the mother from hers. The therapist asksthe mother bo pretend to be afr"aidof robbers.The child pretendsto protect her. I,low the problemof protectionis transformed.The
hierarchy of mother and child is realignedby the pretendtechrrique,for
a child protectshis rnother only in play.
These casesdemonstratehow the techniquesof the strategicschool
are governedby the t.heoreticalschema.Thesetherapistsuse many different techniquesin r:lifferentfamily situations. But the gover.ningconcept is the specificgoal for family change.

lrr

67

Change

ever, are describedwith such specificity and their intention seemsso

clear that they appealto the therapist interestedin craft. It is therefore
important to understandthat, without the strategicconceptualizationof
the meaningof dysfunctionand change,thesetechniqueslose their efed tools.
r family as an organism:a complex
re therapistunderminesthe existing
the systemtoward the developrnent
of a better functioning organization.Thus, the structural approachhas
elementsof both the existentialand the strategicframeworks.Like the
strategist,the structuralist realignssignificantorganizationsto produce
changein the entire system.And like the existentialist,the structuralist
challengesthe family's accepted reality with an orientation toward
growth. Structural family therapy partakes of the existentialigt's conl . _
. ^ , " r , , r
n
r f f
cern fortgtow_th{andthe stJglgqst',sconcernfor&]lr9
The techniquesof struwural therapy lead to family reorganizationby
challengingthe family organrzation.The rvord challenge highlights the
nature of the dialectic struggle betweenfamily and therapist within the
therapeuticsystem.The word doesnot imply harsh maneuvers,or confoontation,though at times both may be indicated. It suggestsa searc_h.
for new patterns, as well as the fact that, as in the work of Siva, goddess
of destruction, the old order must be undermined,to allow for the formation of the new.
There are three main strategiesof structural family therapy, each of
which is servedby a group of techniques.The three strategie-sare%hallenging the symptom?challengingthe family structure, and?rallenging
the family reality.
THT] SYMPTOM
Families coming to therapy after a prolonged struggle have usually
identified one farnily member as the problem. They pour out to the
therapist their struggle,the solutionsthey have tried, and the failure,of
every attempt. The therapist,however,entersthe therapeuticsituation
with the assumption that the family is wrong. The problern is not the
identified patient, but certain family interactional patterns. The solutions the family has tried are stereotypedrepetitions of ineffectivetransactions, which can only generateheightened affect without producing
change. By observing the family members' organization around the
symlitbm and the symptom bearer, the therapist may gain a "transacCHALLENGING

t16

Family Therapy Techniques

i:

tional biopsy" of the preferential responsesof the family organisrn-the

responsesthat the family is still using inappropriately to meet the curre
herapist seesthe symptom as a protective solution: the
crifice.sh:imselfto defendthe family homeostasis.The
din?-i-liffi;ly
as an organism, seesthis protection
not as a purposeful,"helpful" response,but as a reaction o_fAn orsanlgm
q4{
s. The other family members are equally symptomatic. The
trierapist's task, then, is to challengethe family's definition of the problem and the nature of their response.Challengecan be direct or indirect,
or reframe the family's view of the problem, pu
mernbers to
for
alternative
search
behavioral,cognitive,and affectiveresponses.The

The Mitchells, a farnily of professional parents with a l2-year-old gful

and a five-year-oldboy, cameto therapy becausethe boy urinates on the
floor wheneverhe is angry at his rnother.The parentshad tried a variety
of approachesto no avail, including rewards,such as involving the chitrd
in pleasurable activities, and punishments, such as withholding affection
and spanking.Both parents and child feel hopelesslydepleted,helpless,
and guilty. They are tremendouslyoverinvolvedwith each other around
the symptom.
In an initial interview held at the therapist's home, the therapist uses
his dog as a cotherapist: an expert in defining turf by urinating. He invites the child to follow the dog around the gardenand observeits techniques.
by suggestingmore destrucr than the one the boy is using:has he ever thought
n his sister'sbed and peeing in her face?Humor helps the
of s
parents regain their perspective.Now they can see the child as a relatively small five-year-oldwhosecontactingresponsesare incompetent.
The therapist then exploresalternative ways of expressingresentrnent
and disagreementin this family. He examinesthe different intensitiesof
eachparent's involvement with the symptom, the meaningthe symptom
holds for each family member,and the utilization of the symptom in the
spouseand.siblingsubsystems.The symptom is redefinedas a way of reengagingthe mother, who has recently changedher relationship with
the child and her husband.This redefinition opensup new perspectives
on the conflictual relatio:nshipbetween the spouses,the distancing between the father and son, and the privileged position of the son in the

AI+

69

Change

sibling.s-ubqystem.
As the family membersfind themselvesexplgringnew
ierritory, their mood chaBges,becomingmore intense and at the sarne
time more hopeful

b)CHALLENGINGTHH FAMILY STRUCTURE

The worldview of family membersdependsto a eat extent on therr
positions in- 9i{erent family holons. If there irGuuri"yoluu-rnt) the

there r@he

rrGmbi"-..*uy

Pdqgl::
port. tqfiagg1g ot a@$1ag-thd proximily_pgffijne
L

r and lack sup-

mernbersof

may bring fq-rylhaftern_atiyeways"qf..

giruSs.anth-o--lqns
!huhg*L-e=9li$g,
tltgt
have
been
inhibited
p.artj_sipation.
a.!49
bysubsystg"m
*4
When the therapistjoins the family,he becomesa participantin the
systemthat he is attemptingto transform.As he experiences
the farn-

"fern=
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"4p9!-.re-i
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ThisffiSxJr#*psh.Ilcates
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ily's trals_agltg.3pr
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bersvis--h-viso.nganother.Itrevealscoalitions,affiIiati-o-ns,explicitand
implicit conflicts, and the ways famdy_-ffj_eftrle1s
g1p-upJh_e_fnS_ely.es
in i,
- : _ ' ' - -

! #

coffict resolutiqn.
conflict
ieiolution: Ifld;ntiffiJ-famit
It identifies famil.y members who operate as detorileri of conflict and family membeiswho finction ai rryilghb_qgftl.-

T'Hd'ifihp
chartsthenurtqleJs,
ISIF"ffi
IJ-qlS, urd l9..3peggatg.

of the bgundaries befiileenqub,syq-t-e

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S[rQI]$!{I
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work in alternative subsystems,challengingthe famil members' own

delineation
deiine
ation of
ffi their
ffi roles
r"6Hd
and functibnS;
tunctibris
:.T1ier
ft""ffiffi
"il
strategy are Fgg4{ary ryaking, u.nbalancu,rg,
-?
taritv.
; . ., The Dexter family, for example, composedof two parents in their
thirties and two boys,.-{1ark,age nine, and Ronny, age four, came into
'therapy
becauseRoiiny ilrasseriouseczemawhich is exacerbatedby his
nstant, uncontrollabl.escr_atcfr-ing.ffi. Dexter is overinvolved with
)nny. Whenevershe pays attention to Mark, Ronny beginsto scratch,
ting his eczemaand reinvolving his mother with himself. The father, a competent teacher, has the capacity for involvement with his
children, but his wife's overinvolvementwith Ronny leaveshim in a peripheral relationship with his youngerson. He thinks that his wife is too
-*+_;.+**#*F+r''

,..^-;-....

L ;

?,I&

70

Family Therapy Techniques

involved with Ronny. Both parents, though overprotective, are concerned, child-centeredpeople. The relationship between the spousesis
somewhatdistant.
The family therapist watches Ronny's constant engagementof his
mother for a few minutes, experiencingthe e
this dyad
and the boundariesaround the dyad that excludethe fathier and Mark.
Then he organizesa task. He instructs the parentsto talk without letting
Ronny intrude. Whenever Mrs. Dexter looks at Ronny, Mr. Dexter is to
re-engageher attention.
This boundary delineation produces Ronny's usual response. He
begins to whimper, then cry, jumping .rp and down in his chair and
scratching furiously. But with the therapist's help the parents ignore
him, continuing to talk to each other. Mark, obviously the parental
child, tossesa toy to Ronny, engaginghim in a playful, slightly aggressive transaction. Soon Ronny throws the toy at Mark and runs to his
mother. Mr. Dexter attracts his wife's attention again.
At first Ronny returns to his mother every minute or so. But as she
does not respond, he begins to function differently. He explores the
room, then picks up a large toy and beginsto toss it to Mark. His motor
activity becomesless hesitant, and his scratchingceasescompletely. At
the sametime, as Mrs. Dexter's almost ticlike hovering over Ronny disappears,she becomesmore direct in her contact with her husband. He
makessomecriticism, and insteadof detouring by engagingwith Ronny,
she respondsby confronting her husband directly.
It seemsthat certain behaviorsare signaledin the overinvolved dyad
of the mother and Ronny. The disappearanceof this signalingbecauseof
the therapist's boundary delineation allows the boy's usually underutilized skills to appear.
In this situation, the therapist's intervention has changedthe family
members'contexts.An overinvolvedpair has beenslightly distanced. As
a result, Ronny movesinto participation with his older brother, forrning
a dyad that requires him to function more competently. The mother
moves from a situation in which she is exclusively a parent, nurturing
and controlling, to a conflict negotiationwith a peer in the spouseholon.
The changesin subsystemparticipation have'produced a change in
functioning, which enablescoping capacitiesto appear.
By challenglngthe rules that constrainpeople'sexperience,the therapist actualizessubmergedaspectsof their repertory. As a result, the family membersperceivethernselvesand one another as functioning in a different way. The modification of context producesa changein experience.

AA?

a1
I I

Change

Another technique for changingthe nature of involvement is to focus

the family_n9t!,p_9.{f:
experience
on_
_tlqlg4ity of b_gng,a.lt_qlffiTfib
rhda-pili;i6*pc tu;li anse'The'famnt
ni;io6
i'i.^nl; tt ; moving
"rr'
"p
them from a definition of the self as a separateentity to a definition of
the self as part of a whole.
An individual therapist tells the patient, "Change yoursel{ work with
yourself,so you will grow." The family therapist makesa statementof a
different order. Family memberscan changeonly if there is a changein
the contextswithin which they live. The family therapist's messageis,
therefore,"Help the other personchange,which wili changeyourself as
you relate to him and will changeboth of you within the holon."
(-)
I

CHALLENGINGTHE FAMILY REALITY

Patientscometo jbgtapl_bgqgqse_rcdity,
eglhgv haveconstruetedit,

eU lypeg_gljb.tupy therefore, depend on a challengeto

their constructs(
therapy postulates that the patient's
consciousreality is too narrow; there is an unconsciousworld that he
must explore.@ffitl-r"ot
suggests
that
tient has mislearnedaspectsof how to deal with his contexts.
py postu$un

M . @ . 4 ,

lates that tr4nsagti.o_"9..4!p_a!S_p;ns."&,p*en$_q.n.

md- c-o_pff_rrthe"\eay_p-e_ople
ex,gggeneareality.Thererfor",tg-gbaugelbe;a*ay-familglrnembg.ts
lq*h _at
r6gltty:e
new
wgye--qt_tp_.t-eJa_c_tiug"ujLq&mf
ily. The
used in this strategy are co.@s,.ptreical interventions, and emphasizingstrength.

ers-and;e-$gmig.eg*rt.
.fanily=-off

The cohflictual and

framing,As the-fami

ster-egtypedreality.-of
"jhg.Spik*:ru*g_ggy_

_-" differe4tly, 4-ew.possibilltles.appear.

For example,the Gilbert family, composedof a mother and father in
il \
their forties and their daughter Judy, aged 15, came to therapy because
, ,'fiAt)tas anorexig.le-ry.p$i,'The family presentation of the problem is
fhzt-they are-{Typical, normal family, with a daughter who was perfect
beforethe illnesstransformedher. For the past year they have beentrying to help their daughter,changingtheir relationship to her on the advice of friends, minister, pediatrician, and child psychiatrisF By now
they feel helplessand considerablyfrightened.
The therapist meetswith the family at lunch and they all eat together.
The therapist asksthe parentsto help their daughter survive by making
her eat. The daughter refusesto eat and respondsto her parents with a
broad range of surprisirgly sophisticatedinsults. The therapist focuses

i
I
I

Lbo

72

Family Therapy Techniques

on these insults, pointing out that the daughter is strong enough to defeat both parents. His intervention produces a reframing. The parents,
who are overinvolved with the daughter and accustomedto triangulating her in their unresolvedconflicts, close ranks. Feeling attacked and
defeated,they simultaneouslyincreasetheir distancefrom the daughter,
removing their overprotection and overcontrol. The parents and therapist together demand that tlg daughtgp,who is suddenly perceived as
strong, competent, and stubborn, monitor her olg_t-_b-ody.
This type of reconstructioncan eiicif a starttea-new look at reality, in
which the potential for changeis suddenly perceived.

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