Professional Documents
Culture Documents
Intensity
Intensity
nsity
Families are not donkeys.any more than therapists are farmers. But
the old joke has a familiar ring to therapists. In enacting the family sce-
nario and in intervening to produce change,t
em of across.
The therapist'sinterventioncan comparedto an aria. Hitting notes
is not enough.The aria must also be heard beyond the first four rows. In
, "volume" is found not in decibelsbut in the
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IL7 Intensity
they may not assimilateit into their cognitive schemaas new inforrna-
tion. If new information requires the acknowledgmentof "difference,"
famiiy membersmay hear what the therapist saysas if it were identical
or similar to what they have alwaysheard in the family. Thus the thera-
pistmayhavegainedtheirattention,andtheymayeve@
-not
hear
Families differ in the degreeto which they demandloyalty to the farn-
ily reality, and a therapist's intensity of messagewill need to vary ac-
il cordingto what is beingchallenged.Sometimessimplecommunications
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afe intense enough,Wtiereasoiher situaiions require high-intensity cri-
1
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t sis.
characteristicsof the th-erap a significant variable in the de-
ty. ertain ts can develop great drama with
very soft interventions, ers require a high level of involve-
ment to achieveintensi have different ways of respond-
ing to the therapist's message. ho for transforrna-
tion may accept the therapist's alternative as a supportive push in the
direction that they are willing to go malseern to
"r,y*"y.@14@es
accept the therapist's messaggbut in fact absorb it into their pTffius
t lu rtr{@Qpenly resist Lhechans.e.A
therapist who has been schooledto pay attention only to the content of
messagesmay be so impressedby the "truth" of his interpretation that
he fails to recognizethat the family membershave simply deflectedor
assimilatedhis messagewithout gaining new information.
Cognitive constructions per se are rarely powerful enough to spark
family change.Nonetheless,therapists are frequently satisfied that a
messagehas been received just because it has been sent. But a thera=
peutic messagemust be "recognized"by family members,meaning that
i em to experi-
encethings in new ways.Therapistsmust learn to go beyondthe truth of
an interpretation to its effectiveness.
The
tion of the feedba.k fto
[.
Tven when therapists recognize the ineffectiveness of their interven-
tionsandwanttochangetl'@g*gtheirintensity,theymayat
times be handicappedb@les oJ:@)Therapists, like their clients,
have beentrained sincechililh6-odin the appropriateresponseto people:
respectand acceptanceof their idiosyncrasies. Besides,therapists and
family members belong to the same culture. They respond to the im-
plicit rules of how to behavein situations in which peopletransact with
118 Family Therapy Techniques
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119 Intensitv
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Hshmantbeginsthe sessionby asking dirt ,rnt *,.,"o
ytry the enr.,pl,e
The man lightly passesoff his oversleepfrg' "w.
didn't move out be-
causeI oversiept.I forgot we were goingtoLove.,,
@@ ald--hisnonchalantat-
titude as a repetition of a life patternJhu
trolled b
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The move was somethingthat had been ptun".J
for months. Further-
rnore' the couple and his parents had been busy readying the place for
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I Family Therapy Techniques
wantsto move out alone.Michael starts to cry: "No, I won't let you
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During the six months of treatment, the family have donewell. The par-
ents have pulled together, and Miriam has gained weight as well as
making progresstoward becomingmore autonomous.But in spite of
Miriam's improvement, t;hefamily's attention has continued.to be riv-
eted on her eating.Their failure to leave this issuehas made mealtimes
the continuedsceneof a power strugglebetweenparentsand daughter.
This past week Miriam lost four pounds.The family is very worrieJ, and
sam scott, the therapist,has requesteda consultation.
The consultant decides to remove eating as a bone of contention so
that the power struggleover it can stop.
o.I,Moiu tvtiti *iU
er ever k b the ts her weieht *
causefor concerq.Othelwise her w t griU b" her business,and the
therapist will be the only other know what it is. Althoueh the
fvith the consultant. he knows from ex he
also needs(tttiriam\tretn to
This requiresa s m terms
behav-
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122 Family Therapy Techniques
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Miriam: In me.
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t
i Minuchin (gentlypinching someshin on Miriam's arm\: Is this fat vour
lt lt
il
fat?
l,
I Miriam: Yeah.
Minuchiu Yeah. so why do they tell you what to eat? Is it right that
your father tells you what to put in your mouth?
Miriam: I guessit is right.
Minuchin; No. ft's wrong. It's wrong. It's your mouth.
Miriam: Yeah.
Minuchin' can you open your mouth? open it. (Miriam slowly opens,
closes,then opens her m.outh.)close it. open it. can you bite your
lips? (Miriam does this.l It's your mouth. when you eat, will you eat
by yourself the food that you want? And then when you come here,
you will go with the therapist to weigh yourself. (picks up father's
hand.) Who's hand is this one?
Miriam: My dad's.
Minuchin; You are certain it's your dad's? (Lifts Miriam's hand.) And,
whosehand is thisi'
Miriam: Mine.
Minuchin: You are certain? okay, so it's your body, you will feed it.
How old are you?
Miriam: Twenty.
Minuchin' Does your father need to tell you what to eat?
Miriam: No.
Minuchin: Does your mom?
Miriam: No.
I
. a rigid family system" The humor adds intensity to the message.
I
, ol\.r.\ n \t( A similar technique is used in the Hanson family when the therapist
k'11\ tr v I
,t asksAlan if he has two hands.However, in that case,instead of accom-
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panying the repetition with gentle humor, the therapist stands up, de-
creasesthe distance between hirnself and the father-son dyad, and
adopts a serioustone of voice to convey that the situation is one of the
utmost gravity. te
for the particular situation.
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123 Intensity
REPETITION OF ISOMORPHICTRANSACTIONS
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124 Family Therapy Techniques
ily. Pauline says that she does not shake hands. The consultant intro-
duceshimself to the mother, who shakeshands.Then Pauline saysthar
she can shake hands with him also,which they do.
Mother: I don't usueillyshake hands, and I think she took after me.
Minuchin (to Pautine): How old are vou?
Pauline: Eleven.
Minuchin: And you talk?
Pauline: Yes.
Minuchin: But your mommy talks for you sometimes?
Pauline: Sometimes.
Minuchin: Like just now?
Pauline: Yes.
Minuchin: Now, I will ask again the samequestion.why did you shake
hands with me now?
Pq,uline:Well-
Minuchin; Why?
Pauline: Becausemy mother did.
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ll The therapist he sessionand
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il framesit in such The closeness
.tl li betweenthe mot -'dpatient is highlighted; the bound_
il aries between the familial and the outside world are underlined; and at
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the sametime, the therapist beginsto focus on the identified patient, ac-
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tivating her. This small d
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,l iving it
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'lI the real problem in the famil,y . The thera-
il
pist ns to track this issue.
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Minuchin (to Tom): I noticed how closepauline is to Mother and how
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closeMother is to Pauline.Is ihat true in other situations?
Tom: Yeah. Even at home, they're very close.
Minuchin: To the point at which Paulinebehaveslike Mother behaves?
Tom: Somewhat,yeahr.Becauseif, say,her mother'supstairsasleepand
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I Paulinehasn't beendownstairsfor a long time and she hasn't seenher
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I mother, or what not, she'll want to know if the mother's upstairsor did
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, she go to the store,or vice versa.
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Minuchin (to Dauiil; How old are vou?
i Dauid: Thirteen and a half.
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125 Intensity
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726 Family Therapy Techniques
theobservation
of ctoseness
to ;# llr"#TlJ#u, of theidentified
pa-
tient. Ten minutes later, while Jim is telling about an incident in which
he took Pauline to the intensive care unit, the mother begins to talk
about Pauline'shairdo, and the therapist againfocuseson this particular
transaction as another instance of the mother's encroachmentinto the
patient's self-definition.
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t27 Intensity
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I28 Family Therapy Techniques
d,
e child,s abili est infor
differentiate herself from her mother.
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131 Intensity
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132 Family Therapy Techniques
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133 Intensity
and The therapist moves the farnily's frame from their concentration on
ach how to help a sick daughterto the questionof how the daughter behaves
nis and affects them. This issue has disappeared before the dramatie
the shadow cast by the serrioussymptom. For the next hour, the mainte-
rsis nance of this focus brings out hidden family dynamics.
)os-
'naI
Gina: Well, I didn't do it on purposejust to get you angry.
not
Minuchin (to mother); I want you to explorethe way in which she doesit
cist
againstyou, becausen think that a lot of the things that she doesare
,fls-
related to you.
bit-
be-
)ur. The therapist maintains the focus. The mother then accolnmodates
ual the therapist.
Mother: Ah-I'll tell you one thing that really bugsme is when I knock
;of on your door and you're on the other side of the door and you pur-
rtic poselydon't answer.I use the word "purposely" on purpose,because
rfe- that's the messagethat I get.
bhe Gina: BecauseI know that you are going to knock and open the door.
;in Mother: But I don't. I stand out there and I wait for you to answerthe
ers door.
;elf Gina: Yeah, but when I go "what," you open the door. what good is
that?
lgs Mother: we knock on the door, Gina, and we ask if you are there, and
when you don't answer,we knock a secondtime, and then we openthe
re- door. Do you know why?
292,
134 Family TherarpyTechniques
Gina: Still, when I say "what," you open the door. I might
be dressingor
something.I like to have my privacy, you know.
Mother: The reasonwhy we cornein after we knock the
secondtime-
and I say "we" becauseDaddy does the same thing-is
becauseone
morning the window was open and you were gone.
Minuchin: Do not include your husbandbecausehe has
his own voice.
Mother: okay, that's the reason why I do it-and because
a couple of
weeks ago' you were talking about doing things to yourself-suicidal
tendencies.I never know what to expectbehind that closed
door be-
causeI feel that you trave manipulated me into a corner
of feal, and I
resenryou for doing that, and I-I get the feeling that I am
helpless,at
times, that I'm at your mercy, and.that's not right-not the
way par_
ents should be-mothers and daughtersshould be.
Minuchin (to mother): you are being very helpless,and you are grving
Gina a lot of power that she doesn't know what to do with. Continue
talking about the kind of things that she is doing to you that you
don,t
like, that you find disrespectful,and that disturb vou.
Mother: one of the things that bothers me very rnuch is the wav
in
which you curse.I don't like that at all.
Gina: I get mad. Kids do it in school,so r get it from them.
Mother: I don't care whether they do it in schoolor not. I d.on,twant you
to do it at home.
Gina: And you do it, too, so why-
Mother: So what! I'm not 14 yearsold.
Gina: Well, you still do it.
Mother: That has nothing to do with what we are talking about. I don,t
like it when you do it at home; I don't like when you answerme back.
Did you like it last night at the table when I hit you? was that nice?
Gina: I don't care!
Mother: well, I'm telling you that as long as you pursuea courseof being
disrespectful,that you're going to expect some kind of flack, because
I'm not going to do that. It's fine for you to have privacy and rights
of
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135 Intensity
ce.
;-like when f can't find anything
rgemy kitchen.
Gina: Well, you never clean it, so I'm
the o'ly oo" that cleansit--
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136 Family Therapy Techniques
Father (to wife): All right, I'll tell you. I can see
Gina,spoint about call-
ing her namesand swearing.I can seethat, and I'mlust
as guilty as
you are, maybe more so.
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137 Intensity
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138 Family Therapy Techniques
Now all the participants have played their part in the farnily drama.
The father enters into the conflict by first disqualifying his wife and then
taking her side. The grandmother first challengesthe granddaughter,
but then sideswith her and criticizesher own daughter'sfunctioning as
a
mother. The therapist, by keepinghimself out of the transactions,main-
taining the focus, directing the entranceof the participants, and length-
ening the time of their involvement, has increasedthe intensity of con-
flict in a family of conflict diffirsers. Half an hour later, after several
repetitions, Gina's position as the family weathervanehas becomeclear.
CHANGING TTTEDISTANCE
Family members develop through life a sense of the .,appropriate',
distance to keep from each other. There is an apocryphal story about
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139 Intensity
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stasis' By resisting the system's induction,
a therapist brings intensity
into therapy.
some of the techniquesused by carr
whitaker as an unmovabre
therapist are in this vein, as is his concern
at the beginning of therapy
about winning the battle for leadership.
This battle can start even before
he has seen the farnj.ry,in the discurrion
over the terephoneabout the
number of participants in the session.
Although instancesof not being
pulled by the family system are sometimes
heroic or dramatic, they are
also frequently of the most undramatic
nature, sinee the resistanceof
the therapist to this put is continuous
throughout therapy.
For instanee, the wilriams couple were
in- therapy for two months,
during which time they made .or,.id"rubre progress
in dearingwith their
difficulties. They were able, in fact, to get
beyond the point where in the
past they usually diffused their difficultie,
UV irrrrolving a third person,
and could now bring some of their disputes
to the point of resorution.
Then one week the wife calls the therapist
and saysshe would like to
speakto him aloneat the beginningof the
next session,and the therapist
agrees'The wife and therapist retire to his
office at the start of the ses-
sion while the husband waits in the lobby.
and12.rhe husband
tefttwoyearsago,
::i :if::..l1oi:l,,usu.:
life has beenexrremerv
e q6rv,
lt l1 [4rp,
r o
with no fixed duties or rules for anyone.
The mother, a young-lookingwoman dressed jeans
in and a tee shirt
which says "Grateful Dead," sits slouchedin
her chair like the children.
In fact, one has to do a doubletake to ascertain
that sheis not just one of
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