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Contents vii
Family Narratives 64
Gender 65
Culture 66
SUMMARY 67
Family Life-Cycle Stage Emotional Process of Second-Order Changes in Family Status Required
Transition: Key Principles to Proceed Developmentally
Leaving home: single Accepting emotional and a. Differentiation of self in relation to family of origin
young adults financial responsibility b. Development of intimate peer relationships
for self c. Establishment of self in respect to work and financial
independence
The joining of families Commitment to new a. Formation of marital system
through marriage: the system b. Realignment of relationships with extended families
new couple and friends to include spouse
Families with young Accepting new members a. Adjusting marital system to make space for children
children into the system b. Joining in childrearing, financial and household tasks
c. Realignment of relationships with extended family to
include parenting and grandparenting roles
Families with adolescents Increasing flexibility of a. Shifting of parent–child relationships to permit ado-
family boundaries to lescent to move into and out of system
permit children’s b. Refocus on midlife marital and career issues
independence and c. Beginning shift toward caring for older generation
grandparents’ frailties
Launching children and Accepting a multitude of a. Renegotiation of marital system as a dyad
moving on exits from and entries b. Development of adult-to-adult relationships
into the family system c. Realignment of relationships to include in-laws and
grandchildren
d. Dealing with disabilities and death of parents (grand-
parents)
Families in later life Accepting the shifting a. Maintaining own and/or couple functioning and
generational roles interests in face of physiological decline: exploration
of new familial and social role options
b. Support for more central role of middle generation
c. Making room in the system for the wisdom and expe-
rience of the elderly, supporting the older generation
without overfunctioning for them
d. Dealing with loss of spouse, siblings, and other peers
and preparation for death
xiii
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Major Events in the History
of Family Therapy
(continued)
xv
xvi Major Events in the History of Family Therapy
(continued)
xviii Major Events in the History of Family Therapy
In this volume, Mike Nichols tells the story of family functioning of all human collectives. A major broad-
therapy—and tells it very well. It’s hard to imagine a side came from feminists who questioned the absence
more readable and informative guide to the field. of concepts of gender and power in systems thinking
Born in the late 1950s, family therapy seemed to and pointed to the distorting consequences of gender-
spring fully formed out of the heads of a group of less theory when focusing on family violence. The
seminal thinkers. Over six decades later, both theory other challenge concerned the connection between
and practice show the uncertainties and doubts that theory and practice: a challenge to the imposition of
define maturity. But in the beginning—as the story- systems theory as the basis for therapeutic practice.
tellers say—there was Gregory Bateson on the West The very techniques that once defined the field were
Coast, a tall, clean-shaven, angular intellectual, who called into question. Inevitably, the field began to re-
saw families as systems, carriers of ideas. On the East open for examination of its old taboos: the individual,
Coast was Nathan Ackerman, short, bearded, portly, intrapsychic life, emotions, biology, the past, and the
the quintessential charismatic healer, who saw fam- particular place of the family in culture and society.
ilies as collections of individuals struggling to bal- As is always characteristic of an official science,
ance feelings, irrationalities, and desires. Bateson and the field tried to preserve established concepts while
Ackerman complemented each other perfectly, the
a pragmatic attention to specific cases was demand-
Don Quixote and Sancho Panza of the family systems ing new and specific responses. As a result, today we
revolution. have an official family therapy that claims direct de-
For all the diversity of the 1960s that saw the new scendance from Bateson and a multitude of excellent
clinical practice called family therapy take a variety practitioners doing sensitive and effective work that is
of names—systemic, strategic, structural, Bowenian, frequently quite different from what systems theory
experiential—there was also a remarkable solidarity prescribes.
in the shared beliefs that defined the field. I see the therapeutic process as an encounter between
As family therapy succeeded and expanded, it distinct interpersonal cultures. Real respect for clients
was extended to encompass different client popula- and their integrity can allow therapists to be other than
tions, with specific interventions for various special fearfully cautious, can encourage them to be direct and
groups—clients with drug addictions, hospitalized authentic—respectful and compassionate—but also at
psychiatric patients, the welfare population, violent times honest and challenging.
families, and so on. All posed their own complexities. This conception of the therapist as an active
Practitioners responded to this expanded family ther- knower—of himself or herself and of the different
apy with an array of new approaches, some of which family members—is very different from the neutral
even questioned the fundamental allegiance to sys- therapist of the constructivists. But, of course, these
tems thinking. two prototypes are entirely too simplified. Most prac-
The challenges to systems theory (the official sci- titioners fall somewhere between these two poles of
ence of the time) took two forms. One was purely the- neutrality and decisiveness.
oretical: a challenge to the assumption that systemic The choice between action and interventionism,
thinking was a universal framework, applicable to the on the one hand, and meaning and conversation,
xxi
xxii Foreword
on the other, is but one of the questions the field is ideas and techniques that make family therapy such
grappling with today; there are many others. Are the an exciting enterprise. Dr. Nichols has managed to
norms of human behavior universal, or are they cultur- be comprehensive without becoming tedious. Per-
ally constructed products of political and ideological haps the secret is the engaging style of his writing,
constraint? How do we become experts? How do we or perhaps it is how he avoids getting lost in abstrac-
know what we know? Can we influence people? Can tion while keeping a clear focus on clinical practice.
we not influence them? How do we know that we are In any case, this superb book has long set the standard
not simply agents of social control? How do we know of excellence as the best introduction and guide to the
that we are accomplishing anything at all? practice of family therapy.
These questions and the rich history and contem-
porary practice of family therapy are explored in
Family Therapy: Concepts and Methods. It is a thor- Salvador Minuchin, M.D.
ough and thoughtful, fair and balanced guide to the Boca Raton, Florida
Preface
One thing that sometimes gets lost in academic dis- they click on the icon and the quiz appears. The
cussions of family therapy is the feeling of accom- first one prompts them to test their knowledge of
plishment that comes from sitting down with an chapter concepts by taking a multiple-choice quiz.
unhappy family and being able to help them. Begin-
The second quiz icon prompts them to apply their
ning therapists are understandably anxious and not
knowledge of chapter concepts by responding to
sure they’ll know how to proceed. (“How do you
open-ended questions by typing their response and
get all of them to come in?”) Veterans often speak
submitting it for immediate feedback. These self-
in abstractions. They have opinions and discuss big
assessments can reinforce understanding of key
issues—postmodernism, managed care, second-order
chapter concepts and support application of newly
cybernetics. While it’s tempting to use this space to
learned content.
say Important Things, I prefer to be a little more per-
sonal. Treating troubled families has given me the
greatest satisfaction imaginable, and I hope that the
same is or will be true for you. Content Changes in the
New Edition
♦ New section on the impact of the Affordable Care Act
New to This Edition ♦ Recommendations for establishing a fee-for-service
private practice
In this eleventh edition of Family Therapy: Concepts ♦ Revised and expanded section on attachment
and Methods, I’ve tried to describe the full scope of theory
family therapy—its rich history, the classic schools, ♦ Questions to ask when doing a genogram
the latest developments—but with increasing empha- ♦ More specific interventions from the MRI
sis on clinical practice. There are a lot of changes in approach
this edition: ♦ Detailed guidelines for making a structural family
therapy assessment
New Digital Enhancements ♦ New section with guidelines on using family
sculpting
in the Pearson eText ♦ More specific techniques used in object relations
family therapy
♦ Videos: Links to video clips of therapists have
♦ Expanded section on spirituality and religion
been embedded for students to view throughout
♦ Expanded and updated section on families and
the chapters of the Pearson eText. Students are
technology
prompted to reflect on and analyze the videos via
♦ Guidelines for therapeutic letter writing
an accompanying question.
♦ New research chapter including a discussion of
♦ Chapter Quizzes: At the end of each chapter why research has failed to influence practice and
Summary, students will find two self-assessments suggestions for bridging the research-practice gap
marked by a checkmark icon. In the Pearson eText, ♦ New case studies
xxiii
xxiv Preface
Instructor Supplements who went out of their way to help me prepare this
eleventh edition were Yvonne Dolan, Jerome Price,
An instructor’s manual, test bank, and PowerPoint Deborah Luepnitz, William Madsen, Frank Dattilio,
slides are available to accompany this text. They can be Vicki Dickerson, Douglas Breunlin, and Salvador
downloaded at www.pearsonhighered.com/educator. Minuchin. And I owe a huge debt of gratitude to Sean
Davis for his extensive and thoughtful contributions
to this edition. Sean has the rare combination of ac-
Acknowledgments ademic smarts and clinical sophistication that makes
his perspective so valuable. To paraphrase John, Paul,
Albert Einstein once said, “If you want to learn about George, and Ringo, I get by with a lot of help from my
physics, pay attention to what physicists do, not what friends—and I thank them one and all. I am especially
they say they do.” When you read about therapy, it can grateful to Julie Peters at Pearson for making a hard
be hard to see past the jargon and political packaging job easier.
to the essential ideas and practices. So in preparing Finally, I would like to thank my postgraduate
this edition, I’ve traveled widely to visit and observe instructors in family life: my wife, Melody, and my
actual sessions of the leading practitioners. I’ve also children, Sandy and Paul. In the brief span of forty-five
invited several master therapists to share some of their years, Melody has seen me grow from a shy young
best case studies with you. The result is a more prag- man, totally ignorant of how to be a husband and
matic, clinical focus. I hope you like it. father, to a shy middle-aged man, still bewildered and
So many people have contributed to my develop- still trying. My children never cease to amaze me. If
ment as a family therapist and to the writing of this in my wildest dreams I had imagined children to love
book that it is impossible to thank them all. But I would and be proud of, I wouldn’t even have come close to
like to single out a few. To the people who taught me children as fine as Sandy and Paul.
family therapy—Lyman Wynne, Murray Bowen, and
Salvador Minuchin—thank you. Some of the people M. P. N.
I n t r o d u c t i o n
T
here wasn’t much information on the
intake sheet. Just a name, Holly Roberts,
the fact that she was a senior in college, The
Foundations
and her presenting complaint: “trouble making
decisions.”
The first thing Holly said when she sat down
was, “I’m not sure I need to be here. You prob- of Family
ably have a lot of people who need help more
than I do.” Then she started to cry.
Therapy
It was springtime. The tulips were up, the
trees were turning leafy green, and purple Leaving Home
clumps of lilacs perfumed the air. Life and all its
possibilities stretched out before her, but Holly
was naggingly, unaccountably depressed.
The decision Holly was having trouble making
was what to do after graduation. The more she
tried to figure it out, the less able she was to
concentrate. She started sleeping late, missing
classes. Finally, her roommate talked her into
going to the counseling center. “I wouldn’t have
come,” Holly said. “I can take care of my own
problems.”
I was into cathartic therapy back then. Most
people have stories to tell and tears to shed.
Some of the stories, I suspected, were dramatized
to elicit sympathy. We seem to give ourselves
permission to cry only with some very accept-
able excuse. Of all the human emotions we’re
ashamed of, feeling sorry for yourself tops the list.
I didn’t know what was behind Holly’s depres-
sion, but I was sure I could help. I felt comforta-
ble with depression. Ever since my senior year in
high school when my friend Alex died, I’d been
a little depressed myself.
♦ ♦ ♦
After Alex died, the rest of the summer was a
dark blur. I cried a lot. And I got mad whenever any-
body suggested that life goes on. Alex’s minister said
that his death wasn’t really a tragedy because now
“Alex was with God in heaven.” I wanted to scream,
1
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Vera had not been wonderful. It is difficult to be wonderful when
your husband has killed himself because he loved another woman
and you did not die in childbirth to let him marry her.
“It’s dreadful,” moaned Jenny. Then suddenly she wondered if
Gervase knew the worst. There was a look of bright peace in his eyes
which seemed to show that he was facing sorrow without humiliation
or fear.
“Did Dr. Mount tell you that—tell you exactly how Peter died?”
“He told me he had been killed accidentally out shooting. He gave
me no details—he couldn’t wait more than a minute.”
“Oh, my dear, it was much worse than that....”
She saw that once again she would have to “break it” to somebody.
It was easier telling Gervase than it had been to tell the others, for he
did not cry out or protest, but when she had finished she saw that his
eyes had lost their bright peace.
Doris was sobbing again, uncontrollably.
“The two of them gone—first Peter and then Father. To think that
Peter should have gone first.... Thank God Father didn’t know! He
didn’t know anybody, Gervase—the last person he recognised was
me. That will always be a comfort to me, though it was so dreadful....
I went into the library, and found him all huddled there, alone ... and
I said ‘Are you ill, Father?’—and he said ‘Get out’—and now, Gervase,
you’re the head of the family—you’re Sir Gervase Alard.”
“We’ll talk that over later. At present I must go and see Mother.”
“But you’re not going to back out of it—you’re not going to leave us
in the lurch.”
“I hope I shan’t leave anybody in the lurch,” he replied rather
irritably, “but there are lots of more important things than that to
settle now. Where is Mother, Jenny?”
“She’s upstairs in Father’s dressing-room.”
She noticed that he looked very white and tired, and realised that
he must have been travelling for the greater part of the night.
“Are you hungry, dear? Won’t you eat something before you go
up?”
“No thank you—I don’t want anything to eat. But might I have a
cup of tea?”
“Speller’s making that upstairs, so come along.”
They were halfway up, and had drawn a little ahead of Doris, when
he bent to her and whispered—
“Does Stella know?”
“Yes—Dr. Mount was on his way home when you met him.”
“Oh, I’m glad.”
So he, too, perhaps thought Stella might be the reason....
The little dressing-room was full of people. Ben Godfrey was there,
the son-in-law and the man of the house till Gervase came. Mr.
Williams was there too, summoned by Rose at a seasonable hour. He
was sitting beside Lady Alard, who had now begun to look old and
broken, and was trying to comfort her with a picture of her husband
and son in some nebulous Paradisaical state exclusive to Anglican
theology. He looked up rather protestingly at the sight of Gervase,
whose habit suggested rival consolations and a less good-natured
eschatology. But young Alard had not come to his mother as a
religious, but as her son. He went up to her, and apparently oblivious
of everyone else, knelt down beside her and hid his face in her lap.
“Oh, Mummy—it’s too terrible—comfort me.”
His sisters were surprised, Ben Godfrey was embarrassed, Rose
and Mr. Williams tactfully looked another way. But Lady Alard’s face
lit up with almost a look of happiness. She put her arms round him,
hugging his dark cropped head against her bosom, and for the first
time seemed comforted.
§ 26
The Mounts’ little servant had gone to bed by the time Stella came
home from church, so she did not hear till the next morning of the
message from Starvecrow. Her father had rung her up earlier in the
evening to say that he would probably not be home that night; and
she was not to sit up for him. So she carefully bolted both the doors,
looked to see if the kitchen fire was raked out, pulled down a blind or
two, and went upstairs.
She was not sorry to be alone, for her mind was still wandering in
the dark church she had left ... coal black, without one glimmer of
light, except the candle which had shown for a moment behind the
altar and then flickered out in the draughts of the sanctuary. Spring
by spring the drama of the Passion searched the deep places of her
heart. The office of Tenebrae seemed to stand mysteriously apart
from the other offices and rites of the church, being less a showing
forth of the outward events of man’s redemption than of the thoughts
of the Redeemer’s heart.... “He came, a man, to a deep heart, that is
to a secret heart, exposing His manhood to human view.”
Throughout those sad nocturnes she seemed to have been looking
down into that Deep Heart, watching its agony in its betrayal and its
forsaking, watching it brood on the scriptures its anguish had
fulfilled.... “From the lamentations of Jeremiah the Prophet” ...
watching it comfort itself with the human songs of God’s human
lovers, psalms of steadfastness and praise—then in the Responds
breaking once more into its woe—a sorrowful dialogue with itself
—“Judas, that wicked trader, sold his Lord with a kiss”—“It had been
good for that man if he had not been born” ... “O my choicest vine, I
have planted thee. How art thou turned to bitterness” ... “Are ye
come out against a thief with swords and staves for to take me?” ... “I
have delivered my beloved into the hand of the wicked, and my
inheritance is become unto me as a lion in the wood”—“My pleasant
portion is desolate, and being desolate it crieth after me.”
Through psalm and lesson, antiphon and response, the Deep Heart
went down into the final darkness. It was swallowed up, all but its
last, inmost point of light—and that too was hidden for a time ...
“keeping His divinity hidden within, concealing the form of God.” In
the darkness His family knelt and prayed Him to behold them; then
for a few brief moments came the showing of the light, the light
which had not been extinguished but hidden, and now for a few
moments gleamed again.
It was all to the credit of Stella’s imagination that she could make a
spiritual adventure out of Tenebrae as sung in Vinehall church. The
choir of eight small boys and three hoarse young men was rather a
hindrance than an aid to devotion, nor was there anything
particularly inspiring in the congregation itself, sitting on and on
through the long-drawn nocturnes in unflagging patience, for the
final reward of seeing the lights go out. Even this was an uncertain
rite, for old Mr. Bream, the sacristan, occasionally dozed at the end
of a psalm with the result that he once had three candles over at the
Benedictus; and another time he had let the Christ candle go out in
the draught at the back of the Altar and was unable to show it at the
end, though his hoarse entreaties for a match were audible at the
bottom of the church. But Stella loved the feeling of this His family
sitting down and watching Him there in stolid wonder. She loved
their broad backs, the shoulders of man and girl touching over a
book, the children sleeping against their mothers, to be roused for
the final thrill of darkness. She was conscious also of an indefinable
atmosphere of sympathy, as of the poor sharing the sorrows of the
Poor, and drawn terribly close to this suffering human Heart, whose
sorrows they could perhaps understand better than the well-
educated and well-to-do. She felt herself more at ease in such
surroundings than in others of more sophisticated devotion, and on
leaving the church was indignant with an unknown lady who
breathed into her ear that she’d seen it better done at St. John
Lateran.
Up in her bedroom, taking the pins out of her hair, her mind still
lingered over the office. Perhaps Gervase was singing it now, far
away at Thunders Abbey.... She must write to Gervase soon, and tell
him how much happier she had been of late. During the last few
weeks a kind of tranquillity had come, she had lost that sense of
being in the wrong with Peter, of having failed him by going away.
She saw that she was right, and that she had hated herself for that
very reason of being in the right when poor Peter whom she loved
was in the wrong. But her being in the right would probably be more
help to him at the last than if she had put herself in the wrong for his
dear sake.
“Judas the wicked trader
Sold his Lord with a kiss.
It had been good for that man
If he had not been born.”
She too might have sold her Lord with a kiss. She wondered how
often kisses were given as His price—kisses which should have been
His joy given as the token of His betrayal. She might have given such
a token if He had not preserved her, delivered her from the snare of
Peter’s arms ... oh, that Peter’s arms should be a snare ... but such he
himself had made them. She had not seen him for a long time now—a
whole fortnight at least; and in less than another fortnight she would
be gone.... He was keeping away from her, and would probably keep
away until the end. Then once more he would see Vera, his wife,
holding their child in her arms ... and surely then he would go back.
Probably in a few days too he would be Sir Peter Alard, Squire of
Conster, head of the house ... then he would be thankful that he had
not entangled himself with Stella Mount—he would be grateful to
her, perhaps....
“For I have delivered my beloved into the hand of the wicked,
And my inheritance is become unto me as a lion in the wood
My pleasant portion is desolate—
And, being desolate,—it crieth after me.”