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PATHOLOGIC TRIANGLES

Pathologic triangles are at the heart of several family therapy explanations of behavior disorder. Among these, Bowen’s is the most elegant. Bowen explained how when two people are in conflict, the one who experiences the most anxiety will triangle in a third person. This model not only provides an explanation of systems pathology but also serves as a warning: As long as a therapist remains allied with one party in an emotional conflict, he or she is part of the problem. In psychoanalytic theory, oedipal conflicts are seen as the root of neurosis. Here the triangle originates in family interactions but becomes lodged in the individual psyche. A mother’s tenderness may be seductive and a father’s jeal ousy threatening, but the wish to do away with the father and possess the mother is a product of fantasy. Pathological fixation of this conflict may be caused by developments in the outer space of the family, but the conflict lives in the inner space of a child’s mind. Structural family theory is based on triangular con figurations in which a dysfunctional boundary between two subsystems is the reciprocal of a boundary with a third. A father and son’s enmeshment reflects the father and mother’s disengagement; a single mother’s disengagement from her children is the counterpart of her overinvolvement outside the family. Structural theory also uses the concept of pathological triangles to explain conflict-detouring triads, whereby parents divert their conflict onto a child. Minuchin, Rosman, and Baker (1978) have even demon strated that physiological changes occur when parents in conflict transmit their stress to psychosomatic children. Strategic therapists typically work with a dyadic model, in which one individual’s symptoms are main tained by others’ efforts to resolve them. Haley and Selvini Palazzoli, however, used a triangular model in the form of cross-generational coalitions. These “perverse triangles,” as Haley (1977) called them, occur when a parent and child collude in covert opposition to the other parent. Triangular functioning is less central to the newer models because they’re not concerned with how families develop problems. It might even be argued that ignoring family dynamics is one of the strengths of narrative and solution-focused approaches, if doing so helps these thera pists zero in on the constricting habits of thought they’re interested in. It might also be said, however, that ignor ing family dynamics is a weakness of these approaches, especially in cases where family conflict isn’t just going to disappear because family members work together to solve a common problem.

DECISIVE INTERVENTION

Family therapists use a vast array of techniques—some dictated by their model, others by the therapist’s personal ity and experience. Even if we limited our attention to the techniques specific to each of the schools, the list would be long and confusing. Some techniques are used by virtually everyone—asking questions, reflecting feelings, clarifying communication—and this list has been growing as the field has become more integrated. Each school, however, relies on one or two techniques that are unique and decisive. In psychoanalytic therapy there are two defini tive techniques. The first of these, interpretation, is well known but not well understood. Properly used, interpreta tion refers to elucidating unconscious meaning. It doesn’t mean statements of opinion (“You need to express your feelings before you can really be close”), advice (“As long as you continue writing to him, the affair isn’t over”), the ory (“Some of the reasons you were attracted to him were based on unconscious needs”), or confrontations (“You said you didn’t care, but you were really angry”). Interpre tations are statements of unconscious meaning: “You’ve been complaining about your son’s arguing with you all the time. Based on what you’ve said previously, I think some of your anger is deflected from your husband. He does the same thing, but you’re afraid to tell him so, and that’s why you get so mad at your son.” The second decisive technique in analytic treat ment is silence. A therapist’s silence permits him or her to discover what’s on a patient’s mind and to test a family’s resources; it also lends force to the eventual interpretations. When a therapist is silent, family members talk, following their own thoughts rather than responding to the therapist. When they learn that the therapist won’t interrupt, they respond to one another. This produces a wealth of informa tion that might not otherwise emerge. If a father begins by saying, “The problem is my depression,” and the therapist immediately asks, “How long have you been depressed?” he or she may not discover what thoughts are associated in the man’s mind with his depression or how the man’s partner responds to his complaint. The decisive technique in experiential therapy is confrontation. Confrontations are designed to provoke emotional reactions and are often blunt. It isn’t unusual for experiential therapists to tell clients to shut up or to mock them for being insincere. Confrontations are often combined with personal disclosure, the second signature technique of this school. Experientialists use themselves as emotionally expressive models. Finally, most experiential therapists also use structured exercises. These include role playing, psychodrama, sculpting, and family drawings. The rationale for these techniques is that they stimulate emo tional experiencing; the drawback is that they can be arti ficial. Family members may get something off their chests in a structured exercise but may not transfer this to their interactions at home. Most people associate reinforcement with behav ior therapy, but reinforcement isn’t a technique used in cognitive-behavioral family therapy; observation and teaching are the vehicles of this approach. Behavioralists begin by observing the contingencies of reinforcement. Their aim is to discover the antecedents and consequences of problem behavior. Once they’ve completed a functional analysis of behavior, they become instructors, teaching families how they inadvertently reinforce undesirable behavior. As teachers, their most useful lesson is the use of positive control. They teach parents that it’s more effective to reward good behavior than to punish bad behavior; they teach married couples to substitute being nice to each other for their usual bickering. Positive control—rewarding desirable behavior—is one of the most useful principles in psychotherapy. It’s a valuable lesson for families and for therapists. Therapists, like parents, tend to chide their charges for mistakes; unfor tunately, if you’re told you’re suppressing your feelings, 240 Part 4 • The Evaluation of Family Therapy spoiling your children, or using coercive control, you’re apt to feel picked on and put down. Although it may be necessary to point out some mistakes, it’s more effective to concentrate on praising the positive aspects of clients’ behavior. As behavior therapists have paid increasing attention to cognition, they have endeavored to uncover and chal lenge assumptions that underlie unproductive behavior. That is, they do when they’re using the cognitive- behavioral model effectively. We have observed a significant differ ence between some practitioners of this approach who attribute clichéd assumptions to clients—assuming, for example, that anyone who is depressed must be pessi mistic about themselves, the world, and the future—and those practitioners who don’t make assumptions and don’t preach. These cognitive-behaviorists use Socratic ques tioning to find out what their clients actually believe and then help them test the validity of those assumptions for themselves. Bowen systems therapists are also teachers, but they follow a different curriculum. They teach people to be responsible for themselves and how by doing so they can transform their entire families. Being responsible for yourself means getting clear about what you think and feel—not what your mother says or what you read in the New York Times but what you really believe—then being true to your beliefs in dealings with other people. You don’t take responsibility by changing others or wishing they were different; you do so by speaking for yourself and main taining your own values. The power of this position is tre mendous. If a client can accept who he or she is and that other people are different from himself or herself, then he or she no longer has to approach relationships with the idea that someone has to change. This enables the client to be in contact with people without becoming unduly upset or emotionally reactive. In addition to teaching differentiation, Bowenian therapists promote two corollary lessons: avoiding trian gulation and reopening cut-off family relationships. Taken together, these three lessons enable one individual to trans form the whole network of his or her family system. Even if her spouse nags, if his children are disobedient, if her mother never comes to visit, the client can create a change. Other schools of therapy gain leverage by including the entire family in treatment. Bowenians teach individuals to be themselves, to make contact with others, and to deal directly with the people they have conflicts with. This gives a person a tool for change that’s portable and lasting. Communications family clinicians contributed so much to the theoretical base of family therapy that it’s dif ficult to single out particular interventions. Perhaps their greatest achievement was pointing out that communication