Module 3
Origins & Growth Family Therapy
a. Historical Roots of Family Therapy
Most authorities point to the decade following World War II as the period
when researchers and then practitioners first turned their attention to the family’s role
in creating and maintaining psychological disturbance in family members. The sudden
reuniting of families in the aftermath of the war created numerous problems (social,
interpersonal, cultural, situational) for which the public sought solutions from mental
health specialists.
As professionals accustomed to working with individuals, therapists faced a
significant shift in expectations as they were now tasked with effectively addressing a
wide range of issues within the family system. This transition required therapists to
adapt their skills, knowledge, and therapeutic approach to the complexities of family
dynamics, which encompassed not only individual concerns but also relational
patterns, communication styles, and systemic influences.
One of the key challenges therapists encountered in this transition was the
need to expand their conceptualization of clients from singular individuals to
interconnected members of a family unit. This shift in perspective necessitated a
broader understanding of the interplay between individual experiences, family
dynamics, and contextual factors, such as culture, socioeconomic status, and
community resources. Therapists had to develop the ability to assess and intervene at
multiple levels of the family system, recognizing that individual problems often stem
from or are exacerbated by relational and systemic factors.
Moreover, therapists had to navigate the complexities of working with
multiple individuals within the same family, each with their own unique experiences,
perspectives, and needs. This required therapists to cultivate skills in facilitating open
communication, managing conflict, and fostering collaboration among family
members. Therapists also had to navigate power dynamics and role expectations
within the family, ensuring that all voices were heard and respected in the therapeutic
process.
Additionally, therapists had to adapt their therapeutic techniques and
interventions to suit the needs of the family system. While traditional individual
therapy approaches may focus on intrapsychic processes and personal growth, family
therapy requires a more systemic and relational approach that addresses the dynamics
of the entire family unit. Therapists had to learn to use techniques such as genograms,
eco-maps, and systemic interventions to assess and address family dynamics,
communication patterns, and relational conflicts.
Furthermore, therapists had to grapple with the ethical and professional
considerations inherent in working with families, including issues of confidentiality,
informed consent, and boundary management. They had to navigate complex ethical
dilemmas, such as balancing the needs of individual family members with the goals of
the family as a whole, while also ensuring that their interventions were culturally
sensitive and inclusive of diverse family structures and values.
In conclusion, the transition from working with individuals to working with
families presented therapists with a host of challenges and opportunities for growth.
By expanding their understanding of clients to include the family system, therapists
were able to address a wider range of issues and promote more holistic and
sustainable change within families. This shift required therapists to adapt their skills,
techniques, and ethical practices to suit the complexities of family dynamics,
ultimately enhancing their ability to support families in navigating challenges and
fostering resilience.
In general, psychotherapy became more accessible to people from a broader
range of social and educational backgrounds than had been the case before the war.
Practitioners from many disciplines—psychiatrists, clinical psychologists, social
workers, marriage counselors, pastoral counselors—began to help. The definition of
problems considered amenable to psychotherapy, previously dealt with by extended
family members and institutions such as the church, expanded to include marital
discord, separation and divorce, delinquency, problems with in-laws, and various
forms of emotional disturbance not requiring hospitalization.
While many clinicians remained focused on providing individual treatment, a
growing number recognized the importance of considering family relationships and
transactions as integral components of achieving individual well-being. This shift in
perspective marked a significant departure from traditional approaches that primarily
focused on intrapsychic processes and individual pathology. Instead, therapists began
to appreciate the interconnectedness of individuals within their family systems and the
impact of relational dynamics on mental health and functioning.
For these pioneering therapists, the decision to incorporate family therapy
principles into their practice was driven by a recognition of the limitations of
individual-focused approaches in addressing complex psychosocial issues. They
observed that individuals often presented with symptoms or difficulties that were
closely tied to their family dynamics, communication patterns, and relational
histories. By exploring these familial influences, therapists could gain deeper insights
into the underlying factors contributing to their clients' challenges and develop more
effective interventions that targeted systemic sources of distress.
Moreover, therapists who embraced family therapy principles recognized the
potential for systemic interventions to promote lasting change and enhance overall
well-being for individuals and families alike. They understood that modifying
dysfunctional family transactions and fostering healthier relational patterns could not
only alleviate individual symptoms but also strengthen family resilience and cohesion.
By empowering families to address conflicts, improve communication, and navigate
life transitions collaboratively, therapists could support long-term positive outcomes
for all members.
In practice, therapists who integrated family therapy principles into their work
adopted a systemic lens that emphasized the interconnectedness of family members
and the reciprocal nature of their interactions. They utilized techniques such as
genograms, eco-maps, and systemic assessments to map out family dynamics and
identify areas for intervention. Through guided exploration and dialogue, therapists
facilitated conversations that shed light on underlying relational patterns, conflicts,
and unmet needs, empowering families to develop new strategies for coping and
problem-solving.
Furthermore, therapists who embraced family therapy principles often
collaborated with other professionals and community resources to provide
comprehensive support to families. They recognized the importance of addressing
systemic issues such as socioeconomic disparities, access to healthcare, and cultural
barriers that may impact family well-being. By partnering with schools, social
services, and advocacy organizations, therapists could leverage additional resources
and support networks to promote holistic healing and empowerment for families.
In conclusion, the integration of family therapy principles into clinical practice
represented a significant paradigm shift in mental health treatment. By recognizing
the interconnectedness of individuals within their family systems and the impact of
relational dynamics on well-being, therapists were able to provide more
comprehensive and effective care. Through systemic interventions that targeted family
transactions and fostered healthier relational patterns, therapists empowered families
to achieve lasting individual and collective well-being.
The Macy Foundation Conferences, begun during wartime and continued in
peacetime, provided some fundamental postulates of systems theory that were later to
prove so central to family therapy formulations. Gregory Bateson, a pioneering
thinker in the fields of anthropology, cybernetics, and systems theory, made
invaluable contributions to our understanding of human interactive systems and the
role of feedback loops in shaping social and behavioral dynamics. His insights have
had a profound impact not only on the social and behavioral sciences but also on
fields as diverse as communication theory, psychology, and ecology. Bateson's work
laid the foundation for a more holistic and systemic approach to understanding human
behavior and interactions, emphasizing the interconnectedness of individuals within
their social and environmental contexts.
One of Bateson's key insights was the recognition of feedback loops as
fundamental mechanisms driving change and adaptation within human systems. He
understood that individuals and groups are constantly engaged in reciprocal
interactions with their environment, receiving feedback from their actions and
adjusting their behavior accordingly. Bateson's concept of "cybernetic feedback"
highlighted the importance of these feedback loops in maintaining homeostasis and
facilitating learning and adaptation within social systems.
Moreover, Bateson's work challenged reductionist and linear models of
causality, advocating instead for a more systemic and relational approach to
understanding human behavior. He emphasized the importance of context,
relationships, and patterns of interaction in shaping individual and collective
dynamics. Bateson's concept of the "double bind" highlighted the role of conflicting
messages and paradoxical communication patterns in creating dysfunction within
social systems, offering valuable insights into the complexities of human relationships
and communication.
Furthermore, Bateson's interdisciplinary approach bridged the gap between the
natural and social sciences, paving the way for greater collaboration and cross-
fertilization of ideas. His work drew on insights from biology, anthropology,
linguistics, and psychology, demonstrating the interconnectedness of seemingly
disparate fields and the relevance of cybernetic principles to understanding human
behavior. Bateson's influence extended beyond academia, shaping the development of
therapeutic approaches such as family therapy and systemic psychotherapy, which
emphasize the importance of relational dynamics and context in promoting healing
and growth.
In recognition of his contributions, Bateson deserves acclaim for his visionary
thinking and groundbreaking research, which continues to inspire scholars and
practitioners across disciplines. His legacy reminds us of the importance of taking a
systemic and relational approach to understanding human behavior and interactions,
recognizing the interconnectedness of individuals within their social, cultural, and
environmental contexts. By embracing Bateson's insights, we can gain a deeper
understanding of the complexities of human systems and work towards fostering
greater harmony, resilience, and well-being within our communities and societies.
b. Studies of Schizophrenia and the Family
The investigation into the family environment as a potential factor
contributing to various forms of adult psychopathology represented a significant
paradigm shift in psychological research. Researchers sought to understand the
complex interplay between familial dynamics and the development of mental health
disorders, with a particular focus on conditions such as schizophrenia.
This line of inquiry emerged from earlier studies that had identified
correlations between certain family dynamics and the onset or exacerbation of
psychiatric symptoms. Researchers hypothesized that the quality of interactions
within the family unit, including communication patterns, emotional expressiveness,
and levels of cohesion and conflict, could influence individuals' vulnerability to
developing schizophrenia and other psychopathological conditions.
The investigation into the role of a pathogenic family environment in
schizophrenia marked a departure from earlier, more individual-focused models of
understanding mental illness. Instead, researchers recognized the importance of
considering the broader systemic context in which symptoms arise, acknowledging
the potential impact of familial relationships, roles, and communication styles on
individuals' psychological well-being.
In conducting their research, investigators employed a variety of
methodologies, including observational studies, family interviews, and psychometric
assessments, to examine the link between family dynamics and psychiatric outcomes.
They sought to identify specific patterns of interaction within families that were
associated with increased risk for schizophrenia, as well as protective factors that may
buffer against the development of the disorder.
Furthermore, researchers explored the underlying mechanisms through which
family dynamics may influence the onset and course of schizophrenia. Some
hypothesized that dysfunctional family environments could contribute to the
development of maladaptive coping strategies, interpersonal difficulties, and distorted
perceptions of reality, all of which are characteristic of schizophrenia. Others
investigated the role of genetic and biological factors in mediating the relationship
between family environment and psychopathology.
As research in this area progressed, scholars began to recognize the limitations
of simplistic models that attributed mental illness solely to family dysfunction. They
acknowledged the importance of considering multiple factors, including genetic
predisposition, neurobiological vulnerabilities, and environmental stressors, in
understanding the etiology of schizophrenia and other psychiatric disorders.
In conclusion, the investigation into the role of the family environment in the
development of schizophrenia represented a significant advancement in psychological
research, highlighting the complex interplay between familial dynamics and mental
health outcomes. While early studies focused on identifying correlations between
family variables and schizophrenia, contemporary research takes a more nuanced
approach, considering the interaction of genetic, biological, and environmental factors
in shaping individuals' vulnerability to psychopathology. This holistic understanding
of mental illness underscores the importance of adopting a systemic perspective that
recognizes the interconnectedness of individual, familial, and societal influences on
psychological well-being.
Following the then prevalent view that the mother’s child-rearing behavior
established her developing child’s emotional stability, some researchers attempted to
reconstruct the early mother–child relationships of adult schizophrenics. Maternal
rejection was postulated by4Frieda Fromm-Reichmann (1948) for the development of
male schizophrenia. In a widely quoted paper at the time, this prominent
psychoanalyst, known for her work with schizophrenics, introduced the term
schizophrenogenic mother to denote a domineering, cold, rejecting, possessive, guilt-
producing person who, in combination with a passive, detached, and ineffectual
father, causes her male offspring to feel confused and inadequate and ultimately to
become schizophrenic (a linear cause-and-effect relationship between pathogenic
parents and schizophrenia).
Although Fromm-Reichmann emphasized the destructive nature of such
parenting, she nevertheless viewed schizophrenia as an intrapsychic disorder, residing
within the individual patient. She did not suggest treating the family together but
instead saw the clinician’s role as freeing the patient from the parents’ noxious
influences. Fromm-Reichmann’s theorizing evolved over nearly three decades of
work at Chestnut Lodge mental hospital. Through that work, she came to appreciate,
in contrast with the prevailing views of the time, that no patient, however disturbed,
was beyond the reach of psychotherapy, including schizophrenics.
These initial efforts to link schizophrenia to family life were ultimately
disavowed. Researchers today no longer look for a culpable, pathologizing parent and
a victimized child but more commonly search for biological or genetic markers in
trying to understand the disorder’s origins. Nevertheless, the concept of the
schizophrenogenic mother remains historically important in the evolution of family
therapy, because it directed attention to dysfunctional interactions occurring within a
family context and shared by all family members. Family communication difficulties
and disturbances in the expression of affect are once again the focus of schizophrenia
research today, although precisely how these interactive patterns arise or affect the
vulnerable person at risk remains elusive.
During the 1950s, a major impetus for family research in schizophrenia came
from Gregory Bateson in Palo Alto, California; Theodore Lidz at Yale; and Murray
Bowen (and later Lyman Wynne) at the National Institute of Mental Health. Working
independently at first, they did not become fully aware of each other’s research until
late in the decade. In 1952, Bateson—then affiliated with the Palo Alto Veterans
Administration Hospital— received a Rockefeller Foundation grant to study
communication patterns and paradoxes. Soon he recruited Jay Haley, then a graduate
student studying communication; John Weakland, a former chemical engineer with
training in cultural anthropology; and William Fry, a psychiatrist. Together they
examined various communication patterns in humans and animals alike, especially
possible contradictions between levels of messages—what is communicated and how
it is qualified (or in some cases contradicted) by messages from that same person at
another level of communication. What ultimately proved most intriguing to this group
was the manner and frequency with which schizophrenics sent conflicting and
contradictory feedback messages at one and the same time.
Using some of the emerging cybernetic concepts Bateson brought to the
project, the researchers hypothesized that the family, when upset and threatened, seeks
a homeostatic state through feedback mechanisms that monitor the family’s behavior
in an effort to achieve balance and stability. Perhaps, they speculated, the appearance
of schizophrenic symptoms in a family member interrupted parental conflict when it
occurred and instead united the adversaries in their parental concerns for their child,
returning the system to its former level of equilibrium. Although this description of
schizophrenic symptoms is viewed now as an oversimplification, these researchers, by
attending to family communication sequences, were beginning to redefine
schizophrenia as an interpersonal phenomenon; in so doing, they challenged the long-
held psychodynamic view of schizophrenia as an intrapsychic disorder that
subsequently damaged interpersonal relationships. More specifically, they
hypothesized that the family might have shaped the strange and irrational behavior of
a schizophrenic by means of its contradictory and thus impossible communication
requirements.
Eager to publish their preliminary results, Bateson, Jackson, Haley, and
Weakland (Fry was in the armed services at the time) issued a landmark paper (1956)
introducing the double-bind concept to account for the development of schizophrenia
in a family member. A4double-bind situation occurs when an individual (often a child)
receives repeated conflicting injunctions from the same person (say, an adult) with
whom the child has an important ongoing relationship. In their exchange, a primary
negative injunction by the adult (“don’t do that or you will be punished”) is followed
by a conflicting secondary injunction at a more abstract level (a gesture such as a hug,
demanding compliance), again with the threat of punishment if the child disobeys. As
a tertiary injunction, the adult demands a response but forbids the child to comment
on the contradiction, thus forbidding escape from the confusing situation. The child,
perceiving the threat to his or her survival, feels compelled to make some response
but feels doomed to failure no matter what response he or she chooses. Repeated often
enough, any part of the sequence can set off upset, panic, or rage in the trapped
recipient. Note particularly that the child is faced with more than conflicting messages
(where he or she might choose to obey one and disregard the other). In a double-bind
situation, the key is in the two conflicting levels of messages.
When a person is confronted by expressions of love and hate, with an
invitation to approach and an injunction to stay away issued by the same important
figure, Bateson’s group hypothesized that he or she is forced into an impossible
situation of trying to discriminate correctly between the contradictory messages.
Unable to form a satisfactory response (and especially in the case of a child, unable to
escape) and unable to comment on the dilemma without being punished further, the
person becomes confused and suspicious that all messages have concealed meanings.
It becomes impossible for the person to understand what people really mean or how to
communicate or relate to others. Response leads to rejection, and failure to respond
leads to the loss of potential love—the classic “damned if you do and damned if you
don’t” situation. For example, if a parent then denies sending simultaneous
contradictory levels of messages, this only adds to the child’s confusion. Once the
pattern is established, these researchers hypothesized, only a hint of the original
sequence is enough to set off a panic or rage reaction and, for schizophrenics, may
lead to gradual withdrawal from the world of relationships.
Bateson and his colleagues suggested that the typical result of repeated and
prolonged exposure to this kind of impossible situation is that the child learns to
escape hurt and punishment by responding with equally incongruent messages. As a
means of self-protection, he or she learns to deal with all relationships in this distorted
manner and finally loses the ability to understand the true meaning of his or her own
or others’ communications, believing every message contains a concealed meaning.
At this point, the child begins to manifest schizophrenic behavior. Although double-
bind communications later proved not to be the cause of schizophrenia, the historical
importance of this landmark research is its focus on schizophrenia as a prototype of
the consequences of failure in a family’s communication system.
The double-bind hypothesis opposed the established outlook of the psychiatric
community. By attending to relationships, it challenged the orthodox position that the
schizophrenic’s problems stemmed from the inner workings of his or her mind, the
prevalent psychodynamic view of the time. Not surprisingly, the double-bind idea
stimulated much controversy. Particularly troublesome to later critics was its gender
bias and linear outlook— the idea that double-bind communication from parents,
especially mother toward child, caused schizophrenia. Further research made it clear
that double binding occurs at one time or another in most families, without such
serious pathological consequences as schizophrenia. Schizophrenia is now seen as a
debilitating brain disorder, although one in which communication difficulties and
reduced social functioning between family members are often present.
A psychiatrist trained in psychoanalysis, Lidz nevertheless rejected the notion
advanced by Fromm-Reichmann and others that adult schizophrenics were suffering
from maternal rejection. He argued that a family-oriented perspective could contribute
to a needed overhauling of psychoanalytic theory (Lidz, 1992). Particularly refuting
the singling out of rejecting mothers by calling attention to the father’s possibly
destructive role, Lidz, Cornelison, Fleck, and Terry (1957a) described five patterns of
pathological fathering of schizophrenics: rigid and domineering, hostile, paranoid, of
little or no consequence at home, passive and submissive.
To these researchers, carrying out longitudinal studies of families with
hospitalized schizophrenic members, schizophrenia was a “deficiency disease”
resulting from the failure of both parents to play supportive and complementary roles
with one another. Lidz and his associates (1957b) described two patterns of chronic
marital discord that are particularly characteristic of families of schizophrenics
(although each may exist in “normal” families to a lesser extent). Marital schism
refers to a disharmonious situation in which each parent, preoccupied with his or her
own problems, fails to create a satisfactory role in the family that is compatible with
and reciprocal to the other spouse’s role. Each parent undermines the worth of the
other, especially to the children, and they seem to compete for loyalty, affection,
sympathy, and support of the children. Each parent may fear that a particular child (or
children) will grow up behaving like the other parent. Threats of separation or divorce
are common; it is usual in such families for the father to become ostracized, a virtual
nonentity if he remains in the home.
In marital skew, which the researchers also observed in families with
schizophrenic offspring, the marriage is not threatened, but mutually destructive
patterns nevertheless exist. The serious psychological disturbance of one parent (such
as psychosis) usually dominates this type of home. The other parent, often dependent
and weak, accepts the situation and goes so far as to imply to the children that the
home situation is normal. Such a denial of what they are actually living through may
lead to further distortions of reality by the children. Lidz and associates (1957b)
concluded that male schizophrenics usually come from skewed families in which
there is a dominant, emotionally disturbed mother, impervious to the needs of other
family members but nevertheless intrusive in her child’s life. At the same time, a
skewed family usually has a father who can neither counter the mother’s child-rearing
practices nor provide an adequate male role model.
First at the Menninger Foundation in Topeka, Kansas, in the early 1950s and
later at the National Institute of Mental Health (NIMH) near Washington, DC, Murray
Bowen, a psychiatrist, broke new ground in the study of schizophrenia. In a dramatic
experiment at NIMH, Bowen arranged for mothers to move into cottages on clinic
grounds near their hospitalized, schizophrenic children for several months. He was
especially interested in identifying unresolved symbiotic mother–child interactions.
As he later reported (Bowen, 1960), families of schizophrenics often demonstrate
interaction patterns resembling Lidz’s findings about marital schism.
Bowen termed the striking emotional distance between parents in such a
situation emotional divorce. He described relationships of this kind as vacillating
between periods of4overcloseness and overdistance. Eventually the relationship
becomes fixed at a point of sufficient emotional distance to avoid anxiety; they settle
for “peace at any price.” One area of joint activity—and, commonly, conflicting views
—is the rearing of their children, particularly of children who show signs of
psychological disturbance. It is as if the parents maintain contact with each other (and
therefore a semblance of emotional equilibrium) by keeping the disturbed child
helpless and needy. Thus, adolescence, the period in which the child usually strives
for a measure of autonomy, becomes especially stormy and stressful. This is typically
the time when schizophrenic behavior first appears.
Bowen proposed the intriguing notion that schizophrenia is a process that
spans at least three generations before it manifests in the behavior of a family
member. He suggested that one or both parents of a schizophrenic are troubled,
immature individuals who, having experienced serious emotional conflict with their
own parents, are now subjecting their offspring to similar conflict situations.
According to Bowen, that child, ultimately less well functioning than his parents,
seeks out a marital partner with a comparable upbringing and level of psychological
disability, especially with respect to individuation.
The intergenerational transmission of dysfunction within families, as
described in the scenario, highlights the complex and multifaceted nature of mental
health outcomes, particularly in the context of schizophrenia. This process involves a
cascade of factors that contribute to increased vulnerability and risk across
generations, ultimately culminating in the development of schizophrenia in an
individual.
At the heart of this phenomenon lies the transmission of adverse experiences,
maladaptive coping mechanisms, and dysfunctional relational patterns from one
generation to the next. The child of the couple, growing up in an environment
characterized by familial discord, emotional instability, and potentially abusive or
neglectful parenting, may internalize these negative experiences and develop
maladaptive coping strategies as a result. These coping mechanisms, while initially
adaptive for navigating a challenging environment, can ultimately contribute to the
perpetuation of dysfunction and increase the child's vulnerability to mental health
issues, including schizophrenia.
Furthermore, the intergenerational transmission of dysfunction may be
exacerbated by genetic and biological factors that predispose individuals to
psychiatric conditions like schizophrenia. Research suggests that genetic vulnerability,
combined with environmental stressors and early-life experiences, can significantly
increase the risk of developing schizophrenia. Thus, the child of the couple may
inherit a genetic predisposition to the disorder, further amplifying their susceptibility
to dysfunctional outcomes within the family system.
As the child grows older and transitions into adulthood, they may struggle to
establish healthy relationships, maintain stable employment, and cope with the
challenges of daily life. These difficulties can perpetuate the cycle of dysfunction
within the family system, as the individual may replicate the same maladaptive
patterns of behavior and communication that they experienced in their upbringing.
Moreover, the stress and strain of navigating these challenges may exacerbate
symptoms of schizophrenia or trigger the onset of the disorder in vulnerable
individuals.
The consequences of intergenerational dysfunction extend beyond the affected
individual to future generations, as the cycle of dysfunction continues unabated. The
individual, now a parent themselves, may struggle to provide a stable and nurturing
environment for their own children, perpetuating the same adverse experiences and
relational patterns that contributed to their own mental health issues. Thus, the cycle
repeats, with each successive generation facing heightened vulnerability to
dysfunction and mental illness.
Breaking the cycle of intergenerational dysfunction requires a comprehensive
and holistic approach that addresses the complex interplay of genetic, biological,
environmental, and psychosocial factors. Interventions aimed at promoting resilience,
strengthening family relationships, and providing support and resources to at-risk
individuals and families are essential for interrupting the transmission of dysfunction
and promoting positive mental health outcomes across generations. By addressing the
root causes of dysfunction and fostering healthy family dynamics, we can work
towards breaking the cycle and creating a more supportive and nurturing environment
for future generations.
When Bowen moved on to Georgetown Medical School in 1956 to found a
family therapy training program, he was succeeded as head of the family studies
section at NIMH by Lyman Wynne. Wynne, trained in both psychiatry and the social
sciences, focused his research on the blurred, ambiguous, and confused
communication patterns in families with schizophrenic members. In a series of papers
over the next decade (Wynne, Ryckoff, Day, & Hirsch, 1958; Wynne & Singer, 1963),
he and his colleagues addressed the social organization of such families, searching for
ways in which their communication patterns could be differentiated from those
observed in more normal families. For example, observing the families’ recurrent
unreal, fragmented, and irrational style of communication, these researchers
hypothesized that such a family pattern contributes to the schizophrenic member’s
tendency to interpret events occurring around him or her in blurred or distorted ways.
In turn, such confusion or occasional bafflement increases the schizophrenic’s social
and interpersonal vulnerability, both within and outside the family.
Wynne, a productive researcher and teacher, left NIMH in 1972 but continued
his research at the University of Rochester, in New York, where he helped organize a
family therapy training program. His emphasis on how disordered styles of
communication—what he terms communication deviance—are transmitted in
schizophrenic families provides an interactional vehicle for understanding the
development of a thought disorder, the defining characteristic of young schizophrenic
adults.
Analyzing the foregoing history, Seeman (2009) interprets the shift in the
understanding of schizophrenia and the family from a feminist perspective. She
suggests that the work of Bateson, Lidz, Fleck, and Cornelison, and Wynne, while
offering new insights, maintained a then prevailing view of the mother as a damaging
cause of illness. She also notes that, in time, fathers joined mothers as involved in the
illness of their children through the hostility, critical comments, and over-involvement
they conveyed to them. Rather than being causes of illness, they were seen as being
responsible for psychotic relapses. Seeman concludes that our current judgment of
parents of schizophrenic children is more benign in viewing them as co-victims of the
illness who suffer along with their children because of the burden of caring for them.
All studies described thus far were cross-sectional in design, involving
families in which schizophrenia had been diagnosed in a member, usually a young
adult, often long before the research was carried out. A common underlying
assumption was that disturbances in family relationships are the major cause of
mental disorders in general and that perhaps distinctive patterns of family dynamics
can be discovered for each form of psychopathology.
Goldstein's observation from 1988 underscores a significant challenge faced
by researchers in the study of familial dynamics and their relationship to major mental
disorders like schizophrenia. Indeed, the timing of when families are studied in
relation to the onset and progression of psychiatric conditions poses a considerable
barrier to accurately assessing the impact of family environment on mental health
outcomes.
One of the primary difficulties lies in the retrospective nature of many studies,
where families are typically examined long after the manifestation of the mental
disorder within the family system. This temporal gap makes it challenging to
disentangle causality and identify the precise role that family dynamics may have
played in either precipitating or exacerbating the psychiatric condition. Researchers
must rely on self-reporting and retrospective accounts, which may be subject to recall
bias and may not accurately reflect the nuances of family interactions at the time of
illness onset.
Moreover, studying families post-diagnosis introduces the possibility of
confounding variables, such as the effects of illness-related stress, stigma, and
treatment on family dynamics. These factors can significantly influence family
functioning and communication patterns, making it difficult to isolate the specific
contributions of pre-existing familial factors to the development or course of the
mental disorder. Additionally, the process of diagnosis and treatment may itself alter
family dynamics, further complicating efforts to assess their impact on mental health
outcomes.
Furthermore, the stigma surrounding mental illness and the reluctance of
families to participate in research can present additional challenges to studying
familial dynamics in relation to psychiatric conditions. Families may be hesitant to
disclose sensitive information or may feel blamed or stigmatized for their loved one's
illness, leading to underreporting or selective reporting of family experiences. This
reluctance to engage with researchers can limit the availability of data and hinder
efforts to accurately assess the relationship between family environment and mental
health outcomes.
Despite these challenges, researchers have made significant strides in
understanding the role of family dynamics in mental illness through longitudinal and
prospective studies, as well as through innovative methodologies such as ecological
momentary assessment and observational research in real-time family settings. By
capturing data closer to the onset of illness and tracking changes in family dynamics
over time, researchers can gain a more nuanced understanding of the complex
interplay between familial factors and psychiatric outcomes.
In conclusion, while studying families long after the onset of mental illness
presents inherent challenges, researchers continue to develop innovative approaches
to overcome these barriers and advance our understanding of the role of family
dynamics in psychiatric conditions like schizophrenia. By addressing methodological
limitations and adopting longitudinal and prospective study designs, researchers can
better elucidate the complex interplay between familial factors and mental health
outcomes, ultimately informing more effective interventions and support strategies for
individuals and families affected by mental illness.
Despite these deficits in research design, considerable enthusiasm was aroused
by this new field of clinical inquiry into the baffling etiology of schizophrenia. A
group of schizophrenia/family researchers met for the first time at the 1957 national
convention of the American Orthopsychiatric Association. The cross-fertilization of
ideas culminated in Intensive Family Therapy (Boszormenyi-Nagy & Framo, 1965), a
report by 15 authorities on their research with schizophrenics and their families. The
clinical investigations initiated a decade earlier laid the groundwork for the emerging
field of family therapy.
c. Marriage and Premarriage Counseling
The fields of marriage and premarriage counseling, precursors of family
therapy, are based on the concept that psychological disturbances arise as much from
conflicts between persons as from conflict within a person. Focusing on some of the
unique problems of this special form of coupling, early marital counselors
(gynecologists and other physicians, lawyers, social workers, psychologists, and
college professors who were family-life specialists), viewed as “experts,” attempted to
provide answers for people with sexual and other marital difficulties (Broderick &
Schrader, 1991). Clergy were especially prominent in offering formal premarital
counseling, often as part of an optional or mandatory preparation program before a
wedding.
If we assume that people have always been ready to advise or seek advice
from others, informal marriage counseling has certainly existed for as long as the
institution of marriage has. On the other hand, formal counseling by a professional
marriage counselor probably began somewhat more than 70 years ago in the United
States, when the physicians Abraham and Hannah Stone opened the Marriage
Consultation Center in New York in 1929. A year later, Paul Popenoe (a biologist
specializing in human heredity) founded the American Institute of Family Relations in
Los Angeles, offering premarital guidance as well as aid in promoting marital
adjustment. Family educator Emily Mudd started the Marriage Council of
Philadelphia in 1932 and later wrote what is thought to be the first textbook in the
field (Mudd, 1951). In 1941, largely through Mudd’s prodding, the American
Association of Marriage Counselors (AAMC) was formed. The AAMC brought
together various professionals, primarily physicians, but also others concerned with
the new interdisciplinary field of marriage counseling. This organization led the way
in developing standards for training and practice, certifying marriage counseling
centers, and establishing a professional code of ethics.
Similarly, the first documented premarital intervention program was offered
by Ernest Groves (later to be first president of AAMC) in 1924 in a family life
preparation course at Boston University. Through the mid-1950s, the small quantity of
pertinent literature available often focused on such individually oriented topics as
physical examinations by physicians as part of premarital counseling efforts.
Assistance from clergy was apt to be spiritual, educational, and informational, with an
intrapsychic and religious orientation rather than attending to the interpersonal
relationship. If relationship problems were addressed at all, they were seen as a by-
product of a problem within one or both of the prospective newlyweds (Stahmann &
Hiebert, 1997). Rutledge’s survey of AAMC members in 1966 found very few
professionals performing premarital counselling.
By the mid-1960s, it was still possible to characterize marriage counseling
(and premarriage counseling) as a set of practices in search of a theory (Manus, 1966).
No breakthrough research was being carried out, no dominant theories had emerged,
no major figure had gained recognition. The AAMC published no journal of its own.
If practitioners published at all, they apparently preferred to submit articles to journals
of their own professions. By the 1970s, however, the situation began to change.
Among others, Olson (1970) urged an integration of marriage counseling and the
emerging field of family therapy, since both focus on the marital relationship and not
simply on individuals in the relationship. In 1970, the AAMC, bowing to increased
interest by its members in family therapy, changed its name to the American
Association of Marriage and Family Counselors. In 1978, it became the present
American Association for Marriage and Family Therapy. In 1975, the organization
launched the Journal of Marriage and Family Counseling (renamed the Journal of
Marital and Family Therapy in 1979). By then, as Broderick and Schrader (1991)
observe, marriage counseling (and by implication premarriage counseling) had
“become so merged with the more dynamic family therapy movement that it had all
but lost its separate sense of identity”.
What exactly was marital therapy at that time? Not considered to be as deeply
probing, intensive, or as prolonged as psychotherapy, marital therapy tended to be a
short-term attempt at repairing a damaged relationship. By and large, it dealt with
here-and-now issues rather than those from the past. Unlike psychotherapy, which
presumably probed inner meanings, marriage counseling addressed reality issues and
offered guidance to troubled couples in order to facilitate their conscious decision-
making processes. Early premarital counseling, which tended to be even less attentive
to relationship issues or why this couple chose one another, was content to help the
pair prepare for marriage by becoming aware of any neurotic individual problems that
might cause later hardships.
Couples entering premarital therapy may have done so as a checkup on the
viability of their relationship before marrying or due to fear that some underlying
conflict remains unresolved and may lead to a further deterioration of their
relationship once married. In some cases, premarital therapy was mandated by
religious groups to which they belong. When one or the other (or both) has been
divorced, particularly if there are children from a previous marriage, such caution is
pertinent.
Most people who seek help for their marriage are attempting to cope with a
crisis (such as infidelity, threat of divorce, disagreements regarding child rearing,
money problems, sexual incompatibilities, ineffective communication patterns,
conflicts over power and control) that has caused an imbalance in the family
equilibrium. Each partner enters marital therapy with different experiences and
expectations and with different degrees of commitment to the marriage. At least one
of the partners is usually invested in staying married or they would not seek
professional help, but the strength of the determination to stay together may vary
greatly between them.
The evolution of marital counseling towards a focus on the couple's troubled
relationship marked a significant shift in therapeutic practice, reflecting a growing
recognition of the importance of addressing relational dynamics in promoting
individual and collective well-being. This transition from individual-focused therapy
to conjoint therapy, where couples work together with the same therapist in the same
room and at the same time, represented a pivotal moment in the development of the
profession of family therapy.
Conjoint therapy emerged as a response to the limitations of earlier approaches
that focused primarily on individual pathology and intrapsychic processes. Therapists
recognized that many of the issues presented by clients were rooted in the relational
dynamics and communication patterns within their intimate relationships, particularly
within the context of marriage or partnership. By bringing couples together in therapy
sessions, therapists could directly address the interpersonal conflicts, emotional
barriers, and communication breakdowns that contributed to marital distress and
dissatisfaction.
Conjoint therapy offered couples a safe and supportive space to explore their
relationship dynamics, express their thoughts and feelings, and work towards
mutually agreed-upon goals. By facilitating open dialogue and collaboration between
partners, therapists could help couples develop healthier ways of relating to one
another, resolve conflicts constructively, and strengthen their emotional connection
and intimacy.
Moreover, the shift towards conjoint therapy signaled a broader recognition of
the interconnectedness of individuals within their relational and social contexts.
Therapists began to appreciate the reciprocal influence that partners exerted on one
another's thoughts, feelings, and behaviors, as well as the ways in which broader
systemic factors, such as family-of-origin dynamics and societal norms, shaped
marital dynamics. By taking a systemic approach to therapy, therapists could address
the underlying systemic patterns and dynamics that contributed to marital discord and
facilitate lasting change within the couple's relationship.
The emergence of conjoint therapy also contributed to the professionalization
of family therapy as a distinct and specialized field within the mental health
profession. Therapists began to receive specialized training in family systems theory,
relational dynamics, and therapeutic techniques for working with couples and
families. Professional organizations and academic programs dedicated to family
therapy proliferated, providing therapists with opportunities for advanced training,
supervision, and professional networking.
Furthermore, the growing popularity of conjoint therapy paved the way for the
development of evidence-based approaches to couples therapy, grounded in empirical
research and clinical efficacy. Therapists began to utilize structured interventions and
standardized assessment tools to guide their work with couples, enhancing the
effectiveness and accountability of therapeutic practice.
In conclusion, the transition from individual-focused therapy to conjoint
therapy represented a pivotal moment in the evolution of family therapy, signaling a
shift towards a more systemic and relational approach to addressing mental health
issues within the context of intimate relationships. By bringing couples together in
therapy sessions, therapists could directly address the interpersonal dynamics that
contributed to marital distress and facilitate positive change within the couple's
relationship. This shift laid the foundation for the professionalization and growth of
family therapy as a specialized field within the mental health profession, with
implications for both clinical practice and research in the years to come.
d. The Child Guidance Movement
Two additional streams of thought and clinical development deserve mention
for their influences in the evolution of family therapy. The child guidance movement,
emerging early in the 20th century, was based on the assumption that if emotional
problems did indeed begin in childhood—as Freud and others were arguing—then
early identification and treatment of children could prevent later psychopathology.
Alfred Adler, an early associate of Freud’s, was especially cognizant of the
key role early family experiences played in determining later adult behavior. Adler
helped found the child guidance movement in Vienna in the early 1900s, and while he
did not work therapeutically with entire families, he did influence one of his disciples,
Rudolf Dreikurs, who later emigrated to the United States, to expand child guidance
centers into family counseling centers (Lowe, 1982). In 1924, the American
Orthopsychiatric Association, devoted to the prevention of emotional disorders in
children, was organized. Although child guidance clinics remained few in number
until after World War II, they now exist in almost every city in the United States.
Major settings for identifying and treating childhood psychological disorders,
such as schools, clinics, and community centers, play a pivotal role in promoting the
mental health and well-being of children and adolescents. These settings serve as
critical access points for early intervention and support, providing essential resources
and services to address a wide range of psychological and emotional challenges that
young people may face.
Within these settings, multidisciplinary teams of professionals, including
psychologists, counselors, social workers, and educators, collaborate to assess,
diagnose, and treat childhood psychological disorders. By leveraging their expertise
and working collaboratively, these professionals can provide comprehensive and
integrated care that addresses the complex needs of children and their families.
One of the key strengths of these settings is their capacity to involve parents
and caregivers in the therapeutic process. Recognizing the significant influence of
familial and environmental factors on children's mental health, professionals in these
settings prioritize family involvement and engagement. By working closely with
parents, therapists can gain valuable insights into the child's home environment,
family dynamics, and social support networks, which can inform treatment planning
and intervention strategies.
Moreover, these settings provide opportunities to address the larger social
systems from which the presenting problem evolved. Professionals in schools, clinics,
and community centers are uniquely positioned to advocate for systemic changes that
promote mental health and well-being at the individual, family, and community levels.
This may involve collaborating with policymakers, community leaders, and other
stakeholders to address social determinants of health, reduce barriers to access, and
promote equity and inclusion within the broader social context.
In addition to providing direct clinical services, these settings offer a range of
supportive programs and interventions aimed at promoting positive mental health
outcomes for children and adolescents. This may include psychoeducation, skill-
building workshops, group therapy, and peer support programs designed to enhance
social-emotional learning, resilience, and coping skills. By fostering a supportive and
nurturing environment, these programs empower young people to navigate life's
challenges more effectively and develop healthy coping mechanisms.
Furthermore, schools, clinics, and community centers serve as important hubs
for collaboration and coordination among various service providers and community
organizations. By fostering partnerships and leveraging resources, professionals in
these settings can ensure that children and families receive seamless and integrated
care that addresses their holistic needs. This collaborative approach promotes
continuity of care, reduces fragmentation of services, and maximizes the impact of
interventions on children's mental health outcomes.
In conclusion, major settings for identifying and treating childhood
psychological disorders play a vital role in promoting the mental health and well-
being of children and adolescents. By providing comprehensive, family-centered care
and addressing the larger social systems from which problems arise, these settings
serve as crucial resources for fostering resilience, promoting positive development,
and building stronger, healthier communities.
Early treatment programs were team efforts, organized around a psychiatrist
(psychotherapy), a psychologist (educational and remedial programs), and a social
worker (casework with parents and outside agencies). It was standard procedure (and
still is in traditional clinics) for a parent to visit the clinic regularly for treatment,
usually seeing a different therapist from the one working with her child. This
collaborative approach has now evolved into conjoint therapy sessions in most clinics,
involving both parents as well as siblings of the identified patient. Rather than
viewing the child as the identified patient with intrapsychic problems or the parents as
the source of the child’s difficulties, today’s outlook focuses on pathology among all
the family participants.
Child guidance clinics represent a cornerstone of early intervention efforts
aimed at addressing the emotional and behavioral challenges faced by children and
families. Operating on the principle of preventive care, these clinics play a vital role
in identifying and addressing emotional problems in children and their families before
they escalate into more serious disabilities or mental health disorders.
At the heart of child guidance clinics' mission is the recognition that early
intervention is key to promoting positive developmental outcomes and preventing the
onset of more severe psychological difficulties later in life. By providing timely and
targeted support to children and families experiencing emotional distress or
behavioral challenges, these clinics aim to mitigate risk factors, strengthen protective
factors, and promote resilience in children and their families.
One of the primary goals of child guidance clinics is to provide comprehensive
and integrated services that address the complex needs of children and families. This
may include diagnostic assessment, individual and family therapy, psychoeducation,
and case management services tailored to the unique needs and circumstances of each
family. By offering a range of therapeutic interventions and support services, clinics
can ensure that children and families receive the care and resources they need to
thrive.
Moreover, child guidance clinics serve as important hubs for collaboration and
coordination among various stakeholders involved in children's mental health and
well-being. This may include educators, healthcare providers, social workers,
community organizations, and other professionals working together to support
children and families in their communities. By fostering partnerships and leveraging
resources, clinics can maximize the impact of their interventions and promote holistic
approaches to children's mental health.
In addition to providing direct clinical services, child guidance clinics play a
crucial role in community outreach and education. By raising awareness about
children's mental health issues, reducing stigma, and promoting early intervention
strategies, clinics can empower families to seek help and access support services
when needed. This proactive approach helps to destigmatize mental health care and
promotes a culture of mental health awareness and acceptance within the community.
Furthermore, child guidance clinics are often involved in research and
evaluation efforts aimed at advancing the field of children's mental health. By
conducting research studies, evaluating program effectiveness, and disseminating
findings to policymakers and practitioners, clinics contribute to the evidence base for
early intervention strategies and inform best practices in children's mental health care.
In conclusion, child guidance clinics play a vital role in promoting early
intervention and preventing the development of more serious disabilities or mental
health disorders in children and families. By providing comprehensive, family-
centered care, fostering collaboration and coordination among stakeholders, and
engaging in community outreach and education efforts, these clinics help to ensure
that children have the support they need to thrive emotionally, socially, and
academically.
e. Group Dynamics and Group Therapy
Group dynamics and the behavior of small groups served as models of family
functioning for some early family therapists such as John Bell (1961). For these
therapists, family therapy was a special subset of group therapy, except the
participants were not strangers. These practitioners took the position that families are
essentially natural groups, and that the therapist’s task was to promote interaction,
facilitate communication, clarify the group process, and interpret interpersonal
dynamics—as any group therapy leader would do. Bell called his approach family
group therapy.
Group therapy has been practiced in one form or another since the beginning
of the 20th century, but the impetus for its major expansion came from the need for
clinical services during and immediately after World War II. The earliest use of the
group process in psychotherapy can be credited to the Austrian psychiatrist Jacob
Moreno, who, around 1910, combined dramatic and therapeutic techniques to create
psychodrama. Moreno, whose psychodramatic techniques are still used today (Landy,
2007), recreated in the therapeutic process the various interpersonal situations that
may have led to the patient’s psychological difficulties. Moreno, in the role of
therapist/director, used a stage on which the patient could act out his or her significant
life events in front of an audience. In these psychodramas, various people (frequently,
but not necessarily, other patients) represented key persons (“auxiliary egos”) in the
patient’s life. At certain junctures, the director might instruct the patient to reverse
roles with one of the players so the patient could gain a greater awareness of how
another person saw him or her.
The exploration of a family's interpersonal dynamics, including the give and
take of relationships and the resolution of conflicts, lies at the heart of family therapy.
Psychodrama, with its emphasis on enacting real-life scenarios and exploring
underlying emotions and tensions through dramatic role-playing, emerged as a natural
fit for many family therapists seeking to engage clients in dynamic and experiential
interventions.
Psychodrama offers a unique and powerful approach to family therapy by
providing a structured framework for exploring complex relational dynamics and
addressing unresolved conflicts within the family system. Through the use of role-
playing, improvisation, and group interaction, psychodrama allows family members to
step into each other's shoes, gain new perspectives, and empathize with one another's
experiences. This experiential approach can facilitate deeper insights, emotional
expression, and catharsis, paving the way for healing and transformation within the
family.
One of the key strengths of psychodrama in family therapy is its ability to
bring hidden tensions and underlying issues to the surface in a safe and supportive
environment. By enacting family dynamics and interpersonal conflicts in real-time,
family members can confront unresolved emotions, challenge maladaptive patterns of
communication, and work towards resolution and reconciliation. This process of
dramatization and role-playing can be particularly effective for families who struggle
to communicate openly or who are resistant to traditional talk therapy approaches.
Moreover, psychodrama allows for the exploration of family roles, identities,
and power dynamics, which are often central to the functioning of the family system.
By embodying different roles and perspectives, family members can gain a deeper
understanding of their own behavior and its impact on others, as well as the dynamics
of power and control within the family. This heightened awareness can foster
empathy, mutual respect, and collaboration among family members, leading to more
harmonious and satisfying relationships.
Additionally, psychodrama encourages creativity, spontaneity, and playfulness
within the therapeutic process, which can be particularly beneficial for engaging
children and adolescents in family therapy. Through imaginative play and role-playing
exercises, young clients can explore their emotions, express themselves more freely,
and develop coping skills for managing family conflicts and stressors. Psychodrama
also offers opportunities for families to strengthen their bonds, build trust, and create
positive shared experiences that promote resilience and well-being.
Furthermore, psychodrama can be adapted to address a wide range of family
issues and concerns, including trauma, addiction, divorce, and grief. Therapists can
tailor psychodramatic interventions to meet the specific needs and goals of each
family, drawing on the principles of spontaneity, creativity, and group dynamics to
facilitate meaningful and transformative experiences.
In conclusion, the use of psychodrama in family therapy offers a dynamic and
experiential approach to exploring interpersonal dynamics, resolving conflicts, and
promoting healing within the family system. By providing a safe and supportive space
for families to engage in role-playing, improvisation, and group interaction,
psychodrama can facilitate deeper insights, emotional expression, and positive
change. As such, it continues to be a valuable tool in the toolkit of many family
therapists seeking to empower families to overcome challenges and thrive together.
Stimulated largely by the theories developed by British psychoanalysts
Wilfred Bion and Melanie Klein, considerable interest in group processes developed
during the 1930s at the Tavistock Institute in London. Several psychoanalysts began
experimenting with group intervention techniques (Bion, 1961). In particular, they
emphasized dealing with current problems rather than searching for past causes and
explanations or reconstructing possibly traumatic early experiences. Samuel Slavson,
an engineer by training, began to do group work at the Jewish Board of Guardians in
New York City at the same time. He created the activity-group therapy technique, in
which a group setting encourages disturbed children or adolescents to interact, thereby
acting out their conflicts, impulses, and typical behavior patterns (Slavson, 1964).
Slavson based his approach on concepts derived from psychoanalysis, group work,
and progressive education. In 1943, the American Group Psychotherapy Association
was formed, largely through Slavson’s efforts.
In the 1960s, inspired by the emergence of various personal growth centers
around the United States—particularly the Esalen Institute in Big Sur, California—the
encounter group (part of the human potential movement) made a dramatic impact on
the therapy scene and attracted large numbers of people, mostly from the upper
middle class. Today, that enthusiasm has waned, although traditional group therapies
(Yalom & Leszcz, 2005) and, to a lesser extent, encounter groups, continue to exist
side by side.
Fundamental to the practice of group therapy is the principle that a small
group can act as a carrier of change and strongly influence those who choose to be
considered its members. A therapy group is a meaningful and real unit in and of itself,
more than a collection of strangers, more than the sum of its parts. Another way of
putting it is that the group is a collection of positions and roles and not of individuals
(Back, 1974). The Tavistock version of group therapy is a good illustration: The group
is treated as if it were a disturbed patient who is hurting because certain functions are
not being carried out successfully. In a Tavistock group, the leader helps the group
function in a more balanced, coordinated, and mutually reinforcing way so the group
can accomplish productive work more efficiently. The implications for group therapy
with a dysfunctional family are obvious.
f. The Evolution of Family Therapy
We have suggested that early studies in schizophrenia and the family, early
marriage and family counseling, the child guidance movement, and group dynamics
and group therapy have all contributed to the development of family therapy by
illustrating how problems experienced by individuals can be understood and
addressed within the groups of which they are part. This section traces the
development of family therapy as a distinct field.
Most of the surveys of the family therapy movement (Broderick & Schrader,
1991; Goldenberg & Goldenberg, 1983; Guerin, 1976) agree it was founded in the
1950s as the theories and approaches we have been describing seemed to coalesce.
Those ideas, to be sure, pertained more to clinical research than to clinical practice.
Observation of the family—particularly one with a symptomatic member—could be
justified only if it was presented as a research strategy because of the prevailing
sanction of confidentiality against a therapist’s contact with anyone in the family other
than her or his own patient.
Family therapy therefore owes its legitimacy to the following facts: (a) it was
carried out for scientifically defensible research purposes and (b) the “research” was
being done on clinical problems such as schizophrenia that did not respond well to the
established psychotherapies of that time (Segal & Bavelas, 1983). As Wynne (1983)
notes, all early schizophrenia initiatives were initially research motivated and research
oriented. Wynne’s own work at NIMH with schizophrenics was based on the use of
therapy as a source of experimental data. The apparent success of the family research
helped give the stamp of approval to the development of therapeutic techniques.
Who actually deserves credit for first adopting a family therapy approach with
client families? Certainly, no single person—although Nathan Ackerman, a child
psychoanalyst in the child guidance movement, is generally credited with having
written the first paper dealing specifically with treating an entire family (Ackerman,
1937). In contrast to the coordinated approach practiced by most child guidance
clinics, in which parent and child were seen by separate but collaborating therapists,
Ackerman began seeing entire families together at least a decade before other
therapists joined him in this approach.
John Bell, an academic psychologist at Clark University in Worcester,
Massachusetts, was another major architect of family therapy. Bell (1975) recalled
that a casual remark overheard while he was visiting the Tavistock clinic in London in
1951—to the effect that John Bowlby, a prominent psychoanalyst, was experimenting
with group therapy with entire families—stimulated his interest in applying the
technique to treat behavior problems in children. Bell incorrectly assumed that
Bowlby was treating the entire family, but Bowlby only occasionally held a family
conference as an adjunct to working with the problem child. Based on this
misinformation, Bell began to think through the technical implications of meeting
with an entire family on a regular basis. Then a case gave him the opportunity to try
out this method in therapy. Bell’s description of his work was not widely disseminated
until a decade later (Bell, 1961). That groundbreaking monograph, along with
Ackerman’s 1958 text, is often thought to represent the founding of family therapy as
practiced today. Unlike most of their colleagues in the 1950s, both Bell and Ackerman
worked with nonschizophrenic families.
As noted previously, Don Jackson deserves recognition as a family therapy
pioneer, introducing an influential, if still rudimentary, set of descriptive constructs for
comprehending family communication patterns (family rules, homeostasis, the
redundancy principle) and initiating conjoint treatment to help overcome noxious
family interactive patterns. Along with other members of the Palo Alto group,
particularly seminal thinkers Jay Haley and John Weakland, Jackson helped develop
innovative ways to influence a family’s relationship context in order to produce
change. (Bateson, a founder of the field but himself not a therapist, was less
concerned with the application of the clinical ideas his group had generated than he
was with the philosophy underlying those ideas.) A list of family therapy trailblazers
must also include Murray Bowen, for his theoretical proposals and his innovative
technique of hospitalizing families with a schizophrenic member in order to study
mother–child symbiotic influences.
Carl Whitaker was another early leader in the field. Whitaker began working
with families at Oak Ridge, Tennessee, the site of the secret government plant
manufacturing the first atomic bomb during World War II. Whitaker, a gynecologist,
was not a psychiatrist, and his innovative and often idiosyncratic techniques perhaps
reflect his unorthodox training. He used a co-therapist and included intergenerational
family members in a patient’s therapy. He4displayed a highly active style in working
with patients.
By organizing a series of family therapy conferences devoted to the treatment
of schizophrenia—including a celebrated 1955 event at Sea Island, Georgia—
Whitaker was able to bring together many leaders of the emerging family therapy
field (including John Rosen and Albert Scheflen from Philadelphia as well as Bateson
and Jackson). The conferences, in which schizophrenics and their families were
interviewed while being observed behind a one-way mirror, led to the publication of
an early text on the psychotherapy of chronic schizophrenic patients (Whitaker, 1958).
The use of a one-way mirror lifted the secrecy from the therapeutic process.
Introduced into family therapy by Charles Fulweiler, the mirrors allowed others to
observe families in psychotherapy, often producing insights into their interactive
patterns. Slovik and Griffith (1992) consider the introduction of this observational
technique a landmark in the history of family therapy, providing, as it did, clinical
confirmation of such concepts as circular causality.
