Haley, Jay (1962): Introduction to Family Process. In: Family Process, 1 (1), S. 1–4.
Abstract: With the publication of this first issue, we give birth to a new journal, Family Process. We do so with a full sense of the challenge and excitement of launching a new venture, but also with a keen awareness of the responsibility. We feel convinced that the creation of this journal is timely, that it fills a need for a forum for the systematic examination of the nature of family living. It is with good cheer that we undertake the duties of nourishing this off-spring to responsible maturity. We express the hope that this journal can fulfill its mission of enlightenment and service to the behavioral sciences and to the community at large.
Family Process is co-sponsored by The Mental Research Institute of the Palo Alto Medical Research Foundation and The Family Institute. The editorial board and the board of advisory editors are composed of individuals who, by their achievements, have added to our understanding of the nature of the human family.
The aim of Family Process is to foster a development of a science of the family. Today, the study of behavior and the treatment of disorders of behavior is undergoing a quiet revolution. The climate of opinion is changing. There is a sharp stir in the air. No one can be certain which way the winds will blow, but blow they must and many traditional edifices will topple. A pervasive process of re-thinking on basic questions is occurring. All knowledge in the behavioral sciences is being checked and re-interpreted and new knowledge is being added at an accelerated pace.
In the purview of history, the study of the human being has gravitated to two extremes: the investigation of the isolated, individual personality and the study of society and culture. The family, which is the link between the individual and his socio-cultural organization, has been curiously neglected. This polarization of the study of the human being continues. At one end of the scale there is the emphasis upon mass behavior of man; at the other end there is the concentration on the dynamics of the individual, exemplified in the psychoanalytic focus on unconscious mental mechanisms and on the phenomenological nature of human experience via the existential movement. To bridge the gap, it is essential to study the natural habitat of the person, his family. We can no longer afford the error of evaluating the individual in isolation from his usual environment or appraising that behavior in artificial settings. We must study the person where he breathes, eats, sleeps, loves and where he learns his place in society: in the intimate climate of his day-by-day family relationships. It is in this setting that we strive toward the development of a social psychology and social psychopathology of family life.
The individual, the family and the social community are a continuum. At each of these levels behavior is governed by a relative autonomy, but there is a continuous interpenetration of influence among these several levels of organization of human experience. The salient events at any one level invade and influence events at the other levels. The patterns of the wider community encroach upon the inner life of the family, the family shapes the development and adaptation of the individual person and, in turn, there is a feedback from the individual and family patterns of organization into the processes of the wider community.
Weblin, John (1962): Communication and Schizophrenic Behavior. In: Family Process, 1 (1), S. 5–14.
Abstract: “I wave. I have a handkerchief, I wave. Bye Bye.” With these words a schizophrenic woman of 50 stood at the door of my office and then entered for an interview. What really was happening? Her greeting was a farewell. Her face smiled, yet her voice seemed wistful and sad. She spoke and made gesturesshe was heard and seen; that iscommunication took place. That was the simple, basic and irreducible fact of those few moments.
In this age the word communication evokes visions of ticker-tape and television, Chevrolets and Caravelles, and even MACH-5 mobilized beatniks in Sputniks.
Whether these splendours of civilization ultimately promote or impair true communication is uncertain. What is certain is that communication is, elementally, the means whereby one person relates to another.
When communication takes place a relationship is formed, and this is built on the interaction that develops between the participants.
Communication is a basic condition of human life, and its workings mould and shape the individual personality through its relationships with others. Indeed personality, that complex marriage of “nature” and “nurture,” may be described as the sum pattern of a person’s way of communicatingthe total impression he makes on others.
One of the remarkable things about personality is its mutability. Perhaps one can do no better than quote the celebrated comments on personality structure of the greatest of Elizabethan psychiatrists”All the world’s a stage, and all the men and women merely players. And each one in his time plays many parts.”
Macgregor, Robert (1962): Multiple Impact Psychotherapy with Families. In: Family Process, 1 (1), S. 15–29.
Abstract: This is a report of an investigation into the way in which self-rehabilitating family processes can be mobilized with brief psychotherapeutic intervention.1 The fact that families when threatened with evidence of mental illness in a child will travel
relatively long distances to the University of Texas Medical Branch Hospitals at Galveston puts The Youth Development Project, an outpatient psychiatric clinic for adolescents, in a position to study families in crisis. The method employed requires devoting the entire time and facilities of an orthopsychiatric team to one family for half a week. Starting with a team-family conference, it proceeds through a series of different combinations of the people involved. It includes multiple therapist situations, individual interviews, and group therapy interspersed with brief staff conferences. Twelve families during 1957-1958 were seen by the team during the development of the procedures. In April, 1958 the development, demonstration, and study of the method was undertaken by a full-time team. Since that time fifty-five families with problem adolescents have been treated.
The work has been particularly useful with families whose participation in usual child guidance procedures could not be gained. In forty-eight of the cases, exclusion of the child from the community had occurred or was imminent. In the remaining seven, the break-up of the home was imminent. Follow-up studies which are routine at six and eighteen months and include home visits to half the cases, indicate the method to have treatment results comparable to established intensive methods. Research results have contributed to the development of family diagnosis.
Ackerman, Nathan W. (1962): Family Psychotherapy and Psychoanalysis: The Implications of Difference. In: Family Process, 1 (1), S. 30–43.
Abstract: In our time we are witness to a spreading contagion of interest in the family approach to mental illness. There is a rising inquiry as to the possibility of understanding and treating psychiatric illness in a family way. Historically speaking, it was psychoanalysis that gave pointed emphasis to the role of family conflict in mental illness. It is of no small interest today, therefore, to observe how members of the psychoanalytic profession respond to the concept of the family as the unit of mental health and the unit of diagnosis and therapy. Here, as elsewhere, in matters pertaining to theory and practice, psychoanalysts are divided. Once again we discover the familiar split in the psychoanalytic family as between the conservatives and the liberals. In the evolution of ideas, here as elsewhere, there is value in both points of view. Toward the principles of family diagnosis and treatment, some analysts are critical and antipathetic from the start. They sense in it a threat to the established position of the psychoanalytic technique. One such analyst said to me: “The psychotherapy of the whole family makes me uneasy. It threatens my sense of mastery in the exclusive one-to-one relationship.” Other psychoanalysts, skeptical to be sure, are otherwise open-minded and willing for the concept of the family as the unit of mental health to face the test of time.
Regardless of the dilemma of the psychoanalysts, present evidence suggests that this new dimension is here to stay. The family approach offers a new level of entry, a new quality of participant observation in the struggles of human adaptation. It holds the promise of shedding new light on the processes of illness and health, and offers new ways of assessing and influencing these conditions. It may open up, perhaps for the first time, some effective paths for the prevention of illness and the promotion of health.
In the perspective of the history of mental science, the emergence of the principles of family diagnosis and treatment is an inevitable development. It is the natural product of the coalescence of new conceptual trends in a number of fields: cultural anthropology, group dynamics, communication, the link of psychoanalysis with social science, ego psychology, and child development. The family phenomenon bridges the gap between individual personality and society. On this background, it is hardly a coincidence that some psychoanalytic associations now devote whole meetings to the themes of psychoanalysis and values, and psychoanalysis and family. It seems likely, therefore, that the evolution of family diagnosis and family treatment holds far-reaching implications for the future relations of culture change, behavior theory, and the evolving ideology of psychoanalysis and psychotherapy.
I shall present first a brief, impressionistic view of the techniques of family psychotherapy, and then attempt a comparison with psychoanalytic therapy within the frame of two contrasting theoretical models of psychotherapeutic process. In advance of this, however, I must mention two basic considerations. Just so long as we lack a unitary theory of human behavior and cannot accurately formulate the relations of emotion, body, and social process, we shall be unready to build a comprehensive theory of psychotherapy. We have no psychotherapeutic method that is total. We have no known treatment technique that can affect with equal potency all components of the illness process. The various psychotherapeutic methods presently available are, each of them, specialized, and exert partial, selective effects on certain components of the illness process, but not on all. It is the social structuring of a particular interview method which determines both the potentials of participant observation and the selective effects of a given therapy. In this sense, the psychoanalytic method provides one kind of participant experience, group psychotherapy another, and family psychotherapy still another. It is the specific point of entry of each of these methods which affects the kind of information obtained, the view of the illness process which is communicated to the therapist, and the quality of influence toward health that he may exert. Family interview and family psychotherapy hold the potential of shedding a different and added light on the illness phenomenon and provide still another level of intervention on the area of pathogenic disturbance.
Sonne, John C., Ross V. Speck & Jerome E. Jungreis (1962): The Absent-Member Maneuver as a Resistance in Family Therapy of Schizophrenia. In: Family Process, 1 (1), S. 44–62.
Abstract: Interest has increased greatly over the past thirty years in the psychoanalytic study of the attitudes and interplay of small groups of people, including the special small group called a family (1, 2, 3). As part of this development a theoretical approach to the study of emotional illness has evolved in which emotional illness is conceptualized in terms of a couple, a group, or a family, rather than primarily in terms of an individual. Psychopathology, in addition to being considered intra-psychically, is considered as it is contained in the matrix of social relationships, or as socially shared psychopathology (4, 5).
In the approach to group theory and treatment in terms of socially shared psychopathology, the concept of a group or family member’s role has been an important one, and the question of who is a healthy and who is a sick member of a group becomes open for re-definition. A member acting and thought of as healthy on the manifest level is often revealed on closer scrutiny as sick beneath his healthy role portrayal; whereas a member exhibiting symptoms is correspondingly often revealed as much less sick than his sick role portrayal (6).
The concept of socially shared psychopathology can be applied in the treatment of families by working with the relationships with the family members physically present so that the intrapsychic images, memories and fantasies may be expressed in the presence of a potentially creative constellation of significant relatives (2, 7, 8). Our group1 comprised of three psychiatrists, three psychologists and two social workers, has used this approach over a period of two years in the treatment of ten families containing a clinically identified schizophrenic offspring, none of whom had a history of infantile autism. Two therapists, a psychiatrist and either a social worker or psychologist, visited the families in their homes, once a week, for a session of an hour and a half. We were especially alert to any evidence of socially shared psychopathology in the schizophrenic family and hoped to define and conceptualize this pathology when we saw it. We hoped also possibly to gather clues pointing towards a more effective therapy of schizophrenia.
Weakland, John H. (1962): Family Therapy as a Research Arena. In: Family Process, 1 (1), S. 63–68.
Abstract: No one who has attempted or even observed family therapymeaning conjoint treatment of a family groupwould think it inapt to call the family treatment situation an arena. There, with a therapist as actual observer, and also as representing a wider audience, the members present family dramas, spectacles, and often contests. But this as a research arena? Can it be, and should it be even if it can be?
My own answer is “yes” to both questions, and I would like here to discuss 1) how the family therapy situation offers some special potentialities for important research and 2) why, at least at this stage of our knowledge, grasping these research opportunities seems quite consonant with holding basic therapeutic aims in interviewing family groups.
This second point had best be dealt with first. Otherwise, doubts about the propriety of any deliberate mixing of research into therapy might block free and unbiased considerations of the research potentials of the family treatment situation. I see two main reasons why research and therapy are compatible in work with families. The first, to speak plainly, is that at present we know so little about family therapy, both theoretically and practically, that whatever we essay in treatment is bound in large measure to be only tentative and hopeful. We simply have not yet developed a well-defined concept and technique of treatment with certain known powers and limits, nor can this be approximated by relying on principles taken from the practice of psychotherapy with individual patients. Even if much more were known and agreed on in that field than is now the case, family therapy is too different from individual psychotherapy for any simple transfer of rules to be reliable. Thus, there is in this area no standard of “conservative treatment” from which exploratory operations would be a clear departure, properly requiring certain decisions and safeguards because extra risks would knowingly be run. Therefore, in practicing family treatment at present one has only the choice between being cautious in overall attitudewithout having adequate guides to what appropriate caution specifically would beor being more frankly exploratory.
Haley, Jay (1962): Whither Family Therapy. In: Family Process, 1 (1), S. 69–100.
Abstract: The treatment of an entire family, interviewed together regularly as a group, is a new procedure in psychiatry. Just when Family Therapy originated is difficult to estimate because the movement has been largely a secret one. Until recently, therapists who treat whole families have not published on their methods, and their papers are still quite rarealthough we may soon expect a deluge. The secrecy about Family Therapy has two sources: those using this method have been too uncertain about their techniques and results to commit themselves to print (therapists of individuals have not let this dissuade them), and there has apparently been a fear of charges of heresy because the influence of family members has been considered irrelevant to the nature and cure of psychopathology in a patient. As a result, since the late 1940’s one could attend psychiatric meetings and hear nothing about Family Therapy unless, in a quiet hotel room, one happened to confess that he treated whole families. Then another therapist would put down his drink and reveal that he too had attempted this type of therapy. These furtive conversations ultimately led to an underground movement of therapists devoted to this most challenging of all types of psychotherapy and this movement is now appearing on the surface.
There are three general arguments offered for treating the family as a whole rather than the individual with symptoms: (a) often individual therapy has failed with a type of patient, or a particular patient, and it is argued that his family environment is preventing change and should be treated, (b) when individual treatment is slow, difficult, and subject to 69frequent relapses, it is similarly argued that the environment of the patient is inhibiting change, and (c) the appearance of distress and symptoms in other family members when the patient improves raises questions about the responsibility of a therapist to other family members.
Hildreth, Harold M. (1962): Family Treatment Of Schizophrenia: A Symposium. Opening Remarks. In: Family Process, 1 (1), S. 101–102.
Abstract: Family therapy is one of the “new frontiers” of the mental health field. As a pioneering endeavor it holds much promise for the future, not only as a therapeutic technique but even more importantly as a method of gaining deeper understanding of man in terms of his most fundamental human relationshipsthose of the family. Work in this field is arduous, and few professional or scientific people have yet undertaken it. The participants in this symposium represent a fair proportion of those who have.
Boszormenyi-Nagy, Ivan (1962): The Concept of Schizophrenia from the Perspective of Family Treatment. In: Family Process, 1 (1), S. 103–113.
Abstract: The concept of a disease in the customary nosological sense is based on distinctive diagnostic and etiologic criteria. Since the criteria of the etiology of a physical illness are usually connected with organic, heredito-constitutional or acquired causal factors, physical medicine expects to find the causal mechanisms within the biological boundaries of the diseased individual. Psychiatry, on the other hand, is generally concerned with concepts of causation that are quite different from those typically used in medicine. Schizophrenia, in particular, is not exhaustively described by the traditional nosology, as the results of various studies including the present one undertaken at the Eastern Pennsylvania Psychiatric Institute suggest.
It is perhaps justifiable to say that schizophrenia is a diagnostic entity. But only if it is looked upon as a state of acute confusion or psychotic disturbance of thought and volition can it be regarded as analogous to certain etiologically well-defined syndromes of disordered brain functioning. A shift in the focus of observation to the interlocking between the patient’s psychotic symptomatology and the patterns of his family life clearly raises the possibility of a need for a new nosology. Such a nosology requires terms based on a psychology which transcends concentration on determinants within the individual patient to include an operational consideration of the unconscious, hidden motivations in the other, presumably healthy, members of the patient’s family, motivations which act as external determinants of the patient’s behavior.
This paper, then, will address itself to the problems and mechanisms of close, family relationships, the total interactional field of the family with special emphasis on the determining influence exerted on the patient by the unconscious motivations of other family members. Since family life can be considered as simultaneously determined by genetic-historic as well as present interactions among members, the dynamics to be discussed will pertain to both aspects. Furthermore, a hypothesis will be examined, according to which schizophrenic personality development may in part be perpetuated by reciprocal interpersonal need complementarities between parent and offspring.
Midelfort, C. F. (1962): Use of Members of the Family in the Treatment of Schizophrenia. In: Family Process, 1 (1), S. 114–118.
Abstract: In the fifteen years that the writer has experimented with the use of family therapy, members of the families of patients treated in the La Crosse Lutheran Hospital were used as companions, constant attendants and nurses. The hospital being a general hospital in which there is no special psychiatric facility, the patient and members of the family stayed in a private room on the first floor along with other types of patients.
The longest stay in the hospital has been three weeks. During the last eight years the average stay has been from seven to ten days. The cost to the patient is sixteen dollars a day and this includes two dollars a day for the relative who sleeps on a cot and takes his meals with the patient. The care after hospitalization is in the Clinic where patient and relatives are seen once in two weeks for one-half hour to begin with and later on once a month, then once in six months or once a year. Not all continue to come for therapy, but many have been followed for years. The total average cost for the patient, including everything, is about two hundred dollars.
Members of the family took part in therapeutic interviews with patient and psychiatrist. Some members of the family, when present, made the patient’s illness worse while others seemed to be very helpful. It was easy to tell to which category the relatives belonged because the patient changed noticeably within a day. It did not follow, however, that the relative whose presence increased the patient’s illness was a poor companion for the patient. On several occasions a relative might have had to sit outside the patient’s room at intervals, but in spite of this the patient improved.
Framo, James L. (1962): The Theory of the Technique of Family Treatment of Schizophrenia. In: Family Process, 1 (1), S. 119–131.
Abstract: Technique in any form of treatment, when it exists independent of rationale or theory, is likely to be mechanical or directionless. Since the theoretical underpinnings of family treatment are, of course, loosely constructed, the techniques we have come to develop have had to rely upon a body of findings which are confirmed only by that apologetic term »clinical validity.« I am going to attempt to make explicit some of the things we have learned in treating schizophrenics with their families, and I will state them in the form of a series of propositions. The techniques to be described will make more sense when viewed from the standpoint of these clinical findings, which, in essence, constitute our rationale of family treatment.
Friedman, Alfred S. (1962): Family Therapy as Conducted in the Home. In: Family Process, 1 (1), S. 132–140.
Abstract: The home visit in psychiatry and social work has not always been regarded with favor and has been out of style for many years. Even in the field of general medical practice, it has become a frequent complaint in recent years that it is difficult to get a doctor to come to the home. Now, with the new emphasis on conceptualizing emotional illness in terms of family and social roles, and with the advent of a new family therapy, there is need for reassessment of the place of the home visit. This assessment is indeed being made, and we find that there are some advantages in making the evaluation of the family in its own setting in the home.
Once we have gone out to the home for this purpose, the next question follows naturally: Why not return there regularly and conduct the family therapy on the spot, rather than admitting the primary patient to the hospital? Therapy of some sort can perhaps be conducted in any setting. A more meaningful question might be whether a family unit therapy conducted in the home is more effective than a family therapy conducted in the clinic or hospital; also whether a family therapy in any setting is as effective as individual therapy. We are, however, not in a position as yet to answer these important questions. The necessary controlled comparative studies have not been conducted. This paper will only present some of the initial experiences, and some of the problems that occur in conducting home therapy. These are presented mostly in the form of anecdotes and observations, because we are still in the first data-collecting stage of our knowledge in this field.
First, it is necessary to justify why one would ever consider going to the home to conduct therapy in the first place; to present a rationale and make a few speculations about possible advantages of this approach, as follows:
1. There may often be an advantage in maintaining the responsibility for the patient and his illness within the family, and not permitting the family to deny or “exorcise” what it considers to be the sick or “bad” part of itself by sending the patient to the hospital. It is very tempting for the family to push the whole responsibility for this difficult problem onto the doctor, and then perhaps to suffer guilt later for this action. In addition, this hope of escaping the responsibility usually turns out to be only illusory.
2. Many patients are brought unwillingly to the mental hospital by their families by means of subterfuge, threat or force. This does great damage to the relationship and results in a further estrangement of the patient even when it is recommended and clearly indicated. With a withdrawn, housebound patient, the most practical procedure for the situation may be to initiate the family therapy on the spot in the home.
3. Temporary resistances sufficient to break office or clinic therapy may be overcome by this home treatment arrangement, and family members may stay in treatment longer. In a sense, the family becomes a captive patient in the home therapy approach, just as the individual patient becomes when he is hospitalized.
4. The transfer value of a psychotherapy conducted “in vivo” in the real milieu of the family and home, is greater than that of psychotherapy done in the socially isolated context of office or hospital. In conventional therapy the patient has to transfer what he has learned in his therapy, secondarily, over to the relationships with the members of his family.
5. The process of therapy is altered when it moves into the home setting, as a function of the heightened reality context in which the therapy occurs; of the possible participant-observer role of the therapist; the more active involvement of the family members, and the opportunity for immediate analysis of their actual ongoing behavior in the here and now laboratory of family therapy.
Osterweil, Jerry (1962): Discussion. In: Family Process, 1 (1), S. 141–145.
Abstract: It is one of the challenging and often frustrating consequences of conducting intensive treatment of schizophrenics that it leads more than any kind of therapeutic work to frequent self examination. It is no accident that the people working in this area were prominent among those who first became interested in such topics as “immediate experience,” shared relationships, “parataxic distortion,” and “communication problems.” In keeping with this critical introspective spirit, this symposium rather than being an uncritical testimony as has so often characterized panels discussing new methods of treatment, focuses on the problematic aspects of family treatment.
Dr. Framo, for example, has emphasized the basic need for a rationale in undertaking family treatmenta conception of one’s theoretical model and goals for the treatment process. He has also properly acknowledged that family treatment is conspicuously lacking such a conceptual framework at present. Anyone who has tried to do this kind of treatment will readily understand why it has been difficult to arrive at a satisfactory conceptual scheme.
The literature on family treatment has consisted largely of highly intuitive papers which have attempted to develop new concepts to describe the interplay of intra-psychic dynamics and family interactions. There are only a handful of major theoretical concepts or hypotheses that are primarily of a descriptive, clinical character although they may be suggestive of broad functional relationships. Wynne’s concept of pseudomutuality, which has provided part of the background for all these papers, is the most comprehensive formulation thus far and I believe comes closest to providing a preliminary model for treatment.
In reflecting on these papers it is necessary to have this concept clearly in mind. Wynne (1) describes the pseudomutual relationship in the family of schizophrenic patients as one in which there is a strong primary investment in maintaining a sense of relationship … even though it may be illusory … an absorption in fitting together … even at the expense of a failure to differentiate their identities, achieve personal growth or attain rich satisfying relationships. There is, furthermore, and inability to acknowledge or work through real differences in interests or feelings or any sources of dissatisfaction that normally occur in any relationship. This concept like most of the thinking about family treatment is a complicated mixture of many different frames of reference, such as the role theory borrowing from the work of Talcott Parsons and his group, the interpersonal theory of the Sullivanian group, communication theory, Freudian psychodynamics, as well as the newer thought in psychoanalytic ego psychology, particularly Erickson’s work on ego identity. It is still very difficult to systematically articulate the relationship between these various frames of reference, and the various authors often describe very similar phenomena from only slightly different vantage points.
Handlon, Joseph H. (1962): Discussion. In: Family Process, 1 (1), S. 146–152.
Abstract: In his discussion of the papers of this symposium, Dr. Jerry Osterweil has outlined for us what he believes are the major theoretical issues that have been raised. I should now like to shift the frame of reference a bit and suggest some of the problem areas that I feel are in the greatest need of further research exploration. In making these suggestions, I am following the lead of my colleague, Dr. Morris B. Parloff, who in a symposium on The Outlook for Psychotherapy Research, presented during the current 68th Annual Convention of the American Psychological Association, pointed out that, historically, research planning in a field such as the one of family treatment has followed the lead of clinical insights and hunches (Parloff, 1961). Certainly, during this symposium we have been treated to brilliant clinical hunches and challenging ideas. A whole smorgasbord of exciting research possibilities has been laid before us. How can we choose wisely from such a fareindulging our more exotic tastes and yet preserving a balanced diet?
In order to point out where I feel we need to invest the greatest amount of research effort, I have proposed two sets of research questions. The first set of questions has to do with the relationships between the family dynamics on the one hand and the etiology and maintenance of schizophrenia on the other. The second set of questions is related to research having to do with the methodology of family treatment per se.
Watzlawick, Paul (1962): Review – Ronals D. Laing: The Self and Others. Further Studies in Sanity and Madness. In: Family Process, 1 (1), S. 167–168.
Abstract: As the subtitle indicates, the present book is a further exposition of the author’s thesis originally set forth in The Divided Self. A Study of Sanity and Madness (Tavistock Publications, London, 1960). Dr. Laing, a research psychiatrist at the Tavistock Institute of Human Relations and the Tavistock Clinic, has been engaged for several years in the study of interactional and communicational aspects of human relations and their effect upon an individual’s mental health. Both books make it evident that Dr. Laing is one of those rare psychiatrists who combine clinical experience and intuition with a gift for methodic research and a wide range of knowledge in many other fields, such as philosophy, sociology, anthropology, literature etc.
While The Divided Self dealt more with the single individual, the present work⎯in the author’s own words⎯”attempts works own to depict the one person within a social system or nexus of other persons; it attempts to understand the way in which the others affect his experience of himself and of them, and how, accordingly, his actions take shape. The others either can contribute to the person’s self-fulfilment, or they can be a potent factor in his losing himself (alienation) even to the point of madness.” (p. IX)
Jackson, Don D. (1962): Review – Norman W. Bell and Ezra S. Vogel (eds.) (1960): A Modern Introduction to the Family. Glencoe, Ill. (The Free Press). In: Family Process, 1 (2), S. 168-168.
Abstract: The Editors have produced what will probably remain for some time the bible on the family. By selecting fifty-one papers ranging from sociological studies to clinical psychiatric studies, they have covered a wide range of ways of viewing the family. In the introduction (part one) papers are included which consider such questions as “Is the family universal?” In part two, “The Family and External Systems,” papers consider the family and value systems, the family and the community and other aspects of impingement of modern environment upon family structure. In part three, the internal processes of the family are considered, and in part four, the family and personality. Certain specific attempts to tie in personality with family interaction occur, such as the paper by Henry, “Family Role Structure and Self-Blame.” In this section there are also papers by Wynne and Lidz describing their work with the families of schizophrenics.
Each of these sections will have more appeal to one discipline than to another. For example, the psychiatrist will typically flip to the back and read the last section on the family and personality. Yet so much material is provided that there may be a kind of “halo” effect in which the non-clinicians will read something about clinical opinions and therapy and the clinicians will allow some of the sociological studies to rub off on them.
In such a monumental compendium, one can always object to the inclusion of certain papers and the exclusion of certain others. Yet this is counting the angels on the head of the pin since the authors have succeeded in their task of presenting a broad scope and have provided the incentive for the reader to view family studies from many contexts.
Grotjahn, Martin (1962): Review – Nathan W. Ackerman (1958): The Psychodynamics of Family Life: Diagnosis and Treatment of Family Relationships. New York (Basic Books). In: Family Process, 1 (1), S. 168–169.
Abstract: After 25 years of clinical work and much preliminary writing, Nathan Ackerman reports now with this book in full about his pioneering work in family therapy. His thesis is straightforward: any treatment which excludes a patient’s family cannot deal efficiently with the patient’s problems, conflicts and sickness.
Part one deals with the theoretical aspects of family neurosis and treatment. It starts with a description of Freud’s basic concepts, and ends with defining and discussing concepts like homeostasis and family identity. Identity answers the questions: “Who am I?” or “who are we?” or Individual identity is closely related to the identity of the family. Stability of behavior is based on the continuity of identity. There is constant interchange and interaction between the individual and his family.
Part two describes in detail the clinical aspects of family therapy, starting with the difficulties in diagnosing a family. This is a new field not yet allowing systematic presentation. Ackerman’s experience is based on many years of work with many families. He describes in detail his method of working with one family so that the reader is in a position to appreciate both the problems and the way in which they are handled. A group of 50 families has been investigated with special care. They give the material for special study of marital pairs, parental pairs, of childhood and adolescence conflicts. There are even families which react with psychosomatic illness to the family conflict.
Part three is most interesting since it gives in detail the technical aspects of family therapy. Ackerman starts with an outline of psychotherapy today, its theory, its technique and its goals. He gives in these pages his version of an integrated family therapy. A call for research concludes the book.
Peters, Carl (1962): Review – John Elderkin Bell (o.J.), Family Group Therapy. Public Health Monograph No. 64, United States Department of Health, Education and Welfare. In: Family Process, 1 (1), S. 169–170.
Bell, Norman W. (1962): Extended Family Relations of Disturbed and Well Families. In: Family Process, 1 (2), S. 175–193.
Abstract: It has long been recognized that the mental health of individuals is related to the family. However, until recently there has been a failure to conceptualize the family qua family; studies of individual pathology have usually reduced the family to individual psychodynamic terms (1). Beginning with Richardson’s (2) pioneer attempts to characterize the family as a group with properties in its own right, considerable changes have taken place. Numerous investigators have developed conceptual schemes to describe the subtle and complex processes in families. Such reformulations involve a shift away from the view that mental illness is a characteristic of an individual toward the view that disturbance in one member is a symptom of the functioning of the whole family. Concomitantly, different therapeutic approaches to families as groups (3) or to individuals (4) as family members have been developed.
These reconceptualizations produce a needed corrective to earlier tendencies to overemphasize the significance of an individual’s innate tendencies or of isolated segments of relationships in which he may be involved. However, to the family sociologist, there appears a danger that the fallacies of oversimplification and reductionism characteristic of the focus on the individual are being repeated again at the family level. Family psychiatrists seem, by and large, to view the family as a self-contained, invariable unit (5) existing in a social and cultural vacuum. The significance of a grandparent1 or an extra-family activity of a parent may be recognized as incorporated in one member’s pathology in particular instances. But systematic consideration of the interdependence of the nuclear family and related families of orientation, or of the nuclear family and the surrounding society as a universal structural principle have been lacking.2 Both on theoretical (7) and empirical (8, 9) grounds it is difficult to find justification for neglecting the frameworks within which families function.
Birdwhistell, Ray L. (1962): An Approach to Communication. In: Family Process, 1 (2), S. 194–201.
Abstract: Although communication as a subject for contemplation has a history almost as long as that of writing, as a subject for scientific investigation it is terra incognita. Man has long been aware that he is a communicator, but only recently has he found it necessary to investigate the process. In art and literature there have been several centuries of concern with the senses involved in communication and with certain expressions, but communication as a focus for scientific research may, with only a few notable exceptions, be dated from shortly before World War II.
The brief life span of research in communication has been marked by a geometric progression of projects engaged in research upon communicational phenomena, particularly in the fields of family research and psychotherapy. In fact, the present interest in communication is so great as almost to constitute a fad. For the past two or three years every major meeting of leading societies in the social sciences has included panels or sections centering upon communication theory or research. With the exception of those centering around ethological or comparative psychological investigations, most of these panels have been concerned with theory rather than with research. In part this is due to the fact that much of the current research in communication does not lend itself to presentation within the limits imposed by the conventions of scientific meetings. We simply do not know enough about communication to communicate efficiently about scientific research upon it. In addition much prevalent theory is constructed from the deadwood of misconceptions about communication.
Ackerman, Nathan W. (1962): Adolescent Problems: A Symptom of Family Disorder. In: Family Process, 1 (2), S. 202–213.
Abstract: The adolescents of our time are hoisting distress signals. In many ways, both direct and indirect, they let the rest of us know that they are in trouble. Their disordered behavior today is an almost universal phenomenon. We have in the United States of America the teenage gangs and beatniks; in England, the “angry young men”; in Germany, the “Bear-Shirts”; in Russia, the “Hoodlums”; in Japan, the split of the teen-agers into “wet” and “dry.” These are but a few examples of semi-organized group expressions of wide-spread adolescent conflict. Conspicuously in evidence are signs of disorientation, confusion, panic, outbursts of destructiveness and moral deterioration. The disordered behavior of the adolescent needs to be understood not only as an expression of a particular stage of growth, but beyond that, as a symptom of parallel disorder in the patterns of family, society, and culture.
In a setting of world crisis the distress of the adolescent may be viewed as a functional manifestation of the broader pattern of imbalance and turbulence in human relations. The family, as a behavior system, stands intermediate between the individual and culture. It transmits through its adolescent members the disorders that characterize the social system. In our native community we confront the special challenge of the anarchy of youth. The recurrent bursts of bizarre teen-age violence are emblazoned for us in the daily papers and other mass media. This is dramatic and frightening. But the problem embraces far more than juvenile delinquency. While some adolescents explode crudely in extremes of destructive anti-social action, others manifest their distress in a more subtle, indirect and concealed way, no less serious for its inconspicuousness. Fundamentally, what underlies the entire range of disorders is the adolescent’s fierce, often failing struggle to find himself in this chaotic world. He is searching for a sense of identity, for a sense of wholeness and continuity, in a society that is itself anything but whole and anything but steady in its movement through time.
But let us not imagine that it is the adolescent only or exclusively who experiences this painful struggle. It is all of us, at all stages of life, who echo in our personal lives the disorder of the social system. The agitation of the adolescent surely does not exist in isolation. It is matched and paralleled by the emotional insecurity of his parents, the imbalance of the relations between them, and the turbulence and instability of the family life as a whole. The family, as family, does not know clearly what it stands for; its resources for solving present day problems and conflicts are deficient. Not only are families confused, disoriented, fragmented and alienated; whole communities sometimes exhibit these same trends.
Burton, Genevieve & Donald R. Young (1962): Family Crisis in Group Therapy. In: Family Process, 1 (2), S. 214–223.
Abstract: The aspects of group counseling discussed in this paper1 are based on the taped transcriptions and experiences with three groups of alcoholic husbands and their wives, comprising four couples each, which were seen in weekly counseling sessions for a minimum of thirty weeks. Although there have been reports on psychotherapeutic work with alcoholics and their wives seen separately in group settings (1, 2, 3, 4), only a very brief reference relates an experience with alcoholics and their spouses seen simultaneously (5). The writers served as co-therapists for each of these groups. The major research focus is upon the interpersonal behavior of the alcoholic and his wife as they interact in the group setting. This paper, however, is limited to a consideration of the reporting by group members of crises arising within the marriage and/or family. Family crisis and disorganization have been the subject of sociological inquiry as demonstrated in the publications of Koos (6), Waller and Hill (7). The term “crisis” as it is used in this paper refers to any situation that has led to intense argument or conflict that either one or both are unable to resolve to their mutual satisfaction. Crises reported in these groups run the gamut from disagreement over child discipline or drinking, to accusations of infidelity or threat of divorce.
First, we will share with you some general observations about the reporting of crises, based on observation and the study of records from various sessions. Then we will present in greater detail the interaction of one group session focused on one couple’s bitter argument. Specifically we are raising the following questions in regard to the reporting of crises in the group sessions:
(a) What use does each spouse make of the crisis itself?
(b) What are the motivations of each spouse in reporting his version of the crisis or his part in it?
(c) How do the other group members react to or use the report of the crisis?
(d) What roles do the co-therapists play as the crisis is reported?
Kempler, Walter, Robert Iverson & Arnold Beisser (1962): The Adult Schizophrenic Patient and His Siblings. In: Family Process, 1 (2), S. 224–235.
Abstract: This investigation1 began after a review of the literature failed 1 to clarify the following question: If the parent-child relationship is significant in the evolution of schizophrenia, are there not detectable and describable differences in the various parent-child relationships in the families of schizophrenic patients? Many investigators in recent years have worked with the families of schizophrenics, for example, Bateson (1), Wynne (2), Ackerman (3), and Lidz (4, 5, 6, 7). None of their published works has focused on the differences in parent-child relationships within such families.
We proposed to interview the schizophrenic patients and their siblings with the above stated broad question in mind. Admittedly, this focus of attention carries with it an inherent prejudice; however, in the interest of establishing the broadest possible approach, the project was conducted without further formal hypotheses. We felt that Franz Alexander (8) stated most clearly the scientific philosophy underlying such an investigation when he said, “Intelligent experimental work which is not a waste of energy and time can only begin when through careful comparative observations the relevant and significant variables have been recognized and meaningful correlation hypothesized. The more complex and less known a field is the more it needs the creative type of comprehensive observation viewing the totality of the phenomenon.” In other words, we did not know what would emerge or how it would emerge and we intended to listen and observe.
Our methodology was briefly as follows: With each family in our series we interviewed the schizophrenic patient and his siblings. Two of the investigators were present at the interviews. One conducted the interview and the other took as nearly verbatim notes as possible. In addition each interview was tape recorded. Subsequently all three investigators independently compared the notes with the tapes and it was felt that the notes were complete enough and sufficiently accurate to serve our purpose. In the interviews the subjects were asked a series of open-ended questions, e.g., “Tell us about the patient…tell us about the family…tell us about your mother…etc.” If these questions did not result in a description of the family figures and interrelationships these areas were clarified by further questioning with the investigators’ attempting to minimize their own interventions.
Osberg, James W. (1962): Initial Impressions of the Use of Short-Term Family Group Conferences. In: Family Process, 1 (2), S. 236–244.
Abstract: AMONG THE FUNCTIONS of the Mental Health Study Center in Prince George’s County, Maryand are research into the problems of community mental health and the operation of a psychiatric outpatient clinic. The clinic functions in a setting which is partly urban, partly rural, with a population of around 400,000. Since its organization in 1948, the clinic staff has maintained an orientation of working within the framework of the family. This has included psychotherapy with children with collaborative casework, the use of joint conferences with parents to report the staff’s evaluation and recommendations, and an increasing use of conferences with family members as a therapeutic technique. We have been influenced in this endeavor by Bell’s description of his work with the family as a group, by our own search for therapeutic techniques which permit a broader public health approach to mental health problems, and by the occasional striking changes that have followed conferences with parents.
As a learning experience and in an effort to appraise this approach, we have seen 38 families for family group treatment during a four year period. We have also offered selected individual families a series of three to five joint conferences subsequent to our usual intake and diagnostic interviews. Our initial goals, as the staff formulated them during several meetings, were “to facilitate communication within the family, help family members to become more aware of their difficulties so that they themselves may find more adequate solutions to their problems, and to offer a brief type of service.” In this paper only our early experiences with approximately fifteen families will be described, with the emphasis upon our initial impressions of short-term family group conferences.
Fry, William F. (1962): The Marital Context of an Anxiety Syndrome. In: Family Process, 1 (2), S. 245–252.
Abstract: Many clinicians, from Freud on (1, 2, 3), have described cases of neurotic anxiety with accompanying symptoms in the individual patient. It appears, however, that the relationship with the marriage partner is intimately related to the psychopathology of the patient. This paper will add a brief description of the marital context in which some patients develop these symptoms.
The syndrome of concern here is that of anxiety, phobias, and stereotyped avoidance behavior. The anxiety usually takes the form of intermittent, acute attacks of panic accompanied by the usual psychologic and physiologic phenomena. There is nothing obvious about the etiology of these attacks; they seem to occur in a variety of emotional and interpersonal situations with variable intensity and a fluctuating range of phenomena. This symptom generally conforms to classic descriptions of neurotic anxiety (4).
The phobias include fear of being afraid, fear of being alone, fear of open spaces, wandering, traveling, and sometimes claustrophobia and fear of crowds. These phobias, like the anxiety attacks, are not individually remarkable, or unlike, in any way, phobias described in classical psychiatric and psychoanalytic literature. It is interesting to note, however, that as a group the phobias encountered in this syndrome concern concepts of space and area and distance. The single exception to this generalization is the fear of fear. The fear of being alone is no exception, since it is more a fear of the sensation of being physically isolated than of the emotion of loneliness. As a matter of fact, the emotion of loneliness, as we shall see, is rather constantly present and is relatively well tolerated, in contrast to these phobias.
The avoidance behavior is related to the phobias by acts that are calculated to prevent the patient’s contact with phobia-stimulating situations. For instance, a patient insists on remaining housebound to avoid stimulating her fear of wandering about. Another demands the continuous presence of another personpreferably the marriage partner-to forestall any stimulation of her fear of being alone. These behavior symptoms frequently are so intense and so far-reaching that serious restrictions on the patient’s activities are imposed. One couple with whom we have had contact was so restricted by behavior symptoms that neither husband nor wife was able to leave the house for a period of several years.
From the intrapsychic point of view, these patients are defending themselves against unconscious ideas. The conflict consists of a struggle within themselves. Granted such a point of view, the marital partners of these patients should be a heterogeneous group. Although the patients might be similar to each other since they have similar problems, the spouses need not be similar if they are not involved in the psychopathology.
Gehrke, Shirley & James Moxom (1962): Diagnostic Classifications and Treatment Techniques in Marriage Counseling. In: Family Process, 1 (2), S. 253–264.
Abstract: In marital counseling, the approach used by many caseworkers has been to treat the individuals involved in terms of their respective neuroses, with change in the marital relationship coming as a by-product of improved individual adjustment. This method really amounts to treating an individual who happens to have a marital problem rather than treating the marriage relationship itself. The same approach would be used whether the person, married or single, was requesting help about a problem in his job, school, marriage or other relationships.
Such an approach undoubtedly has its merits and is in some cases one answer, in others the only answer. However, with this method, long term treatment is often necessary before there is any improvement in the presenting marital problem. Many clients may not sustain treatment to this extent because their request is for relief of conflict in the marriage and not reconstruction of their individual personality patterns.
We have focused our treatment approach on the marriage relationship itself because we see a difference in treating an individual who has a marital problem and in treating the problem in the marital relationship. In explanation, it is our contention that people marry each other to have certain needs met through marriage and, as long as these needs are met, the marriage can be stable even with an extreme degree of neurosis in one or both partners. When something happens to upset the balance in this mutually satisfying relationship, conflict results. To illustrate:
A equals the husband and his total personality adjustment.
B equals the wife and her total personality adjustment.
C equals the marriage relationship which contains both A and B but also something different and apart which is the
result of the interaction of A and B and their effect on each other.
It is C on which we focus.
Haley, Jay (1962): Family Experiments: A New Type of Experimentation. In: Family Process, 1 (2), S. 265–293.
Abstract: In the search for more satisfying ways of explaining differences between individuals, the emphasis in psychiatry and psychology has been shifting from the study of the processes within an individual to the study of the processes which occur naturally between people. There are increasing attempts to classify and describe the functioning of married couples and families as well as ongoing groups in industry, military organizations, different psychotherapy situations, and other “groups with a history.” The study of established relationships offers an opportunity for a new type of experimentation on human behavior; new because the variables to be measured are those which other psychological experiments are designed to eliminate. This paper will present some of the problems in design, sampling, and measurement as well as the results of a pilot experimental program on families containing a diagnosed schizophrenic.
Erickson, Milton H. (1962): The Identification of a Secure Reality. In: Family Process, 1 (2), S. 294–303.
Abstract: Reality, security, and the definition of boundaries and limitations constitute important considerations in the growth of understanding in childhood. To an eight year old child, the question of what constitutes power and strength and reality and security can be a serious matter. When one is small, weak, and intelligent, living in an undefined world of intellectual and emotional fluctuations, one seeks to learn what is really strong, secure, and safe.
Towne, Robert D., Sheldon L. Messinger & Harold Sampson (1962): Schizophrenia and the Marital Family: Accommodations to Symbiosis. In: Family Process, 1 (2), S. 304–318.
Abstract: The importance of symbiotic relations1 for the psychopathology of schizophrenia is well known. Symbiotic relationships have been described, for the most part, in the family of origin, (10, 14) mainly between mother and child. Relatively little attention has been given to the form of similar relationships in the marital family.2 It is readily apparent that many married adult schizophrenic patients ostensibly separated from their parental families continue to participate in symbiotic involvements within their new family structures. Despite this seemingly incontrovertible fact there are no outstanding studies of the ways in which contemporaneous marital families include, evoke and sustain symbiotic partnerships.
Our inquiry into the ways in which the marital families of schizophrenic patients have served to shape and sustain pathological behavior has afforded us the opportunity to study the structure of current adult symbiotic relations. This report is based on a study of nine marital families in which a wife with young children was hospitalized for the first time in a California state mental institution, diagnosed as schizophrenic.3 We have found that the symbiotic involvements encountered in the marital family encompassed more complicated patterns of personal relations than the prototypical mother-child dyad. Family arrangements that evoked or sustained symbiotic attachments always included a critically interested third party. The role of the third party seemed essential for the perpetuation of the symbiotic partnership, both promoting union and forestalling progressive differentiation.
Through a detailed presentation of the cases to be described we shall illustrate three distinguishable patterns of family arrangements which accommodated symbiotic relations. In each pattern, although in different ways, the wives’ partial withdrawal from adult object-choices and ways of relating were institutionalized within the family system. This allowed them to maintain a tenuous commitment to marital roles in the face of pressure for symbiotic union. These family arrangements included the reciprocal participation of wife, husband, and parental family members, and served to invite and accommodate the latter in taking over marital roles. As a consequence, the wives’ partial investment in both adult object-choices and symbiotic ties to parental figures was sustained and made a day-to-day part of routine family life. In all patterns a role was created for the wives by the conjoint participation of husband, wife, and parental figure that suspended them between (a) the regressive claims of childhood symbiotic attachments and (b) the progressive demands of marital family life. This role, once established, permitted the continuance of marital life by temporarily allowing the wives to live in two worlds and by compensating for their withdrawal from marital functions. It also insured that the wives would experience continuous conflict.
We shall emphasize the conjoint character of the family arrangements containing this role. That is, these arrangements were established by a network of intimates in an attempt to cope with their inter-related problems in dealing with the demands of marital life. We had some indication that when the accommodated state of symbiotic relatedness faced dissolution, when under changed circumstances the wives came to expect to relinquish one or the other set of conflicting commitments, their conflict became a dilemma and they were precipitated into a schizophrenic disorder.