A personal retrospective of the family therapy field: Then and now

Journal of Marital and Family Therapy, Jul 1996 by Framo, James L

Because the parents were intruding so much, we started inviting them to the patient group meetings, and these came to be called "patient-relative" meetings. The siblings of the patient were also included - a rarity in the mental health field. Based on our observations of the behaviors in these meetings, we got the idea of seeing whole families. The creative step here was taking what was ordinarily regarded as interference and using it for therapeutic change. (Most therapists who do only individual therapy regard the family of their patients as the enemy.) Frankly, at that stage we were thinking of the family as a resource to help us in treating the patient. We had no idea we were on the threshold of a whole new theory of human relationships, of symptom formation, and of treatment. It was a remarkable shift when the family, rather than being regarded as a noxious influence, was recognized as needing help and containing the potential for possible change which could be capitalized upon. Whatever had been known about families previously came from individually administered questionnaires or from family members seen separately. The family had never before been observed interacting together in a clinical professional setting. When we saw whole families, we began seeing things nobody had ever seen or noticed before except novelists, playwrights, and film writers. Being with one's own family is taken for granted, like the air one breathes; we almost never looked at our own families with objectivity. Attending to whole families clinically was somewhat akin to the discovery of the microscope because phenomena began to be revealed that had never been seen before. Here are some of the things we learned early on when we observed interactions among the family members during the family meetings: The symptoms of the designated patient began to make sense and be decoded when seen in the context of the family interactions. As the patient began to improve, it frequently happened that someone else in the family developed symptoms. This was one of the first clues of the family as a system.

We learned, with revolving door patients who were sent home to the same family environment, that some patients could not change without parallel changes in the family.

We found that the psychology of intimate relationships is very different from all other social relationships; you are a different person when you are with your family than you are with other people. You regress and your immature personality features emerge when with your family. You will show your greatest cruelty to your family members, yet for them you will make boundless sacrifices. No price is too high to pay for parental acceptance.

Every family has rules, myths, assigned roles, loyalties, and alliances (one alliance almost guaranteed to develop symptoms in a child is when a parent allies with a child against the other parent).

In these families any two members could usually relate well to each other on a one-to-one basis, but trouble began when three interacted. A common sequence occurred when the mother pressured the father to control the disobedient daughter. Father would discipline daughter, mother would say he was too harsh and would comfort daughter, and mother and daughter would unite against the bad father. We came to recognize the centrality of the marital relationship of the parents. And when this relationship breaks down, generational boundaries are crossed and children are parentified and exploited. Parents live through and repeat with children and spouses the conflicts derived from their families of origin. Problems in a family tend to be repeated from one generation to the next. Symptoms, we discovered, can balance family as well as intrapsychic forces. (For example, whenever the schizophrenic patient got angry at mother, mother would label her anger as mental illness. Fathers passively stood by while siblings tried to learn what behaviors were wise to avoid.)