AFTA 2000
Embracing Complexity and Compassion:
The Evolution of Family Therapy
San Diego, June 21-24

The Clinical Plenary
by Norma Akamatsu
edited by Hinda Winawer

Editor's Note: The clinical plenary, Social Context in Practice as Epistemological Transformation, is dedicated to Dick Auerswald and to those who first broke ground in the field of Family Therapy. The presenters are Miguel Hernandez, Marion Lindblad-Goldberg and William Madsen. Moderated by Norma Akamatsu, the plenary will open with a brief historical prelude, facilitated by Kitty La Perriere, to give us an opportunity to acknowledge the legacies of those whose years of work contributed to this moment in the evolution of the family therapy movement. The clinical plenary is one of the many venues in which the Program Committee has sought to continue our tradition to do justice to the complexity of diverse perspectives within AFTA throughout our history.

To contextualize the clinical plenary within the annual meeting, here, as it appears in the printed program, is the explication of the annual meeting theme:

The Family Therapy Field, since its inception, has sought to embrace an increasingly contextual understanding of human struggle and resilience. Inquiry and practice have become multilevel, encompassing individual, relational, biological, communal, cultural, economic, and political perspectives of experience. A view of the structure and emotional fabric of family life is now set within the panorma of a diverse and often challenging social context. Changes in epistemology and in the nature and venues of practice have added to the richness of the conversation within the AFTA community. This conference provides an opportunity to reflect upon the foundations of the field and its evolution toward increased complexity and social responsibility.

We may consider, then, the clinical plenary as similar to the complexity of perspectives within AFTA. Our colleagues who will present are unlike one another in a number ways, including generation, theoretical heritage, perspectives and practice venues. The unifying feature, in the spirit of Dick Auerswald and of the pioneers of the field, is the insistence upon opening the aperture of practice in search of an expanded view and a greater depth of perception of the multiple levels of people's experiences.

My appreciation, as Program Chair, to Norma Akamatsu, for her collaboration and for the following description of Dick Auerswald's legacy as a setting for the clinical plenary. We have dedicated this session to our professional forebears with respect, with appreciation, and with a deep sense of connection.

As a rather young woman in the prerecorded days before I began training as a family therapist, I enjoyed the exceptional good fortune of working with and learning from Dick Auerswald. His enthusiasm for our field inspired and drew me in. For Dick, family therapy was not merely a field, nor simply a model and most certainly was not a "modality." For Dick, family therapy was a "movement" "family therapists broke the rules of mechological thinking [the prevailing epistemology]...and learned to induct families into their new reality" (Auerswald, 1990, p 48).

In Dick's view, our history converges with a 20th and now 21st century epistemological shift a potentially far-reaching transformation of the Western scientific "edit of reality" that has dominated the industrialized world since the 17th century. Making distinctions similar to those attributed to modernist vs. post-modern or structuralist vs. post-structural thought (White, 1997), Dick's "holodigm" contrasts "mechologic" and "ecologic."

In brief, mechologic is characterized as Aristotelian (dualistic, either/or), reductionistic (the thing is understood by examining its parts), Newtonian (based on the premise of objectivity), rationalistic, explicate (objectifiable, charted) and is associated with texts espousing universal truths. "Ecologic" is aligned with New Science (Einstein, Planck) and characterized as holistic, pertaining to "the domain of relational connectedness," heuristic, subjective, implicate (non-objectifiable) and is associated with personal language and poetry. While the former "edit of reality" has clearly been predominant, Dick believed the latter, relegated to the realm of the artistic, mystical or simply foolish, is emerging as a way of knowing that brings forth a perspective of social relatedness on many levels. Dick describes the potentially lethal epistemological blunder of forcing the square peg of mechological thinking upon the round (w)hole of the "domain of relational connectedness":

The outcome is a fragmented institutionalized society divided into separate institutionalized systems and subsystems and sub-subsystems each constructed to deal with a part of the whole of human life in a mechological reality that ignores the implicate relational domain...or worse that results in fragmentation and disconnection...and pulls people apart (p.33).

Dick expropriated the word "apartheid" to refer more generally to this process which culminates in a definition of community as an "us" pitted against "them" (others) and a society held together by blame systems.

Within the smaller arena of health care delivery systems, we can easily recognize how mechologic finds expression in a medical model of humans as parts, treated by a hierarchy of specialists with monocular explanatory frameworks that preclude apprehension of the realities of the relational webs (families, neighborhoods, communities and social contexts) that are the lived experience of those "treated." Since his landmark contribution, "Interdisciplinary versus ecological approach" (Auerswald, 1968), this has been Dick's subject and project. The two health care delivery systems he designed and directed, the Gouverneur Health Services Program and the Maui Mental Health System were the practical embodiments of his holodigm (see Auerswald, 1982 and 1985.)

In 1990, Dick challenged us: [T]here is a fork in the road ahead. You have a choice. You can join the mechological grouping which considers family therapy to be simply a new modality of treatment to add to the many.... Or you can join the ecological grouping which considers family therapy to be a way of thinking, indeed, a participant in a movement designed to ensure, reinforce and hasten the evolutionary emergence of a new and generally accepted human view of reality one that connects, not disconnects (p. 48) Here I get metaphorically to rip open my respectable blue Clark Kent business suit and reveal the shiny red "E-T-W" spandex number I wear underneath but do not like to show because it makes me look a bit fringy that is, my Epistemological Transformation Warrior jumpsuit. This is yet another Auerswaldian phrase for the ideal end-product, in his view, of a sensible family therapy training program:

For those who want to participate in this needed transformation, there is a movement to be organized and some immediate tasks. We must apply ourselves to the task of learning to think in two...reality systems...and to distinguish one thought...system clearly from the other. Then we must teach others to do this, especially our children. Too, we will have to develop ways of thinking thus together. We might be able to develop a corps of transformational warriors dedicated to forging the evolutionary transformation, to moving our species to a mode of existence beyond apartheid/apartness and beyond the dualistic cycle of peace and war ( p. 47).

Dick was not one to shy away from the grand meta-narrative or a progressive idealism often now interrogated and scrutinized with mistrust. Yet, ever pragmatic, he understood such movement is not merely the fruit of good intentions, but follows from an apprehension of our interconnectedness, as in the 1970s ecologist's quip: "Hey, your end of the boat is sinking."

For Dick, the foundational shift is to step out of the box of detaching humans from their social contexts, that epistemological slight of hand so endemic to mechologic, then to sharpen our lenses for ruptures at "interfaces" rather than locating problems inside "things" persons and institutions -- and always to listen for and respond to the human story of the pain of disconnection and the murmuring poetry of our relatedness.

References

• Auerwald, E.H. (1968). Interdisciplinary versus ecological approach. Family Process, 7(2), 202-215.
• Auerswald, E.H. (1982). The Gouverneur Health Services Program: An experiement in ecosystemic community health care delivery. Family Systems Medicine, 1, 5-24.
• Auerswald, E.H. (1985). Thinking about thinking in family therapy. Family Process, 24, 1-12.
• Auerswald, E.H. (1990). Toward epistemological transformation in the education and training of family therapists. In M. Pravder Mirkin (Ed.), The social and political contexts of family therapy. Needham Heights, MA: Allyn and Bacon.
• White, M. (1997). Narrative therapy and poststructuralism in Narratives of Therapists' Lives. Dulwich Centre Publications: Adelaide, South Australia.

Norma Akamatsu is in private practice in Northampton, Mass and is on the Board of Directors of AFTA.

Hinda Winawer is Faculty, Ackerman Institute for the Family and Co-founder of the Center for Family Community and Social Justice, Inc. at Princeton Family Institute and AFTA 2000 Program Chair.