Review of Clinical Plenary Session on SOCIAL CONTEXT IN PRACTICE AS EPISTEMOLOGICAL TRANSFORMATION

By Kitty LaPerriere

The body of this session was devoted to three presentations exemplifying the application of systemic epistemology to different treatment contexts. The celebration of new developments was placed against a background of acknowledging and honoring the pioneers of family therapy who took issue with the codified rigidities of the mental health field of their day. Their work broke the ground, clinically as well as conceptually, for the varied and creative expansion the field of family therapy is experiencing today.

The audience was invited to retrace the steps each of us had taken on the path toward becoming family therapists. We were asked to remember the shock, the surprise, the pain and conflict we experienced when new truths clashed with long held beliefs, and the excitement and highs that accompanied the discovery of new ways of thinking. We recalled in silence the family therapists who mentored each one of us, who affected us, who allowed us to learn. There was a strong wish on the organizers' part to have these names spoken out loud, to have some, if not all of them, heard and recognized by everyone present, but we all understood that we had to content ourselves with a symbolic evocation. A book was provided to hold people's entries and provide a testimony of our historic awareness, our remembrance, recognition and gratitude.

This clinical plenary, organized by the program chair, Hinda Winawer, was dedicated to Edgar H. Auerswald, or Dick, as we all knew him. She must have read his stuff, perhaps listened to him speak, perhaps studied with him. I don't know. But she felt strongly that family therapy owed him a big debt. Two of his articles were handed out at the meeting, one a reprint from the AFTA Newsletter of the winter of l985, "Removing The Straightjacket." The other, also from 1985, was called "Thinking About Thinking In Family Therapy." The titles intrigue. Let yourself be tempted and read, or reread, the articles. They focus one's thinking. While Hinda had been working behind the scenes, along with many others, to help us remember Dick, Norma Akumatsu was there to speak of him. She had been his student while he ran the Mental Health Service on Maui, and had seen him apply his concepts to daily work. Also in the audience was Alma Menn, Dick's partner, who was most likely instrumental in making the brief video collage about him possible.

The first presenter was Miguel Hernandez, who spoke about a case he had treated at the San Clemente Mental Health Center. He referred to Dick with three guidelines he has found useful: first, move one step back; second, reflect instead of react; and third, invite political action. In his own work, Miguel subscribes to transparency, a careful matching of language, social empathy and, as a somewhat more unusual addition, perhaps, he includes the transforming power of affect, which helps take the family from blame to healing. His patients were a young couple with a two-year-old son. They represented an intermarriage, the woman described as Jewish middle class, the husband as Chinese from Indonesia, whose family had to leave the country for political reasons, so that he grew up in Belgium, Montreal and New York. The presenting problem was the "spoiled child" indulged primarily by the father. Miguel' chose as his first context the issue of cultural differences, taking the problem out of the personal sphere and giving the couple a chance to unite around problems each of them had experienced both differently and similarly. The second context was more specifically the family, issues of adoption, giving material things as a proof of love, unspoken stories of the past. The work looped back to large system issues of racism and lastly, of personal oppression. The work left the couple aware that their personal problems were embedded in larger contexts, and they emerged as allies instead of enemies.

Marion Lindblad-Goldberg told of a long ongoing program that encompasses all counties of Pennsylvania. Originally funded with the mandate of tending to children of alcoholic parents, and also using funding from children and adolescent services, a new philosophy of service delivery was developed. While centrally conceived, the program took pains to customize its approach in each of the counties, establishing working alliances with the pertinent local agencies, including the court system. The parents were definitely viewed as collaborators who had to teach the therapist team the essentials of the family culture for the treatment to be possible. The appreciation of each child's unique make-up led to a competency enhancing treatment. In addition to the establishment of many collaborative professional partnerships, parent advocacy networks formed in each county, knowledgeable about children's rights and in touch with state legislators. The program achieved the feat of having all its activities billable, including travel, home visits, and phone consultations. It also developed a statewide training initiative with a certification for the home based practitioner.

The last presenter was William Madsen. His therapy is currently informed by four conceptual shifts. First, he organizes relationships with clients, away from the tyranny of technique. He sees himself as an appreciative ally against the problem. Next, the problem is externalized - the person does not have a disease, the disease has a person. As a third step, a life is built outside the problem and the therapist brings a proactive vision. And lastly, the concept of "teaching to" is recast as "learning with." He presented the case of a woman who presented herself as a bad parent, out of fear. The therapeutic work consisted of helping her become a good parent, out of love. She was to focus on her daughter, as opposed to focusing on herself as a guilty and deficient mother. This process was fostered by providing the patient with a virtual community, anchoring her in a chorus of positive inner voices that approve of her and replacing the original, self-damning ones. In all, the session was informative and positive. No hackles were raised, no passions were inflamed, no criticisms, gripes or hurt feelings were vented. It would appear that the move away from personal or familial pathology and the inevitable blame assigning that comes along with it has been banished from therapy. The process of externalizing problems is by now pretty universal. It is surely important that we gain a perspective on our relatively small size and limited power as we try to swim in and make sense of a confusing, fast paced world that is truly oblivious of the needs of people. Are we going a little too far?

Kitty LaPerriere is in private practice in New York City, working with couples, families, individuals and other groupings. Issues of gender, ethnic, immigration, life cycle, and health related type come up daily, in various combinations. She does occasional supervision and consultation work and is a member of the AFTA board. "All my other professional accomplishments," she says, "are in the past."