THE FUTURE OF FAMILY THERAPY

Plenary I Wednesday June 2, 2001

Presenters Sal Minuchin and Rachel Hare-Mustin

Introduction and Discussion by Kaethe Weingarten

Still tingling from a short dip in the aquamarine waves of Miami Beach, I looked forward to seeing figures instrumental in shaping my knowledge of family therapy. As a new member to AFTA, I must admit that I'm still a bit in awe of my famed colleagues. That evening as I sat and applauded our guests from numerous countries, it was clear that family therapy had global dimensions. The influence of all the people in the room, not solely that of our famous counterparts, holds tremendous potential for the future of family therapy.

"Family therapy is in decline," stated Sal Minuchin. I had to agree with his statement, though I wanted to shout, "Let it not be so!" Sal went on to point out that each new theory of family therapy created a group that believed its patch "contained the whole American quilt of family therapy." Tensions between factions of family therapists in the United States have impeded their ability to form a united group of family therapists interested in creating positive changes in the mental health field.

Sal suggested we look to our neighboring family therapists in Europe for inspiration. In Britain, there is a national health system that provides therapy for any person or family. Family therapy was inserted into the existing system without changing the system as a whole. In Italy, the multiple groups of family therapists that started simultaneously in the 60s eventually joined together to form a single organization and develop a single program for Italian family therapy. There are no divisive groups in Italy, rather, theirs is a single unified system. Sal stressed the need for a collaborative effort among groups of family therapists in the United States to address the government on health issues.

As Sal traced the history of family therapy, he showed how each new theory built on what came before, and how each provided a new perspective. He split the theories of family therapy into two schools, those arising from Ackerman and those from Bateson and the Palo Alto group. I had not thought of the history of family therapy in these terms and found his discussion quite interesting. In graduate school, we traced the directive versus nondirective movements, and those that privileged the client's experience (a la Milton Erickson and Carl Rogers) versus the therapist's expertise. Hearing one of the family therapy theorists define the theories in the manner in which he had lived them was enlightening. Sal Minuchin will forever be the family therapist who privileged "joining" and the value of therapeutic relationships.

However, I could not agree with Sal's declaration that in these postmodern times, family therapy has returned to a theory of individuals, returned to the very point of departure that family therapists took to set them apart from the psychoanalytic theorists of yesteryear. Although many postmodern family therapists see individuals in session, during that session there are always relationships and "others" present in nonverbal conversations. Sal's criticism of postmodern theories was based on what I see as a common misunderstanding of the postmodern concept of "self." Once the modernist concept of "self" with its defined borders is deconstructed, "self" then becomes a being with unlimited relational connections. It becomes an intersubjective self, and the intersubjective self is a "both-and" construction. It is both an "object," a biological organism with a unique genetic array, and a "subject," a fluid collection of perceptions about self, others and the world. Intersubjective selves can only exist in relation to others.

Postmodern theorists view the self as existing in connection with all of the family members and the people with whom it has come in contact in its lifetime. An infant grows and learns to think only in relation to its others. The intersubjective self is a biological entity in relationship with others in its environment, and intricately related to all of the others in its web of existence, past and present. Similarly, the concept of development, of living and growing in connection with others, was one of the most important contributions of feminists.

Following Sal's presentation, Rachel Hare-Mustin addressed the group. She opened the presentation to include all of the diverse peoples present, all of the marginalized and less dominant voices. Rachel and other feminists contributed to family therapy by bringing to the foreground the marginalized voices of women. It is always a struggle to bring change to the status quo, the "dominant discourses" of society. Rachel noted how the female voice has helped family therapists recognize the disparities in gender relations. In maintaining a single view of how the family should be, family therapists were privileging the male dominant viewpoint, and in some cases, actually causing harm to women. Although the two-parent family is still the preferred model for many people, the reality is that women are being abused in order to maintain an idealized family structure. Both Sal and Rachel agreed that today's world presents challenges to families. The ideal family structure may take on many shapes and forms. It is important to hear the different voices and to privilege each person's experience.

After the feminist objections, other marginalized voices could be heard. Cultural issues began to share the stage with gender issues. Sensitive therapists have started to listen for the "not yet said" or the understated. In conjunction with the postmodern therapists, the feminist therapists have made the concept of alternative perspectives a reality in family therapy. What is striking, despite our efforts, is that social justice is far from a reality in our society and in other societies worldwide.

Problems associated with poverty continue to run rampant. Sal mentioned that he is still dealing with the same bureaucratic issues today that he addressed forty years ago. Rachel noted the numerous ways that women are treated unjustly. The numbers of single mothers with children living in poverty is staggering, especially in so wealthy a country as the United States of America. The "glass ceiling" still exists and equal pay for equal work is still a dream. Abused women are trapped in violent marriages, unable to leave because they cannot afford to take care of themselves and their children without the husband's income. Very little social assistance is in place for battered women, and large numbers of women are killed by estranged husbands, or lovers, daily.

 Family therapists must realize that all actions are political. It is not enough to entertain an impartial stance, or to ignore the politics of our own actions. We have to be aware of the injustices that exist and not be lulled into thinking that we are already taking care of gender and cultural issues in our practices. In mainstream American life, it is easy to allow oneself to think that "those issues" are already being handled by others. Social justice issues need to be addressed daily on local, national and global scales.

Kaethe Weingarten wrapped up the session with a concise summary and opened the floor for discussion. An interesting discussion began on the "medicalization" of the mental healthcare field. There seemed to be a consensus that in the past family therapists shunned the use of medications and alienated all mental health professionals who used the word patient and practiced from a medical model. Although this may have been true, and a large segment of family therapists are still "anti-medication," enormous strides in working collaboratively with the healthcare field have already been made by other family therapists. The most obvious example is a Rochester group that has formed the Collaborative Family Healthcare Coalition. They have recognized that the mind-body connection is a strong and essential force in the health and welfare of individuals and families.

I agree that we need a unified group of family therapists to address mental health issues in the United States. We also need to embrace all of our divisive factions, in a manner similar to the way we embrace diverse people and viewpoints in our practices. We are not using all of our valued resources if we alienate postmodernists, modernists, white males or feminists, psychoanalysts or medical healthcare workers. We need more than a both-and attitude in family therapy. We need an all-and approach to family therapy for our American healthcare quilt.

Gabrielle Carey, Ph.D., LMFT is in private practice in San Antonio, Texas. She is co-author of Hispanic Family Therapy: Toward Appreciating Diversity, Allyn & Bacon (2000).