Techniques of Family Psychotherapy: A Primer
by Donald A. Bloch , (Ed. ), Grune and Stratton , New York , 1973 , 124 pp. , $7.50 .
Dr. Donald A. Bloch has succeeded admirably in his task of assembling a collection of articles that give the reader an introductory overview of family systems psychotherapy. Although there is a stated emphasis on clinical technique, this is not merely a random assemblage of promising methods. Each article, which was written specifically for this book, adds a different view of the family and has a cumulative effect that renders this collection a valuable entity in itself.
The first two articles, “Techniques of Family Therapy: A Conceptual Frame” by Bloch and LaPerriere and “Touring the Literature of Family Therapy” by Sander, supplement each other. Bloch and LaPerriere offer a concise presentation of the roots of family therapy, tracing its development from Freud's Little Hans. The contributions of the neo-Freudians, sociology, small group psychology, communication theory, and general systems theory are delineated. Family therapy is characterized as an action therapy dealing directly with a natural system-a therapy of confrontation, exploration, and trial of alternate modes of adaptive interaction. The role of the therapist as a model is stressed, as well as innovative techniques to promote disequilibrium in the family homeostatic mechanisms; indications and contra-indications are discussed. The conciseness of this article with its emphasis on a general systems approach to human behavior may intimidate some readers. This is offset, however, by Sander's article, which touches on much of the same material from a more relaxed viewpoint starting with a study of the family in literature from biblical times to the present.
The next article, a “Standard Initial Interview” by Franklin and Prosky, gives a format for handling the first contact with a family. There is emphasis on taking the family history, which can be done therapeutically as well as diagnostically by mapping out the systems aspects of the presenting complaints. This is followed by articles by Bloch discussing the usefulness of a clinical home visit and by Alger on modern, audio-visual equipment. Both articles present specific examples helpful to the beginner.
There are two articles that describe methods for seeing families in groups. Laqueur uses a question-and-answer format in presenting his highly original and productive work on multiple family therapy. Framo's article on “Marriage Therapy in a Couples Group” is also a practical introduction. Both authors have written about their work before, and they show an increased ability to describe extremely complicated work in a straightforward, easily understood manner.
Space and its relation to learning and sculpture in family therapy is an intriguing article by the Duhls and David Kantor. This Boston group presents action techniques that are useful in helping people to know and experiment with changing the system of which they are a part. The “sculptor,” usually a family member, is aided by the “monitor” in recreating in a kind of psychopageantry, specific events of the past or present. Other members are brought in one by one and assume characteristic postures. Included are applications of this technique to the issues of intimacy and intrusion in dyadic relationships, as well as to training of professionals. The authors present their own theoretical base, which is influenced by Piaget. Their techniques remind me of Virginia Satir's “family sculpturing,”“stress ballet,” and “family reconstruction.” Their article is too concise to do justice to the subject matter. I recommend they expand it to book length with further discussion of theory and transcripts of actual sessions.
Pittman's article on managing acute psychiatric emergencies stresses definition of the problem. He makes a distinction between treatment as “the pointed effort to solve a specific problem and therapy, the nonspecific process of improving peoples' mental health…” The seven phases of family-crisis therapy are reviewed. This is a very practical article summarizing the past seven years of Pittman's work, which had its origin in avoiding hospitalization by treating psychiatric emergencies in a family context.
The last article in the collection deals with the problems of a beginning family therapist. Napier and Whitaker emphasize encounter, “the of the face-to-face moment.” They point out the importance of a therapeutic team that is in itself warm, stimulating, and creative. Their method of treatment emerges from their discussion of frequent problems of the beginning family therapist; these include lack of leadership and failure to include the extended family as well as other therapists. There is special emphasis on the guarded and pseudo-mutual family and the ways in which the therapist can, unwittingly, perpetuate this pattern. Finally, there is a helpful discussion of the stages of experiential family therapy. Progress begins when the therapist is assertive and sets a firm structure. This leads after a time to the family confronting each other and then in despair turning to the therapist. At this point, the family wants the therapist's person, not his ideas and strategies. The therapist participates actively as a person. In later stages of treatment there are often dyadic, loving encounters between a therapist and a family member that spread throughout the family. The final stage is anticlimatic with emphasis on prevention. Napier and Whitaker's article deserves careful reading as it is based on rich, personal experience.
