Family Therapy, Salvador Minuchin, and Family Systems

ncomplete dialogues destroy family systems. Family therapists with a concern for the whole system insist on meeting with everyone --- father, mother, sons, daughters, important "others" --- participating in their discussions, wrangles, angers, insights, watching their unspoken hates and prejudices.

Salvador Minuchin sounds like a refugee from a New York salsa band --- but is, in reality, an Argentine/Jewish family therapist practicing in Philadelphia. And his therapy technique is a doozy, outside the mainstream, culling the best of Fritz Perls, Freud, Alice Miller, Milton Erickson; but --- most of all --- a technique and an attitude all his own, the Minuchinesque school of therapy which is positive, hopeful, trusting:

When the girls showed fear of abandonment, anger at their parents, conflicts, and neurotic attempts at problem solving, I hesitated, acknowledged these as real things, smiled, and asked for a new look, a different perspective. It's not that I fail to see what other experts see. I simply prefer another framing.

Minuchin also acknowledges that the structure of the family has changed --- changed radically in the past decades --- but accepts that

families will divorce and that the divorced family is a viable family organization, one of many our culture has institutionalized.

Family Kaleidoscope could be considered as one expert's description of his technique of family therapy --- but it's more. For Minuchin is a dramatist --- one who works with the real plasma of real people --- and reading the dialogues is not unlike reading Shakespeare. The characters formulate themselves on the page; their own words (Minuchin tapes many of the transactions he is involved in) delineate their prejudices, the very locks on their thoughts that prevent them from interacting with the people they live with and love:

LORETTA: I'm the bad person in the family. I'm the black sheep of the family simply because I stand up and say what I feel. The other kids are always good. They're always your little sweethearts because they don't open their mouths.
MOTHER: No Loretta, nobody is sweetheart.
LORETTA:They agree about everything with you and Daddy. Whatever you say is all right with them.
MOTHER:When you want something I can't buy you, you cry for three days, you get nervous. You stop eating. Right away --- no food. Not get up from the bed. You don't want to see nobody. You don't want to talk to nobody. And Mama cries.

Minuchin has chosen exact passages to include --- and they read much as if we are reading from Macbeth or King Lear (or All's Well That Ends Well). We have here a sixteen year old girl of a working class Italian-American family. She goes on binges of non-eating. Her brothers and sisters are sweethearts because they won't open their mouths, and so Loretta refuses to open her mouth. To take nourishment. She is what they call an anorexic.

Minuchin has been treating anorexics for thirty years. In between the angry dialogues that he presents us with (Loretta against Mother, Mother against Father, Father against Loretta) he inserts commentaries --- as rich as any from Bradley or George Kittridge --- to let us in on the workings of the characters:

I am listening to what the family is saying, but I am triggered by the parents' persistence in replying to questions posed to Loretta. I know from previous experience that Loretta's symptoms may be expected to improve as she begins to gain the autonomy proper to a sixteen-year-old. I also know that Loretta's dependency and her mother's concern are interacting elements of the same pattern: whenever I touch one, I will touch the other.

Systems theory suggests that all elements of the family --- "good" or "bad" --- are necessary to insure the stability of the system. Alcoholics, dominant mothers, passive fathers, child abusers, martyrs --- all of what we call "antisocial behavior patterns" are necessary to the continuation of the perceived structure. It is required that Loretta be anorexic for the family to survive --- no matter how painful and destructive that particular survival mechanism.

Minuchin sees his job as one of introducing a revision to the system --- one subtle enough and yet strong enough to move the family from being locked in nagging, self-blame, self-pity, and anorexia to one that is more creative, able to move and change:

I have been with the Genottis for thirty minutes, immersed in their experience, absorbing their language, observing their transactions. With their help, I have begun to compose a therapeutic theme that will become the arena in which I'll challenge their reality. Replacing "we are a normal family with an anorectic child and helpful parents," the therapeutic exploration will follow the theme, "You are a family that got stuck in your development and must grow up to adjust to the growth of your adolescent children."
The family and I will build this alternative with material carefully culled from their own language and transactions, so that they can feel they are still dealing with the familiar. As the session continues, the alternative will make it possible to challenge the rigidity of this family organization and to free Loretta from her role as family stabilizer.

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have said that Minuchin is not only a therapist but a dramatist. To read this work is not unlike reading excerpts from classic plays. In fact, Minuchin actually sets one family interaction (a Marxian/hippy "family") in the form of a playlet, fantasized and written by him. He also concludes each chapter in the form of a dialogue with the reader. These mini-dramas are not as successful as the recorded interactions between him and the families, but they show his willingness as an original and controversial psychiatrist to stretch the form of the narrative this-is-how-we-experts-do-therapy book into something as strange and wonderful fiction.

In addition, there are multitudes of asides (he is his own Greek Chorus) that summarise volumes of therapeutic techniques, such as:

For the most part, society acts as if all family violence is instrumental, and the response therefore is to increase control. But it is clear to us as family therapists that most cases of family violence are the products of generations of powerlessness. When we try to intervene by controlling the parents or with concern for the child alone, we can only produce a continuation of the pattern.

Or:

Drinking is a conflict area where the couple can complain about each other endlessly with no demand for change... Through the years Lars' drinking has become the "cause" of all family problems. This fixing of causality on the behavior of one person blurs the nature of the other family transactions.

Not satisfied with the rich field of the present, Minuchin presumes to enter the past with reëxaminations of the Pierre Riviere 1833 murder (mother, sister, brother), and the early twentieth-century case of Ellen West of Switzerland. For this reader, he was less successful with these forays into the past, but these in no way diminish the power of the book. It is an masterfully written examination of the work of an idiosyncratic --- and apparently successful --- authority on the family and its strange and twisted workings.