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Thursday, September 17, 2020

What Ever Happened to Family Systems Psychotherapy?

 



Back beginning with the March/April 2001 issue of a magazine that was originally produced for the followers of the new family systems psychotherapy models, it changed its name from the Family Therapy Networker to the Psychotherapy Network. The magazine had started 20 years earlier in January, 1982. What happened?

 

The editor of the magazine then and now is a fellow by the name of Rich Simon. In the March/April issue of the magazine in 2012 he related the fascinating history of why this happened in an essay called Still Crazy After All These Years? A Look at 30 Years of the Networker.

 

Back in the 1980’s and 1990’s there was an explosion of new ideas about how to get psychotherapy patients to change both their behaviors and their negative moods that went well beyond the three basic paradigms or schools of therapy at the time: psychodynamic, cognitive-behavioral, and emotion-focused. Something like 300 different schools came to be, although most of them were just variations on the existing schools.  The Milton Erickson Foundation in Phoenix, AZ sponsored several “Evolution of Psychotherapy” Conferences in which the leaders of the various schools came to argue with each other in front of large audiences.

 

Family Systems therapy was the most noteworthy of the new models, because it was seemingly the first to recognize that since human beings are among the most social of all organisms, perhaps looking at herd behavior might tell us more about human beings than just looking at them in isolation.

 

Of course, even within systems therapy, there were quite a few widely varying ideas about how to proceed with psychotherapy clients. In the beginning, the Networker profiled the colorful characters who were coming up with them: Salvador Minuchen, Jay Haley, Murray Bowen, Mara Selvini-Palazzoli, Virginia Satir, Ivan Boszormenyi-Nagy, and Carl Whitaker.  

 

Of course, just like in all of the earlier schools, there was also plenty of nonsense within the movement. Some theorists imagined a sort of Zen perspective in which the thought that we had individual selves to call our own was an illusion. They became like extreme behaviorists, who instead of viewing humans as rats in a physical maze, viewed them as rats in a family homeostatic maze - with no ability to think for themselves. 


Others started explaining real brain diseases like schizophrenia on the basis of family double binds, which themselves were very common in the families of people without any schizophrenic members. Still others viewed the dynamics of any particular family as if they had just come into being as is, without reference to the cultural milieu in which they developed. Even Murray Bowen, who developed a three-generational model, only looked at who was enmeshed or at odds with whom, without specifying over what behaviors they were enmeshed or at odds about.

 

According to Simon, feminists started complaining that women seemed to be getting the brunt of the blame for, as well as the responsibility for changing, the family dynamics - especially when patients with histories of child abuse became brave enough to come forward. The latter issue also led to a reaction in which people were accused of having “false memories” (and which were being prompted by some therapists if the people were suggestible enough). Some elements of society were also upset with the so-called “abuse excuse” in which victims were seemingly encouraged to see themselves as permanently damaged victims who took no personal responsibility for themselves.

 

The confluence of converging forces mentioned in the masthead of this blog then started to develop with a fury. Longer-term treatments were no longer being covered by insurance, which only covered symptomatic treatment. Bogus “medical necessity” criteria were used to drastically cut down the number of sessions therapists could administer. Drugs were pushed even for diagnoses for which there was no good evidence that they worked at all. “Major Depression” became just ‘’depression.”

 

“Biological” psychiatrists who were not even aware of the latest discoveries in neuroscience pushed a disease model for everything. In fact, science has clearly showed beyond a reasonable doubt that the structure of the “plastic” human brain is in part determined by interpersonal interactions, and that most of what we do is learned and done automatically in response to environmental clues without any conscious deliberations.

 

Simon added that they did take a lot of flack after the magazine got renamed for “abandoning” systems therapy, but, “…as we saw it, we were just creating room for a bigger, more diverse “blended” family of therapeutic approaches.”


Tuesday, September 8, 2020

Parents who Feel Both Guilty and Angry About Their Parental Performance




I recently received an e-mail from an irate reader of my blog on Psychology Today. It was in reaction to a post I wrote about parents who were cut off by their adult children acting as if they had no idea why that happened, when in fact the majority of them (but certainly not all of them) have at least a pretty good idea. She told me I was an a**hole who was automatically calling all such parents “dicks” and “a**holes.” I of course actually made no statements like that in the piece.

Of course, if a history of child abuse is involved, which it may or may not be in such cases, parents have the responsibility for that and not their children, at least before the children grow up and have minds of their own. But this was not the subject of the post.

I wrote back to her:

Sorry if the piece sounded like I was calling the parents a**holes. I don't believe that. And of course not all families that have problems like the ones I describe [in the post] are in denial about what's going on. I view everyone in the whole family as all caught within a devilishly-difficult problem to solve that is created by a variety of external factors over at least three generations. 

I never recommend cutting off parents -  even when the parents actually were (unlike you) physically or sexually abusive - and take a lot of heat for advocating that they try to work things out for everyone's eventual benefit (not that it is at all an easy thing to do this).

I of course have no way of knowing anything about particular families like yours without ongoing in-person evaluation and therapy, so what I'm about to say may or may not apply to some degree to your situation. In some families in which parents, in the estimation of the adult children, seem to be frequently beating themselves up with guilt about their worth as parents, the kids worry that they need to fix that. And what they then do is start to piss the parents off on purpose to make them feel angry at them instead of guilty. Hatefulness as a gift of love, as it were..

That last bit referred to how, in the patient with borderline personality disorder’s spoiler role, the adult child is regulating their parents’ de-stabilizing internal conflict over having children (described in this post). When the parent starts to feel too guilty, their children make them angry. When the parents start to get to angry, they lay guilt trips on them.

As I said in my reply, I don’t know if that dynamic applies to the writer and her children or not. So what made me think that it might very well apply? Well, there were certain sentences in the writer’s original inquiry that seemed to indicate a lot of guilt as well as a lot of anger:

Implying guilt:

  • “I have admitted and apologized for the times I was a bad parent, naming specific incidents and listening to them to tell me other times they were hurt by me. I try as hard as I can to listen, be supportive, and not be overbearing.”
  •  “I don’t know that any parent who needs to be told they’re a dick would accept that from you. It made me feel defensive and hurt, all over again. Trust me, most of us a**hole parents don’t realize we’re being a**holes.”  
  • “I really do not know why my kids, especially my younger daughter, hold a grudge against me.  They have never said anything that I didn’t acknowledge, apologize for, and try to make right.”   

Implying anger/defensiveness:

 

·         Calling me an a**hole for allegedly implying she might be an awful person when I hadn’t actually said anything of the sort, and accusing me of “taking sides.”

·         “If they are mad because I turned out not to be perfect, but downright human and not always the best decision maker when it came to parenting, well, I at least know I always loved them immensely and would have, & still would, die for them.”

 

You be the judge.