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 up until his recent death was 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.”

Book Review: The Coddling of the American Mind by Greg Lukianoff and Jonathan Haidt

This highly recommended book addresses an extremely important issue: why the current climate we have in the States is characterized by increased and pathological polarization between various groups and subgroups, with each group vilifying the others. The authors also focus on a cultural shift on college campuses that has often led to an environment characterized by political correctness rather than free and open debate between opposing viewpoints. Groups can even turn on their own members for deviating ever so slightly from a “party line.”

The book is almost a textbook about certain processes that are characteristic of groupthink. Groupthink is when a group of people, in an effort to demonstrate harmony and unity, fail to consider alternative perspectives and ultimately adopts a shared narrative about the world which actively tries to keep out opposing viewpoints. 

Haidt, in a previous work reviewed here, pointed out that when groups of people who know each other share goals and values, this enhances “our ability to work together, divide labor, help each other, and function as a team is so all-pervasive we don’t even notice it.” He adds that “Words are inadequate to describe the emotion aroused by prolonged movement in unison that drilling involves.” 

However, sometimes groupthink goes way too far. Even supposedly objective scientists are not immune from overdoing it, which will be the subject of an upcoming book on groupthink in science I am co-editing for Springer.

Group process, in human psychology, is often at odds with our own brain’s ability to be selfish and think about what we want and believe instead of what others want us to want and believe. There is a war between individualist and collectivist tendencies within all of us. This idea is at the heart of my own therapy model, unified therapy. Its roots, in turn, are found in the model of family systems therapy formulated by Murray Bowen. 

His was the first, and is still seemingly the only other, therapy model that recognizes this basic conflict, which is found everywhere in nature. We are biologically programmed to, under certain environmental circumstances, sacrifice our own needs and beliefs – and even our very lives – for our kin or ethnic group.

The book discussed here looks at not only political correctness as an impediment for finding truth in the universe, but what they see as a related issue: why the rates of depression, anxiety, drug abuse and suicide have been rapidly increasing in college aged kids and others over the last few years. He attributes this to the adoption by large numbers of people in the Western world, particularly in the States, of what he calls “three great untruths:”

1.      The untruth of fragility: what doesn’t kill you makes you weaker.

2.      The untruth of emotional reasoning: always trust your feelings.

3.      The untruth of Us versus Them: life is a battle between good people and evil people.

When I was growing up in the 1950’s, all of the children I knew were out riding their bicycles in the neighborhood, wandering freely over significant distances, and spending much of their time engaged in free play. Many of them walked or rode their bikes to school, and baby sitters hired by parents at night could be as young as 12. What a difference from today, when someone might call the police or child protective services on you for letting a 9 year old walk home from school without adult supervision! 

Ironically, the rate of child abductions and crimes against kids was no different then than it is today, but partly because of pictures of missing kids on milk cartons and also because of widespread illiteracy about probability, today’s parents are downright paranoid.

The effect is disastrous. Human beings are, in many but of course not always, what the authors term anti-fragile. Of course, if trauma is severe or frequent, children often become more fragile and fall apart emotionally more easily later on. However, as the authors point out, if they are not exposed to a certain amount of stressors and challenges, they do not seem to learn to tolerate adversity, adapt to stressful circumstances, and grow up. They get weaker. Some stress is good for you! 

This is a good illustration of what I call the “principle of opposite behaviors.” Two opposite but extreme approaches to life and parenting lead to the very same problem. In this case, people who act fragile. Parents who over-protect their children end up harming them and driving their emotional problems.

My view about the interpersonal processes involved here differs somewhat from that of the authors. I do not think these folks are usually as fragile as they might appear. I think they act that way because they believe that their parents need them to be that way so the parents can feel good about themselves.

Over-protective parenting has become epidemic in society. The authors go into several revealing reasons for this phenomenon, although they do not mention as one of these reasons what I believe to be a major contributor: Over the period from 1965 to today, the change in gender role expectations and the need for two career families has led parents to feel guilty about not being there as much for their kids. They make up for it by being overly solicitous. These guilty feeling are exacerbated by today's culture wars.

One of the odd things going on in college campuses lately stems directly from the parenting changes: the absurd emphasis on “triggers,” “microaggressions” and the need for “safe spaces.” What this means is that both the kids and the adults running the schools think that a kid can be literally traumatized by hearing someone’s conflicting opinion. Not just upset, annoyed or even angry about it, but literally traumatized. Scarred for life!

The professors who don’t believe this to be the case feel intimidated and fearful for their jobs if they challenge this belief, and so they usually remain silent. This has led to something akin to a “speech police.” Speakers are prevented from coming to campus by occasionally violent protesters, and well-meaning professors and administrators have been fired for using the wrong word in something they wrote. The authors give several truly frightening examples.

This culture is completely the opposite of the culture that led to the “free speech movement” at the University of California in Berkeley in the mid 1960’s. Human knowledge advances by the free exchange of ideas as well as challenges to those ideas. That idea used to be at heart of the philosophy of higher education in the United States, but in many cases it seems to have disappeared.

Particularly enlightening – and frightening – is the book’s chapter on witch hunts. These occur when “A community becomes obsessed with religious or ideological purity, and believes it needs to find and punish enemies within its own ranks in order to hold itself together” (p.99). If someone offers any kind of differing viewpoint, they become the enemy. Everything starts to reek of “Us versus Them,” and the idea that people are either good or evil, and everyone seems to assume the worst about almost everyone else.

The Relationship between Marital Problems and Family of Origin Dysfunction

The essay In Consultation: Becoming a Therapist for Each Other: How to Deepen Couples Therapy by Ellen Wachtel Ph.D. in the Psychotherapy Networker from July/August 2018 answers a therapist’s question about a difficulty the therapist consistently ran into in his work with married couples. The question involved how to deal with the emotional difficulties of one of the members of the couple without derailing the work on the couples’ relationship issues.

Since in my experience both members of couples who seek marital therapy usually come to the relationship with pre-existing emotional issues – which I believe to be highly relevant if not crucial to their marital problem – that problem would come up no matter which member of the couple the therapist focuses on. Dr. Wachtel seems to understand this when she correctly points out that, “It’s common for one person in a couple to believe that the lion’s share of the problems in the relationship arises from the other’s emotional difficulties. As a firm believer that ‘it takes two to tango,’ I try to resist joining with that point of view.”

Unfortunately, she also adds, “But sometimes it’s just too big a stretch to see both partners’ contributions as anywhere near equal.” Nonetheless, she goes on to point out that, no matter how clear that seems to be,  the person “chosen” for individual work invariably reacts with, “’Why me? Shouldn’t she (or he) get therapy too?’ Or ‘I react the way I do because he’s so provocative.’”

I must say I agree with the member of the couple who says that. While one member’s dysfunctional behavior may be far more dramatic or dysfunctional than that of the other, in my opinion both members of the couple have a stake in their relationship continuing in its current dysfunctional form. The way this goes down and the reasons it happens were discussed in my previous posts “I’ll enable you if you enable me” and “The Obvious Secret of Interpersonal Influence in Families.”

Briefly, each member of the couple is enabling the other member to maintain a role function that each believes necessary to stabilize their own parents, who are unstable due to an intrapsychic conflict that is shared by the entire family. I call this mutual role function support. Each member of the couple thinks the other member of the couple needs them to play this role because both of them compulsively act out their roles in the face of repeated and obvious drawbacks and negative consequences. Each person would deny this if asked for various reasons, so the other person has to guess why that person continues in their self-defeating or self-destructive habits, and they usually make the guess based on watching their partner interact with the partner’s parents (cross motive reading).

Wachtel comes very close to this formulation by recommending approaching the couple issues by saying, “We’re all stuck with some emotional issues from our childhoods, and even if we work on them in individual therapy, they’re still likely to have a hold on us. In our work together, we’ll try to find ways to keep these issues from affecting the relationship as much as they are now.” She also helps each member of couple construct their genogram to “get a window” into the source of problematic patterns. 

I would add that the emotional issues are not just from childhood but are in fact family emotional issues that are continuous and ongoing.

I have a lot of respect for Dr. Wachtel. She, along with her husband Paul, wrote a book called Family Dynamics in Individual Psychotherapy: A Guide to Clinical Strategies, the first edition of which came out in 1986.  This was one of the first books that attempted to integrate family systems ideas into individual psychotherapy.  (I must also admit I was a little annoyed when it came out because I was still trying to find a publisher for my first book, which attempted to do the same thing, and they beat me to it!)

Unfortunately, in this piece for the magazine, she falls into the exact same trap that Murray Bowen—the family systems therapy theorist who first started tracing dysfunctional relationship patterns through genogram construction—fell into. With his patients, as pointed out by Daniel Wile in his book on couples therapy, Bowen used education, logic, and collaboration to help educate his patients on the reasons for their self-destructive behavior. 

When he sent them back to their families of origin, however, he taught them to use the paradoxical interventions, therapeutic double binds, and strategic maneuvers that are part and parcel of Jay Haley’s alternative type of family systems therapy. In a way, he coaches patients to use this type of therapy on their family members instead of employing Bowen therapy. Wile asked why Bowen did not coach his patients on how to use Bowen therapy on their parents.

Wachtel starts to go down this route. She recommends to each member of this couple to offer support for, rather than merely challenge, the other member’s need to persist in each one's seemingly unproductive habits. In strategic family therapy, this is a paradoxical technique which often seems to have the opposite effect from what it seems to be intended to have: the partner might, in response to being given a green light, start to “be more able to hear his own internal voice that questioned the need to do the task.”

While this might help in couples that come from only mildly dysfunctional families, in my experience with more highly dysfunctional families, any good that comes from a paradoxical prescription will in fairly short order be undone due to the continued  and more powerful influence of the families of origin of each member of the couple. The parents and other family  member, as I often say, will invalidate the efforts of their adult child to step out of their dysfunctional family role with devastating effectiveness.

I find that members of a couple, with the right coaching, can move from the mutual role function support that attracted them to one another in the first place to becoming allies in the efforts of each to deal with his or her primary attachment figures. After constructing the two genograms, the therapist can help devise strategies for each member of the couple to stop dysfunctional interactions with each’s own parents. This can be done with the full understanding of the spouse so the spouse knows why their mate is suddenly trying to change things and understands how the devised strategies might actually work.

In fact, they can practice the strategies with each other. The spouse role plays the role of the other spouse’s targeted parent – and the spouse is usually well acquainted with that in-law and can do so very accurately – while the spouse practices the moves and countermoves planned with the therapist. This practice allows each one to stick with the script more effectively in the face of problematic responses from the parents.

I go into more detail about this process in my upcoming self-help book, due out November 1.

What Happens if Adults with Borderline Behavior Start to Act Better?

People who have dealt with those who have been diagnosed with borderline personality disorder (BPD) often wonder why those folks persist in their often infuriating as well as self-destructive behavior when it seems so obvious that they are making themselves as well as everyone who cares about them completely miserable. 

When I first started to treat them, I know I did. These patients were not psychotic, nor were they stupid, so why did they persist in dysfunctional behaviors in the face of overwhelming evidence of their consequences. So I started asking the magic, Adlerian question: What would happen if you got better and stayed better?

As I described in that previous post, patients would often answer with the non-answers, "I'd just find some other way to screw things up" or "I cannot even imagine what that would be like." I would not accept those "answers" and pressed on.

When the answers finally started to emerge, I was totally amazed. One thing that might happen was described in my very last post. If a patient with BPD got better, their families would run for the hills. Exile them. Shun them. Abandon them. Anyone wonder why those with BPD have "abandonment issues?" Wonder no more.

But abandonment was far from the worst or the most likely outcome when patients acted beter.

I found that something family therapy pioneer Murray Bowen described was quite real - only that it was the just the first thing that would begin to happen before things got far far worse.

I found that the power of family members to invalidate anything a therapist tries to teach a patient should not be underestimated. As first pointed out by Dr. Bowen, they will literally gang up on a patient with messages that scream, roughly translated, "You're wrong! Change back!"  Previously uninvolved family members may come out of the woodwork, and previously sympathetic family members may suddenly turn on the patient and scream things like, "HOW CAN YOU TREAT YOUR MOTHER LIKE THAT!?!" 

I dubbed this phenomenon "clustering." Try to imagine what it would be like if everyone you know and loved started to come after you like that. If you don't think you would wilt, you are kidding yourself. And that would be true even if you came from a family that was relatively functional to begin with. Imagine having been invalidated like that for your whole life.

As I said earlier, however, that would only be the first thing that would happen if someone with BPD started to act better. The next thing that happens is that the parents start to act out in alarming and frightening ways. I'm talking about things like parents making suicide threats or actual attempts, increasing drug or alcohol abuse to alarming levels, worsening domestic violence, family members getting thrown out on the streets penniless, or any children left in the home starting to be abused, neglected or molested. You know, minor, inconsequential stuff.

Furthermore, as first pointed out by Lorna Smith Benjamin, in "borderline families" all these problems would be blamed on the patient, who would be subtly expected to somehow exert control over them.

Think you'd be able to turn your back on your family if all this happened to you? Very few can. Even if you could, it would only be because your family would, through their own behavior, engineer your dismissive attitude - so that you would continue to not only be their scapegoat, but so they could also label you as an uncaring son of a bitch as well. 

Americans like to think that they don't care what their families think of them. Horse manure!

In response to all of this, individuals with BPD usually start to actively undermine ("spoil") any efforts anyone might make to encourage them to continue with their "good" behavior - without telling anyone (including a therapist if they have one) about any of their family's behavior - and revert right back to the way they had always been. 

The Individual or the Family for Psychotherapy?

My interest as a therapist has always been finding what is called a "metatheory." Psychological theories, particularly those which try to explain why people who seek therapy are often so self-destructive, tend to focus on just one aspect of the problem almost to the exclusion of many other important considerations. 

In looking at patients, therapists from different "schools" of therapy that deal only with individuals focus solely on just one of the following: environmental factors which seem to trigger the behaviors, thoughts that are irrational and lead to counterproductive feelings and behaviors, seemingly inappropriate affects, or internal conflicts which pit one’s biological urges against values learned and internalized from one’s family or culture. 

Psychiatrists these days tend to focus just on biological and neurological processes.

Therapists with training in social psychology or family systems theory may look at either the family dynamics or at larger sociocultural influences.

There are mental health professions who are trying to counter this myopia (also called reductionism) and who would like to integrate all of these viewpoints. The typical metaphor employed by those folks is the famous story of the blind men and the elephant. One blind man feels the tail of the beast and makes conclusions about what the elephant looks like based solely on this, while others feel other parts of the elephant such as the hind quarters or the trunk, and make conclusions about the what the elephant might look like from those alone.

Some "integrationists” want to look at the whole elephant, so to speak, but are overly cautious about it. They stick to just looking for commonalities among the theories of the various blind men, rather than the whole picture. They are afraid that "integrated" therapy would be just one more school. This is reflected in the absurd name of their organization: Society for the Exploration of Psychotherapy Integration (SEPI). 

In other words, do not actually integrate anything, just "explore" the possibility. Luckily, there are a few members of SEPI who want to understand the whole elephant as a complete unit unto itself. I count myself among their number, and am part of something called the Unified Psychotherapy Project.

My main theory, which is the force behind the type of psychotherapy I do with those of my patients who present with repetitive self-destructive behavior patterns -  I call it Unified Therapy - looks at the relationship between individuals and their internal processes, and the processes of the social groups to which they belong. Many of the conclusions I have drawn are based on the following series of propositions:

1.            The relationship between a self and its social system is not a constant but a variable.

2.             As children get older, their "self" differentiates from it social system - in most cases his or her family of origin - in a process known as separation-individuation. In other words, children gradually gain the ability to separate and express their own intellectual and emotional functioning when it is different from or disagrees with that of most of their family members.

3.             All individuals go through this process as they negotiate the passages of individual development whether they want to or not.

4.     Human culture has evolved over history so that, at each stage of human childhood and adult development, individuals have been able to differentiate more and more from the collec­tive as they go through the process of separation-individuation. The overall balance between individual expression and group conformity has, at least in developed countries, gradually shifted over history towards the former.

5.             Consensual validation from other members of the family system is necessary for  individuals to feel comfortable expressing individuated behavior, also called self-actualization.

6.             Because individuals have an inborn biological propensity to concern       themselves with the survival of the species, they are willing to sacrifice themselves, or aspects of themselves, in order to further what they perceive to be the greater good of their own family and ethnic group (kin selection).

7.             When individuals find that certain differentiated aspects of self seem to threaten the immediate representatives of the species, the family system, they will attempt to sup­press or completely sacrifice those self-aspects.

8.             In order to do so, they develop a false self, or persona, which is then maintained by a variety of self-suppressive devices such as self-scaring through the irrational thoughts catalogued by cognitive therapists (catastrophizing for example)- also called self-mortification - and through the use of the traditional defense mechanisms catalogued by psychoanalysts like Anna Freud. The de­velopment of a persona often causes individuals to appear to be incapable of certain kinds of activities, which makes them appear to be defective in ways that they are not.

9.             The needs of the family system to respond to the cultural forces which seem to mandate the evolu­tion of increased self-actualization often conflict with the needs of the system for stability and predictability (family homeostasis).

10.              Younger members of the family are often induced by the needs of the larger culture to behave in a fashion that is far more differentiated than the behavior of the parents. The parents, who are the leaders of the family system and its most important constituents, may be unable to com­fortably tolerate such behavior, even when they are them­selves attracted to it. The whole family system becomes threat­ened.

11.              This problem often cannot be solved in ways other than through the sacrifice of the younger system members' individuality because of two factors: the tendency of fam­ily members to protect one another from anxiety and shame, leading to an avoidance of discussing what is going on between them (metacommunication), and secondly, the tendency of family members to rely on past experience in evaluating new family behavior, leading to the so-called game without end.

12.             These factors not only lead to impaired individual func­tioning but hamper the family from adjusting to new cul­tural contingencies. The efforts of individuals to protect one another, in particular, lead to eventual harm for everyone. I call this the altruistic paradox (or sometimes the Mother Teresa paradox).

A therapist can help solve the problem of self-sacrifice by work­ing with individuals and teaching them how to avoid the difficul­ties that lead to impaired family problem solving. The pioneer in this approach was Murray Bowen. He used education, logic, and collaboration to coach his patients on how to deal differently with their families. However, what he tought them often involved techniques other than education, logic, and cooperation. 

In Unified Therapy, the  ther­apist instead teaches patients to adopt a problem-solving ap­proach with their families.

Specifically, patients can learn to overcome both their own and their family's resistances to metacommunicating about family difficulties. They can learn to bring up systemic problems in ways that do not induce negative reactions from other members of their family systems. The keys to effective metacommunica­tion are empathy, avoidance of moralistic blaming behavior, and respect for the integrity and potency of all family members.

In therapy, patients come to an expert to learn how they are induced by the reactions of others to behave in self-destruc­tive ways and why the others behave in the ways that they do. Patients learn to empathize with and understand the reasons for the negative behavior of other system members without agree­ing that the behavior is good and without sacrificing their own thoughts or emotions.

They learn to differentiate between emotional reac­tivity and emotional reactions. They learn to tolerate and to sub­vert attempts made by other family members to stop them from proceeding in the task of metacommunicating. They have an op­portunity to practice what they have learned by role playing with the therapist.

Specifically, the patient is trained to deal with various maneuvers that the rest of the system uses to get them to shut up and not challenge the rules by which the family operates. These maneuvers represent attempts to withdraw consen­sual validation from the patient and include such things as accusations of self­ishness, changing the subject, unreasonable behavior, double binds, blame shifting, nitpicking, overgeneralization, mental gymnastics, and fatalism. 

The patient is also trained to prevent family members from uniting in various combinations to defeat the patient's efforts to metacommunicate. Once the systemic problem has been dealt with, mal­adaptive and self-destructive behavior problems begin to disappear, along with many types of anxiety and mood symptoms. 

Book Review: Transcending the Personalty Disordered Parent: Psychological and Spiritual Tactics.

Self-help books for the adult offspring of highly dysfunctional, personality-disordered parents are in woefully short supply. Children raised in such households often grow up to have high emotional vulnerability,  a poor self image, and a high degree of confusion about what kind of people they are supposed to be or what they should expect from their relationships.  Worse yet, they sometimes become just like their parents in some way, even if they try to do things in an exactly opposite way.

If they do not have access to a therapist for whatever reason, is there anything they can do in order to better understand what has happened to them, and how to think about the problems that have resulted from their bewildering and traumatic upbringing? 

In a new book, academic psychiatrist Randy Sansone and academic psychologist Michael Wiederman attempt in ordinary language to help such individuals recognize the dysfunctional parenting styles they had been subjected to, and to understand a little bit about what makes their parents act the way they do. 

They describe in detail how such parents may do any or all of the following, among other things:  

• ·     They act like monsters with their family members, but are liked and highly-respected outside of the home - creating an almost Jeckyl and Hyde situation. 
• 
  
• ·     They seem to think that their children should be taking care of them - but undermine any effort the children make to actually try and do so.
• 
  
• ·     They seem to see children a big burden, yet won’t them go.
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• ·     They pit one of their children against another, creating even more widespread family discord.
• 
  
• ·     They accuse their children of the very negative traits that they themselves display in spades.
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• ·     They seem to over-react to seemingly minor transgressions made by family members, and in response become abusive and bullying.
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• ·     They seem to be in a constant state of denial about past misdeeds.  Or are they maybe just lying about it?
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• ·     They oscillate between intruding on the lives of their children when they don't need help, and neglecting them when they do.

The authors go on to suggest ways in which readers who have grown up with parents like these can conceptualize and think about their family experiences. 

Although they do not cite her by name, many of their recommendations seem to stem from the concepts of “mindfulness” and "radical acceptance" that come from the work of Marsha Linehan with personality disordered patients.  These ideas involve the adult children giving up trying to completely make sense of their dysfunctional parents, completely accepting their situation as it is, stopping efforts to make their parents change, and viewing their experiences as an opportunity for growth rather than as an obstacle to it.

As I mentioned, there is a serious need for a book like this, and I applaud the authors for their efforts. I also think many of their suggestions are indeed helpful, especially for those who are not seeing a family-systems oriented psychotherapist for whatever reason.

I do, however, have some quibbles with their explanations for the personality disordered parents, and I frankly strongly disagree with a couple of their recommendations.

The authors do try to be somewhat empathic with the plight of the dysfunctional parents, but their descriptions of them, understandably, veer away from that. The authors could benefit from an understanding of family systems theory. They come ever so close to Murray Bowen’s three generational understanding of the origins of self-destructive behavior, but just miss it.

For example, they discuss how the reader may have been given what Transactional Analysts call a “script” by their parents – in which the recipients of the script act out in ways that seem to be for the benefit of their parents at the expense of their own happiness. The authors do not mention, however, that perhaps the dysfunctional parent is also the unfortunate recipient of such a script from the grandparents.

In the same vein, the authors, like Marsha Linehan herself, mix up the personality disordered parent’s true self with his or her false self or persona. Is the exemplary behavior seen by outsiders the "true" nature of their personalities, or is it within their hidden-from-view dysfunctional family behavior?  This issue is somewhat analogous to my problem with Linehan’s idea of apparent competence – that somehow people can demonstrate through performance an ability they do not in fact have. How is that possible?

One father who they describe was a physician who was loved and idealized by his patients, but treated his children like crap. The authors seem to assume that the father’s “real” personality was the one he exhibited at home, while the one he exhibited at work was a fraud. Could it not be in fact the other way around?

I disagree with the authors recommendation that children of dysfunctional parents give up the idea of ever truly understanding their parents' behavior. I believe that through the use of three generational family histories called genograms that it is indeed possible to understand parental misbehavior (which, BTW, does not entail approving of it).

The authors also seem to be saying that nothing will ever change in their relationship with their parents, and that there is nothing the child can do about it. Those who read this blog know that I believe that, while adults (not children) are indeed powerless to change their parents, they  certainly do have the power to change their relationship with those parents.

The authors provide an example (p.187) purportedly showing the futility of getting personality-disordered parents to even admit that they did anything wrong in the past:  

“A patient was on the telephone with her highly dysfunctional mother. The mother was intoxicated with prescription analgesics, which was typical for her. The patient broached the issue of a babysitter who molested her and her sister for an entire year during their childhoods. At the time, both girls had told their mother about the molestation by the female sitter, but the mother continued to employ the sitter anyway. During the telephone conversation, the mother defensively stated in a slurred voice, “She only molested you girls a few weeks,” as if this nullified the injustice. Understandably, the patient exploded and proceeded to call her mother a number of obscenities.”

The authors concluded that the mother lacked the ability to validate her daughters feelings. The daughter therefore would never be able to get this validation, for which she longed.

I completely disagree. Let’s look at what happened in more detail. First of all, the daughter called the mother when the mother was intoxicated. I understand that it might be difficult to find a time to call when she was sober, but that fact alone guaranteed that the daughter would fail in her efforts to obtain validation. Second, I suspect that the way that the daughter brought up the molestation made it obvious to the mother that the daughter was highly critical of the mother’s lack of responsibility - as obvious as that lack of responsibility was. To the both of them, I might add. 

When anyone is attacked, they tend to respond with defensiveness, flight, or a returned attack. This is especially true in this case since I would wager that the mother really did, covertly, feel terrible about what she had done, and believed that the daughter was right to hate her for it.  Furthermore, I find that such parents feel they deserve hatred, and that their children are really better off without them.  

Mother therefore responded in a very hateful manner, which very helpfully gave the daughter more righteous justification for her hatred, and pushed her away to a place in which the mother viewed the daughter as safe from the mother’s pernicious influence.

If this daughter really wanted validation, she went about asking for it in exactly the wrong way, and the horrific response was entirely predictable.

Not that the right way is something easy to devise or to do, or that the complicated techniques that do in fact work are obvious. And this problem is further complicated by the fact that the right approach is different in every family and must be customized to each family member's sensitivities. Generic assertiveness skills are often useless.

Confronting maladaptive family patterns may in fact be extremely dangerous if done poorly. It almost always requires the coaching of a therapist who does this sort of work. As I have said repeatedly in this blog, finding such a therapist is well worth the effort.

The 12 Steps of Alcoholics Anonymous - a Translation

Getting all of the blame, but none of the credit

One of the central ideas I use in trying to understand the relationships between various theories and treatment models within psychotherapy is that, within all groups of human beings, there is a constant battle (called a dialectic) going on between what Murray Bowen’s protégé Michael Kerr called the "forces of individuality" versus the "forces of togetherness" (collectivism, in politics speak). The dialectic between individual desires and group norms can be seen dramatically within the twelve steps of Alcoholic Anonymous (AA). 

Caveat: while this post may seem critical of some aspects of 12 Step Programs, I want to emphasize that these groups do help a certain percentage of addicts. Being addicted to substances is usually far worse that endorsing any of the problematic aspects of the AA ideology. Until something much better comes along, AA represents the only hope for some individuals. 

The strategy that AA uses to help alcoholics and other addicts is based on techniques used by Protestant religious denominations to convert non-believers. Those, in turn, are based on the techniques that such groups use to enforce group behavioral norms while still allowing a certain degree of individuality, as described by Erich Fromm in his classic book, Escape From Freedom. 

While giving some praise to the individual in a series of clever paradoxes and ambiguities, certain aspects of individuality are ritually denounced - most usually, the "dangers" of unrestricted willfulness. Willfulness, or the desire to follow our own inclinations, is equated with sin, and is seen as leading invariably to de­gredation and despair. 

The alcoholic and the teetotaler really believe much the same thing and need one another desperately. The teetotaler says that self-indulgence leads to ruin, and the behavior of the alcoholic proves the point. Without the example of the latter, the philosophy of the former could not be reasonably maintained. Without the warnings of the non-drinker, the alcoholic would have no one to defy. The success of AA is dependent on a continuing supply of new "sinners." 

The 12 Steps refer to the issue of the individual versus the collective both directly, when the issue of human will is discussed, and indirectly, when they speak of God or a "higher power." To show how often the denigration of individuality arises in Twelve Steps and Twelve Traditions, I am going to list some quotations from the book. 

Admittedly, I am taking these quotes out of context. The reason that I do so is that, as I will show shortly, the context contains large numbers of contradictory statements that are not juxtaposed for comparison, as well as paradoxical statements, which mask the underlying message. Of particular note is that the entire book is written using the collective pronoun we. 

[Page numbers that are referred to are from the following edition: 
Alcoholics Anonymous. Twelve Steps and Twelve Traditions. New York: Alcholics Anonymous World Services, Inc., 1981. (Originally published 1952)]. 

…self confidence was no good whatever; in fact, it was a total liability. (p. 22) 

…the average alcoholic, self-centered in the extreme... (p. 24) 

"How he [the practicing alcoholic] does cherish the thought that man, risen so majestically from a single cell in the primordial ooze, is the spearhead of evolution and therefore the only God that his universe knows!" (p. 25) 

…those filled with self sufficiency who have cut themselves off [from God] (p. 28) 

Now we come to another problem, the intellectually self-sufficient man or woman... far too smart for own good... blow ourselves into prideful balloons... (p. 29) 

cut away the self will... (p. 34) 

The philosophy of self sufficiency is . . . a bone-crushing juggernaut whose final achievement is ruin. (p. 37) 

We want to find exactly how, when, and where our natural desires have warped us. (p. 43) 

It is not by accident that pride heads the procession [of the seven deadly sins]. (p.48) 

It is worth noting that people of very high spiritual development almost always insist on checking with friends or spiritual advisers in the guidance they feel they have received from God. (p. 60) 

It is a spiritual axiom that every time we are disturbed, there is something wrong with us. If someone hurts us and we are sore, we are in the wrong also. (p. 90) 

…any success we may be having [in remaining sober] is more His [God's] success than ours. p. 92) 

…personal ambition has no place in A.A. (p. 183) 

…A.A.'s twelve traditions repeatedly ask us to give up personal desires for the common good... (p. 184) 

Moved by the spirit of Anonymity, we try to give up our natural desires for personal distinction ... p. 187) 

…a loving God as he may express Himself in our group conscience. (p. 
189) 

As I mentioned earlier, these types of statements are intermixed with paradoxes and ambiguities. On page 26, we are told that the AA group does not demand any belief or behavior — that all twelve steps are merely suggestions. Of course, on page 174, we are told that any group member that defies the "suggestions" has probably signed his own death warrant. 

We are exhorted to keep an open mind while at the same time to "resign from the debating society" (p. 26). We are told that the best way to get rid of self-will is through our willingness to do so. We are told that dependence upon a higher power is a means of gaining "true independence of the spirit" (p. 36). 

One rather frequent ambiguity in the book is that it sometimes implies that its ideas concerning over-indulgence apply primarily to the issue of alcohol, while at other times it seems to apply its concepts far more generally. Page 36 implies strongly that the twelve steps do not apply just to the issue of alcohol. 

Throughout the entire volume, debatable statements about self-indulgence are mixed up with statements concerning over-indulgence that only a fool would debate. Page 44 sensibly discusses instincts running wild, and, on page 65, we are even told, paradoxically, that God does not expect us to fully eliminate all of our natural drives. 

The book's discussion of pride also presents us with a mix of statements that confuse one type of pride — unwarranted pride — with all types of pride. It is also fascinating that, shortly after discussing the alcoholic's generic pride, the book goes on to discuss the alcoholic's generic feelings of inferiority and inadequacy. Are we to assume that alcoholics are both truly proud and ashamed of themselves simultaneously? 

Allow me to translate the 12 Steps from the collectivism vs. individualism perspective. In step one, addicts admit their powerlessness over their own impulses. The way to stop behaving self-destructively, says step two, is to turn to a power greater than ourselves. Step three defines exactly what it is that we are supposed to do in relation to that power. We are supposed to turn our will over to it. We must not trust our own instincts, but only some power greater than ourselves- the collective, of course. 

In step four, we make a moral inventory, in order to discover our liabilities. The type of "defects" under consideration here are spelled out quite dearly. They are the old familiar seven deadly sins. Notice that the issues of the harm that we have done to others and making amends to others do not come up until steps eight and nine — after this moral inventory. We must deal with our own intrinsic evil before we can address the evil that we have inflicted upon others. 

In step five, we are to admit the exact nature of the wrongs discovered in step four to ourselves, God, and another person. We cannot be honest with only ourselves and God; after all, we may be deluding ourselves about God's will. We must confess our sins to others. We must let them know that we were not in control of our impulses. 

The AA book clearly compares this step with the confession of sins in organized religion. In the group meetings, members announce their names and add, "and I am an alcoholic." They say there is no shame in this, but clearly members are ritualistically humiliating themselves in front of the group. 

They may say that they are doing this in order to overcome the denial characteristic of the alcoholic. However, if alcoholism truly is a manifestation of willfulness, then, when practicing alcoholics insist that they can control their drinking whenever they want to, they are telling the truth. The real denial comes when they "admit" that they were not deliberately choosing to drink all along, but were responding to their "disease." 

Steps six and seven involve asking the higher power to remove our shortcomings; again this is to be done before we even consider the harm that we have done to others. The concept of humility and our own powerlessness over our impulses is stressed. 

If we do well in the future, the credit goes to the higher power who has removed our shortcomings. If we screw up?  Well, that's just our own shortcomings.

After we deal with the harm we have done to others in steps eight and nine, step ten involves continuing the process of self-criticism that had begun in step four. The priority goal of this process is self-restraint and the avoidance of pride. This is accomplished by attributing any sobriety we have achieved not to ourselves, but to God. Kindness and love to others arises from our devotion to God, not from our own selfish instincts or will. 

Step 11 involves the personal relationship to God. We are to meditate. and pray to God "as we understand him." On what this understanding is supposed to be based is never specified exactly. In fact, the book takes a religious stance by adopting the notion that the Lord works in mysterious ways which no mere mortal can understand. 

It is clear that what happens in the world is not supposed to happen according to our own notions of right and wrong or our own will. We are to pray for what God wants, not for what we want; we are to ask only for knowledge about God's will for us and His power to carry it out. 

This knowledge does not involve specific answers to behavioral dilemmas, but only knowledge about how we might best forget ourselves and serve the collective. Only then will love, forgiveness, truth, and harmony come about, and we will be rewarded by a sense of belonging to the group. In the twelfth and final step, we are encouraged to spread the gospel, and to apply it to all of our affairs. 

Why are the anonymous groups so powerful when it comes to stopping compulsive behavior? (At the risk of offending the devout, I am going to discount the possibility of divine intervention.) I submit that the answer to the question lies in the fact mentioned above —that both the practicing and the recovering AA alcoholic prove the point that individual will power is a bad thing: Many of the families of addicts are grappling with problems created by the increasing value placed on the individual by society at large, and how the newer prevailing philosophies conflict with the need for their families to function according to an old set of rules. 

Practicing alcoholics appear to be rebelling against collectivist tendencies by indulging themselves with no concern for the health and safety of loved ones or anyone else. They often lie, put others in double binds, defeat expressions of caring and concern, and drive while intoxicated. 

Many individuals and family members directly involved with the problem of alcoholism argue that this behavior results primarily from the influence of the drug, but the 12 Steps argue more convincingly than I ever could that they really do not believe it. The behavior of the alcoholic is clearly attributed to a self-centered attitude. 

The alcoholic's willfulness, pseudo-selfishness (they are really self-destructive), and lack of concern for others, however, does not work. Alcoholics end up depressed, humiliated, and often physically ill. Their rebellion has failed. Willfulness has failed. The only way to happiness is to return to conformity. When they stop drinking and join AA, their lives improve. 

This proves beyond a doubt that conformity is superior to willfulness. By providing such proof, they help to reinforce the role functioning of other family members who are themselves experiencing internal pressures to express selfish impulses at the expense of old established family rules.