Advances in coaching: Family therapy with one person
This paper describes the process of “coaching” individuals in their efforts to change themselves in the context of their nuclear and parental family systems. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques for intervention are not widely understood. Moreover, we have expanded the Bowen approach to address powerful cultural and family life cycle influences. The goal of coaching is to help clients define themselves proactively in relationship to others in their families without emotionally cutting off or giving in- Coaching begins by training clients to become observers and researchers of their own role in the family and of family patterns of behavior. Coaching then moves to help them bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family “rules.”
In 1967 Murray Bowen rocked the family therapy field at a conference of family researchers, when, instead of presenting the usual formal dry research paper, he stunned his colleagues by presenting a daring analysis of his personal work on his own family (Bowen, 1978b). This presentation was the first articulation of Bowen’s theoretical concepts, which have been developed by him and his many students over the last 3 decades. This theory provides a way of thinking and intervening in the full spectrum of social and emotional functioning by providing a way of thinking about people in the context of their family emotional system in response to any variety or degree of dysfunction in any family member. Based firmly on the systems idea that if one person changes, all others in emotional contact with him or her will be likely to make compensatory changes, Bowen family systems therapy is not defined by or restricted to the number of family members who attend therapy sessions.
THE EVOLUTION OF THIS APPROACH
This paper describes the process of “coaching” individuals in their efforts to change themselves in the context of their nuclear and parental family systems. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques for intervention are not widely understood. We have developed and elaborated these processes in our work over the last 25 years (Carter, 1991, 1996; Carter & McGoldrick, 1976, 1980, 1989, 1999a,1999b; McGoldrick, 1987, 1989, 1995, 1998; McGoldrick & Carter, 1999; McGoldrick, Gerson, & Shellenberger, 1999; McGoldrick & Watson, 1999; Walsh & McGoldrick, 1991; Walters, Carter, Papp, & Silverstein, 1988). Coaching is also often undertaken by trainees as part of their professional training to become family therapists.
At a time when most family therapists still used a combination of group therapy techniques to work with families, interspersed with traditional individual therapy for the “sickest” or most dysfunctional member of the family, Bowen’s ideas were revolutionary. He developed a systems approach that eschewed working through the transference or doing supportive therapy in which the therapist “lends ego” to the client. His way of doing family therapy with one person developed out of his personal efforts to apply his theory to himself in his own family and his subsequent discovery that his trainees made significantly more progress when he coached them to change relationships in their own families than when he focused exclusively on their clinical work. When only one family member is available or motivated, we work with that person alone, teaching him or her concepts of family and emotion process. This is much more efficient than struggling with clients who use therapy to attack each other or excuse themsleves.
Over the last 2 decades we have expanded our therapeutic lens to understand and address the powerful influences of culture, class, race, gender, and sexual orientation on family patterns and the well being of all individuals both within the family and in our human community. We also pay attention to each individual and family’s developmental passage across the multigenerational family life cycle.
The effort of family therapy with one person is to help a client define his or her own beliefs and life goals, rather than just accepting the family or the culture’s values unthinkingly or reacting against them. Coaching begins by encouraging clients to become observers of their roles and behavior in their family, trains them to become researchers of family patterns, and then moves to help them bring their behavior more in line with their deepest values. In discussing values with clients and encouraging them to be authentic and to stand up for their beliefs, the coach is guided by systemic principles, especially the belief that we are all in it together and that how we relate to all others is part of an ecological system in which no part is dispensable or irrelevant. Thus, the coach should challenge a client’s antihumanistic beliefs, such as racism, sexism, homophobia, or the use of violence, that reflect a lack of awareness of systemic connections. Clients are encouraged to examine their roles in their social system and helped to translate complaints about others in their families-and in larger systems as well-into personal empowerment and to work on changing negative aspects of these roles where possible (Carter & McGoldrick, 1999a). That is, the family and social system are assumed to play a profound role in the structuring of the psyche; just as the physiological system affects one’s thinking and emotions, the social and psychological systems can influence the biological system, and so forth, in reciprocal fashion.
Distinguishing This Approach from Traditional Work with Individuals
In this approach, individual symptoms and problems are placed in systemic context and explored in terms of the entire spectrum of functioning and relationships. Discussion focuses on overall patterns in the network of relationships, rather than primarily on the individual’s intrapsychic processes. Coaching is usually done with the most motivated and functional family member, rather than the most symptomatic, because this is the person most able to take action to change his or her part in the family process. The emphasis is on the “who, what, when, where, and how” of family patterns and themes, rather than on the “why” of individual motivation. This can be surprisingly difficult when there is only one client in the room, even for systems therapists, especially if they have had prior training in psychodynamically oriented therapy. The main work of the therapy is conducted outside of sessions in the relationships with actual family members, rather than during sessions in the relationship with the therapist. Teaching, thinking, and planning are given priority over interpretation, insight, or emotional catharsis and support. Healthy and dysfunctional families operate on a continuum of emotional fusion, cut-off, or differentiation. Feelings are connected back to family emotional patterns and relationships, rather than “worked through” by direct expression to the therapist. This does not discount the impact of the internal psychological or physiological system on a person’s functioning. Rather, the internal and external systems are seen as having significant reciprocal influence on each other, but the internal system is not seen as the most relevant to psychological functioning. The assumption is that external systems frequently determine internal feeling states. In contrast to narrative approaches, which are largely aimed at intrapsychic transformations, and solution-focused approaches, which tend to minimize understanding of the evolution of the system, this approach assumes that it is relevant to understand both the historical processes in the family and the larger social context in order to transform family relationships in the present.
Because the goal of this systems method is to coach the individual in work to be undertaken in the natural family group, the role of the therapist or coach is very different from the traditional role that therapists have taken in therapy. In this method, the natural system is given clear priority over the therapeutic system. In fact, Bowen used to remark that he spent only 50% of his energy doing the work and the other 50% of his energy on staying out of the family process. Emotional issues and expression of feelings are steered toward the naturally evolving family relationships-where they belong-rather than being displaced into the therapy session or the therapeutic relationship. Because family systems theory does not view change as something brought about through a corrective relationship with a therapist, transference phenomena are actively discouraged, and therapists, standing on the sidelines of the natural system and serving as consultants, try to keep themselves from entering or being pulled into the family emotional field, while developing a reality-oriented, open, and, hopefully, warm and respectful relationship with the individual who is consulting them.
BASIC FAMILY SYSTEMS ASSUMPTIONS
Because the family is, except in rare circumstances, the most important emotional system we ever belong to, it shapes and continues to determine the course and outcome of our lives. As in any system, relationships and functioning (physical, social, emotional, and spiritual) are interdependent, and a change in one part of the system is followed by compensatory change in other parts of the system. This makes the family our greatest potential resource as well as our greatest potential source of stress.
Family relationships tend to be highly reciprocal, patterned, and repetitive, and they tend to have circular, rather than linear, motion. Cause-and-effect thinking, which asks “why?”, tends to blame someone for the problem, however unwittingly, and is not as useful as identifying patterns and tracing their flow. This is because family patterns, once established, tend to be perpetuated by everyone involved in them, although not all family members have equal power or influence on family processes. The key clinical point is that, although there is a reciprocal aspect to all relationships, a person’s individual participation in any system is all he or she can change.
If any person changes, his or her predictable emotional input and reactions also change, interrupting the previous flow of interactions in the system. Other family members will be jarred out of their own unthinking responses, and, in the automatic move toward homeostasis that is inherent in all systems, will tend to react by trying to get the disrupter back into place again. In two-person subsystems, such as married couples or parent-child relationships, the element of reciprocity of emotional functioning can be striking, as in enduring marriages of the sinner and the saint, the master and the servant, the dreamer and the doer, the optimist and the pessimist, or the involvement between the nagging parent and the dawdling child. This is not to say that the power of both partners to change a relationship or resolve the problem is equal. Thus, women and children in families embedded in a patriarchal social system have decidedly less power to influence the structure than do men, and in a hierarchically organized, racist, classist, and heterosexist system, the poor, people of color, gay men and lesbians are highly disadvantaged in their freedom to change existing social structures. Further, we have come to realize that the analysis of the system must include analysis of the unequal power distribution among members of a system. Thus, men in all patriarchally structured societies have more power than do women to define and determine the relationships in the systems of which they are part, parents have more power than children, and people who are more privileged because of their race, culture, class, or sexual orientation have more power than those with less privilege. This does not mean that the relationships are not reciprocal; rather, one must factor in the dimension of power in order to think clearly about how to change them.
Fusion and Differentiation
Emotional anxiety tends to lead to a kind of fusion, or “stuck togetherness,” of family members within a system. They may attempt to control or dominate others, fail to develop themselves, or give up part or most of their autonomy out of fear that they will lose the love of other family members. Indeed, women in our society have for centuries been raised to give up self in this way. Emotional maturity is a measure of the extent to which individuals are able to think, plan, know, and follow their own values and self-directed life course, while being emotionally present with others, rather than living reactively by the cues of those close to them. They do not have to spend their life energy on winning approval, attacking others, intellectualizing, keeping themselves emotionally walled off, or maneuvering in relationships to obtain control or emotional comfort. They can move freely from emotional closeness in person-to-person relationships to work on their personal life goals and back. They can freely take “I positions,”-calm statements of their beliefs or feelings-without having to attack others or defend themselves. In their personal relationships they can relate warmly and openly without needing to focus on others or on activities or impersonal things in order to find common ground.
In cultures that focus on family and/or team functioning rather than on the individual, the expression of individuality will look different than it does in Anglo-European families. For example, the reactions to young adults’ departure from the parental home in early adulthood, separately domiciled nuclear families, or spending leisure time with family may be very different in a Latino, African, or Asian family than in a British or Scandinavian family. Nevertheless, every culture will still have its own norms for individual maturity. Ignoring such cultural differences leads to errors, such as an Anglo therapist thinking that daily phone calls in a Latino or Jewish family indicate fusion in the same way they might in an Anglo family. Or perhaps a client from the younger generation is angrily and defiantly adopting mainstream American norms over the objection of immigrant parents. In this case, a coach should try to help the client to understand where the parents are coming from and find culturally acceptable, respectful ways of disagreeing, if at all possible.
Forming a triangle is a typical way for two-person systems under stress to stabilize themselves (Bowen, 1974, 1975; Caplow, 1968; Fogarty, 1975; Guerin, Fogarty, Fay, & Kautto, 1996). Few people can relate as a dyad for very long before running into some issue that makes one or both anxious, at which point it is common to “triangle” in a third person or thing (e.g., TV or alcohol) as a way of diverting the anxiety from the relationship of the twosome. Triangles are dysfunctional in that they offer stabilization through diversion, rather than through resolution of the issue in the twosome’s relationship. They are also harmful to those who are scapegoated or pulled either into the middle or on to one side of a conflict. Thus, a couple under stress may focus on a child because his or her misbehavior gives them something on which they can come together in mutual concern. Repeated over time, triangulation becomes a chronic dysfunctional pattern, preventing resolution of differences in the couple and making one or more of the three vulnerable to physical or emotional symptoms. Such dysfunctional stabilization, although problematic, may be experienced as preferable to change.
In a healthy triad, each relationship is independent of the other two. In a triangle, the three relationships are interdependent; they are not three separate person-to-person dyads. Any dyad in a triangle is a function of the other two. The more distance there is between spouses, the closer one spouse will be to the third point of the triangle (e.g., a child or a grandparent). The closer one parent and one child are to each other, the more distant both will be from the other parent. Attempts to change this by moving toward the distant person will disturb the equilibrium with the close person and also that person’s relationship with the distant person.
Detrianglulation is the process whereby the client frees him- or herself from the enmeshment of the triangle and develops separate person-to-person relationships with each of the other two. Involvement in triangles and interlocking triangles, is one of the key mechanisms whereby patterns of relating and functioning are transmitted over the generations in a family. Since the concept of the triangle is so crucial and methods of detriangling are often counterintuitive, the reader is referred to the detailed explanations by Fogarty (1975), Bowen (1978a), and Guerin et al. (1996).
Distancing and Cut-off
The concepts of fusion and reactive distance or total cut-off are central to Bowen systems theory. The pull for togetherness in a relationship can be pictured as exerting a force like that of two magnets. When the pull becomes too strong and threatens to engulf individuality and blur separateness, there will be a reactive pulling away on the part of one or both. Much of the emotional interaction between spouses and between parents and children consists of the jockeying of each for an optimal position in relation to the other, in which the emotional bond will be felt as comfortable, rather than too close or too distant. Because each is highly likely to have a different comfort range, the shifting back and forth is continuous. When the emotional intensity in the system is too great, and the pull toward fusion too strong, family members frequently try to cut off the relationship entirely.
Cutting off a relationship by physical or emotional distance does not end the emotional process; In fact, it intensifies it. If one cuts off relationships with parents or siblings, the emotional sensitivities and yearnings from these relationships tend to push into one’s other relationships, (e.g., relationships with a spouse or with children), becoming all the more intense in the displacement. The new relationships will tend to become problematic under this pressure and lead to further distancing and cut-offs.
Bowen’s (1978b) concept of differentiation describes a state of self-knowledge and self-definition that does not rely on the acceptance of others for one’s beliefs but, rather, encourages one to be emotionally connected to others without the need to defend oneself or attack the other. Ironically, although Bowen’s is the only early family therapy theory that gives equal weight to autonomy and emotional connectedness as characteristics necessary for the differentiation of adult maturity, he is widely misunderstood in the field. Bowen’s term “differentiation,” which he equated with “maturity,” is commonly misused and misquoted as if it meant autonomy, separateness, or disconnectedness. And because Bowen emphasized the necessity of distinguishing between thinking and feeling, he has been criticized by some feminists for elevating “male” attributes of rationality over “female” expressiveness. Actually, Bowen was addressing the need to train one’s mind to control emotional reactivity so that we can control our behavior and think about how we want to respond, rather than be at the mercy of our fears, compulsions, instincts, and sexual or aggressive impulses. This does not in any way mean suppressing authentic and appropriate emotional expressiveness, which is part of the primary goal of Bowen therapy (Papero, 1990). Grounding oneself emotionally and learning to connect emotionally by developing a personal relationship with every member of one’s family, are, indeed, the “blueprints” for all subsequent emotional connections. Goleman (1997), in his book Emotional Intelligence, discusses this same process of mind over emotional reactivity, crediting Aristotle with defining the original proposition: “Anyone can become angry, that is easy. But to become angry with the right person, to the right degree, at the right time, for the right purpose-this is not easy” (cited in Coleman, 1997, p. ix). Coleman says the question is, “How can we bring intelligence to our emotions and civility to our streets and caring to our communal life?” (p. xiv).
The blind spot in Bowen theory (1978b), as we see it, is that it does not account for the fact that women and minorities have experienced a socialization that actually proscribes the assertive, self-directed thinking and behavior that are necessary for differentiation. Failure to acknowledge the disparities of opportunity and power that exist within our society mystifies those who are in an oppressive, inequitable situation and are not starting on an even playing field. Women have long been expected to put the needs of others before their own. Even to define their own values, wishes, or opinions has generally been seen as selfishness. People of color are raised to be deferential to whites and to accept the privileges that whites have in this society. They must fight harder for any opportunities they get and accept-in most situations without resistance-the prejudice and need to stifle their resentments of slights on an everyday basis. Gays and lesbians are told by official U. S. military policy and by social attitudes and laws, “Don’t tell us who you are.” A heterosexual white male who tries to differentiate will generally be responded to with respect; a woman, gay person, or person of color who tries to differentiate may be penalized, ostracized, or even harmed by the family or community. Thus, our assessment of a person’s development must include assessment of social obstacles to accomplishing the tasks that lead to maturity.
The Role of the Coach
Bowen’s concept of the role of the coach seems remarkably similar to the Buddhist idea of a master teacher. The Buddhist nun Perna Chodron in a dialogue with bell hooks has described her mentor, Trungpa Rinpoche, as a master of not confirming: “Talking to him was like talking to a huge space in which everything bounced back-you had to be accountable for yourself.” (Chodron & hooks, 1997, p. 11) She believes that the teacher’s role is to wean students from dependency, from the parent-child view of life, the theistic view:
Theism implies that you can’t find out for yourself what’s true. You take Buddhist teachings-or any teachings-and try to fit yourself into them, without really grappling with them in a way that could transform your being. You’re just trying to live up to some ideal. You’re still looking for the security of having someone else to praise or blame. Accountability, on the other hand, doesn’t offer that kind of support. There is no hand to hold. No matter what other people say, when it comes down to it, you are the only one who can answer your own questions. (Chodron & hooks, 1997, p. 11)
It is useful to help the client conceptualize the presenting problem in terms of triangles, looking for the family forces that help to maintain the problem or exacerbate its stress. A family that presents with an Alzheimer’s patient, for example, will probably have both an overburdened caretaker (usually female) and other family members trying to escape the emotional turmoil by distancing. A client can be taught how triangles work and then be coached to change his or her input into the triangles of the presenting problems as a way of untying the knot that brought him or her into therapy. Once this initial work has achieved some relief, the therapist reviews with the client the ways in which his or her emotional reactivity may be connected to triangles and issues in the family of origin or larger social context and suggests that the client work on these. The decision is up to the client, and if the decision is not to continue, the therapist should express willingness to continue in the future if the client has a change of heart or mind.
Helen, a divorced, Jewish, middle-class, single mother with an 11-year-old daughter, Stephanie, came to therapy because of intense conflict with her ex-husband, Stephen, who kept threatening to sue for sole custody of Stephanie. With the coach’s help, Helen discovered that there were three or four generations of “daddy’s little girl” triangles in her family and in Stephen’s-that is, triangles in which parental competition for the daughter’s allegiance in parental disputes undermined the marriage and led to mother-daughter conflict. Helen acknowledged ruefully her own close alliance with her father and ongoing conflict with her mother, but wanted to work only on the trouble with her ex-husband. She was coached over a period of months to stop her end of that battle, at which point Stephen stopped threatening legal action, and she left therapy against the coach’s advice. A year later she returned, saying that the escalating level of conflict between her and her daughter made her think that perhaps she did need to work on that triangle with her parents after all. “You said this stuff goes down the generations without anyone really wanting it to,” she said to the coach. “I remembered that.”
Once the immediate crisis that brought a person into therapy is put in perspective, coaching generally focuses on helping the client to define a self in the family of origin and in the current family. This is a longterm effort by the client to increase his or her functional and emotional level of maturity. Except in rare circumstances, the most important triangle is that of the client and his or her parents. Detriangling from that and staying detriangled from multigenerational family patterns make up the core of the work of becoming a more mature self, at once autonomous and emotionally connected.
However, a person may become enmeshed in many other intense triangles in the original family, the nuclear family, or the current relationship system at work, with friends, or in the community. And coaching may mean helping a client to deal with any of the above, whether the client has previously done the basic work with parents or not. We believe that all intense emotional triangles interlock with the parental triangle or are in some ways displacements of unresolved issues with parents. Thus, other emotional triangles are much more easily dealt with if the basic work has been done. However, relatively mature and highly motivated clients can often be coached to change their behavior and emotional functioning in other current triangles before or even without any particular effort with the family of origin.
A basic assumption of Bowen systems thinking is that if one person changes her or his emotional functioning in the family, the system will eventually change. In this framework, family relationships are forever, and it never makes sense to write off a family member once and for all. The exception would be couple relationships, the only “optional” relationships in a family-the only ones that we choose and that we may decide to end. Even here, we cannot end our ongoing connections to a former partner if we have had children together. In other words, one can be an ex-spouse but not an ex-coparent, an ex-father, ex– mother, or ex-child.
If one partner really changes and the other remains inaccessible or unchanging, it means that the couple system is not viable, and the first partner probably has no option but to move on. Thus, if the wife of an alcoholic differentiates, it may precipitate her husband into AA, or she may learn that her husband is too caught up in his addiction to respond, no matter what she does. If he chooses his addiction over the marriage, her only real choice eventually may be to leave. The difference between this and a relationship with an alcoholic parent or sibling is that in those relationships, the mature family member remains open to the possibility of a transformation of the relationship, however unlikely. In general, the systemic assumption is that if one person changes her or his role, the system will be altered, and the person will be able to function more freely in current and future relationships, whether family, social, or job related. A person’s ability to change his or her emotional functioning will depend, of course, on a number of factors. Children and people of any age who are not financially independent will have limited ability to take a position of emotional independence in a family. Furthermore, as indicated above, there are situations in which family members are so locked into their addiction or other dysfunctional patterns that a differentiating move clarifies that the immediate system is too rigid, disengaged, or immature to move beyond its reactivity. In such cases, the person’s efforts to differentiate may only bring positive results in the broader system, changing the legacy for the next generation, even though there is no change in the immediate family. This perspective requires one to think in very wide and long range terms about the possibility of change, and is necessary in thinking about changing larger societal patterns of injustice and oppression. But, as Margaret Mead once said, “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it’s the only thing that ever has.” The same might be said about the efforts of a thoughtful, committed family member in changing a system.
THE PROCESS OF COACHING
The process of coaching comprises at least five overlapping phases: The engagement of the client in the process; the teaching or planning phase; the reentry; the work; and the follow-through.
Engagement and System Mapping
Engagement consists of helping clients to see their problems in a systemic way, that is to shift focus from the self or others to a view of self-with-others. As Gilles-Donovan (1991, p. 9) has described it, although others may focus on the internal experience of the individual person who is experiencing problems, in this orientation “the focus is on knowing the system, the structure and how it works, and moving self into the structure in order ot rework one’s place in it, thereby changing one’s internal experience.” Clients frequently portray themselves as victim or rescuer, with judgmental reports of emotional or behavioral transactions among family members. They tend to accept uncritically the view of the parent with whom they are aligned, failing to consider the subjectivity of each perspective. At this stage, we find it useful to encourage them to broaden their perspective on the presenting problem or the central relationships by asking about similar issues at various levels of the system, inquiring about various members’ views of central issues and gradually introducing systems concepts, such as triangles and automatic reactive processes into the discussion. This standard Bowenian technique was later described by Milan systemic therapists as circular questioning. It is a very useful way to interview individuals. We have also found it helpful to recommend systems readings, including stories of others’ family work, to help orient clients to a family systems perspective. (See Appendix A for a listing).
The first real step in coaching is to ask the person to draw a genogram (McGoldrick, 1995; McGoldrick et al., 1998; Watts Jones, 1999), showing factual and relationship information for the family over at least three generations-names, births, deaths, marriages, divorces, geographical location, and all significant physical, social, and psychological changes or dysfunction. This includes the biological, legal and “kinship type” relationships with godparents, foster parents, or family friends with emotional significance and the sociocultural and migration history of the family (Congress, 1994; Hardy & Laszloffy, 1995; Hernandez & McGoldrick, 1999; McGoldrick & Colon, 2000; McGoldrick, Giordano, & Pearce, 1996). Family history is mapped through discussion of the genogram, which should not be treated as a form to fill out, but rather as a framework for understanding family patterns. Questions or comments from the coach that highlight the connection between the presenting problem and the family system will, hopefully, enhance the client’s engagement.
We also ask for a family chronology, which is like a time map, as the genogram is a structure map. It shows in chronological order the major family events and stresses, and it is especially useful for understanding the motion of family patterns over time and the intersection of the client’s life and symptoms with these patterns. This is important because the connections among major family events tend to be obscured by the anxiety that these events create.
During the initial phase of engagement and history taking, it is important for the coach to set a calm, matter-of-fact tone to help defuse the intensity of emotion that is aroused by a current crisis or by opening up anxiety-producing material. It is also useful to introduce family systems concepts as soon as the anxiety is low enough for them to be heard, including ideas about emotional interaction, reciprocity, triangles, changing self, effects of sibling position on relationships, and the transmission of relationship patterns from one generation to the next.
Planning: Learning About the System and One’s Own Role in it
Planning is usually an indistinct continuation of the initial stage of engagement, but it should not be started until the client’s anxiety is low enough to discuss how personal thoughts and feelings fit into family patterns and give some consideration to possible changes and their effects. Once the client’s anxiety is low enough to discuss these issues, planning can begin. She or he may ask, “If I were to try to get to know my father better, how would I go about it, and how would that help me with my current problem?” Understated questions from the coach that are designed to elicit in detail the tone and history of this relationship and the main triangles in which it is embedded are better at this point than suggestions for concrete actions, which may increase the person’s anxiety. However, gathering genogram information and the very process of looking at the family in this way shifts the focus from guilt and blame to a more objective “researcher” position. As the coachee begins to observe and listen at a family gathering, instead of participating in his or her usual role, he or she may experience shifts in thinking or relating; these should be carefully noted and incorporated in the planning.
Gaps in the genogram or family chronology are obvious places to start. The assumption is that the more information you have, the better position you are in to evaluate what has happened in your family and, thus, to understand your own position and to change it if you wish. In terms of gaining a preliminary focus on the family patterns, for example, one could look at the similarity between the central triangles over three generations: Self, mother, father, and each parent with his or her parents; the effects of sibling position on the family process (McGoldrick, 1995; McGoldrick & Watson, 1999; Sulloway, 1997; Toman, 1976) and triangling in each generation; and the stress on the family at crucial points in the family history, such as just before the marriage and around the birth of each child. Other patterns that may be examined are the reciprocity in the marriages in the family: Who overfunctions and who underfunctions? Who tends to move in and who tends to move out? What toxic issues in the family tend to be avoided? All of these are of primary importance. When a client is too caught up in a current crisis to sit still for “history,” it is useful to take the crisis theme and the red-hot triangle in which it is embedded, and track this theme and triangle (e.g., parents and a child who is acting out; a couple with wife and mother-in-law conflict, etc.) through the extended family and past generations. This will give access to the necessary historical information, while reassuring the client that his or her current problem is being addressed.
We favor holding off on concrete moves in a family at least long enough for the person to get a general notion of how the emotional system operates, what the central issues are, and what the client’s own agenda and motivations are. If one wants to make someone else happy, save someone, change someone, tell someone off, get someone’s approval, or justify and explain oneself, the effort will likely fail. In any case, it will not be worth the struggle, because it will either present no change, or it may even reverse positions, as when the victim becomes the bully.
The process of differentiating can be rather simply defined: It consists of developing personal and authentic emotionally engaged relationships with each member of the family and changing one’s part in the old repetitious, dysfunctional emotional patterns to the point at which one is able to state, calmly and nonreactively, one’s personal view of important emotional issues, regardless of who is for or against such a view. It involves learning to see your parents as the human beings they are or were, rather than as your “inadequate parents,” and relating to them with respect and generosity. This sounds so simple that it is difficult to convey the anxiety that is aroused at each step of the way, even for the people who are most committed to the work. The first moves to be recommended by the therapist will depend on what kinds of relationships the client currently maintains with family members and what objectives she or he has for changing these relationships. A relationship that has been intense and conflictual will require a gentler reapproach than one that is characterized by distance.
Cheryl, a 30-year-old African-American social worker, who had not seen her father for many years, spent several sessions describing her current marital and in-law conflicts, which had led her to seek help. She had not corresponded with her father since he left the family to live with a girlfriend years before. She had had a distant relationship with her mother since she left home at 17 to live with an aunt and attend college. She considered her mother “hopeless” for having stayed so long with her father, who was cold and critical, and then with a boyfriend, whom she was still supporting. She saw both parents as irrelevant to her current life and problems. After discussing the striking patterns of marital conflict, in-law problems, and emotional cut-offs on her genogram, she was encouraged to undertake a coaching process to explore her role in her family of origin as a way to gain more flexibility for her marriage. She explored the cut-off with her parents and became aware with the coach that her issue with her mother was much less intense than the one with her father. As her first move of reentry, she decided to write a letter to her father in which she referred briefly and regretfully to their cut-off and then went on in a low-key way to express interest in his life, his wife, and young son (whom she had never met), and to bring him up to date about her life. To her mother, for whom she realized she had fewer conflictual feelings, she wrote in more depth about her life and proposed to visit her in the near future.
If the person is involved in a conflictual relationship with a parent, and the issue has been displaced onto some specific concrete explosion, such as a falling out over some long-past insult, or on to some ritual argument over religion or politics, we frequently recommend that the person “let go of the rope” in the tugof-war as a first step, so that the buried emotional issues can have a chance to emerge.
Kathy came from an Irish Catholic family. She was the only member who had left the Church and married a Protestant. Since her marriage, she had had little contact with her mother about anything else because her mother was so intense in promoting her religious beliefs, which Kathy argued about with equal intensity. After some discussion, Kathy became interested in the idea of trying a “reversal,” which became increasingly true as she carried it out. Kathy wrote to her mother that she was coming to appreciate her mother’s strong faith, and wished that she could share it, although she found she could not. She said that she admired her mother’s inner peace, which seemed to be related to her faith, and that she felt somewhat lonely and cut off from her family as a result of not being able to share their faith. To her great surprise, her mother responded warmly, saying that she had been very touched by the letter, was surprised that Kathy thought she had such inner peace because at times she herself felt isolated. From here Kathy was able to move into dealing with her own important personal issues with her mother.
In other words, the client is asked to give up fruitless arguments so that the relationship can move on to other more emotionally important issues.
If a client has been maintaining routine, dutiful contact with the family through general letters addressed to both parents or phone conversations with only the mother, who acts as the central switchboard, he or she may be coached to establish direct contact with the father and other family members. This shift alone may bring long buried issues to the surface.
Joe, a 40-year-old, working-class, Italian garage mechanic described his family as “friendly and close.” He saw no connection between the state of his family relationships and the problem for which he was referred by his wife’s doctor: Dealing with the effects of his wife’s serious physical illness. He called his mother weekly for an exchange of general family news. He saw his father, brother, and sister on holiday get togethers a few times a year. Initially he maintained that he would have no difficulty talking directly with each family member, but that it would make no real difference. However, once he started to do it, he found that he became intensely nervous after a few minutes of talk with his father because he could find nothing to say; that his brothers quickly turned the phone over to their wives, and that his sister responded to a call from him with an angry attack about his having left responsibility for their aging parents entirely to her. These responses in himself and his family enabled him to recognize that he had been emotionally pulling away from his wife in her illness as he had pulled away from his family and their concerns. He embarked on restoring his family relationships with the initial motivation that they could offer each other support.
If the person has a fused relationship with one or both parents that is not overtly conflictual, a first step might be to break off routine patterns such as daily phone calls or weekly visits on a certain day, making contacts less ritualized and more unpredictable.
Such initial contact steps are usually followed with brief visits, during which the person’s main task is to observe and listen to family interaction in a new way. This information is then incorporated into the further planning sessions, during which tentative hypotheses are developed concerning the role the person plays in the family process; what role he or she would like to have, and what predictions can be made about the reactions of others to any changes in stance or behavior on the client’s part.
The Main Work
Once clients have begun to think about themselves and their families in systems terms and to make initial moves to shift their position, they may begin to put a lot of thought and effort into the endeavor, often focusing at first on the family themes that seem most relevant to their current lives.
At this point, the coach must pay very careful attention to the details of relationship interaction so that it becomes clear what exactly the client needs to change in word and deed to promote positive change. It is very important to get a grasp here of the family’s cultural norms, which are influenced by their race, ethnicity, religion, education, income, gender attitudes, and life stages. “Too involved” is a totally different concept in Jewish, Scandinavian, or African-American families. Almost no client complaints can be understood or addressed apart from their socioeconomic context, including clearly universal issues, such as violence. Even addictions and mental illness are construed differently in different cultures. All of this becomes particularly intricate when coach and client are from different cultures.
Because this work is about changing relationships, which in turn affects the themes and patterns that will be transmitted to the next generation, it is important for the coach to be aware of the typical triangles and issues at each stage of family life (see Carter & McGoldrick, 1999a). For example, coaching a stepfather in a remarried family about how to position himself with an adolescent stepson (as benign and casual friend and mentor) in relation to the son’s biological mother, who must play the role of limit setting, is completely different from coaching a biological father about how to deal with his teenage son (as caring, but limit– setting parent) in relation to his wife, who is coparent. Coaching parents once their children have left home and become self supporting is completely different, and these life cycle stage differences must always be taken into account.
The length of time that people will devote to intensive work with their family of origin varies with the degree of motivation and the felt impact of the results on their lives. Once a person has decided to engage in coaching, there is often a period of considerable enthusiasm. People tend to begin work around some central problematic focus-with a parent or a spouse, a significant family secret, or a cut-off. Sometimes, during work on a relationship that mistakenly ignores an important triangle in which the dyad is imbedded, the intensity of the third person’s reaction is seen as a new and startling problem that may confuse and overwhelm the client. This is particularly likely to occur when a sibling has not been taken into account in the planning of work with a parent.
In our experience, clients tend to work in phases interspersed with periods of inactivity and to vary in the ability to work at certain levels. For example, some work very well for a time in the nuclear family but have great difficulty moving into the extended family. Others will work well and hard in the parental generation but have great difficulty understanding how symptoms are related to a spouse or an ex-spouse. At times, a coach may recommend shifting some particular issues to another level of work as a way around an impasse at the immediate level. Those who work in a systemic way over an extended period of time can have very positive results in the form of relief of immediate stress and an ability to deal differently with future stress.
Coaching sessions may begin at regular weekly or biweekly intervals, but these intervals will usually be lengthened as the focus shifts from learning and planning to doing the work. A systems therapist rarely terminates a case in the traditional sense of a mutual decision that the work is finished. Rather, appointments gradually become spaced at longer intervals, and even when it is agreed that a major piece of work is accomplished, there is usually the understanding that the person will continue on his or her own trying to apply the principles in family, work, and social relationships, and that further appointments with the therapist can be sought if s/he gets stuck, or sees a potential crisis ahead. It is not uncommon for a client, after 1 or 2 years’ absence, to request a few appointments to get back on course.
The basic idea of coaching is that, if you can change the part you play in your family and hold it despite the family’s reaction while keeping in emotional contact with family members, you maximize the likelihood (not a guarantee!) that they will eventually change to accommodate your change. Any change involves a minimum of three steps: (1) The change; (2) the family’s reaction to the change; and (3) dealing with the family’s reactions to the change. These three steps could, of course, take years. Most of us do what Bowen called “the two-step” much of the time: We attempt to change, but when someone says, “change back,” we do it. Successful change involves going beyond this and planning how to deal with the predictable reaction to the initial effort.
The ideal of family systems work is to develop a person-to-person relationship with each living person in your extended family. The process of working out personal relationships occurs at different levels. The most intimate level is the immediate household. This area is often the most intense because of the high level of ongoing involvement. However, for most people it is also the area of highest motivation. The next level is that of the family of origin. The most difficult relationships to work out here are also the most important: The triangle with one’s parents and then the relationships with one’s siblings. Aunts, uncles, or grandparents are usually at somewhat greater distance. However, these relationships may prove extremely fruitful for an understanding of some of the closer relationships and for stopping repetitive patterns. At a still greater distance are cousins and research on the family history and genealogy. The payoff for work at these levels is least immediate, but it can give a rich perspective on one’s origins and on certain highly significant family patterns that may flow over many generations.
A reversal is essentially an attempt to change a habitual pattern of relating by saying or doing the opposite of what you usually say or do in response to someone else. Although a client may at first call this “lying,” the reversal actually expresses the unspoken and unacknowledged other side of an issue and tends to break up rigid, predictable, repetitive communication patterns. A wife who ordinarily gets angry when her husband gets sick and calls him a hypochondriac reverses her pattern and plays Florence Nightingale; a man who usually cannot talk to his father because he is so dictatorial may ask for advice.
Detriangling is shifting the motion of a triangle and unlocking the compulsory loyalties so that three dyadic relationships can emerge from the enmeshed threesome. Reversals use the recurring pattern in the triangle but place the client in a different position in it. For example, a son who has an overly involved relationship with his mother and a distant relationship with his father might begin to detriangle by going to his father with the confidences his mother has inappropriately shared with him and saying, “Mom seems terribly upset, and I’m sure you will be able to help her out. I don’t know why, but she came to me with her worries and said . . .” To prevent a two-step, the original plan would have to include a way to deal with mother’s anger and sense of betrayal after father confronts her with the son’s report. He might do this by telling the mother, if she confronts him, that he was so distressed by her upset that he felt he had to share it with his father to help the mother out.
It is important to realize that strategies such as reversals are not to be undertaken lightly. They succeed only when the person doing them has the emotional control to edit his or her feelings of hurt, anger, sarcasm, and vengeance out of the communication and when they convey a respect for the other. Such techniques are not a substitute for person-to-person intimacy; they are simply a method to getting around roadblocks to intimacy. In disciplined hands, they can substitute for the destructive emotional games and repetitive interchanges that tend to be part of our relationships and thus reduce some of the distance or repetitious conflict that stands in the way of intimacy.
Opening up a Closed System
In trying to open important but buried issues, there are several ways to proceed. Sometimes it can be done merely by contacting family members who have been cut off from the family; or by carefully raising the loaded issues with various family members. A more complex operation for a system not in current crisis is what Bowen called setting up “a tempest in a teapot”-magnifying small emotional issues in such a way that old, dormant triangles are activated and can be dealt with in a new manner. Tactics that stir up an emotional system that is not currently in a state of tension without attacking it are necessary because emotional patterns tend not to be clear when the system is calm. The triangles and other patterns are dormant, waiting to be activated in the next family crisis.
It might be necessary to activate a dormant triangle, for example, if a person cannot move directly toward his father without the father’s withdrawing. In such a case it may be necessary to move toward those people with whom the father has relationships, perhaps the father’s siblings or his parents. Such moves can not only provide a wealth of information and perspective on the father, but they may also activate the triangle between the father, his brother, and their mother. Once the father realizes that his brother is giving family information, he may feel himself impelled to open up with his side of the story. If the father felt like the outsider in the relationship with his mother and brother, he is likely to fear being the outsider again if his own child moves toward his brother. If the direct contact with the uncle is not enough to create a shift, the son may want to raise a toxic family issue with the uncle, on the theory that the uncle may then take a different move with the father and thus open the system. If the system is very closed, the son may have to magnify a small issue with the uncle in order to push the system to react. It is important to distinguish such a push from destructive and hurtful threats or unleashed sheets.
Money and the Family
Analyzing how a family deals with money is an important issue in coaching: Among the questions to ask are:
Who handles it?
Who controls it?
Have there been conflicts or cut-offs over wills?
How do siblings in different financial positions deal with these differences? (This is really a question about how class issues play out for different siblings.)
What are the family’s beliefs about children’s right to support, help for education, inheritance, buying a home, and so on?
How are financial arrangements made for the care of any disabled family member and how does this interact with emotional caretaking?
What have been the gender differences regarding the control or managing of money?
The handling of money issues in coaching is a complex issue. Here we can only allude to a few of the common problems. Where a family business or a will has left family money unequally divided among siblings, relationships are likely to be impaired or even cut off, often for generations. Coaching family members about undoing such arrangements before they happen or after they happen for the benefit of their relationships may be the best way around such difficulties. In addition, family members who are held hostage by threats of being cut off and losing their inheritance if they contact a “forbidden” relative or marry someone from another race, may be encouraged to “let go of the rope” in order to free themselves emotionally. If they are not prepared to lose the inheritance, they can never free themselves emotionally.
Gender Issues in Coaching
Women are typically the carriers of family heritage in certain ways. They often feel more responsible for the family, for those in need, for dealing with the pain of family secrets, and for injustices done to family members. Men may disconnect more easily, given society’s support for the “independent” male. Older sisters may be particularly accessible and helpful in promoting family reconnections because they are likely to feel so responsible for family well being. Because of our society’s rules for male and female socialization, men may fit into the stereotypes of being less accessible, less willing to acknowledge their vulnerability, and less aware of the emotional process in the family. However, if the coach keeps a life-cycle perspective, he or she can be on the lookout for moments when male clients may become more open, especially during times of transition and loss. As with race or any other issue of injustice in relationships, a sister will have to come to terms with the unfairness before she will become free to move toward a new equilibrium and attempt to change oppressive family rules of overresponsibility for daughters and glory for sons.
Taking an “I-Position”
An “I-position” is a clear statement, neither offensive nor defensive, of one’s thoughts or feelings on a subject. Ultimately one hopes to be able to relate by stating I-positions clearly, but there are many times when other ways of communicating are necessary first in order to open up a system. This is especially true in tight triangles in which I-positions may create a negative reaction and tend to close down relationships. For example, consider a situation in which a mother-in-law was telling her son negative things about his wife; the son repeated them to the wife, who became very upset. The wife might have decided to tell his mother directly what she honestly thought of such criticism. This would undoubtedly have intensified the mother-in-law’s negativity toward her. She might have said to her husband: “I wish you could stand up to your mother. I don’t think I deserve her dislike of me.” She might then say to the mother-in-law, “My husband told me what you said about me, and I was upset and hurt by your saying that to him. In the future, I wish you would tell me directly what you think of me:’ Hopefully one does arrive at the point at which one can deal with thoughts and feelings this directly; but it is usually possible only in a cultural context in which emotional directness between a mother-in-law and a daughter-in-law is acceptable and in which the system is relatively open and anxiety free. When it is not, I-positions may further raise the level of tension. The mother’s negativity might increase, and she might become more subtle in her reactivity, fearing that her son might again tell his wife of her feelings if she speaks to him directly. In this situation, therefore, the wife was advised to detriangle by use of a reversal. She was urged to say to her mother-in-law, “Your son has been telling me some of the things you’ve been saying about me, and I’m so relieved to know, because I was so worried that you would not like me or would wish your son hadn’t married me.” When the wife did this, she felt a sense of immediate relief. As she told her mother-in-law of her real anxiety about not being acceptable to her, the mother-in-law immediately shifted toward her and began reassuring her about her feelings. Subsequently, the husband reported that his mother had completely stopped her negative comments about the wife.
The intense and automatic reaction of the system to maintain homeostasis and resist change has led to the development of various direct and indirect strategies, including the ability to laugh at yourself and gain a certain lightness with regard to your own emotional reactivity. Indeed, humor is one of the most effective ways to detoxify a situation. Part of the very power of triangles, ruts, labels, and rigid patterns is that we feel stuck and take the situation too seriously. Surprise and a gently humorous redefinition of a situation may jostle that inflexibility in such a way that the challenge is softened by an element of sharing. After a long story about a mother’s “unbelievable intrusiveness,” for instance, a coach might smile and say, tongue in cheek, “It sounds like you’re having a hard time appreciating her great love for you.”
Carrying a situation to the point of absurdity may often help people gain perspective on their overly intense involvement in a rigid position and reduce what was threatening and serious to triviality. After long complaints about a wife’s conversational style at a party the coach might say, jokingly, “It sounds like you shouldn’t take her anywhere until she learns how to behave right.”
Furthermore, the very act of sharing a laugh can help to reduce the tension and restore some of the commonality that has been cut off by bitterness. By suddenly disorganizing the established social situation, humor creates a surprising new arrangement and opens new possibilities. “Just think,” one coach remarked, “of the wonderful opportunity that impossible man is giving you to learn patience.” (This would obviously not be an appropriate comment if the wife is being intimidated or abused by a bullying husband.) Humor relabels a situation and may allow us to gain power over a system in which we have previously been caught. It is essential to be sure that the client (and, of course, the coach) understands the difference between the playfulness of genuine humor and the anger and bitterness of sarcasm. In order to avoid the latter tone, the client has to move emotionally away from anger and become aware of the absurdity of the struggle. This is a good example of the ways that a client can change while planning how to deal differently with difficult relationships. It also enables the therapist to play “devil’s advocate,” challenging the client to concentrate on his or her own values and wishes, rather than remaining stuck and helpless about another person’s behavior or point of view.
Coaching Clients from Marginalized Groups
All clients have very specific emotional issues and triangles related to their stage of the family life cycle and to the particular history and circumstances of their families of origin. In addition, many problematic issues and triangles in the families of people of color and gays and lesbians are directly related to their lack of power and stigmatized status in the larger society. The most important clinical intervention is to help family members to get on the same side to overcome obstacles rather than letting social problems divide them.
A young, middle-class, lesbian couple, Janella and Joyce, presented with intense conflict in their relationship. “She’s totally hyper,” said Joyce, a graphic artist of Polish/German background. “Every time we get settled, she decides that the neighbors don’t seem to approve of our relationship and we’ve got to move. We’ve moved four times in 4 years and now she wants to move again.” Careful exploration of the situation by the therapist revealed the fact that Janella, whose parents had immigrated from Cuba, was a school teacher and feared, realistically, that she would be fired if her sexual orientation were known. Subsequent coaching sessions led to Joyce’s understanding of the possible consequences for Janella, which in turn led to their decision to move one last time to a community that supported racial diversity and same-sex couples and their careers. After the resolution of the presenting problem, both women moved on to dealing with the complex and acrimonious reactions to their sexual orientation in both families of origin.
It is essential to evaluate carefully the consequences for such clients of changing their role in any system, emotional or social, and to incorporate these caveats in the planning. It is very important that the therapist understand that disadvantaged social status reduces the options available for personal change. The difficulties of changing in the face of social obstacles and stigma should not be attributed to lack of client motivation or maturity.
Guidelines for the Therapist (Coach)
1. Expect intense resistance to the idea of dealing directly with parents and family members in real life about troubling issues instead of complaining in private to an understanding therapist. Discuss the advantages for the client in doing so. The client must be helped to see that the goal is to create change in the actual family relationships, not simply a change in the client’s feelings about them. We often encounter clients whose years in psychodynamically oriented therapy have produced little or no change in their family interactions. They may have tried to initiate change, but were then unprepared for family resistance-“the two step.” Suggest readings and tell stories of colleagues and other clients’ success and satisfaction, including personal stories, when clinically appropriate (see Appendix A).
2. Clients often come in crisis, but the coach works to create a calm, thoughtful atmosphere for the sessions, which are about thinking and planning, not emotional catharsis. When the coach shows interest in the client’s reports and information about the family through comments and questions and does not encourage or support emotional reactivity, the client’s anxiety level, hopefully, goes down enough for him or her to be able to hear the coach’s ideas about the situation. Now the coach can start to explain systems concepts, tell stories about others or his or her own family, and suggest readings that are relevant to the client’s situation (see Appendix A). In addition to material written for the general public, many clients also benefit from reading various professional books and chapters written for therapists, such as those referenced in this article, if the material relates to the client’s specific problem or circumstances, or to the client’s ethnicity, race, gender, class, sexual orientation, or culture (see Appendix A).
3. Advise the client to expect a surge of anxiety symptoms with each new move, and normalize this. We sometimes ask what symptoms the client experienced during adolescence as a way of indicating the intensity of the emotional reactions that are ahead.
4. Once the client has agreed to work, emphasize the need for planned, not reactive or impulsive moves in the family system.
5. Resist the pull to see the individual as the unit of dysfunction or treatment. Resist the pull to accept the client’s descriptions of family members and their motivations as “truth.” Keep the multigenerational family and its cultural context in mind as the client speaks. Put yourself mentally in the position of various family members the client is complaining about.
6. Be prepared to help the client to prioritize and strategize throughout the work, without getting ahead of the client in investment in the work. Encourage the client’s curiosity and research interest in family patterns by asking questions about family process. Keep in mind the gender, sexual orientation, racial, and cultural context of the client and family when making suggestions.
7. Keep monitoring your own family, gender, life cycle, class, race, and cultural issues.
8. Remember that a coach also cheers from the sidelines and provides encouragement and appreciation. This is not the same as being a source of emotional support, approval, reassurance, or pity, all of which may be condescending or disabling to the client because they increase the transference phenomena, focusing the client’s attention and emotions on the therapist instead of on the client’s own family. The therapist should convey the belief that the client can deal with his or her own family, a premise of Bowen systems therapy.
9. If you have not worked on differentiating yourself in your own family, you will probably be prone to misjudge the intensity of systemic reaction to your client’s moves and also prone to accept the client’s resistance.
10. When the client is concurrently in another type of therapy, suggest that the client put one of you on hold until the other therapy is completed because this orientation goes counter to most other therapies.
11. Resist the client’s tendency, especially if he or she has been in psychodynamically oriented therapy, to try to make you the “good parent” or intensify the emotional climate between you. Explain openly that coaching is focused on dealing with family-of-origin relationships directly, rather than through replacement relationships with the therapist.
12. If the client is of a different race, ethnicity, religion, gender, sexual orientation, or social class, you have a responsibility to educate yourself about the issues involved for that client. Guidelines to Teach Clients
1. Keep your own counsel. Do not try to share efforts with others in the family. At times there is a strong pull to “differentiate together,” with a spouse, for example, or a favorite sibling; but differentiation is an individual process and talking about it with others in the family may raise their anxiety and lead to efforts to get you to stop, or at least do it their way.
2. Keep clearly in mind that your changes are for yourself. The work cannot be undertaken for the coach, for a partner, or for anyone else but yourself. Nor can it be an effort to change others in the family, although that is often the initial motivation.
3. Do not underestimate the family’s reaction to your efforts. Your family’s reactiveness is likely to be intense, and will take you off guard if you are not prepared.
4. Clarify your personal goals, schematize, hypothesize, and have a plan. This will help you avoid getting caught up in your family’s emotion process and becoming reactive to them. Your most useful mantra will be “Don’t attack; don’t defend, and don’t shut down.”
5. Use strong feelings of anger or hurt as signals. When you start to see villains or victims in the family or to feel that you are one yourself, question your own feelings to get a better perspective on their place in the circular processes of the system.
6. Distinguish carefully between planned and reactive distance. It is often useful to distance from an intense emotional field in order to gain objectivity. In particular, it is useful for people who tend to move toward others to plan instead to back off. However, it is important that this move be intentional and based on flexibility, so that when the other starts moving in, you are free to come back also, rather than keeping the distance fixed.
7. Expand the context. It is often useful, when anxiety is high, to bring up the problem with members of the larger family system in order to increase the realm in which it can be dealt with and absorbed.
8. Keep family visits time limited in order to maintain your focus. Never stay with your family longer than you can manage to be generous. Once you lose your generosity, you are better off not being there.
9. Take up serious issues with people individually, rather than at large, ritualized family gatherings.
10. If someone is blocking the way to a distant family member, it is usually futile to try to get around such interference. It makes much more sense to develop a relationship with the person who is blocking, even though he or she may seem peripheral to your efforts. If, for instance, your sister-in-law monitors all your efforts to deal directly with your brother, you will need to commit yourself to developing a relationship with her as a necessary part of getting connected with him because you are unlikely to be able to go around her to get to him.
11. Writing letters that are not attacking or defensive is a useful way to open difficult emotional issues without having to deal immediately with the reactivity of the system. By predicting the response in the letter itself, some of the intensity can also be deflected. In general, writing individual letters, and taking up only one emotional issue in each letter may help to focus your efforts.
Although the contextualization of problems goes counter to the quick-fix orientation of today’s managed care pressures, coaching can be, indeed, a practical format to use when there are time constraints placed on our therapy. This approach generally requires far fewer sessions than other therapies and emphasizes clients’ work on their own between sessions. Reading, doing homework tasks with the family, making notes after each family move, and an occasional telephone call to the therapist in a crisis, easily carry the motivated client from session to session. This model places much less clinical strain on the therapist, since clients are encouraged to turn to their natural resources for support, a situation which can enhance therapist attentiveness, interest and learning. The method does require that therapists have a sophisticated understanding of their own issues as well as a comprehensive appreciation for the patterns that make all families tick. The hopeful and expansive orientation of this approach in its focus on the connectedness of all systems tends to encourage therapists to help clients find the strengths and resources in their history and in their present that will empower them for their future. This orientation toward individual and family resilience (Walsh, 1999) is an extremely useful approach in this era when health care is being so strenuously limited.
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Multicultural Family Institute, Highland Park; NJ
Family Institute of Westchester White Plains, NY
Monica McGoldrick, MSW, PhD, is Director, Multicultural Family Institute, 328 Denison St., Highland Park, NJ 08904; e-mail: firstname.lastname@example.org.
Betty Carter, MSW, Director Emerita, Family Institute of Westchester, 50 Aubinwood Rd., Amherst, MA 01002; e-mail: email@example.com
Copyright American Association for Marriage and Family Therapy Jul 2001
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