Values in the role of the family therapist: Self determination and justice
Melito, Richard
Recently, there has been renewed interest in the role of values in family therapy. A number of theorists agree that there is an inherent ethical dimension in all forms of therapy, because therapy necessarily involves influencing others in accord with a set of values. In cultures that value self determination, a potential conflict arises between the therapist’s inherent moral influence and protecting the client’s self determination. This article identifies that dilemma and investigates how different treatment approaches resolve it as they attempt to promote justice in the family.
I worked for years in community mental health settings and attended the many case conferences and discussions that took place there. I learned a great deal from hearing differing perspectives on the individuals and families we discussed. The discussions not infrequently involved impassioned views regarding clients’ behavior and how they should best be treated. Those impassioned views often involved questions of values-of what was right and just and of how best to treat our clients with respect and dignity. The discussion presented here demonstrates that issues of values, in particular freedom and justice, are of central importance in diverse treatment approaches and guide, implicitly or explicitly, the actual work of the therapist.
In the past, the value position of the family therapist seemed not to have been made explicit or was assumed to be neutral (e.g., McConaghy & Cottone, 1998). This situation began to change when some feminist practitioners criticized family systems theory for its supposed failure to address issues of justice and individual responsibility in families, especially in situations of family violence. The critique of family systems theory initiated and led by feminist family therapists (e.g., MacKinnon & Miller, 1987; Taggart, 1985; Walters, Carter, Papp, & Silverstein, 1988) was basically value driven. With respect to domestic violence, for example, the position taken was that abusers should be held responsible for their actions and that any theory that could not provide a ground for that judgment or that held abuser and victim equally responsible was inadequate. Values therefore were given a central position and were addressed much more deliberately than appeared to have been the case before the feminist critique.
Recently, there has been renewed interest in the ethical and moral dimensions of our work that goes beyond feminist concerns (e.g., Doherty, 1995; Fowers & Wenger, 1997; Pare, 1996; Prilleltensky, 1997). There are those who argue that the current paradigm shift, from viewing families as biological or mechanical systems to viewing them as meaning-making entities, places greater emphasis on “accountability and the responsibility of family members to each other” (Pare, 1996, p. 28). Further, a number of theorists agree that there is an inherent ethical/moral dimension to all forms of therapy, because they necessarily involve influencing others in accord with a set of values and concern questions of how we should live (e.g., Boszormenyi-Nagy & Spark, 1973; Doherty, 1995; Fowers & Wenger, 1997; Goldner, 1999; London, 1964; Margolis, 1966; Prilleltensky, 1997). Therefore, even if a moral position is not explicitly articulated, one can investigate a particular therapeutic approach for its implicit moral position. This position refers not merely to the moral conduct of the therapist, but also to the therapist’s values, assumptions, and therapeutic practices (Prilleltensky, 1997). From this perspective, the therapist cannot be neutral; he or she necessarily always operates from a value position. Promoting therapeutic neutrality itself reflects a particular value, namely that of safeguarding the client’s autonomy and self determination.
Once the step is taken of asserting that “moral conversation pervades psychotherapy” (Doherty, 1995, p. 17) and that the therapist necessarily operates as a moral agent and influence, important questions and issues arise concerning the therapist’s role as a change agent. One issue raised is that regarding the therapist as a moral agent who should promote justice while safeguarding self determination.
Asserting the role of the therapist as a moral agent opens the door (or perhaps Pandora’s box) on the issue of moral absolutism versus moral relativism, which has a long history (e.g., Bernstein, 1983, 1986)1. The danger of an absolutist moral approach to human conduct is that it may interfere with personal freedom and self determination and that the “universal frameworks” invoked may serve only “the interests of the powerful” (Prilleltensky, 1997, p. 528). In contrast, a relativistic, “anything goes” approach brings with it no firm basis on which to take action against wrongs. As Prilleltensky (1997) beautifully understated it: “Being passive or recondite in the face of injustice is hard to defend” (p. 528). Justice and liberty (if you will) are important Western cultural values (I do not presume to speak for Eastern values), and this probably accounts, in part, for the importance given to them in the role of the therapist. Certainly, in the US when we pledge allegiance to flag and country we pledge “with liberty and justice for all.” These values at times have been given different emphases by different societal factions and as a consequence have sometimes been pitted against each other (e.g., the different emphases given these values by the American Civil Liberties Union vs. law and order factions). However, further discussion of these sociopolitical factors is beyond the scope of this article. Of course, other value positions may figure importantly in the role prescribed for the family therapist (e.g., the set of five values proposed by Prilleltensky, 1997), but the current discussion will focus on self determination (liberty) and justice.
Applying this issue to the therapist’s stance, we would have at one extreme the danger of the “moralistic” therapist who would, in the interest of justice, wittingly or unwittingly act as “propagandist” (Rioch, 1960, p. 138) or social controller (Cecchin, 1987), interfering with the client’s moral self determination and, in so doing, perpetrating a form of “therapeutic violence” (Cecchin, 1987, p. 411; cf. Rioch, 1960, pp. 138-139). At the other extreme would be the therapeutically neutral therapist who would, in the interest of protecting moral self determination, act as a relativistic bystander to injustice. The added danger of the neutral therapist is that not directly confronting injustice in the family may implicitly sanction it (see Goldner, 1998). Between the therapist as propagandist and the therapist as bystander to injustice, there must be some alternative. How can the therapist as a moral influence respect the family members’ moral autonomy and avoid being a propagandist or moralistic blamer? How can the therapist as protector of the family members’ moral autonomy and self determination avoid becoming a bystander to injustice? How can the family therapist respect liberty and justice both? I will attempt to show that these questions and the values that they reflect regarding the role of the family therapist figure prominently in diverse family therapy approaches.
CLINICAL APPROACHES
I have chosen deliberately to investigate both systems and constructionist approaches in part because some have found systems approaches to be relatively lacking in their ability to address ethical issues (e.g., McConaghy & Cottone, 1998; Pare, 1996). It will be seen, however, that ethical concerns are addressed, contrary to what some postmodernists assert, whether the form of influence is systemic (e.g., in terms of circular interactions) or constructionist (e.g., in terms of co-constructed meanings). Ethical concerns do not appear to be the sole province of any particular approach, although the ethical emphases and particular ethical stands may differ. Furthermore, not only do diverse approaches identify justice and self determination as values to be addressed by the therapist, some of the attempts to resolve the potential dilemma posed by this set of values are remarkably similar despite their very different theoretical and philosophical bases.
For these reasons, and because I have experience with them, I have chosen to investigate the treatment approaches of Doherty (1995), Tomm (1984, 1987, 1988), Boszormenyi-Nagy and colleagues (Boszormenyi-Nagy & Spark, 1973; Boszormenyi-Nagy & Ulrich 1981; Boszormenyi-Nagy, Grunebaum, & Ulrich, 1991), Jenkins (1990), and Sheinberg (1992).
The Approaches of Doherty and Tomm
I begin the discussion with the approaches of Doherty and of Tomm. These two differing approaches provide a contrast for each other that highlights their main points and that defines a continuum of direct versus indirect modes of influence. Doherty (1995) proposed that therapists should “promote moral responsibility” by acting as a “moral consultant” (pp.7-8) to clients. This position asserts that the behavior of any therapist inherently carries moral implications. Doherty (1995) also proposed that the therapist should acknowledge this influence explicitly and be direct with clients in addressing moral concerns. The therapist as moral consultant collaborates with clients, helping them to “reflect on the moral dimensions of their lives” and “neither dictates moral rules nor claims to know all the answers” (Doherty, 1995, p. 39). Doherty suggested that clients, for the most part, already possess moral rules that they have acquired in the process of socialization. It is, in part, on that basis that the therapist may reinforce, elicit from, and exhort clients to responsible and just behavior. Doherty proposed eight types of responses the therapist may engage in to promote moral behavior. These responses range from less to more direct, going from validation of the client’s spontaneous moral concerns to elicitation by questions of the client’s thoughts about the consequences of their actions on others, to more active attempts at persuasion and exhortation to do the right thing (Doherty, 1995). Finally, Doherty (1995) advised that the therapist “clearly state when you cannot support a client’s decision or behavior, explaining your decision on moral grounds and, if necessary, withdrawing from the case” (p. 45). This may occur in extreme cases when the client is engaging in morally reprehensible behavior and is not willing to change. It is both by a respectful, collaborative approach and by an explicit sharing of his or her moral position that the therapist in this approach safeguards the moral agency of the client, while encouraging the client’s ethical behavior.
Doherty’s (1995) approach does not impose a particular moral position on clients; however, it proposes that the therapist address directly the moral implications of clients’ behavior so that they may take responsibility for their actions. In contrast to this “direct” approach is that of Tomm (1984, 1987, 1988), whose implicit values are not addressed with clients directly. Tomm (1984) espoused a circular epistemology and argued that its value, in contrast to a linear epistemology, is that it leads to being less judgmental and moralistic. According to Tomm (1984):
The situation, when regarded as one in which the participants are ‘caught’ in a recursive pattern becomes more like a misfortune, calling for compassion for the persons involved rather than condemnation …. The therapist becomes more neutral, which in turn allows the family more freedom to explore alternatives for change. (p. 118)
The values that drive Tomm’s approach are that the therapist should be accepting and nonjudgmental and should be “respectful of the family’s autonomy,” rather than “telling family members how they erred and how they ought to behave” (1988, pp. 8-9). From the current perspective, to label Tomm’s position, as he does, as neutral would be misleading. First, the therapist certainly is not neutral with regard to safeguarding clients’ self determination. Nor is the therapist truly neutral about ongoing injustice in a family. Rather, there is an explicit assumption that an accepting and nonjudgmental (neutral) stance by the therapist can liberate the family’s “natural healing capacity” (Tomm, 1988, p. 13). The implication is that in an abusing family, for example, this self-healing will result in cessation of the abuse. For this reason, I propose we refer to Tomm’s approach as relatively indirect regarding moral influence, in contrast to an approach such as Doherty’s (1995), in which the therapist addresses moral issues more directly. In this way, too, we avoid the simple-minded polarization that asserts one approach is more ethical than another.
In Tomm’s (1988) approach, an accepting and nonjudgmental stance that respects the family’s autonomy is embodied in circular and reflexive questioning. Circular questions, according to Tomm (1988), explore the circularity of behavior patterns and implicitly accept the family as they are; this counters “the immobilizing effects of blame” (p. 13) and frees the family to “make their own connections” and view their problems from a new perspective (p. 11). Reflexive questions trigger the family to reflect on their belief systems and “invite” them to entertain new views; rather than pushing the family into new behavior, these questions facilitate them in mobilizing their own resources. With reflexive questions, “The therapist’s influencing intent is moderated by respect for autonomy” (Tomm, 1988, p. 12).
Acceptance and respect for autonomy are central to Tomm’s approach as they are to Andersen’s (1987) reflecting-team approach, both of which may be seen as relatively indirect with regard to moral influence. In his approach to promoting justice (through responsibility), Doherty (1995), although relatively more direct is, as discussed, also cognizant of and careful to protect the client’s moral autonomy. The difference in these approaches, then, would seem to be more on how (rather than on whether) to protect that autonomy. Of course, the concern of a relatively direct practitioner might be that approaches such as Tomm’s (1984, 1987, 1988) and Andersen’s (1987) could leave the therapist in the unacceptable position of being a bystander to injustice. Similarly, Tomm might be concerned that a more direct approach would be judgmental and moralistic, thereby constraining and immobilizing the family. Both of these perspectives do our clients and us a service in highlighting the dangers of which we must beware in our role as therapists and healers. The issues highlighted in contrasting these two approaches also figure prominently in the approaches discussed below.
The Approach of Boszormenyi-Nagy
In contextual family therapy, there is acknowledgement of both systemic and ethical dimensions of therapy and of balancing the therapist’s moral agency with clients’ moral self determination. Contextual family therapy considers four interrelated dimensions that comprise “the relational context and dynamics” of family life, namely: facts, psychology, transactions or power alignments, and relational ethics (Boszormenyi-Nagy et al., 1991, pp. 203-205).
Relational ethics are central to Boszormenyi-Nagy’s approach (Boszormenyi-Nagy et al.,1991) and constitute his unique contribution to the field. Relational ethics concerns the balance of justice and injustice in the family and involves, specifically, the “process of achieving an equitable balance of fairness among people” (Boszormenyi-Nagy et al., 1991, p. 204). The role of the contextual therapist is to actively enable and encourage family members to adopt a “multilateral perspective of fairness.” This involves encouraging family members to balance “self validation,” asserting their own claims and view of things- and “fair accountability,” hearing and being accountable for being fair to others (Boszormenyi-Nagy, et al., 1991, pp. 220-221). The central method employed by the contextual therapist is that of multidirectional partiality. This method involves the therapist giving “consideration … to the interests of all involved” by siding with each member, and by balancing that siding with holding each member accountable to the others (Boszormenyi-Nagy et al., 1991, pp. 222-223).
The therapist in this approach is thus very direct in promoting greater justice (i.e., fair accountability) in the family. As Boszormenyi-Nagy, et al. (1991) noted, “the therapist’s values and definitions of fairness inevitably will become part of the treatment situation” (p. 231). However, multidirectional partiality is considered to be a safeguard against the therapist imposing his or her views of what constitutes fairness. With a multilateral perspective, the therapist considers the interests of each family member from their own and others points of view, and the therapist’s vantage point is merely one among others (Boszormenyi-Nagy & Ulrich, 1981). Judgment of the fairness of each person’s position, then, is based on “the outcome of dialogue and negotiation,” (Boszormenyi-Nagy, et al., 1991, p. 221) a process that includes the therapist. Such a position is similar, as we shall see, to that described by Cecchin (1992) regarding social-constructionist approaches.
Jenkins’ Approach
Jenkins (1990) developed an approach to assist men who are abusive to stop their abusive behavior by accepting full responsibility for it. Jenkins’s (1990) approach lies within a cybernetic and constructivist philosophic tradition; in particular, it is based on “a theory of restraint” (p. 14) that derives from the ideas of Bateson as developed by White (1986, 1988). According to cybernetic theory, one of the reasons events take the course they do is “because they are restrained from taking alternative courses” (White, 1986, p. 169). Restraints limit “the trial-and-error searching” (White, 1986, p. 171) necessary for developing new ideas and new responses. Jenkins based his approach with abusive men “on the assumption that males will relate respectfully, sensitively and non-abusively with others, unless restrained from doing so” (1990, p. 32). Restraints include “traditions, habits, and beliefs” that affect the ways abusive males understand and relate to the world; these restraints “can prevent these men … from accepting responsibility for their abusive behavior” (Jenkins, 1990, p. 32). There are a variety of types of restraint including sociocultural, developmental, interactional, familial, and individual.
It is instructive to note how Jenkins (1990) views interactional restraints. Interactional patterns involving the abusive man often involve his reliance on other family members to take social and emotional responsibility for the pressures of family life. A recursive pattern can thereby be created in which family members “tolerate, excuse, ignore and forgive his abusive behavior” (pp. 49-50). Such behavior by family members constitutes an interactional restraint for the abusive male accepting responsibility for his abusive behavior. Jenkins (1990) invites the abusive males he works with to acknowledge and challenge these restraints and take responsibility for their own behavior. He also may work with other family members, inviting them to challenge their own restraining habits, values, beliefs, and patterns of interaction. Justice in the family is thereby promoted as family members take responsibility for the part they play in maintaining restraints to responsibility and the abuser takes responsibility for the abuse.
The method that Jenkins (1990) uses involves posing questions based on White’s (1986, 1988) approach. The questions posed focus on taking responsibility, whereas the process of questioning allows room for moral self determination. Questions allow the therapist to take a stance of inviting the man to take responsibility, rather than arguing for, urging, or prescribing responsibility (Jenkins, 1990). For example, through questions Jenkins (1990) invites the abuser to argue for a nonviolent relationship and to consider what has stopped him from taking responsibility for his abusive behavior, how he has stood up to these restraints, and what plans and strategies he has for demonstrating that he can take responsibility. The therapist in Jenkins’s approach acts as a “consultant” (1990, p. 63) to the man’s efforts to change his abusive behavior.
Jenkins’s (1990) approach is direct in the sense of keeping the focus on the issue of taking responsibility for one’s actions. At the same time, the client’s moral autonomy is preserved by means of a method that does not impose or dictate, but rather, through questions invites responsibility taking. This method also relies on the assumption, reminiscent of Tomm’s (1987), that the client will act in a responsible manner if not hampered from doing so.
Sheinberg’s Approach
Working with families in which domestic violence (incest and physical abuse) has been committed, Sheinberg (1992) also has addressed the issue of how the therapist can take a stand regarding injustice while respecting the client’s autonomy. With regard to domestic violence, she believes that combining social– constructionist and feminist perspectives allows the therapist to take a stand against injustice without also assuming a hierarchical, social control stance. Such a stance can promote defensiveness and polarization between therapist and family and can reinforce “paralyzing” self blame and shame (Sheinberg, 1992, pp. 204, 214). From a feminist perspective comes the necessity for the therapist “to take a stand, to advocate, to challenge stereotypical expectations surrounding gender” (Sheinberg, 1992, p. 202); from the social– constructionist perspective comes the therapeutic value of a nonhierarchical, collaborative stance. Joining these perspectives allows the therapist to integrate being “responsible” (just) with being “nonhierarchical” (Sheinberg, 1992, p. 203). Sheinberg (1992) maintains this integration by keeping the focus in therapy on addressing the abuse, but doing so in a collaborative, coauthoring manner. In one case, for example, Sheinberg (1992) collaborated with neglectful parents in coauthoring a letter with them about how they plan to care for their children.
Another aspect of Sheinberg’s (1992) treatment approach is relevant. In her approach with abusive parents she emphasizes “future planning” about caring for their children over “recriminations over past behavior” (p. 205). Such an approach to responsibility is consistent with Finagrette’s (1963) idea that “guilt is retrospective, but responsibility is prospective” and has a lot to do with acting “to make … the world as we would like it to be” (p. 164).
For Sheinberg (1992), then, the use of future questions and coauthoring letters with neglectful parents allows the therapist to address directly the parents’ responsibility as parents in a way that is accepting and nonjudgmental and that promotes their self determination. Sheinberg (1992), in accord with Gilligan (Gilligan, Ward, &Taylor, 1988), does more than address facilitating abusers in taking responsibility for their actions. She also attends to promoting in abusers caring about the impact of their actions on the victims. A discussion of care in the value position of the therapist is, however, beyond the scope of this article.
DISCUSSION
I have examined diverse approaches to family therapy with regard to the role prescribed in each of them for the family therapist. In all of them, despite their broad theoretical differences and claims to the contrary, there is concern with what values the therapist should be guided by in his or her therapeutic activity. Values appear in the stance prescribed for the therapist and also in particular therapeutic methods. With regard to therapeutic stance, two general positions appear to be prominent-that of consultant or guide and that of co– collaborator. With regard to methods, the processes of negotiation and of asking certain kinds of questions stand out.
Balancing Justice and Self Determination
In reviewing the approaches discussed, one can discern in the stances proposed a concern, either direct or indirect, with promoting justice in the family (or, with an important condition of justice-assuming responsibility) and with safeguarding the family’s self determination. In some of the approaches discussed, namely Doherty’s (1995) and Jenkins’s 1990), the emphasis is on promoting justice and responsible moral behavior. In some, namely Tomm’s (1984, 1987, 1988) and Andersen’s (1987), the emphasis is on moral self determination. In the other approaches considered, Boszormenyi-Nagy’s (Boszormenyi-Nagy et al., 1991) and Sheinberg’s (1992), explicit attention is paid to balancing justice with a nonhierarchical, nonjudgmental stance. Even in those approaches that emphasize one of these values over the other, one can detect a concern with the other value. Thus Doherty, who emphasizes promoting moral behavior, acts to not impose any particular moral behavior on his clients. He assumes that suggestion or even exhortation merely will tap into the common value system he shares with his clients; if it does not, he reserves the option of removing himself from the case, rather than impose his specific views. Similarly, Tomm (1984, 1987, 1988), while emphasizing self determination, assumes that if the family is freed from debilitating blame (by reflexive questioning) they will heal themselves and thus, supposedly, act responsibly.
Therapist as Guide, Consultant, and Coach
Behind all these approaches appears to lay an antipathy to any sort of controlling or imposing on the part of the therapist. The therapeutic stance in all of these is decidedly nonhierarchical. In the approaches of Doherty (1995), Tomm (1984, 1987, 1988), and Jenkins (1990), a nonhierarchical stance is achieved by the therapist acting as a consultant (Doherty, 1995; Jenkins, 1990) or as a “guide” (Tomm, 1988) and certainly not as a judge, director, or benign manipulator. It is interesting to note that Bowen (1978), who emphasized autonomy and self determination in the form of differentiation, proposed a therapeutic stance of therapist as coach, which is quite similar to that of consultant or guide.
Doherty (1995), Jenkins (1990), and Tomm (1984, 1987, 1988) all assume that the therapist as consultant or guide can create conditions that allow clients to assume responsibility voluntarily. For Tomm (1987) and Jenkins (1990) this is based on the assumption that clients will act responsibly if freed to do so by questions that either promote self healing (Tomm, 1987) or that remove restraints on responsibility (Jenkins, 1990). For Doherty (1995), the process of socialization makes the client amenable to moral consultation.
Collaboration, Negotiation, and Multidirected Partiality
The approaches of Boszormenyi-Nagy (Boszormenyi-Nagy et al., 1991) and of Sheinberg (1992) directly attempt to balance promoting justice with protecting the moral autonomy of family members. Boszormenyi-Nagy attempted both to directly confront issues of fairness and justice in the family as well as to safeguard each person’s moral autonomy by means of his method of multidirected partiality (Boszormenyi-Nagy & Ulrich, 1981). Sheinberg (1992) attempts to combine promoting justice with a collaborative, nonhierarchical stance. Collaboration, of course, can safeguard the client’s moral autonomy by allowing a co-construction of the therapeutic action while the therapist acts to promote justice. Cecchin (1992) has articulated how a constructionist approach in general would address and balance both justice and moral autonomy. A constructionist therapy proceeds by means of curiosity, questioning, and negotiation. Liberty and justice can be integrated because negotiation and co-construction allow therapist and family ideally to create “viable and sustainable ways of being that fit with the family, the therapist, and the culturally sanctioned ways of being” (Cecchin, 1992, p. 93). Such a position is quite similar to that proposed by Boszormenyi-Nagy et al. (1991), although his approach is systemic rather than constructionist. Specifically, as cited earlier, Boszormenyi-Nagy et al. (1991) propose that the ultimate judgment as to what is fair and just is based on “the outcome of dialogue and negotiation” (p. 221).
Justice, Self Determination, and the Posing of Questions
Posing questions of a certain kind has a central place in all of the approaches discussed and relates directly to balancing justice and self determination. Questions of a particular kind seem to do the job of directing attention to issues of justice without imposing and of engaging and stimulating the client’s own moral consciousness. Future questions have a particular usefulness because they can emphasize taking responsibility for what is to be done rather than blame for what has occurred. Tom (1987, 1988) emphasized, however, that the intention behind the question is most important. Thus, with reflexive questions the intent is “facilitative rather than directive” (Tomm, 1987, p. 172). Of course, a facilitative stance can be taken without the use of questions, as in Andersen’s (1987) reflecting team. In a reflecting– team approach, a facilitative, non-hierarchical, non-directive stance is embodied in the reflecting team’s tentative, conjectural (“perhaps,” “I wonder,” “I had this idea”), both/and statements and in the structure of the reflection that invites the family to select those ideas to pursue in which it is interested. As one couple eloquently observed regarding the reflecting team, “Your way is perfect. It tells without telling, says without saying…. That’s good for us because neither one of us wants to be told what to do!” (Davidson, Lax, Lussardi, Miller, & Ratheau, 1988, p. 76).
The Limits of Self Determination
Last, the question is raised of the limits of any therapy that seeks to promote justice while respecting moral self determination. What if clients’ and therapists’ values clash irreconcilably or if a particular therapy is failing to promote justice in the family? Doherty (1995) is the only one to consider the possibility of withdrawing from a case if he could not support a client’s behavior on moral grounds. In certain situations, however, such as those involving physical and/or emotional harm, one cannot simply say “Sorry, I can’t work with you” and leave it at that, because questions of on-going or potential harm call for moral action to end it. I doubt Doherty simply would leave it at that, but it is not clear exactly what he thinks one should do in such situations. Goldner (1998), in conjoint cases where there is domestic violence, includes a “consultation” phase which allows for the possibility of the case never getting to the “therapy” phase if “a safe and effective format for ending the violence” cannot be agreed to (p. 272). She also stressed the need for there to be a clear “moral bottom line” regarding safety (Goldner, 1998, p. 267) without which the therapy cannot proceed, but does not spell out what to do if there is no agreement. The dilemma of respecting self determination when there is on-going or potential harm is shown in the case of a couple described by Davidson et al. (1988) using a reflecting-team approach. In that case, a wife had attempted to shoot her physically abusive husband. After an initial reflection, the team was not satisfied that the violence would not recur. What recourse did they have? The team did a second reflection, after which the couple agreed to no further violence. But what if they had not so agreed? The second reflection begs the question.
All of the approaches discussed, most self-consciously the constructionist, but also the systemic, require therapist and client to be open to mutual influence and negotiation. Negotiation is a way to respect the client’s self determination. If either party is not so open, a potential ethical dilemma is created. How does one protect client self determination in such cases and still heed the ethical imperative to protect victims and prevent harm? The question has not been adequately resolved.
As therapists and moral agents we work to allow individuals to find their own truths while respecting the rights and freedoms of others. When someone’s way of being interferes with the self determination of others and that person is unwilling to change, we as therapists are at the limits of protecting the self determination of that person. Indeed, we are at the limits of therapy; that is, we are at the boundary where we, as therapists, must shift our role from responsible therapist to responsible citizen and, perhaps, agent of social control.
CONCLUSION
Hopefully, this article demonstrates the importance that values, specifically freedom and justice, play in defining the role of the family therapist in diverse approaches, in how conflict arises and resolution is attempted between these values, and in how these values are embodied in treatment methods. A noteworthy byproduct of this discussion is the discovery of remarkable similarities among diverse approaches regarding how they implement these values and how they attempt to resolve the potential conflict between them.
I hope this article will lead to further discussion of values in family therapy. I believe fruitful areas for investigation will be valuable in relation to theory construction and the development of treatment methods as well as further studies of values in the role of the therapist.
NOTE
1 Bernstein (1983; 1986) notes that this dichotomy (to which he refers as “objectivism” vs. “radical relativism”) has characterized contemporary ethical discourse (1986, p. 9), and proposes some thoughts about moving beyond such a dichotomy. Here, I use the terms moral absolutism and moral relativism as conceptual tools of analysis (specifically, as “ideal types”) without claiming necessarily that any one person or approach is purely or consistently absolutist or relativistic.
REFERENCES
Andersen, T. (1987). The Reflecting Team: Dialogue and metadialogue in clinical work. Family Process, 26, 415-428. Bernstein, R. (1983). Beyond objectivism and relativism: Science, hermeneutics, and praxis. Philadelphia: University of Pennsylvania Press.
Bernstein, R. (1986). The question of moral and social development. In L. Cirillo & S. Wapner (Eds.), Value presuppositions in theories of human development (pp. 1-12). Hillsdale, NJ: Lawrence Erlbaum.
Boszormenyi-Nagy, I., Grunebaum, J., & Ulrich, D. (1991). Contextual Therapy. In A. S. Gunman & D. P. Kniskem (Eds.), Handbook of family therapy (Vol. 2, pp. 200-238). New York: Brunner/Mazel.
Boszormenyi-Nagy, L, & Spark, G. M. (1973). Invisible loyalties. Hagerstown, MD: Harper and Row.
Boszormenyi-Nagy, I., & Ulrich, D. (1981). Contextual family therapy. In A. S. Gunman & D. P. Kniskern (Eds.), Handbook of family therapy (pp. 158-186). New York: Brunner/Mazel.
Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson.
Cecchin, G. (1987). Hypothesizing, circularity, and neutrality revisited: An invitation to curiosity. Family Process, 26, 405-413. Cecchin, G. (1992). Constructing therapeutic possibilities. In S. McNamee & K. J. Gergen (Eds.), Therapy as social construction (pp. 86-95). London: Sage.
Davidson, J., Lax, W., Lussardi, D., Miller, D., & Ratheau, M. (1988, Sept./Oct.). The reflecting team. Family Therapy Networker, 44-77.
Doherty, W. (1995). Soul searching: Why psychotherapy must promote moral responsibility. New York: Basic Books. Fingarette, H. (1963). The self in transformation. New York: Basic Books.
Fowers, B. J., & Wenger, A. (1997). Are trustworthiness and fairness enough? Contextual family therapy and the good family. Journal of Marital and Family Therapy, 23, 153-169.
Gilligan, C., Ward, J.V, & Taylor, M.J., with Bardige, B. (1988). Mapping the moral domain. Cambridge, MA: Harvard University Press.
Goldner, V. (1998). The treatment of violence and victimization in intimate relationships. Family Process, 37, 263-286. Goldner, V. (1999). Morality and multiplicity: Perspectives on the treatment of violence in intimate life. Journal of Marital and Family Therapy, 25, 325-336.
Jenkins, A. (1990). Invitations to responsibility. Adelaide, S. Australia: Dulwich Centre Publications. London, P. (1964). The modes and morals of psychotherapy. New York: Holt, Rinehart, & Winston.
MacKinnon, L. K., & Miller, D. (1987). The new epistemology and the Milan approach: Feminist and sociopolitical considerations. Journal of Marital and Family Therapy, 13, 139-156.
Margolis, J. (1966). Psychotherapy and morality. New York: Random House.
McConaghy, J., & Cottone, R. R. (1998). The systemic view and violence: An ethical perspective. Family Process, 37, 51-63. Pare, D. A. (1996). Culture and meaning: Expanding the metaphorical repertoire of family therapy. Family Process, 35, 21-42. Prilleltensky, I. (1997). Values, assumptions, and practices: Assessing the moral implications of psychological discourse and action. American Psychologist, 52, 517-535.
Rioch, M. J. (1960). The meaning of Martin Buber’s “Elements of the interhuman” for the practice of psychotherapy. Psychiatry,
23, 133-140.
Sheinberg, M. (1992). Navigating treatment impasses at the disclosure of incest: Combining ideas from feminism and social constructionism. Family Process, 31, 201-216.
Taggart, M. (1985). The feminist critique in epistemological perspective: Question of context in family therapy. Journal of Marital and Family Therapy, 11, 113-126.
Tomm, K. (1984). One perspective on the Milan systems approach: Part I, Overview of development, theory, and practice. Journal of Marital and Family Therapy, 10, 113-125.
Tomm, K. (1987). Interventive interviewing: Part II, Reflexive questioning as a means to enable self-healing. Family Process, 26, 167-183.
Torn, K. (1988). Interventive interviewing: Part III, Intending to ask circular, strategic, or reflexive questions? Family Process, 27, 1-15.
Walters, M., Carter, B., Papp, R, & Silverstein, 0. (1988). The invisible web: Gender patterns in family relationships. New York: Guilford.
White, M. (1986). Negative explanation, restraint, and double description: A template for family therapy. Family Process, 22, 255-273.
White, M. (1988, Winter). The process of questioning: A therapy of literary merit? Dulwich Centre Newsletter
Richard Melito
Newton, Massachusetts
Richard Melito, PhD, family therapist in private practice, Newton, Massachusetts.
Correspondence concerning this article should be addressed to Richard Melito, 93 Union St., Suite 406, Newton, Massachusetts, 02459.
Copyright American Association for Marriage and Family Therapy Jan 2003
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