PATTERNS OF EFFECTIVE FAMILY THERAPY LEVEL I

There are several important things which an effective family therapist assumes when he or she walks into a session with a family. First, the fact that the family has come to family therapy is a direct statement that they have hopes that they can change. This is true in our experience even when the family members are not aware of it. In fact, even in the extreme case of court referrals, the family has made a choice to come to therapy rather than selecting jail. Their presence in therapy, then, is a direct reflection of their hopes about continuing as a family, and that they believe at some level that they are capable of change.

Second, we assume, by the fact that the family is in our presence for therapy, that they recognize at some level that they need assistance in making those changes. In our experience, we have found it useful to assume that the family has the resources necessary to make those changes, and our task, then, is to help them tap those resources. Thus, one of our major goals is to assist the family members to recognize and accept the resources already in the family system, although they may be presently unacknowledged and untapped. The therapist will work to develop rapport and mutual trust with the family as a necessary first step in making changes. Without trust, no real risks will be attempted and no real changes will occur.

Third, by accepting the particular therapist, the family is accepting that person as a guide to lead them in changing. The therapist serves as a model for the family. More specifically, the therapist offers a model of openness — the freedom to select from what is available that which is relevant at the time and place for the therapist and for the family. This requires that the therapist be in touch with his own processes, as well as with the needs of the family. This modeling occurs not only at the conscious level but also at the subliminal level, i.e., the messages carried by the therapist's body posture, voice tone, etc., serve as a model for the family members.

We begin with an account of an opening session of family therapy. The therapist has just introduced himself and learned the names of the family members. Join us in a walk through the therapy session in which we will illuminate some of the ways by which the desired phenomena appear. We wish to point out to the reader that the following transcript is partial and fragmented. The quoted portion dealing with Dave is only a part of the full transcript. The therapist uses the same patterns and takes the same time and care with each family member in turn. To enable us to present these patterns in a clear way, we have left out sections of the transcripts.

Therapist: Well, I'm very pleased to be here with you this afternoon. I'm wondering what it is that each of you hopes to change by coming here to work together with me. I don't know whether the process which you went through in deciding to come here was easy or difficult for you, but I do know that your coming here is the first step in making those changes which each of you wants, (pause) Dave (addressing the father in the family), I'm curious whether you can shed some light on the hopes which you have for yourself and your family. Can you tell me what you hope, specifically, will change by your coming here?

Dave: Well ... I feel like we're just not pulling together as a family . . . like some things are missing . . . I'm just not sure. I can't get ahold of it — I can't get a handle on it.

Therapist: Yes, Dave; can you tell me one thing that is missing for you?

There are several important patterns in this short transcript which emerge clearly. First, the therapist assumes or presupposes that:

(1) There are things which the family wants to change. (. . . wondering what it is that each of you hopes to change those changes which each of you wants shed some light on the hopes which you have what you hope, specifically, will change . . .)

(2) The family went through the process of deciding to come to therapy. (. . . whether the process which you went through in deciding to come here was easy . . .)

(3) The process of change has already begun. (. . . your coming here is the first step in making those changes . . .)

Notice that the therapist does not ask the family members if they have hopes of being able to change; rather, he presupposes that they do, and he asks, instead, what are the specific changes which they desire. The family, thereby, comes to focus their attention on what changes and hopes rather than on whether changes and hopes exist. The therapist is systematic in the language forms he uses — specifically, he uses language assumptions (presuppositions)[1] as a tool in talking to the family in therapy. In other words, rather than using the language forms in column A, he uses those in column B:

By the skillful use of language assumptions (presuppositions), the therapist can assist the family in focusing upon the issues which are most important for achieving what they want in the therapeutic session.

We have found it to be very important in our experience to understand that the family therapist needs to make contact with each of the family members individually. The therapist must be careful not to assume that any one member of the family is a spokesperson for the rest of the family. The therapist makes a series of contracts for change — one for each family member. In this way, the therapist explicitly recognizes the integrity and independence of each member of the family. The basis of the art of family therapy is the therapist's ability to integrate the independent growth needs of each family member with the integrity of their family system. In exploring the desired changes with the individuals, the therapist makes skillful use of language assumptions (presuppositions). The specific language assumptions used by the therapist will be effective only to the extent that they are congruent with the growth needs of the family.

A second important pattern illustrated by the foregoing transcript is the delicate way in which the therapist begins the process of gathering information. There are several patterns which the therapist uses in the transcript. He begins with a statement about himself (I'm very pleased to . . .). Next, he uses a series of "questions" which aren't really questions in the usual sense. Notice, for example:

I'm wondering what it is that each of you .. .

I don't know whether the process . . . was easy or difficult. . .

I'm curious whether you can shed some light. . .

The particular language form used in this questioning is called embedded questions.[2] When questions are embedded as they are in the examples above, they do not demand an answer, yet they begin the process of bringing certain issues to the attention of the people listening — in this case, the issues concerning which hopes about which changes are held by each of the family members. In addition, this form of questioning opens up the possibility for any one of the listeners to respond if he so chooses. In other words, it allows the listener the maximum number of choices about how and when he will respond. This seems to us to be particularly important in the initial stages of family therapy, when the therapist is gathering information. Finally, in conjunction with this pattern, the therapist pauses after he has presented several embedded questions, to allow any family member the space to exercise the choice of responding to the questions if he so chooses.