60 Years of Practice,Research, and Teaching in Family Psychology and Family Therapy

Recent theoretical and empirical evidence as well as experimental and practical highlights from 60 years of clinical practice, research, and teaching in family therapy are summarized. This summary contains recent highlights that remain in my memory more vividly than others. I shall start with selected models of Relational Competence Theory (RCT), including variations on the theme of the Deadly Drama Triangle and their workbook applications.     

The Dyadic Relationships Test: Creation and Validation of a Model-Derived,Visual-Verbal Instrument to Evaluate Couple Relationships. Part II

The second part of this article adds evidence to support the psychometric properties of the Dyadic Relationships Test (DRT), designed to evaluate dyadic relationships from a theoretical Selfhood model. This model was presented in an early publication (Cusinato & L'Abate, 2003) and in the first part of this article.     

Therapeutic Action in the Work of a Playful Clinician: A Reflection on Dr. Silber’s Reimagining of Humpty Dumpty

ABSTRACT

In my discussion of Dr. Silber’s paper, Reimagining Humpty Dumpty: The Therapeutic Action of Play, I mirror Dr. Silber’s playful posture in her use of the Humpty Dumpty fable to talk about children and their care by society. My reflections on Dr. Silber’s therapeutic work with her two young patients focus on her co-creating meaning with each child’s parents as well as with the child. I discuss that by holding in her mind both the subjectivities of the child and his parents, Dr. Silber is able to practice a fundamentally relational therapy. I would have liked to have heard more about her emotional reactions in her work with both cases as another important dimension of her work. Finally, I emphasize through my play with Humpty Dumpty several ways that society can support children and families that are essential for their development: parental leave, developmentally approptiate expectations for children in school, and the facilitation and protection children’s open ended time and ability to play.     

Response: How Do We Know What We Know About the Amish and Other Minorities?

The appraisal by Cory Anderson, Joseph Donnermeyer, Jeffrey Longhofer, and Steven Reschly (hereafter, appraisers) highlights a methodological divide that is important to the study of the Amish and other ethnic or religious minorities. In my reply, I discuss how my work is rooted in a cultural analytic paradigm that differs from the appraisers’ methodological orientation. My reply includes a deconstruction of the appraisal and a discussion of its “shortcomings.” I conclude by showing how the discourse surrounding this appraisal raises important epistemological questions of how we understand human societies.     

Coping with the Angry Patient

This patient is enacting two chronic maladaptive patterns. In one he alternates between the role of victim and abuser while inducing the therapist to play the counterrole. He tries to master the abuse he suffered passively as a child by becoming abusive with the therapist and having her experience what it feels like to be mistreated. My effort would be to interpret this pattern even while acknowledging and absorbing some degree of his anger. In a second pattern he acts like an angry, demanding child in an effort to extract nurturance and special treatment from the therapist. I would help him explore this posture in terms of his deprived background and its maladaptiveness in his current life. Finally, I present vignettes from my own practice to demonstrate how I work with patients' anger when it is expressed indirectly rather than in Mr. P's very direct manner.     

Twenty Years on – Water under the Bridge

My paper in the first issue of the Journal of Family Therapy outlined some ideas which have continued to form the basis of my practice of family therapy ever since. Using the psychoanalytic concept of 'counter-transference' I suggested that opening themselves to the emotional interaction of the family will usually lead to a reproduction of the essential basic family conflict within the therapists' own psyches. In this way the therapist takes on the role assumed by many 'family scapegoats', expressing some emotion 'for' the family which other members dare not articulate or even entertain.     

Reply to Oppy on God,the Best and Evil

My reply corrects one misstatement in Oppy’s summary of my book, abandons a footnote in the light of one of Oppy’s criticisms, and argues that Oppy’s other criticisms do not succeed in showing either that my claims are mistaken or that the arguments by which I supported them are defective.     

“Polarity,Paradox and the Organizing Process in Development”; Parent-Infant Psychotherapy and Child Analytic Technique: In Honor of Louis Sander

ABSTRACT

A child analysis and a subsequent family therapy are presented and discussed in terms of Sander’s monumental contributions to infant-parent development and clinical theory. I draw on earlier discussions with Sander on these topics and note how his insights validate a certain kind of child analytic technique I practice.     

Silence and Memories of War: An Autoethnographic Exploration of Family Secrecy

A personal journey and a scientific challenge, this is an autoethnographic study about my own family's secrecy. I knew my grandfather had been a German prisoner of war during World War II. We all knew. But nobody talked about it. Then one day I decided I wanted to do systematic research on the issue of family secrecy around my grandfather's war experiences. Researching one's own family can be called autoethnography. It could be said that autoethnography is an approach to research that aims to describe and systemically analyze (graphy) personal experience (auto) to understand social and cultural phenomena (ethno). This scientific approach is quite new in the field of family therapy. This study has been an important personal quest, but it also led to important reflections on silences in families, on my own professional development, and on methodological issues concerning autoethnographical research. For one thing, it highlights some of the positive aspects of family secrecy and silences, and invites us—when confronted with family secrecy in clinical practice—to carefully consider the potential destructive and life‐giving aspects of the silence.     

Building on Wachtel’s Points About Implications of Mitchell’s Ideas: Suggestions Based on the Participatory Philosophical Perspective for Locating the Person in the World of Practical Activities

In his paper “The Relationality of Everyday Life,” Wachtel (this issue) successfully moves us further along the path of the “unfinished journey” (p. 509) of Mitchell’s work. I begin my comments by pointing out how Wachtel identifies the importance for both theory and practice of focusing on everyday life in addition to early parent–child interactions and what transpires in psychoanalytic/psychotherapy sessions. His points about everyday life include rejecting one-person notions of internal processes that are “frozen” in time and offering a way to understand the vicious circles that are a prominent part of most clinical problems. My comments also include suggestions about how we can take another step along the path Wachtel has encouraged us to pursue—which he aptly describes as treating the person as a “self-in-context” (p. 507)—if we approach basic issues about the person’s relationship to others and the world at large along the lines of the participatory philosophical perspective (e.g., Westerman, 2005, 2013, 2014; Westerman & Steen, 2007). That perspective takes as its cornerstone idea the view that from the outset the person is a participant in practical activities. Guided by the participatory perspective, I add to Wachtel’s suggestions about how a focus on everyday life can enter into therapeutic work; present a different view of what are typically called “inner” processes and discuss some of the implications of that view for clinical work; and, most important, put forward an alternative account of vicious circles.     

Eating Disorders,Impaired Mentalization,and Attachment: Implications for Child and Adolescent Family Treatment

ABSTRACT

This article reviews the attachment and neuroscience model of Mentalization Based Treatment (MBT) (Allen, Fonagy, & Bateman, 2008) and its application for understanding and treating eating disorders (Skarderud & Fonagy, 2012). Mentalization, or mentalizing, refers to the capacity to apprehend one’s own and others’ behavior in terms of underlying mental states (needs, emotions, desires, beliefs, goals, reasons, and thoughts). Evidence from prospective studies suggests that insecure attachment and poor mentalizing difficulties may be risk factors for the development of eating pathology (Jewell et al., 2015; Rothschild-Yakar, Levy-Shiff, Fridman-Balaban, Gur, & Stein, 2010; Rothschild-Yakar & Stein, 2013). Preliminary research on the use of MBT for treating eating disorders, with nonsuicidal self-injury co-morbidity, suggests some promise for this model (Robinson et al., 2015). The theoretical rationale and key interventions of the MBT eating disorder model (MBT-ED) used in a multicenter research and treatment project are discussed (Skarderud & Fonagy, 2012; Robinson et al., 2015). Modifications of MBT-ED’s structure and techniques are proposed for family treatment of adolescent and child patients with eating disorders. Case example illustrates the impact of problems in the family system with mentalizing capacities on family cohesion, the therapeutic process, and the family’s ability to help the child recover.     

Applications of Carl Rogers' theory and practice to couple and family therapy: a response to Harlene Anderson and David Bott

Recent articles by Harlene Anderson and David Bott in the Journal of Family Therapy (Volume 23) are a gratifying examination of the contribution of Carl Rogers' philosophy and practice to family therapy. However, in my view, an already existing highly effective application of Rogers' approach to couple and family therapy was omitted from Bott's review of the literature. My reading of the two articles has inspired the following response given in the spirit of dialogue with the hope of furthering a conversation on this subject.     

The paternal function in Winnicott: The psychoanalytical frame

My first aim has been to identify the implicit assumptions underlying Winnicott's detailed notes on a fragment of an analysis dating from 1955 and published after his death. The importance given by Winnicott to the father figure as early as 1955 is one of my discoveries; another is the deep Freudian roots of his thinking. In this essay I propose a new way of linking together the concepts of ‘paternal function’ and the ‘psychoanalytical frame’. Developing my hypothesis, I compare my reading of Winnicott and my way of reading José Bleger's study on the frame. Like Winnicott, I explore in detail a process of discovery, focusing on what the analyst and the patient are nor fully aware of …'as yet'. I am not proposing to unify Winnicott's and Bleger's thinking. My aim is to avoid the pitfall of eclecticism and, in so doing, to recognize both the related depths they sound in their thinking and their otherness. I want to share with the readers their ‘meeting’ in my mind.     

Emotions–Adaptive Standards And/Or Primitive Constructs: A Reply to Mascolo and Mancuso

Abstract

In replying to Mascolo & Mancuso's paper, I have contrasted their functionalist approach to emotional states and experience with my position on emotions as epigenetically-available primitive constructs. Biologically, Mascolo & Mancuso treat emotions as mobilizaiton in the face of discrepancies. My proposal of a four-dimensional model provides a biological grounding for the marvellous diverisyt of human emotional experience. Where Mascolo & Mancuso treat emotions as discrete entities and highlight emotion knowledge, J have suggested emotions operate as bipolar constructs, and I have highlighted experience. We should attend to emotions in terms of both knowledge and experience, but it is important to maintain the distinction     

Art therapy in transcultural family therapy

The increased existence of foreign culture patterns in the child population calls for transcultural comprehension in child psychiatry. This case report describes transcultural aspects in the therapy of an 11 year-old Moslem girl admitted to a child psychiatric department. Her symptoms were abdominal pain, headache, anxiety, and pretended fever. A family therapeutic approach was used together with elements of art therapy and individual therapy in a successful treatment. The family therapeutic approach was based on art therapy as a part of the communication where cultural symbols were an important part. An interpreter was not used. The cultural context where it is acceptable to overstep the borderline between reality and fantasy is seen as an important healing capacity.I would like to acknowledge my debt and my appreciation to Ebba Ernst, psychologist of the department and supervisor in the therapy of the S. family. I would also like to thank professor Kai Tolstrup and child psychiatrist Torben Marner for stimulating support in the process of writing the article. A grant from Enkefrue Hermansens Mindelegat made the participation in the Krakow Congress possible.     

Singapore's Cultural Experimentation: Gay Rights,Stem Cells,Casinos and the Evangelical Response

Abstract

Since the early 1990s the Singapore government has been taking a more liberal stance on controversial issues such as gay rights, embryonic stem cell research and the gaming industry. My paper analyses the Singapore state's utilitarian justification and its authoritarian enactment of these liberal policies. The first part looks at the underlying motivation for the cultural makeover. I frame my analysis around the reaction of the Singapore Christian community to these developments. I focus on the criticisms of the state's ‘liberal’ agenda made by Evangelicals, and describe how the People's Action Party (PAP) regime has defended these policies on utilitarian grounds. The first part ends with a comparative analysis of how the ‘cultural war’ debate was played out in Singapore and the USA. In the second part I examine the procedural aspects of this cultural experimentation. I start with a review of Singapore's political reform. I show that civil society in Singapore has attained a new openness. Yet there remain constraints, leading critics to label the PAP-led government as a ‘soft-authoritarian’ democracy. Singapore's cultural policies, I explain, are essentially an ‘elitist’ state-engineered top-down development. This is in contrast to the experience in the USA, where grassroots activists exercise tangible bottom-up influence on how cultural contests are resolved. My main thesis is to argue that Singapore's recent cultural liberalisation is guided by social–economic expediency notwithstanding the alleged moral risks, and that these are state-commanded liberal experimentations, imposed by the ruling elite upon a constituency that is still largely conservative in moral outlook.     

Languages of trauma; towards a phenomenological response

In this article, I explore the possibilities of a phenomenological perspective on trauma in psychoanalytic practice. I highlight the problem of interpretations that universalise experiences of trauma, provide explanations in terms of ‘causes’ and assume particular processes/stages of ‘recovery’ from it. The notion of trauma challenges dichotomies of ‘internal’ and ‘external’ worlds. Traumatic experiences always have a context – that of the immediate relational circumstances of the individual suffering from the trauma, including the wider social/relational context, and the person’s history. I argue for an attunement to the language and specificity of the meanings, verbal and non-verbal, conscious and unconscious, of the client’s suffering within the analytical relationship. This requires the therapist to avoid ‘ready-made’ interpretations from psychoanalytic theory and to be open to the poiesis of the speech, which emerges between therapist and client. My discussion of my reading of the Chilean documentary film, Nostalgia for the Light, which focuses on the traumatic experiences of those who survived Pinochet’s military regime (1973–1989), highlights how diverse responses to trauma are. The originality of the language of the film calls on us as therapists to discover new ways of listening and speaking to our clients’ suffering.     

Comparative Evaluations

My response to Engelmann (2008) will be based on several questions that will allow both its author and the general reader to determine whether the assumptions I make as an interpreter of this complex paper are congruent or incongruent with their own interpretations of the text. The interpretations by the writer, by any commentator, and the diverse interpretations of a general audience together with my own interpretations will, I hope, facilitate some fruitful ‘comparative evaluations.’ I articulate my inferences of the most dense part of the paper, namely the ‘concrete immediate Consciousness and the developing absent outside.’ My hope is to address Engelmann’s question: “Am I in a better disposition to judge modern theories of consciousness?” The last section of my response spells out more personal comments to my all too brief and single encounter with Arno Engelmann. It is there that Arno Engelmann’s fascinating statement “I am a citizen of the world” is addressed through its counterparts in my life.     

Twenty years of family therapy in Israel: a personal journey

This article is a personal statement of my beliefs and practice of family therapy, from the time I first introduced the concept to Israel over twenty years ago to the present day. It reflects the evolution and changes in my clinical work against the background of major developments in the field of family therapy.