Family Therapy in Trouble: Psychoeducation as Solution and as Problem

The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a “medical model” or “biogenic” view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psycho-therapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.     

The capacity to forgive: An object relations perspective

Forgiveness is commended by Christianity, as well as other religious traditions, as one of the most central of virtues, so central that the New Testament links man's very salvation to his ability to forgive. However, mental health professionals have correctly pointed out that the mandate to forgive is often used by religious patients in the service of defenses such as reaction formation, undoing, and denial. The forgiveness ideal is often misunderstood as a command not to experience aggressive feelings.It is the thesis of this paper that the capacity for genuine forgiveness is central not only to spiritual development but to psychological development as well. It is suggested that Kernberg's object relations theory provides the best model for understanding the nature and importance of forgiveness. Mature forgiveness does not involve the elimination of negative feelings toward others (or oneself) but the integration of negative and positive self-object representations and their connected affect. Anger at the offending persons must then be tempered by appreciation for their concomitant good qualities and motivations or, at the very least, empathy for the flaws which prompted them to behave destructively. The result is a more realistic and balanced view of others (and oneself), a more genuine relationship to the full range of one's own inner experience, and a greater ability to respond constructively to frustrating persons and situations.This paper was presented at the Annual Meeting of the American Psychological Association in New York in August 1987. The author wishes to thank Mark Finn, Ph.D., and David Hamblin, Ph.D., for their valuable discussions in the development of the ideas in the paper. Address requests for reprints to Dr. Gartner, Dept. of Pastoral Counseling, Loyola College, 7135 Mistrel Way, Columbia, MD 21045.