9 trrr.

nsity

A farmer had a donkey that would do anything he was asked.When told to

stop, the donkey stopped"When told to eat, he ate. One day, the farmer sold
the donkey.That sameday, the new owner complainedto the farrner. "That
donkey won't obey me. When you ask, he will sit, stop, eat-anything. For me,
he doesnothing." The farmer picked up a two by four, and wallopedthe don-
key. "He obeys,"the farmer explained."But first you have to get his atten-
tion."

Families are not donkeys.any more than therapists are farmers. But
the old joke has a familiar ring to therapists. In enacting the family sce-
nario and in intervening to produce change,t
em of across.
The therapist'sinterventioncan comparedto an aria. Hitting notes
is not enough.The aria must also be heard beyond the first four rows. In
, "volume" is found not in decibelsbut in the

Family membershave senseof hearin areas of

ve deafness that are lated their co histo Further-
more. all families, even those consi
's message
erate within a certain range. As a result, the

Family membersmay listen to the therapist's message,but

of d.eafness.
116

L+{
 IL7 Intensity

they may not assimilateit into their cognitive schemaas new inforrna-
tion. If new information requires the acknowledgmentof "difference,"
famiiy membersmay hear what the therapist saysas if it were identical
or similar to what they have alwaysheard in the family. Thus the thera-
pistmayhavegainedtheirattention,andtheymayeve@
-not
hear
Families differ in the degreeto which they demandloyalty to the farn-
ily reality, and a therapist's intensity of messagewill need to vary ac-
il cordingto what is beingchallenged.Sometimessimplecommunications
E
afe intense enough,Wtiereasoiher situaiions require high-intensity cri-
1
I

t sis.
characteristicsof the th-erap a significant variable in the de-
ty. ertain ts can develop great drama with
very soft interventions, ers require a high level of involve-
ment to achieveintensi have different ways of respond-
ing to the therapist's message. ho for transforrna-
tion may accept the therapist's alternative as a supportive push in the
direction that they are willing to go malseern to
"r,y*"y.@14@es
accept the therapist's messaggbut in fact absorb it into their pTffius
t lu rtr{@Qpenly resist Lhechans.e.A
therapist who has been schooledto pay attention only to the content of
messagesmay be so impressedby the "truth" of his interpretation that
he fails to recognizethat the family membershave simply deflectedor
assimilatedhis messagewithout gaining new information.
Cognitive constructions per se are rarely powerful enough to spark
family change.Nonetheless,therapists are frequently satisfied that a
messagehas been received just because it has been sent. But a thera=
peutic messagemust be "recognized"by family members,meaning that
i em to experi-
encethings in new ways.Therapistsmust learn to go beyondthe truth of
an interpretation to its effectiveness.
The
tion of the feedba.k fto
[.
Tven when therapists recognize the ineffectiveness of their interven-
tionsandwanttochangetl'@g*gtheirintensity,theymayat
times be handicappedb@les oJ:@)Therapists, like their clients,
have beentrained sincechililh6-odin the appropriateresponseto people:
respectand acceptanceof their idiosyncrasies. Besides,therapists and
family members belong to the same culture. They respond to the im-
plicit rules of how to behavein situations in which peopletransact with
 118 Family Therapy Techniques

other people. Therefcrre,when family members show in a sessionthat

they have reachedthe limit of what is emotionally acceptableand signal
that it would be appropriate to lower the level of affective intensity, the
therapist must learn to be able not to respondto that request,despite a
lifetime of training in the opposite direction.
o Once the therapist has observeda family's transactions and learned
their accustomedpatterns, the goal is to make the family experiencethe
how of their interaction as the beginningof a processleading to change.
The question is how to make the family "hear" the message.There are
for making oneself heard.
nterventtons r intensifying mess vary according to the thera-
pis t. At the evel of involvement are the
erapy of cognitive constructions.At
he interventions in thera-
rily. In training, th vels of
involvement are emprhasized: the techniques of creating t
increase the
may include
ti-mein which e are involv
in a transactio
fl
EPETITION OF MESSAGE
The therapist repeatshis messagemany times in the courseof ther-
ap is is an iilporta4{qgEnique for increasing intensity.
ian involve content and structure. For 6 therapist in-
sists that parents agreeon a set bedtime for their child and the parents
have trouble arriving at a decision,then the therapist can repeat that it
is essentialfor the parents to aglee (structure) on a bedtime (content).
The Malcolms are the family who were referred for family therapy
becauseMichael, 23, had been hospitalizedfor two months following a
psychotic break during his senior year at professionalschool. During
that period his wife, Cathi, Iived with his parents.
At the initiation of family therapy, the young couple set a date to
move out of Michael's parents' home into their own apartment. On the
day of the move, with their new apartment entirely furnished, Michael
I{ slept until two in the afternoon. Cathi, testing her husband's commit-
:i ment to her as comparedwith his loyalty to his parents, let him sleep'
I
I
The sessionwith the coupletakesplacet
I

ri

2+v
 119 Intensitv

(,--t=---,
Hshmantbeginsthe sessionby asking dirt ,rnt *,.,"o
ytry the enr.,pl,e
The man lightly passesoff his oversleepfrg' "w.
didn't move out be-
causeI oversiept.I forgot we were goingtoLove.,,
@@ ald--hisnonchalantat-
titude as a repetition of a life patternJhu
trolled b
w+ v.
The move was somethingthat had been ptun".J
for months. Further-
rnore' the couple and his parents had been busy readying the place for

sibilitv fbr his acti

bers.This is directry contrary io thffi-Df therapy, which is
' l f l Michael's autonomy and responsib@, so that he
+'1 \ re madnessas a way of achieving desiredchange
is not
^ [ in his en-
;)l 1 rut instead cu!-acl_diteclly, to plqduce
f . @n,
'AsU ":-,*--'-- *^^anFe
r r r d a he
h - , rdesite,s,
^^?Il^ ---irr^---.. ;
@ltrqr & is to li"reasuffilosun"s, to his
would be for him to take sibilitv for the
atic so that
relatio
rauluruuru resuru qryy_A$..a_Dylgfo_drlc-t
of his madness.
t The therapist,supervisedhere by Jay Hul"yffi*enes by asking
Michael,inhiswife'spreSence,@AtfustMichael
respondswith vagueanswersit *fti.tt t uU5rlt*tur,y responsibitity.
The
"
therapist then decidesthat increasedintensity is necessaryin order to
get Michael to "own" rrrisaction.' so he seis
about asking Michael,
repeatedly, "f wonder wlurJou didn't rn-oveout." In the
course of the
sillion, yhich lastsaboutthreehours,the therapistasksMichael
-,,
t(j."u@u]iml about
"why didn't you move out?,,Michael continuesto
@any responsibilitl--
The sessionlasts so l'ng becausethe therapist needs to generate
/ enough intensity to force the issue of why Michael has not
committed
I himself either to living closelywiirr his wife in their own apartment
or to
I
) sayingthat he doesnot want to Iive with her becausehe is unsure
about
the relationship or unhappy with her. It takes three hours for both
Mi-
) chael and his wife to seethe matter, not just as someanomarythat
Mi-
3 chael did not get up in tirne to move out, but as a graveissuethat is
cen-
I tral to them both and which requires an answer.
As the sessiongoeson, cathi comesto regard her husband'sfailure to
move out of his parents'houseas more and more significant.EheU.sins
. Finally, she saysthat she

pv<
 I Family Therapy Techniques

wantsto move out alone.Michael starts to cry: "No, I won't let you
I

moveout alone.I want to go with you." Cathi replies,"No, you didn't

I

I movewhenyou had a chance,so now I'll go alone."

I
I
I
Michaelis in a dilemma.To let Cathi moveout alonewouldleavehim
;
I ho thout Cathi to act as a buffer betweenhirn and
his mother. Yet he cannot forbid Cathi to move. It is her aparbment,too,
and.as she has the only job betweenthem, she can afford to maintain the
place.For the purposeof this particular therapeutic strategy,Michael is
treated temporarily as if he were the beginningof the circle, or in control
you
of the situation which clearly he is not. Finally Michael says,"Okay,
can move out." Now Cathi begins to indicate that she realtrydoes not
I want to move alone.Two days later, the couple move together to their
' new aPartment'

ll's decisionnot to move is tied to his rela-

message
tionship with his wife and parents.Evidencethat the therapist's
a decision.
has been effective comesfrom the fact that Michael rnakes
HemovesoutwithCathitotheirnewapartment.
sug-
Fof the therapist to talk about nothing else for an entire session
geststhat the topic must be very important. Furthermore, the therapist
producesintensity in terms of process
e; that is, th
hat in the past have been inflexible must now
Had
be modified in order to accommodateto the immovable therapist.
like the
the therapist allowed himself to be moved, he would have acted
have
other membersof 1;heMalcolm family. In this family, all members
does.This
a lower threshold f'or modifying their behavior than Michael
change.By being
allows Michael to remain static, while all around him
Michael to move'
unmoved, the therapist changesthis pattern, forcing
issueby de-
The therapist can seculeunwaveringattention to a single
scribingitagainandagainintheSamephrase,likealitany.orhecanuse
his capacityfor meta-
a variety of ways tg describethe sameissue,using
phorsandimagerylikeapoetorpainter,focusingonavarietyoftrans-
actionsinsuchawaythateverynewdescriptionhighlightstheSameness
ofthetransactions.Usingrepeatedconcreteimagestogiveclarityand
with families with young
intensity is frequently necessaryin working
childrenandwithretardedchildrenoradults.
clinic becausetheir 20-
e Lippert family have been referred to the
has anorexia nervosa'
old moderately retarded daughter, Miriam,

2+!
?_? IzL Intensitv
d,
During the six months of treatment, the family have donewell. The par-
ents have pulled together, and Miriam has gained weight as well as
making progresstoward becomingmore autonomous.But in spite of
Miriam's improvement, t;hefamily's attention has continued.to be riv-
eted on her eating.Their failure to leave this issuehas made mealtimes
the continuedsceneof a power strugglebetweenparentsand daughter.
This past week Miriam lost four pounds.The family is very worrieJ, and
sam scott, the therapist,has requesteda consultation.
The consultant decides to remove eating as a bone of contention so
that the power struggleover it can stop.
o.I,Moiu tvtiti *iU
er ever k b the ts her weieht *
causefor concerq.Othelwise her w t griU b" her business,and the
therapist will be the only other know what it is. Althoueh the
fvith the consultant. he knows from ex he
also needs(tttiriam\tretn to
This requiresa s m terms
behav-

Minuchiu Let's jrrmp out of the groove. (Touches Miriam,s hand,s.l

Miriam, are theseyour hands?
Miriarn: Um-hum.
Minuchin; They are not your father,s hands?
Miriam: They are not.
Minuchin (touching her biceps);Is this your muscle?
Miriam: Yeah.
Minuchin; Are you certain?
Miriam: Yes.
Minuchin (touching her nose);Is this your nose?
Miriam: Um-hum.
Minuchin: Not your father's nose?
Miriam: Yeah.
Minuchin: Are you certain?Absolutelv certain?
Miriam: Yes.
Minuchin: Is that your mouth?
Miriam: Um-hum.
Minuchiu Who eats when you eat ?
Miriam: Me.
Minuchin: Where doesthe food go?

R{o
 t i
II
I
1
t :
I
!
l
122 Family Therapy Techniques
I
L
I
l,
{
Miriam: In me.
I
t
i Minuchin (gentlypinching someshin on Miriam's arm\: Is this fat vour
lt lt
il
fat?
l,
I Miriam: Yeah.
Minuchiu Yeah. so why do they tell you what to eat? Is it right that
your father tells you what to put in your mouth?
Miriam: I guessit is right.
Minuchin; No. ft's wrong. It's wrong. It's your mouth.
Miriam: Yeah.
Minuchin' can you open your mouth? open it. (Miriam slowly opens,
closes,then opens her m.outh.)close it. open it. can you bite your
lips? (Miriam does this.l It's your mouth. when you eat, will you eat
by yourself the food that you want? And then when you come here,
you will go with the therapist to weigh yourself. (picks up father's
hand.) Who's hand is this one?
Miriam: My dad's.
Minuchin; You are certain it's your dad's? (Lifts Miriam's hand.) And,
whosehand is thisi'
Miriam: Mine.
Minuchin: You are certain? okay, so it's your body, you will feed it.
How old are you?
Miriam: Twenty.
Minuchin' Does your father need to tell you what to eat?
Miriam: No.
Minuchin: Does your mom?
Miriam: No.

This is an exampleof in n of theGontentl

The therapist, at the sametime, assertsand reassertsthe
tween Miriam and her c .The

I
. a rigid family system" The humor adds intensity to the message.
I

, ol\.r.\ n \t( A similar technique is used in the Hanson family when the therapist
k'11\ tr v I
,t asksAlan if he has two hands.However, in that case,instead of accom-
;lI
panying the repetition with gentle humor, the therapist stands up, de-
creasesthe distance between hirnself and the father-son dyad, and
adopts a serioustone of voice to convey that the situation is one of the
utmost gravity. te
for the particular situation.

&<l
 123 Intensity

REPETITION OF ISOMORPHICTRANSACTIONS

w
,n
U
n

ffi1 llllu. ln":ii*J", "wlraia,''

leyel. Although their content is
addressedto isomorphic transactionsin the family
different, th-y *"
structure.
Family structure is manifestedin a variety
of transactionsthat obey
vvvJ
the samesystemrules a'd which are therefore
dynamically equivalent.
-lsol
strucr"r"*
i-rroililt.'il"i,,j
tensity by the repeiition of messagein pr=ocess.
Z:r-,!L-- +. r.t

This ir-rierv-ention can

focus on the
nnectedeventsinto
lqg4qbers'experience
In the curran family, consisting of an enmeJed
dyad-a widowed
mother and her only son-the therapist makes various
interventions.
Fishman insiststhat Jimrny look at him and not
his mother when they
are talking. He encouragesJimmy to learn to drive
and to start dating.
He praisesthe mother when she mentionsjoining
a Great Books group,
and he convincesthe two that Jim*y, ug. 1g, siould
be able to sleep
with his door closedand be responsiblefor waking
himself in time for
school. The content of these interventions is different,
but they are
structurally equivalent,and hence identical in process.
single interventions, no matter how inspirei, are
rarely effective in
changing patterns of interaction that have usually gone
tn fo, years.
systems have an inertia that resists change,and repetition
is required
for repatterningto occur.Therapy is a matter of repetition,
in which de-
sired structural changesare pursued in many different
ways. The thera-
pist's goal,new and more functional transactionalpatterns
for the fam-
ily, is kept in the therapist's mind throughout the
session.It guideshis
\\-# repetition of therapeutica.[yrelevant interventions.
The Thomas family has been in family therapy for over
-I,\^onp becausePauline, 11, is asthmatic. Her asthma started.
six months
when she was
three years old, and during the last few years she has been
hospitalized
in intensivecare as frequentryas four or five times a month.
The partici-
pants in the sessionare the mother, in her late pauline;
thirties; her
brother,@-lgih".: rrgl@, in her u*ty nrti*'ffiher,s
older brother Jim, *h.driie. *ith his
sfurfriend in the samehouse;and
Tgr!, ^ yormfrftncle in his twenties.
The therapist, Kenneth coverman,introducesMinuchin to the
familv
as a consultant. Minuchin shakes hands with every member
of the fam-

,-\o s"r

Q<z
 124 Family Therapy Techniques

ily. Pauline says that she does not shake hands. The consultant intro-
duceshimself to the mother, who shakeshands.Then Pauline saysthar
she can shake hands with him also,which they do.

Mother: I don't usueillyshake hands, and I think she took after me.
Minuchin (to Pautine): How old are vou?
Pauline: Eleven.
Minuchin: And you talk?
Pauline: Yes.
Minuchin: But your mommy talks for you sometimes?
Pauline: Sometimes.
Minuchin: Like just now?
Pauline: Yes.
Minuchin: Now, I will ask again the samequestion.why did you shake
hands with me now?
Pq,uline:Well-
Minuchin; Why?
Pauline: Becausemy mother did.
i
:l
ll The therapist he sessionand
rl
il framesit in such The closeness
.tl li betweenthe mot -'dpatient is highlighted; the bound_
il aries between the familial and the outside world are underlined; and at
ji
the sametime, the therapist beginsto focus on the identified patient, ac-
,I
tivating her. This small d
I t 1 l , l '.
,l iving it
I
'lI the real problem in the famil,y . The thera-
il
pist ns to track this issue.
:I
i
I
Minuchin (to Tom): I noticed how closepauline is to Mother and how
I
i
closeMother is to Pauline.Is ihat true in other situations?
Tom: Yeah. Even at home, they're very close.
Minuchin: To the point at which Paulinebehaveslike Mother behaves?
Tom: Somewhat,yeahr.Becauseif, say,her mother'supstairsasleepand
i
I Paulinehasn't beendownstairsfor a long time and she hasn't seenher
I
I I
I mother, or what not, she'll want to know if the mother's upstairsor did
I
, she go to the store,or vice versa.
i
I

I
Minuchin (to Dauiil; How old are vou?
i Dauid: Thirteen and a half.
:l
rl

"9sb
 125 Intensity

Minuchiu Is the situation betweenDavid

and Mother d.ifferent,or is it
also close?
Tom: It's close.Not as close,but it,s close.
Minuchin: Do you think that David is too
croseto Mother? As a boy of
thirteen, do you think that he shourdbe
more independent?
Tom: Well, you know, he,s basicallv
closeto his mother now, basicall5
then, on the other hand with pa
sister.
IEinueitin: His mother watchespaurine,aner
he aiso waiches her?
Tom: David watches both of them. He tends
to watch his sister a littre
closerbecausehe, in a sense,can tell when
'Cause she,shaving theseattacks.
she won,t say anything to anybody else.
Therapist (to Pauline): And you will tell yo.r,
brother about your at_
tacks?
Pauline: Sometimes.
Minuchin: Jim, what's our feeling about the question
of closenessbe-
tween Pauline and her mother?
Jim: They're very close. sometimes their
affection is a iittle bit too
much affection.

The theme of the c

anded to a closenessbetweenthe mother and
giqlS{tsV tracking and questioning in a
singlearea'family croseness,
the the]apist'*, -Juu;
observationof one family member,the identified ";;-f*;;t;;
patient, to an elabora-
tion of a problem that the whole family has.
The mother then takes ouc
somethingfrom her coat and givesit to pauline.

Minuchin (standing up and warking ouer to paurinel:

just do, Mother? what did you
Mother: oh, I just gave her her barrettesto hord
so I won,t forget thern
becausethey were in my coat pocket.
Minuchiu What are those?
Pauline: Barrettes.
Therapisf; I am looking at what is making pauline
have these attacks. I
am watchinghow close,Mom, you are with paurine.
It seems,Mom,
that you don't finish and pauline begins,that you
and she are like one
DOOV.

l"( h
 726 Family Therapy Techniques

The therapist again tal<esan apparently meaninglessincident that

occursin the transaction betweenmother and daughter and reinterprets
that incidentin terms of the closeness
betweenmother and daughter.
is reinforcing a theme that he has constructedby utilizing observations
of concreteevents in which he and the ily members have

theobservation
of ctoseness
to ;# llr"#TlJ#u, of theidentified
pa-
tient. Ten minutes later, while Jim is telling about an incident in which
he took Pauline to the intensive care unit, the mother begins to talk
about Pauline'shairdo, and the therapist againfocuseson this particular
transaction as another instance of the mother's encroachmentinto the
patient's self-definition.

Minuchin; What happenedjust now?

Mother: I asked her why she didn't have those rollers out before she
came down.
Minuchin; And what did you say, Pauline?
Pauline: She said she was going to do it.
Minuchin: Did you roll up your hair?
Pauline: No, my mother did it.
Minuchin: Your mother. And you like her doing that?
Pauline: It's all right.
Mother: You don't like the way I roll your hair up?
Pauline: It's all right.
Mother: "AII right" meansyou don't like it.
Minuchin: Ask again. Go ahead,Mom.
Mother: All right! Maybe it'll do, but it wasn't exactly put the way you
want it, huh?
Pauline: It was put the way you wanted it.
Mother: well, you didn't say anything was wrong when your hair was
rolled up.
Pauline: Becauseyou wererolling it up.
Mother (laughing); I'm going to punch you in the nose.
Pauline: No, you're not. (Laughs.l
Minuchin: No, no, no, no. This is not a laughing matter. This is irnpor-
tant. It's important that you did let your mom roll up your hair the
way she likes it and you didn't tell her that you didn't like it like that.
Why didn't you tell her?
Pauline: Becauseshe wanted to roll my hair up.
Minuchin: Yeah, but you dlon'tlike it. Okay, I am talking about Pauline

l{.(
 t27 Intensity

having a voice and a mind and then

having a body. If paurine has a
voice and a mind, then she will control
heriody.
while the theme in the sessionremains
pretty much restricted to the
r, the therapist centralizesthe identi_
'. His interventions
are slow, accom-
nrtrative of the identified patient, but insisting
on a dialogwith her that at times seems
almost like an echo.The results
of this type of support for the grrl's initiative
and of challengeto the fam-
iiy's enmeshed style of transaction
*" urriJurt when the identified
rer. This changein the identified pa_
nother is feasibleonly becauseof the
lme theme for the Iast twenty min-
utes.

Minuchin'Now, be straight with me, paurine.

Do you like your hair like
that?
Pauline: Yeah.
Minuchiu Are you certain?Are you certain
that,s what you want? Look
straight in this mirror. It's not that Mom likes
it Iike that?
Mother: Do you know what he means?
Pauline: No.
Mother: He means-
Minuchin (to mother); Hold it. Hold It. (To
Paulzze.) You don't know
what I mean?I will tell you that. Ask me.
Pauline: I don't know what that means.
Minuchiu You still don't understand?very good.
Now, Mommy didn,t
talk for you, you talkeclfor yourself. That;s good. (shakes pauline,s
hand.\
Pauline: What did you shake mv hand for?
Minuchin; BecauseI shakeharrdswhen I like something.
That,s my way
of sayingI like that. It's goodthat you're beginning
to think separately
from your mommy. your mom is learning ,r"ot
to tark for you. And one
of thesedaysyou will tankfor yourself.(To mother.l
Doyou think she
will be able to talk for herselfl
Mother: I hope so.
Therapis* But, for Paurineto change,you
wil need to change.

The therapist is continuing the sametheme in

the same slow move_
ment' The therapist is concrete and repetitive;
he establishescontact

4.6
 I28 Family Therapy Techniques

with the ghl at a very concrete level,

which is necessaryto activate
someonewho has been made the recipient
of the family,s support, pro_
tection, and control. When the girl fails to
understandhis statement, the
therapist does not respond to her lack of
understandingbut instead in-
terprets her request for information as an
act of autonomy, confirming
the patient instead of stressing her difficulties.
In this episode, the
therapist's use of isomorphic transactionsgives
intensity to his message
that the pattern of overprotection of the iJenfified
patient is contribut-
*
I,qvrvrrv rD uLrllt,

d,
e child,s abili est infor
differentiate herself from her mother.

Grandmother: I've had pauline on the

weekendswith me, and she,dget
attacks' WeIl, my nervesare bad anyhow,and
this would scareme half
to death, and I'd have to rush her to the hospital
or call the police. But
that's another reason why we've been so crose
to her. Now, what
would be the causeof pauline not to tell when
she,scoming with one
of these attacks?
Minuchin: Pauline is here. Ask her.
Grandmother: Pauline, what is your reasonfor
not telling us when you
knew these attacks were coming on? was it that you
didn,t want to go
to a hospital and be stuck so much rike they
usedto stick you?
Pauline: Yeah.
Grandmother: These needleswould frighten you?
Minuchin: The
lhing tkrat I'm trying to do here is for pauline to rearn to
talk for herself, to think for herself, to feel what
she feels in her own
body' I think that becausethe farnily is so loving, pauline
is not caring
for her own body. First you askedher, "why do you
get upset?,,And
rl
il
then what did you say?
Grandmother: And then I asked her why she wourd
tell us because_I
said, "why do you think, becausethe doctors are
sticking you with
theseneedles?"But she had tord me that before.
Minuchin'You askedh.era questionand you gave
her arsoan answer.so
this young gfuldid not think. she did not think of
I it, becauseshe could
II say yes, and that's it. And what I want to help you with, pauline,
is to
I
think on your own, becausein my experience-and
I il I have seenmany
children with asthma-when children with asthma
learn to have their
own minds, a mind of their own, they also learn to control
the asthma.

z(Y-
 L29 Intensity

The mother's overprotectiveness

of her daughteris presentedas being
repeated by different participants.
The gxaidmother dears with the
granddaughterby supporting
her passivity and not requiring
the kind of responsethat *outa from her
be expect; f.;* an rl-year-ord
mal intelligence.. of nor_
bherapisi chariengesthe grandmother,
.The
spondsto the criticism who re_
with anger.Her mood then ericits
nals on the part of other familylembers nonverbalsig_
which are supposedto instruct
the therapist not to crossthe grandrnother.yet
pist to challengethe grand-othu. the ability of the thera-
and rnaintain his position is an im_
portant exampleof ciiff'erentiation
for this fu*ilv.
CHANGINGTHE TIME
Family members have evolved
a systern of notation to regulate the
tempo and time of their dance.
so*! ;h;;^irot". are conveyedby
small, nonverbal signals that carry
the"fmessage,.,We have reached a
dangerousthreshold, or an unused
o. .rr,or,rJp"tt way. Beware, srow
up, or stop." This signalingis so autornatic
that family membersrespond
without being aware thai they
have reachedlorbidden territory and
have been brought up short uy tt
e reins of the family system. Like a
well-trainedhorse,they resporri bufore
the rein is shortenedand thus do
not feel the bit in their mouth.
f?, increasing
intensityis for the rherapisrto
:::"^"j^t1.^t"""*y:::
*fly me:mbersro
:ff::::::t}" continue
transa;il;#;;; ili", of
transaction is done hesitatingly by A;-i,*d#Ji
the family, their move
ld

" ity of their al-

1'P9"rtrlqr.t'"t
ducing the time re-
'
Kril€rl\l @heKuehnfr-ir,. r qfton +r"^ r^mily has
transacted the
rnn r,^^r *^,_,r
regulateth-eirusual patternsfor control,
i :':l::n"t rhe therapist creates
I
christmas
7;:,:i::: *:::jne:nother.
cookies. Td lu"ghter ptaywith puppetsmaking
Aftera while,
rh"?"rh"r';ilr';; illrl. fiil:I:
nario is kept going for around twenty
,ninuieu, long after the family
membersindicate that they want to stop
it. The long transactionaround
pleasureand nurturance involving
the father as wen as the mother car-
ries in itself, without any verbal cornmentary
by the therapist, the mes_
i,
-- but availabre possibilitiesin the family sysrern:the fa-
:ff:" has
:i:Ylnused
^;;:^
the capacity for softnessand nurturance.
| -fielther
ln the Jry" family, the
. rq.r..nJ, therapist has
Lne f,neraprcc
i-Ft'- has difliculty
difficulty iin helping the
5kF

)sr
\-(,t u- D 130 Family Therapy Techniques

mother and daughter to continue negotiating around issues

of mutual
respectas adults beyondtheir usual threshold of negotiation.The
family
comprisesa widowed mother and her lg-year-old daughter Julie,
who
has left school in the naiddleof her first year and returned home.
The
mother and daughter are tryrng to work out some kind of coexis6g11ss.

Mother: I am changing my mind. I was not going to ask Julie

for the
money that I am giving her, but I arn.
Fishmau I don't think you czrnchangeyour rnind every week.
Mother: If you want to kick us out, then kick us out. I am changing
my
mind as a result of her behavior.
Fishman; You let her down, too. you prornised to pay her at a given
time, and you promisedthat her money is to spendthe way she wants
to. I think the two of you have to work out a way. you are two adults.
She is not your little girl anymore.
Mother: Do you know what the money is being used for?
Fishman: That's her business.she is not your little girl anymore.she is
growing up.
Mother: She bleachedher hair. All she usesthe money for is for herself.
The least I can get is a little respect.
Fishman; I want you to look at Julie.
Mother: I don't want to nookat her. I'm tired of looking at her!
Fishmqu I want you to cloit anyway. Look at her. She is not a little girl
anymore. she's very pretty. she's a gro\Mnwoman. Now I want you to
talk to her, not like she'sa little girl, but like she'sanother adult living
in your home. Becausethat is really how it is.

The mother and daughter's pattern of mutual negotiation is very

short, interrupted wheneverone of thern stops it by introducing a com-
plaint about the unfairnessof the other. The therapist helps the mother
and daughter to begin to negotiate issueswithin the frame of .,mutual
respect,"and he framesthe mother'sbeginningcornplaintin terms of a
continuation of the same need for respect.He
over and over the theme, "your daughter is an adul
When the mother resistsgi grievance,the therapist doesnot
get involved with its content but simply repeatshis rnessage,,,Treat her
as an adult."

Mother: But she is not acting like an adult.

Fishman: I don't think this is Julie having a little grrl's tantrurn. This is
a grown woman who had a contract with you.

)e?
 131 Intensity

Mother: I just don't want you hangingaround

the houseand waiting for
your boy friend. I would rike you to get a job
in the interim until you
start schooi again-if you want to start school. (To
therapisr.) The
reasonI have beenso inflexibleis because
I have rnadeoo _, mind
about something before we camein_
Fishmau unless it is rerevantto this topic,
te[ rne rater.
fuIother:Okay, I wiII tell you later.
Fishman: Now, this is going to can for more
flexib'ity.
Mother: I am sick and tired of this flexibility. I
have had 1gyea-rsof this,
and that is about enough.I don't want ury*or*.
I want her out of the
house.I don't want her in the houseurry*or".
Therapisf Talk to Julie about that.

The therapist resiststhe induction by other .,juicy

themes,,that the
mother danglesin front of him-"unress it's rerevant,
teil ms l6fs1,,_
and then activates mother-daughter transactions.
His previous chal-
lenge to the mother gives the daughter spaceto respond
to her from a
position of being supported,which *uy ullo*
for beginningof changein
the transaction.

Julie: I want her to see my side. you said I courd say

my side-
Mother (intercupting): Julie, you_
Julie: I'm talking now. My boy friend and I were rnessing
around in my
room. I don't have to go into detailsto explain what
we were doing, or
how we kid around, or what kind of relationship we
have. My mother
knocked on the door harshly, and she embarrassed
me no end. she
said,"Bob, leaveJulie alone,or I am goingto beat you
up.,,It was ex_
tremely humiliating. I neededthe money that day, I
neededevery cent
of it. I was counting on the money and I neededit that
day. I wanted.to
borrow the car and I asked my mother for the car
and she said she
wouldn't give it to me, and I cursedat her. I had every
right to cursear
her. I was rip-roaring mad. I have every single right
to curse at her_
Mother (intercupting): Before she went_
Julie (shrieking); That is none of her business.she is
interrupting rne,
and it is none of her businesswhere I go or where I have
my hair done.
It is my hair.

when Julie respondsto her mother, the responseis the complemen_

tary side of the mother's coin: she is petulant, demanding,
and childish,
and pretty soon mother and daughter are back on square
one. The

&gD
 132 Family Therapy Techniques

therapist is now in a position to requestthat Julie respondto her mother

as an adult and negotiatefrom a position of mutual respect.This theme
is played for thirty minutes, and wheneverthe dyad tries to changethe
theme, the therapist reframes it in terms of mutual respect.In order to
resist the family pattern of cursorily dropping topics,he deliberately in-
creasestheir duration or treats them as isomorphic-"You need to re-
solve it within a frame of mutual respect."
In the Poletti family Gina, a l4-year-old anorectic girl, vomits and
takes laxatives to maintain herself at her pitiful weight. She was pre-
viously a "good daughter," and the parents feel helplessto deal with the
strangebehavior that the sicknessimposeson their daughter.The fam-
ily is composedof the father, 40; the mother, 30; Gina; John, her six-
year-old brother; and the maternal grandmother.
The therapist moves the family away from the symptom and
Iengthensthe transactionsin which they talk about what they do to each
other. His goal is to convey the messagethat the daughter'sposition is
systemic and that she is caught in a conflict of loyalties between the
mother, father, and grandmother. To transform the family diagnosis
from "we are a helpful family trying to help a sick daughter who is pos-
4 sessedby a mysterious illness" to "we are all involved in a dysfunctional
dancethat is manifestedmost visibly in the daughter'ssymptom" is not
a simple task. After thirty minutes into the first session,the tLrerapist
succeedsin eliciting from the mother a descriptionof a conflictual trans-
action betweenherself and her daughter.This conflict offersthe
ity of fre tion and thus be-
/ cirmds the frame for thre therapist's interventions over the next hour.
eth involved in the of their conflictual
transaction gives clarity and intens

Mother: When I dumped the garbage,there were two empty bottles of

Ipecacafter she had promisedthat she wouldn't take that for emetic
purposes.I had sorrreappetite depressantpills that had been pre-
scribed for me by nry doctor, and there were pills missing from the
bottle. The salt shaker periodically disappearsbecauseshe takes it in
the bathroom and usesit to vomit with. She went through my drawers
after I confiscatedan infant syringe that I had to use to give herself
enemas,and I found that hidden again in the bathroom.
Minuchin; What do you do when your lovely daughter doescrazy things
like that?
Mother: I-it makes me feel very angry, and then I try very hard to re-

&u
 133 Intensity

;her memberthat she'ssick and she'snot really doing it to me on purpose,

)me but then it makesme feel sad,so it's like goingfrom anger to sadness.
the Minuchin: You don't think she'sdoing that to you on purpose?
rto Mother: I think someof the things that she does,she doesto manipulate
in- me. I let her get away with a lot.
re- Minuchin (to Gina); Your rnother says-and you know, it's a very inter-
esting hypothesis-she says you do that on purpose to make her
and angry. Could that be true?
)re- Gina: I don't do it on purpose.
the Minuchin: w'hy doesshe think so? Taik with her-iaik w-ith her about
lm- her persistencethat you are willfully doing certain things to get her
six- mad. Talk with her about that.

and The therapist moves the farnily's frame from their concentration on
ach how to help a sick daughterto the questionof how the daughter behaves
nis and affects them. This issue has disappeared before the dramatie
the shadow cast by the serrioussymptom. For the next hour, the mainte-
rsis nance of this focus brings out hidden family dynamics.
)os-
'naI
Gina: Well, I didn't do it on purposejust to get you angry.
not
Minuchin (to mother); I want you to explorethe way in which she doesit
cist
againstyou, becausen think that a lot of the things that she doesare
,fls-
related to you.
bit-
be-
)ur. The therapist maintains the focus. The mother then accolnmodates
ual the therapist.

Mother: Ah-I'll tell you one thing that really bugsme is when I knock
;of on your door and you're on the other side of the door and you pur-
rtic poselydon't answer.I use the word "purposely" on purpose,because
rfe- that's the messagethat I get.
bhe Gina: BecauseI know that you are going to knock and open the door.
;in Mother: But I don't. I stand out there and I wait for you to answerthe
ers door.
;elf Gina: Yeah, but when I go "what," you open the door. what good is
that?
lgs Mother: we knock on the door, Gina, and we ask if you are there, and
when you don't answer,we knock a secondtime, and then we openthe
re- door. Do you know why?

292,
 134 Family TherarpyTechniques

Gina: Still, when I say "what," you open the door. I might
be dressingor
something.I like to have my privacy, you know.
Mother: The reasonwhy we cornein after we knock the
secondtime-
and I say "we" becauseDaddy does the same thing-is
becauseone
morning the window was open and you were gone.
Minuchin: Do not include your husbandbecausehe has
his own voice.
Mother: okay, that's the reason why I do it-and because
a couple of
weeks ago' you were talking about doing things to yourself-suicidal
tendencies.I never know what to expectbehind that closed
door be-
causeI feel that you trave manipulated me into a corner
of feal, and I
resenryou for doing that, and I-I get the feeling that I am
helpless,at
times, that I'm at your mercy, and.that's not right-not the
way par_
ents should be-mothers and daughtersshould be.
Minuchin (to mother): you are being very helpless,and you are grving
Gina a lot of power that she doesn't know what to do with. Continue
talking about the kind of things that she is doing to you that you
don,t
like, that you find disrespectful,and that disturb vou.

The therapist's intervention serves to ensure the continuity

of the
focus.He seesthe mother's atternpt to bring her husbandinto
the trans-
action as one of the signalsthat the family memberssend when
a trans-
action reachesa dangerousor stressfulthreshold,and thus he frames
the
father out, maintaining the mother and daughter in this transaction
longer than is their habit.

Mother: one of the things that bothers me very rnuch is the wav
in
which you curse.I don't like that at all.
Gina: I get mad. Kids do it in school,so r get it from them.
Mother: I don't care whether they do it in schoolor not. I d.on,twant you
to do it at home.
Gina: And you do it, too, so why-
Mother: So what! I'm not 14 yearsold.
Gina: Well, you still do it.
Mother: That has nothing to do with what we are talking about. I don,t
like it when you do it at home; I don't like when you answerme back.
Did you like it last night at the table when I hit you? was that nice?
Gina: I don't care!
Mother: well, I'm telling you that as long as you pursuea courseof being
disrespectful,that you're going to expect some kind of flack, because
I'm not going to do that. It's fine for you to have privacy and rights
of

21b
 135 Intensity

your own_I believe in that_b

The therapist chalengesthe daughter

to continue in the conflict.

ipect for me. you expect rne to have

.ve any for rne.
absoiute,outright iie.
all those obscenenames and everv_
1g?
rn your mother.
difference.
akesa difference?Then in other words,
the messageI'm getting from you
is that you could really operate in
this whole family structure without
u motir"*. Is that right?
Ginq: I didn't say that.
Mother: well, tr I-T just going to be
something that can be answered
back and somethingthratcan be cursed
ur,a so what, etc., etc., the
"t
could care less whether I'm here or
screamingabout the fact that I feel
e in this farnily.
The continuing conflict shows the
mother and daughter nroving
through a seriesof isomorphic themes
locked in the same symmetricar
transaction' The last statement,where
the mother definesthe daughter
as being the challengerand the winner,
shows the mother to be in a
strangeand powerressposition.There
has beena shift from the daughter
hter and mother as locked in a con_

ce.
;-like when f can't find anything
rgemy kitchen.
Gina: Well, you never clean it, so I'm
the o'ly oo" that cleansit--

24h
l r
136 Family Therapy Techniques

MTther: But that's not your business.The way

in which I run the
nouse_
I
Gina: well, me and Nanny do it, too, so you can,t
I
; arwaysblameit on me.
I
Mother: And Nanny has her own praceto take
care of,
Gina:'I know, but sometirnesyou put things away
and you blame me for
it.
Mother: I would prefer that both of you stay
out.
ppy.
affair, not yours. Just like it,s mv af_
.r brother.
ou, what do you do when two mem-
bers of your family are having an argurnent?
Father: I am not sure-I am not sure what to
do_
uiyulnln.'No, don't tell me. you intervene in that
situation. Go ahead.
Just do something.

The therapist rnaintains the same focus but expands

the number of
participants, askingthe father to enact his part
in the drama. The temp_
tation is great to exprore the depth of the mother-daughter
dysfunc-
tional relationship, but parad.oxic"Uy,u., exploration
of this issuewould
decreasethe affectiveintensity and bring the therapist
in as a member of
a triangle and a conflict diffuser. By rnaintaining
himself as a time
gatekeeperand introducing the father into the
conflict, which now also
includes Nanny, the therapist keepsthe conflict alive.

Father (to wife): All right, I'll tell you. I can see
Gina,spoint about call-
ing her namesand swearing.I can seethat, and I'mlust
as guilty as
you are, maybe more so.

The father takes Gina's position in the conflict.

Mother: Then how comeyou don't get the samekind

of flack I do?

The wife extendsthe conflict to the spousedyad.

Father: Ah-for somereason,and I don't_

Gina: Becauseyou don't ret me get your goat, that,s
whv.

The daughter affiliates with the father.

2td
 137 Intensity

Futher: well, I don't know. Maybe,

I don,t know, but that,s not the
point-
Mother: what about ail the times
before when your father was very
quick with his hand?who was the
personwho had the long fuse then?
*i.
Themotherrequesrs
rharGinashiftloyalties. t-
ffi07
tc'0
Gina: well, sometimesyou don't have
short fuses.
The daughteracceptsthe mother,s
message.
Father: Yeah, but this doesn't arter
the fact, you know, you,re saying
things about a sloppy house and everything"else
which are not true.
Okay?
Gina: But-
Father: Your mother works all day long,
and you can,t expect her to
come home and cook and clean and have
everything nice and neat.
There are many times when you have been
askedto do sornethingand
you give us a big hassleabout it. Yet
when you feel like cleaningsorne-
thing up that Mommy doesn'trecessarily
want you to clean, you go
ahead and do it anyway. I think this is the
kind of thing that annoys
her-and it annoysme.

The husband affiliates with the wife after

the daughter shifts loyalties.
Minuchin (to grandmother): Mrs. Sansone,you
have a certain wisdorn
becauseyou are older. what do you thinl
about the happeningsin
your family?
Grandmother: um-hum. we[, I would say to
Gina that she should try a
little harder to show respectto her parlnh,
becauseif I did whar you
are doing to your parents now, we would have
got tkre back of the
nand.
Gina: That was then. This is now.
Grandmother: No, honey, respect is respect,
and you don,t say it was
then, or now' or_tomorrow. If you want respect
from your parents,you
have to show them respect, too. (To moiher.l
Now that starts with
you, Mara. All right? (To therapist.)
Mara doesbother me when she
losesher temp_er,and a couple of times I said
to her when she caned
Gina names,"Don,t say that." Correct,Mara?
Mother: Um-hum.

2A6
 138 Family Therapy Techniques

Now all the participants have played their part in the farnily drama.
The father enters into the conflict by first disqualifying his wife and then
taking her side. The grandmother first challengesthe granddaughter,
but then sideswith her and criticizesher own daughter'sfunctioning as
a
mother. The therapist, by keepinghimself out of the transactions,main-
taining the focus, directing the entranceof the participants, and length-
ening the time of their involvement, has increasedthe intensity of con-
flict in a family of conflict diffirsers. Half an hour later, after several
repetitions, Gina's position as the family weathervanehas becomeclear.

Minuchin; So you are acting,really, in strangeways,Gina. you're acting

as if you are six, and you're acting as if you are over 60, like your
grandma. And both of your parents accept that, so it's not your fault.
It's absolutely not your fault if you are running this household.But,
Gina, you are caught becauseyo her the kinds
of things that you think your ther wants to tell your dad, so you
amplily Mother's voice.
things that you know your grandma and your father say to your
mother. So . You
don't have your own voice. You are the puppet of the .,r-rrttoq.ri"t.
Have you ever seen a ventriloquist? sit on your mother's o, yo,r,
grandma's lap. Just for a moment, sit on her lap. (Gina obeys.)Now
tell your mother the way in which she should change,thinking Iike
grandmother.
Gina (using the disembodied uoice of a uentriloquist's puppet): you
should be a lot lesssloppy.
Minuchin: Say to your rnother the kind of things that your father wants
to say.
Gina: Pick up your clothes off the floor.
Minuchin: okay. It's extraordinary, Gina. you have developedinto the
ventriloquist's puppet in this family.

After the family presentstheir way of transacting, the therapist cre-

ates a dramatic scenario.He givesthe family a powerful metaphor of the
way in which they are interlocked-a way that is manifestedopenly in
Gina's symptomatology.

CHANGING TTTEDISTANCE
Family members develop through life a sense of the .,appropriate',
distance to keep from each other. There is an apocryphal story about

L-_
)0+
-b
 139 Intensity

rapists, Braulio Montalvo and paul

ho feelsmore cornfortablewhen he is
oserto Watdawick who would with_
{ontalvo's three stepsforward, to be
reat. By the end of their .huj, they
ies.Reportedly,their chat was about
appropriatedistancesamongpeople.
The movementsback unJ rtrtr, that
the two therapists did to main_
tain themselves"correctny"spaced
were done automaticalryand out of
awarerress. The sameexperiencecan be undergone
by the reader at any
party where he gets closer to a person
than feels appropriate to him.
This is true not onry of measurablephysicar
distancebut also of less
visible psychologicaldistances.chansine
the automaticalry maintained
distancemay produce a changein the
degreeof attention to the thera_
peutic message.
The utilization of the officespaceis a significant
tool in the delivery of
the therapeutic message.If the therapisi
u,,ar,".1"
;#.'ii;:ilffi jl;
talks with a smail child, the
,xilHjl"il:i1x,
,preferably touching the child. If the therapist wants to
ious messagg, he mav get un- movc fnurqr.d o fo-ir.,
ln in fr..r^l nf L.l*
andtemp;;#:t*i:ff:*ffi;
aware of his movements,3"ustletting himself
be directeJt;il;
the need for intensity in the theraplutic
-"rrugu und his trust that the
family memberswilr direct his movement
b6their feedback.
The therapist can arsoincreaseintensitv{b}"rrungirrg
the position of
the family members vis-h-vis each other,"t#r"g
thern sit together to
llsrrlisht the significanceof their o, ,*puruti".,ga member to inten-
{vud
\sifvhisperipherality.Int@"mily,thetherapistasksthesonto
\ik+lf* siinuar tris ratrrer, recre6ting the situation
r"' of overprotective enmesh-
ment that characterizes their dyad,and then delivershis messageabout
autonomy while getting physically closer
to them.

RESISTINGTHE FAMILY PULL

sometimes"not doing" can createintensity in
therapy. This is espe_
cially true when the therapist does not
do what the family system
"wants him to do." Therapists are necessarily
and unwittingly inducted
into the family system as members of the
therapeutic system. sorne_
times this induction serves to maintain dysfun"tionul
family horneo_

Bq<
 .tki* = =tt +o-tf
r40 , i.
,:
I
stasis' By resisting the system's induction,
a therapist brings intensity
into therapy.
some of the techniquesused by carr
whitaker as an unmovabre
therapist are in this vein, as is his concern
at the beginning of therapy
about winning the battle for leadership.
This battle can start even before
he has seen the farnj.ry,in the discurrion
over the terephoneabout the
number of participants in the session.
Although instancesof not being
pulled by the family system are sometimes
heroic or dramatic, they are
also frequently of the most undramatic
nature, sinee the resistanceof
the therapist to this put is continuous
throughout therapy.
For instanee, the wilriams couple were
in- therapy for two months,
during which time they made .or,.id"rubre progress
in dearingwith their
difficulties. They were able, in fact, to get
beyond the point where in the
past they usually diffused their difficultie,
UV irrrrolving a third person,
and could now bring some of their disputes
to the point of resorution.
Then one week the wife calls the therapist
and saysshe would like to
speakto him aloneat the beginningof the
next session,and the therapist
agrees'The wife and therapist retire to his
office at the start of the ses-
sion while the husband waits in the lobby.

wife: Frank doesn't understandme. Every

time I rnention my concerns
about my mother, he gets mad.
Fishman; This is between you and Frank.
He needs to be here to re-
spond.

The goal is to strengthen the relationship

between the spouses.To
allow the wife to complain about her husbarra
to the therapist would not
only involve the therapist inappropriatery
in their murriagu but wourd
also lose an opportunity for the husbandand
wife to resolvetheir differ-
encesthemselves.By refusing to listen to
the wife about the husband,
the therapist givesintensity to the therapeutic
Gq*rf rnessagethat the coupre,s
transactionsare complementary.
.o"-ir-t'-lf rhe.mother,
Tl: j::1,?_T]tr rE,14,
an arrisrin hermid_rhirties, ! vtgD,

and12.rhe husband
tefttwoyearsago,
::i :if::..l1oi:l,,usu.:
life has beenexrremerv
e q6rv,

Tlrl::-" ln:i' chaoricfor rhe family.The chil-

vv^rvvi

lt l1 [4rp,
r o
with no fixed duties or rules for anyone.
The mother, a young-lookingwoman dressed jeans
in and a tee shirt
which says "Grateful Dead," sits slouchedin
her chair like the children.
In fact, one has to do a doubletake to ascertain
that sheis not just one of
 L41 Intensity

the kids. The therapist seesthat this is ,,reft-bank,,family

a in which the
mother, who has a Bohemian life styre
hersel{ is very uncomfortabre
setting ruresfor her kids. The therapzutic
g;"1 i. to herp to createa gen-
erational boundary in this family rt th^t "thuru
is an executivesubsys-
Throughout the course of therapy the
children and especiary the
mother invite the therapist to intervene
and set limits. The pressureis
tremendous for the therapist to activate
and ,,help this family into
shape."The-therapeuticgoalremains,however,
to get the mother to as-
sume the role of the leaderfor her familv
this job would only aUow the mo
The correctintervention for the tt
sisting the induction into the role of ,.herper,,
for the family. otherwise,
he will only contribute to the mother's displacement
from an executive
role.
Enactment is like a conversation,in which
therapist and family try to
make eachother seethe world as they see
it. Intensity can be likened to
i a shouting match between the therapist
and a hard-of-hearingfamily.
f Therapeutic efficiencycan be drastically undercut
by a therapeutic ori-
entation that.lets a therapist assumea correct
messagehas been heard
just becauseit has been sent, and
by the rules of etiquette that incline
peopleto fake understandingrathulh"n
appearrude. The family must
truly hear the therapist'srnessage.If they *" t *a of hearing the thera_
pist will have to shout.

t*to o