Family therapy differs from other psychological and environmental treatments in its perception of the family as an organism which is made up of individuals closely bound by their interactions. It imposes an ecological framework which assumes that the mutual relationship between family members and their environment is a pivotal area of intervention. This definition encompasses a seminal conceptual shift from the understanding of illness and pathology in individual psychological terms to that of the interactions between individuals in close emotional relationships. This shift of focus from intrapsychic to ecologic carries implications as profound as that which the Viennese neurologist, Sigmund Freud, pioneered when he recognised hysteria as a psychologically caused disorder rather than one physically caused. In family therapy, an assumption is made that the whole is equal to the product of its parts rather than the sum and cannot be fully explained by means of theories that describe the parts separately.
Families are those individuals bound by blood or marriage who, through their culture, make up a kinship. The family is in the broadest sense a kinship of three or four generations interrelated like the tiers of a wedding cake. At the top and smallest layer are the remains of the eldest generation, below which are arrayed several large layers until the base is reached wherein are contained numerous nuclear families. The nuclear family includes mother, father, and children and forms the substrate upon which many family therapists restrict their field of activity. For example, conjoint family therapy is usually defined as the treatment of the nuclear family in regular sessions attended by all family members. The therapeutic focus is the troubled family interaction within the session. The curative treatment involves changing those destructive interactions which occur in the family so as to mutually benefit all of the family members. Some conjoint family therapists would occasionally include important extended family members such as grandparents, but concentration on the narrowed substrate of the nuclear family imposes a useful boundary for many of the problems which are family based. An
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eight year old boy with a school phobia required only two conjoint nuclear family sessions. The parents' conflicting desires had previously prevented them from exercising the mutual parental guidance and control necessary to allow the child freedom from anxiety while at school. Family therapy may take other forms, however, in order to meet the needs of the family and its problems.
Transgenerational theory and analysis address the circumstances arising when the interactions of the nuclear family members are inexplicable and uncorrectable in the session without recourse to the other tiers of the family cake. Transgenerational analysis is a dissection of the transmission of family culture in its broadest sense from one generation to the next encompassing those patterns, styles, customs, secrets, myths, and problems which determine the uniqueness of a family.
Transgenerational theory focuses on the dimension of time within family systems in an attempt to catalyse the present through the use of the past. It can bring a thorough understanding to the present family quandary leading to a more elegant solution to the unresolved family problem. The transgenerational approach connects the present nuclear family quandary with the past as far back as four or five generations, as well as to the living past in the form of the present extended family. It is a wide-angle view which gains in breadth what it may lose in detailed study of the current interactions and communications.
In order to understand why the family, whether defined narrowly or broadly, can be treated as a client or patient, it is necessary to understand the reasons for the very existence of family life. Families exist for reasons. Although attempts have been made to envisage civilisations without families, these visions have remained the province of gothic predictive works such as 1984 and Brave New World. There have been no serious attempts to totally eliminate the family as an institution.
Families exist initially out of biological requirements. Men and women attach themselves to each other and have children, all of whom must be fed, clothed, sheltered, raised and acculturated. The closeness of relationships between the various family building blocks are variables which allow for the diverse family arrangements which exist in different cultures. Husbands and wives may meet only for sexual contact or they may be inseparably bound for a lifetime. Children may be raised by either mother or father living together, or separately. Roles are assigned to family members by utility at first and later by tradition. The roles are based on the constraints of the physical and social environment in a
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pattern constructed over millenia which has had to alter and adjust to the exigencies of new discoveries, social changes and environmental alterations. The family's basic aim is to survive and reproduce itself. Viewed organismically, any influence which attempts to destroy a family or prevent it from procreating will be resisted. Failure of that resistance will result in the death of the family as it was constituted. In times of extreme hardship, family members needed to co-operate in order to eat, be protected from the elements and allow enough energy free to bear offspring in order to continue the family. This cohesive force of co-operation was a selective force for survival in that those family members who followed their own individual proclivities contrary to the family and kinship would become outcasts with less chance of survival.
In most Western civilisations the basic biological requirements are plentiful. Secondary goals of family life assume a greater relevance, while individuality is relatively less dangerous to the family member. Secondary goals of family life assume a greater relevance , while individuality is relatively less dangerous to the family member. Secondary goals can be subsumed under the term acculturation. The provision of the culture of a family as codified in the beliefs, practices and verbal and non-verbal patterns becomes a unifying force in the family. Acculturation encompasses religious beliefs, ethics, standards of conduct, and the learning of emotional expressivity. Family culture is passed from one generation to another in this way and the sums of individual family cultures are passed on as community heritage. Where family and community culture is static and unchanging the older generations' accumulated wisdom will remain valid and will be valued by succeeding generations.
Family quandaries develop when the aims of the family are thwarted. Four different areas may be involved in the development of a quandary. Failure to meet basic needs such as food, clothing and shelter will cause stress and tension within the relationships of a family. Here the quandary is generated through conflict between the family and its physical environment. Individual proclivities of family members which conflict with the family culture will generate tension in the relationships and cause the development of a quandary. Here, the quandary is generated through conflict between the family and one of its members. The social milieu in which the family exists may radically differ from that of the entire family as in immigrants and minority races or religions. Here the quandary is generated through conflict between the family and the community culture. Finally, in cultures which rapidly change their social rules, the older generation is no longer valued for its attempts to pass on obsolete wisdom to the younger generation within the same family. Here the quandary is generated between one generation of the family and
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another.
I have not at any point mentioned individual pathology. The family quandary differs qualitatively from individual problems although it encompasses them. Unfortunately despite efforts at developing an objective taxonomy of family dysfunction, most family therapists still classify families by the problems of the identified patient such as the schizophrenic family, the anorexic family or the phobic family. It was upon the family quandary that therapists slowly began to focus their therapeutic interventions, as a basic redefinition of the therapeutic task. The concern with relatedness as opposed to the inner subjective life is responsible for the diversity of techniques and methods of treatment found in the family therapy movement.
Family therapy is a relatively young discipline originating in the late 1940's in the United States where three independent research teams were studying the family relationships of schizophrenics. Eventually, these teams developed treatment methods based on their understanding of the families they were studying and began to apply them to those families. By 1957, the family researchers had discovered each other through presentations of work at the American Orthopsychiatric Association and the American Psychiatric Association. The therapeutic aspects of the family research were raised incidentally but a national impetus had been stimulatedNote 1. In the ferment that followed, therapists such as Ackerman, Bell and Satir who had independently been practising family therapy became better known. The arena of family therapeutics expanded rapidly.
In Britain little actual work on the development of family therapy occurred until the late 1950's and early 1950's when ScottNote 2, HowellsNote 3 and SkynnerNote 4 were independently developing their own approaches. Skynner initially based his treatment of the family as a whole on his training as a group analyst, conceiving of the family as a 'natural' group as opposed to a 'stranger' group. Out of this beginning and coupled with his work as a child psychiatrist he eventually saw the need for the establishment of an introductory course teaching family and marital therapy which was begun in 1972 at the Institute of Group Analysis in London. The teachers on this course were from various disciplines and theoretical backgrounds, brought together by their interest and work in family therapy. Realising their common interests, a process was initiated which led to the establishment of the first international association devoted to family therapy in 1976; the Association for Family Therapy. Walrond-
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Skinner established a Family Institute in Cardiff in 1971, the first setting devoted wholly to family therapy practice.
The 'unstructured state of chaos' which Bowen wrote about when describing the state of family therapy in 1971 no longer exists. The development of 'schools' of family therapy has not yet occurred but there are dimensions along which family therapists group themselves, based on either their theoretical orientations, their activity, or their conceptual focus in their family work. Transgenerational analysis introduces a fourth dimension, the attention to the effects of time on the family and its quandary. SteinNote 5 has organised the various therapists into groups based on their adherence to one of three theoretical orientations. CroweNote 6 would include a fourth orientation, based on learning theory and behavioural treatments. The other three are as follows:- the psychoanalytic theorists whose adherents have attempted the expansion of classical psychoanalytic thinking into the family; the integrative or eclectic theorists whose dual focus gives equal attention to intrapsychic and interpersonal theories, attempting to interdigitate the two into an organised whole; and the communicative-interactive theorists who use general systems theory and interpersonal concepts as their sole model.
Beels and FerberNote 7 classified therapists along an activity dimension, viewing therapists as either conductors, reactors, or systems purists. Conductors were defined as charismatic figures who openly confront and challenge the family with their own value systems. Reactors allow themselves to be engulfed by the family and work in pairs so that their partners can rescue them before they are overwhelmed. Systems purists control the family through analysis and mastery of the established family rules. An analogy would be the alteration of the chess board so as to contain only white squares. The established rules would no longer apply. Through droll instruction and modelling, the systems purist dodges, shifts and feints his way through the family rules altering them as he goes.
Crowe's radical-conservative dimension corresponds roughly to the A to Z scale developed by the GAP report in 1970Note 8. Both classify therapists based on whether their conceptual focus is narrow or broad. On one end of this continuum are the conservatives (A) who use family techniques to help with their individual therapy with patients. At the radical end (Z) of the scale the therapists evaluate all emotional problems in family terms, including the extended family.
The fourth dimension ranges from a focus on the present family words and actions solely as opposed to focusing on the past in order to gain insight into the present. A transgenerational approach would be located
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midway on this dimension, for it attempts to understand the present through the use of the past so as to plan and catalyse a new future.
The fourth dimension mentioned adds a unique perspective too often ignored in family therapy. Family systems are not only integrated and interactive in cross-section; they are equally connected longitudinally along the time axis as is illustrated in the following example.
Mrs G. and her husband were referred to me because of sexual problems. Mrs G. could enjoy sex and have orgasms only through external stimulation. On entry she became unfeeling. Masters and Johnson's treatment had failed. The couple were seen initially and a detailed history received that Mrs G's sexual attitudes could be traced through her mother to her grandmother. Her mother had married an impotent man who left to fight in the war. She then had an affair with a Polish airman who abandoned her when he learned that she was pregnant with Mrs G. Her husband returned from the war, allowed his name to be given to Mrs G. and then disappeared.
Mrs G. was raised by her mother who had only negative experiences with men. Mrs G's grandmother had initially rejected her mother because of her 'promiscuity' and through the sexual treatment contact had been maintained between daughter, mother and grandmother. Any changes that might have occurred in the sexual therapy sessions were constantly sabotaged by the slightest comment by her mother or grandmother about 'nasty men and their filthy habits'. An understanding of this situation led me to request that mother and grandmother be included in the sessions. Many excuses by Mrs G. and her mother and grandmother led to the structuring of tasks at home in which her husband and she were to talk about sex in front of the older generations. They were also asked to talk about and imagine these older family members in their bedrooms while they were sexually active. Their sexual relations rapidly improved as did their relations with their own children. Although Mrs G. was temporarily estranged from her mother and grandmother a newly forged relationship was soon established in which men were no longer a subject of disgust and ridicule.
The sexual sessions were not enough to counteract three lifetimes of learned attitudes which continued to be reinforced through contact. The feedback from one generation to the next, rooted in years of experience, had to be actively altered rather than dwelling solely on the immediate interactions between the marital couple.
The family is a sequence of generations stretching backward into the
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past whose links in the present make up the extended family. But those present links are also parts of a chain of family cultural transmission which were active and formative in the past. I altered the family relationships of Mr. and Mrs G. by changing the nature of the links which had been established and were still operating.
Transgenerational theory also includes a natural extension into the future. A family quandary may relate more to the inevitability of a future event such as the death of a parent, grandparent or other relative, an approaching marriage or a birth. Future family plans are actively mapped out so that the frustration of a future goal rather than a present circumstance or past troubled history may be the cause of the existing crisis. BerneNote 9 calls this transmission process 'the family parade' and through an extension of transactional theory has attempted to show how a 'family script' which was written in the Napoleonic Wars was being projected forward to the year 2000.
Although individual family members may die, the family provides relative group immortality through its links between past and future generations. Within this perpetuating group the death of individuals does not end their ability to effect an influence on the families' decisions, feelings, thoughts and directions. I can recall at the simplest level several family quandaries generated by the last will and testament of an individual family member. But also, through their influence on the generations which they have helped to create and raise, through incorporation of their values which are then passed on to the next generation, the individual passed an individual uniqueness to be incorporated in the collective family culture.
I have attempted to define and limit transgenerational theory in practice to the family as a four or five-generation system. The limiting number of generations is based on the impact of direct and indirect influences which can commonly reach into the third, fourth and fifth generations. Most children have direct experience of their grandparents. Their parents have had personal experience of their own grandparents. The fifth generation is remote but I have seen occasional families in which the fifth generation has been of profound significance in their influence and importance on the nuclear family being treated. This influence may very well be profound because of their longevity and the increased effect that longevity has had on the multiple feedback relationships established between subsequent generations. My own family has had this experience of a long-lived relative being increasingly powerful in their influence.
One of the social revolutions to which modern societies have had to
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adjust is the increased longevity of individuals and hence their increased influence. Most nuclear families recently established have had the experience of knowing septuagenarian and octogenarian extended family relatives. They may well have relatives in their ninth or tenth decade of life. For this reason the four or five-generation family system is of increasing relevance to family life and society.
1. M. Bowen, 'Family Therapy after 20 years' in J.Dyrud and D.Freeman (eds)., American Handbook of Psychiatry, vol. 5 (Basic Books, New York, 1975).
2. R.D. Scott and P.L. Ashworth, 'The Axis Value and the Transfer of Psychosis', British Journal of Medical Psychology, vol.38 (1965), p.97. Scott began his work with the families of schizophrenics but since then he has developed a unique crisis intervention family approach based on a catchment area mental hospital.
3. J.G. Howells, Family Psychiatry (Oliver and Boyd, London, 1963). Howells began his work in 1949 and developed a system of family psychiatry based on the concepts of 'vector therapy'. He has remained outside of the mainstream of family therapy in Britain.
4. A.R.C. Skynner, One Flesh,Separate Persons (Constable, London 1976).
5. J.W. Stein, The Family as a Unit of Study and Treatment (Regional Rehabilitation Research Institute, University of Washington School of Social Work, Seattle, 1969).
6. M.J. Crowe, 'Evaluation of Conjoint Marital Therapy', unpublished MD thesis, Oxford University, 1976.
7. C.C. Beels and A.Ferber, 'Family Therapy: A View, Family Process, vol.9 (1969), p.280.
8. Group for the Advancement of Psychiatry, The Field of Family Therapy, Report No 78 (New York, 1970).
9. E. Berne, What Do You Say After You Say Hello? (Andre Deutsch, London, 1974).