Figure 11.1 The Lieberman Geneogram (First Attempt)
Self knowledge is best learned, not by contemplation,
but action.
Goethe
Psychological treatments requiring the development of a relationship between the client and therapist led to the need for a personal training experience for students which in some way mirrored the therapeutic process. To become a psychoanalyst, trainees now submit to a personal analysis; to become a group analyst trainees are expected to take part in personal group sessions. This personal tuition is an early requirement in the process of becoming a qualified therapist recognised by various training institutes.
Such personal analyses have developed in order to meet emotional and educational objectives simultaneously. That the experience is akin to the therapeutic process the student will later employ, provides a unique understanding of that process. A recipient of therapy gains an empathic training which will stand any therapist in good stead in the future when dealing with his own clients. If the therapeutic procedure effectively induces change in the trainee, then his emotional investment and belief in the method will be strengthened. If the change induced resolves personal problems which would interfere with the therapeutic abilities of a student, then the experience is worthwhile for that reason alone. Finally, such a personal analysis exposes the trainee to an experienced therapist who is employing considerable skills and knowledge while in close contact with the student. Such an experience models the more subtle techniques of the therapeutic method for the trainee.
The discipline of family therapy faces an added dilemma when trying to provide a personal training analysis. Previous psychological treatments have been limited to the intrapsychic, interpersonal dysfunctions of
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individuals. The therapists, in order to gain a personal familiarity with individual or group therapy, needed only to commit themselves to the training experience. Family therapy involves a higher hierarchical level of organisation. In family therapy, the client is the family. Family therapists, in order to enjoy a suitable personal training model, might reasonably be expected to include their own family members (nuclear and extended). But it is impractical to require trainees to commit their entire family network to conjoint family sessions. Such an unwieldy model of personal training would be difficult to constitute or maintain in any training institute.
The ingenuity of family therapists has been taxed to devise alternatives to conjoint family sessions for the personal training of their students. Through the use of sculpting and the simulation of family sessions in groups of trainees, attempts have been made to bypass the need for any active participation of real family members. In a few training programmes the participation of the spouses of trainees has been encouraged. Other programmes content themselves with an insistence on the requirement that their trainees receive some alternative form of individual or group analysis. None of these alternatives fulfil necessary emotional and educational criteria for a training analysis for family therapists.
I wish to describe a model which does involve students in experiencing the rewards and difficulties of working within their own family system. It is a short step from the type of therapy described in Chapter Eight to the use of similar methods with motivated family therapy trainees. The use of geneograms and transgenerational analysis provides a way for trainees to be guided to work with their own families without requiring the presence of family members in conjoint sessions.
This model originates with Bowen. In 1967 he described his efforts to put his theories into practice by differentiating himself from his family of origin. Since that presentation and its subsequent publicationNote 1 several similar accounts have been written and presented by family therapistsNote 2 guided by the postulates of the Bowen Theory. I have presented an account of work with my family of originNote 3 using some of his techniques without adhering to his theoretical bias. All of these accounts have developed from efforts to coach trainees in work which involved changing their relationships within their family of origin.
BowenNote 4 continues to use this model of training for his student family therapists. He describes the training technique as follows: A detailed family history for multiple generations in the past is drawn up and a personal relationship is developed with all important relatives.
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Activation of old family relationships brings about old triangles. With the advantage of objectivity and knowledge of triangles the old relationships are detriangled as they are brought to life. This paradigm of a family training analysis is used in a group seminar of trainees with one or more experienced therapists. In these 'coaching' sessions, trainees report on the visits they have made to their family of origin and extended family. Problems with detriangulation are discussed and advice is given on how to deal with situations which might develop on their next visit home.
Framo has taken the use of the family of origin one step further by inviting them to attend family therapy sessions as a resourceNote 5. During my psychiatric training I watched a similar technique being used by PaulNote 6. Neither are adherents to the Bowen Theory but they have borrowed freely from his therapeutic methodology. The training analysis which I favour would combine the different methods of using the family of origin as a resource.
The following account describes work with my family of origin during my psychiatric training. It was motivated by a quest for self-knowledge rather than as a training requirement. During the three years of this work a family seminar led by Norman Paul helped bring the work with my family of origin to fruition. I include this material as an example of work which is possible as part of a family analysis. I hope it will also serve to illustrate certain principles of the training analysis.
Early in my psychiatric training I began to develop the use of family trees derived from genetic diagrams. As I began to plot the non-genetic influences on my patients, I was stimulated into an awareness of the position I occupied within my family of origin. It was a position with which I was unhappy.
I constructed a geneogram of my family as I then knew it. There were so many missing bits of information that I despaired of collecting them (see Figure 11.1). My younger brother had once prepared a family geneology, an occupation for which I had previously ridiculed him. I wrote and asked him to send me a copy but when it arrived I found it skeletal, lacking much of the information that I wished to obtain.
During the year that followed I searched for the missing information. At this time I was not motivated by a desire to change myself, my family members or my relationship with them. I wanted to develop specific character sketches of distant relatives or relatives who had died before I was able to establish an adult relationship with them. I was also
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When my parents planned to visit with us in Boston I prepared myself. Upon their arrival from Miami, I had a list of questions organised in my mind which I intended to press. I approached each of them separately and asked about certain areas in my life history or theirs which were vague or poorly understood by me. For example, I asked my father to share his feelings about our move from Chicago in 1951 when he first separated entirely from his family of origin. I asked my mother to tell me about her reactions to my maternal grandmother's slowly developing senility.
Much of my probing was met by embarrassed silence or hesitant half-statements. Some of the information awakened long-buried memories. Some questions were side-stepped by my parents so that by the end of their visit I was in many ways no wiser than I had been about the details of my family history. But, as I left the airport after putting my parents on a plane, I was seized by an admixture of grief and happiness which I had never before experienced. My eyes were filled with tears on my drive back from the airport. In my mother's next letter she described a similar feeling which had filled her on the flight home. Several weeks passed in which a feeling of freedom and sadness intermingled and prevented me from fully concentrating. Much later I realised the significance of those feelings. They heralded a change in communication pattern between myself and my parents which was kindled during that visit.
I soon began to gather detailed information about my family by letter and telephone conversations. This long-distance communication was necessary because I lived in Boston, most of my family of origin lived in Florida (except for my eldest brother who lived in California), and my extended family lived in Chicago.
I wrote separate letters to each of my parents and asked them to send me the history of their lives - whatever they remembered which was particularly formative to their character. I asked them for old photographs to be sent with explanatory notes about the more distant relatives. I then waited expectantly for their replies.
My mother responded quickly with a nine-page letter. She started with a history of her many medical illnesses during my early years which
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had required that I board with uncles and aunts. She provided information about the characters of her brothers and sisters and told me of some who had died in their childhood and whose existence was unknown to me. Secrets about the less reputable behaviour of my grandfather were revealed. He had been and still remained as a powerful influence within our family.
The following excerpt about my mother's birth and first year of life reduced me to tears and it gave me a feeling of compassion and an understanding of my mother previously lacking.
Anyhow Isaac Mizus jumped the ship in New York, received help from a New York organisation. How is this possible? Years ago when you saw a man with a beard he was a jew. You spoke to him and the jews always helped each other. They gave him a room, bath and clothes and money to go to Chicago where Isaac had a brother. Isaac got a job, borrowed money from his friends and got his wife and children here to America (plenty of men never ever sent for their wives and children). My mother and five children arrived on January 1st, 1916. January 1st 1917 I was born. My mother developed 'bed fever', infected ovaries from instruments or dirty hands from doctors during my delivery. (I was the first child that she had a doctor). I was boarded out to a Dutch woman who was drunk all the time. Zelda, Rae and Yetta went to an orphanage home. Morrie and Goldie were home. My mother was taken to the hospital. She was operated on; they removed one ovary. She almost died. She was in the hospital 6 months. Meanwhile Zelda developed measles and almost died. Isaac was called twice during the night, at different nights. This was the cause of her heart condition. Plus, they say, she must have had rheumatic fever. I was so badly cared for that when mother got well and they took me home I was skin and bones. Mother said all she saw in me was my big black eyes and running nose and ears.
The deprivation and hardship in my mother's past contrasted starkly with the life my parents provided for me. Her account led me to re-evaluate my opinion of her. Some of the anger and resentment I felt towards her abated. Simultaneously, buried feelings of loss were awakened when I read her account of my grandmother's hard life in Russia and France. The information in the letter added to my family geneogram (See Figure 11.2).
I decided to write to my Uncle Morris, my mother's eldest brother. I wanted his account of events prior to my mother's birth. I asked in my
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Dear Stuart,
Now to explain of my late letter I must say that I should have wrote much sooner perhaps but when I did get your letter I wrote to my father and your mother telling them about your letter, so not until the 10th of this month did I get an answer. My Pa told me that your mother sent you a letter with all the information which you might have wanted, but Stuart I must tell you that what you want to know is that which I must get and have more time to do it. I have gathered some notes so far. For I went back into my boy days to try and remember what went on in those years with my mother and the rest of the children. But I've been reading your letter and I am trying to figure out what you really mean to find out for yourself? I think if your mother did give you a history of my mother it could be up to a certain amount of years for her, but I do have some answers about my mother that perhaps you might have forgot to mention. But I am holding back. So - perhaps you might tell me just what information, or if any, she did give you?
By this time I was attending the family seminar led by Norman Paul. I discussed my work so far and mentioned this particular impasse. The way out of it was clear to my colleagues. Since my mother's letter was my property, I sent a copy of it to my uncle and again asked for his help. When several weeks passed I telephoned him. He was able to tell me a great deal over the phone which he had found himself unable to commit to paper. He disagreed with several of the stories in my mother's letter and told me something of his past. He also mentioned peculiar behaviours of some of his siblings which were familiar to me through my psychiatric training. After our conversation I was elated. I felt as if I had become one with my mother's generation; I had altered my position in relation to my mother's family of origin.
My work with m mother's family emboldened me to turn my attention to my siblings. I copied letters that I had so far received and sent them to each of my brothers. I asked for their memories of our early years and for their feelings about me, past and present. My letter to Charles also contained some advice about his future. He sent back the
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following reply:-
I don't need any such advice from you or Mom. I know my own strengths and weaknesses better than anyone. Should you or Mom or anyone think that my judgement is faulty that is tough titty. I am not about to abdicate control over the major steps in my life to anybody.
You know quite well my psychiatrist-brother that I have grown up under your shadow and Mike's and of course Mom's. And that all of my life has been a struggle to come out of that shadow, to overcome the passivity of my nature. I need not ask why Mike lives in California and you in Boston. Please don't think me ungrateful, brother, but I wanted to clear things up. Your interest in the family past I find somewhat mystifying. With a wife, 3 children and a mentally stimulating job, I do not understand you harkening back to the past. For my own self, I sought to fill in the great holes in my psychological foundation. But for Stuart it would seem not so.
His communication was a shock to me both for its content and its confrontative honesty. I realised that my image of my brother had to change. I had felt a need to protect him and ease his path while his letter indicated that he had progressed far beyond me in some respects. My respect and admiration for him increased.
I waited for eight months for a letter from my father about his family. Nothing was forthcoming despite several letters and telephone calls requesting the information. My own resistance to a visit home was uncovered in my discussion in the family seminar. It was made clear to me that I would have to visit Miami. In March 1972, the opportunity arose to holiday with my parents. I stayed with my parents in their home. We dusted off the family albums and discussed each relative as their photo appeared. My father spoke freely about his family and promised to put more of his thoughts on paper. I visited my grandmother's grave in order to recapture some lost memories and turbulent life. My relationship with my parents was less strained than it had ever been. I could move easily from being a child to being an adult in their presence.
When I returned to Boston, a letter arrived shortly containing my father's account of several important events in his life. It was incomplete but explained some of the influences which moulded my father. It also contained some information about his family of origin which was of interest. The following excerpt includes a story which illustrates the
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value of being a good neighbour as a transgenerational pattern.
Samuel would go outside and look around for Jewish men who were killed by the Bolsheviks, the Russian communists. If found, he would make sure they were buried according to Jewish law. On one of these occasions a dozen wagons were brought in with dead people fished out of the Boog river. Samuel sent to the wagons to find Jewish bodies which the Russians had killed during their retreat. A troop of Polish soldiers came riding up on horseback to the town square. The commanding officer saw Samuel with his Tallis and Tfillin looking at the bodies in the wagon. He took out his gun and said 'A Jew! I have one more bullet left, I will kill this Jew'. Thinking that he would be a hero in the eyes of the Polish people about him. The crowd cleared away from Samuel and I; Jerome the small son ran to his side crying with fear. Gittle ran to the commanding officer pleading for Samuel's life telling the officer what a good man her husband was. The Polish neighbours also ran up to the officer and begged for Samuel's life. They exclaimed 'he is a good Jew, honest, never cheating anyone and always ready to help a neighbour'. The officer said 'Jew, you are lucky, the Polish people like you'. Because of his goodness to people his life was spared.
Another story told of an incident in which my father had been tormented by a neighbour's son. He had hit back and fled in fear when the boy fell to the ground. The neighbours came looking for him in an ugly mood and he had to remain hidden in the manure pile for many hours. This story helped to explain the long fuse to my father's temper.
There remained much more of interest to me in my father's family. I heard that my father's younger sister was due to visit Boston. I contacted her and arranged to meet her. She revealed several gaps in my father's stories. She told me that my father was the second eldest in their family. The eldest child died in his first year from pneumonia; my father carried the same name as this child. She also explained that their family had emigrated to America from Poland shortly after the death of another brother in an artillery bombardment. Further details were supplied until my understanding of both of my parents' family influences were sufficient to satisfy me. I was able to add new information to the geneogram (see Figure 11.3). I felt comfortable with my family of origin. I wondered whether I could test my position in my extended family.
Two years after the beginning of my quest the opportunity arose for
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One of my goals for the visit was to view the family cine films made between 1948 and 1951 and had not been shown since then. Since the films had to be shown at a family gathering I found there was great resistance. Each person in turn whom I approached commented that they wouldn't mind but pointed to another relative as being unable to tolerate the memories that might be resurrected. Finally, by asking all of them and receiving assurances from each individually, I negotiated an occasion when the film show was held. I was able to see myself at six, eight and twelve; I saw relatives who had since died. More importantly, in the process of negotiating the film show, I maintained and extended my new position within the generational hierarchy of my extended family. I also managed to visit my old neighbourhoods, taped conversations with my grandmother and took cine film of much of my family. I returned to Boston pleased and satisfied.
The work which I did with my family of origin gave me confidence and the capability of dealing more comfortably with problems in my nuclear family. It also provided me with a resource and an understanding which have been invaluable in my clinical work. The experience provided me with an empathic awareness of the fears and difficulties involved in attempting to alter human relationships within a family system.
The meaning of much of the material added a great deal to my self awareness and insight. For example, I discovered that I was named after my mother's grandfather. My mother's grandmother bears a striking resemblance to my mother in old photographs a fact which partly explained the close attachment between my mother and grandfather. My older brother was named after my father's grandfather. My interpretation is that we each belonged to a different side of the family. Our sibling rivalry was a symbol of the family collision. It could also be seen as the competition between families and between my parents. Our
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close relationship as brothers mirrored the marriage of the two extended families through my parents.
My family history and the stories within it showed a repetition of patterns handed down from generation to generation along with the stories. Several recurring themes such as emigration, secret marriage and fixed emotional patterns such as extreme containment of anger existed in at least three different generations. Understanding these patterns and their origins led me to an acceptance of some of them and an alteration of those patterns which were less useful.
I believe that an experience similar to the work with my family under organised supervision would meet the criteria of a family therapy training analysis. If it were combined with a programme of didactic courses and live or recorded supervision, a balanced training for family therapists could be achieved.
The training analysis could be organised as follows. Applicants for formal training at a family therapy institute would be advised that they would be required to undergo a family training analysis as an integral requirement of their educational experience. Those individuals accepted for training would be assigned to a supervisor whose task it would be to help the trainee in work with his own family. The analysis would require ten to twenty one-hour sessions spaced over monthly intervals, and held in the supervisor's office. Family members who were interested could be invited to attend sessions although most of the work would involve the trainee only.
The content of such an exercise would be centred on the transgenerational analysis of the trainee's family background. An understanding of relationships between the trainee and his significant family members would also be included. The trainee should, as well, discover the reasons for his interest in family therapy. The discovery of the origin of motivation is important since it will help guard against the tendency towards becoming a compulsive therapist. Finally any work involved in altering relationships within the trainee's family system could be planned and the alterations carried out.
The process of the family analysis would begin with the construction of a geneogram by the trainee with the help and assistance of his supervisor. Study of the results will provide an opportunity for tentative analysis and formulation of tasks. The significance of the trainee's sib-
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ling position may be important in relation to his parents or grandparents. The timing of the entries and exits within the family may prove significant. Reactions to loss, secrets and family patterns can be explored. This analysis of transgenerational influences would point the way toward the first tasks. The trainee would absorb an understanding of the way family therapy concepts apply to himself and his own family. Following the initial session, the trainee would be asked to construct his own geneogram and fill in missing details. Visits to relatives, letters, tape-recorded conversations, telephone calls and/or examination of family documents could be discussed and planned. The trainee would then consider which of his family relationships he would like to alter, if any.
The process of the analysis would continue in the following sessions. The supervisor would act as a problem-solving resource if the trainee was unable to work out a correct strategy for dealing with one of his relatives. The supervisor would also serve as an advisor who could spot blind-spots in the trainee's conscious awareness. For example, one valuable insight was given to me when the importance of my rivalry with my brother was pointed out. Since the alteration of a relationship in one's family might be an essential element of the exercise, the supervisor would be responsible for ensuring that the trainee accomplished this task without being destructive or malicious. The supervisor would ensure that no self-defeating moves were taken. The supervisor would also be available for family crises or visits by family members interested in attending a session.
A family training analysis would end when both trainee and supervisor were satisfied that the trainee had a comprehensive understanding of those transgenerational influences which moulded and continued to influence him. Concomitantly, the alteration of one or more relationships within the family would have been satisfactorily accomplished. The trainee should have experienced the emotional impact of a change in their own family.
If successfully concluded, the above process should meet the following criteria. First, the use of transgenerational methods will provide insight and increase self-awareness both of strengths and weaknesses. Since much of our character is moulded into us by our family, an understanding of that family inevitably leads to self-understanding and greater insight.
Second, the process of family therapy will be thoroughly understood by the trainee who has actually experienced it while working with his own family. A surgeon need not experience an appendectomy to do one, but in many psychological procedures, experiencing the effects - as
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long as they are not noxious - can provide an education which no amount of didactic teaching will provide. Because of the painful emotions involved in psychotherapeutic procedures, personal involvement will provide much greater understanding and tolerance. Certainly, before working with my family I had no clear understanding of the resistances which I would experience and the emotions which were to be raised, nor of the ways in which I would cope with them.
The third criterion for a training analysis is that it develops empathic sensitivity in the therapist. The ability to put oneself in the position of one's client should be enhanced by a personal training experience. Accurate empathy is held to be one of the three necessary qualities for any counsellor or psychotherapistNote 7; the exploration of transgenerational influences aids the development of empathy. The similarities between my family and client-families from diverse backgrounds were more apparent after my work increased my empathic awareness. Most families have secrets, losses, recurrent patterns and griefs. Exploring one's own family provides awareness of those elements of humanity which are common to us all.
The fourth criterion for a family analysis is the provision of an association with an experienced therapist who knows how to deal with problems that arise during family therapy. Since a trainee's family problems will be of the greatest importance to him, a supervisor will have the opportunity to acquaint the trainee with techniques, methods and strategies during first-hand experience. The training analysis could be likened to an apprenticeship; the personal work involved is the most difficult which the trainee might be called upon to face.
Finally the training analysis can be a therapeutic experience for the trainee and his family. Various of the personal insights and growth experiences recommended by other psychotherapy disciplines contain within them an element of therapy. My experience with my family was a personal help to me, in my relationships with my family of origin and more importantly in my relationship with my wife and children. Therapy under the guise of a training experience has enabled many trainees to mature and perfect skills which were held back by personal problems.
Variations of the proposed training analysis could be equally effective. The analysis might incorporate a small group (six to eight trainees) led by a supervisor. A training group would provide the support and encouragement of peers. It would also supply cross-fertilisation from the variety of family constellations represented by its members. The disadvantage of a group would include a lack of confidentiality and de-
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creased time for the intricate discussion of each family at every session. The combination of a small group experience with individual sessions might prove a useful variation. Finally, the inclusion of the trainee's spouse and/or children might be an optional variant. The spouse could simultaneously do work on their family of origin and extended family.
Difficulties would arise when trainees with no living relatives in their extended family were accepted for training. Although the use of the geneogram and transgenerational analysis could proceed, experience of a change in relationship would not be possible. With those trainees engaged in a family analysis, any problems arising within the context of the work would necessarily be the joint responsibility of the trainee and supervisor. Relatives, unhappy with the trainee's attitude, could be encouraged to take part in explanatory sessions if they so wished. Complaints from relative should be dealt with personally by the trainee and supervisor within the context of the family training analysis.
I believe that the format proposed would provide family therapists with a personal growth experience and insights comparable in most respects to individual and group analysis. This model would additionally provide trainee family therapists with a personal experience of working within and changing a family system.
The use of the student's family of origin as a training resource is no longer as controversial as in the past. There have been many exercises and structured experiences devised so as to give the simulated feeling of involvement of family members. They can provide powerful emotional experiences and generate insight, but the exercise lack the feedback responses from relatives which are so necessary to test the effect of changes which occur internally.
Some of these exercises were used in the Family and Marital Course at the Institute of Group Analysis in groups of twelve to fifteen members. Many more family training exercises exist than are included here. I have outlined only those which provide some alternate experience of a trainee's own family system.
Goals:
Materials required:
Process:
Variations:
Goals:
Time required: Approximately one to one and a half hours.
Group size: Six to fifteen participants.
Process:
Variations:
This exercise is similar to the sculpting exercise. The family members chosen from the participants to represent the family of one of them is allowed to act and speak in a form of psychodrama. The participants portray a particular scene and they are then de-briefed and de-roled followed by discussion of the exercise.
1. M. Bowen, 'Differentiation of Self in One's Family', in J. Framo (ed), Family Interaction (Springer, New York, 1972).
2. F. Colon, 'In Search of One's Past: An Identity Trip', Family Process, vol. 12, no. 4 (December 1973); anonymous, 'A Family Therapist's Own Family', read at Georgetown University Family Symposium, November 1973; anonymous, 'First Moves Back into my Family', read at Georgetown University Family Symposium, 1974.
3. S. Lieberman, 'A Search for Identity: Working with One's Own Family', unpublished paper presented to the Group Analytic Society, London, 17 March 1975.
4. M. Bowen, 'Family Therapy after 20 Years', unedited draft chapter for Handbook of Psychiatry.
5. J. Framo, 'Family of Origin as a Therapeutic Resource for Adults in Marital and Family Therapy: You can and Should Go Home Again', Family Process, vol. 15, no. 2(1976), pp. 193-210.
6. N. Paul, 'Personal Communication': I viewed a multiple family group for over six months run by him in which he included extended family members.
7. C. Truax and R. Carkhuff, Toward Effective Counselling and Psychotherapy(Aldine Press, Chicago, 1967).
