After the attack: supporting families

What was your impression regarding the attack?

Charles Fishman: The reaction of our community in the United States was impressive; we were deeply shaken. As family therapists, a fundamental question arises: in what way has the event affected, directly or indirectly, the family group? The essential thing is to know how to work so that the family keeps moving forward. Rehabilitation is an important subject that almost no one talks about.

We must ask ourselves what we can do with the people affected to reduce their isolation, to build a system of fellowship in which friends can help make “good medicine,” by offering a broader social context, community support. That helps reduce isolation. We obviously have to do concrete things for the families, but we are talking here about two different things: one is the social support system the family is part of; the other, the relationships within the family. Neither of the two can be ignored.

I understand that every family is different, but is there nevertheless a strategy that can be used in these cases, or a precaution to take?

Charles Fishman: In a way, we family therapists are always present in moments of crisis. Not in moments as extreme as this one, but, in general, people come to therapy at moments of emotional instability in families. So, to extrapolate to the crisis situation, there are a number of different areas that family therapy must address. The first is to bear witness to people’s experience, to be with them, to accompany them. It is impossible to ignore the pain they are enduring.

Do you think this could be addressed specifically through network work?

Charles Fishman: One has to determine which people in the system can function as genuine support for the family, maintaining homeostasis. One example could be the social service, or social workers. There are two ways of reinserting oneself into the system: the first is to help rebuild a genuine system; the second, to observe the functions within the system and restructure them.

The “Second Revolution”: beyond family therapy

Alberto Vásquez: For us at “Contextos,” this terrible event touched us closely, because the work we are going to do with Charles Fishman when he returns to our country, in the first week of October, was to be work at the AMIA, where I was trainer and supervisor of the social service for fourteen years. At that time, “Contextos” had a double insertion: on the one hand, because the director of the social service, Norma Lew, is one of our associates and one of our teachers; on the other, because we continue to train the AMIA social service and to remain in contact with it. That social service, which very few people know about, has been working for ten years, both inside and outside the community, in contextual therapies. That is why we decided to bring Charlie Fishman, for all the experience he could bring to our vision and to our fieldwork.

Starting from this situation, we decided to reformulate the seminars. We call them the “Second Revolution,” precisely because they speak of everything we family therapists can do beyond family therapy. In the current circumstances, this takes on an even greater meaning.

In our country, there is a lot of work in contextual therapies, in social services, outside the “psy” world, in the courts for example. The AMIA case allows all these experiences to come to light. People are now learning that at the AMIA, or at the San Isidro hospital, this is how work was done.

Moreover, people who work in social services have no time to write, because action is needed right away. There is so much work that no time is left for conceptualizing, even when one works seriously. Perhaps this will serve to make people aware that new tools exist, that there are areas to cover, and that we family therapists are not exempt from them. As Charlie (Fishman) says in the first chapter of his book Intensive Structural Therapy, we systemic family therapists were responding inadequately to pressing problems, such as unemployment, problems at work, family violence, insecurity. For us Argentines, this question of terrorism is now added. It is now a scenario for the whole world, and not only for what is called the “first world.”

Family therapy and managed care in the United States

Dr. Fishman, is it true that in the United States family therapy and brief therapy are now mostly chosen and that traditional therapies are disappearing?

Charles Fishman: Family therapy is developing, but it is a very slow process. It is true that traditional therapies are losing ground, but this in no way constitutes a conceptual revolution. It is a new phenomenon that in the United States is called managed care, the system of managed health insurance. People ask clinicians how many sessions their treatment will last, because the health insurance funds require it. That is why some traditional therapies, such as psychoanalysis, are disappearing: the insurers do not reimburse them. In the United States, no one pays for their treatment out of pocket. It is the health funds or insurers who do so.

Could you summarize the fundamental concepts of your work?

Charles Fishman: I can say that, like many of my colleagues, I am disappointed by the effects of family therapy in the United States. Over the past twenty years, the family has changed drastically. It is less transgenerational, grandparents are no longer taken into account as much; it is the contemporary system that has a much greater impact on the family: friends, institutions, social services.

The conceptual change consists in this: the solution to problems must be found within the framework of contemporary systems. The essential thing is to determine the contemporary context, in order to develop the therapy within that context and to build a broader, deeper system that influences the lives of many families, in particular for children’s problems, and not only in the judicial context, but in the particular context of each family.

The second area in which family therapy is developing has to do with social workers. In my experience, people appreciate the help they receive from these practitioners. I think family therapists have stayed shut in for too long. They are now finding new forms of approach, in which practitioners act within the community itself.

I think we family therapists have an inferiority complex. We can help find the right interventions in several fields, such as law and medicine. I believe it is essential that we be as effective as possible in reducing human suffering, which we can achieve through systemic interventions. Such treatments or interventions can be even more effective when carried out within the social context itself.

“Altruism” (excerpt)