Introduction, by Richard Simon

It has now been almost twenty years since I first saw Salvador Minuchin at work. At the time, I was a young graduate who had started his first clinical job a few months earlier. At university, I had of course read Minuchin’s books (Families of the Slums and Families and Family Therapy), which were, as far as I knew, practically sacred texts, but I had never seen him do therapy in person. The family field was at the peak of its messianic, “we-must-change-the-world” phase, and Minuchin, in his fierce opposition to psychiatric orthodoxy, was both its visionary leader and its wise clinician.

My trip to the Philadelphia Child Guidance Clinic, for an introductory workshop on structural family therapy that Minuchin was giving, was therefore much more than the pursuit of a certificate. It was a pilgrimage to the place Minuchin had turned into the Mecca of family therapy, an initiation into the mysteries of putting the volatile abstractions of systems theory to work in order to transform lives.

Standing in front of an audience of 200 therapists, Minuchin, a compact and lively man, with a Latin accent as pronounced as his black moustache, gave off an air of brusqueness and directiveness, running against the traditionally pacifist culture of psychotherapy. Heaven help anyone who stumbled into an unacceptable question or tried to say something kind about psychoanalysis. He seemed to me the most self-assured person I had ever met, as if he had climbed the mountain, contemplated the Truth and discovered that he embodied it. He was, of course, exactly the kind of hero I was looking for. And when he began to explain a clinical strategy by quoting a sixteenth-century book called The Way of the Samurai, the last reservation I might have had vanished completely.

The centrepiece of the workshop was a live family therapy session, relayed to the audience by closed-circuit television. Once the interview began, Minuchin’s intimidating aura dissipated and he turned into a kind of therapeutic bloodhound – patient, respectful, infinitely curious, often playful, surprisingly kind, but above all absolutely devoted to making sense of the puzzle that was maintaining the problem the family was trying to solve. At times Minuchin would lean back in his chair and take long drags on his cigarette while questioning the family. Hyper-attentive to each of their gestures, to every pause, to every shift in mood, Minuchin seemed to absorb information through every pore while pursuing his questioning.

The fact is that once you have seen Salvador Minuchin work, a small part of him remains indelibly alive somewhere inside you. Throughout the founding years of family therapy, he became the model against which therapists measured their best work, and when they failed miserably with a family, they wondered what Minuchin would have done. From his early work with delinquents and their families at the Wiltwyck School in New York, in the sixties, to his long tenure as director of the Philadelphia Child Guidance Clinic, he was probably the most renowned – and the most imitated – family therapist in the world.

Over the past fifteen years, although he has continued to write about family therapy, to run workshops and to direct a small training centre in New York, Minuchin has apparently been looking for new worlds to conquer. He spent a few years travelling and taking an interest in playwriting, to see whether he could transfer his gift for drama from the consulting room to the stage. For more than a decade, he did battle with New York City’s child welfare bureaucracy, trying to apply his ideas about family systems to the reform of the foster care system.

Today, at 75, he speaks with a certain perplexity about his reputation for charisma in the consulting room. Fifty years of experience with families have softened the edge of absolute certainty that once gave his work its sense of urgency. These days, he sees himself less as the champion of a particular clinical method or theory than as the philosophical meta-observer of a profession that he, almost like no one else, helped to create, and for which he continues to feel responsible. He has just completed his ninth book, Mastering Family Therapy: Journeys of Growth and Transformation, written with nine of his supervisees, which offers his current view of the state of family therapy training.

In this interview, Minuchin reflects on the latest developments in family therapy, discusses his own evolution as a clinician and offers his perspective on nearly fifty years of the field’s history.

Conflict at centre stage

How would you situate your work in relation to the approaches that are now in favour among young therapists?

I think I am much more interested in exploring conflict than many of today’s therapists are. My therapy was born of the active therapy of the sixties, with all its optimism and energy, its experimentalism, its creativity and its candour. I bring the family drama into the consulting room. I encourage family members to interact directly with one another, in the conviction that the family is the arena where people can express themselves in all their complexity. Family interaction, with all its potential for destruction as well as for healing, therefore continues to occupy centre stage in my practice.

But today’s therapists are wary of my brand of therapeutic interventionism. They seem to believe that it is impossible for the therapist to produce specific, observable changes in the family. They want to be non-interventionist and to make therapy a simple conversation between people. The therapist asks questions that give people the chance to reconsider meanings and values they had until then taken as “given” or normative. The “solution-focused” and narrative therapists say: “Let’s not address problems. Let’s address solutions.” But in that process, it seems to me, the therapist ends up confined to a collaborative and symmetrical posture. Gone is the freedom to play, to give one’s opinion, to be in the consulting room the complex, many-sided person one is outside it. All that remains is to be a distant and respectful questioner.

Janet Malcolm once wrote in the New Yorker: “Watching a Minuchin session, or a video of one, is like attending a solidly constructed, well-directed and beautifully acted play.” You seem to take pleasure in handling explosive situations in therapy. What attracts you to that?

I think what led me to family therapy was excitement. Every family represented an exciting puzzle. When I was working with delinquents and their families at the Wiltwyck School, in the sixties, the particular challenge was to help them find concrete ways of calibrating their relationships. We were intent on helping disorganised families to bring more order into their relationships. So we would interrupt an argument in the family to say: “When your mother is talking, you can’t talk. Okay, now you can answer.” The emphasis was on direction. At that time, Virginia Satir had developed a very popular therapy that emphasised care and nurturing. But we felt that, in the families we were seeing, people already knew how to nurture. The problem was that the parents were ineffective at taking control of their children. What they lacked was the consistency that would have allowed them to give the children a sense of self-efficacy.

A good part of your reputation as a master therapist rests on your ability to get apparently resistant families to do what you ask of them. How did you manage that?

At the time I wrote Families of the Slums, I was overflowing with political passion for the defence of the underprivileged. I had enormous fervour and people responded to it. We were all, at that moment, tremendously hopeful about the possibility of teaching the poor to become competent in that social laboratory, the family. We relied on techniques that involved entering the conflict and stepping out of it, being at once observer and participant in the session. We would say: “Mum, talk to Jimmy and find a way to make sure he really listens.” The aim was to get parents to exercise their competence in an area where they could succeed. The more competent people felt, the more they listened. Our naivety, at the time, was that we could not yet see beyond the boundaries of the family and recognise the impact of the wider culture. That came later.

The art of the small victory

When I think of the teaching videos you made at the Philadelphia Child Guidance Clinic, what strikes me is the art of the small victory – going through a hellish battle to get someone in the family to do something they had never done before. Of all the cases you have treated, is there one that stays with you?

There is a famous video of a young anorexic girl eating a sausage. It was a dreadful family situation. There was this girl, Carol, whose weight was so low that she was in danger. So I said to her parents: “If she doesn’t eat, she will die. You are the parents. Don’t let her die. Do something.” In that way I tried to help the family discover a new pattern of interaction by creating a crisis in which the parents had to do something new for them. Those parents now found themselves facing an impossible situation. The mother begins by saying, “Carol, I want you to eat,” but shortly afterwards she and the father start arguing, and then I say: “Look at what is happening now. Carol still isn’t eating.” And the parents then turn on the daughter: “You are going to eat!” And food is no longer the subject; questions of power, autonomy and control become the central theme of that transaction. At that point, it becomes possible to come in supporting the daughter’s autonomy, not around eating, but around what her parents are doing.

But how did you avoid getting stuck in the power struggle?

A therapist has to walk on both sides of the street. At the same time as you get the parents to take control, you also talk about the daughter’s autonomy. You explain that good parenting is not only about control, it is also about giving space. And while you are encouraging the daughter’s autonomy, you talk to her about the parents’ need to be respected. Bringing the conflict into the consulting room is only the first step in challenging the old pattern and moving the parents out of the daughter’s world. Perhaps I am thinking of this particular family because Carol called me a few months ago to tell me that her father, whom she had not seen for 25 years, was dying and wanted to speak to me one last time. After all those years, he still felt connected to me and to what had happened in therapy. In a way, talking to me at the end of his life was a way of closing the circle. I am often surprised at how long the memory of the therapist lasts in a family’s life.

Your skill in handling conflict seems to rest on your talent for convincing each of the parties that you are with them. What stops families from seeing you as a manipulator?

For people to accept my interventions, they have to know that I really see them. They have to say to themselves: “Yes, that’s me. Yes, he’s got my number.” I think what makes that possible is that I genuinely care about them. As soon as I work with a family, I am absolutely preoccupied with it. I suffer with it. I weep with it. When Jay Haley wrote about Milton Erickson, he emphasised his inventive interventions and his handling of hypnosis and metaphor. But when you watch the videos of Erickson with patients, what you see above all is an absolutely kind man.

Exploring the past to widen the present

Since the early days of structural family therapy, you have been regarded as the champion of the here-and-now approach to change. So I was surprised to read, in your new book: “We have tried to revisit family history.”

I believe that, in order to understand the present, one must always make forays into the past, so as to free oneself from it. The analysts believed that too, but for them the investigation of the past was open-ended and took a great deal of time – “First, tell me about your father. Now, tell me about your mother.” And one went on exploring, again and again, weaving those threads together to build an interpretation of the present. My idea of how to explore the past was different. I saw it not as an intellectual exploration but as a search for new responses. One begins by seeing the narrowness of people’s responses in the present, and one asks: “How was that narrowness learned?” Then one explores the past, looking for something very specific and very targeted. The exploration is the search for the solution that will make the client more complex in the present.

What exactly are you looking for in that exploration?

One explains to people that families turn people into specialists. The speciality may be: “I have to defend myself against criticism,” or “I am accepted when I help others,” or “I am recognised when I am a winner.” Each of these labels of the self comes with a view of the complementary roles that others adopt, and with a few preferred strategies for facing life. People thus develop a style of transaction with their significant others and, although they may have other alternatives available, they are specialists in that one. As a therapist, one looks at the past to see how it created limitations that are no longer useful now. And one says to the client: “Let’s use this knowledge to free you from the constraints that no longer serve you.”

Does that knowledge, in itself, free people?

It is, fundamentally, Harry Stack Sullivan’s concept of parataxic distortion: the idea that one is not really responding to the present, but seeing it through blinkers one has forgotten one is wearing. And the therapist, in short, says: “Let’s take those blinkers off.”

What do you think of Jay Haley’s statement in his latest book: “Rather than assuming that insight into past causes produces change, it is better to think that change produces insight into the past”?

I think he is wrong and he is right. I am an old man, but I still have childhood memories that cannot be erased. Some are uncomfortable and I would like to erase them, but they do not go away, even though I have changed and am richer in experience. I know how those early experiences continue to organise my thinking today. But, up to a point, I am able to marginalise them so that they are not significant in the way I function. They are still part of me, and I continue to believe, truly, in the importance of understanding the past, so as to give people the freedom to take off their blinkers and see how the past organises the present. From that point of view, I disagree with Jay Haley. But I also think he is right. Something else happens when one works with memory. Not only does it change the way the person observes the present, it also rearranges the past.

What do you mean?

I think we are continually rearranging our past. Some therapists, like Milton Erickson, would sometimes deliberately introduce, through hypnosis, old memories that had in fact never happened. But even outside therapy, this happens automatically, all the time. Let me give you an example. A few years ago, I visited my old secondary school, in Argentina, where I met a lady of my age who asked me what I was doing there. I answered, metaphorically: “I am hunting ghosts,” which is a very Argentine way of speaking. As the conversation went on, we discovered that we had both been at the school at the same time. But although she told me her name, I could not remember who she was. Later, I went to the school office and asked for the register of former pupils. The moment I saw her name in the register, the memory of her as an adolescent came completely into focus. Obviously, her adult presence was interfering with my memory. Suddenly, all sorts of memories that had not come back to me in 50 years came back, not in the competitive and shy form in which I had originally lived them, but from the perspective of an older person looking back. My memory created at that moment something very different from older memories of the same period.

So you think we are constantly “recovering” memories?

Yes, I do. The mistake some therapists make is to believe in the immutability of memories. I believe we are always creating memories; it is a normal and natural process. What I disagree with is the idea that once those memories appear in therapy, they represent truth or reality. Therapists must take care not to see memories as an immutable truth.

What twelve years have changed

Since our last interview, 12 years ago, what have you discovered about what it is to be a good therapist?

Over those 12 years, the certainty I had when I was younger has disappeared. I no longer believe I hold the truth and I have become more tolerant of other points of view. I know myself better, and I know that when something new appears in the field, my first response is to oppose it, and that only afterwards do I begin to integrate it. My first response to the feminist movement was to react negatively to what I saw as stridency, all the more so as I was the target of many of its criticisms in the field. But I have learned to integrate many feminist ideas. And yet I still have difficulties with the constructivists, as I was saying earlier; something similar happened to me with the work of Michael White and Steve de Shazer. I begin with polemical oppositions, then I move towards assimilating what I consider useful.

So, for example, what do you find useful in solution-focused therapy?

I like looking beyond problems, towards solutions, saying to clients: “What would happen if one day you woke up in the morning and your problem had disappeared? What would that look like?” I sometimes use those questions, just as I have integrated a good part of what has been written in family therapy, in particular the ideas of Jay Haley and Carl Whitaker. Today, technically, I am much more complex than when I was a younger therapist. A large part of that, of course, is the fruit of age. As one gets older, all certainties turn into question marks. One also begins to ask oneself fundamental questions, such as: “Would the world be different if I did not exist?” One then becomes less attached to one’s particular contribution.

How have you assimilated elements of feminism into your work?

The feminists made me aware that I had locked women into narrow categories and that my labels for women carried gender bias: for me, a mother’s concern could easily be dismissed as “overprotection.” I focused on the man, who provided direction, and on the woman, who provided nurturing, and in my work I insisted on the importance of direction while taking nurturing for granted. I think I no longer do that. I am more attentive to the messages that labels carry and I am careful about what I privilege. But I continue to work, systematically, by observing how the partners in a couple trigger one another in their interactions. I have always thought that working with the man was an important way of drawing him towards the family, of making him more involved and of lightening the woman’s burdens; but today I take more care to make sure that her voice is heard, that her pain is expressed and that her need for respect is understood.

And the narrative approach?

Do you remember Nathan Epstein?

Of course.

Nathan Epstein had an extraordinary quality: he inspired family members and quickly turned them into talmudim.

Meaning?

Talmudim – literally, it means “students,” but I understand it as “the rabbi’s pupils.” Epstein would say to his patients: “I want you to study your family,” and, one way or another, he managed to create a lively atmosphere of intellectual investigation in which everyone became involved. Externalisation has the same capacity to reduce emotionality and to place people in a position of investigating the effects of the world on them, while strengthening the intellectual possibilities of something new. It gives families the idea that the enemy is outside them and that the family members are okay, united against the forces outside. I find that very clever and very good.

So you have assimilated these various influences, but do you think therapy has really changed much?

Theoretically, I do what I have always done. I keep looking for the way the family’s ordinary transactions sustain the conflict. In a way, I still say to people: “There are more possibilities in you than you think. Let’s look for a path to help you be less narrow.” But the ways in which I say it today are less dramatic than they used to be. I ask more questions and give fewer prescriptions.

The therapist as an instrument of change

When you look at today’s family therapists, what bothers you most about the direction the field is taking?

Let me take a detour to answer that question. I think what therapists do is get people to respond to the tools they use. So, if my favourite tool is the question “Imagine that one day the problem has disappeared,” I am going to have to create an articulate patient who responds to that tool. The same goes for externalising questions. I remember watching Michael White conduct a teaching session of narrative therapy, but it was like watching a sheepdog at work. He pushed people through a series of questions constructed with the aim of getting them to see their story more positively, which was what he wanted for them. The therapist changes the old story and convinces the client that the new story is truer than the old one. We all offer our patients a language, and we tell them: “Let’s start seeing your life in this language, and I will give you solutions in this language.” I do it. Everyone does it. What bothers me today is that, as a field, we have become so interested in these therapeutic techniques and in our particular language that we pay little attention to the family-therapist system and to the therapist as an instrument of change.

Why do you think we have gone in that direction, towards what you call the “non-interventionist, restricted” therapist?

Some people talk about doing a “more respectful” therapy, one that does not impose the therapists’ biases. But I do not think it is about being more respectful towards clients. I think it has to do with changes in the social outlook. As citizens of this pessimistic society, therapists have lost their optimism and now have only low expectations of effective change.

Does that include you?

No.

How did you escape it?

I grew up as the son of immigrants in an expanding world, where people felt that through hard work one could realise one’s dreams and master one’s destiny. For many people today, those beliefs seem naive. Perhaps I am still part of the nineteenth century. But I think it is also important that, years ago, I stopped thinking of myself as a family therapist and became interested in how the skills of systemic therapists can be applied to the wider world. I moved from thinking about the small family unit to thinking about the possibilities of acting on larger institutions. So, working in a field where there are new possibilities, I am still optimistic. I am exploring with the Massachusetts Department of Mental Health ways of making home-based therapy more effective, which is the kind of challenge I love. If I worked only as a therapist, I would probably have had to respond to the limitations of the market like anyone else. I would be tinkering with alternative therapeutic approaches that are easier to use, or with simple methods for training people at lower cost.

How do you see your relationship with the field of therapy today?

I used to influence the field from the centre. Today, I do so from the periphery. I am now an elder. I support other people whom I think are doing interesting work. I think being critical is part of being an older person. I also think an elder is the bearer of the field’s oral history, and that is why I feel bad when young therapists do not recognise the influence of people like Murray Bowen, Virginia Satir, Jay Haley, Carl Whitaker and Lyman Wynne.

Do you feel satisfied with your life, at 75?

I thought that at 75 I would retire and become a full-time grandfather. But retirement is not a comfortable niche for me. Other people, at 75, think it is time to paint, to play the piano. But that is not enough for me at this stage. Patty and I moved to Boston to be near our children and our granddaughter. My relationship with my granddaughter is very, very special. So there is a renewal there. But I am someone who likes helping others. I do not find it very useful to look too much towards the past or to project oneself too far into the future. I am in touch with the immediacy of the present. Even though we are financially comfortable, I need to work to keep myself intellectually fit, and because I enjoy it. After all these years, if a family calls and wants to come into therapy with me, I still enjoy it.

Two views of Minuchin