What I am talking about, and from where

Responding to the request made of me to give my perspective on the evolution of systemic therapy in the United States, and far from attempting to draw an exhaustive map, conceptual or otherwise, of the territory of systemic therapy describing its schools and its trends, I will mention a few developments that, in my opinion, have significantly changed the way systemic therapy is practised and taught in the United States. It goes without saying that these changes are intrinsically linked to the contextual changes in the field of mental health that swept across the professional arena in the 1990s and the early years of the twenty-first century. I will not claim that my opinions are comprehensive or exhaustive. They are, however, the inevitably partial perspectives of a professional who has been very heavily involved in these developments.

I will focus mainly on the field of family therapy which, traditionally, has been the mainstay of the development of systemic therapy since its beginnings half a century ago. Organisational consulting and mediation have been other areas of application of systemic thinking and have developed significantly under the effect of the changes I am going to explore in this article, but they are not my main fields of practice and I will not deal with them. Under the heading of family therapy, on the other hand, I will include systemic interventions in the field of mental health, both at the level of direct clinical care and at the level of the making of health policy in the community, two domains that have evolved alongside family therapy and that are also part of my professional practice.

The end of the masters and the gurus

Born as an intellectual adventure at the margins of the then dominant psychodynamic perspective, systemic therapy first committed itself to practices that addressed the most demanding cases in mental health: psychoses, anorexia, delinquent and oppositional conduct in adolescents, and so on. Lacking an adequate language to describe those early studies, the founders of this new field showed others their actual practice, and the one-way mirror rapidly became the instrument of a transparency until then unknown in the domain. Expertise ceased to be understood as the skill of conceptualising clinical cases and became the skill of actually conducting those difficult sessions in which families were beginning to be included, in order to make a difference in situations that had until then remained resistant to change. Although theories developed quickly, the knowledge of how to conduct sessions remained an essential part of training in systemic family therapy; and the field, however much it was born of heterodoxy, could not do without its masters, who at times took on the proportions of gurus.

But the decades have not passed in vain on this point. In the United States at least, the great masters of family therapy are in retreat, partly because family therapy is no longer the great new fashion in a country where new trends arise and subside quickly, but also for other reasons. The dynamic of following a Master developed at a time when, despite the supposedly irreverent spirit of the 1960s, the authoritarian flavour of interactions remained fairly dominant. Patriarchal practices, criticised since then by the feminist movement that existed within the field, have clearly been part of the equation as well.

Since that time, authoritarianism has become unacceptable in educational institutions, the civil rights movements have worked to consolidate the position of minorities, women have gained greater equality at every level of professional practice, and teachers are only rarely treated any longer with that mystifying respect which prevented students or young professionals from questioning them: the latter ask for more transparency and demand that the “secrets” which make the former experts in the field be revealed to them.