Rome, the 1970s: between psychoanalysis and systemic thinking

When did you begin to take an interest in family therapy?

In the 1970s, family therapy in Italy was carried by the anti-psychiatry movements, and I became interested in it because it meant re-valuing the environmental context, placing the emphasis on the symptom and decentring the identified patient. With Carmine Saccu, we began in the child neuropsychiatry department of the university. Minuchin had not even been translated yet! In 1975, we organised the first family therapy congress in Europe. That congress created a division, and my group ended up being made up of Saccu, Menghi, Andolfi and myself; we began working with schizophrenia and we agreed on the need to use new techniques. That is how the group ventured into provocation.

I represented the wing of the group most open to emotions. I was in personal analysis and I began to explore these two lines that seemed hard to integrate: psychoanalysis and systemic thinking; the intrapsychic influence of affects led me to take an interest in metaphor, and so I focused more on the study of metaphor than on provocation.

Does the use of metaphor serve the same purpose as in Erickson?

Not exactly; I was influenced by the work of Whitaker and of Bateson, who was the author who most aroused my interest. Among the members of the group, I was the one who paid most attention to the symbolic aspects of the interpersonal dimension, in the family as much as in the individual or in the group. The way in which the symptom can represent a symbol – whether within the functioning of the individual, or as the symbolic dimension of a world not communicated by the family – could find in the metaphorical object a vehicle of expression. A translation took place between two languages: on the one hand from the language of the individual to the system, on the other from the pathological language, incomprehensible as such, to the language communicated by the family, which is shared.

And, as such, what is its impact on the level of affects…?

For me, today, it is extremely high.

But, from that time until today, both the systemic model and the psychoanalytic model have evolved. What do you think about that…?

Absolutely. With the revolutionary impact of the systemic approach, very important changes have taken place over the years; certain themes have been brought back into discussion, such as the focus on behaviour or on the symptom, or the fact of not observing historical continuity; the history of the family, the multidimensional dimension, has therefore taken on a great deal of importance.

Bateson gave importance not only to communication and language, but also to play, to metaphor and to the dimension of emotions, aspects that are very often relegated.

And in the psychoanalytic field?

At least, what has happened in Europe and also in the United States is a series of works centred on the here and now, where relational aspects take on great importance; those classical aspects of psychoanalysis that made it an outdated model have been lost. For me, the relationship between analyst and patient in the here and now is very important, and the intervention arises from this relationship. Today there are currents that speak of the shared fantasy of the analyst-patient couple, and even interpretation itself comes to be structured within the work of this relationship. That seems to me a “grossa”, a great transformation of the perspective of psychoanalysis.

Anna, do you also adopt the concepts of transference and countertransference?

There are two ways of conceiving these two concepts: the classical way, as the transposition of the past into the subject’s present – I think that is a restrictive conception. There is another position, which sees transference as a global situation, that is, within the transference one can observe everything that belongs to the therapeutic relationship. We can imagine that each person carries relational models: from birth, the human being decodes, learns each successive experience of reality. For example: a mother brings her child for his first day at nursery school. It is an important experience, because one can see in it how separation is faced. She may bring him with the father, or leave him quickly, she may be moved by the child’s tears; another mother will tell him that he is a big boy and must not cry. The child will learn from this experience, which will have an effect not only on the cognitive level, but also on the emotional level; these affects, this way of coding reality, will therefore mark the rest of his life – but not rigidly, because we learn from many experiences.

The therapist as a transforming element

And how does the learning from these experiences come into play in the therapeutic system?

When the therapeutic system is constituted, the therapist, the patient, the family re-propose relational models and contract a new mode of relational functioning. For example, a family tries to place the therapist in the relational function that is complementary to it, and the therapist can become a transforming element for the family insofar as he is capable of decoding within himself the function that the family wants to assign to him, and which he will try to modify, both in the sense of his being in the here and now and on the cognitive level, that is, by working through the experience with the family.

How would this position translate into an example…?

A family calls me urgently: “You must see me as a matter of urgency, because something terrible is happening to me…”; the first question I ask myself is whether I should respond to urgency with urgency, or set a session after a certain delay. From the first meeting, I observe how this family presents itself: it may focus the problem, ask me for specific things that I may consider non-urgent. I think I have given an answer by delaying the session, but I can also think that this is not enough, that it must be linked to an analysis of what I see; or I can make an intervention after listening to the family, pointing out to them “that, in their home, one can only be heard when things are serious or urgent”. The important thing is always to accompany this study of the anxiety and the defence that the family presents, by developing it in the here and now of the session. So I have to intervene on two levels: one with my response in the therapeutic attitude, the other with the explanation of what I see.

Resonances: “Each plays the other’s game without realising it”

It is obvious that in every human relationship, to one degree or another, affect circulates. What difference do you see with the concept of “resonances” proposed by Mony Elkaïm?

I think we can change the name of many things, but things are not always that; the important thing is that we understand the concept. I am referring to a natural complementarity that arises in human relationships, where each person carries relational models that are enacted in interaction with others, who in turn respond with their own models.

So choices would not be the product of chance…

In a marriage, it is not by chance that one person chooses another, according to their needs, their demands; the choice of a partner is a choice of unconscious complementarity, which is why the choice is not fortuitous: it is an unconscious contract that is fulfilled, a dimension of reciprocal agreement. Laing pointed out that “each plays the other’s game without realising it”. On the one hand, it is an explicit communicative game, and on the other an implicit game, made up of reciprocal projections, fantasies, fears, feelings. The concept of “resonances” clearly evokes countertransference for me. Family therapists have frequently spoken more of this concept than of that of transference, because it is easier to delimit. There is a general dimension of the emotions that the therapist experiences during the session; by decoding it, one understands what the problem, the conflict, the emotion of the family member who is communicating is, and this takes place through the therapist, because personality is like an organ of perception and must be used as such.

What I understand is that, in your view, there would be no difference…

For me, no; but it seems to me that Mony emphasises (“sottolinea”)… In any case, I think it is extremely interesting that family therapists are approaching this concept. I could add another idea: I believe that the potential of many systemic family therapists who theorise about prescriptive aspects or place the emphasis on language lies in their personality. In my group, we had invited many trainers, for example Minuchin, Whitaker, and what was extraordinary about these therapists was the emotional impact. Therapy is not made up solely of theoretical conceptualisations, but also of emotionality and of the capacity to modify problematic situations. What I am trying to understand is this dimension of emotional impact.

Interpretation or construction?

Could we think, from a constructivist perspective, that interpretation becomes effective because the therapist introduces into the patient’s cognitive system new information that resizes his reality, rather than thinking that its effect lies in making the unconscious conscious?

Certainly, that is right. I believe that the conceptualisation of interpretation as the revelation of something hidden, the revelation of the unconscious, is no longer endorsed by any psychoanalyst in the world. Interpretation is a hypothesis that the analyst formulates around a narrative constructed, on the one hand, with what the patient tells and, on the other, with what has been told during the session through the therapeutic process, according to the patient’s behaviour in the course of it. This hypothesis, which is debatable, is offered, and it arises from the therapist-patient relationship.

Obviously, one offers another way of conceptualising not only the problem, but also the theory that the patient has of himself and of his functioning with the world; one also seeks to reconceptualise it in a different context: the therapeutic context.

It is important not only to offer a cognitive instrument, but that it be experienced in a different way in the relationship; for example, each family comes with its myth, but I will only be able to know it insofar as each member tells me a piece of it; the final product will be the result of my co-construction of the myth with the others, which will always be different from the original myth; the latter does not interest me, because in itself it is not knowable. I construct something old, but which is posed in a new way; every construction, co-construction or reconstruction brings something new; the operation by which I construct a new myth reconceptualises the old myth and brings about in the family the opening of a new possibility, of a different view of the myth they carry. The past in itself is not knowable.

So where is psychoanalysis, if interpretation does not reveal the unconscious and if the past is not important…?

For me, the past is always present and manifests itself in the here and now in a transformed form; we carry our past and we constantly re-actualise it. That is how there are moments in our lives when, thanks to our particular experiences, we can reconceptualise and remember things whose existence we did not even know of before, and which allow us to look from a new perspective. The unconscious is a theory; it has never been demonstrated on the neurophysiological level, it is a construct. The word unconscious means what is not known; it is obvious that we carry many things of which we have no knowledge, which are deposited in us and which are activated at certain moments and not at others; either one can go through one’s whole life without becoming aware of them, or they can be deposited in a kind of family memory. For example, the concept of the transgenerational: there are aspects or characteristics that pass from one generation to the next, of which we are not aware, but which we carry.

I can re-propose the modality that was my mother’s without knowing it; yet I put it into play. It is a different conception, where the unconscious is conceived as a big bag in which things are kept. It is made up of memories and relational styles that change continually, that are shaped and modified.

Freudian psychoanalysis at the beginning of the century was surely very different… What do you think of this highly structured division between observing families from a systemic viewpoint and from a psychoanalytic vision?

I have retraced a little of the history of my group because the opposition we had at the beginning, when family therapy was defining itself between psychoanalysis and the systemic world, was not an opposition to systemic epistemology, but to what we considered its behaviourist version. The former nowhere says that there are no affects or dimensions that we do not know at all. Behaviourism, on the other hand, speaks of the black box and asserts that we can only know visible interactions – mainly among certain therapists of strategic orientation, who maintained that one could only act on observable interactions, what could be seen on the videotape and commented on…

If we speak of affects, emotions, resonances, we are dealing with non-visible interactions; there are multiple imperceptible interactions that pass between people. The important thing is that we manage to observe that, in reality, there are various levels of reading.

What would they be…?

The levels of reading are many, all are present and all are valid; the problem is to adopt an epistemology of greater complexity that leads to integrating them. One level could be that of visible communicative interaction, classical family therapy, as taught in part by the “pragmatics of human communication”. Another would be to conceive the family through boundaries and hierarchies, the study of alliances and coalitions, etc. I remember an article by Sluzki which recommends, in the treatment of a couple with their child, observing who looks at the husband while the therapist is talking to his wife, and whether there is a coalition or an alliance expressed visibly; the level of non-verbal redundancy is very important, because it allows us to see a first outline of the system and its rules.

Where do you situate, among these levels of reading, the plane of affects?

It would be a second level; for example, the anxiety that each person carries within.

There are families that are constituted on the basis of a separation anxiety, or of the mourning that marked the parents, of the defence against that mourning, with which “that is not talked about”, or else, when separation is talked about, they act as if everything were fine. But in reality there is, on the one hand, the anxiety itself and, on the other, the anxiety that diversifies in each of the members, who enacts it in a different way. The family may defend itself as a group or individually. This can be seen in the therapeutic process: when separation is talked about, the family will defend itself against the resulting anxiety; it is a second level of non-visible interaction, which is expressed in the analogical dimension of the frame (the “setting”), in fantasy, in lived experience, in free associations, in dreams.

Who does the dreamer’s dream belong to?

Do you integrate the technique of dream interpretation into your work?

Yes, I work a lot on the family’s dreams. Each family member associates on the dream that one of them presents. I try to see what the family’s common complementary dreams are, what things are shared and what defences each one has in a differentiated way.

In the dream, do you work on the symbolic, the metaphorical plane?

Yes, but not only that: I also work on the way in which it is constructed. I recently wrote an article entitled “Who does the dreamer’s dream belong to?”, which presented the very interesting case of an obese patient, who recounted a dream that terrified her, the main content of which was snakes coming out from under her bed and wanting to bite her… In parallel, there was her father’s dream, in which he said that someone gave him a basket from which snakes came out, writhing wildly in the warmth of his hands. The dream was longer, but the interesting thing is that the anxiety was the same in the father and in the daughter. This father maintained that he had no problem with his daughter’s individuation, since she had begun to live alone, she was autonomous. In reality, there was a great complementarity, expressed in the dream at incestuous levels, which led her to be unable to experience her woman’s body as an exciting, erotic, sexual body. The symptom becomes the metaphor of a problem that involves the whole family; I have only told you about the father and the daughter, but other members are included in it.

According to your line of work, past and present are continuous, interpretation does not reveal the unconscious, and it is not a matter either of finding the present effect in the causes of the past. So where is linear epistemology in your whole psychoanalytic model?

Exactly! There is no linear epistemology; but I am not the only one to say so, forty years have gone by, many think this way, for example Bion. I think history is important, since we are constituted according to the experience of our past and the context in which we act in the present.

Each of us may have traumas in the linear sense; nevertheless, we cannot speak simply of trauma, we must speak of responsibility, of subjective response, of the fact that our history is organised in a certain way, that we are the product of interaction with our family, that there is a level of mirroring between individual functioning and family functioning. We carry our internal family, which is the subjective transformation of our real family. We carry a past as well as its transformation. Pathology blocks the possibility of transformation, it hinders the normal capacity to learn new things from experience, which leads to modification.

In our past lie our family relational models, but also other models, and in the encounter we gradually modify them.

Finally, do you integrate behavioural prescriptions into your work? In general terms, what is your form of intervention?

My style is based on the therapeutic relationship and on the possibility of using interpretation. Since, in the family, primitive dynamics are activated, I do not use this technique alone. For example, I work with confrontations of the contents that each family member possesses, and I circulate this information throughout the whole family. Currently, I no longer use prescriptions.