Canevaro’s model: between belonging and differentiation

Alfredo Canevaro presents a model that recommends meeting the patient alone four or five times before meeting them with their family of origin. According to Matteo Selvini — author of the preface to the Argentine psychiatrist’s book —, in this way it will then be impossible to reduce them to a pawn in their parents’ marital impasse, or to a mere victim of a chain of transgenerational suffering that could be visualised in the representation of their genogram (Matteo Selvini, 2008).

In the author’s experience, 70 to 80% of the content of individual sessions revolves around problems concerning difficult differentiation from the family of origin and, as a result, the difficulty of finding one’s place in society with a satisfying existential project.

He reflects on the fact that if we follow the current of preconceptions — some of which cling to our thinking as tightly as a mussel to its rock —, we could let ourselves be drawn into guiding individuals towards a struggle against their family system, then understood as resisting the person’s process of individuation. He reminds us that, for him, one of the most pervasive myths in psychotherapy is the belief that an adult individual must fend for themselves through this difficult period without the help of their family of origin. Yet, if we polarise the reflection the way this author does, the human being seems to struggle along an axis oscillating between two great needs: the need to belong to a family system that gave us life, our name, and with which we have accumulated thousands of interactions; and the need for differentiation, a spontaneous drive that leads us to explore the world and to draw up an autonomous existential project. In this way, eventually, it will be possible to reclaim our lineage in a transgenerational mechanism of survival of the positive values we have inherited.

Canevaro follows the line of authors such as Bowen (1978), who was the first to insist on the importance of the individual’s differentiation from their family of origin, sending patients back to their families so that they could face them and try to de-triangulate themselves from them.

Quoting another author: “I am convinced that a single session held with an adult, their parents and their siblings can sometimes achieve better results than those observed after a full course of psychotherapy” (Framo, 1996).

Inviting the family of origin into the session: what effects?

The direct presence of family members in the session:

• produces a Rashomon effect, with different versions of the same event, which enriches complexity and puts individual positions into perspective;
• fosters the understanding of obscure facts in the family and personal history;
• unveils unsuspected or mystifying secrets through the self-interested version given by certain family members;
• fosters the definition of the relationship within families and with our clients;
• improves the quality of the emotional encounter in the session or, at least, signals the impossibility of achieving it after having tried, which can represent a new starting point (see the paragraph “A frustrating and liberating encounter”);
• fosters forgiveness and reconciliation, which brings deep relief and allows a more autonomous and creative use of one’s energies for the development of one’s own Self.

Yet the summons is always a source of doubt and anxiety. “Won’t my loved ones fall apart if I really lay out what I think?” “Won’t Dad, who has already had a heart attack, relapse during this session?” (p. 53).

The therapist clearly explains the reason for the invitation: “So-and-so came to see me to get help with their problems and, since I consider the family to be very important in a person’s life, I need your collaboration in order to help them better. I will therefore ask you to speak sincerely about the current problems, the reasons behind them and the solutions you propose. Help me to help them.”

This sincere request for mutual help on the therapist’s part is very important to place the family in a favourable position towards the therapeutic process and to keep it from opposing it. The therapist’s art consists in channelling these forces in that direction, in order to facilitate an intervention often deemed useless out of ignorance.

The impact of emotions

“According to Greenberg and Johnson (1990), emotions give meaning to the construction and organisation of reality. They are pre-reflective, immediate, and they synthesise incoming information. They inform individuals about their inner state as a reaction to external events. Awareness of emotional experience provides the individual with crucial information about the satisfaction of the basic needs for survival and the effective resolution of problems. They have a communicative function in social interaction. They orient the individual towards, or away from, the surrounding objects of the physical world and, when processed at a higher level, they prepare the individual for action. In therapy, they foster interpersonal change when we get in touch with the unexpressed emotions underlying an interpersonal vicious circle and redefine the needs or motivations capable of helping to restructure the interaction.” (p. 64)

Forgiveness in traumatic situations

“It is very common that, during therapies and encounters with significant family members, we have to face unresolved conflicts from the past that continue to manifest themselves in current relationships.” Let us recall the therapeutic objectives of these encounters (p. 65):

1. asking for help and information;
2. clearing up misunderstandings;
3. correcting distortions and/or mistaken representations, allowing reconciliations;
4. fostering differentiation;
5. defining the relationship;
6. understanding the parents’ humanity and/or fragility, demythologising them;
7. “moving from intergenerational intimidation to intergenerational intimacy” (D. Williamson, 1981).

The backpack ritual

“For many years I have been practising techniques to facilitate individual or couple psychotherapy. During my research, I invented, on an experimental basis, a manoeuvre (Canevaro, 1999) aimed at fostering the expression of the feelings related to the phase in which a young adult differentiates from their parents, a technique I called the backpack.” (p. 81)

“To facilitate this phase, the backpack exercise allows emotional interexchange and the positive redefinition of the parent-child relationship by giving back to each what they are entitled to have: to the child, self-confirmation and permission to explore the world; to the parent, the fulfilment of an attribution inseparable from their role. Once the first phases of defining the problem are completed and the family members have been summoned to the session, we reach the third phase of the protocol, the interview that will allow misunderstandings to be clarified and the therapeutic objectives to be achieved. After this explanation, and once the parents’ agreement to help their child overcome their difficulties has been obtained, everyone is invited to take part in an experience.” (p. 84)

The technical nuances of this exercise are numerous, and the therapist must be close, not only physically (the distance: the one that allows the therapist to touch the young man’s shoulder with his hand when he says “and he carries a backpack with him”), while lending attentive and silent listening as he writes down what they say on a sheet of paper.

1. It is important to help the parent express one concept clearly amid everything they may say, sometimes by trying to grasp it or condense it into a single word, and then asking them the reason for it. For example, if the father says to the son: “You must be yourself and have a strong, unassailable personality”, we lead him to say: “I give you my determination to be myself so that it may serve you as a strong personality that no one will attack.”
2. Try to keep them from giving recommendations or suggestions, and instead have them make an effort to find a quality or a certain aspect of character to give their child. Instead of saying: “You must be strong in life”, say: “I give you my strength so that it may be useful to you in life when you need it, in moments of discouragement and difficulty.” Or, instead of saying: “I hope you will be able to turn to me if you are in difficulty; the father you lost when you were little is present today, he is here”, say: “I give you my presence so that it may serve you in the important moments, in the difficult moments.”
3. Try to make sure they look each other in the eye when they speak to each other, and remind them to do so, even if they start crying and try to avoid that contact.
4. Keep them from talking to each other through a third person, for example addressing the therapist to speak about their son.
5. Have each of them repeat once or twice what they say, and if necessary have them read what the therapist has written on a sheet divided vertically in two: the left side used to note what the father or mother has given, and the right side what the son leaves of himself. When they finish, ask them to embrace in silence for as long as needed, each resting their head on the other’s shoulder. It is an important moment, often very moving, which — beyond leaving a deep mark on the participants — gives the therapist a great deal of information. Some embrace with difficulty and pull apart immediately. It is then necessary to ask them, if possible, to keep contact with the other for longer.

The therapeutic journey

Initial phase

A-B: Trust — therapeutic alliance — therapeutic philosophy — strategy for convening the family.

B-C: “Greenhouse effect” phenomenon — meetings with the parents and/or the siblings.

Central phase

C-D: Partner — possible meeting(s) with the partner.

D-E: Existential project — after the meetings with the family of origin, the person is already more differentiated; the original existential project is mapped out.

Concluding phase

The changes made are evaluated to understand whether the therapeutic objectives have been reached.

E-F: Verification and therapy review — in this phase, some meetings with the significant persons may be repeated to establish the individual changes in the relationship and the possible returns into the family system as co-therapists.

F-G: Quarterly check-ins at 1 month and 6 months; possible follow-up at 1 year and 2 years.

What I take away from it

Alfredo Canevaro speaks to us of a psychological phenomenon he encounters very often in his daily work as a therapist, and I can only agree with him from my own experience.

The backpack ritual strikes me as very interesting and I have stored it in my personal toolbox; no doubt I will use it in my practice, adapting it to my style.

I hope this short summary has made you want to go further. To extend this reading, the video offering a synthesis of it — in French — can be watched below.