A powerful yet little-known approach

Among the approaches that have gradually founded schools in family therapy, there is one, the subject of the present article, little known but therapeutically powerful. Its relative lack of diffusion is due — in my assessment — to conceptual causes, to technical causes and to causes bound up with the training of psychosocial practitioners.

Among the first, the fact of widening the unit of diagnosis and intervention gives it an inflection of its own, which makes its traditional classification awkward.

Moreover, because it counts among its pioneers eminent family therapists of psychodynamic orientation such as Bowen, Whitaker and Boszormenyi-Nagy — to name only the internationally best known —, it has aroused a certain mistrust among systemic “purists”, who are horrified by the notion of history or of the past. It must be said here that a frequent mistake — because one works with the families of origin — consists in believing that one works with relationships belonging to the historical past, in the manner of the objects introjected in the unconscious that traditional psychoanalysis privileges. Nothing of the sort: operating within the current relationship with a significant figure in the lives of the members of the nuclear family clearly situates this work in the here and now. This relational reading in turn radically differentiates it from psychodynamically oriented therapists who work with relatives as a function of the individual patient or of the family unconscious.

Among the causes of technical origin, it matters greatly to stress that the pioneers cited above had a characteristic in common, one and the same clinical context of apprenticeship: psychotic patients and their relatives. The dissatisfaction of these clinicians with the therapeutic results obtained by the two-person psychotherapeutic approach led them to widen the therapeutic context. The great emotional, psychological and practical dependence of these patients on their significant relatives led to those relatives being brought into the treatments, and thence to a systematic reference to the families of origin. Added to a greater emotional commitment and to the need to work as a team and in co-therapy, these elements make such treatments objectively more complex.

Among the reasons bound up with training, there is not only the scarcity of teachers clinically trained in this approach, but also the existence of a subjective element of considerable importance. The relational difficulties within the therapists’ own families of origin, the very engine of their vocational choice, mean that there exists a reluctance and a fear — sometimes rationalised — to become involved in the complexities of dysfunctional family systems.

The double message of the therapist’s family of origin — “Get an education so that you can cure our psychological difficulties, even though we shall never acknowledge them” — is followed by the double message of the patients’ families: “Relieve us of our suffering, but without changing us.” Onto the existential challenge of the first is superimposed the technical challenge of the second.

Therapeutic foundations

The essential paradigm of family therapy, the one that differentiated it from other disciplines, was that in order to relieve the symptomatic patient, their family context had to be modified. Far more than that: when we have a global view of the dysfunctional family system, we see that the pathological signals are perceptible in three different domains — the mind, the body and the relationship to society.

Consequently, a dysfunctional system will “suffer” through its members in different domains of individual symptomatic expression. Thus, from the systemic point of view, a psychopathological problem will have the same symbolic value as a psychosomatic or sociopathic one.

By treating a family group as a whole, one should relieve the symptoms in all these domains, and not only in that of the identified patient. This requires that the whole family system be understood and treated.

It is here that certain technical difficulties appear, coming from the surrounding culture. What is the context that must be changed so that the nuclear family can improve its functionality? It is not only a matter of modifying the intrafamily dynamics, but also its relationship with the social macrosystems that attempt to compensate for the shortcomings of the contemporary nuclear family.

The change in the traditional structure of the family (the cohabitation in situ, or nearby, of the three generations), together with the prevailing mythification of individualism, has caused the loss of functions of solidarity that the traditional family fulfilled and that present-day society still does not ensure (see Zwerling and Boszormenyi-Nagy).

So it is that summoning the families of origin is necessary not only in order to reconstruct a shared reality, like the pieces of a puzzle, which gives history its meaning and helps towards better primary prevention, but also in order to reinvigorate bonds of solidarity of great emotional power which, channelled therapeutically, can be of enormous help.

Here the therapist must be the catalytic enzyme that activates self-therapeutic elements always present in every family system, and at the same time the integrating pivot of the diachronic and synchronic axes of those systems.

As Boszormenyi-Nagy puts it: “The conjunctive reversal of relational stagnation (relationships that have been interrupted, denied, abandoned, rigidly fixed, and so on) may offer a more effective strategy than the undeveloped psychological resources of the individual.”

Essentially, therapeutic work with the families of origin contains a highly paradoxical element: going back in order to move forward better. The search for better differentiation is achieved by engaging with them until maturity is reached, like a fruit that falls from the tree at the right moment — and not, to continue the metaphor, as when it is picked while still green to be kept in the refrigerator. “Taking one step back in order to take two forward” means drawing one’s strength from that energy badly spent in neutralising relational disagreements, and using it for a creative insertion into society.

The central element of a symbiosis is a deep disagreement. The frustration of the passing on of the affective, psychological and functional elements that characterise the confirmation of the other’s identity, in both directions, is what contributes to the transgenerational arrest, the source of many conflicts. That blockage is what deprives a system of its functionality, by preventing it from advancing in the process of life. It is in intergenerational harmony, where each fulfils the role assigned to them by their own evolutionary moment, that the secret of a family system’s functionality lies.

The generational transcendence of affective and cultural values is what guarantees the survival of persons beyond their physical death. Just as all the elders on this hierarchical scale have a right to that transcendence, all those who come after them also have the right to feel nourished by that strength which comes to them from their roots.