Family therapy and the glamour of science

Journal of Family Therapy (1991) 13: 17-30 01634445 $3.00

Family therapy and the glamour of science

David Goldberg* and Anthony S. Davidt

It is argued that family therapy has adopted esoteric and unrelated theories from ‘New Science’ in order to maintain its glamour and individuality in comparison with other therapies. One unfortunate consequence of this is to limit the development of the practice of family therapy by prejudicing empirical validation. An alternative approach which attempts to integrate linear and systemic viewpoints is suggested.

We have this massive addiction to physical metaphors which, as far as I know, are completely inapplicable to the life and epistemology of real organisms living in a real world. (Rateson, 1981, p. 355. Quoted in Schwartzman, 1984)

Introduction

What does family therapy have in common with chemistry, physiology, palaeontology and meteorology? Although family therapy is about families, which are fundamentally different units from molecules, organs, fossils and weather clouds, all these ‘sciences’ share the use of models or schemata, theoretical maps or frameworks, by which their subject matter can be conceptualized. All these sciences offer explanations or representations of the nature of the world. Family therapy, in offering such representations, acts like science (Schwartzman, 1984; Dell, 1985). The ‘science’ of family therapy uses its models in two related ways, both of which are essential for the healthy development of the subject. Firstly the nature of the model is debated as part of the evolution and intellectual growth of the subject, thus adding understanding (Coyne et al., 1982; Dell, 1982a, 1985); secondly, the models are used when contrasting family therapy with other disciplines. This paper will fiocus on the latter.

* Senior Registrar in Child Psychiatry, St George’s Hospital Medical School,

t Lecturer in Psychiatry, Institute of Psychiatry, Denmark Hill, London SE5 8AF, London.

England.

18 David Goldberg and Anthony David

Family therapy and scientific theory

Family therapy uses many explanatory models including the disease model (or biomedical model), those derived from psychoanalysis and cybernetics, plus the so-called structural and systemic model which are composites derived from multiple sources but which family therapy can justifiably call its own. More recently, some family therapists have tended to adopt certain theoretical models in the physical sciences, particularly those of the avant-garde, sometimes referred to as ‘New Science’. This encompasses quantum mechanics, relativity and chaos theory. The science is new in the sense that it challenges the existence of certainty, objective measurement, and absolute notions of space and time. Light is both particle and wave. The position of sub-atomic particles can never really be known. Events in the universe are unpredictable. Space and time are relative to the observer, and so on.

This, the theorists contrast with what they perceive as ‘established’ science. The process is often seen as a fight between Kuhnian paradigms (Kuhn, 1970) as noted by Minuchin and others who wrote in 1978: ‘Psychotherapy is now in a period of scientific revolution or paradigm shift’ (p. 76). Neutral objectivity is seen as intrinsic to the old-fashioned mechanistic philosophy of Descartes and is seen to be in conflict with the ‘subjectivist view’ where the observer is part of the process under observation (Keeney, 1979; Schwartzman, 1984). Conventional scientists are parodied by being portrayed as absolute or naive realists. These realists believe that X causes Y through process A; that seeing is believing; that i t is difficult, but not impossible, to be objective; that some things are true and others false. These beliefs are opposed to the paradigm of the family therapists who have taken the mantle of avant-garde science. This paradigm we call ‘naive unrealism’: nothing can be separated from anything else; believing is seeing; objectivity is impossible; and truth and falsehood are relative. It is often not realized that these ‘constructivist’ notions of reality (Efran et al., 1988; Held, 1990) have been around in psychology since the nineteenth century, as in the work of Helmholtz and others (Gregory, 1987).

In this turbulent period, some prominent family therapists have allied themselves with New Science, and have appropriated the languages of mathematics (cybernetics and now chaos theory) (Cronen and Pearce, 1985; Bogdan, 1987; Chubb, 1989), physics (quantum theory and relativity against Newtonian mechanics)

Family therapy and the glamour of science 19

(Schwartzman, 1984), as well as chemistry (Progogine) (see McLeod, 1988), biology (Maturana) (Keeney and Sprenkle, 1982; Dell, 1985) and palaeontology (Romer) (Schwartzman, 1984). All these are allied with revolutionary theories which successfully challenge the existing order in their subject.

Why does family therapy need t.o justify its theories in terms of sciences to which it is not directly related (other than metaphorically)? The answer we suggest is that family therapy as a profession gains credibility by claiming that its theories are upheld in disparate areas of science. One family therapist goes as far as to state, in this context, that: ‘We wanted to validate ourselves as scientists not as mystics’ (Auerswald, 1987). A model may be considered more valid in family therapy if it is comparable to o,ne currently used in another area. The family therapists cited above choose the physical sciences and not the social sciences despite the fact that family therapy is more closely related to the latter. Family therapy, like all other social sciences, is concerned with sets of moral views, values and attitudes; it is this concern with a symbolic system which is inherent in the study of social science. Sets of moral views, values and attitudes are not inherent in what the physical sciences study; in fact they are proscribed. Theories from the social sciences derived from Marx, Weber and Durkheim are rarely used by family therapists. This may be because the physical sciences - including the new variety - are meant to deal with the most ‘real’ (of worlds, that they are ‘harder’, more concrete and somehow more connected to the outer physical world. In our society ‘harder’, more concrete sciences are given more prestige than the ‘soft’, more ephemeral liberal or social sciences.

One reason why aspects of models from certain sciences are drawn on by family therapists may be due: to the fact that it is difficult for most therapists to criticize a science that does not form part of their training. The experimental work of Maturana, Prigogine, von Foerster and other physical scientists is criticized from within their own professions but none of this i!: discussed by family therapists, partly because we do not have thle required expertise. Each new theory presents a metaphor (Hesse, 1963) which acts as a catalyst, stimulating new associations and usurping others. The end result, while productive, is, we argue, independent of the validity of the original scientific theory.


Family therapy theory

Justifying theory by reference to esoteric knowledge is a way in which family therapy attempts to maintain the esteem of its profession within the maelstrom of other health care professions (McLean, 1986). Special theoretical justification is needed to keep family therapy unique. We predict that the more abstract and unchallenge- able the theory that the family therapy leaders take up, the more successful the theory or model is, initially.’Once the theory has become less abstract and can be put into practice, i t inevitably loses glamour. Newer scientific theories are then needed and the cycle repeats itself. A well known example of this is the double bind theory (Bateson et al., 1956), which provided great impetus to the family therapists of its day and became a widespread non-technical concept and part of popular discourse. As this took place, so family therapists appeared to abandon the concept and replace it with an heir, such as paradox and counterparadox (Selvini Palazzoli et al., 1978), and subsequently, the invariant prescription (Simon, 1987). Could this be explained by waning prestige rather than the failure to confirm the hypothesis in certain limited contexts (Schuham, 1967)? T o survive the pressures of assimilation into the established order, family therapists need to gain status among health care colleagues and preserve their specialist position (De Swaan, 1990). T o maintain their separate identity they are attracted to new scientific models - different from those applied by other health care workers - and the legitimacy they confer. ‘If the speculations of family therapists were perceived as parallel to, or as consistent with, the mainstream, some of the glamour would be lost’ (Bogdan, 1987, p. 32).

The process of incorporating esoteric ideas can be seen throughout the history of family therapy. This can be examined as a myth (Lkvi- Strauss, 1968). The United States of America arguably sees itself as the centre of new approaches to health care. ‘Culture heroes’, such as Maturana, von Foerster and most of the other originators of theories based in ‘hard’ science, come from over the seas and, often using ‘acolytes’ such as Dell (1985), transcribe their works into family therapy theory. These culture heroes act as messiahs who convert the family therapy ‘faithful’ to their theory. This myth is reminiscent of psychoanalyst Wilfred Bion’s messianic basic assumption which saves the group from examining the difficulties of the ‘work group’ (Bion, 1961). Family therapists choose the myth that a model from a distant country and distant science validates their own methodology. This

Family therapy and the glamour o f science 21

helps family therapists as a group in (differentiating from neighbouring therapists whose theories are derived from other sources. The myth also has the effect of seeming to render empirical validation of the methods and assumptions of family therapy unnecessary, since family therapists appear to have already achieved this by proxy, given the undisputed credentials of the ‘culture hero’, and the weight of his or her scientific credentials.

Gregory Bateson, like Freud in the: field of psychoanalysis, created a theory, a model with which to look a.t the world, and with it defined a new field of study (Bateson, 1972). Both men, as fathers to generations of therapists, saw continuity between the empirical biological sciences studied at the onset of their respective careers and their newly created fields. The inheritors of Freud’s or Bateson’s models continue the tradition by seeking justification for their theories in the ‘harder’ sciences without the need to study these in detail as their spiritual father had. Who would seriously consider that the study of the nervous system of an animal such as the lamprey (as Freud did) is useful for the aspiring psychotherapist? The fact that Bateson was both a ‘hard’ scientist and a social anthropologist presents family therapists with a dilemma, whether to choose social or physical science as their theoretical basis. Why do they choose the ‘harder’ of these sciences?

Science and culture

Some clues to an answer for this question may be found by considering the culture of science. Established science is allied with those in political power, and is seen as linked with the mundane world of technology and is considered reactionary. This is opposed to the glamour, art and spirituality of family therapy (Stierlin, 1983), which is seen as avant-garde and revolutionary. This is supported by the number of family therapists who are sympathetic to Eastern philosophy such as Buddhism (Dell, 19823; Madanis, 1989) and to those fighting against political repression (Stagoll, 1986). The pattern is not exclusive to family therapy. Ever since Rousseau, those seeking change have believed that it can occur predominantly though the manipulation of the environment, while those who want to see continuity put their faith in biology (see Rose et al., 1984). Biology, being harder to change, is seen as a reactionary force, pitted against the revolutionary force of environrnental pressure. This dichotomy between old and new, reactionary versus revolutionary, inevitably

22 David Goldberg and Anthony David causes a paradox. As soon as family therapy gains a place alongside related professions it becomes part of mainstream conservative thought. I t will then lose some of its properties. I t will change from being glamorous to being dull, from being revolutionary and challenging to the establishment, to being reactionary. Family therapy has only recently gained a place within conventional psychiatric practice; therapists are now discussing the creation of specialist family consultants and hence there is a danger of its losing its revolutionary fervour and ‘ecosystemic way(s) of working’ (Bloch, 1989).

The glamour of family therapy derives from the belief that ‘systemic thinking’ is radically different from the ‘linear thinking’ of established science. Systemic thinking, the idea that simple cause and effect relationships are abstractions from an overall pattern, runs counter to empirical science. It is, instead, the recognition of patterns or form which is opposed to the atomism and segmentation of linear thinking. This leads to the following contrasts:

Family therapy Systemic thinking New science Cybernetics Wholes Circular Form or pattern Eastern

Conventional therapy Non-systemic thinking Old science Atomism Parts L’ lnear Content Western

One point of interest is that these dichotomies are the same ones that are discussed when the two sides of the brain are compared. The left hemisphere is seen as controlling language, linear thought and the fragmentation of experience. The right hemisphere is considered, in comparison with this, to be concerned with empathy and wholeness and to have a synthesizing function (Keeney and Sprenkle, 1982, p. 15). These oppositions are based on minor differences in one realm of knowledge, neurophysiology, and are used to justify grand opinion in another realm, social and political science (David, 1989). Family therapy theorists use the same dichotomies in an effort to remain both esoteric and scientific.

Circular and linear theory

The combination of circularlsystem thinking and ‘New Science’ with


its idioms of chaos, uncertainty, relativity and so on, introduces notions of unpredictability, randomness, and dependence on the perspective of the observer, and so poses problems for the empirical investigator (see Hofstadter, 1 9 8 5 ) . To adopt the naive unrealist position inspired by New Science confers the prestige of science without its constraints. One particular constraint is the demand for empirical validation. We contend that if systemic ways of working are excused the need for quantitative (empirical) as well as qualitative validation, by claiming to have powerful scientific credentials by association, they will not progress. We will discuss some of the assumptions underlying systemic thinking in an effort to show that it is compatible with these sorts of 'evaluation without sacrificing its uniqueness.

Systems thinkers claim that cutting up the world is artificial and arbitrary. You cannot have a causal sequence between two continuous events (Bateson, 1 9 7 5 ) : therefore family therapists claim that you cannot talk about causal sequences in a system. However, systems thinkers need to cut up their experilence of the world in order to think about it. As soon as you do this, linear causal sequences are implied, however much the intention of implying them is denied. Selvini Palazzoli et a l . (1978) put this argument forward as follows:

In fact, since rational thought is formed through language, we conceptualize reality (whatever that may be) according to the linguistic model which thus becomes for us the same thing as reality. But language is not reality. In fact, the former is linear while the latter is living and circular. (p. 52)

The problem is that all representations of the world, when expressed in words, can always be taken to imply linear causality. This gives family therapy an inbuilt tension or dynamism. All circular processes can also be understood by a series of linear statements; therefore all systems can be placed in opposition to linear causal networks. It is impossible to escape from the pervasive dichotomy: linear versus systemic. Whenever a systemic explanation is expressed in words it can be segmented and each segment criticized for being linear. Thus, each new seemingly systemic conceptualization, for example homeostasis, which was central to family therapy theory for many years, when scrutinized, turns out to have covert linear undertones and so has to be modified. The popularity of the theory of homeostasis arose and declined, not because it failed an empirical test, but because an alternative model, coherence (Dell, 1982a) ,\appeared more acceptable

f o r theoretical reasons.


Another problem is that the practice of family therapy is often at odds with systemic non-causal views of the world. ,When push comes to shove we find it hard to relinquish linearity. Dell (1989) has argued how violence is indubitably and justifiably linear. Equally, if an anorexic girl doesn’t eat she’ll starve. Too rigid adherence to theory causes further dissonance between theorists and practitioners faced with difficult clinical problems (Held, 1990). However, the circularity of the system in which violence occurs is not negated merely because violence is always part of a linear sequence.

A similar dichotomy to that of ‘linear versus systemic thinking’ occurs in orthodox psychiatry. Jaspers, in his famous essay ‘Causal and meaningful connections’ ( 19 13/1974), separates the two disconnected and frequently opposed themes. The causal connections (Erklaren) are related to linear processes of cause and effect which are open to empirical investigation. The meaningful connections (Vererstehen) in psychiatric illness can be seen as non-linear and non-causal. This split has continued down the history of psychiatry and is seen institutionalized in the professional division that separates many psychiatrists from psychotherapists. The psychiatrists ally themselves with the causal and frequently the biological, while psychotherapists (including family therapists) are seen by psychiatrists as allied with the meaningful and usually the non-causal and non-biological.

Systems theory (von Bertalanaffy, 1975) as applied to family therapy is a misnomer: it is not a theory as it does not make predictions. It does not consist of a series of testable hyptheses. Instead it offers a new way of seeing the world, or an epistemology. Non-causal systemic family therapy theories will always be deconstructed and expressed in terms of causal linear sequences (e.g. double binds, homeostasis) so losing their recursive non-causal properties. After each flurry of hypotheses describing causal sequences, family therapy tends to generate a new non-causal theory or adapt one from another science. In order to maximize the yield of this cycle, family systems theorists may wish to consider a more pragmatic approach.

A pragmatic approach Many authors hold that family therapy theory is incommensurate with other theories derived from the physical or social sciences. For example, Auerswald (1986) stated: ‘A new set of rules governing thought, is immanent in “new science” which is profoundly different from the predominant thought system of the Western world, and


furthermore, . . . these two thought systems are separate and discontinuous’ (italics added, p. 13). As this belief will lead to the isolation of family therapy as a discipline and will stunt its growth, we suggest that the relationship between systemic hypothLeses and linear causal statements be clarified. We present in Figure 1 a schematic, pragmatic model. Family therapy can be placed on two related levels, the systemic theory on one level and multiple discrete linear theories on the other. Each systemic hypothesis or theory can be fragmented by a process of deconstruction (discussed above) into a series of causal statements. Each causal or linear statement is open to empirical testing - the staple of unglamorous ‘old science’. The results may disconfirm these statements, leading to modification, or the hypotheses may be reformulated. This process itself is cyclical (Figure 1) .

Systemic hypothesis a

Linear statements

a

b C

connected circular statement disconnected statements

Figure 1. CO-evolution of systelmic and linear hypotheses.

Initial systemic hypotheses are generated, creatively, by an observer in a context, e.g. a participant entering an institution or a supervisor witnessing a family interview. The method is akin to participant observation of mother-infant interaction in psychoanalytic training or anthropological fieldwork. It is generally referred to as ‘qualitative research’ in that the resulting hypotheses are in essence systemic and specific to that context and observer. Once these have been deconstructed, their validation between contexts, rejection or remodelling becomes logically feasible. New linear sequences may then prompt further systemic formulations, and so on in a productive cycle.

Some examples

An interplay between the linear ancl the systemic can be seen in the development of the concept of expressed emotion (EE) (Leff and


Vaughn, 1985). The idea that psycho-social and biological factors interact in a complex multidimensional manner is implicit in early descriptions of families with a schizophrenic member. The linear- causal hypothesis, the double bind (Bateson et al., 1956), arose from this. This was empirically tested and, as discussed above, was largely unsupported (Schuham, 1967), but in the course of this process, a number of supplementary systemic questions pertaining to how individual disturbance is reciprocally linked to family process, suggested themselves. Breaking the process down into linear statements takes us nearer to the conventional view espoused by Leff and colleagues. Here, schizophrenia is a biological disorder which renders an individual at an increased risk of relapse when exposed to certain attitudes ahd modes of relating (an index of which is high levels of EE within the family). EE is clearly a linear, causal conception. By reducing EE, the risk of relapse is reduced (Leff et al., 1984), adding evidence as to the direction of causality. A holder of the former systemic view is entitled to construct things differently; for example, ‘psychiatric symptoms are one way a person can escape a high EE atmosphere’, or ‘psychiatric breakdown in a child is a way of deflecting criticism (a component of EE) away from a marital couple’. By reframing the circumstances in these ways the family may be able to moderate its EE without feeling criticized and without the identified patient feeling blamed. In both cases, that of scientific research and that of systemic family therapy, the concept of EE can be used productively and without compromise. Another example is the finding that high EE predicts drop-out from therapy in ‘anorexic families’ (Szmukler et al., 1985; see also Dare, 1989). Armed with this causal, non-systemic knowledge, a non-linear family therapist may be able to make more useful interventions to ensure a successful outcome, however defined (e.g. by suggesting to the family that they will drop out, and therefore making them less likely to do so).

A major difference between systemic and linear hypotheses is that the former is context-related while the latter may be tested in a range of contexts. In moving from systemic to linear, there is a move from the specific to the generalizable (and vice versa). The following example of a family with an enuretic son is described to illustrate this dialogue further. The therapist’s systemic view is that the child is resisting a different ‘call of nature’, namely to grow up, since his view of the adult world is tainted by the unexpressed tension between his parents. The more intractable his problem appears, the more tense his parents become, so perpetuating the symptom. However, the

Family therapy and the glamour of science 27 therapist begins with some linear hypotheses: that the child wets the bed at night because his bladder capacity is small (testable by measuring volume and frequency of micturition); and the parents have failed to regulate his bladder emptying because of unresolved differences between them as to whose job this should be (testable by behavioural analysis of the parents’ behaviour prior to and following putting the child to bed, etc.). This is done in order to generate a systemic intervention-cum-hypothesis, that the child will only be dry at night when both parents are able to co-operate in training the child’s bladder using the ‘bell and pad’ method. If the intervention were to ‘work’ - a linear notion - all would be well. However, it transpires that the mother has not got time to ‘use the bell and pad because of the birth of a new child. This may generate the linear hypothesis that enuresis is commoner after the birth of a sibling, testable through epidemiological research. As time goes on, the family communication becomes more irritable and the boy’s behaviour more disruptive, leading to more irritation. This systemic conception can be generalized to two linear statements: enuresis is commoner when communication within a family is fraught, and, when enuresis stops, family communication improves. The therapist may then ask the mother to keep a ‘star chart’ of dry (or wet) nights and the father to alternate days when he and his wife argue and talk about pleasurable things, monitoring the effect this has on the son’s behaviour. As well as providing useful information the instruction serves to engage the father more in child care. This may then stimulate the systemic view whereby the enuresis functions both to make the father more peripheral and to encourage him to be less peripheral. This can lead to a more general linear hypothesis that where enuresis is unresponsive to simple bell and pad treatment, the family is more likely to be reconstituted. The family can be told the empirical evidence about the relatively high rates of enuresis in the population and that i t is commoner in larger families, ‘so it is less worrying’, and so on. These static ‘facts’ are offered to the family in response to the systemic hypothesis that parental concern is exacerbating and is exacerbated by the symptom.

Throughout the session, linear statements generate systemic ideas which are fed back to the family who change their linear ideas, and so on (see Figure l ) . To test the statements, all participants are asked to be empirical scientists by, for example, observing associations between phenomena, keeping charts and monitoring feedback. This extends the lines of causality. This process, the interchange between

28 Dauid Goldberg and Anthony Dauid

linear and systemic, may sound rather complex when elaborated in this pedantic way but we suspect that it describes what frequently occurs in the daily practice of a systemic therapist. Systems theory may be a different paradigm from linear theory but the two are intimately and necessarily related. They do not exist on different planets but are mutually intertwined like oxygen-producing plants and oxygen-consuming animals. The problem of wanting systems theory to be incommensurate with positivistic linear theory is that systems theory can escape the scrutiny of empiricists and comparison with other, linear, theories. We believe this separation to be both harmful and unnecessary.

Conclusion

Family therapy has grown and developed at a great rate since the late 1950s. At that time individuals from diverse backgrounds and belonging to separate distinct professions joined together using theories derived from cybernetics, information theory and social anthropology. Today a new profession of family therapists is defining itself with the creation of professional bodies and distinct institutions, each with their own hierarchy. As individual therapists join together, the rules they follow are in danger of becoming more rigid, and their theories more difficult to challenge. As with all institutions, success stimulates the development of increasing dogma. This may be positive as i t brings with it stability. However, more and more emphasis is being placed on the quest to define a unique philosophical stance, and an alternative way of thinking using systems, and with it, increasing value is being placed on arcane theory. Regardless of the appeal of the metaphors employed or how learned the analysis, this trend threatens to deflect therapists and academics from the task of developing treatment strategies which are useful clinically, can be taught easily and which are open to empirical validation or costlbenefit analyses. Unfortunately, theory justified by esoteric ‘harder’ sciences, with their allusions to uncertainty and the infinite, may render family therapy theory closed to modification and development. Multiple theories distilled from varied disciplines are nevertheless of value in pressing therapists to examine their methods in novel ways. Theories derived from other sciences are not bad in themselves, but their uncritical acceptance at the expense of more mundane methodology causes paralysis and stifles the emergence of a new genuinely creative field: family therapy.


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Family therapy and the glamour of science