I’m working on a writing discussion question and need an explanation and answer to help me learn.
Citing the Minuchin et al. and Nichols readings, please identify two different Structural interventions used in the video of a family session with Aponte.
What is your assessment of this family’s structure, including an assessment of the boundaries between individuals and subsystems?
Did you see Aponte follow the outline of a first family session as described weber the article? If so, which of the steps did he follow?
What did he do that you could see yourself doing in a first session with a family?A Beginner’s Guide to the Problem-Oriented First
Family Interview-’
TIY0tM~FR;PH.D.t’
JAMES E. MeKEEVER. PH.D.:
SUSAN Il. MCDANIEL, PH.D.5
liar iargr volume and diuersit,v of family therapy resources eafl often coniusc
tminees adto are in need of more abbreoiated#uidefines for mana& their clinid reapomibilities. 77th paper prese+s a
rtntctwed outline of a probkm-oriented
f5rs: family interview for the family therapy rupercisor and the beginning family
thenlpist. we vits the fit iJaterview as
on integrated process including the
important tasks preceding and follotaing
the initial family meeting. After the goals
refemA mw and (12) gathering meor&. This approach to the first in&ntiao
integmtes a uariety of structural and stmtegie procedums. The guide, intended ior
use in conjunction with claw supemisk,
mayremeos4fuun&tiononlehiJIbeginning thempists can build their unique
styles.
th8t8lKiJKthUlkl-kOfth~/intinL~
slEmfimilythmpiiise
fronwdwith8peadl8rproblan.
cm deswibed, a s&p-by-step yide to the
tweiae phcses of the interview is presentedz l7) telephoning; (m) fomGn,g h-ypotheses; (31 the greeting; (4) the social
phase; 13) identiiying the problem: (6)
obseming family patterns; (?I degoals; @I coeachg; (9) ChecMist; (IO)
raising hypotheses; (11) contacting the
T
.
This-isoftat~8pp8ralt8t
thcpohtofthebntmee~wlth8frnrily
when ‘krildaed and ambus trainem are
oblige6 m take leadership, -da&g the
m8ss 0: clinic8l optioBs into 8 prdcrl,
sensible. well-org8a~ iat8n6ew wltb 8
group of 8umprs. tkd~ly, t&neesofwmrill8skpriortom8etlngwith8
family for the bnt time, “How do I proceed?“; -Wbcn do I begin?“; ‘Whet do I
do&rIbegia?“;“WbatsbauldItryto
l ccoqdish?” Although the questions
ttlainwul:rboutgetting~my
3581
F-Y –
seem elementary to the seasoned therapist, sion of the many procedural variations that
.trainees may have a fresh sense of a funda- are bound to arise in working with any
-mcnt,al point Haley (5) has notad: “If thu- family. Such matters are more effectively
apy is to end properly, it must begin prop- addressed through background reading
erly-by negotiating a solvable problem and direct supervision, indispensable supand &covering the social situation that ports for beginning family therapists. Also,
makes the problem necessary” (p. 9). “Be- our intention has not been to provide
ginning properly,” without drifting and extensive and exhaustive examples of each
getting muddled in irrelevant details, is an task. Rather, we have stayed within the
imposing challenge to both the beginning narrow bounds of presenting an overview of
therapist and more experienced therapists. those tasks we believe constiwte a crisp
Rccogni&tg the pivotal importance of and efficient problem-oriented hst family
the fint iaervkw with a family, Haley interview. Finally, OUT goal has not been to
wrote hia important and influential chap- provide a detailed review of the literature,
tar on “Conducting the Fit Interview” citing references to support the guidelines.
that appeared in the 1976 publication We havelistedaources at the conclusion of
J+&iern Soluiry Thcrapr (5). Several this paper that the baginner may find helpother authors have focused on procedures ful in understanding both the theory and
for conducting this- initial-: meetimg taehn+s-of tha problem-oriented 6rst
(1,Z 3.4,7,8,101. Theea- presentations, family interviewFour primary goala ahape the work of&he
and the structural and strategic theories on
whichthayarebased,havebeenespecUly
flratintarvia=
valuableforbeg&ingtmlnaeswho,inour
h a,t&.m accommod8~ to.the
experience, tend to work most effectively
style of family .members and creating an
using a concrete, problem-oriented frameenvironBleat in which family member8
work (6). Nwuthelas, as us&l u these
will feel aupportad.
theoretical and clinioal discustions have i w the,bterv+ a. that family
bcm, they m8y not meet the needs of
members will begin to gain confidence
trainees who are in search of a concise,
in the therapist’s leadership.
*P-by*kP & for nqd*fietuLged territory of the iirat interview.
& G~~info~ti~ about the problem
inauchrwaythatthefhilfstruts-
Thepurposeofthispaperistopresenta
&ions uound the problem become
dH.
~-~.~b-tep, beg@ds ruidr to
the problem-oriented 6rst family inter- 4. Negotiate a therapy contra@ emphasiiview. This guide ls au integration of proceing the family’s initiative in de&sing
dures from a variety of approaches rooted
goals and desired changea.
inthestnxamlutdatr8tegic0rimt8ti~
AS fdy olerapy aupankm we have
Our guide for the 6rst interview is a
found the guide to be useful in our work
ositb b&nning trainees in a variety of compendium of rpe& tasks designed to
trtining contexta We want to en&&e accomplish the four & It b oriented
~t~(uideshouldbeusedonlyinthe towardafamilyinterview,althoughitcan
axhxt Of ~prehenaive training and easily be adapted for a couple or family~perrrition in hmily th~0t-y and therapy.
oriented indihklual session- Nec&mt the+
b k-ping rrith oar god of making the *text& the 6rst intenk~~~~w
@de = t&f= poaible. WY brat •~aid~d bwh; pn-iatu*im-m& pore-httprim
=mmmW On the theoretied premises tub The hiti c&ct wioith &e f&y
forthw UAS axad hr~a
. limited our discus- over the tiephone h a Qudtl pr#cu &t
. l+m!-R-t)u
– “itdp the thempiat b~Stcntrti*c hyp~thtaes based on prelimiii&rmation and
setsthetoneudp8ttemofinquiryfortbe
first mciting. Likewise, after the interview,
itlsasaltkltorcviewthainf~tion
gathqed, evaluate how the interview was 1.Td~phoning
conducted, and organize a.treatmeat plan
~~l~dthetelepboneallisfode
aothatthw8pycariproceedmostc8ectiwly. These crrcatial tasks help polish the anmcft with the family and to coatmct for
tberajSst’8 &inking utd work ln subse- thefimintcninr.
quant meatingk ,Witb 8ome a+ions 1. Gather UC tionnrtian. ia&*
&3,4,&W, f&r too little attention has
-aa l Mrtsw,andpbaneaumbas.
been given to these fundam&aJ prepua- 2 Askfor&iefdascriptioaoftlaeprot+
tosr-d revkwtasksmdhowtheyanb
integratedwiththefemilyirltrrvicn.
3. -=@=mwMWW~.
.
+-=P-mm.
wd&ggT: -y–=
4. contractforthekstiu~,,irrdud~
ingI.
.
8.Whowltlattatd(ifthecontutpaaorlresl8labrlngkgthaotirqfunlly4aembaaafthe~
tltebnt#rboo,~twnt’aptiats
tif’ the probkw (6) obsavbq family
vuJvi&ameetwltbthafwily
pattcnrr;CI)drlininrm&@)contnctiry;
memknmatc-anKdabguttba
(9) chqckw (IO) rwiah trJpotbcw; Olh
problem or iwist that all m
emu* the referral puaoa; and (la
mambemmustattaxl.Priorbthe
gatheringrewds.Thasectagaoftha
illtaviewitselfue8imilutow~soutPl==an,tac stlpahwahouldba
line (6). However, we have added addiconsulted rtpd@g posibk op
tions).
.
tioMlph#r,~~dpOIt
b. Dateandtimeaftheintwiew~
interview tads rod have integrated
t@i&dqw hm other qQro8cba that we c.Wbereitistotakeplace&dudiDg
.
dirdorrrtotlu~md~-h~
b8vefoa8dmefd
Although t&e phases are clearly demarwf3. Feefurtheillitid~
ate&udphaeswithintiteintaview
itself ue assigned approximate time 5. Iftbcfbilyi8notself-refermdandtbe
refwingpasaQansbefoeetbe~
framesfarckityandpacing,theactu8l
a. Illqrrirs~therefariDg~‘S
pmcassofintbrvi~danandsa~
undemmdingoftbeprob~
me8sureofsedtiv&tothe%&uralfi~
b. Ckrifywbattherefemimgpemnis
6f moving from one phase to anotbu.
.
Phases am ovakp or take place concurrcqucstiry kg, – orreferral for therapy).
rently in m 8ctttal interview. The au&iv-.
c. Agreeonhowfcllknv~iIlfoxm8tion
ityaad&xibi&requiredtoadjasttothe
willbe~totherefaringpasonVUiOUSt8SbU!Wd&gMW8SthCrrpi8U
xbgardl~0fwbet.h~oraottbe
gainmoreexpaienceinworkingwithfamircfdng paam a l l a befort’the
Lies.
interview, contact should b@made
The foliowing guide is intended for use
followiagtheiatcnicn.. .
.
by tr&tts in conjundion with close
Fam he., Vd. 24, September 1935
,
FAMILY ?Rocms
3 6 0 f.
11. FG+hlg Hypotheses
TIIC purpose of this phase is to develop
initial hypothcscs to help guide the exploration of issua in the first interview.
1. Develop tentative hypotheses to be
tested in the interview (these hypotheses will be expancled and revised as new
information is gathered throughout
treatment).
a. Begin by deterAn& the. life-cycla
SW ofthe family and the predicted
problems and tasks of that life-cycle
shsc
. b- On this foundation, buildhypothusingotherdatasuchasthenatureof
the referral, the emotional tone conveyed by the contact person on the
telephone, and the family member
identi6ad as “the patient.” A background in family theory and close
s-on are essential in forming
crisp and testable hypotheses. Beginners should not expect themselves
immediately to provide sharp’hypotheses. This skill develops with
experience and supervision.
2Develop~aatrategyforthefImtLinmE
view, inchxiiip specific questions, obsmai~ or tasks that will facilitate
data-gathering and help test the
hypothases (the strategy will help prevent muddled thi&ing and drifting in
thesession).
3. Having developed initial hypothesas
and a working strategy, be careful to
remain open to the uniqueness of the
family and to information that supports
&wnative hypothescr
IIL’
.* The Greeting (approximately s minutor)
. . Beaus it is difikdt for most ueople to
~+e into tremnent, the goal of thii phuc
p to welcome and identify the famfiv mem+ ad h5a to introduce them-to the
@@q-d to the therapist.
GWOdUCe Yourscll to the contact person
and to other adults in the household.
Shake hands and greet each member of
the family (greetings should be ageappropriate, i.e., use formal names for
adults, at least initially; be sure to greet
and make contact with all children
attending, no matter ahat their age).
2. Invite the family members to sit where
they wish (use this information diagnostically).
3. Orient the family to’the room (e.g., videotaping, observation mirrors. where
toys for children are located, etc.) and to
the format of the session (t.gW length of
the meeting, split session, etc.?.
4. If you are audio or videotaping, cbtain .
oral permission’ from adult members.
(Signatures on the consant forman be
grthired rt the end of the interviewer
IV. Tho~~Soclal Pharr (approximately 5
minutes)
Thegoalofthesocialphaseistobuilda
nonthreatening setting for the family, to
get to know them batter, and to heIp them
become more comfortable.
1. Help the family to get comfortable by
engaging in informal coavemation, followed by introducing the agendr “It
would help me if I 6rst got some further
infonB8ti& 8bout you.”
2 Increase conmct with each family member by rquesting demographic information from each of them such as their age,
work/school wtivity, education, length
of marriage, ek Try-to 6nd something.
ium&pRmJbtJ&.~ia~~.~
h~and!genem
to the funily (e.g,
by following up on a family member’s
job or interests).
3. While talking to the family, remember *
to give specialdtention and respect to
the adult Iuder/spokesperson of the
family. Make3&aL &oWto. engage
those:- in+ the fan& ubor. ark direspm5dy~pwho.did not-make
thr.ini~ collt8cb
WZURRAL
4. Nofa each fsmiiy member% knme
and nonverhsl behavior and attempt to
match and use this style snd language in
au$equequyt;~i when working with
.
V. Idonllfying thr Prohl~~~approximstelY
15 f@wtos)
ThsgorlofthisphssabtoupIonaach
Iunity member’s view of the problem in
8ptdfi~ b&~%r~l terms, as well as the
solutions that have been attempted.
1. Continue de6ning the yen& “Often in
fadiu psoph hsva dilTersnt vks
about what the problam is.‘Todsy I
would Iike to hesr from each of you
SbOUthOWyoUKcth~PploblcLa”
2 Address .each member’ of the far&,
~beginningwiththesdultwho
spptalstobcmort-t~~pmbklrL
?
a Help frmily members he more concrete
~apecikbysskil!g,YHowisthis*
pmbkm for you?3 “wbcn dii the prdb-
k 361
b. Hemp fsm~y me&em to cktify w
though&
Cm hinhinsn ampsthic and noa&&
~stancewitheuhpersolL .,
d.AfEirmtheimportanceofeachpetma’s contriiution.
8. At tbi~ point, don’t off~ &iicc ot
brpretstionsevenifss~
.f. Bbck
interruptioas
from
0th~~
if
.
PuamtenL
0. Nota, but don’t emphasii d@~=w-ngfrmilym~bctt. _
h. Goslowly!
Vi. Observing Family Psttoms (approximately 15 minutes)
TblgOSiifthiSphueblo%ingthe
problem into the room” so that the b.
pist~tbafalaikyCSIgata&arerpicwra
oftbe
.
-~tt-offsahilymsmbers around *Problem.
l.Havsfuniiymembtnduify8~
behsvioralupectoftheprualting
problem in one of seversI ways
Iem begin?“; -what prompted you to
come in now??
l.~~frmilOBlSdXXS(t&
father and mother, father and toa,
c. Find out how members of the family
have attampted to sofg the problem
bro’tber and sister, ctc) to tak to
8nd what the resdts oftbue repted
CrChOtk8hOUttbcpXOhklOmd
howith8skmhandkd.
sohltionshsvebeen.
5 Explore tbs involvelns!lt of otbars in the
hHavshaiIymambasdescribatba
. prablun: Wave you been given advice
interactions of Other family memhas
from other people about this problem?“;
utbcprupondtotbeprob~
-what do you think of their advice?”
(“Joluwhenyou~intor~htwith
(ln&de@quiriasaboutprthustbtrsyoursista,whatdoesyourmotha
do?““Andwbenyourmotherdoes
pista and ether p~fessioark1
6. &ik &out recqt changes in the Sadly,
that3 what dots porrr father do?“)
c. Have family members n-enact an
S&I u moves, ilhss, dath, ocwpational shifts, or exits and entrances of
l xsmple of the problem (e.g., “Show
me what hsppens in w house when
members into the family orgsnizstion.
Wliile kaapkg a focus on the presenting
Susie comes bane late”).
problem,be l wsre ofcontext chsnges .2 Step bsck, observe, snd Iisten to the
in the family system that inh~rce and
fsmily in order to make 8a intersctionsl
are influenced by the presenting probsssessmen~ espuisuy noting psrtidar
repetitive behsvior squences tbst occur
Iem.
around the problem.5. Process reminderr
8. Eocmrage family members to be 3. If snychanje in cbe family’s inter&ion
is proposed, this chsnge should be be&
specik ask for exsmplet.
r’=ln. Proc., vo12:. Sep1c.dv 19z
362 I
PALY PRdCEJS
slowing thtm down. Sometimes a home&)lear thernpcutic goals and family’s
work assignmtnt, such as asking them to
behikor in the session (e.g, if mother is
gather more information about the
the parent who is busily managing the
problem, is useful at this point.
children in the ression while the fnther
* :
..I
remains quiet and distant, the therapist
may sugg~c “John could you help your VIII. ContiscUng- (approximately 5 minchildren find something to play with SO
utes)
that you, Mary, and I can continue taikThe god of this phase is to reach sn
ing over here.“)
agreement
regarding the continuation of
‘1. Complimtnt specific family memben on
therapy
snd
its structura.
concrete actions that were positive (e.g.
“Mary, you seem to have some good 1. At the end of the interview ask the
family about the next step, empbasixing
ideasastohowtogetyourdsdtohear
their initiative (e.g., What is the plan for
>f-“)
pKxxedblg??“).
2
If
the family does not e&‘to continue,
VNrG.efInln~ Goals (spproxSmstaly 5 minoffer
a referraJ to another therapist or
utes)
agency or indiit.e how they might
The god of this phase is to crystsllise the
return to tberspy in the futum If they
goals of trestmmt as viewed by each family
elect to continua, arrange for the next
memher in sped& and rdistic behsviord
appointment snd determine who will
attend (the structure of treatment is the
1. Ask each family member to summarize
therapist’s responsibility).
vrhathecrshewouldliketcseechsnged 5 Some hmilies ma+sut to contract fat
a spec%c number ‘of sessions This
(notice similarities snd differences
option should be considered since some
among the goals of di!hent family
members).
fsmiiies may work more effectively
when therapy is time-limited.
2 Define the chsngu in terma of specific
positive behaviors rather than negative 4. &view the business vt induding fw insurance informstion, etc
bhvi~~ kg., “I’d like Dad to help me
lrith my English sssignmen~” rsthsr 5. Ask the adults to sign the tsping consent
forms snd the nmssay release of inforthan “I’d like Dsd to stop nagging me
.
about my homework”).
mation forms for gathering relevant
3.Undarcoahtbe-straIgWofthsfsmiLy
informstion frcm other practitioners
and agencies (physiciaas, schools, pre-,
bv ukiry, “I’m sure thw is a lot you do
vious thenpists, etc).
tooch~r thrt you would like to keep
doing. What it it thst you would like not 6. Ask if family members~ have any ques, tiolu
b druyc?” (This qua&ion may be
riocn to MY membem as a task for 7. Condude the interview.
~~~tbinirSbOUtbSf0mtbrn~
S-i-1
+.H~P the family mtmbcr~~ to apetrify
their UpKtrtions mom cksrly *ad rulbGdY b ukiry, “What would k the
makst bge that might indiate that
UP m moving in a better dim.tion?”
UC. Fiat Intarvlow ChocklIst
Use the following cheddist to evaluate
the process of the 6rst interview. Did the
thUrpilk
1. ms%e ccntrct with each member of the
family and help hi or her feel as
confortshle as possible;
2. titabkh leadership by clearly rtructuring the i~terviear;
3. develop n working relationship with
4. LYtht grouDdwork fOrulydl&O+
tba ntccsury for aurying out the tr&ti
meat 8t&&gy.
“professioDal” or too persoD&
4. rtco~ stre~gtbs in tbt f+ily and in
.
.
family mrmbcn,
XII- Glthtrlng Records
tbc funilywithwt~ig either too
W&Z for 8chool records, records of pn&us ~tatmcnts. or nay other relevant
infOmWion from profession& or so&l
8gencitr.
.
*
5. XDaiDtaia aa tDlpathic position, tup-
porting family members rad l voidiDg
blamingcucriticbinf;
SUMMAilY
6. identify the specific problems tic ftiily bring w treatmcat and their pn0~gdiathispaperhubetDtop~
vious rttempted solutions;
v& beginning therapirts and their er7. start to Itam the hnily’r view of tbe visors alI a highly strum siDlpli&&
world and each family member’s lan- ad p~utkal guide for conducting a prob.
guage, style, and perspective on the letp-oritnttd Grst family intemiew. T&S
guide is inteDded to be a basis from which
problem;
6. begin to undershnd the family’s repet- beginning therapists a~ develop their peritive interactions around the problem sod stylts. Each in&l inttrvitw is
unique requiring the therap&& to be 5aS
b&l¶ViOr.
9. gathtr information a’bout sigaiiic8Dt ble in order to kcompiisb the iaterview
othtr family fhads and professioDals gcbak.Tbisguideprovidesthetraineewitb
.m
a framework for coibolved with the problem;
10. negotiate a contract with the femily rte goa& tbe behavioml t8sks IZX
. rt8cb those gods, urd approximte that
that is m~tuallyacceptab~
limitswithiawhichthtstgo8lsnuybe
accomplished. Wii super+ioa urd expeX. Rtvising Hypothtfts
Use the information gathered h the 5rst rieact#thtbegbiagtraiaet~thtn
iatewiew to rtvise and refint tht pre- tackle the multiple subtleties i~v&ed in
]+
inttrvitw bypothtsts tnd plan for the Dext t8chstageofthtdrrtiattrvitw.
‘f
inttrview.
Xl. Conttcting the Refeml Ptrson
.
u tht ?cfd ptrran anS Dot prWDt for
the 6rst faDlily iDterview, CODtaCt tbt referralperson..
1. Inciicttt that the bmily has been seta
and c~mmu~icste sny treatment con;
tmct th8t has been negotiated.
2. Get the refed person’s perspective OD
tbc problem.
3. Share a brief, initial asstssment of the
family and itr problem. Supwision is
importaslt here in helpiDg to determioe
what information should be shared with
the refer&g person depending oa that
pcson’s position in the system.
Fam Roe., VOL 24, Sep~~~brr 1225
;.
2 BROJS A. (ed..), Fomify Thaapy: ?Mnci&
ofStmtyicRoccice,N~York,Guilf~
PILtf1983.
3. DE s.tlM.z& s, Portems of Brirf Li;
Thtro~ A n &cosystemic Apptooch,
NcrrYorkGuWrdPras,1982
4. Flsc&RwEAltMD. J.XksndSs&L.
The Tactics of Chanm- Doing Thaopy
Briefly, Son Frmdrco, Josses
1932
X.ROvkingHYPOtbSW
wttthtiaf~tio;rg.thmdiatht~
ixl~tombc~8ndnfiwthtprt-
interview hypotheses and pka for the next
ilBtttdtW.
XL canttcting tht Rtftml Ptftml
.
uthereferrdpersan~Dotprcscrrtfor
thebntfamilyiaWVkW,conttttbrtftr-
rJpnarr.*
1. Il¶rkt’th8t the fhily h8s been seen
d CommuDiate my t.?mtmtDt coa;
&act ihrt hr bna Dt@-i.
2 Get tbe rdtml paton’s perspdoe aa
tbe problcor,
3.Shue~bri~hitid-tdthe
fax& and its problem. sspmisioa is
@toant htre ia helpbg to dtttrmbt
what inforxD8tion should be shred with
the roftrrbg m dw-dinf oa that
.
PC~SOII’S positioa ia the systaa.
FWIL Rtc., Vol. 24 September 1#lj
ebook
THE GUILFORD PRESS
WORKING WITH FAMILIES OF THE POOR
The Guilford Family Therapy Series
Michael P. Nichols, Series Editor
Recent Volumes
Working with Families of the Poor, Second Edition
Patricia Minuchin, Jorge Colapinto, and Salvador Minuchin
Couple Therapy with Gay Men
David E. Greenan and Gil Tunnell
Beyond Technique in Solution-Focused Therapy:
Working with Emotions and the Therapeutic Relationship
Eve Lipchik
Emotionally Focused Couple Therapy with Trauma Survivors:
Strengthening Attachment Bonds
Susan M. Johnson
Narrative Means to Sober Ends: Treating Addiction and Its Aftermath
Jonathan Diamond
Couple Therapy for Infertility
Ronny Diamond, David Kezur, Mimi Meyers, Constance N. Scharf,
and Margot Weinshel
Short-Term Couple Therapy
James M. Donovan, Editor
Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide
Scott P. Sells
The Adolescent in Family Therapy: Breaking the Cycle
of Conflict and Control
Joseph A. Micucci
Latino Families in Therapy: A Guide to Multicultural Practice
Celia Jaes Falicov
WORKING WITH FAMILIES
OF THE POOR
PATRICIA MINUCHIN
JORGE COLAPINTO
SALVADOR MINUCHIN
THE GUILFORD PRESS
New York London
© 2007 The Guilford Press
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Library of Congress Cataloging-in-Publication Data
Minuchin, Patricia.
Working with families of the poor / Patricia Minuchin, Jorge
Colapinto, Salvador Minuchin. — 2nd ed.
p. cm. — (The Guilford family therapy series)
Includes bibliographical references and index.
ISBN-13: 978-1-59385-347-1 (pbk. : alk. paper)
ISBN-10: 1-59385-347-5 (pbk. : alk. paper)
ISBN-13: 978-1-59385-405-8 (hardcover : alk. paper)
ISBN-10: 1-59385-405-6 (hardcover : alk. paper)
1. Family social work. 2. Social work with people with social
disabilities. 3. Family psychotherapy. 4. Problem families—Services for.
5. Poor—Services for. I. Colapinto, Jorge. II. Minuchin, Salvador. III.
Title.
HV697.M55 2006
362.5—dc22
2006034444
About the Authors
Patricia Minuchin, PhD, is Codirector of Family Studies, Inc., and
Professor Emerita at Temple University, and is associated with the
Minuchin Center for the Family in New York City. Dr. Minuchin has
taught at Tufts University and served as Senior Research Associate at
Bank Street College of Education. A developmental psychologist,
trained in clinical psychology, her publications have focused on the
growth and functioning of children in the context of the family, the
school, and the conditions created by poverty, foster placements, and
family disorganization.
Jorge Colapinto, LPsych, LMFT, is a family therapist and a consultant to human service organizations in the development and implementation of systemic models of service delivery. He has developed
training curricula and practice materials for the Administration for
Children’s Services of New York City and other service agencies. He
has been on the faculties of the Philadelphia Child Guidance Clinic,
Family Studies, Inc., and the Ackerman Institute for the Family,
where he directed the foster care project.
Salvador Minuchin, MD, is Director of Family Studies, Inc., and is
associated with the Minuchin Center for the Family. Dr. Minuchin
was formerly Director of the Philadelphia Child Guidance Clinic and
Professor of Child Psychiatry and Pediatrics at the University of
Pennsylvania. A major figure in the field of family therapy, he has
published widely on family theory, technique, and practice.
v
Acknowledgments
This second edition builds on the work described in the first edition,
and we continue to be grateful to all those who participated in the
programs and experiences reported previously. However, this new
edition is focused on the work of the last decade, presenting new
material in the areas of substance dependence, foster care, and the
mental health of children. We want especially, therefore, to acknowledge the people and the institutions that have been so helpful since
the publication of the first edition, facilitating the work and contributing in fundamental ways to our learning and to the results of our
efforts.
New and continuing projects have been conducted in three states
in the Northeast. The longer-term substance abuse program has been
located at Bellevue Hospital in New York; the more recent program
has been implemented in collaboration with Daytop New Jersey.
James Curtin, Administrator of Daytop New Jersey, initiated the
contact with the Minuchin Center for the Family and provided constant support throughout the duration of the program. The newest
phase of the foster care project was conducted under the auspices of
the Administration for Children’s Services, City of New York. We are
grateful to Commissioners Nicholas Scoppetta, William Bell, and
John Mattingly for their leadership in an area of service that is so
complex, difficult, and important. The mental health programs were
conducted in collaboration with the Department of Mental Health,
Division of Child/Adolescent Services, in Massachusetts. Several
vii
viii
Acknowledgments
administrators in that large system, including Phyllis Hersch, Julia
Meehan, Gordon Harper, and Joan Mikula, made our work possible
and exciting. We also thank Anne Peretz and her group, in the Massachusetts area, and are grateful to the many people who implemented our programs in the several locations where we have worked.
In particular chapters, we have thanked other people by name and
hope that we have not inadvertently omitted any members of the
working teams or institutional personnel who advanced our efforts
and taught us so much.
Our colleagues at the Minuchin Center for the Family have been
helpful in many ways. The Center came into being after the publication of the first edition and is now the sponsor for ongoing projects.
Active in the area in and around New York, the staff at the Center
continues to develop and expand on the ideas and programs that are
basic to our approach. We are particularly indebted to David
Greenan and Richard Holm, who were the primary consultant/trainers for the substance abuse programs, provided the basic material
concerning their work, and are fittingly described as our coauthors
for Chapter 5, on substance abuse. In addition, Daniel Minuchin
contributed material about training programs for both the substance
abuse and mental health chapters.
Finally, we want to thank Series Editor Michael P. Nichols, who
was, as always, a knowledgeable and careful reader, and Senior Editor Jim Nageotte at The Guilford Press, who was patient and supportive throughout the process. We also thank the families who are
the raison d’être for writing this book. In acknowledging the families
who appear throughout these pages, we are moved to echo what we
observed in the earlier edition: Working with families who are poor
and facing multiple crises is a constant reminder of both their difficulties and their strengths. They deserve our compassion, our respect,
and our best efforts.
Contents
PART I
FUNDAMENTALS OF FAMILY-ORIENTED THOUGHT
AND PRACTICE
ONE
The New Edition: Elements of Constancy
and Change
3
TWO
The Framework: A Systems Orientation
and a Family-Centered Approach
14
THREE
Working in the System: Family-Supportive Skills
34
FOUR
Changing the System: Family-Supportive
Procedures
65
PART II
IMPLEMENTING A FAMILY-ORIENTED MODEL
IN SERVICE SYSTEMS
FIVE
Substance Abuse: A Family-Oriented Approach
to Diverse Populations
89
SIX
Foster Care: Children, Families, and the System
133
ix
x
Contents
SEVEN
The Mental Health of Children
188
EIGHT
Moving Mountains: Toward a Family Orientation
in Service Systems
232
References
247
Index
251
WORKING WITH FAMILIES OF THE POOR
PART I
Fundamentals of Family-Oriented
Thought and Practice
CHAPTER ONE
The New Edition
Elements of Constancy and Change
Why have we written a new edition of this book? Certainly, many
aspects of our family orientation and systemic approach remain constant. Yet, as time has gone by, the world has changed and we have
changed. Society has become more complex, challenging the helping
systems to keep pace in their delivery of services, and we have gained
more long-term experience with a variety of problems and service
systems. In the process, we have developed a clearer understanding
not only of the obstacles to progress, which have long been familiar,
but also of the factors that support the work and enable positive
changes to endure. In this edition, we describe those forces and suggest procedures to strengthen the likelihood of successful interventions.
This first chapter provides a general orientation to the book. It
includes a brief discussion of the changing world and the nature of
service systems, an indication of what has been constant in our systemic approach, and a commentary on the search for forces that can
enable a new approach to survive. The chapter concludes with a case
history illustrating the problems and characteristics of the multicrisis
poor, as well as a description of the services assembled to provide
help.
3
4
FUNDAMENTALS OF THOUGHT AND PRACTICE
THE CHANGING WORLD
With the advent of the 21st century, the world has become more
complex and, in some ways, more frightening. We feel more vulnerable than we did, and the poor and needy are the most vulnerable of
all; most directly in the paths of hurricanes, economic crises, inadequate health care, and other natural or man-made disasters. If that is
the reality, how do current helping systems compare with those of a
decade ago? Are they better organized? More compassionate? More
effective? Yes, in some places and in some particulars, but, overall,
the problems and inadequacies that existed a decade ago are still
there.
Current services are often marked by procedures that are fragmented and involve needless duplication, by the efforts of multiple
helpers who do not communicate with each other, and by a focus on
the individual client without considering the relevance or resources
of the family. In a social climate where priorities have shifted and
funding for social services has become less available, it’s especially
important to consider how services for this vulnerable population
can be reorganized so that they become more effective and humane.
We suggest, in this volume, that a systemic, more family-oriented
approach serves this purpose.
Beyond being confronted with the need to deal in better ways
with familiar problems, service systems now face issues that stem
from increasing diversity in the population and changing social values. Since the first edition of this book was published, the country
has seen a significant increase in immigration from diverse corners of
the globe, as well as the development of new lifestyles and social
beliefs within the culture. Immigration means that recently arrived
individuals and their families must cope with the difficulties of acculturation: social isolation, a new language, and the challenge of
becoming economically stable, as well as the need to develop patterns of family life that acknowledge the different experiences and
needs of older and younger family members. Changing values mean
that traditional perspectives coexist with new ways of defining the
basics of the social network—in sexual identity, in the definition of
family, in the creation and raising of children, and in the very definition of life and death. People finding their way in these new forms
must handle conflicts and confusions that have few precedents.
The New Edition
5
Although these differences were in formation toward the later
years of the 20th century, they are now a staple of daily life, social
conflict, and legal issues, and present special questions: To whom do
children “belong” legally? Which adults should be included in the
process, when social services are making decisions about a child, if
the family is separated, blended, three-generational, consists of a
same-sex couple, or is otherwise complex? What is the appropriate
balance between welfare and work, when parents, children, and society must all be served; and who should be making policy that must
take into account the different developmental needs of 2-year-olds, 7year-olds, and 13-year-olds? The challenge to society is profound. We
are in need of compassionate and effective services in all areas that
affect the health, welfare, and protection of a complex and changing
population.
WORKING WITH FAMILIES AND SERVICE SYSTEMS:
FUNDAMENTAL PRINCIPLES
Our work has long been guided by two fundamental principles: a
systemic orientation and an emphasis on families as the primary
social context for its members. We have carried that perspective
through decades of working with people in need and with the systems that serve them. Despite shifts in the population and in the
problems that must be dealt with, those principles have always been
relevant.
A systemic orientation is both a mode of thinking and a guide
for facilitating change. It means that we understand the behavior of
people and organizations as functions of connections and interactions, and that when we intervene to facilitate a constructive change,
we must take account of the relevant network. From that perspective, it is never enough to isolate individuals as the sole focus of
attention. When the services concern or affect children, that point is
self-evident, but it also applies to recipients of any age and in any situation. We are better able to plan and implement effective services if
we understand the context within which people live; the involvement
of others in their problems; and the resources available from immediate family, friends, and extended kin.
A grasp of systemic principles is also essential when we intervene
6
FUNDAMENTALS OF THOUGHT AND PRACTICE
in the policies and procedures of an organization. If we want to create an impact, we need to understand how a particular issue fits into
the larger whole, and when the organization is large and complex,
we need to accept the fact that the process of change will probably be
slow and the effect will generally be partial.
As the reader moves through this book, it will be useful to keep
in mind that large organizations, such as the complex enterprise that
manages foster care in New York City, and small units, such as the
family of a soldier or an unemployed single mother, are all systems.
As such, they have similar features. They all contain subsystems and
hierarchies of authority; they are marked by boundaries that are
sometimes functional and sometimes not; and they must deal with
growth and change over time and handle the inevitability of conflicts
that may or may not be easily resolved. And, large or small, they
must constantly balance the patterns of the whole with the particular
needs of their individual members. In the remaining chapters of this
first section, we expand on systems, families, and the details of working from a systemic and family-oriented perspective.
WORKING WITH FAMILIES AND SERVICE SYSTEMS:
INTERVENTIONS
In the second section of the book, we describe the application of our
model in three areas: substance abuse, foster care, and mental health.
We have included some projects described in the previous edition,
along with material concerning later developments in this work, and
have added new projects conducted in recent years.
In presenting this material, the emphasis is on the experience
of entering an organization to introduce a new, family-oriented
approach to the services they provide. We describe our contact
with administrators, the training of institutional staff, and our
direct work with families. The material is detailed and concrete; we
describe the steps and sequences involved in the intervention process and provide specific examples of how the new approach has
been implemented. We also discuss how institutional staff, families,
and consultants faced and dealt with the many issues that arise,
inevitably, when familiar pathways are disrupted. The aim is to
provide ideas and examples that will be useful for people who
work in similar circumstances.
The New Edition
7
THE SEARCH FOR FACILITATING FACTORS
This new edition also discusses our concern with the long-term
effects of constructive interventions and with the factors that support
such effects. We have accumulated experience over more than two
decades, and have been involved with a variety of community organizations. Every chapter in the second section describes interventions in
at least two kinds of organizations, covering a broad range: hospitals, residential centers, day and home-based programs, community
agencies, and city and statewide systems. Some interventions have
been large, some smaller; some have been self-contained, others wide
open to pressures from elsewhere. Because of these varied experiences, we have been able to identify a number of factors that sustain
the basics of a new approach.
At the end of each chapter, we address the same question: What
enables a new approach to survive? We answer that question by
drawing on the programs described in the chapter, noting the features that have been supportive in that context. Because our understanding has grown by accumulating ideas from the different areas of
intervention, we bring the reader through the same experience in
reading the successive chapters. We first present the factors that
emerged in connection with the substance abuse programs; then we
consider the factors that reappeared or were new in the context of
foster care, and so on. In the final chapter, we synthesize the material.
The search for facilitating factors is a crucial task for the field at
large, both for the institutions that invest in learning about different
ways of working and for the teachers who enter an institution as proponents of something new. It’s important to structure an intervention
so that it creates an immediate impact, but it’s equally important to
consider what happens when a project has finished and the original
proponents leave the scene. Community services function within an
ever-changing environment of policies and personnel, and neither the
worth of a program nor research about its effects guarantees its survival over time. In our search for relevant factors, therefore, we have
considered characteristics of the times, the leaders who make policies
and shape services, and the institutions where interventions are
mounted, as well as the behavior of the consultants and trainers who
bring in new approaches. Not surprisingly, all of these aspects have
been relevant.
8
FUNDAMENTALS OF THOUGHT AND PRACTICE
In coordinating our material in this way, we have been interested primarily in the trajectory of our own interventions and the
fruits of our own work. We value the principles of a systemic,
family-oriented model, and we want our interventions to survive.
It’s probable, however, that the factors we have identified are applicable to the survival of any new program introduced into an
existing organization.
THE MULTICRISIS POOR: AN ILLUSTRATIVE CASE
Before presenting the principles and skills that are central to our
work, we need to bring the problems of poor families to light.
We can do this best by describing a particular situation. Readers
acquainted with Angie’s case from the previous edition can proceed
directly to the next chapter, but for new readers, her story is a useful
prologue to the remainder of the book.
Angie and Her Family
Angie is at the center of this case, but she’s not alone. Her world
includes her companion, their two young children, the foster families
with whom the children reside, and Angie’s parents, siblings, and
assorted aunts and uncles. Over the years, Angie and her family have
passed through courts, hospitals, shelters, housing programs, drug
centers, rehab clinics, day care facilities, and foster care agencies; and
they have been attended by lawyers, investigators, doctors, social
workers, drug counselors, foster care staff, and therapists. The
helpers in this case have been serious about their roles and have
wanted a happy ending for some, or all, of the principals. Inevitably,
however, they have jostled each other and the family, and often it has
been unclear how everyone’s work fits together.
Angie, a troubled woman in her early 20s, has had a difficult
past. As a child, she was sometimes ignored and sometimes a caretaker for others, and she was abused intermittently and raped more
than once. As a young adult, her life has been erratic. She has grappled with drug addiction, maintained an on-and-off relationship with
her male companion, and borne children who were removed from
her care—a pattern shaped by poverty, poor education, and multiple
trauma. Depending on one’s focus, Angie can be seen as uncertain,
The New Edition
9
depressed, and irresponsible, or as assertive, realistic, and resilient,
or—more accurately—as all of the above.
What would not be accurate is to think of Angie as an isolated
individual. In her own view, she is part of a small nuclear family
composed of Harlan, her companion, and two young children—
Jocelyn, who is 3, and Gail, who is 2. Harlan is the father of both
children, and he and Angie clearly consider themselves a couple,
although their relationship is volatile.
Harlan suffers from a chronic disease, but he is surprisingly
competent in managing his severe handicap. He appears to have no
permanent housing and is often vague and unrealistic when he talks,
yet he has a strong sense that they are a family. He wants the children
to live with Angie, and has an intense interest in Jocelyn, who has
inherited his illness. He feels he can help her cope with her condition.
Jocelyn has been in foster care for 2 years. She is unable to walk
and appears much younger than her age in speech and intellectual
development, but she can do some things for herself and is affable
and responsive. She receives rehabilitation services, attends a day
care center for handicapped children, and lives with a family trained
to deal with her special needs. Jocelyn and the foster family have
adapted well to each other, but because Jocelyn lived with her mother
until the second child was born, Angie feels that she and Jocelyn have
a continuing bond.
Gail, a beautiful, wide-eyed little girl, has been luckier than
Jocelyn, since she has not inherited her father’s disease, but her life
has not been smooth. Angie was drug dependent when Gail was
born, and the infant was immediately placed in foster care. The
bonding in this foster home is strong. Angie knows she never had a
chance to connect with Gail, but she and Harlan both want her
returned to live with her mother.
Despite their problems and uncertainties, these people are connected. Harlan and the children are part of Angie’s sense of herself
and her situation. It’s important to keep this in mind as we review the
organization of services she has been offered by the community of
helpers.
The Community of Helpers
Social organizations have made multiple efforts to provide services
for Angie and members of her family. Certainly, the worst disasters
10
FUNDAMENTALS OF THOUGHT AND PRACTICE
have been averted. The city has provided shelter, Jocelyn and Harlan
have received medical attention, the children are cared for, and Angie
has participated in counseling and substance abuse programs. But
these interventions have had complex by-products. The system has
sometimes confused Angie so that she becomes less competent, and
the family has been fragmented by procedures that solidify the separation and make a viable reunion difficult. If we are to be helpful in
such cases, it’s necessary to understand the problems created by system interventions, as well as the good intentions and positive effects.
The services provided fall into four areas: professional assistance, the provision of housing, foster care for the children, and a
drug rehabilitation program.
Professional Assistance
The number of social service workers involved in Angie’s life is
overwhelming. It may seem good that so many people have tried to
help or wasteful that so much time and money has been poured into
one case, but the important point is that the involvement is uncoordinated. Angie has memorized the number on her file that renders her
anonymous, and, as the file is handed from one worker to another,
she feels impatient with the repetitions. As a result of the turnover at
one agency, she says she has dealt with six different workers in a
short period of time, and that she’s “sick and tired of telling my story
to all these people.”
Inevitably, perhaps, Angie has learned to work the system, and
has been something of an advocate for “us” (the recipients) versus
“them” (the system and the staff). Workers have found her difficult
at times—“a woman with an attitude.” She talks about meetings at a
women’s shelter where the staff would ask the opinion of the women,
and she says impatiently that “you had to do what they want anyway, so why ask?” She doesn’t recognize that the staff must work
within certain rules, or that they may genuinely want to incorporate
group opinion when they can. At the same time, one can understand
her sense of frustration and her impression that the system is
inefficient and chaotic.
Angie claims that she doesn’t trust any of the workers except
Mona, whom she considers an exception. Mona is an experienced
social worker, whose way of functioning generates both respect and
concern in a thoughtful observer; respect because she’s an empathic
The New Edition
11
and skillful coordinator, concern because she has taken over much of
the executive part of Angie’s life. Angie’s dependence on the system
and its workers is ingrained and has grown deeper with time, even
while she feels hemmed in and resentful.
Housing
The urban population of the homeless and/or drug addicted includes
a high percentage of women like Angie, whose children have been
removed and placed in care. According to both Mona and Angie, the
local system has established a Catch-22 policy: “You can’t have
housing unless you have your children . . . and you can’t have your
children until you get housing.”
Angie has been relatively fortunate. She was contacted by a
women’s advocacy group and moved into living quarters where
children can visit while their mothers wait for official action. Once
the children are returned, a family apartment is provided, along with
day care for children and counseling for mothers. This new facility
has solved some of Angie’s problems, but created others. Since male
companions are not admitted, there’s no provision for Harlan, and
an apartment for their nuclear family could not be arranged at this
facility.
Foster Care
It would be a distortion to discuss the foster care system as if it had
completely failed this family. The children are cared for, and Jocelyn
receives the special services required by her physical condition.
Nonetheless, the separate services have pulled family members away
from each other so that, in the ordinary course of events, they will
grow increasingly distant. Jocelyn and Gail are in the care of different foster agencies and do not live with the same foster family. The
agencies are geographically distant from each other, have no contact,
and it is a logistical problem to arrange family visits. Angie describes
the setting for visits organized by protective services as “like a warehouse . . . stuff cluttering up the spaces . . . it’s dirty . . . I can’t let the
girls play on the floor.” This is nobody’s fault, perhaps, but it is an
indication that family contacts have low priority. It’s difficult for
parents to maintain the visiting schedules, which are usually evaluated as a sign of interest in later court hearings concerning custody.
12
FUNDAMENTALS OF THOUGHT AND PRACTICE
Even if plans for family reunification go forward, there’s little
understanding of how complex such a transition would be. There
have been many years of separation since the children were placed in
foster care, and there has usually been little preparation for the
successful management of becoming a family again. Angie is clear
about the limitations of the mandatory parenting classes she has
attended: How can she answer questions about the way she disciplines her children or what games they play when they don’t even live
with her? Observing her during an arranged visit, it’s clear that she’s
loving, wants contact, and has some good ideas, but she has few
parenting skills for issues that arise in the course of a day with one
child, let alone two—one of whom is severely handicapped and
requires special care.
There are other matters that have never been addressed, including Harlan’s role as a father and the relationship between this family
and the foster families that have become so important to the children. In a later section of the book, we discuss a family-oriented
approach to foster care, in which procedures would be available for
working on such issues.
Drug Rehabilitation
Angie has spent time in a residential drug center as part of the
required activity for getting her children back, as well as because of
her own desire to become free of drugs. She comments that the
program helped her to understand herself and control her habit, but
she left long before the allotted duration. “If I stayed up there, I
would learn that I could live without Harlan and without the
children and be my own person, and take care of me . . . but my concern is toward him and the children.”
The program presented Angie with a dilemma, but the confusion
was not only internal; it was also a function of the mixed messages
coming from different agencies. In a meeting that brought together
drug counselors and foster care workers, it became clear that each
service had its own priorities. The foster care agency was concerned
with family relationships and the coordination of Angie’s contacts
with Jocelyn and Gail. The drug program focused on Angie as an
individual, maintaining that she needed to be honest about what she
wanted and become strong as an individual before she could deal
with other issues.
The New Edition
13
When a visit with the children upset Angie, the staff of the drug
program placed a moratorium on the visits. At that point, Angie
faced the contradiction and made a choice, opting for continuing
contact with the children. She left the residential program, hoping to
remain drug free with the help of counseling—and understandably
uneasy about an uncertain future.
In offering this case history, we stop at an arbitrary point. We
have wanted only to present a concrete example of the population
that comes to the service systems for help and to raise the issues we
have addressed in formulating a systemic, family-focused approach
to their needs.
CHAPTER TWO
The Framework
A Systems Orientation
and a Family-Centered Approach
We suggested, in the previous chapter, that the prevailing forms of
service delivery are both inefficient and hard on families. In this
chapter, we present the fundamental framework for a different way
of working, emphasizing an approach that is more integrated,
systemic, and supportive of families. We begin by discussing the basic
elements of systems theory; then we describe our concept of families,
including both the general features of any family system and the
particular realities for multicrisis families in need of services.
THE SYSTEMIC ORIENTATION
We noted earlier that a systems orientation is both a mode of thinking and a guide for facilitating change. We begin, therefore, by considering what it means to be a systems thinker.
We all know what a system is; we talk about social systems, the
nervous system, the solar system. The term is familiar, and with a
moment’s thought, we understand that it has to do with connectedness, with the poetic idea that when you take a flower in your hand,
you sense that it is connected to the universe. But a systems perspec14
The Framework
15
tive highlights something more: the understanding that the parts are
related in particular ways. Because of relationships, we can make
predictions. Scientists can forecast the moment in which the moon
will be positioned between the sun and the earth to produce a lunar
eclipse, and they can describe the consequences for the earth and its
inhabitants. The parts of a system affect each other, and because
these effects repeat themselves, we can study the way they work and
predict what will happen.
Systems of different kinds have specific features, but any system is organized and characterized by repetitive patterns. Neither
the solar system, the welfare system, nor a family is haphazard in
the way it functions. The sun will rise tomorrow and the welfare
system will follow particular procedures for supporting dependent
children, just as a family will follow organized and predictable patterns of its own.
Connections seem to be understood as a universal truth. When
fish begin to die off, we understand readily that certain birds will
go hungry unless a functional ratio between these species is reestablished. Yet we are inconsistent in the way we think about people. We celebrate our national figures as if they acted and triumphed alone, and we see the problems and needs of individuals
as if they existed in a vacuum, disconnected from their environment and other people. It is a kind of tunnel vision that overrides
the basic understanding of connections, and it has major implications for the way we organize the delivery of services. It means that
delinquent adolescents and substance-dependent adults are treated
in isolation, as if neither their problems nor the solutions were connected to other people.
When we look at how systems are organized, we need to consider a variety of features: the presence of subsystems, the way in
which the parts influence each other, and the fact that every system
inevitably goes through periods of stability and change. These ideas
apply not only to families but also to all social systems, such as hospitals and social service agencies that affect family life. For example,
the surgical, outpatient, and social work departments of a hospital
are subsystems of the larger institution. Each has a particular function, is related to other departments, and is regulated in its functioning by hospital policies and procedures. Perhaps less obvious is the
complex and circular way the parts interact. Maybe the approach of
16
FUNDAMENTALS OF THOUGHT AND PRACTICE
the social workers has broadened the surgeons’ way of thinking that
“Patient X is a kidney problem.” Maybe the surgeons have taught
the social workers something about the urgency of emergencies.
We’re aware that policies tend to travel from the top down, but we
pay less attention to the fact that the departments affect hospital policy through the ideas they funnel to administrators and the way they
implement or resist directives.
Of course, mutuality doesn’t necessarily mean equality. The
influence of hospital subsystems on overall policy depends on the
flexibility of the system, and within any structure, the power of the
different parts is apt to be uneven. In most settings, for instance, the
social work department has less overall influence than the surgical
division. The point arises again in a family context, particularly if we
think about families who are poor and dependent on help from organized institutions. Those families are seldom able to influence the
patterns of the systems that serve them, and constructive intervention
is often a matter of trying to redress that imbalance.
However they are organized, all systems go through cycles of
stability and change. During periods of stability, a system functions
through familiar patterns, and, for the most part, repetition is adaptive. Hospitals don’t need to reinvent the admission procedure with
each new patient, and families don’t need to establish new rules for
bedtime every day. But all systems that involve living creatures are
open-ended. New events occur at intervals, and, as a result, stable
patterns are perturbed. One hospital might merge with another and
be run thereafter by an HMO. The current procedures would then be
challenged. Even if the hospital had been functioning smoothly in the
previous circumstances, it would need to reorganize structures and
procedures. The staff would go through a transitional period of confusion, searching for patterns that preserve what is valued from the
past, while adapting appropriately to the new reality.
Like hospitals, social service agencies are organized systems, and
their realities are almost always complex. They’re generally embedded within larger social and political structures, subdivided into internal subsystems, and coexistent with other agencies that serve
many of the same families. An adoption agency, for example, is embedded in a social–political context that determines legal requirements, the official or unspoken policy on interracial adoptions, the
attitude toward gay couples who want to become parents, and the
speed with which parental rights are terminated in cases of alleged
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neglect. These combined factors increase or decrease the number of
children eligible for adoption.
Within the agency, work is divided into sections. Particular
departments are responsible for different functions, such as locating
and evaluating potential adoptive parents, handling legal aspects, or
monitoring placement through follow-up visits. Each department has
procedures of its own, and the different departments must coordinate
their relations with each other and with agencies that work with the
same families. Logically, the communication between the department
that selects families and the department that monitors placement
should be extensive, allowing each to adapt to the realities faced by
workers in the other section. An adoption agency should also be in
constant communication with services relevant to particular cases,
such as the residential center where a child has been living for 2 years
before coming up for placement, or the program for children with
special needs in the local area where a child is about to be adopted.
The connection should be more than a matter of paperwork, especially when a difficult transition, such as adoption, is planned or
underway.
Integrating the work of different subsystems and agencies is apt
to be time-consuming, but perhaps no more so than handling the
negative effects of poor coordination. “Turf” problems between the
subsystems of an agency have a corrosive effect, as do communication failures between different agencies. Training is a useful and necessary way to introduce change, but the positive effects are limited if
training touches only one corner of a complex system. We’ve learned,
for example, that the ability of line workers to sustain new ideas and
procedures depends on the support of their supervisors, as well as on
the possibility of influencing agency policies so they can move in the
same direction.
A systems orientation is not an academic luxury; it’s a necessary
tool. Understanding that different agencies are interactive forces
within the network encompassing a family is a cornerstone of collaborative work and is essential for handling interventions at crosspurposes. If professionals can accept their connections and find constructive ways of handling their differences, they will increase the
efficiency of the system and improve the quality of help offered to
their clients.
We move now from this brief description of systems to a more
detailed look at the families who are the recipients.
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FUNDAMENTALS OF THOUGHT AND PRACTICE
FAMILIES
A family is a special kind of system, with structure, patterns, and
properties that organize stability and change. It’s also a small human
society, whose members have face-to-face contact, emotional ties,
and a shared history. We especially need to understand the families
served by social agencies. We can approach that understanding best
by means of a more general discussion, considering families first as
systems and then as small societies.
FAMILIES AS SYSTEMS
Patterns
When we describe families as having a structure, we mean more than
a map of who’s in the family. We’re referring to patterns of interaction that are recurrent and predictable. These patterns reflect the affiliations, tensions, and hierarchies important in human societies,
and carry meaning for behavior and relationships.
In most families, there are multiple patterns of alliance, involving people who are emotionally close and mutually supportive. Jerry
and Clarissa Brown have been married for more than 20 years. The
way they enjoy leisure time together, deal with their family, and handle problems clearly illustrates a stable alliance. But there are other
kinds of alliances that are less obvious than theirs. For instance,
Grandma and Jenny have a special bond. They spend time together.
Grandma is Jenny’s confidante and both enjoy the fact that people
think they look alike.
Sometimes alliances take a different form. They involve people
who are drawn together by an opposition to other family members—
and their alliance is more accurately described as a coalition. These
coalitions are frequently transient and may be relatively benign. In
one family, for instance, the adolescents gang up against their mother
whenever she proposes a weekend visit to an unpopular aunt and uncle. In another family, however, the coalition is more stable and less
good-humored. The daughters are in alliance against their stepfather,
finding a host of ways to oppose him, though they’re not close to
each other in most other matters.
Patterns that organize the hierarchy of power appear in every
family. They define the family pathways for making decisions and
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controlling the behavior of its members. Patterns of authority are
particularly important aspects of family organization. These patterns
carry the potential for both harmony and conflict and are subject to
challenge as family members grow and change.
Authority patterns that are clear and flexible tend to work well.
Clarissa and Jerry Brown have developed a viable process over the
years. They defer to each other’s authority in particular areas, consider the input of the children when important family decisions are to
be made, and have yielded increasing power and autonomy to their
children as each one has entered adolescence. Other families, however, have less functional patterns for arriving at decisions and few
skills for resolving their differences. Families often come for therapy
because their discussions are rigidly organized around winning and
losing, and they can’t manage to change the patterns that increase
family conflict. Authority problems aren’t always a matter of rigidity,
however. Control may be erratic rather than inflexible, with unfortunate by-products that aren’t recognized. In three-generational, singleparent families with young children, for instance, authority may
sometimes rest with the mother, at other times with the grandmother,
and at still other times with uncles or older sisters—depending on
who happens to be around. Messages that are unclear or contradictory confuse the children and interfere with their understanding of
acceptable behavior.
Some patterns are ethnic in origin. By and large, families in the
Latino community have different patterns for expressing affection,
voicing disagreements, and cuddling their young than do their
Northern European neighbors. Because South and Central American
families have been migrating to North America for some decades, we
tend to recognize and accept Latino patterns, but people who have
migrated more recently from other parts of the world often seem
“foreign” to many Americans, especially if they maintain clear
boundaries around their own communities. As a nation, we don’t
understand the patterns of Middle European, Arabic, or Asian family
life very well, but when these families arrive as immigrants without
many resources, they are apt to need a variety of services. Aside from
economic, medical, and educational needs, many of these people will
need help with resolving the issues that divide generations in a new
culture: the elders bring values and expectations from the society
they have left; the young are exploring the lifestyles of their peers in
the streets, in the schools, and through the media. Planning for this
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FUNDAMENTALS OF THOUGHT AND PRACTICE
reality requires, at the least, an increasing sensitivity to cultural
diversity in family patterns, a concentrated effort to broaden the ethnic base of a service staff, and the creation of networks that can provide diverse families with relevant services.
Subsystems
Each family contains a variety of subsystems. Age and gender are
among the most obvious examples: Adults have functions and relationships that separate them from their children; males are one unit
and females are another; and adolescents form a group with special
interests. Within a “blended” family, there are subgroups of “his,”
“hers,” and “theirs.” Spoken and unspoken rules govern relationships between the units: The younger children may not disturb the
adolescent when the bedroom door is closed; the children will tattle
to adults only when beset by injustice; the mother’s children will not
expect to go on a Saturday outing with their stepfather and his son
unless specifically invited; and Grandpa can stand up for a child in
trouble with his or her siblings but not when the parents are enforcing discipline.
The concept of boundaries is important in relation to subsystems, as it is in relation to the family as a whole. Boundaries are invisible but, like the wind, we know they exist because of the way
things move. All of the examples in the previous paragraph refer to
boundaries, marking thresholds that should not be crossed, as well as
the conditions under which they’re more permeable.
The firmness of subsystem boundaries varies with a family’s particular style. Thanksgiving dinner at the Smiths brings together three
generations, with lots of crowding and a high noise level. That arrangement would make no sense to the Barrys, who put the children
at a separate table and call for quiet when the kids act up. In both
families, however, there will be developmentally appropriate changes
over the family life cycle. The boundaries between adults and children will inevitably grow firmer as the children move toward adolescence. Parents usually intervene if the 5-year-old’s teasing brings her
little brother to the brink of a tantrum, but when the children
become adolescents they’re usually expected to fight their own battles; both parents and their children are likely to draw boundaries
that provide the adolescents with more privacy. As the parents’ generation becomes older, the boundaries may change again, reflecting
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the needs of the elders and the increasing involvement of their offspring in their health and well-being.
When family patterns are not working well, it’s useful to look
separately at the different subsystems. Meeting with just the group of
children, for instance, provides a view of family hierarchy and family
crosscurrents from the bottom up rather than from the top down. It
may also shed light on the repertoire of family members, some of
whom may function very differently in different subgroups. Twelveyear-old Mario, for instance, may be a creative and fair-minded
leader with his siblings, even though he clams up or is surly when his
father is around. That observation provides a useful lead for helping
a family explore their own functioning and develop patterns that
encompass the needs of particular members.
The Individual
The individual is the smallest unit in the family system—a separate
entity but also a piece of the whole. In the framework of a systems
approach, it’s understood that each person contributes to the formation of family patterns, but it’s also evident that personality and
behavior are shaped by what the family expects and permits.
This view is more revolutionary than it may sound. It challenges
both prevailing theory and the usual organization of social services,
which tend to focus on the individual as the appropriate and sufficient unit. We emphasize this point throughout the book, maintaining that an exclusive concern with individual history, dynamics, and
treatment is insufficient, and that it’s necessary to work with people
within the context of their families and their extended network.
If we are to think of individuals as part of a system, we must
develop a different view of how self-image is formed and how behavior is governed. Families define their members partly in relation to
the qualities and roles of other members. In so doing, they create
something of a self-fulfilling prophecy, affecting the self-image and
behavior of each individual. Joe is described as shyer than the other
children, and he thinks of himself that way. Annie, the oldest girl, is
expected to help with the cooking and with the little ones, and she
absorbs the role of “parental child” without question—at least until
adolescence. Mother is the one who handles contact with the schools
and other institutions. The shaping of behavior by the family often
involves the recognition of individual qualities, but it may also lock
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FUNDAMENTALS OF THOUGHT AND PRACTICE
behavior in place, restricting exploration and limiting elements in the
concept of self.
From a systems point of view, behavior is explained as a shared
responsibility, arising from patterns that trigger and maintain the actions of each individual. It’s customary to think that “my child defies
me,” or that “my partner nags,” but these are one-way, linear descriptions. In fact, the child’s defiance or the partner’s nagging is only
half of the equation. The process is circular and the behavior is complementary, meaning that the behavior is sustained by all the participants. All of them initiate behavior and all of them react; it’s not really possible to spot the beginning of the pattern or establish cause
and effect. We can say with equal validity that, when Tamika is defiant, her mother yells, Tamika cries, and her mother hits her—or that,
when the mother yells at her daughter, Tamika cries, her mother hits
her, and Tamika becomes defiant. Their interaction is patterned, and
we cannot explain the behavior of one without including the other.
The concept of complementarity has offered a useful, if somewhat startling, way of looking at diagnosis, as well as cause and effect, but it has also raised some cautionary flags. Behavior may reflect a circular pattern, but some behavior is dangerous or morally
wrong, exploiting the weakness of some family members and endangering their safety. Feminists have made this point in relation to male
violence toward women, and all of society condemns the abuse of
children. In such situations, the primary task is to protect victimized
individuals and to take an ethical stand, while working with the family to change recurrent patterns that are dangerous or morally unacceptable.
Transitions
All families go through transitional periods. Members grow and
change, and events intervene to modify the family’s reality. In any
change of circumstances, the family, like other systems, faces a period
of disorganization. Familiar patterns are no longer appropriate, but
new ways of being are not yet available. The family must go through
a process of trial and error, searching for some balance between the
comfortable patterns that served them in the past and the realistic demands of their new situation. The process, often painful, is marked
for a period by uncertainty and tension.
Some transitions are triggered by the normal cycle of develop-
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ment. When a child is born, the helplessness of the infant calls for a
new care-taking behavior that changes the relationships among
adults within the household. As children grow, there are increasing
demands for privacy, autonomy, and responsibility that upset the system and require new patterns. As the middle generation become seniors, problems of aging and frailty require a shift in some functions
from the older generation to their adult children. Some transitions, of
course, are not developmental at all. They reflect the vicissitudes of
modern life and the unexpected events that may happen to any family: divorce, remarriage, unexpected illness, mobilization for war,
sudden unemployment, floods or earthquakes, and so on.
Whatever the stimulus, it’s important to realize that behavioral
difficulties during periods of transition are not necessarily pathological or permanent. They often represent the family’s attempts to
explore and adapt. Anxiety, depression, and irritability are the affective components of a crisis. Although the behavior may seem disturbed or dysfunctional, a focus on pathology is not helpful; it tends
to crystallize the reaction and compound the difficulties.
FAMILIES AS SMALL SOCIETIES
There’s something impersonal about discussing the family as a system, probably because it bypasses the feelings and complexities of
human interaction. If we look more closely, we can pay attention to
the emotional forces that tie people together and pull them apart.
People in a family have a special sense of connection with each other:
an attachment, a family bond. That’s both a perception and a feeling.
They know that “we are us,” and they care about each other. When
we work with families, we know that its members are usually concerned to protect, defend, and support each other—and we draw on
this bond to help them change. We know also that tension, conflict,
and anger are inevitable, partly because of the ties that bind. As some
earlier examples have suggested, a family limits and challenges its
members even while it supports them.
The sense of family is expressed by feelings and perceptions, and
by the way members describe their history, their attitudes, their
style—what some refer to as “the family story”: “We’re a family that
keeps to ourselves; we don’t want trouble in this neighborhood,” or
“We had a hard time moving from the islands, but we’re doing OK
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FUNDAMENTALS OF THOUGHT AND PRACTICE
now,” or “We can’t ever seem to resolve anything without getting
into a battle,” or “All the women in our family suffer from depression.” There are alternative stories, of course, told by different members, but families usually share some version of who they are and
how they function.
The counterpart of family affection is family conflict. All families have disagreements, must negotiate their differences, and must
develop ways of handling conflict. It’s a question of how effective
their methods are: how relevant for resolving issues, how satisfactory
for the participants, how well they stay within acceptable boundaries
for the expression of anger.
Families sometimes fall apart because they can’t find their way
through disagreements even though they care for each other. Most
families have a signal system, a threshold above which an alarm bell
sounds that registers the need for family members to cool down and
avoid danger. It matters how early that warning comes, and whether
the family has mechanisms for disengagement and crisis control or
typically escalates to the point of violence.
FAMILIES IN NEED OF SERVICES: THE MULTICRISIS POOR
Principles of family structure and function are generic, but they have
special features when applied to families served and controlled by the
courts, the welfare system, and protective services. For one thing, the
affection and bonding in these families is often overlooked. We hear
that people are so spaced-out on drugs they can’t form attachments,
that mothers neglect their children and fathers abuse them, and that
families are violent and people are isolated. These are all truths for
some families but only partial truths, highlighting the most visible
aspects of individual and family misery while ignoring the loyalty
and affection that family members feel for each other. They generally
share a sense of family, no matter how they look to others or how
fragmented they have become as a result of interventions that have
both helped them and split them apart. Observant foster parents tell
us that foster children love their biological mothers and want to be
with them, even if they have been hit or neglected. Though this seems
an illogical state of affairs, it reflects the deep feeling and emotional
ambivalence that accompanies family attachments.
One recurrent and disturbing fact about such families is that
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they do not write their own stories. Once they enter the institutional
network and a case history is opened, society does the editing. When
a substance-dependent woman moves through the system and her
children are placed in foster care, a folder goes from place to place,
transmitting the official version of who she is and which members of
her family are considered relevant to her case. A friendlier approach
to families elicits their own perspective on who they are, who they
care about, and how they see their problems.
Just as connections and affection are not usually recognized, neither are the family structures: the actual membership of the family
and the patterns that describe their functioning. Families served by
the welfare system often look chaotic; people come and go, and individuals seem cut off. That instability is partly a lifestyle, amid poverty, drugs, and violence, but it’s also a by-product of social interventions. Children are taken for placement, members are jailed or
hospitalized, services are fragmented. The point is not whether such
interventions are sometimes necessary but that they always break up
family structures. The interventions are carried out without recognizing the positive emotional ties and effective resources that may have
been disrupted as well. When all the children in a family are taken
away for placement, the mother’s adolescent protector against an
abusive boyfriend disappears and the mutually supportive group of
siblings is disbanded.
Boundaries are fluid in these families, and workers enter with
ease. Often, the family’s authority structure, erratic to begin with,
disappears. The decisions come from without, and the children learn
early on that adults in the family have no power. The worker may
unwittingly become part of dysfunctional subsystems, influencing the
patterns in a way that is ultimately unhelpful. If the worker supports
the adolescent daughter, for instance, allowing her to invoke the
power of protective services in battles against her mother, the possibility for the family to manage its own affairs is diminished rather
than enhanced.
Violence is a major fact of life for these families, and it takes
more than one form. What comes to mind first, because it is the more
conventional association, is the violence that occurs within the families themselves. Poverty, impotence, and despair are embedded in the
family cycles of this population, often leading to shortcut solutions:
drugs, delinquency, impulsive sex, and violence.
When we look inside violent families, we see a derailment of or-
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FUNDAMENTALS OF THOUGHT AND PRACTICE
der. The usual fail-safe mechanisms that protect family members and
ensure the survival of society don’t hold. Any worker who deals with
inner-city welfare families faces moments of ugly reality: brutal punishment, incest, abandoned children. As consultants and trainers, we
have always been invested in the concept of family preservation and
we have supported interventions that keep children in their own
homes, but we pay serious attention to the problem of family violence and to the question of how to assess and ensure the safety of
family members. The official pendulum that swings through extremes, from removing children to maintaining the family unit to removing the children again, fails to provide a sophisticated solution to
this basic issue. The mandates are procedural and global. They are
well intentioned but not helpful enough in specific situations. A
worker must be able to explore family conflict and to assess the family’s potential for positive change before making a decision of this nature. We discuss this important matter further in succeeding chapters.
There is a second form of violence experienced by these families,
though we don’t usually think of it as such. It comes from intrusion,
and from the absolute power of society in exerting control. The rhetoric, and sometimes the reality, is that of protection for the weak, but
the intrusion into the family is often disrespectful, damaging ties and
dismembering established structures without recognizing that the
procedures do violence to the family. Because there is so little recognition that individuals and families are profoundly interconnected,
legal structures and social policy set up an adversarial situation, with
an associated imbalance between the rights of the family and those of
the individual. Procedures are determined through court hearings,
where professional advocates present their recommendations and the
viewpoint of family members is not directly heard. As a result, the
outcomes are usually preordained, following general policies and
precedents. The family is the victim, in a sense, of unintended social
violence.
Social interventions are often necessary, though less often than
they occur and not in the form in which they are generally carried
out. If we recognize that the family has structures, attachments, recurrent patterns, and boundaries that have meaning, even if they do
not work well, procedures become more family oriented. It’s useful
to highlight what that implies: A family-oriented approach means
that we begin to look for relevant people in the family network and
accept unconventional family shapes. We notice subsystems and the
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rules that govern family interactions, both those that lead to crises
and those that indicate strength. We realize that social interventions
create transitions, and that families will go through temporary periods of confusion, anger, and anxiety that should not be treated as
typical or permanent. We also become aware that when they are actively intervening, workers are part of the family system. Their role
in working with poor families is far more powerful than the role carried by teachers, physicians, or ministers, in relation to more stable
and privileged families. The driving force of a family-oriented approach involves a recognition of these realities and a style of intervention that enables a family to help themselves.
We know that it’s difficult for most agencies to adopt and implement a family systems approach, and we have grappled with why
that should be so. In this second edition of the book, we are especially interested in the factors that enable an approach of this kind to
endure, but it’s also important to review the obstacles that stand in
the way. We do so, briefly, in the next section, where we discuss three
factors that tend to block change: the nature of bureaucracy, the
training of professionals, and the attitudes of society.
OBSTACLES TO A FAMILY SYSTEMS APPROACH
The Nature of Bureaucracy
Bureaucracies become top-heavy by accident. They begin by identifying necessary tasks and developing the structures to carry them out.
Certainly, the social institutions that serve the poor were created to
be helpful: to cure suffering, to protect the weak, and to provide a
safety net for society and its members. But the increase in poverty,
homelessness, drugs, violence, and the endangerment of children has
imposed new demands on protective systems. Ideally, increasing
demand would be met by a comprehensive plan to govern the integration of services. In fact, however, the situation has typically given
rise to a patchwork of distinct and disconnected elements: shelters,
temporary housing, and police action to deal with homelessness; a
variety of programs to treat substance abuse; a spectrum of agencies
that offer foster care, adoption, residential placement, or clinical
therapies for children at risk; and so forth.
The elements of the social service bureaucracy have become specialized turfs, rather than interactive subsystems of an organized
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FUNDAMENTALS OF THOUGHT AND PRACTICE
structure, and they compete for funds. The level of funding is always
inadequate to meet the needs, but an increase in the flow of money
would not, in itself, correct the situation. The fundamental problem
is that services are not integrated and money is earmarked for specific categories: babies born with positive toxicity or pregnant teenagers or workfare initiatives. Categorical funding labels the territory,
points toward certain procedures, and supplies an ideology for preserving artificial boundaries. As a result, agencies and departments
vying for financial support shape their language, procedures, and
training in accordance with available funding opportunities.
Current policies and procedures focus primarily on the individual. Every case centers on an identified client who has been referred
to a particular agency for help with a specific problem. From our
perspective, the issue is not that a substance-dependent adult is sent
to a drug program or that qualified people are seeking an appropriate foster home for a child; that kind of specialization reflects the
competent functioning of the system. The problem is that the customary procedures create a barrier around the individual. There’s no
provision for the idea that a drug-addicted individual has important
connections with other people, or that it’s important for the child
and birth family to maintain contact through the period of placement.
It’s difficult to challenge this individual orientation because the
procedures are tied to well-entrenched bureaucratic structures. Budget allotments, caseloads, and insurance reimbursements are based
on individual appraisal and treatment. Such arrangements are cumbersome and they don’t yield easily. In addition, the emphasis on the
individual is taken for granted, not only by the officials who manage
the system but by most of the professionals who work within it.
The Training of Professionals
When professional workers ask themselves, “What are we here
for?”, the answer is usually simple: “To help the patient” (or the
abused child, the pregnant teenager, the heroin addict). The focus on
the individual is a legacy of professional training that emphasizes
individual theory, case material, and therapeutic techniques. Social
workers, psychologists, and psychiatrists approach their professional
work with a framework of ideas about personality, pathology, and
treatment, along with particular skills for dealing with the individual.
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Perhaps it’s natural to respond to individual qualities and actions,
especially if people are in pain. It requires a complex kind of training
to respond to the person in context, and to apply healing procedures
that go beyond individual distress in order to mobilize the system.
We have yet to reach that point. If anything, advances in scientific knowledge about the brain and the body, the proliferation of
medication as the frontline of treatment, and the control of reimbursement by HMOs have reinforced the focus on the individual. In
the current climate, that focus begins with intake. Workers are
expected to follow prescribed procedures; to gather the required
information; and to work toward a definite decision that will move
the case to the next step. Though they may enter the system with
innovative ideas, workers generally survive by learning how things
are done, who’s in charge, and what it takes just to keep track of the
caseload. It’s often assumed that the established procedures are
inflexible laws or official mandates: You must fill in the forms this
way . . . . You have to arrange visits by following these procedures
. . . . This is how you do discharge planning. The professional staff
are generally overworked and are apt to view a family orientation as
an addition to their jobs rather than a useful approach that’s central
to the work. They know they’re vulnerable, and that if something
goes wrong, the bureaucracy will not protect an employee who has
not worked according to the rules. The reality of the job doesn’t lend
itself to time spent searching for families, exploring their strengths,
and handling the complexities that multicrisis families present.
If a social service staff can accept the idea that families are a
resource, they are on the verge of a more effective approach, but it is
only a beginning. They cannot work productively if they do not
understand how a system such as the family functions: how the
behavior of the individual reflects his or her participation in family
patterns, how the actions of courts and agencies reverberate through
the family, and how positive changes depend on working with the
network within which their client is embedded.
There’s an interesting paradox here. Unlike the practitioner in
private practice, professionals who work in social agencies are experiential experts on the meaning of an interactive system. In their own
working environment, they’re aware of hierarchies, rules, coalitions,
alliances, subsystems, and conflicts. They’re also aware of their particular place in the system. They know that their roles and possibilities are formed and constrained by the way the system works, and
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FUNDAMENTALS OF THOUGHT AND PRACTICE
that, when they modify or challenge the rules, it has repercussions
elsewhere and for other people. It’s interesting—and a bit puzzling—
that the idea of the family as an interactive system doesn’t resonate
automatically for staff members. In particular, it should be obvious
that the individual doesn’t function independently, and that the effects of individual effort are unlikely to be sustained if the relevant
system doesn’t change. Because that awareness of how systems work
may be close to the surface, it may not be so difficult to help workers
understand that their clients function within a network.
Social Attitudes toward Families That Are Poor
or “Different”
Within social agencies, the effects of the bureaucratic structure and
the traditional concentration on individuals are compounded by a
view of poor families that is essentially pragmatic and often moralistic. In many settings, the definition of family is narrow. The social
work staff must arrive at solutions, and they tend to define family in
relation to information that must be funneled to courts or child welfare departments, such as who in a family can supply information
about this child’s early physical and social history, who might be able
to take a neglected child in a kinship foster care arrangement, or
where a pregnant adolescent can go with her baby when the infant is
born. The staff looks for who might be available to help and who
must be ruled out because the record suggests they are destructive in
their relationship with the client.
Though definitions are often narrow, judgmental attitudes tend
to be broad. Moralistic attitudes toward poor families are submerged
but pervasive in the culture. The families are blamed for their substance abuse, homelessness, and economic dependency, and viewed
as a burden on society. Separating or ignoring families is partly a
reflection of disapproval—accompanied by a missionary spirit when
children are seen as the victims. There’s a countertrend, of course,
which is certainly just as valid. From this different perspective, poor
families are viewed as the victims of bad economic times and reactionary policies who react to the hopelessness of their condition with
self-destructive and socially unacceptable behavior. In practice, however, criticism and social impatience tend to outweigh compassion,
especially when the political pendulum swings in a conservative
direction.
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Even when families aren’t blamed for their poverty or their
social behavior, they’re often blamed for the plight of the client.
They’re seen as part of the problem rather than part of the solution.
Mara drinks because her boyfriend is abusive, her parents made her
feel a failure, and other family members are also drug dependent.
Jamal has been neglected by his mother, his grandmother doesn’t
seem interested, and his uncle said he would take over but never
helped him. Jane took up with a boy and got pregnant because the
home environment was so bad. And so on.
There’s some truth in these judgments, but such a one-sided
analysis doesn’t acknowledge what the system has squelched, who
might be available as a source of strength, or how the family’s
resources could be tapped to create a more protective and effective
context for its individual members.
To this point, we have commented on social attitudes toward the
poor, but, as suggested in the first chapter, we also need to consider
the attitudes that have greeted increasing ethnic diversity and new
lifestyles. Families that have come to this country from unfamiliar
backgrounds tend to arouse discomfort and distrust. What are their
values and religion? Are they illegal? Are they taking our jobs? Are
they a terrorism threat? How can they treat their children that way?
When they come into contact with the service systems, they may face
not only a lack of understanding, but also policies that compound
their problems and workers who carry negative attitudes. To serve
these families well, we will need to develop new and thoughtful policy initiatives. We also will need to change the preparation of professional workers so that it includes more emphasis on the diversity of
social service clients and on the ways that families from different cultures view the world, form relationships, and function at home and
in society.
People who have formed new social units—nontraditional in
their attitudes toward gender, toward the definition of family, and
toward the creation and rearing of children—will certainly face
social barriers, legal problems, and religious criticism from the culture at large. Though people implementing unique lifestyles are generally not poor or in need of help at survival levels, it seems likely
that they will be needing services of some kind. We know, for
instance, that many people with committed, well thought-out attitudes toward life and relationships find that the raising of children
brings on unexpected disagreements, and parents with new and com-
32
FUNDAMENTALS OF THOUGHT AND PRACTICE
plex lifestyles are probably not an exception. In one unique situation,
for instance, four friends who had formed two same-gender partnerships—one of males and one of females—had cooperated in producing a child. The child now lives in the house shared by the two couples, all of whom are her parents, though only two are biologically
related to her. The arrangement worked well through the child’s earliest years when affection and nurturance were shared and abundant,
but as the child has grown, the details of control and discipline have
raised disagreements that these four people did not expect, and they
have found both the situation and the child’s reactions difficult to
handle. Such situations, and many we cannot yet imagine, will be
brought to professional workers in the future, and the clients may
come up against attitudes that are deeply critical and that interfere
with the necessary search for constructive ways of helping in unfamiliar situations.
WORKING TOWARD CHANGE
The material of this book is aimed at advancing practical knowledge.
We try to provide concrete illustrations of a systems framework and
specific examples of interventions that can be helpful in the delivery
of services. We know that a staff encouraged to work with families is
often uncertain of how to proceed. Workers who aren’t accustomed
to thinking about family systems lack the skills for effective interventions, and therapists who have worked with system concepts may not
know how to apply their skills to agency families. In the remaining
chapters of this first section, therefore, we present the material that is
most important for training a staff in a family-oriented approach. We
discuss the skills necessary for working with families, as well as the
details of effective procedures.
It may be useful to note, first, that we’ve had a particular role in
the agencies where we’ve worked, and that the professional role of
the reader may be either analogous or different. As consultants and
trainers, we’re outsiders, which gives us certain advantages: some
freshness of perspective when we look at the agency’s structure and
way of working, and some freedom from the alliances and tensions
that subdivide the insiders. It also brings disadvantages: We must
take time to learn how the agency functions, and we miss important
subtexts obvious to any member of the staff. Some readers probably
The Framework
33
share the role we have carried and can read the material for its direct
application to what they do. Others may be responsible for training
within their own agency and will have a different context for processing the material. The basic points, however, and much of the
detail, should make instant sense to any reader who has worked with
the complex problems of the multicrisis poor, and should provide
some guidelines for people who are planning to move into this field
of work.
CHAPTER THREE
Working in the System
Family-Supportive Skills
Social service workers bring two sets of skills to their work: a way of
thinking about their clients and a way of functioning to encourage
change. If workers are to increase their mastery of interventions that
support families, they must develop both a systemic, family-oriented
framework and an expanded set of techniques for implementing new
ideas. Practical skills are the most direct, involving interaction with
clients, but they’re not optimally useful or self-sustaining unless
accompanied by a mind-set in which the importance of the family
and a knowledge of how systems shape behavior are firmly established ideas.
In this chapter, we discuss conceptual skills (elements of a mindset for understanding a family and organizing the information) and
practical skills (procedures that help families to mobilize and develop
their resources). We treat them separately but they’re actually linked,
and in the following sections it will become clear that they overlap.
Examples that concretize the ideas involve some intervention, and
interventions are described against the background of our thinking.
That is, of course, how skills are implemented in actual practice.
When services are offered, they are necessarily sp…
Purchase answer to see full
attachment
![I’m working on a writing discussion question and need an explanation and answer to help me learn.
Citing the Minuchin et al. and Nichols readings, please identify two different Structural interventions used in the video of a family session with Aponte.
What is your assessment of this family’s structure, including an assessment of the boundaries between individuals and subsystems?
Did you see Aponte follow the outline of a first family session as described weber the article? If so, which of the steps did he follow?
What did he do that you could see yourself doing in a first session with a family?A Beginner’s Guide to the Problem-Oriented First
Family Interview-’
TIY0tM~FR;PH.D.t’
JAMES E. MeKEEVER. PH.D.:
SUSAN Il. MCDANIEL, PH.D.5
liar iargr volume and diuersit,v of family therapy resources eafl often coniusc
tminees adto are in need of more abbreoiated#uidefines for mana& their clinid reapomibilities. 77th paper prese+s a
rtntctwed outline of a probkm-oriented
f5rs: family interview for the family therapy rupercisor and the beginning family
thenlpist. we vits the fit iJaterview as
on integrated process including the
important tasks preceding and follotaing
the initial family meeting. After the goals
refemA mw and (12) gathering meor&. This approach to the first in&ntiao
integmtes a uariety of structural and stmtegie procedums. The guide, intended ior
use in conjunction with claw supemisk,
mayremeos4fuun&tiononlehiJIbeginning thempists can build their unique
styles.
th8t8lKiJKthUlkl-kOfth~/intinL~
slEmfimilythmpiiise
fronwdwith8peadl8rproblan.
cm deswibed, a s&p-by-step yide to the
tweiae phcses of the interview is presentedz l7) telephoning; (m) fomGn,g h-ypotheses; (31 the greeting; (4) the social
phase; 13) identiiying the problem: (6)
obseming family patterns; (?I degoals; @I coeachg; (9) ChecMist; (IO)
raising hypotheses; (11) contacting the
T
.
This-isoftat~8pp8ralt8t
thcpohtofthebntmee~wlth8frnrily
when ‘krildaed and ambus trainem are
oblige6 m take leadership, -da&g the
m8ss 0: clinic8l optioBs into 8 prdcrl,
sensible. well-org8a~ iat8n6ew wltb 8
group of 8umprs. tkd~ly, t&neesofwmrill8skpriortom8etlngwith8
family for the bnt time, “How do I proceed?“; -Wbcn do I begin?“; ‘Whet do I
do&rIbegia?“;“WbatsbauldItryto
l ccoqdish?” Although the questions
ttlainwul:rboutgetting~my
3581
F-Y –
seem elementary to the seasoned therapist, sion of the many procedural variations that
.trainees may have a fresh sense of a funda- are bound to arise in working with any
-mcnt,al point Haley (5) has notad: “If thu- family. Such matters are more effectively
apy is to end properly, it must begin prop- addressed through background reading
erly-by negotiating a solvable problem and direct supervision, indispensable supand &covering the social situation that ports for beginning family therapists. Also,
makes the problem necessary” (p. 9). “Be- our intention has not been to provide
ginning properly,” without drifting and extensive and exhaustive examples of each
getting muddled in irrelevant details, is an task. Rather, we have stayed within the
imposing challenge to both the beginning narrow bounds of presenting an overview of
therapist and more experienced therapists. those tasks we believe constiwte a crisp
Rccogni&tg the pivotal importance of and efficient problem-oriented hst family
the fint iaervkw with a family, Haley interview. Finally, OUT goal has not been to
wrote hia important and influential chap- provide a detailed review of the literature,
tar on “Conducting the Fit Interview” citing references to support the guidelines.
that appeared in the 1976 publication We havelistedaources at the conclusion of
J+&iern Soluiry Thcrapr (5). Several this paper that the baginner may find helpother authors have focused on procedures ful in understanding both the theory and
for conducting this- initial-: meetimg taehn+s-of tha problem-oriented 6rst
(1,Z 3.4,7,8,101. Theea- presentations, family interviewFour primary goala ahape the work of&he
and the structural and strategic theories on
whichthayarebased,havebeenespecUly
flratintarvia=
valuableforbeg&ingtmlnaeswho,inour
h a,t&.m accommod8~ to.the
experience, tend to work most effectively
style of family .members and creating an
using a concrete, problem-oriented frameenvironBleat in which family member8
work (6). Nwuthelas, as us&l u these
will feel aupportad.
theoretical and clinioal discustions have i w the,bterv+ a. that family
bcm, they m8y not meet the needs of
members will begin to gain confidence
trainees who are in search of a concise,
in the therapist’s leadership.
*P-by*kP & for nqd*fietuLged territory of the iirat interview.
& G~~info~ti~ about the problem
inauchrwaythatthefhilfstruts-
Thepurposeofthispaperistopresenta
&ions uound the problem become
dH.
~-~.~b-tep, beg@ds ruidr to
the problem-oriented 6rst family inter- 4. Negotiate a therapy contra@ emphasiiview. This guide ls au integration of proceing the family’s initiative in de&sing
dures from a variety of approaches rooted
goals and desired changea.
inthestnxamlutdatr8tegic0rimt8ti~
AS fdy olerapy aupankm we have
Our guide for the 6rst interview is a
found the guide to be useful in our work
ositb b&nning trainees in a variety of compendium of rpe& tasks designed to
trtining contexta We want to en&&e accomplish the four & It b oriented
~t~(uideshouldbeusedonlyinthe towardafamilyinterview,althoughitcan
axhxt Of ~prehenaive training and easily be adapted for a couple or family~perrrition in hmily th~0t-y and therapy.
oriented indihklual session- Nec&mt the+
b k-ping rrith oar god of making the *text& the 6rst intenk~~~~w
@de = t&f= poaible. WY brat •~aid~d bwh; pn-iatu*im-m& pore-httprim
=mmmW On the theoretied premises tub The hiti c&ct wioith &e f&y
forthw UAS axad hr~a
. limited our discus- over the tiephone h a Qudtl pr#cu &t
. l+m!-R-t)u
– “itdp the thempiat b~Stcntrti*c hyp~thtaes based on prelimiii&rmation and
setsthetoneudp8ttemofinquiryfortbe
first mciting. Likewise, after the interview,
itlsasaltkltorcviewthainf~tion
gathqed, evaluate how the interview was 1.Td~phoning
conducted, and organize a.treatmeat plan
~~l~dthetelepboneallisfode
aothatthw8pycariproceedmostc8ectiwly. These crrcatial tasks help polish the anmcft with the family and to coatmct for
tberajSst’8 &inking utd work ln subse- thefimintcninr.
quant meatingk ,Witb 8ome a+ions 1. Gather UC tionnrtian. ia&*
&3,4,&W, f&r too little attention has
-aa l Mrtsw,andpbaneaumbas.
been given to these fundam&aJ prepua- 2 Askfor&iefdascriptioaoftlaeprot+
tosr-d revkwtasksmdhowtheyanb
integratedwiththefemilyirltrrvicn.
3. -=@=mwMWW~.
.
+-=P-mm.
wd&ggT: -y–=
4. contractforthekstiu~,,irrdud~
ingI.
.
8.Whowltlattatd(ifthecontutpaaorlresl8labrlngkgthaotirqfunlly4aembaaafthe~
tltebnt#rboo,~twnt’aptiats
tif’ the probkw (6) obsavbq family
vuJvi&ameetwltbthafwily
pattcnrr;CI)drlininrm&@)contnctiry;
memknmatc-anKdabguttba
(9) chqckw (IO) rwiah trJpotbcw; Olh
problem or iwist that all m
emu* the referral puaoa; and (la
mambemmustattaxl.Priorbthe
gatheringrewds.Thasectagaoftha
illtaviewitselfue8imilutow~soutPl==an,tac stlpahwahouldba
line (6). However, we have added addiconsulted rtpd@g posibk op
tions).
.
tioMlph#r,~~dpOIt
b. Dateandtimeaftheintwiew~
interview tads rod have integrated
t@i&dqw hm other qQro8cba that we c.Wbereitistotakeplace&dudiDg
.
dirdorrrtotlu~md~-h~
b8vefoa8dmefd
Although t&e phases are clearly demarwf3. Feefurtheillitid~
ate&udphaeswithintiteintaview
itself ue assigned approximate time 5. Iftbcfbilyi8notself-refermdandtbe
refwingpasaQansbefoeetbe~
framesfarckityandpacing,theactu8l
a. Illqrrirs~therefariDg~‘S
pmcassofintbrvi~danandsa~
undemmdingoftbeprob~
me8sureofsedtiv&tothe%&uralfi~
b. Ckrifywbattherefemimgpemnis
6f moving from one phase to anotbu.
.
Phases am ovakp or take place concurrcqucstiry kg, – orreferral for therapy).
rently in m 8ctttal interview. The au&iv-.
c. Agreeonhowfcllknv~iIlfoxm8tion
ityaad&xibi&requiredtoadjasttothe
willbe~totherefaringpasonVUiOUSt8SbU!Wd&gMW8SthCrrpi8U
xbgardl~0fwbet.h~oraottbe
gainmoreexpaienceinworkingwithfamircfdng paam a l l a befort’the
Lies.
interview, contact should b@made
The foliowing guide is intended for use
followiagtheiatcnicn.. .
.
by tr&tts in conjundion with close
Fam he., Vd. 24, September 1935
,
FAMILY ?Rocms
3 6 0 f.
11. FG+hlg Hypotheses
TIIC purpose of this phase is to develop
initial hypothcscs to help guide the exploration of issua in the first interview.
1. Develop tentative hypotheses to be
tested in the interview (these hypotheses will be expancled and revised as new
information is gathered throughout
treatment).
a. Begin by deterAn& the. life-cycla
SW ofthe family and the predicted
problems and tasks of that life-cycle
shsc
. b- On this foundation, buildhypothusingotherdatasuchasthenatureof
the referral, the emotional tone conveyed by the contact person on the
telephone, and the family member
identi6ad as “the patient.” A background in family theory and close
s-on are essential in forming
crisp and testable hypotheses. Beginners should not expect themselves
immediately to provide sharp’hypotheses. This skill develops with
experience and supervision.
2Develop~aatrategyforthefImtLinmE
view, inchxiiip specific questions, obsmai~ or tasks that will facilitate
data-gathering and help test the
hypothases (the strategy will help prevent muddled thi&ing and drifting in
thesession).
3. Having developed initial hypothesas
and a working strategy, be careful to
remain open to the uniqueness of the
family and to information that supports
&wnative hypothescr
IIL’
.* The Greeting (approximately s minutor)
. . Beaus it is difikdt for most ueople to
~+e into tremnent, the goal of thii phuc
p to welcome and identify the famfiv mem+ ad h5a to introduce them-to the
@@q-d to the therapist.
GWOdUCe Yourscll to the contact person
and to other adults in the household.
Shake hands and greet each member of
the family (greetings should be ageappropriate, i.e., use formal names for
adults, at least initially; be sure to greet
and make contact with all children
attending, no matter ahat their age).
2. Invite the family members to sit where
they wish (use this information diagnostically).
3. Orient the family to’the room (e.g., videotaping, observation mirrors. where
toys for children are located, etc.) and to
the format of the session (t.gW length of
the meeting, split session, etc.?.
4. If you are audio or videotaping, cbtain .
oral permission’ from adult members.
(Signatures on the consant forman be
grthired rt the end of the interviewer
IV. Tho~~Soclal Pharr (approximately 5
minutes)
Thegoalofthesocialphaseistobuilda
nonthreatening setting for the family, to
get to know them batter, and to heIp them
become more comfortable.
1. Help the family to get comfortable by
engaging in informal coavemation, followed by introducing the agendr “It
would help me if I 6rst got some further
infonB8ti& 8bout you.”
2 Increase conmct with each family member by rquesting demographic information from each of them such as their age,
work/school wtivity, education, length
of marriage, ek Try-to 6nd something.
ium&pRmJbtJ&.~ia~~.~
h~and!genem
to the funily (e.g,
by following up on a family member’s
job or interests).
3. While talking to the family, remember *
to give specialdtention and respect to
the adult Iuder/spokesperson of the
family. Make3&aL &oWto. engage
those:- in+ the fan& ubor. ark direspm5dy~pwho.did not-make
thr.ini~ collt8cb
WZURRAL
4. Nofa each fsmiiy member% knme
and nonverhsl behavior and attempt to
match and use this style snd language in
au$equequyt;~i when working with
.
V. Idonllfying thr Prohl~~~approximstelY
15 f@wtos)
ThsgorlofthisphssabtoupIonaach
Iunity member’s view of the problem in
8ptdfi~ b&~%r~l terms, as well as the
solutions that have been attempted.
1. Continue de6ning the yen& “Often in
fadiu psoph hsva dilTersnt vks
about what the problam is.‘Todsy I
would Iike to hesr from each of you
SbOUthOWyoUKcth~PploblcLa”
2 Address .each member’ of the far&,
~beginningwiththesdultwho
spptalstobcmort-t~~pmbklrL
?
a Help frmily members he more concrete
~apecikbysskil!g,YHowisthis*
pmbkm for you?3 “wbcn dii the prdb-
k 361
b. Hemp fsm~y me&em to cktify w
though&
Cm hinhinsn ampsthic and noa&&
~stancewitheuhpersolL .,
d.AfEirmtheimportanceofeachpetma’s contriiution.
8. At tbi~ point, don’t off~ &iicc ot
brpretstionsevenifss~
.f. Bbck
interruptioas
from
0th~~
if
.
PuamtenL
0. Nota, but don’t emphasii d@~=w-ngfrmilym~bctt. _
h. Goslowly!
Vi. Observing Family Psttoms (approximately 15 minutes)
TblgOSiifthiSphueblo%ingthe
problem into the room” so that the b.
pist~tbafalaikyCSIgata&arerpicwra
oftbe
.
-~tt-offsahilymsmbers around *Problem.
l.Havsfuniiymembtnduify8~
behsvioralupectoftheprualting
problem in one of seversI ways
Iem begin?“; -what prompted you to
come in now??
l.~~frmilOBlSdXXS(t&
father and mother, father and toa,
c. Find out how members of the family
have attampted to sofg the problem
bro’tber and sister, ctc) to tak to
8nd what the resdts oftbue repted
CrChOtk8hOUttbcpXOhklOmd
howith8skmhandkd.
sohltionshsvebeen.
5 Explore tbs involvelns!lt of otbars in the
hHavshaiIymambasdescribatba
. prablun: Wave you been given advice
interactions of Other family memhas
from other people about this problem?“;
utbcprupondtotbeprob~
-what do you think of their advice?”
(“Joluwhenyou~intor~htwith
(ln&de@quiriasaboutprthustbtrsyoursista,whatdoesyourmotha
do?““Andwbenyourmotherdoes
pista and ether p~fessioark1
6. &ik &out recqt changes in the Sadly,
that3 what dots porrr father do?“)
c. Have family members n-enact an
S&I u moves, ilhss, dath, ocwpational shifts, or exits and entrances of
l xsmple of the problem (e.g., “Show
me what hsppens in w house when
members into the family orgsnizstion.
Wliile kaapkg a focus on the presenting
Susie comes bane late”).
problem,be l wsre ofcontext chsnges .2 Step bsck, observe, snd Iisten to the
in the family system that inh~rce and
fsmily in order to make 8a intersctionsl
are influenced by the presenting probsssessmen~ espuisuy noting psrtidar
repetitive behsvior squences tbst occur
Iem.
around the problem.5. Process reminderr
8. Eocmrage family members to be 3. If snychanje in cbe family’s inter&ion
is proposed, this chsnge should be be&
specik ask for exsmplet.
r’=ln. Proc., vo12:. Sep1c.dv 19z
362 I
PALY PRdCEJS
slowing thtm down. Sometimes a home&)lear thernpcutic goals and family’s
work assignmtnt, such as asking them to
behikor in the session (e.g, if mother is
gather more information about the
the parent who is busily managing the
problem, is useful at this point.
children in the ression while the fnther
* :
..I
remains quiet and distant, the therapist
may sugg~c “John could you help your VIII. ContiscUng- (approximately 5 minchildren find something to play with SO
utes)
that you, Mary, and I can continue taikThe god of this phase is to reach sn
ing over here.“)
agreement
regarding the continuation of
‘1. Complimtnt specific family memben on
therapy
snd
its structura.
concrete actions that were positive (e.g.
“Mary, you seem to have some good 1. At the end of the interview ask the
family about the next step, empbasixing
ideasastohowtogetyourdsdtohear
their initiative (e.g., What is the plan for
>f-“)
pKxxedblg??“).
2
If
the family does not e&‘to continue,
VNrG.efInln~ Goals (spproxSmstaly 5 minoffer
a referraJ to another therapist or
utes)
agency or indiit.e how they might
The god of this phase is to crystsllise the
return to tberspy in the futum If they
goals of trestmmt as viewed by each family
elect to continua, arrange for the next
memher in sped& and rdistic behsviord
appointment snd determine who will
attend (the structure of treatment is the
1. Ask each family member to summarize
therapist’s responsibility).
vrhathecrshewouldliketcseechsnged 5 Some hmilies ma+sut to contract fat
a spec%c number ‘of sessions This
(notice similarities snd differences
option should be considered since some
among the goals of di!hent family
members).
fsmiiies may work more effectively
when therapy is time-limited.
2 Define the chsngu in terma of specific
positive behaviors rather than negative 4. &view the business vt induding fw insurance informstion, etc
bhvi~~ kg., “I’d like Dad to help me
lrith my English sssignmen~” rsthsr 5. Ask the adults to sign the tsping consent
forms snd the nmssay release of inforthan “I’d like Dsd to stop nagging me
.
about my homework”).
mation forms for gathering relevant
3.Undarcoahtbe-straIgWofthsfsmiLy
informstion frcm other practitioners
and agencies (physiciaas, schools, pre-,
bv ukiry, “I’m sure thw is a lot you do
vious thenpists, etc).
tooch~r thrt you would like to keep
doing. What it it thst you would like not 6. Ask if family members~ have any ques, tiolu
b druyc?” (This qua&ion may be
riocn to MY membem as a task for 7. Condude the interview.
~~~tbinirSbOUtbSf0mtbrn~
S-i-1
+.H~P the family mtmbcr~~ to apetrify
their UpKtrtions mom cksrly *ad rulbGdY b ukiry, “What would k the
makst bge that might indiate that
UP m moving in a better dim.tion?”
UC. Fiat Intarvlow ChocklIst
Use the following cheddist to evaluate
the process of the 6rst interview. Did the
thUrpilk
1. ms%e ccntrct with each member of the
family and help hi or her feel as
confortshle as possible;
2. titabkh leadership by clearly rtructuring the i~terviear;
3. develop n working relationship with
4. LYtht grouDdwork fOrulydl&O+
tba ntccsury for aurying out the tr&ti
meat 8t&&gy.
“professioDal” or too persoD&
4. rtco~ stre~gtbs in tbt f+ily and in
.
.
family mrmbcn,
XII- Glthtrlng Records
tbc funilywithwt~ig either too
W&Z for 8chool records, records of pn&us ~tatmcnts. or nay other relevant
infOmWion from profession& or so&l
8gencitr.
.
*
5. XDaiDtaia aa tDlpathic position, tup-
porting family members rad l voidiDg
blamingcucriticbinf;
SUMMAilY
6. identify the specific problems tic ftiily bring w treatmcat and their pn0~gdiathispaperhubetDtop~
vious rttempted solutions;
v& beginning therapirts and their er7. start to Itam the hnily’r view of tbe visors alI a highly strum siDlpli&&
world and each family member’s lan- ad p~utkal guide for conducting a prob.
guage, style, and perspective on the letp-oritnttd Grst family intemiew. T&S
guide is inteDded to be a basis from which
problem;
6. begin to undershnd the family’s repet- beginning therapists a~ develop their peritive interactions around the problem sod stylts. Each in&l inttrvitw is
unique requiring the therap&& to be 5aS
b&l¶ViOr.
9. gathtr information a’bout sigaiiic8Dt ble in order to kcompiisb the iaterview
othtr family fhads and professioDals gcbak.Tbisguideprovidesthetraineewitb
.m
a framework for coibolved with the problem;
10. negotiate a contract with the femily rte goa& tbe behavioml t8sks IZX
. rt8cb those gods, urd approximte that
that is m~tuallyacceptab~
limitswithiawhichthtstgo8lsnuybe
accomplished. Wii super+ioa urd expeX. Rtvising Hypothtfts
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ebook
THE GUILFORD PRESS
WORKING WITH FAMILIES OF THE POOR
The Guilford Family Therapy Series
Michael P. Nichols, Series Editor
Recent Volumes
Working with Families of the Poor, Second Edition
Patricia Minuchin, Jorge Colapinto, and Salvador Minuchin
Couple Therapy with Gay Men
David E. Greenan and Gil Tunnell
Beyond Technique in Solution-Focused Therapy:
Working with Emotions and the Therapeutic Relationship
Eve Lipchik
Emotionally Focused Couple Therapy with Trauma Survivors:
Strengthening Attachment Bonds
Susan M. Johnson
Narrative Means to Sober Ends: Treating Addiction and Its Aftermath
Jonathan Diamond
Couple Therapy for Infertility
Ronny Diamond, David Kezur, Mimi Meyers, Constance N. Scharf,
and Margot Weinshel
Short-Term Couple Therapy
James M. Donovan, Editor
Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide
Scott P. Sells
The Adolescent in Family Therapy: Breaking the Cycle
of Conflict and Control
Joseph A. Micucci
Latino Families in Therapy: A Guide to Multicultural Practice
Celia Jaes Falicov
WORKING WITH FAMILIES
OF THE POOR
PATRICIA MINUCHIN
JORGE COLAPINTO
SALVADOR MINUCHIN
THE GUILFORD PRESS
New York London
© 2007 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored in a
retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, microfilming, recording,
or otherwise, without written permission from the Publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9
8
7
6
5
4
3
2
1
Library of Congress Cataloging-in-Publication Data
Minuchin, Patricia.
Working with families of the poor / Patricia Minuchin, Jorge
Colapinto, Salvador Minuchin. — 2nd ed.
p. cm. — (The Guilford family therapy series)
Includes bibliographical references and index.
ISBN-13: 978-1-59385-347-1 (pbk. : alk. paper)
ISBN-10: 1-59385-347-5 (pbk. : alk. paper)
ISBN-13: 978-1-59385-405-8 (hardcover : alk. paper)
ISBN-10: 1-59385-405-6 (hardcover : alk. paper)
1. Family social work. 2. Social work with people with social
disabilities. 3. Family psychotherapy. 4. Problem families—Services for.
5. Poor—Services for. I. Colapinto, Jorge. II. Minuchin, Salvador. III.
Title.
HV697.M55 2006
362.5—dc22
2006034444
About the Authors
Patricia Minuchin, PhD, is Codirector of Family Studies, Inc., and
Professor Emerita at Temple University, and is associated with the
Minuchin Center for the Family in New York City. Dr. Minuchin has
taught at Tufts University and served as Senior Research Associate at
Bank Street College of Education. A developmental psychologist,
trained in clinical psychology, her publications have focused on the
growth and functioning of children in the context of the family, the
school, and the conditions created by poverty, foster placements, and
family disorganization.
Jorge Colapinto, LPsych, LMFT, is a family therapist and a consultant to human service organizations in the development and implementation of systemic models of service delivery. He has developed
training curricula and practice materials for the Administration for
Children’s Services of New York City and other service agencies. He
has been on the faculties of the Philadelphia Child Guidance Clinic,
Family Studies, Inc., and the Ackerman Institute for the Family,
where he directed the foster care project.
Salvador Minuchin, MD, is Director of Family Studies, Inc., and is
associated with the Minuchin Center for the Family. Dr. Minuchin
was formerly Director of the Philadelphia Child Guidance Clinic and
Professor of Child Psychiatry and Pediatrics at the University of
Pennsylvania. A major figure in the field of family therapy, he has
published widely on family theory, technique, and practice.
v
Acknowledgments
This second edition builds on the work described in the first edition,
and we continue to be grateful to all those who participated in the
programs and experiences reported previously. However, this new
edition is focused on the work of the last decade, presenting new
material in the areas of substance dependence, foster care, and the
mental health of children. We want especially, therefore, to acknowledge the people and the institutions that have been so helpful since
the publication of the first edition, facilitating the work and contributing in fundamental ways to our learning and to the results of our
efforts.
New and continuing projects have been conducted in three states
in the Northeast. The longer-term substance abuse program has been
located at Bellevue Hospital in New York; the more recent program
has been implemented in collaboration with Daytop New Jersey.
James Curtin, Administrator of Daytop New Jersey, initiated the
contact with the Minuchin Center for the Family and provided constant support throughout the duration of the program. The newest
phase of the foster care project was conducted under the auspices of
the Administration for Children’s Services, City of New York. We are
grateful to Commissioners Nicholas Scoppetta, William Bell, and
John Mattingly for their leadership in an area of service that is so
complex, difficult, and important. The mental health programs were
conducted in collaboration with the Department of Mental Health,
Division of Child/Adolescent Services, in Massachusetts. Several
vii
viii
Acknowledgments
administrators in that large system, including Phyllis Hersch, Julia
Meehan, Gordon Harper, and Joan Mikula, made our work possible
and exciting. We also thank Anne Peretz and her group, in the Massachusetts area, and are grateful to the many people who implemented our programs in the several locations where we have worked.
In particular chapters, we have thanked other people by name and
hope that we have not inadvertently omitted any members of the
working teams or institutional personnel who advanced our efforts
and taught us so much.
Our colleagues at the Minuchin Center for the Family have been
helpful in many ways. The Center came into being after the publication of the first edition and is now the sponsor for ongoing projects.
Active in the area in and around New York, the staff at the Center
continues to develop and expand on the ideas and programs that are
basic to our approach. We are particularly indebted to David
Greenan and Richard Holm, who were the primary consultant/trainers for the substance abuse programs, provided the basic material
concerning their work, and are fittingly described as our coauthors
for Chapter 5, on substance abuse. In addition, Daniel Minuchin
contributed material about training programs for both the substance
abuse and mental health chapters.
Finally, we want to thank Series Editor Michael P. Nichols, who
was, as always, a knowledgeable and careful reader, and Senior Editor Jim Nageotte at The Guilford Press, who was patient and supportive throughout the process. We also thank the families who are
the raison d’être for writing this book. In acknowledging the families
who appear throughout these pages, we are moved to echo what we
observed in the earlier edition: Working with families who are poor
and facing multiple crises is a constant reminder of both their difficulties and their strengths. They deserve our compassion, our respect,
and our best efforts.
Contents
PART I
FUNDAMENTALS OF FAMILY-ORIENTED THOUGHT
AND PRACTICE
ONE
The New Edition: Elements of Constancy
and Change
3
TWO
The Framework: A Systems Orientation
and a Family-Centered Approach
14
THREE
Working in the System: Family-Supportive Skills
34
FOUR
Changing the System: Family-Supportive
Procedures
65
PART II
IMPLEMENTING A FAMILY-ORIENTED MODEL
IN SERVICE SYSTEMS
FIVE
Substance Abuse: A Family-Oriented Approach
to Diverse Populations
89
SIX
Foster Care: Children, Families, and the System
133
ix
x
Contents
SEVEN
The Mental Health of Children
188
EIGHT
Moving Mountains: Toward a Family Orientation
in Service Systems
232
References
247
Index
251
WORKING WITH FAMILIES OF THE POOR
PART I
Fundamentals of Family-Oriented
Thought and Practice
CHAPTER ONE
The New Edition
Elements of Constancy and Change
Why have we written a new edition of this book? Certainly, many
aspects of our family orientation and systemic approach remain constant. Yet, as time has gone by, the world has changed and we have
changed. Society has become more complex, challenging the helping
systems to keep pace in their delivery of services, and we have gained
more long-term experience with a variety of problems and service
systems. In the process, we have developed a clearer understanding
not only of the obstacles to progress, which have long been familiar,
but also of the factors that support the work and enable positive
changes to endure. In this edition, we describe those forces and suggest procedures to strengthen the likelihood of successful interventions.
This first chapter provides a general orientation to the book. It
includes a brief discussion of the changing world and the nature of
service systems, an indication of what has been constant in our systemic approach, and a commentary on the search for forces that can
enable a new approach to survive. The chapter concludes with a case
history illustrating the problems and characteristics of the multicrisis
poor, as well as a description of the services assembled to provide
help.
3
4
FUNDAMENTALS OF THOUGHT AND PRACTICE
THE CHANGING WORLD
With the advent of the 21st century, the world has become more
complex and, in some ways, more frightening. We feel more vulnerable than we did, and the poor and needy are the most vulnerable of
all; most directly in the paths of hurricanes, economic crises, inadequate health care, and other natural or man-made disasters. If that is
the reality, how do current helping systems compare with those of a
decade ago? Are they better organized? More compassionate? More
effective? Yes, in some places and in some particulars, but, overall,
the problems and inadequacies that existed a decade ago are still
there.
Current services are often marked by procedures that are fragmented and involve needless duplication, by the efforts of multiple
helpers who do not communicate with each other, and by a focus on
the individual client without considering the relevance or resources
of the family. In a social climate where priorities have shifted and
funding for social services has become less available, it’s especially
important to consider how services for this vulnerable population
can be reorganized so that they become more effective and humane.
We suggest, in this volume, that a systemic, more family-oriented
approach serves this purpose.
Beyond being confronted with the need to deal in better ways
with familiar problems, service systems now face issues that stem
from increasing diversity in the population and changing social values. Since the first edition of this book was published, the country
has seen a significant increase in immigration from diverse corners of
the globe, as well as the development of new lifestyles and social
beliefs within the culture. Immigration means that recently arrived
individuals and their families must cope with the difficulties of acculturation: social isolation, a new language, and the challenge of
becoming economically stable, as well as the need to develop patterns of family life that acknowledge the different experiences and
needs of older and younger family members. Changing values mean
that traditional perspectives coexist with new ways of defining the
basics of the social network—in sexual identity, in the definition of
family, in the creation and raising of children, and in the very definition of life and death. People finding their way in these new forms
must handle conflicts and confusions that have few precedents.
The New Edition
5
Although these differences were in formation toward the later
years of the 20th century, they are now a staple of daily life, social
conflict, and legal issues, and present special questions: To whom do
children “belong” legally? Which adults should be included in the
process, when social services are making decisions about a child, if
the family is separated, blended, three-generational, consists of a
same-sex couple, or is otherwise complex? What is the appropriate
balance between welfare and work, when parents, children, and society must all be served; and who should be making policy that must
take into account the different developmental needs of 2-year-olds, 7year-olds, and 13-year-olds? The challenge to society is profound. We
are in need of compassionate and effective services in all areas that
affect the health, welfare, and protection of a complex and changing
population.
WORKING WITH FAMILIES AND SERVICE SYSTEMS:
FUNDAMENTAL PRINCIPLES
Our work has long been guided by two fundamental principles: a
systemic orientation and an emphasis on families as the primary
social context for its members. We have carried that perspective
through decades of working with people in need and with the systems that serve them. Despite shifts in the population and in the
problems that must be dealt with, those principles have always been
relevant.
A systemic orientation is both a mode of thinking and a guide
for facilitating change. It means that we understand the behavior of
people and organizations as functions of connections and interactions, and that when we intervene to facilitate a constructive change,
we must take account of the relevant network. From that perspective, it is never enough to isolate individuals as the sole focus of
attention. When the services concern or affect children, that point is
self-evident, but it also applies to recipients of any age and in any situation. We are better able to plan and implement effective services if
we understand the context within which people live; the involvement
of others in their problems; and the resources available from immediate family, friends, and extended kin.
A grasp of systemic principles is also essential when we intervene
6
FUNDAMENTALS OF THOUGHT AND PRACTICE
in the policies and procedures of an organization. If we want to create an impact, we need to understand how a particular issue fits into
the larger whole, and when the organization is large and complex,
we need to accept the fact that the process of change will probably be
slow and the effect will generally be partial.
As the reader moves through this book, it will be useful to keep
in mind that large organizations, such as the complex enterprise that
manages foster care in New York City, and small units, such as the
family of a soldier or an unemployed single mother, are all systems.
As such, they have similar features. They all contain subsystems and
hierarchies of authority; they are marked by boundaries that are
sometimes functional and sometimes not; and they must deal with
growth and change over time and handle the inevitability of conflicts
that may or may not be easily resolved. And, large or small, they
must constantly balance the patterns of the whole with the particular
needs of their individual members. In the remaining chapters of this
first section, we expand on systems, families, and the details of working from a systemic and family-oriented perspective.
WORKING WITH FAMILIES AND SERVICE SYSTEMS:
INTERVENTIONS
In the second section of the book, we describe the application of our
model in three areas: substance abuse, foster care, and mental health.
We have included some projects described in the previous edition,
along with material concerning later developments in this work, and
have added new projects conducted in recent years.
In presenting this material, the emphasis is on the experience
of entering an organization to introduce a new, family-oriented
approach to the services they provide. We describe our contact
with administrators, the training of institutional staff, and our
direct work with families. The material is detailed and concrete; we
describe the steps and sequences involved in the intervention process and provide specific examples of how the new approach has
been implemented. We also discuss how institutional staff, families,
and consultants faced and dealt with the many issues that arise,
inevitably, when familiar pathways are disrupted. The aim is to
provide ideas and examples that will be useful for people who
work in similar circumstances.
The New Edition
7
THE SEARCH FOR FACILITATING FACTORS
This new edition also discusses our concern with the long-term
effects of constructive interventions and with the factors that support
such effects. We have accumulated experience over more than two
decades, and have been involved with a variety of community organizations. Every chapter in the second section describes interventions in
at least two kinds of organizations, covering a broad range: hospitals, residential centers, day and home-based programs, community
agencies, and city and statewide systems. Some interventions have
been large, some smaller; some have been self-contained, others wide
open to pressures from elsewhere. Because of these varied experiences, we have been able to identify a number of factors that sustain
the basics of a new approach.
At the end of each chapter, we address the same question: What
enables a new approach to survive? We answer that question by
drawing on the programs described in the chapter, noting the features that have been supportive in that context. Because our understanding has grown by accumulating ideas from the different areas of
intervention, we bring the reader through the same experience in
reading the successive chapters. We first present the factors that
emerged in connection with the substance abuse programs; then we
consider the factors that reappeared or were new in the context of
foster care, and so on. In the final chapter, we synthesize the material.
The search for facilitating factors is a crucial task for the field at
large, both for the institutions that invest in learning about different
ways of working and for the teachers who enter an institution as proponents of something new. It’s important to structure an intervention
so that it creates an immediate impact, but it’s equally important to
consider what happens when a project has finished and the original
proponents leave the scene. Community services function within an
ever-changing environment of policies and personnel, and neither the
worth of a program nor research about its effects guarantees its survival over time. In our search for relevant factors, therefore, we have
considered characteristics of the times, the leaders who make policies
and shape services, and the institutions where interventions are
mounted, as well as the behavior of the consultants and trainers who
bring in new approaches. Not surprisingly, all of these aspects have
been relevant.
8
FUNDAMENTALS OF THOUGHT AND PRACTICE
In coordinating our material in this way, we have been interested primarily in the trajectory of our own interventions and the
fruits of our own work. We value the principles of a systemic,
family-oriented model, and we want our interventions to survive.
It’s probable, however, that the factors we have identified are applicable to the survival of any new program introduced into an
existing organization.
THE MULTICRISIS POOR: AN ILLUSTRATIVE CASE
Before presenting the principles and skills that are central to our
work, we need to bring the problems of poor families to light.
We can do this best by describing a particular situation. Readers
acquainted with Angie’s case from the previous edition can proceed
directly to the next chapter, but for new readers, her story is a useful
prologue to the remainder of the book.
Angie and Her Family
Angie is at the center of this case, but she’s not alone. Her world
includes her companion, their two young children, the foster families
with whom the children reside, and Angie’s parents, siblings, and
assorted aunts and uncles. Over the years, Angie and her family have
passed through courts, hospitals, shelters, housing programs, drug
centers, rehab clinics, day care facilities, and foster care agencies; and
they have been attended by lawyers, investigators, doctors, social
workers, drug counselors, foster care staff, and therapists. The
helpers in this case have been serious about their roles and have
wanted a happy ending for some, or all, of the principals. Inevitably,
however, they have jostled each other and the family, and often it has
been unclear how everyone’s work fits together.
Angie, a troubled woman in her early 20s, has had a difficult
past. As a child, she was sometimes ignored and sometimes a caretaker for others, and she was abused intermittently and raped more
than once. As a young adult, her life has been erratic. She has grappled with drug addiction, maintained an on-and-off relationship with
her male companion, and borne children who were removed from
her care—a pattern shaped by poverty, poor education, and multiple
trauma. Depending on one’s focus, Angie can be seen as uncertain,
The New Edition
9
depressed, and irresponsible, or as assertive, realistic, and resilient,
or—more accurately—as all of the above.
What would not be accurate is to think of Angie as an isolated
individual. In her own view, she is part of a small nuclear family
composed of Harlan, her companion, and two young children—
Jocelyn, who is 3, and Gail, who is 2. Harlan is the father of both
children, and he and Angie clearly consider themselves a couple,
although their relationship is volatile.
Harlan suffers from a chronic disease, but he is surprisingly
competent in managing his severe handicap. He appears to have no
permanent housing and is often vague and unrealistic when he talks,
yet he has a strong sense that they are a family. He wants the children
to live with Angie, and has an intense interest in Jocelyn, who has
inherited his illness. He feels he can help her cope with her condition.
Jocelyn has been in foster care for 2 years. She is unable to walk
and appears much younger than her age in speech and intellectual
development, but she can do some things for herself and is affable
and responsive. She receives rehabilitation services, attends a day
care center for handicapped children, and lives with a family trained
to deal with her special needs. Jocelyn and the foster family have
adapted well to each other, but because Jocelyn lived with her mother
until the second child was born, Angie feels that she and Jocelyn have
a continuing bond.
Gail, a beautiful, wide-eyed little girl, has been luckier than
Jocelyn, since she has not inherited her father’s disease, but her life
has not been smooth. Angie was drug dependent when Gail was
born, and the infant was immediately placed in foster care. The
bonding in this foster home is strong. Angie knows she never had a
chance to connect with Gail, but she and Harlan both want her
returned to live with her mother.
Despite their problems and uncertainties, these people are connected. Harlan and the children are part of Angie’s sense of herself
and her situation. It’s important to keep this in mind as we review the
organization of services she has been offered by the community of
helpers.
The Community of Helpers
Social organizations have made multiple efforts to provide services
for Angie and members of her family. Certainly, the worst disasters
10
FUNDAMENTALS OF THOUGHT AND PRACTICE
have been averted. The city has provided shelter, Jocelyn and Harlan
have received medical attention, the children are cared for, and Angie
has participated in counseling and substance abuse programs. But
these interventions have had complex by-products. The system has
sometimes confused Angie so that she becomes less competent, and
the family has been fragmented by procedures that solidify the separation and make a viable reunion difficult. If we are to be helpful in
such cases, it’s necessary to understand the problems created by system interventions, as well as the good intentions and positive effects.
The services provided fall into four areas: professional assistance, the provision of housing, foster care for the children, and a
drug rehabilitation program.
Professional Assistance
The number of social service workers involved in Angie’s life is
overwhelming. It may seem good that so many people have tried to
help or wasteful that so much time and money has been poured into
one case, but the important point is that the involvement is uncoordinated. Angie has memorized the number on her file that renders her
anonymous, and, as the file is handed from one worker to another,
she feels impatient with the repetitions. As a result of the turnover at
one agency, she says she has dealt with six different workers in a
short period of time, and that she’s “sick and tired of telling my story
to all these people.”
Inevitably, perhaps, Angie has learned to work the system, and
has been something of an advocate for “us” (the recipients) versus
“them” (the system and the staff). Workers have found her difficult
at times—“a woman with an attitude.” She talks about meetings at a
women’s shelter where the staff would ask the opinion of the women,
and she says impatiently that “you had to do what they want anyway, so why ask?” She doesn’t recognize that the staff must work
within certain rules, or that they may genuinely want to incorporate
group opinion when they can. At the same time, one can understand
her sense of frustration and her impression that the system is
inefficient and chaotic.
Angie claims that she doesn’t trust any of the workers except
Mona, whom she considers an exception. Mona is an experienced
social worker, whose way of functioning generates both respect and
concern in a thoughtful observer; respect because she’s an empathic
The New Edition
11
and skillful coordinator, concern because she has taken over much of
the executive part of Angie’s life. Angie’s dependence on the system
and its workers is ingrained and has grown deeper with time, even
while she feels hemmed in and resentful.
Housing
The urban population of the homeless and/or drug addicted includes
a high percentage of women like Angie, whose children have been
removed and placed in care. According to both Mona and Angie, the
local system has established a Catch-22 policy: “You can’t have
housing unless you have your children . . . and you can’t have your
children until you get housing.”
Angie has been relatively fortunate. She was contacted by a
women’s advocacy group and moved into living quarters where
children can visit while their mothers wait for official action. Once
the children are returned, a family apartment is provided, along with
day care for children and counseling for mothers. This new facility
has solved some of Angie’s problems, but created others. Since male
companions are not admitted, there’s no provision for Harlan, and
an apartment for their nuclear family could not be arranged at this
facility.
Foster Care
It would be a distortion to discuss the foster care system as if it had
completely failed this family. The children are cared for, and Jocelyn
receives the special services required by her physical condition.
Nonetheless, the separate services have pulled family members away
from each other so that, in the ordinary course of events, they will
grow increasingly distant. Jocelyn and Gail are in the care of different foster agencies and do not live with the same foster family. The
agencies are geographically distant from each other, have no contact,
and it is a logistical problem to arrange family visits. Angie describes
the setting for visits organized by protective services as “like a warehouse . . . stuff cluttering up the spaces . . . it’s dirty . . . I can’t let the
girls play on the floor.” This is nobody’s fault, perhaps, but it is an
indication that family contacts have low priority. It’s difficult for
parents to maintain the visiting schedules, which are usually evaluated as a sign of interest in later court hearings concerning custody.
12
FUNDAMENTALS OF THOUGHT AND PRACTICE
Even if plans for family reunification go forward, there’s little
understanding of how complex such a transition would be. There
have been many years of separation since the children were placed in
foster care, and there has usually been little preparation for the
successful management of becoming a family again. Angie is clear
about the limitations of the mandatory parenting classes she has
attended: How can she answer questions about the way she disciplines her children or what games they play when they don’t even live
with her? Observing her during an arranged visit, it’s clear that she’s
loving, wants contact, and has some good ideas, but she has few
parenting skills for issues that arise in the course of a day with one
child, let alone two—one of whom is severely handicapped and
requires special care.
There are other matters that have never been addressed, including Harlan’s role as a father and the relationship between this family
and the foster families that have become so important to the children. In a later section of the book, we discuss a family-oriented
approach to foster care, in which procedures would be available for
working on such issues.
Drug Rehabilitation
Angie has spent time in a residential drug center as part of the
required activity for getting her children back, as well as because of
her own desire to become free of drugs. She comments that the
program helped her to understand herself and control her habit, but
she left long before the allotted duration. “If I stayed up there, I
would learn that I could live without Harlan and without the
children and be my own person, and take care of me . . . but my concern is toward him and the children.”
The program presented Angie with a dilemma, but the confusion
was not only internal; it was also a function of the mixed messages
coming from different agencies. In a meeting that brought together
drug counselors and foster care workers, it became clear that each
service had its own priorities. The foster care agency was concerned
with family relationships and the coordination of Angie’s contacts
with Jocelyn and Gail. The drug program focused on Angie as an
individual, maintaining that she needed to be honest about what she
wanted and become strong as an individual before she could deal
with other issues.
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13
When a visit with the children upset Angie, the staff of the drug
program placed a moratorium on the visits. At that point, Angie
faced the contradiction and made a choice, opting for continuing
contact with the children. She left the residential program, hoping to
remain drug free with the help of counseling—and understandably
uneasy about an uncertain future.
In offering this case history, we stop at an arbitrary point. We
have wanted only to present a concrete example of the population
that comes to the service systems for help and to raise the issues we
have addressed in formulating a systemic, family-focused approach
to their needs.
CHAPTER TWO
The Framework
A Systems Orientation
and a Family-Centered Approach
We suggested, in the previous chapter, that the prevailing forms of
service delivery are both inefficient and hard on families. In this
chapter, we present the fundamental framework for a different way
of working, emphasizing an approach that is more integrated,
systemic, and supportive of families. We begin by discussing the basic
elements of systems theory; then we describe our concept of families,
including both the general features of any family system and the
particular realities for multicrisis families in need of services.
THE SYSTEMIC ORIENTATION
We noted earlier that a systems orientation is both a mode of thinking and a guide for facilitating change. We begin, therefore, by considering what it means to be a systems thinker.
We all know what a system is; we talk about social systems, the
nervous system, the solar system. The term is familiar, and with a
moment’s thought, we understand that it has to do with connectedness, with the poetic idea that when you take a flower in your hand,
you sense that it is connected to the universe. But a systems perspec14
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tive highlights something more: the understanding that the parts are
related in particular ways. Because of relationships, we can make
predictions. Scientists can forecast the moment in which the moon
will be positioned between the sun and the earth to produce a lunar
eclipse, and they can describe the consequences for the earth and its
inhabitants. The parts of a system affect each other, and because
these effects repeat themselves, we can study the way they work and
predict what will happen.
Systems of different kinds have specific features, but any system is organized and characterized by repetitive patterns. Neither
the solar system, the welfare system, nor a family is haphazard in
the way it functions. The sun will rise tomorrow and the welfare
system will follow particular procedures for supporting dependent
children, just as a family will follow organized and predictable patterns of its own.
Connections seem to be understood as a universal truth. When
fish begin to die off, we understand readily that certain birds will
go hungry unless a functional ratio between these species is reestablished. Yet we are inconsistent in the way we think about people. We celebrate our national figures as if they acted and triumphed alone, and we see the problems and needs of individuals
as if they existed in a vacuum, disconnected from their environment and other people. It is a kind of tunnel vision that overrides
the basic understanding of connections, and it has major implications for the way we organize the delivery of services. It means that
delinquent adolescents and substance-dependent adults are treated
in isolation, as if neither their problems nor the solutions were connected to other people.
When we look at how systems are organized, we need to consider a variety of features: the presence of subsystems, the way in
which the parts influence each other, and the fact that every system
inevitably goes through periods of stability and change. These ideas
apply not only to families but also to all social systems, such as hospitals and social service agencies that affect family life. For example,
the surgical, outpatient, and social work departments of a hospital
are subsystems of the larger institution. Each has a particular function, is related to other departments, and is regulated in its functioning by hospital policies and procedures. Perhaps less obvious is the
complex and circular way the parts interact. Maybe the approach of
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FUNDAMENTALS OF THOUGHT AND PRACTICE
the social workers has broadened the surgeons’ way of thinking that
“Patient X is a kidney problem.” Maybe the surgeons have taught
the social workers something about the urgency of emergencies.
We’re aware that policies tend to travel from the top down, but we
pay less attention to the fact that the departments affect hospital policy through the ideas they funnel to administrators and the way they
implement or resist directives.
Of course, mutuality doesn’t necessarily mean equality. The
influence of hospital subsystems on overall policy depends on the
flexibility of the system, and within any structure, the power of the
different parts is apt to be uneven. In most settings, for instance, the
social work department has less overall influence than the surgical
division. The point arises again in a family context, particularly if we
think about families who are poor and dependent on help from organized institutions. Those families are seldom able to influence the
patterns of the systems that serve them, and constructive intervention
is often a matter of trying to redress that imbalance.
However they are organized, all systems go through cycles of
stability and change. During periods of stability, a system functions
through familiar patterns, and, for the most part, repetition is adaptive. Hospitals don’t need to reinvent the admission procedure with
each new patient, and families don’t need to establish new rules for
bedtime every day. But all systems that involve living creatures are
open-ended. New events occur at intervals, and, as a result, stable
patterns are perturbed. One hospital might merge with another and
be run thereafter by an HMO. The current procedures would then be
challenged. Even if the hospital had been functioning smoothly in the
previous circumstances, it would need to reorganize structures and
procedures. The staff would go through a transitional period of confusion, searching for patterns that preserve what is valued from the
past, while adapting appropriately to the new reality.
Like hospitals, social service agencies are organized systems, and
their realities are almost always complex. They’re generally embedded within larger social and political structures, subdivided into internal subsystems, and coexistent with other agencies that serve
many of the same families. An adoption agency, for example, is embedded in a social–political context that determines legal requirements, the official or unspoken policy on interracial adoptions, the
attitude toward gay couples who want to become parents, and the
speed with which parental rights are terminated in cases of alleged
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neglect. These combined factors increase or decrease the number of
children eligible for adoption.
Within the agency, work is divided into sections. Particular
departments are responsible for different functions, such as locating
and evaluating potential adoptive parents, handling legal aspects, or
monitoring placement through follow-up visits. Each department has
procedures of its own, and the different departments must coordinate
their relations with each other and with agencies that work with the
same families. Logically, the communication between the department
that selects families and the department that monitors placement
should be extensive, allowing each to adapt to the realities faced by
workers in the other section. An adoption agency should also be in
constant communication with services relevant to particular cases,
such as the residential center where a child has been living for 2 years
before coming up for placement, or the program for children with
special needs in the local area where a child is about to be adopted.
The connection should be more than a matter of paperwork, especially when a difficult transition, such as adoption, is planned or
underway.
Integrating the work of different subsystems and agencies is apt
to be time-consuming, but perhaps no more so than handling the
negative effects of poor coordination. “Turf” problems between the
subsystems of an agency have a corrosive effect, as do communication failures between different agencies. Training is a useful and necessary way to introduce change, but the positive effects are limited if
training touches only one corner of a complex system. We’ve learned,
for example, that the ability of line workers to sustain new ideas and
procedures depends on the support of their supervisors, as well as on
the possibility of influencing agency policies so they can move in the
same direction.
A systems orientation is not an academic luxury; it’s a necessary
tool. Understanding that different agencies are interactive forces
within the network encompassing a family is a cornerstone of collaborative work and is essential for handling interventions at crosspurposes. If professionals can accept their connections and find constructive ways of handling their differences, they will increase the
efficiency of the system and improve the quality of help offered to
their clients.
We move now from this brief description of systems to a more
detailed look at the families who are the recipients.
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FUNDAMENTALS OF THOUGHT AND PRACTICE
FAMILIES
A family is a special kind of system, with structure, patterns, and
properties that organize stability and change. It’s also a small human
society, whose members have face-to-face contact, emotional ties,
and a shared history. We especially need to understand the families
served by social agencies. We can approach that understanding best
by means of a more general discussion, considering families first as
systems and then as small societies.
FAMILIES AS SYSTEMS
Patterns
When we describe families as having a structure, we mean more than
a map of who’s in the family. We’re referring to patterns of interaction that are recurrent and predictable. These patterns reflect the affiliations, tensions, and hierarchies important in human societies,
and carry meaning for behavior and relationships.
In most families, there are multiple patterns of alliance, involving people who are emotionally close and mutually supportive. Jerry
and Clarissa Brown have been married for more than 20 years. The
way they enjoy leisure time together, deal with their family, and handle problems clearly illustrates a stable alliance. But there are other
kinds of alliances that are less obvious than theirs. For instance,
Grandma and Jenny have a special bond. They spend time together.
Grandma is Jenny’s confidante and both enjoy the fact that people
think they look alike.
Sometimes alliances take a different form. They involve people
who are drawn together by an opposition to other family members—
and their alliance is more accurately described as a coalition. These
coalitions are frequently transient and may be relatively benign. In
one family, for instance, the adolescents gang up against their mother
whenever she proposes a weekend visit to an unpopular aunt and uncle. In another family, however, the coalition is more stable and less
good-humored. The daughters are in alliance against their stepfather,
finding a host of ways to oppose him, though they’re not close to
each other in most other matters.
Patterns that organize the hierarchy of power appear in every
family. They define the family pathways for making decisions and
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controlling the behavior of its members. Patterns of authority are
particularly important aspects of family organization. These patterns
carry the potential for both harmony and conflict and are subject to
challenge as family members grow and change.
Authority patterns that are clear and flexible tend to work well.
Clarissa and Jerry Brown have developed a viable process over the
years. They defer to each other’s authority in particular areas, consider the input of the children when important family decisions are to
be made, and have yielded increasing power and autonomy to their
children as each one has entered adolescence. Other families, however, have less functional patterns for arriving at decisions and few
skills for resolving their differences. Families often come for therapy
because their discussions are rigidly organized around winning and
losing, and they can’t manage to change the patterns that increase
family conflict. Authority problems aren’t always a matter of rigidity,
however. Control may be erratic rather than inflexible, with unfortunate by-products that aren’t recognized. In three-generational, singleparent families with young children, for instance, authority may
sometimes rest with the mother, at other times with the grandmother,
and at still other times with uncles or older sisters—depending on
who happens to be around. Messages that are unclear or contradictory confuse the children and interfere with their understanding of
acceptable behavior.
Some patterns are ethnic in origin. By and large, families in the
Latino community have different patterns for expressing affection,
voicing disagreements, and cuddling their young than do their
Northern European neighbors. Because South and Central American
families have been migrating to North America for some decades, we
tend to recognize and accept Latino patterns, but people who have
migrated more recently from other parts of the world often seem
“foreign” to many Americans, especially if they maintain clear
boundaries around their own communities. As a nation, we don’t
understand the patterns of Middle European, Arabic, or Asian family
life very well, but when these families arrive as immigrants without
many resources, they are apt to need a variety of services. Aside from
economic, medical, and educational needs, many of these people will
need help with resolving the issues that divide generations in a new
culture: the elders bring values and expectations from the society
they have left; the young are exploring the lifestyles of their peers in
the streets, in the schools, and through the media. Planning for this
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FUNDAMENTALS OF THOUGHT AND PRACTICE
reality requires, at the least, an increasing sensitivity to cultural
diversity in family patterns, a concentrated effort to broaden the ethnic base of a service staff, and the creation of networks that can provide diverse families with relevant services.
Subsystems
Each family contains a variety of subsystems. Age and gender are
among the most obvious examples: Adults have functions and relationships that separate them from their children; males are one unit
and females are another; and adolescents form a group with special
interests. Within a “blended” family, there are subgroups of “his,”
“hers,” and “theirs.” Spoken and unspoken rules govern relationships between the units: The younger children may not disturb the
adolescent when the bedroom door is closed; the children will tattle
to adults only when beset by injustice; the mother’s children will not
expect to go on a Saturday outing with their stepfather and his son
unless specifically invited; and Grandpa can stand up for a child in
trouble with his or her siblings but not when the parents are enforcing discipline.
The concept of boundaries is important in relation to subsystems, as it is in relation to the family as a whole. Boundaries are invisible but, like the wind, we know they exist because of the way
things move. All of the examples in the previous paragraph refer to
boundaries, marking thresholds that should not be crossed, as well as
the conditions under which they’re more permeable.
The firmness of subsystem boundaries varies with a family’s particular style. Thanksgiving dinner at the Smiths brings together three
generations, with lots of crowding and a high noise level. That arrangement would make no sense to the Barrys, who put the children
at a separate table and call for quiet when the kids act up. In both
families, however, there will be developmentally appropriate changes
over the family life cycle. The boundaries between adults and children will inevitably grow firmer as the children move toward adolescence. Parents usually intervene if the 5-year-old’s teasing brings her
little brother to the brink of a tantrum, but when the children
become adolescents they’re usually expected to fight their own battles; both parents and their children are likely to draw boundaries
that provide the adolescents with more privacy. As the parents’ generation becomes older, the boundaries may change again, reflecting
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the needs of the elders and the increasing involvement of their offspring in their health and well-being.
When family patterns are not working well, it’s useful to look
separately at the different subsystems. Meeting with just the group of
children, for instance, provides a view of family hierarchy and family
crosscurrents from the bottom up rather than from the top down. It
may also shed light on the repertoire of family members, some of
whom may function very differently in different subgroups. Twelveyear-old Mario, for instance, may be a creative and fair-minded
leader with his siblings, even though he clams up or is surly when his
father is around. That observation provides a useful lead for helping
a family explore their own functioning and develop patterns that
encompass the needs of particular members.
The Individual
The individual is the smallest unit in the family system—a separate
entity but also a piece of the whole. In the framework of a systems
approach, it’s understood that each person contributes to the formation of family patterns, but it’s also evident that personality and
behavior are shaped by what the family expects and permits.
This view is more revolutionary than it may sound. It challenges
both prevailing theory and the usual organization of social services,
which tend to focus on the individual as the appropriate and sufficient unit. We emphasize this point throughout the book, maintaining that an exclusive concern with individual history, dynamics, and
treatment is insufficient, and that it’s necessary to work with people
within the context of their families and their extended network.
If we are to think of individuals as part of a system, we must
develop a different view of how self-image is formed and how behavior is governed. Families define their members partly in relation to
the qualities and roles of other members. In so doing, they create
something of a self-fulfilling prophecy, affecting the self-image and
behavior of each individual. Joe is described as shyer than the other
children, and he thinks of himself that way. Annie, the oldest girl, is
expected to help with the cooking and with the little ones, and she
absorbs the role of “parental child” without question—at least until
adolescence. Mother is the one who handles contact with the schools
and other institutions. The shaping of behavior by the family often
involves the recognition of individual qualities, but it may also lock
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FUNDAMENTALS OF THOUGHT AND PRACTICE
behavior in place, restricting exploration and limiting elements in the
concept of self.
From a systems point of view, behavior is explained as a shared
responsibility, arising from patterns that trigger and maintain the actions of each individual. It’s customary to think that “my child defies
me,” or that “my partner nags,” but these are one-way, linear descriptions. In fact, the child’s defiance or the partner’s nagging is only
half of the equation. The process is circular and the behavior is complementary, meaning that the behavior is sustained by all the participants. All of them initiate behavior and all of them react; it’s not really possible to spot the beginning of the pattern or establish cause
and effect. We can say with equal validity that, when Tamika is defiant, her mother yells, Tamika cries, and her mother hits her—or that,
when the mother yells at her daughter, Tamika cries, her mother hits
her, and Tamika becomes defiant. Their interaction is patterned, and
we cannot explain the behavior of one without including the other.
The concept of complementarity has offered a useful, if somewhat startling, way of looking at diagnosis, as well as cause and effect, but it has also raised some cautionary flags. Behavior may reflect a circular pattern, but some behavior is dangerous or morally
wrong, exploiting the weakness of some family members and endangering their safety. Feminists have made this point in relation to male
violence toward women, and all of society condemns the abuse of
children. In such situations, the primary task is to protect victimized
individuals and to take an ethical stand, while working with the family to change recurrent patterns that are dangerous or morally unacceptable.
Transitions
All families go through transitional periods. Members grow and
change, and events intervene to modify the family’s reality. In any
change of circumstances, the family, like other systems, faces a period
of disorganization. Familiar patterns are no longer appropriate, but
new ways of being are not yet available. The family must go through
a process of trial and error, searching for some balance between the
comfortable patterns that served them in the past and the realistic demands of their new situation. The process, often painful, is marked
for a period by uncertainty and tension.
Some transitions are triggered by the normal cycle of develop-
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ment. When a child is born, the helplessness of the infant calls for a
new care-taking behavior that changes the relationships among
adults within the household. As children grow, there are increasing
demands for privacy, autonomy, and responsibility that upset the system and require new patterns. As the middle generation become seniors, problems of aging and frailty require a shift in some functions
from the older generation to their adult children. Some transitions, of
course, are not developmental at all. They reflect the vicissitudes of
modern life and the unexpected events that may happen to any family: divorce, remarriage, unexpected illness, mobilization for war,
sudden unemployment, floods or earthquakes, and so on.
Whatever the stimulus, it’s important to realize that behavioral
difficulties during periods of transition are not necessarily pathological or permanent. They often represent the family’s attempts to
explore and adapt. Anxiety, depression, and irritability are the affective components of a crisis. Although the behavior may seem disturbed or dysfunctional, a focus on pathology is not helpful; it tends
to crystallize the reaction and compound the difficulties.
FAMILIES AS SMALL SOCIETIES
There’s something impersonal about discussing the family as a system, probably because it bypasses the feelings and complexities of
human interaction. If we look more closely, we can pay attention to
the emotional forces that tie people together and pull them apart.
People in a family have a special sense of connection with each other:
an attachment, a family bond. That’s both a perception and a feeling.
They know that “we are us,” and they care about each other. When
we work with families, we know that its members are usually concerned to protect, defend, and support each other—and we draw on
this bond to help them change. We know also that tension, conflict,
and anger are inevitable, partly because of the ties that bind. As some
earlier examples have suggested, a family limits and challenges its
members even while it supports them.
The sense of family is expressed by feelings and perceptions, and
by the way members describe their history, their attitudes, their
style—what some refer to as “the family story”: “We’re a family that
keeps to ourselves; we don’t want trouble in this neighborhood,” or
“We had a hard time moving from the islands, but we’re doing OK
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FUNDAMENTALS OF THOUGHT AND PRACTICE
now,” or “We can’t ever seem to resolve anything without getting
into a battle,” or “All the women in our family suffer from depression.” There are alternative stories, of course, told by different members, but families usually share some version of who they are and
how they function.
The counterpart of family affection is family conflict. All families have disagreements, must negotiate their differences, and must
develop ways of handling conflict. It’s a question of how effective
their methods are: how relevant for resolving issues, how satisfactory
for the participants, how well they stay within acceptable boundaries
for the expression of anger.
Families sometimes fall apart because they can’t find their way
through disagreements even though they care for each other. Most
families have a signal system, a threshold above which an alarm bell
sounds that registers the need for family members to cool down and
avoid danger. It matters how early that warning comes, and whether
the family has mechanisms for disengagement and crisis control or
typically escalates to the point of violence.
FAMILIES IN NEED OF SERVICES: THE MULTICRISIS POOR
Principles of family structure and function are generic, but they have
special features when applied to families served and controlled by the
courts, the welfare system, and protective services. For one thing, the
affection and bonding in these families is often overlooked. We hear
that people are so spaced-out on drugs they can’t form attachments,
that mothers neglect their children and fathers abuse them, and that
families are violent and people are isolated. These are all truths for
some families but only partial truths, highlighting the most visible
aspects of individual and family misery while ignoring the loyalty
and affection that family members feel for each other. They generally
share a sense of family, no matter how they look to others or how
fragmented they have become as a result of interventions that have
both helped them and split them apart. Observant foster parents tell
us that foster children love their biological mothers and want to be
with them, even if they have been hit or neglected. Though this seems
an illogical state of affairs, it reflects the deep feeling and emotional
ambivalence that accompanies family attachments.
One recurrent and disturbing fact about such families is that
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they do not write their own stories. Once they enter the institutional
network and a case history is opened, society does the editing. When
a substance-dependent woman moves through the system and her
children are placed in foster care, a folder goes from place to place,
transmitting the official version of who she is and which members of
her family are considered relevant to her case. A friendlier approach
to families elicits their own perspective on who they are, who they
care about, and how they see their problems.
Just as connections and affection are not usually recognized, neither are the family structures: the actual membership of the family
and the patterns that describe their functioning. Families served by
the welfare system often look chaotic; people come and go, and individuals seem cut off. That instability is partly a lifestyle, amid poverty, drugs, and violence, but it’s also a by-product of social interventions. Children are taken for placement, members are jailed or
hospitalized, services are fragmented. The point is not whether such
interventions are sometimes necessary but that they always break up
family structures. The interventions are carried out without recognizing the positive emotional ties and effective resources that may have
been disrupted as well. When all the children in a family are taken
away for placement, the mother’s adolescent protector against an
abusive boyfriend disappears and the mutually supportive group of
siblings is disbanded.
Boundaries are fluid in these families, and workers enter with
ease. Often, the family’s authority structure, erratic to begin with,
disappears. The decisions come from without, and the children learn
early on that adults in the family have no power. The worker may
unwittingly become part of dysfunctional subsystems, influencing the
patterns in a way that is ultimately unhelpful. If the worker supports
the adolescent daughter, for instance, allowing her to invoke the
power of protective services in battles against her mother, the possibility for the family to manage its own affairs is diminished rather
than enhanced.
Violence is a major fact of life for these families, and it takes
more than one form. What comes to mind first, because it is the more
conventional association, is the violence that occurs within the families themselves. Poverty, impotence, and despair are embedded in the
family cycles of this population, often leading to shortcut solutions:
drugs, delinquency, impulsive sex, and violence.
When we look inside violent families, we see a derailment of or-
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FUNDAMENTALS OF THOUGHT AND PRACTICE
der. The usual fail-safe mechanisms that protect family members and
ensure the survival of society don’t hold. Any worker who deals with
inner-city welfare families faces moments of ugly reality: brutal punishment, incest, abandoned children. As consultants and trainers, we
have always been invested in the concept of family preservation and
we have supported interventions that keep children in their own
homes, but we pay serious attention to the problem of family violence and to the question of how to assess and ensure the safety of
family members. The official pendulum that swings through extremes, from removing children to maintaining the family unit to removing the children again, fails to provide a sophisticated solution to
this basic issue. The mandates are procedural and global. They are
well intentioned but not helpful enough in specific situations. A
worker must be able to explore family conflict and to assess the family’s potential for positive change before making a decision of this nature. We discuss this important matter further in succeeding chapters.
There is a second form of violence experienced by these families,
though we don’t usually think of it as such. It comes from intrusion,
and from the absolute power of society in exerting control. The rhetoric, and sometimes the reality, is that of protection for the weak, but
the intrusion into the family is often disrespectful, damaging ties and
dismembering established structures without recognizing that the
procedures do violence to the family. Because there is so little recognition that individuals and families are profoundly interconnected,
legal structures and social policy set up an adversarial situation, with
an associated imbalance between the rights of the family and those of
the individual. Procedures are determined through court hearings,
where professional advocates present their recommendations and the
viewpoint of family members is not directly heard. As a result, the
outcomes are usually preordained, following general policies and
precedents. The family is the victim, in a sense, of unintended social
violence.
Social interventions are often necessary, though less often than
they occur and not in the form in which they are generally carried
out. If we recognize that the family has structures, attachments, recurrent patterns, and boundaries that have meaning, even if they do
not work well, procedures become more family oriented. It’s useful
to highlight what that implies: A family-oriented approach means
that we begin to look for relevant people in the family network and
accept unconventional family shapes. We notice subsystems and the
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rules that govern family interactions, both those that lead to crises
and those that indicate strength. We realize that social interventions
create transitions, and that families will go through temporary periods of confusion, anger, and anxiety that should not be treated as
typical or permanent. We also become aware that when they are actively intervening, workers are part of the family system. Their role
in working with poor families is far more powerful than the role carried by teachers, physicians, or ministers, in relation to more stable
and privileged families. The driving force of a family-oriented approach involves a recognition of these realities and a style of intervention that enables a family to help themselves.
We know that it’s difficult for most agencies to adopt and implement a family systems approach, and we have grappled with why
that should be so. In this second edition of the book, we are especially interested in the factors that enable an approach of this kind to
endure, but it’s also important to review the obstacles that stand in
the way. We do so, briefly, in the next section, where we discuss three
factors that tend to block change: the nature of bureaucracy, the
training of professionals, and the attitudes of society.
OBSTACLES TO A FAMILY SYSTEMS APPROACH
The Nature of Bureaucracy
Bureaucracies become top-heavy by accident. They begin by identifying necessary tasks and developing the structures to carry them out.
Certainly, the social institutions that serve the poor were created to
be helpful: to cure suffering, to protect the weak, and to provide a
safety net for society and its members. But the increase in poverty,
homelessness, drugs, violence, and the endangerment of children has
imposed new demands on protective systems. Ideally, increasing
demand would be met by a comprehensive plan to govern the integration of services. In fact, however, the situation has typically given
rise to a patchwork of distinct and disconnected elements: shelters,
temporary housing, and police action to deal with homelessness; a
variety of programs to treat substance abuse; a spectrum of agencies
that offer foster care, adoption, residential placement, or clinical
therapies for children at risk; and so forth.
The elements of the social service bureaucracy have become specialized turfs, rather than interactive subsystems of an organized
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FUNDAMENTALS OF THOUGHT AND PRACTICE
structure, and they compete for funds. The level of funding is always
inadequate to meet the needs, but an increase in the flow of money
would not, in itself, correct the situation. The fundamental problem
is that services are not integrated and money is earmarked for specific categories: babies born with positive toxicity or pregnant teenagers or workfare initiatives. Categorical funding labels the territory,
points toward certain procedures, and supplies an ideology for preserving artificial boundaries. As a result, agencies and departments
vying for financial support shape their language, procedures, and
training in accordance with available funding opportunities.
Current policies and procedures focus primarily on the individual. Every case centers on an identified client who has been referred
to a particular agency for help with a specific problem. From our
perspective, the issue is not that a substance-dependent adult is sent
to a drug program or that qualified people are seeking an appropriate foster home for a child; that kind of specialization reflects the
competent functioning of the system. The problem is that the customary procedures create a barrier around the individual. There’s no
provision for the idea that a drug-addicted individual has important
connections with other people, or that it’s important for the child
and birth family to maintain contact through the period of placement.
It’s difficult to challenge this individual orientation because the
procedures are tied to well-entrenched bureaucratic structures. Budget allotments, caseloads, and insurance reimbursements are based
on individual appraisal and treatment. Such arrangements are cumbersome and they don’t yield easily. In addition, the emphasis on the
individual is taken for granted, not only by the officials who manage
the system but by most of the professionals who work within it.
The Training of Professionals
When professional workers ask themselves, “What are we here
for?”, the answer is usually simple: “To help the patient” (or the
abused child, the pregnant teenager, the heroin addict). The focus on
the individual is a legacy of professional training that emphasizes
individual theory, case material, and therapeutic techniques. Social
workers, psychologists, and psychiatrists approach their professional
work with a framework of ideas about personality, pathology, and
treatment, along with particular skills for dealing with the individual.
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29
Perhaps it’s natural to respond to individual qualities and actions,
especially if people are in pain. It requires a complex kind of training
to respond to the person in context, and to apply healing procedures
that go beyond individual distress in order to mobilize the system.
We have yet to reach that point. If anything, advances in scientific knowledge about the brain and the body, the proliferation of
medication as the frontline of treatment, and the control of reimbursement by HMOs have reinforced the focus on the individual. In
the current climate, that focus begins with intake. Workers are
expected to follow prescribed procedures; to gather the required
information; and to work toward a definite decision that will move
the case to the next step. Though they may enter the system with
innovative ideas, workers generally survive by learning how things
are done, who’s in charge, and what it takes just to keep track of the
caseload. It’s often assumed that the established procedures are
inflexible laws or official mandates: You must fill in the forms this
way . . . . You have to arrange visits by following these procedures
. . . . This is how you do discharge planning. The professional staff
are generally overworked and are apt to view a family orientation as
an addition to their jobs rather than a useful approach that’s central
to the work. They know they’re vulnerable, and that if something
goes wrong, the bureaucracy will not protect an employee who has
not worked according to the rules. The reality of the job doesn’t lend
itself to time spent searching for families, exploring their strengths,
and handling the complexities that multicrisis families present.
If a social service staff can accept the idea that families are a
resource, they are on the verge of a more effective approach, but it is
only a beginning. They cannot work productively if they do not
understand how a system such as the family functions: how the
behavior of the individual reflects his or her participation in family
patterns, how the actions of courts and agencies reverberate through
the family, and how positive changes depend on working with the
network within which their client is embedded.
There’s an interesting paradox here. Unlike the practitioner in
private practice, professionals who work in social agencies are experiential experts on the meaning of an interactive system. In their own
working environment, they’re aware of hierarchies, rules, coalitions,
alliances, subsystems, and conflicts. They’re also aware of their particular place in the system. They know that their roles and possibilities are formed and constrained by the way the system works, and
30
FUNDAMENTALS OF THOUGHT AND PRACTICE
that, when they modify or challenge the rules, it has repercussions
elsewhere and for other people. It’s interesting—and a bit puzzling—
that the idea of the family as an interactive system doesn’t resonate
automatically for staff members. In particular, it should be obvious
that the individual doesn’t function independently, and that the effects of individual effort are unlikely to be sustained if the relevant
system doesn’t change. Because that awareness of how systems work
may be close to the surface, it may not be so difficult to help workers
understand that their clients function within a network.
Social Attitudes toward Families That Are Poor
or “Different”
Within social agencies, the effects of the bureaucratic structure and
the traditional concentration on individuals are compounded by a
view of poor families that is essentially pragmatic and often moralistic. In many settings, the definition of family is narrow. The social
work staff must arrive at solutions, and they tend to define family in
relation to information that must be funneled to courts or child welfare departments, such as who in a family can supply information
about this child’s early physical and social history, who might be able
to take a neglected child in a kinship foster care arrangement, or
where a pregnant adolescent can go with her baby when the infant is
born. The staff looks for who might be available to help and who
must be ruled out because the record suggests they are destructive in
their relationship with the client.
Though definitions are often narrow, judgmental attitudes tend
to be broad. Moralistic attitudes toward poor families are submerged
but pervasive in the culture. The families are blamed for their substance abuse, homelessness, and economic dependency, and viewed
as a burden on society. Separating or ignoring families is partly a
reflection of disapproval—accompanied by a missionary spirit when
children are seen as the victims. There’s a countertrend, of course,
which is certainly just as valid. From this different perspective, poor
families are viewed as the victims of bad economic times and reactionary policies who react to the hopelessness of their condition with
self-destructive and socially unacceptable behavior. In practice, however, criticism and social impatience tend to outweigh compassion,
especially when the political pendulum swings in a conservative
direction.
The Framework
31
Even when families aren’t blamed for their poverty or their
social behavior, they’re often blamed for the plight of the client.
They’re seen as part of the problem rather than part of the solution.
Mara drinks because her boyfriend is abusive, her parents made her
feel a failure, and other family members are also drug dependent.
Jamal has been neglected by his mother, his grandmother doesn’t
seem interested, and his uncle said he would take over but never
helped him. Jane took up with a boy and got pregnant because the
home environment was so bad. And so on.
There’s some truth in these judgments, but such a one-sided
analysis doesn’t acknowledge what the system has squelched, who
might be available as a source of strength, or how the family’s
resources could be tapped to create a more protective and effective
context for its individual members.
To this point, we have commented on social attitudes toward the
poor, but, as suggested in the first chapter, we also need to consider
the attitudes that have greeted increasing ethnic diversity and new
lifestyles. Families that have come to this country from unfamiliar
backgrounds tend to arouse discomfort and distrust. What are their
values and religion? Are they illegal? Are they taking our jobs? Are
they a terrorism threat? How can they treat their children that way?
When they come into contact with the service systems, they may face
not only a lack of understanding, but also policies that compound
their problems and workers who carry negative attitudes. To serve
these families well, we will need to develop new and thoughtful policy initiatives. We also will need to change the preparation of professional workers so that it includes more emphasis on the diversity of
social service clients and on the ways that families from different cultures view the world, form relationships, and function at home and
in society.
People who have formed new social units—nontraditional in
their attitudes toward gender, toward the definition of family, and
toward the creation and rearing of children—will certainly face
social barriers, legal problems, and religious criticism from the culture at large. Though people implementing unique lifestyles are generally not poor or in need of help at survival levels, it seems likely
that they will be needing services of some kind. We know, for
instance, that many people with committed, well thought-out attitudes toward life and relationships find that the raising of children
brings on unexpected disagreements, and parents with new and com-
32
FUNDAMENTALS OF THOUGHT AND PRACTICE
plex lifestyles are probably not an exception. In one unique situation,
for instance, four friends who had formed two same-gender partnerships—one of males and one of females—had cooperated in producing a child. The child now lives in the house shared by the two couples, all of whom are her parents, though only two are biologically
related to her. The arrangement worked well through the child’s earliest years when affection and nurturance were shared and abundant,
but as the child has grown, the details of control and discipline have
raised disagreements that these four people did not expect, and they
have found both the situation and the child’s reactions difficult to
handle. Such situations, and many we cannot yet imagine, will be
brought to professional workers in the future, and the clients may
come up against attitudes that are deeply critical and that interfere
with the necessary search for constructive ways of helping in unfamiliar situations.
WORKING TOWARD CHANGE
The material of this book is aimed at advancing practical knowledge.
We try to provide concrete illustrations of a systems framework and
specific examples of interventions that can be helpful in the delivery
of services. We know that a staff encouraged to work with families is
often uncertain of how to proceed. Workers who aren’t accustomed
to thinking about family systems lack the skills for effective interventions, and therapists who have worked with system concepts may not
know how to apply their skills to agency families. In the remaining
chapters of this first section, therefore, we present the material that is
most important for training a staff in a family-oriented approach. We
discuss the skills necessary for working with families, as well as the
details of effective procedures.
It may be useful to note, first, that we’ve had a particular role in
the agencies where we’ve worked, and that the professional role of
the reader may be either analogous or different. As consultants and
trainers, we’re outsiders, which gives us certain advantages: some
freshness of perspective when we look at the agency’s structure and
way of working, and some freedom from the alliances and tensions
that subdivide the insiders. It also brings disadvantages: We must
take time to learn how the agency functions, and we miss important
subtexts obvious to any member of the staff. Some readers probably
The Framework
33
share the role we have carried and can read the material for its direct
application to what they do. Others may be responsible for training
within their own agency and will have a different context for processing the material. The basic points, however, and much of the
detail, should make instant sense to any reader who has worked with
the complex problems of the multicrisis poor, and should provide
some guidelines for people who are planning to move into this field
of work.
CHAPTER THREE
Working in the System
Family-Supportive Skills
Social service workers bring two sets of skills to their work: a way of
thinking about their clients and a way of functioning to encourage
change. If workers are to increase their mastery of interventions that
support families, they must develop both a systemic, family-oriented
framework and an expanded set of techniques for implementing new
ideas. Practical skills are the most direct, involving interaction with
clients, but they’re not optimally useful or self-sustaining unless
accompanied by a mind-set in which the importance of the family
and a knowledge of how systems shape behavior are firmly established ideas.
In this chapter, we discuss conceptual skills (elements of a mindset for understanding a family and organizing the information) and
practical skills (procedures that help families to mobilize and develop
their resources). We treat them separately but they’re actually linked,
and in the following sections it will become clear that they overlap.
Examples that concretize the ideas involve some intervention, and
interventions are described against the background of our thinking.
That is, of course, how skills are implemented in actual practice.
When services are offered, they are necessarily sp…
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)
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