Ms. First then starts to tell about some good results that have been achieved through the new therapy, like keeping schizophrenics out of hospitals, treating extremely disturbed adolescents, and offering hope for one very grave disorder, anorexia nervosa. These results, however, she dismisses as either trivial, or else explainable by age-old remedies which analysts also use, like "relabeling" of the "transference cure." The reader thinks of another question: "Is a method and a rationale for treating a condition like anorexia, which up to now has been highly resistant to any form of therapy whatever, to be dismissed because it may turn out to consist of nothing more than a mixture of 'half ritual drama, half behaviorism'?"
This new question is quickly buried under a splendid explanation of the difficult Batesonian concept of "second order change," featured in a book by Watzlawick, Weakland, et al. The reader is once more beguiled. However, his contended state is broken into by the assertion that the therapists who make use of this concept work in a cynical, authoritarian way. The ideas of Gregory Bateson are only being used as window dressing, to give the place class.
Ms. First ends the article by stating that the systems-theory therapists feel that they have got hold of a "new paradigm," in Kuhn's sense of a new descriptive model. She also states her belief that this paradigm will stand or fall on the merits of the therapeutic techniques operating in its name. And the books she has reviewed, she tells us, do not assure her that "the solutions of family therapy are as yet so convincing."
By this time, the innocent reader will be in a state of bemused confusion. Ms. First, with her flip-top phrases and a smattering of deepness, has shown herself to be a master illusionist. The illusion she gives the reader, in true non-directive style, is that he or she is being asked to make up his or her own mind. But simplified, the underlying argument of this piece could be translated into the following dialogue:
Q: What is bad about systems-theory therapy?
A: It is unpleasantly manipulative.
Q: What is good about it?
A: Apart from some trivial achievements as a treatment modality, it claims to offer a new paradigm.
Q: Then we don't have to judge it as therapy?
A: Not so. If it is ineffective therapy, that will prove the paradigm to be wrong too.
Q: Is there any proof yet that it is effective therapy?
A: No.
Q: Then we can throw it all out?
A: Right.
For myself, I believe in illusions, am convinced that clever writers, like clever therapists, are always weaving them about their clients' heads, and applaud Ms. First for an enchantingly ingenious performance.
Lynn Hoffman
Brooklyn, New York
To the Editors:
We were initially pleased that our bookChange—Principles of Problem Formation and Problem Resolutionwas included in Elsa First's review of several works on family psychotherapy in the February 20th issue ofThe New York Review(V. XXII, No. 2), but then rather disappointed.
This is not because Dr. First's remarks about our work were critical. Criticism is legitimate, and indeed it is expectable that a psychoanalyst's comments on our work should be quite critical. But because often writers are read only by like-minded readers, which gets nowhere, we welcome an opportunity to have our book appraised by someone using different ideas and values in approaching human problems, and very different criteria in assessing change.
What we do regret is that Dr. First has referred to what in our judgment and in the book's emphasis are peripheral aspects. In fact, she quoted us so cursorily that it is difficult to call it a review. We would have hoped that she take her orientation and her task seriously enough to be critical especially of the central points ofChange—our application of group theory and Russell's theory of logical types to human problems, our focus on analyzing "solutions" rather than problems, our choice of deliberate rather than inadvertent manipulation of people, and our unsophisticated concern with observable, concrete and rapid results even in the highly personal business of psychotherapy.
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