Family Therapy: An ExchangeThe New York Review of Books心理学空间

Paul Watzlawick
John H. Weakland
Richard Fisch

Mental Research Institute

Palo Alto, California

Lynn Hoffman's letter is at least a helpful example of how context can affect our reading of content. I was "labeled" inThe New York Reviewas a psychoanalyst; this evidently has led her to suppose that my intention would be to discredit family therapy, albeit in the wily manner of non-directive therapists. It seems to be hard for her to imagine that my approach could be genuinely exploratory (would it have helped if she knew that I had done some work with families?); or that I limited myself to one particular strand of the family therapy tradition not to make it look bad but because I find its ideas enormously suggestive, and because it is a historically significant element in the broader critique of "medical-model" psychiatry.

I do not believe that keeping schizophrenics out of hospitals is in any sense trivial. Nor do I anywhere "state" my "belief" that the new paradigm will stand or fall on the merits of what Lynn Hoffman chooses to call "the therapeutic techniques operating in its name." It would, I think, be somewhat difficult for me to believe that after having read Thomas Kuhn. Moreover, General Systems Theory is scarcely in danger from its having been taken up by family therapists (any more than it is in jeopardy because some psychoanalytic theorists are also trying to make use of it). Even the specific notion that families can be seen as homeostatic systems seems to be thriving nicely.

To raise questions about the efficacy or sensitivity of particular clinical techniques is not necessarily an attack on anyone's paradigm. Every responsible therapist must ask of his techniques: whom does this seem to help best? whom does it not help? how much does it help? for how long? any adverse side effects? etc. Lynn Hoffman, who deserves credit for the major part of the work on the films from the Philadelphia Child Guidance Clinic, must surely realize that a freeze frame of smiling faces is not a complete follow-up study. Dr. Minuchin and his colleagues do, I understand, view their work with anorectics as experimental, and I gather they are already considering modifying some of their more dramatic and sudden techniques as they carefully observe the longer-term outcomes.

Jay Haley has warned us that every therapy tends to define cure in terms of the changes that it is likely to produce. It would be a pity if the promising field of family therapy succumbed prematurely to that sort of doctrinaire attitude. Elsewhere, Lynn Hoffman has written an account of some theories of "deviance amplifying" processes; wherein she valuably traced the notion of deviance as a function of social transactions back to Gregory Bateson's early anthropological study,Naven. Surely she can see that it does not constitute an attack on Bateson's work if one asks whether a good way to intervene in deviance-amplifying processes in a family is for the therapist to keep changing where he sits in the consulting room.

Ihappenrathertoenjoythefactthatwecanjugglealternatedescriptionsofourclinicalmaterial.IconfessthatIamnotatallconvincedthatthepsychoanalyticandthefamily-systemsparadigmsneedatthispointtobeconsideredmutuallyexclusiveinourpractice.Idon'tseewhyIshouldnottrytobeequallyawareoftheimpactofpresentmessages,andofeachpatient'scharacteristicmodesofseekingrelationshipsoravoidinganxiety.Mostclinicianshavehadtheexperienceoffreeinganadolescentfromadouble-bindingfamily,onlytoseehimreplaythesamescriptelsewhere.Similarly,mostofushavehadtheexperienceofofferingtactfullysupportive"directives,"oreventhemostdeftlycasual(ormetaphoric)"suggestions,"orsomeimplici