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 Dedication
to
Jean & Leonard
Eddie & Laura
who gave us our appreciation of families
and to
Jan, Joseph & Alex
Anna, Tesni, Jenny & Joe
who remind us of and develop that appreciation

The Manuscript
Gregory Bateson Esalen, October 5, 1978
So there it is in words
Precise
And if you read between the lines
You will find nothing there
For that is the discipline I ask
Not more, not less.
Not the world as it is
Nor ought to be –
Only the precision
The skeleton of truth
I do not dabble in emotion
Hint at implications
Evoke the ghosts of old forgotten creeds.
All that is for the preacher
The hypnotist, therapist and missionary
They will come after me
And use the little that I said
To bait more traps
For those who cannot bear
The lonely
Skeleton
of Truth
‘The Manuscript’, quoted from Gregory Bateson and Mary Catherine
Bateson (1988) Angels fear: toward an epistemology of the sacred,
New York: Bantam Books. The poem is also printed on page 12 of the
January 1981 Esalen catalogue. Reprinted by permission of the Institute for
Intercultural Studies.
 Contents

Foreword by Andy Treacher ix

Preface xv

1 Beginning at a beginning: family therapy as critique 1

2 A troubled legacy? Systems theory

and family therapy 13

3 Family therapy’s affair with post-modernism 31

4 Freedom or control? The sociological critique

of family therapy 52

5 Who are the family therapists? 72

6 Social policy, social justice and family therapy 90

7 Where is the individual? 112

8 Does it work? 130

9 How does it all go together? 144

10 Beginning at an ending: beyond ‘both/and’ 161

References 167

Index 184
 Foreword

Family therapy, as an alternative and distinctive way of helping

clients, is approximately fifty years old. The oldest family therapy
journal, Family Process, dates from 1962, but family therapy as an
underground movement had started a decade earlier. Sue Walrond-
Skinner, an important pioneer, who produced the first British Family
Therapy text (Family therapy: the treatment of natural systems),
recounts the story of how, in 1951, John Bell, who worked at the
Mental Research Institute, Palo Alto, visited the Tavistock Clinic
while he was in England. He got into discussion with John Sutherland
about how John Bowlby was exploring, from a theoretical point of
view, the significance of seeing whole families rather than individual
clients. According to Sue, Bell misunderstood the convening tech-
nique being used by Bowlby, who was not actually seeing families
conjointly at that time. He went back to America and was prompted
to begin experimenting with convening whole families to family
group meetings, thinking that Bowlby had already pioneered such
work (Walrond-Skinner, 1976).
I rather like this story about the origins of family therapy. No
doubt there are other equally intriguing stories involving other pio-
neers and how they came to start, but the story does prompt some
thoughts about the role of serendipity in developing new ideas. I am
reminded of the apple falling on Newton’s head and of Fleming’s
petri dish becoming contaminated with Penicillium (a penicillin-
producing organism). There is also a certain poignancy in the punc-
tuation created by the story. The Tavistock influences the MRI,
which influences the wider growth of family therapy in America and
beyond. Obviously, that is a different story from one that takes the
MRI as the first point of punctuation.
Sue’s historical anecdote prompts other thoughts too – for example,
why is it that British family therapists have been so heavily influenced
by American theorists? If I think of my own career, which roughly
spans the last twenty five years of family therapy’s history, then I
think of successive waves of American influence: Haley and strate-
gic family therapy, Minuchin and structural family therapy, the MRI
and brief therapy, de Shazer and solution-focused therapy. I would
also include (paradoxically) the Milan school, because I would argue
x Foreword

that Palazzoli and her colleagues did not primarily draw on Italian or
even European traditions to develop their model. Their inspiration
was primarily the work of Bateson and the MRI. In many ways they
took American cybernetic ideas more seriously than any other
theorists, but (as I have argued elsewhere (Treacher, 1986; 1995)),
in doing so, they created an anti-humanist, expert-driven model
(Palazzoli, Boscolo, Cecchin & Prata, 1978), which probably has the
most dubious ethical stance of all the multitude of family models that
are available to us.
Twenty years on, it is remarkable to look back and remember the
popularity of the Palazzoli group. I suspect that their key text,
Paradox and counterparadox, must still hold the record as the most
cited book in the family therapy literature. But do beginning family
therapists ever think of reading it now? The seminal work of Boscolo
and Cecchin (in their post-Milan phase), and the radical impact of
post-modern ideas have effectively erased the original Milan model –
an apparently dialectical process which almost makes me believe in
the truth of Hegelianism. Unfortunately the third element of Hegel’s
triad – synthesis, said to arise from the collision of the thesis with the
antithesis – has not shown any signs of emerging. Contemporary
British family therapy just does not fit such a format. For example,
the two most fashionable current models – narrative therapy and
solution-focused therapy – are strikingly both non-systemic and both
equally antagonistic to the original Palazzoli model.
My concerns about the coherence of family therapy and the prob-
lems that arise from shifting paradigms are partly the reflection
of my role as a family therapy trainer. Since 1991 I have been
involved in co-directing the Diploma in Family and Marital Therapy
at the University of Exeter. I have been involved with four cohorts of
course members during this time, but, if I am honest with myself,
I have to admit that the task of teaching the course has become
increasingly difficult for me because I no longer have a firm idea of
what should be taught. As I have mentioned elsewhere (Treacher,
1998), I feel like a dinosaur who has been rendered extinct by the
rapid conceptual changes that have occurred.
When Eddy and Mark asked me to write the foreword to their
book, I was at first not convinced that I should do so. The last thing
a book needs is a dinosaur to introduce it! But on reading the manu-
script some of my doubts about family therapy’s present and future
evaporated. Their book is part of a series that will look at all the
major forms of psychotherapy from a questioning standpoint. I think
Mark and Eddy are very brave to take on the daunting task of putting
 Foreword xi

family therapy under a critical microscope. The task is a huge one

because of the complexity of the subject matter. Family therapy is a
very diverse field and the conceptual changes that have occurred are,
as I have already documented, bewildering. Quite rightly (given the
size of the task) they have not attempted to write a definitive text but
have instead opted for a less exhaustive approach that deals with
selected facets of family therapy. The choices they have made are
interesting ones and I am prompted to think what I would have
included if I had attempted to write a similar book. In contrasting the
so-called first-order approach of general systems theory with the
second-order post-modern approaches in the opening chapters of
the book is very thought provoking. In reading these chapters I find
I drift into a kind of mourning response: I think of the lost opportu-
nities and, above all else, the major problem that family therapy has
always confronted – the lack of a major, convincing theory which
enables us to have a working understanding of how different types
of family function. Thinking along these lines reminds me of the
work of Arlene Vetere and Tony Gale whose book Ecological stud-
ies of family life (Vetere & Gale, 1987) was such a brave attempt
to launch such a project. Such a project would not, I think, mesh well
with the post-modern ideas that dominate family therapy today, but
I resolutely insist on continuing my mourning. Family therapy as a
solely hermeneutic tradition does not appeal to me because I have
always valued empirical research as a knowledge base that can con-
tribute to the therapy I undertake.
In their next two chapters Eddy and Mark change stance and
adopt a sociological lens, looking first at critiques of family therapy
and then exploring the rather thin literature which has attempted to
answer the question: who are the family therapists? In my book with
Sigurd Reimers, Introducing user-friendly family therapy, I have
explored what I see as a major weakness of family therapy – the failure
to explore family members’ experiences of being in therapy. It occurs
to me (as I read Mark and Eddy’s chapter) that family therapists are
curiously unvoiced as well. Actually this is not at all surprising – the
original general systems theory ideas that were so important in cre-
ating the field of family therapy were very dehumanising. On the one
hand they rendered individual family members invisible, but on the
other they enabled therapists to escape scrutiny because therapists
remained experts outside the system they were viewing. Murray
Bowen is correctly celebrated for breaking out of this tradition by
insisting that the therapist is a vibrant and crucial participant in the
process of therapy. More recently second-order theories and the
xii Foreword

narrative school have encouraged family therapists to recover their

voices and examine their role in therapy, but I nevertheless find it
significant that Mark and Eddy have so few studies to explore.
Narcissism is clearly not a problem we suffer from.
Chapter 7 is an intriguing chapter. Eddy’s grounding in Rogerian
psychotherapy has always played an important role in his approach
to therapy but it is surprising how little attention has been paid to
Rogers’ approach. Some of the early pioneers of family therapy,
and especially Haley, had a mind-set that meant that they rejected
other psychotherapy traditions. Paying attention to the nature of
selfhood opens the door to asking the almost heretical question: why
can family therapy not be undertaken with individuals? Bowen and
other transgenerational family therapists were, of course, never
bothered by this issue, but it is interesting to see how it has now
become a mainstream topic. And there is even some evidence that
working individually can be efficacious.
The question of efficacy in family therapy (Mark and Eddy’s next
topic) is a curious one – for many post-modern theorists such a
crude positivist question is anathema. However, throughout my pro-
fessional career I have always been haunted by the guilty knowledge
that the model of family therapy I had espoused really did not pos-
sess a substantial efficacy literature. I would have felt much happier
if I had felt that the method I was using was tried and tested. The
ethical question posed by this chapter is quite clear to me – is it
justifiable to practise forms of family therapy that have no clear
efficacy? (Narrative therapists may not like the word ‘efficacy’ but
efficacy can be translated into narrative terms quite easily; for
example, for ‘efficacy’ read convincing changes in the stories that
the participants tell about being involved in therapy.) Diplomati-
cally, Mark and Eddy do not conclude their chapter with this ques-
tion but their last chapter does take up this theme.
Chapter 9 is a very ambitious chapter: it attempts to identify core
features or dimensions that are responsible for achieving therapeu-
tic change. Much of the work reviewed here is new to me but I am
a little bit disappointed that Mark and Eddy do not attempt to make
more of what they discover. For instance, what are the training
implications of their discoveries?
This same chapter argues towards a conclusion of integration. I’m
particularly sympathetic to this chapter because as a therapist I am
squirrel-like – I like to hoard everything I have learnt from being
exposed (willingly) to a very wide range of models. Intuitively I feel it
is impossible for any one model to suit all clients (unless the model
 Foreword xiii

is itself an integrative one). I have always worked generically (rather

than having a specialised client group) so I always felt that it is
necessary to continually expand the repertoire of ideas and techni-
ques (to use a word unfashionable in family therapy) that I can offer
my clients. Mark and Eddy comment in the chapter on the work that
Sigurd Reimers and myself undertook under the rubric of ‘user-
friendly family therapy’. Obviously I can’t be very objective about this
part of the book but personally I am glad that this work is getting a
second airing. Writing the book with Sigurd solved something of a
professional crisis for myself – I was becoming lost as a family
therapist and needed to find a firmer and more personally owned
basis that I could use as a springboard for developing my work.
Reading Mark and Eddy’s book at the point of retiring has (as
I have already hinted) not been an easy task. The retired part of me
just wants (among other things) to walk in the Cotswold hills which
I have so rapidly got to love (after moving from Devon). The non-
retired intellectual part of me has enjoyed the challenges of the
book – at times I have agreed and at other times I have disagreed
with what they have to say. But overall the book has helped me
revisit important issues that I feel remain largely unresolved. I am
sure other readers will have a similar experience when reading the
book – this is a book that is designed to provoke and stimulate. At
times it is elusive and at other times very grounded. That is as it
should be since it genuinely reflects many of the puzzling and
enriching ideas that family therapy has spawned during its roller-
coaster history. Whether the unfolding history will ever be less of a
roller-coaster I do not know, but I have a clear preference. I would
want to see family therapy based on firmer theoretical and empiri-
cal foundations than is currently the case. In other words I take an
attachment theory approach to theories – I would prefer to have
securer theories to be attached to. And, to wave a (solution-focused)
magic wand for a moment, I would have preferred family therapy
to place the work of John Bowlby and other attachment theorists
(including Allan Schore, 1994) at the centre of its stage. Building
therapy on shifting sands may be exciting and energising but I
would personally settle for a quieter, less challenging and more pro-
fessionally secure life.

Andy Treacher
Stroud, Gloucestershire
January 2002
xiv Foreword

References
Palazzoli, M.S., Boscolo, L., Cecchin, G. & Prata, G. (1978). Paradox and counter-
paradox: a new model in the therapy of the family in schizophrenic transaction.
Northvale, NJ: Aronson.
Reimers, S. & Treacher, A. (1995). Introducing user-friendly family therapy.
London: Routledge.
Schore, A. (1994). Affect regulation and the origin of the self. The neurobiology
of emotional development. Hillsdale, NJ: Lawrence Erlbaum Associates.
Treacher, A. (1986). Invisible patients, invisible families. Journal of Family Therapy,
8, 267–306.
Treacher, A. (1995). Steps towards a user-friendly approach. In S. Reimers & A.
Treacher, Introducing user-friendly family therapy. London: Routledge.
Treacher, A. (1998). Psychotherapy and research: a cause for concern? Context, 39,
13–15.
Vetere, A. & Gale, A. (1987). Ecological studies of family life. Chichester: John
Wiley.
Walrond-Skinner, S. (1976). Family therapy. The treatment of natural systems.
London: Routledge & Kegan Paul.
 Preface

Just prior to the turn of the last century a number of celebrations and
‘reflections’ occurred in the world of family therapy. At its twenty-
first birthday celebrations in 1996 there was an ‘orgy of remini-
scences’ (Cooklin, 1996) for the Association for Family Therapy and
Systemic Practice (AFT). In 1997 the Association published a
magazine ‘celebrating British family therapy’ (Rivett & Smith, 1997).
Whilst, the following year, the Journal of Family Therapy invited
authors who had contributed articles to its very first edition twenty
years before, to reflect upon their earlier ideas in the light of con-
temporary theory and practice (see Speed & Carpenter, 1998). The
metaphor that was most frequently used during these celebrations
was one of the life cycle. The 1996 conference was sub-titled
‘Coming of Age’: the talk was of ‘maturing’, whilst elsewhere refer-
ences were made to ‘first’- and ‘second’-generation therapists. When
family therapists looked back at the progress of their practice they
naturally thought about growth, evolution and maturation. Indeed,
one of the most recent historical reviews written from the standpoint
of the ‘third generation’ of the field has argued that the concept of
‘abandoning our parents and grandparents’ is a possibility (Dallos &
Urry, 1999).
Within this context, this book seeks to ask ‘how has family ther-
apy got to where it is now?’ and also ‘what is it that exists now that
is called family therapy?’ In one sense we simply here reproduce the
circular questions that family therapists use. The difference is that
the subject in question is not a problematic interaction, a piece of
behaviour, or an emotion. The subject is family therapy itself.
In a field in which metaphors abound, for us the metaphor of
evolution or maturation does not quite describe the subject of this
book. Certainly, here we have once more both interacted with our
professional ancestors and considered future developments. But
from the perspective of the different voices that have occupied our
minds whilst writing, family therapy’s development has seemed to us
to involve a complex process of disjunctions, dilemmas and cyclical
returns rather than maturation. Understandably, we have therefore
wondered about other metaphors that could guide us. In line with
Bateson’s poem, reproduced here, we certainly have felt that we
xvi Preface

have attempted to ‘read between the lines’ and identified the ‘baited
traps’ of others. We have certainly wondered whether ‘the lonely
Skeleton of Truth’ would put in an appearance!
In the end we have realised that we can most clearly describe the
process of writing this book by remembering a very simple medita-
tion technique: ‘Back to one’. In this method when the meditator
loses awareness of the present moment he or she simply returns to
the beginning – but a new moment for that beginning. This is how
it has seemed writing this book: ‘Back to one’. Each perspective
from which we have assessed family therapy has led us not to
increasing complexity, nor to new revelations, but back to the origi-
nal insights and practices as well as a development and growth of
those insights. These remain at the heart of our passion for family
therapy. This passion has been re-awoken in the writing of a book,
a book that proposes a critical, and sometimes sceptical, summary
of the field. We hope that readers will also experience something of
this paradoxical event: doubt serves to stimulate new conviction that
is often shorn of its intellectual trimmings. To borrow another Eastern
metaphor: this book is a koan (or an intellectually unanswerable
riddle).
Here we need to comment upon our contexts that constitute the
particularities of this book. We undertook our professional training
at different times and have differing backgrounds. Eddy is a clinical
psychologist with an initial training in individual psychotherapy
working in the NHS. Mark, initially a social worker, earns his living
both as a family therapist and as a systemic therapist within a
national children’s charity and teaches family therapy at a university.
This unique combination of perspectives has certainly contributed to
the product of this book. We each took responsibility for different
chapters but the way our drafts were passed back and forth makes
all elements of the writing a joint process. A very British book has
resulted. By this we mean that the practicality and scepticism of the
British is apparent in a way that it might not have been if the book
had been written somewhere else in the world. Indeed, again con-
text contributes to this point: family therapy in Britain has all too
often seemed to be driven by gurus from other nations. At one time
they were American; at another time they were Italian. Currently, it
appears to be the turn of Australians and New Zealanders!
Our aim has been to offer a presentation of family therapy in its
intellectual and psychotherapeutic context; to try to step over the
boundaries that have been used to define our field and in so doing to
investigate ideas that are in juxtaposition to ours. All along definitions
 Preface xvii

of family therapy emerge. In the process of doing this we have

realised that what at first we saw as being a straightforward task is
much more complex. The field itself is of considerable breadth and
if, as we have done, one attempts to deal with ideas that are in the
academic arena that surrounds us then the task is indeed a mammoth
one. We have found that issues that we have only been able to deal
with in a paragraph would deserve a chapter in themselves and
chapters could have been books! We hope, however, that the criti-
que we offer here will serve as a benchmark for those that follow us.
Indeed we now view our text as a benchmarking exercise with all the
failings and limitations of such a pursuit.
We begin with an historical perspective in our opening chapter
(Chapter 1) which considers both the origins of family therapy and
its critique of previous therapies. Following our introduction we con-
sider philosophical critiques which we have separated into chapters
exploring systems theory (Chapter 2) and post-modern philosophi-
cal developments (Chapter 3) – chapters which, due to family ther-
apy’s over-focus on philosophy, also bear something of an historical
perspective. These theoretical issues are followed by chapters that
consider family therapy from that of sociological (Chapter 4) and
social justice critiques (Chapter 6). Interweaved is our version of the
sociology of family therapists (Chapter 5). The problems of ‘self’ are
discussed in a chapter on the ‘individual’ (Chapter 7), which includes
a section on the personal development of the therapist. Because of
the importance of evidence-based practice, we follow the theoretical
chapters with two that consider both the traditional ‘outcome’
research (Chapter 8) and ways in which research is arguing for ‘inte-
gration’ (Chapter 9). Our final chapter (Chapter 10) draws together
our understanding of where our review has alighted from its own
journey.
We have written this book with a number of audiences in mind. It
is first and foremost intended to stimulate reflection and debate
amongst family therapists about their own practice and the place of
their inherited theory in that practice. But it is also designed to meet
the requirements of family therapy trainees who need to develop a
reflective and critical view of their professional literature. All too
often professions train their students within an hermetically sealed
bubble. In order to prevent this we have drawn on varied sources,
some totally unrelated to the closed world of family therapy theory,
in order to create an appropriate context for a critical examination
of family therapy theory and practice. However, we must assert
that the interpretations and analyses in these pages are our own.
xviii Preface

We hope that authors who we quote will be generous in allowing us

to interpret their words. We also hope that readers will understand
that we are not here asserting any certainties. We are contributing
to a debate; sometimes asking questions that have not been asked
before, or perhaps not in quite this way. Whatever the value of post-
modernism to the psychotherapeutic theories of family therapy, we
do agree that deconstruction can give valuable insights into texts:
this ‘family therapy’ one in particular. Thus like Don Cupitt we would
argue that ‘truth is the state of the argument’ (1991: 20). If this book
stimulates that argument and the enquiry that goes with it, then our
hopes will be fulfilled.

Eddy Street
Mark Rivett
Cardiff
December 2001
 Chapter 1
Beginning at a beginning:
family therapy as critique

There is no first cause. There is a circular cause, in which the

beginning, which does not exist, meets the end, which is impossible.

Maurice Maeterlinck

To begin at a beginning …
The treatment of an entire family, interviewed together regularly as a
group, is a new procedure in psychiatry. Just when Family Therapy
originated is difficult to estimate because the movement has been
largely a secret one. Until recently, therapists who treat whole families
have not published on their methods, and their papers are still quite
rare – although we may soon expect a deluge. The secrecy about
Family Therapy has two sources: those using this method have been
too uncertain about their techniques and results to commit them-
selves to print (therapists of individuals have not let this dissuade
them), and there has apparently been a fear of charges of heresy
because the influence of family members has been considered irrele-
vant to the nature and cure of psychopathology in a patient. As a
result, since the late 1940’s one could attend psychiatric meetings and
hear nothing about Family Therapy unless, in a quiet hotel room, one
happened to confess that he treated whole families. Then another
therapist would put down his drink and reveal that he too had
attempted this type of therapy. These furtive conversations ultimately
led to an underground movement of therapists devoted to this most
challenging of all types of psychotherapy and this movement is now
appearing on the surface. (Haley, 1962)

So wrote Jay Haley in the first edition of the pre-eminent journal of

the field – Family Process. In these opening remarks Haley alludes to
a number of features of the family therapy endeavour. Firstly, its
origins lie in the developments of the practice of psychiatric psycho-
therapeutic treatment; secondly, it is a practice utilised by clinicians;
thirdly, it is presented as being one thing with a unity of purpose;
fourthly, in meeting a resistance from professional hegemony and
dogma it has a critical almost delinquent stance. It is on this critical
stance that we wish to base our analysis of family therapy.
2 Family Therapy in Focus

From its outset family therapy or perhaps more accurately family

therapists have seen themselves looking on the world of psycho-
therapy and mental health provision with a healthy and at time dis-
respectful scepticism. In this book we wish to use similar critical skills
to examine the theory and practice of family therapy itself. We shall
examine how family therapy has responded to the critiques of itself
and how it has used its own critiques of others to develop itself. Such
a self-reflexive examination is necessary if family therapy is to main-
tain its claim to criticality. More crucially, as ‘archaeologists’ of family
therapy itself (Foucault, 1965) we will seek to highlight particular
paths of development that family therapists chose to follow and
those they chose not to. In such a telling we are hoping that our
reflections on the field do not lead to a view there is only one line of
practical and theoretical development that was possible and that is
possible. We are hoping that our examination leads simply to a
process of continual re-examination.
Typically at this juncture authors would define their terms and set
a boundary around their field of interest; however, we need to be
cautious about this as in adopting our critical stance it could prove
counterproductive. If we are to understand how family therapy has
dealt with critiques and developed further we should not prescribe a
history. If we are to examine how its clinical methods operate in
practice and how its practitioners conduct themselves in the world of
clients and professions we cannot strictly limit our definitions of
those practices. If we are to assume some unity of purpose in the
field we cannot examine that integrity by the field’s own concepts; we
must move outside its conceptual frame in order to offer a varying
perspective. Definition and delineation, if they are appropriate, may
come later but only when we have completed our investigations. In a
task such as this, of a field as wide as family therapy, we cannot hope
to cover every aspect; we can only hope to illustrate and elucidate a
reflective, and sometimes reflexive, critical method. We are aware
that in order to do this we cannot and indeed should not attempt to
provide comprehensive descriptive accounts of many of the positions
that we will come to examine, in this we must rest on the reader’s
appreciation of the subject matter. But we hope that our methodol-
ogy and the conclusions we arrive at through our examination will
cast a different illumination on the family therapy field.
So where do we start? In an examination of any field in which
philosophical, sociological, psychological, empirical and practical
applications are all dimensions that have relevance, it is not possible
to identify a beginning that leads on in some ‘logical’ manner to all