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Friday, 02 January 2009 10:39

It's more Complicated Than That - Page 4

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MINUCHIN : At the time I wrote Families of the Slums, I was full of political passion in defense of the underdog. I had an enormous amount of zeal and people responded to that. All of us back then were tremendously hopeful about teaching poor people to become competent in this social laboratory that was the family. We relied on techniques of moving in and out of the conflict, of being both an observer and a participant in the session. So we would say, "Mom, talk with Jimmy and find a way to make sure he really listens." The goal was to get the parents to exert competence in an area in which they could succeed. The more competent people felt, the more they would listen. Our naivete at that time was that we could not yet look beyond the boundaries of the family and recognize the impact of the larger culture. That came later.

FTN : When I think of the teaching tapes you made at the Philadelphia Child Guidance Clinic, what stands out for me is the art of the small victory going through some hellish struggle to get somebody in a family to do something they have never done before. Of all the cases that you treated, is there one that stands out for you?

MINUCHIN : There is a famous tape of an anorexic girl eating a hot dog. That was a family situation that was horrendous. There was this girl named Carol who was so underweight that she was in danger. So I said to the parents, "Unless she eats, she will die. You are the parents. Don't let her die. Do something." So I tried to help the family discover a new pattern of interaction by creating a crisis in which the parents had to do something that was novel for them. Now these parents were faced with an impossible situation. The mother starts by saying, "Carol, I want you to eat," but soon she and father are beginning to fight, so I say, "Look what's happening now. Carol is still not eating." And the parents now attack the girl, "You will eat!" And food is no longer the issue, and questions of power, autonomy and control become the central issue in this transaction. At that point, it is possible to enter by supporting the girl's autonomy not around eating, but around what her parents are doing.

FTN : But how did you get out of being stuck in the power struggle?

MINUCHIN : A therapist must walk both sides of the street. At the same time you are getting the parents to take control, you also talk about the girl's autonomy. You explain that good parenting is not just control, it is also about giving space. And while you encourage the girl's autonomy, you talk to her about the parents' need to be respected. Bringing the conflict into the therapy room is just the first step in challenging the old pattern and moving parents outside of the world of the girl. Maybe I'm thinking of this particular family because Carol just called me a few months ago to tell me that her father, whom I had not seen in 25 years, was dying and wanted to speak with me one last time. After all these years, he still felt connected to me and what had happened in the therapy. Somehow talking with me at the end of his life was his way of closing a circle. I am frequently surprised how long the memory of a therapist can last in the life of a family.

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