Cloe Madanes

This article first appeared in the September/October 1986 issue.

Here they are, in the therapy room on the other side of the huge one-way mirror, Scarlett and Rhett. So what if you don’t remember Scarlett in flip-flops, madras bermudas, and hair curlers? Who cares if the dashing, thick-maned Rhett of memory has become a glum, shiny-topped man given to twirling and untwirling the few vagrant wisps that still ring his scalp? You’ve got to realize this is the Family Therapy Institute of Washington, DC. Here, they don’t believe self-knowledge fires the engine of change and insist instead that therapy is really just a process of persuasion. Here, therapy is about metaphor and boldly sweeping clients along in unexpected directions—and convincing this unlikely couple that they are just like Scarlett and Rhett.

Nevertheless, a visitor might wonder what on earth the institute’s clients tell their friends about the things they’re asked to do in the name of “therapy.” How does the father whose seven-year-old son suffers from chronic headaches describe having to come home from work every day pretending that he has a headache? And what does the bulimic woman say about being instructed to go home and, rather than binge and vomit, toss out five dollars of food a day? And just what does the ex-addict with the suspicious wife who compulsively rifles through his pockets think as he stuffs notes in them saying “I love you”?

But questions like these don’t excite curiosity around the institute. How clients explain the effect of their therapy isn’t much of a concern here. It’s just assumed that human beings are adaptable and if they can get used to spilling out their problems each week in front of a one-way mirror the size of the monolith in 2001, they can get used to anything.

Besides, there’s an aura about the place, a sense that no matter how ineffective and tradition-bound the rest of the therapeutic world may be, here they produce results. With characteristic audacity—some might even say arrogance—they’ve named the clinic attached to their training institute, The Clinic. And each year students come from around the world in search of the secrets that will unlock all their hopelessly stuck cases.

Behind the mirror, Cloe Madanes, co-director of the institute, watches with a group of students as Scarlett and Rhett grudgingly admit to their therapist that, yes, things were a little better that week “When they first came in, they couldn’t say two words to each other without a terrible argument,” recalls Madanes. “They got in such a battle in the first session over taking out the garbage, that we had to tell them that topics like that were too sordid to discuss in therapy.”

Madanes laughs mischievously as she recalls this opening round victory over the couple’s unquestioning dedication to their quarrel. Decreeing garbage disposal off-limits as a therapeutic issue has tickled her sense of absurdity. As anyone who has read her books or attended her workshops knows, Madanes is quite at home with the fantastic and the absurd. Her therapy often hinges on seemingly bizarre inter ventions that sometimes push things to the edge of mockery but, then instead of giving offense, make people smile.

“Soon the therapist discovered that the wife’s favorite book was Gone with the Wind” remembers Madanes. “So he was asked to tell her that she was just like Scarlett, strong-willed and romantic. And the husband was like Rhett Butler, rough, taciturn, but appealing. So we were starting the therapy by helping the couple to see themselves and each other in the most flattering way. But it’s more than that. The wife was diabetic and drinking herself to death. Since they came here, she has completely stopped drinking.”

Where her more sober-minded colleagues might see sturm und drang, Madanes sees screwball comedy or, if not that, just a tired soap opera in need of a plot twist. Like a wily director, she’s convinced that however impossible a family’s drama may seem at first, the production is only a few rewrites and rehearsals away from something quite workable. Her flair for imaginative interventions and her absolute conviction that the problem is always in the play, never in the actors, has earned Madanes a reputation as perhaps family therapy’s most daring and ingenious strategist.

Strategic Therapy

Students at Madanes’ training institute hang on her words with the absorption of people who don’t know what to expect next. Most will admit they’ve never met anyone remotely like the mercurial Madanes—a woman who manages to be both imperious and child-like, exotic and familiar at the same time. Says one former trainee, “Figuring out Cloe is like trying to analyze a kaleidoscope.” Says another, “Being supervised by Cloe you’re always on the edge of your seat. She expects you to do exactly what she tells you. If you work well under pressure, it probably makes you sharper, quicker. But she’s so quick, it’s hard for her to have the patience for those who plod.”

“People often say that they are afraid of me,” observes Madanes. “That always surprises me because the part of myself that I identify with most is my shyness.” Nevertheless, scarcely a month goes by in which Madanes is not giving a workshop somewhere. Petite and tiny-voiced, she manages to exude the unquestioned authority of a drill sergeant. And what makes the pieces harder to fit together is that, for all her reputation as a master of therapeutic indirection, her conversation typically offers a startlingly frank read-out of her mood and personal preoccupations of the moment. Madanes attributes her candor to her Argentinian upbringing. “In Argentina you talk about things that matter,” she says, ‘You seldom make trivial conversation.” Her husband, Jay Haley, puts it more simply: “She doesn’t like bullshit.”

Describing what’s distinctive about Madanes’ work, Salvador Minuchin says, “Cloe is a true innovator. More than anyone, she has introduced play into family therapy, bringing a sense of lightness and humor to her work that is totally non-threatening. She has learned from doing therapy with children how to make people follow her ideas without realizing they are her ideas.” Smiling at Minuchin’s comment, Madanes adds, “I don’t think it comes from doing therapy with children as much as from my own childishness really.”

Madanes inspires a special curiosity within family therapy these days. Married to Jay Haley, one of family therapy’s pioneers, she has carved out her own reputation as someone who has more clever ways to solve the puzzles families present than just about anyone around (in one recent paper she listed 23 treatment strategies she uses). In her two books, Strategic Family Therapy and Behind the One-Way Mirror, she has tried to persuade her colleagues that spending long days listening to the problems of drug saturated adolescents and binge vomiters can be fun. With her taste for the fashionable and unapologetic attitude towards enjoying the good life, she seems out to prove that it can even be rather glamorous. It’s a message that family therapy’s many toilers in the field have found intriguing.

At their institute and in their workshops over the past ten years, Madanes and Haley have trained thousands of clinicians in a style of therapy rooted in the unconventional work of the now legendary hypno therapist Milton Erickson. During the ’40s and ’50s, when psychoanalysis was the reigning therapeutic ideology’ and insight was regarded as the primary vehicle of change, Erickson developed a non-interpretive, action-oriented therapy that regarded clients’ awareness of their problems as an impediment to solving them. Instead of focusing on painful past experience, Erickson concerned himself •with subtly encouraging his clients to mobilize their personal resources in the present. Rejecting the gloomy, cerebral bent of psychoanalysis, Erickson introduced a distinctively American, can-do spirit into the field of therapy. With his book Uncommon Therapy, Jay Haley popularized Erickson’s unusual approach to change and turned him into something of a therapeutic icon. Applying many of Erickson’s ideas and methods, Haley developed an approach called strategic therapy that today constitutes one of the preeminent schools in the field.

Madanes’ professional identity is closely linked with that of her husband, whom she still considers her mentor. In collaboration with him, she was instrumental in developing both the theoretical and technical features of the strategic model. But as much as a practical approach, strategic family therapy is an ideology about change and the proper role of the therapist. Today many therapists still define themselves by whether they see strategic therapists as manipulators, purveying gimmicky, quick fixes, or enlightened pragmatists cutting through the cant and mumbo-jumbo of the therapy profession.

At the heart of the strategic therapy Madanes and her husband teach is the therapist’s unswerving commitment to solving a client’s presenting complaint. For them, the ball is always in the therapist’s court and the goal is unequivocal—to bring about a clearly defined outcome in the briefest time possible. Like an accountant who doesn’t expect his clients to know the tax laws, the strategic therapist doesn’t expect his clients to understand what he does. What is important, however, is that the therapist always have a plan and not, as Haley puts it, “just have everybody show up and hope for the best.”

Critics

The methods and assumptions of strategic therapy are not everyone’s cup of tea. Since Haley’s earliest writings, some therapists have questioned the ethics of interventions that rely on indirect influence and keep clients in the dark about the therapist’s techniques. Others wonder why a therapy which so prides itself on getting results has produced no research validating its claims of great effectiveness. For many, the question remains open about whether the immediate behavior changes that result from strategic interventions actually last.

Recently, many feminists are questioning whether strategic therapy is irreconcilable with feminism. Some of Madanes’ work, in particular, has been attacked as degrading to women and reinforcing of stereotyped sex roles.

“I don’t think a feminist can be a strategic therapist,” says Deborah Luepnitz, currently at work on a book-length feminist critique of family therapy. “Feminists have always insisted that people need to understand their conditions rather than be mystified by them. The idea that insight is somehow irrelevant to change is a real disservice to women.”

Madanes’ repeated emphasis on the underlying benevolence of family relationships has also been challenged as naively ignoring the patriarchal cultural context in which families develop. Says Luepnitz, “Madanes chooses just to focus on benevolent power in families, but I don’t think you can understand human behavior by denying what you don’t like about it.”

In Maryland, where Haley and Madanes trained scores of therapists under a contract to the state mental health system, strategic therapy is a hot political issue. The local chapter of the National Alliance for the Mentally Ill (NAMI), a self-help group for the parents of schizophrenics, has staged what might be called family therapy’s first consumers’ revolt. They are fighting, quite successfully so far, to block state and county funding for family therapy training and services.

Haley and Madanes’ treatment methods are a special target in this struggle. Says Agnes Hatfield, one of the founders of NAMI and a professor of Human Development at the University of Maryland, “Haley and Madanes seem rather out of date in totally denying that there is a disease called schizophrenia. Looking at their books, I have been astonished by their unwillingness to review the range of new research in this field. The only people they seem to reference is themselves.”

Madanes and Haley invited Hatfield to speak with the trainees at their institute. “The trainees were not impressed with her pessimism about the people she calls “schizophrenics,” says Madanes. “I don’t think she and the other people at NAMI are as concerned as they should be with the human rights of patients and the abuse of medication and hospitalization.”

Not all the criticism of Haley and Madanes’ views on schizophrenia comes from outside the field. Says one family therapist, “They still think it’s the ’60s and they have to help R.D. Laing save schizophrenics from their families and the mad psychiatrists of the world. They don’t understand •what it’s like to live with a psychotic person.”

Regarding Madanes’ and Haley’s precautions against the use of psychotropic medication, Carol Anderson, of the Western Psychiatric Institute and Clinic and co-author of Schizophrenia and the Family, says, “There’s no question about the damaging effect of drugs. But what most patients tell us is that they’d rather put up with the discomfort of the medication and the side-effects than with the terror and pain of schizophrenia. I think all the family treatments of schizophrenia, including what Jay and Cloe do, have promised far more than they can deliver. It’s irresponsible to hold out hope for people that only sets them up for disappointment and disillusionment.”

“Therapists need to comfort and contain patients through their terror and pain,” counters Madanes. “It is unethical not to have hope for those who are still living. Giving people irreversible neurological damage from medication is not desirable.”

Loving in Unfortunate Ways

The hallmark of Madanes’ work is her ability to find tender affection in the most appalling family mess:

Love is complex and it sometimes involves hurting oneself or hurting the object of one’s love … A daughter may make a suicide attempt so that her depressed mother will pull herself together to take care of her daughter and in so doing will come out of her depression. Violence towards others may also have the function of obtaining or of giving love.

(Madanes, 1986)

Her cases ask us to believe in a benevolent world in which each of us is buffered from life’s harshness by almost telepathically sensitive relatives willing to sacrifice themselves if it will only make things a bit easier for their families.

Madanes’ main theoretical contribution to family therapy is the idea that most symptoms, and the responses they evoke from other family members, are realty metaphors that mirror, at the same time as they disguise, other problems whose direct expression might irreparably injure a family’s status quo. So, according to Madanes, something as simple as a child’s bed wetting may metaphorically reflect a father’s improper behavior in bed, and be seen as an attempt to help the parents by distracting them from their other problems. Accordingly, the best way to understand the bed wetting is to see how it focuses the mother on the child’s problems rather than on her own, and involves the father in discussing the boy’s bed wetting rather than his own infidelities. Where others may need to barely scratch the surface of human relationships to find geysers of deceit and exploitation, Madanes’ therapy typically focuses on the discovery of great wellsprings of innocent affection.

Madanes is probably best known for developing her “pretending” techniques, directives instructing symptomatic family members to act as if they had their problem while others pretend along with them. As Madanes explains it:

A therapist can encourage a child to pretend to have a symptom. The parent can also be encouraged to help the child when the child is pretending to have the problem. [In this way] the situation will have changed to a game, to make-believe and play . . . when a sequence of interaction is labeled, “This is pretend” it is difficult for the participants in the sequence to go back to a framework of, “This is real.” (Madanes, 1981)

One of the first cases in which Madanes experimented with pretending as an intervention involved a ten-year-old Puerto Rican boy with night terrors. Madanes hypothesized that the boy’s fears were a metaphor for his mother’s anxiety. “She had lost two husbands, was poor, did not speak English, and was involved with a man in a relationship that had to be kept secret (from welfare investi gators) even though he was the father of one of her children.”

Madanes devised a play scenario in which the mother would be assaulted by an intruder (played by one of her daughters). The boy’s role was to come to his mother’s rescue. “The family had difficulty with the dramatization,” writes Madanes, “because the mother would attack the make-believe thief before the son could rescue her . . . The message that resulted from this failure to act out the scene correctly was that the mother was a capable person who would defend herself; she did not need the son’s protection . . . The son did not have night terrors again.”

Putting Children in Charge

A distinctive feature of Madanes’ work is the way she taps into children’s loving influence in their families, especially in cases in which parents are abusive, neglectful, drug addicted, or severely ill. Introducing a provocative variation on family therapists’ preoccupation with buttressing the hierarchy and helping parents exert their authority, Madanes developed the strategy of putting children in charge of their parents.

Madanes uses this approach with cases that most therapists might throw up their hands at. One such case involved a mother of four, who had repeatedly been brought to the attention of protective services. A former heroin addict, the woman was now heavily involved with her church. Her children, however, had earned a reputation in their neighborhood as unholy terrors. Her seven-year-old twins were encopretic and would stuff their excrement into holes in the walls of their apartment and have contests urinating out the window. They regularly set fires in their home and, on one occasion, to a van in the street. Once they even set fire to a baby in a crib. The mother was suspected of abusing the children. Robert, the most disruptive of the twins, as a baby showed signs of a skull fracture.

The key for Madanes in this case was finding “a frame-work of love, not of violence or punitiveness.” To her, this was not a family wildly out of control, but one in which the children took care of this mother by creating such trouble that outside sources, like protective services, came in to help.

The tape of the first session with this family is one Madanes has frequently shown in her workshops. Recalls one family therapist who has seen it, “I always thought of strategic therapy as rather mechanical and emotionless. Watching that case was absolutely overwhelming. It made me change my mind and see what Madanes does as a way of bringing out the family’s potential for love.”

The pivotal intervention in the first session occurred after the therapist spent some time sympathizing with the mother over her children’s terrible behavior and admiring the mother’s willingness to keep her kids in the face of all the problems they caused her. Then, the therapist turned to seven-year-old Robert, the worst troublemaker, and told him to give his mother a big hug and a kiss. Robert hugged and kissed her for a long time, clinging to her while his five-year-old brother hovered around and tried to dry the mother’s tears. The therapist moved the little one away and asked Robert to wipe the mother’s eyes and say to her, “I’ll take care of you. I promise I’ll take care of you. I promise, Mama, I promise I’ll take care of you.” The child repeated the therapist’s words very softly and hugged the mother for several minutes while the mother caressed him.

The therapist said, “From now on, you are going to be Mama’s helper. You are going to be in charge of helping Mama have an easy life. Tell Mama one thing that you are going to do. You are in charge.” The boy said very timidly, “Clean up.” The therapist said, “You seal that bargain with a hug and a kiss.” And they did. “One more thing as the in-charge person,” said the therapist. “Be good,” said Robert. The therapist said, “Seal that with a kiss, because from now on you are going to be in charge to see that things go well in your house for your mother. What else?” “Behave in school,” said Robert. “Seal it with a kiss,” said the therapist. (Madanes, 1984)

For Madanes, change in this family meant giving Robert a positive way of helping his mother instead of the destructive ways that he had devised. Therapy continued with this family for nine months, but Madanes reports that after this first session all major symptoms in the children disappeared and there was no further abuse on the part of the mother.

To those who feel that asking children to take charge of their parents in this way puts too much of a burden on them, Madanes responds:

All this is done in age-appropriate and playful ways so that there is no burden to the children and, on the contrary, they are relieved to be able to express their love and to take care of their parents. The children are not really in charge, the whole organiza tion is in play, more in fantasy than in reality. The parents are moved as they experience their children’s love for them and respond in kind, taking responsibility for themselves and for their children. (Madanes, 1984)

Madanes’ sparse, understated descriptions sometimes do not communicate the sheer emotional power that her reversal of the hierarchy technique can generate. “Everyone cries in the sessions I supervise,” says Madanes. “The clients, the students watching, even the therapist in the room—everyone except me. I can’t afford to. I have to be thinking about what to do next.”

Incongruities

Madanes is known for the way she weaves therapeutic webs of illusion in which everything becomes its opposite. Her own childhood as the eldest daughter of a well-to-do Jewish family in Argentina had more than its share of sudden twists. When she was eight, for example, her father’s department store was confiscated by Evita Peron. Then, at 15, she and her family had to flee Argentina for several years because of their alleged business connections with the Peronists. “Growing up, my life was full of incongruities and I never expected anyone to be consistent,” says Madanes. “If someone loves me, I don’t expect them not to hate me. I know that admiration always comes together with disappointment and respect with envy. I believe that change for the better—or for the worse—can be brought about so swiftly in therapy because as a child everything and everyone changed so swiftly around me.”

For Madanes, putting children in charge of their parents’ happiness is no mere flight of therapeutic fancy. It comes from her protectiveness of her parents as a child. Madanes describes her lawyer father as “extraordinarily intelligent, charming, and attractive.” “I worshipped him,” she says. “I am not only grateful to him for the love and guidance he gave me, but also because ever since I was a child he let me know that he needed me, that I could help him. He had many ups and downs in life and at times when he was sad or despondent, he looked for my company and let me cheer him up, comfort him, and talk him out of his sadness. That was a great gift that he gave me, the possibility of helping him.”

Madanes credits her father with being the inspiration for many of her playful therapy techniques. “I remember being three or four years old running around in the apartment making trouble on my tricycle and my father saying; ‘Now Cloe the bad one will go away’ (and I would hide behind the curtain) ‘and Diana the good one will come out.’ [Diana is her middle name. ] I would come out looking like an angel and he would say, ‘Oh, Diana, it’s so good to see you. Come and sit next to me. Where have you been?’ and so on. I loved the idea of being two people, and in this way he could get me to behave in seconds. It did not make me schizophrenic, it just made me sensitive at an early age to the complexities of human nature.”

“My father was always a tease. I remember as a teenager when I would reproach him angrily about something at the dinner table, he would take a knife, hand it to me with the blade pointing to himself and say, ‘Stab me. It would hurt me less than your words.’ I would have to laugh at my own anger, which seemed as absurd as his drama.

After getting a degree in psychology in Argentina in 1965, Madanes went to the Mental Research Institute in Palo Alto to pursue her interest in research. There she became interested in family therapy and the work of Milton Erickson. Returning to Argentina in 1968, she was one of a few in her country familiar with the latest developments in family therapy. Although most of her experience -was as a researcher, she suddenly found herself in demand as a therapist and supervisor.

In 1971 she returned to the United States with her husband, an economist in the World Bank, and her two daughters. With the help of Salvador Minuchin, she got a job at the Philadelphia Child Guidance Clinic training Puerto Rican paraprofessionals and other staff to be family therapists. For the next five years, she developed her skills as a supervisor.

It was also during this time that, after the break-up of her first marriage, she developed her personal and professional relationship with Jay Haley, whom she had avoided when both were on the staff at MRI in the mid-’60s. “At that time, I was very serious about psychoanalysis,” remembers Madanes. “I had taken great offense at Jay’s article “The Art of Psychoanalysis” and refused to meet him,” says Madanes, laughing.

Madanes and Haley were married in 1975 and together they founded their own training institute in Washington, D.C. But Madanes found collaborating with someone who had received such acclaim in the field created problems. “It was very difficult because of our age difference and our difference in status,” says Madanes. “It was very important for me to achieve some stature in the field and make some contribution so that I would feel comfortable in teaching next to him. When we started the institute, I was secretary, receptionist, and bookkeeper. Jay was handyman and video technician. We took turns doing live supervision. I made sure that all the students got Jay to supervise them. I didn’t want anyone to feel that they were stuck with me.”

With the publication of Strategic Family Therapy and Behind the One-Way Mirror three years later, Madanes made her contribution with an approach linked with, but distinct from, her husband. “They think alike but act very differently,” says Salvador Minuchin. “Jay’s interventions are much more formal; Cloe’s more spontaneous.” Haley agrees, “I might have started being the authority. But that’s changed.”

After years of following Haley’s approach to training and restricting herself to live-supervision, Madanes recently returned to doing therapy. Despite her reputation as the developer of ingenious clinical techniques, Madanes’ style as a therapist is surprisingly direct.

Madanes sees technique as a way of moving people when the therapist isn’t able to do so through ordinary conversation. “If I am doing the therapy myself, I will move parents by talking about the love that their children have for them,” observes Madanes. “But when I am working with students who aren’t yet able to move people through conversa tion, then I might prescribe a ritual like putting the children in charge. It’s just a metaphor that dramatically symbolizes the children’s love for their parents.

The Clients’ View

What’s striking about talking with the families who have been the focus of some of Madanes’ elaborate interventions is their utter lack of curiosity about the whys of what went on and their relief that someone else took responsibility for straightening out their problems.

“There was no monkey business,” says the mother of a 12-year-old girl who had masturbated compulsively at home and school since she was five. In an intricate case in which, among other things, the girl was required to spend three 20-minute stints a day on a rocking horse and, later on, the father was punished for his daughter’s misbehavior, the girl’s problem was resolved. “We were told what we had to do. Everything was spelled out. It took the burden off our shoulders,” says the mother. Asked if the therapy seemed unusual, she replied, “Oh, it was pretty much what we expected.”

In the case of another family, the “Cobbs,” Madanes went to great lengths to get the three teenage children to take charge of seeing that their parents had fun and spent more time with each other. Special care was taken to avoid directly addressing the family’s presenting problem, Mr. Cobb’s drug addiction.

Looking back on treatment several years later, Mrs. Cobb reported that her husband had been cured of his addiction. And what did she think had been helpful in bringing that about? The unusual directives from the nameless person behind the one-way mirror? The way her children were organized to plan out activities for her and her husband? Not according to Mrs. Cobb: “I think the most important thing was how the therapy (taught us all to share, to be more open and honest with each other.”

Well, if Madanes can transform her clients into Scarletts and Rhetts, why can’t they turn her into Carl Rogers? Besides it’s just the kind of twist that should make Cloe Madanes feel right at home. •

References

Madanes, C., 1981. Strategic Family Therapy. San Francisco: Jossey-Bass.

Madanes, C., 1984. Behind the One-Way Mirror. San Francisco; Jossey-Bass.

Madanes, C., May, 1986. Eros and Violence. A presentation at the Eros and Violence Conference in Amsterdam.