Maestro of Consulting Room

At 83, Salvador Minuchin is still reflecting on clinical wisdom

Salvador Minuchin | PHOTO © STEVE MITCHELL

This article first appeared in the May/June 2005 issue.

If today’s psychotherapy were a color, it would probably be beige. Therapists once presented themselves as expert and authoritative guides through the thickets of human suffering, but now they seem more anxious to show that they’re just regular folks, who want to help out a little. Many shy away from the word therapist, advertising themselves as “life-balance” coaches, educators, peer counselors, advisors, or consultants, as if to emphasize their desire to “collaborate” and “train” clients, rather than “treat” them. As for the once-vaunted “self” of the therapist, treatment often seems to have become so technical that the therapist’s persona seems almost beside the point. After all, how important is the “use of self” for a therapist doing EMDR, TFT, neurofeedback, hypnosis, or the more formula-bound brief therapies? How much scope is left for the therapist’s inventiveness, intuition, and life experience?

For contrast, flash back to a therapy session from 30 years ago. Family therapy pioneer Salvador Minuchin is the consultant, seeing a family of three for the first time. They shuffle into the room–a small, poker-faced, working-class father, dressed in competing plaid pants and coat, in keeping with the peculiar fashion sense of the late ’70s; a prim, stiffly coiffed, sad-faced mother; and their withdrawn, drug-abusing, and possibly suicidal 15-year-old son, Bud, a boy as improbably handsome as a young, sulky angel in a Renaissance painting.

Minuchin, a suave, somewhat rakish figure, with a trim mustache, dark-rimmed glasses, and thick Spanish accent, enters the room, briskly discharges the introductory formalities, and gets right to work. The issue of the day is Bud’s refusal or inability to wake up in the morning, despite the urging of three alarm clocks that go off at staggered times. Not until his mother comes in and drags him out of bed, morning after morning, does he finally get up. Minuchin expresses astonishment at Bud’s talent for shut-eye–“I wish I  had your knack for sleeping!” he says admiringly. “What’s the latest you’ve been able to sleep?”

Before answering, the boy gives a quick, questioning look to his mother–no more than an eye flicker in her direction, but Minuchin catches it. “Don’t ask her!” he suddenly barks. “Don’t ask her! We already know her function–she’s your alarm clock. Is she also your memory?” A moment later, Minuchin directs a question to the father, who also quickly glances at his wife before answering. Minuchin throws up his hands. “Is your wife the memory for the whole family?” he asks incredulously. “She’s a very busy person–both an alarm clock and the family memory bank!”

From that moment on, like a veteran theater director rescuing a troupe of amateur actors from their messy improv, Minuchin assigns roles and shapes the pedestrian matter of the family’s daily life into a sharp, absorbing little drama, even if the actors are mystified by what he’s doing and not necessarily happy with their parts. Within about three minutes of meeting the family, the maestro has defined the structure of the piece–overprotected son, overinvolved mother, underinvolved father (a favorite storyline in early family therapy circles)–and begun overhauling the production.

He invents a metaphor–the idea that the boy is too “wired” to the mother–and raises it again and again. “Are you so wired to your son and husband?” he asks the mother and when she agrees, he bursts out exuberantly, “Isn’t it wonderful how families get wired. It’s beautiful!” He asks the father, a man familiar with tools, if he has “wire-cutters,” to snip away the steely bonds between mother and son. In fact, he repeats the question several times, just to bring the point home.

Minuchin mocks, reassures, flatters, charms, needles, encourages, congratulates, and confronts the family. He orders them around, jokes with them, touches them, and herds them from chair to chair like a scrappy border collie. Sometimes he appears impatient with the cast members–interrupting them in the middle of their speeches to give them new directions. Sometimes he looks bored, smoking a cigarette and staring vacantly into space while they haltingly say their lines. At other times, he hammers home a point with high intensity or crows in delight at a surprising turn of events.

Often Minuchin jumps right into the action himself. If the father seems slow to “cut the wires” between mother and son, Minuchin will put his own hand to it. An anxious look from the mother as Bud begins to speak is enough to propel him out of his chair and across the room to shake her by the shoulders gently but firmly and tell her to “relax”–meaning, stand back, take a powder, get lost. “My goodness, you’re closely wired to him!” he says jovially. “You need to be out of it,” and then over his shoulder, he says sharply to Bud, “This is what keeps you a baby, man.”

Learning that Bud has messed up some of his father’s tools, Minuchin labels him a “klutz” (a much more optimistic and benign condition than depression, drug abuse, borderline delinquency). He flatters, cajoles, urges, and virtually commands the father to act more like a dad and less like a passive wuss. “I was impressed that he said he wanted to be like you. That’s a hell of a nice compliment,” he says to the father. “Can you teach him to be competent like you? I’m talking to you instead of your wife, because she can’t help him be like you.”

The climax of the drama comes near the end of the session, when Minuchin focuses on the son. Standing behind Bud’s chair, he takes the boy’s head in his hands and moves it up, down, and sideways, then lifts the boy’s arms one by one, then raises the back of Bud’s collar so he’s lifted a bit out of his chair–Minuchin is playing a puppeteer pulling on a puppet’s invisible strings. “You have a talent for recruiting puppeteers,” he says, indicating not only Bud’s mother, but even his father, and certainly the various mental health providers he’s collected. “But do you know what the real goal is? To keep the puppeteers out.”

Speaking gravely and directly to Bud, who seems mesmerized, he says, “Everybody thinks you’re a puppet. You’ve fooled all these people. All of them think you don’t have an inner model, that you don’t have a soul. They don’t know the parts of you that are okay. They see you only as a klutz–they don’t see the fact that you’re bright, that you can be helpful, that you’re polite and considerate and responsible. You’ll need to begin tomorrow to convince these people that you don’t need a puppeteer, that you have much more inside than they see.” He shakes the boy’s hand firmly. “You’ll have to do a hell of a lot to convince these people, because they don’t believe you.”

The dramatic conclusion of the session, which ends on a note of suspense, makes it clear that this is fundamentally Bud’s story. What will he do? “It’s really your life,” Minuchin seems to be saying to this passively rebellious, inert, childish boy. “What are you going to do about it?” Then Minuchin exits the stage as briskly as he appeared, leaving the family looking dazed but also oddly buoyant–a far cry from the moribund trio who first entered. What’s happened here? Did it set the family on a new and better path, help the boy grow up? Who knows? But it’s hard to miss the signs of life in what looked like a terminally apathetic boy, the look of new resolve in the father, and even some hints of relief in the mother.

A New Philosophy of Change

Looking at a video of a vintage Minuchin therapy session is more like watching a Samurai flick than, say, My Dinner with Andre. Compared with today’s typically cautious and tactful therapist, Minuchin embodies fearless certainty, preternatural self-confidence, even brashness. To a field coming out of the stultifying world of psychoanalysis in the 1970s, with its snail-like pace and verbal meanderings, Minuchin’s approach was a revelation. “I always had the impression that he was shining a bright light on the family, making transparent patterns and situations that had otherwise seemed completely opaque and confusing,” says Celia Falicov, a family therapist and professor in the psychiatry department of the University of California at San Diego. “He made clear what had been incomprehensible and left us wondering how we could have missed it ourselves.”

Whatever the ultimate outcome for the clients, the videos and live demonstrations of Minuchin’s work were dazzling. “You’d watch him through the mirror as he began to talk to these disorganized families that nobody else could figure out and before you knew it, he’d caught you up in the rhythm of his work. You were riding along with him as if he had a map of the terrain. At the end of the session, you’d know what these people needed and where they needed to go. It was absolutely magical,” says Barbara Bryant, a family therapist trained by Minuchin and now a court-appointed teen advocate in Philadelphia.

Watching Minuchin in action was to see old psychoanalytic commandments being smashed to smithereens, one by one–the dusty ethos of passive taciturnity, infinite discretion, and unassailable privacy being swept away like so much old debris. He trampled underfoot the standard assumption that nobody can change anybody else–that psychological change must come from within. Before awed spectators, he poked, prodded, and jollied client families into changing right then and there, live in prime-time. “Therapists say that you can only change yourself, but Minuchin insisted it was quite the opposite–you can only change the other person and the other person can only change you,” says Jorge Colapinto, an early colleague and now director of the Ackerman Institute’s Foster Care Project in New York. “It’s through the power of human context–our relationships with others–that we change.”

Another standard assumption he rode roughshod over was the idea that people’s feelingshave to change before their behavior can change. Minuchin not only made people change, he seemed to do it regardless of what they were feeling, or whether they even knew what they were feeling. He acted on the premise, says Colapinto, that “if you change the way people relate to each other, their feelings will change as well.”

This premise–that relationships change people–so commonplace now, so novel then–opened the door to an astonishing new view of personality itself. “Minuchin really transformed the perception of personality,” says Braulio Montalvo, one of Minuchin’s earliest colleagues. “It had always been assumed to be something innate to a person, something solid and static, as if made of stone. But Sal could examine a family in a way that showed how malleable human personality was; that it shifts according to context.”

In short, Minuchin not only created a body of clinical theory and practice, but also, through the sheer, blockbuster force of his personality, defined a style of working that seemed to offer a muscular, therapeutic counterpart to liberation theology.

Larger Than Life

Minuchin’s gift for drawing a clear storyline from even the most convoluted and chaotic family circumstances may have stemmed from having to find coherence in the contradictions of his own life. Born an Argentine Jew in 1921, given the Jewish name Schmerl, which somehow morphed into the Spanish Christian name Salvador (Savior), he grew up in what he refers to as a close-knit Russian-Jewish “shtetl” in a small town whose other inhabitants loathed Jews. The walls spouted graffiti like, “Be patriotic: kill a Jew.” By his own account, his was a big, loving, traditionally patriarchal family, but his pride in it, his loyalty to his Jewish roots, was also tinged with shame about that very identity. As he’s written, “Part of a despised minority, I learned to despise my Jewishness, to try to pass, and to hate myself for it.”

Though he felt like an outsider, he was genuinely drawn to and shaped by a Hispanic culture that officially wanted nothing to do with him. He adored Argentine music, particularly the tango, spent much of his childhood on horseback, and, as a young Latin macho, fought hard and often with other boys in the streets on matters that he thought affronted his honor. This early immersion in the South American code of honor would later show up in his attitude about doing therapy. “To be afraid was the worst thing,” Minuchin said about his childhood while reminiscing in a 1998 interview. “It wasn’t important if you were defeated, as long as you fought with honor. Stylistically, as I started family therapy, the idea of challenge was part of my makeup. And then it became part of my theory. . . . Through it all is the awareness that the work of confrontation is about confronting your fears.”

Minuchin seems to have revered his father–a loving, just, tough-minded man, whose word was law. When Minuchin was 9, his father lost his business–a farm implements store–to the Great Depression and, to bring in some cash, rode off into the sunset as a gaucho, driving cattle hundreds of miles across the Argentine pampas. “For a year,” Minuchin writes in The Making of a Family Therapist, “in fact and fantasy I saw him sleeping under the open skies, his saddle for a pillow, fishing in small rivers, herding cows in a never-ending scene in which my father, Tom Mix, and Gene Autry alternated in the saddle.” What he calls his “larger than life” view of his own father–hero, protector, benevolent alpha male of the clan, and unfettered cowboy riding grandly across the landscape all at once–seems to have tinged his idea of what all fathers should be.

An unabashed partisan of the poor, the outcast, and the oppressed, Minuchin was rudely introduced to the darker realities of politics in 1944, when, as a medical student, he took part in a protest against the authoritarianism  of dictator Juan Pero´n. Arrested and jailed, he spent a week alone in solitary confinement (where he was periodically and rather lackadaisically interrogated by the police), then moved to a different jail with other political prisoners. He was released three months later.

In 1948, electrified by the news that Israel had both become a state and been attacked by its Arab neighbors at practically the same minute, he dropped his fledgling pediatrics practice, sold his brand-new equipment, and took off for the Middle East to join the Israeli army. For the first time in his life, as an army doctor in Israel, he paradoxically no longer felt like a Jew. “The Jewishness that in Argentina had been a mainstay of my identity disappeared. The sense of belonging without ambivalence made me not more Jewish but more human. I didn’t have to defend myself. I could join others.” Once the initial fighting was over, he went to the United States, studied psychiatry, got married, and returned to Israel. He then worked as the codirector of five residential programs for disturbed and refugee children–many of them European orphans of the Holocaust, others from Yemen, Iran, Morocco, India, and elsewhere.

In 1954, still feeling ignorant about what made kids tick, he went to New York to study psychoanalysis, at that time the only psychotherapeutic game in town. But psychoanalysis wasn’t a good fit for a gregarious, assertive extrovert–he liked talking and connecting with people too much to enjoy sitting silently behind patients while they rambled on. So while he was in training, he leapt at the opportunity to begin working as a psychiatrist at a residential institution for inner-city delinquents, a school called Wiltwyck. This job would take his life, and the field of psychotherapy, in radical new directions.

The tough, ghetto-raised black and Hispanic adolescents that he found at Wiltwyck in 1958 were nothing like the verbally skilled, introspective, middle-class patients he was seeing as an analyst in training. He soon found that traditional therapy didn’t work well: after months of residential treatment, many of the kids were back in trouble almost as soon as they got home. During the early years of family therapy, mavericks with big personalities and restless brains always seemed to find each other, and Minuchin found like-minded colleagues at Wiltwyck–Richard Auerswald, Bernice Rosman, Charles King, Braulio Montalvo, and Clara Rabinowitz–who were also disillusioned with the status quo and unafraid to try something new.

The story varies, but by one account, Minuchin–perhaps remembering conversations with family therapy pioneer Nathan Ackerman, who’d briefly taken him under his wing–suggested they treat both the kids and their families. The team read a 1954 article by the legendary early theoretician of family therapy Don Jackson (it was the first article on family therapy any of them had ever seen), punched a hole through the wall, put in a one-way mirror, and started observing the resident kids interact with their families. As soon as they got the families together, they realized they were in terra incognita. Trying to find the “individual motivation” inside any one family member was like trying to separate the ingredients of a cake after it had been baked. Recalls Minuchin, “In family sessions, we were suddenly unsure about the beginnings of behaviors or feelings, since we could see them as responses to behaviors or feelings of other family members, who were in turn responding to behaviors and feelings.”

The team didn’t work from any model; nobody knew enough to formulate one. “I don’t think what we did came out of any specific reasoning process,” Minuchin says now. “I didn’t have any particular view about family systems. It was just that we were doing something wrong and thought we ought to try to do something different. So we observed these families through our one-way mirror in order to see how they behaved with each other, what needed repair, how we should interview them–even how we should look at them. That was where the real excitement was–in actually seeing these families in action. From that, we developed some ideas and gradually articulated a correct method of working with them.”

In fact, they experimented madly. They divided families up into different groupings or “subsystems.” First two therapists met with the whole family, then one therapist met with the parents and another with the children, before the whole bunch met together again. They told people to move from chair to chair to create physical metaphors of closeness and distance. They had therapists and clients switch places behind or in front of the one-way mirror–a revelation for both practitioners and families. Not only could therapists sitting behind the mirror see things that the practitioner sitting in front of the mirror with clients missed (including aspects of their–the practitioners’–own actions), but clients got a new and often highly enlightening view of their own families.

Montalvo remembers seeing a single working mother and her four, wildly rambunctious, children. She felt particularly defeated and inadequate as a parent because she had such a hard time controlling her brood. “One day, Sal took the mother behind the mirror and the two of them watched me try to create some order among these kids, and I failed miserably–they only became more obstreperous. ‘You see,’ said Sal to the mother, who was watching, ‘you really do have a lot to handle–the problem isn’t just with you.’ The mother could see what a jerk the therapist was at handling her kids, and that made her feel less incompetent.”

Because these families “communicated” with each other less by talking than by interrupting, yelling, crying, stomping around, and shaking their fists in each others’ faces, the team began crafting rules and techniques to keep the chaos at bay. They used a “magic pencil” that people had to be holding if they wanted to talk, and others had to listen until theygot the pencil. The therapists instructed people to talk to each other, rather than to the therapist, which, over time, evolved into the practice of “enactments”–an interaction between family members staged by the therapist to reveal and change entrenched emotional patterns–which became a mainstay of structural family therapy. It quickly became clear that the focus of the therapy was action, in which the therapist participated as much as the clients. “We weren’t dealing with the way people think about relationships, but the relationships themselves,” says Minuchin. “The idea was to help the dancers dance, and the therapist would be the one leading the do-si-do.”

Even at Wiltwyck, Minuchin was erasing the old line separating the private world of psychotherapy from the public world of political and economic injustice. “We felt very much that we weren’t just doing clinical work, but trying to liberate people of low socioeconomic background. We were trying to change not only family dysfunction, but social dysfunction as well. In fact, we believed we were involved in social revolution, which made it all very exciting.”

The Philadelphia Child Guidance Center

On the basis of his work with poor delinquents and their families–widely considered clinically unreachable by conventional therapists–he was recruited in 1965 to direct the Philadelphia Child Guidance Center (PCGC). A traditional, psychodynamically oriented treatment center located in the inner city, PCGC was itself failing to make therapeutic inroads with the clients it drew from the ghetto around it. Along with Braulio Montalvo and Bernice Rosman, who went with him to Philadelphia, Minuchin immediately began transforming PCGC into a clinical and teaching center for family therapy. He insisted that family therapy wasn’t only for the poor; he and his newly reconstituted team at PCGC believed that individual psychiatric symptoms usually emerged in the context of relationships gone awry. So, change the rules of the relationship, and the symptoms would go away.

In 1967, Families of the Slums was published. Written by Minuchin, Montalvo, and other team members (Bernard Guerney, Bernice Rosman, and Florence Schumer), and based on their work at Wiltwyck, it introduced Minuchin’s particular take on family therapy to the world. By this time, he’d  visited other family therapy hatcheries on both coasts–the Mental Research Institute (MRI) in Palo Alto (Jay Haley, Virginia Satir, Gregory Bateson, John Watzlawick, John Weakland); Murray Bowen and Lyman Wynne in Washington, D.C.; Ackerman in New York–to learn what else was going on in family-based psychotherapy.

In all this, Minuchin may have been an inspiration to his followers, but to the child psychiatrists at PCGC and its parent organization, the University of Pennsylvania Medical School, he was a bat out of hell–they hated everything he was doing. According to Montalvo, as soon as Minuchin made it clear just how radical the changes were going to be, half of the regular clinic staff left, whereupon he hired more like-minded thinkers. Cloe Madanes, Jay Haley, Marianne Walters, Charles Fishman, Harry Aponte, and other leading lights of family therapy got their start at PCGC or worked there at one time or another.

Meanwhile, the child-psychiatry establishment at Penn was outraged that this infidel movement was taking root in their own psychoanalytic soil. Minuchin was repeatedly summoned to meetings to account for the new form of treatment, but in a masterful show of strategic passive resistance, he refused to show up. So the offended psychiatry department sent an investigator to PCGC, who filed a report that Minuchin was “dangerous to the department.” Complaints to the American Psychiatric Association (APA) and the American Medical Association resulted in a three-person visitation from the former that lasted five days. At the end, the APA declared that what Minuchin and his colleagues were doing was, after all, “acceptable” and could continue.

Between the late ’60s and early ’80s, the clinic became probably the world’s largest, best known, and most influential family therapy training center, with more than 300 staff members and a program that drew students and pilgrims from the United States, Europe, Israel, and Latin America. In 1974, came Families and Family Therapy, Minuchin’s book describing the approach he and his team at PCGC used. It became the most popular book about family therapy ever published.

Life with the Master

Like any charismatic figure, Minuchin has inspired a canon of treasured folktales about life with the Master. He was legendary among his staff for doing a lot less stroking and cuddling than prodding and confronting. Among his supervisory gambits remembered by former trainee Jay Lappin was something called “tape roulette.” A staff member would bring a tape of an ongoing case to staff meetings–usually it was of a family with whom some problem had arisen and the therapist felt stuck. “Sal would sit back, smoking, watching the tape,” Lappin recalls. “He’d say something like, ‘This therapist says he has a problem with this family, but it’s hard to know what it is, because, as we can see, the therapist is doing all the talking. If he talks so much, we don’t see the family dynamics. But this therapist does like to hear himself talk. I’ll now fast-forward the tape and when I stop, I’ll bet he’s is still talking.’ Then, while your unlucky colleague was sitting there sweating bullets, he’d stop the tape–and there he was, still fucking talking. ‘Oh, what a surprise,’ Sal would say. ‘the therapist is talking again.’ It felt like you’d witnessed a theoretical wedgie,” says Lappin, “but the point definitely got across.”

That Minuchin had a certain amount of Latin machismo has become part of the canon, though it sometimes revealed itself in ways that suggest Gilbert and Sullivan more than Die Hard. Greenstein recalls that he once was seeing a young man, about 20, who worried about what he felt was his unmasculine fear of fighting (as a bass player in a rock band, he spent a lot of time in bars frequented by belligerent drunks). Greenstein was quietly trying to reassure his client that wanting to fight was certainly not the measure of manhood, nor was not wanting to fight anything to be ashamed of, when both heard a commotion in the hall. Greenstein opened the door to see Minuchin in the hall grappling with a hugely muscled man, a violent and apparently psychotic intruder who’d wandered in off the street.

Together Greenstein and Minuchin subdued the man, but in getting him in a headlock, Greenstein got scuffed up a bit himself. Meanwhile, alarms went on, people poured from offices, and police arrived. Once the chaos died down, Greenstein resumed his session with his client, cowering in his chair. “You see,” said Greenstein, wiping at his bloody nose, breathing heavily, clothes askew. “Fighting is no fun. Look at me. I don’t feel heroic. I feel anxious and upset and generally bad.” Five minutes later, says Greenstein, “the door flies open, in comes Sal–he never did have much respect for closed doors. He’s dancing around with his fists up, pummeling the air, saying ‘Wasn’t that great? Wasn’t that wonderful? Did you see what I did to that guy?'”

At the same time, Minuchin could instantly sense what was happening inside people and intervene in ways that could completely deflate rage and potential violence. Jorge Colapinto describes a fight scene at PCGC, when two “huge” teenage boys somehow got out of the inpatient wing and made their way to the lobby, where they began a violent argument, fists clenched, apparently ready to get extremely physical with each other. “They were creating a real scene, and a number of us were slowly approaching, not exactly knowing what to do and not wanting to get too close to these guys, either,” recalls Colapinto. Minuchin, a much shorter, smaller man than the two furious combatants, came out of his office, got between them and said matter-of-factly, “Can you two tone it down a little? I’m trying to work here.” Immediately, says Colapinto, the two boys stopped fighting, apologized, and went back to the inpatient unit. “When we asked Sal if he wasn’t afraid of being attacked, he said, ‘I’ll never be attacked because I’m a coward.'”

Minuchin’s quirky non sequitur of an answer didn’t supply the real reason, says Colapinto. “I think he has an amazing ability to read human situations, and when it comes to challenges, he knows whom he can yell at and whom he can’t. He came into that situation sensing that somewhere inside those teens were boys who respected authority and would respond to an older guy who needed some peace and quiet to do his work. This is inherent clinical genius, not just something you can imitate.”

It was during the years at PCGC that Minuchin became a star of a type not seen before in the once staid, but now suddenly glamorous, field of psychotherapy. Maverick psychiatrist R. D. Laing may have introduced the genre of therapist-as-roving-magician/entertainer, but Minuchin and his cocreators of family therapy really took this show on the road. As Minuchin describes it, the traveling bands of family therapists took their tapes and their presentations and their particular schticks and went from one conference to another across America, playing to huge crowds. “Everybody was a jazz musician,” he says. “We carried our own equipment with us–sound equipment and mikes–the way musicians traveled around with their instruments.”

At one especially large conference, Minuchin realized at the penultimate moment that he’d accidentally brought a blank videotape, not the session he intended to show an audience of 800 strong. He was desperate, but Carl Whitaker and Virginia Satir were there and volunteered to play the role of the dysfunctional family for Minuchin to interview. Unfortunately, this madly improvised “family” session of what Minuchin has called the most “proximal, experiential, pushy” family therapists in the field wasn’t videotaped, but apparently it was a boffo hit.

The Feminist Critique

One group that was falling increasingly out of love at this stage with Minuchin and the other predominantly male stars of the family therapy firmament were the feminist family therapists, who emerged on the scene during the late ’70s. In 1978, therapist Rachel Hare-Mustin wrote the first feminist analysis of family therapy for Family Process. She castigated the profession for ignoring power inequities between men and women, both in society and within the family. Family therapists, she argued, essentially blamed all family problems on overinvolved, “enmeshed” mothers and peripheral, cowed fathers, “without regard for the underlying inequality that leads to such a situation.” Within a few years, Hare-Mustin’s lone voice had become a deafening roar, as feminist articles, books, workshops, meetings, and symposia poured forth a river of complaint about family therapy’s bias against women and willful blindness to their social, economic, and political oppression.

In this thunderstorm of protest, it was almost inevitable that Salvador Minuchin would become a lightning rod. A Latin man of traditional patriarchal background, he ordered clients around, propped up family hierarchy (which, feminists argued, meant shoring up Dad’s power at Mom’s expense), embodied a clinical style that could be seen as the last word in machismo, ran his clinic like a benevolent dictatorship, had a reputation for arrogance, and famously never yielded ground in an argument. Furthermore, feminists argued, structural family therapists as a group, including Minuchin, were so taken with their intoxicating new systemic vision, with its presumably “neutral” analyses of boundaries, subsystems, coalitions, transactional patterns, and the like, that they were blind to the power of entrenched gender bias.

By most accounts, Minuchin wasn’t “open” to the feminist critique, particularly when it erupted within the walls of PCGC. “He had some knock-down drag-outs with women about the issue, but he wouldn’t give in,” recalls Dave Waters, professor of family medicine at the University of Virginia. Minuchin not only had a reputation for being unfair to women clients and siding with men, but even among his own staff members, he appeared not to understand what the feminist fuss was all about, a source of no little irony to some critics. “He was always so attuned to the social context of people’s lives, so interested in what poverty did to people and how culture shaped them, except that he forgot the differences between men and women,” says Marianne Walters, who was PCGC’s executive training director before moving to Washington and founding the Family Therapy Practice Center in 1980.

Minuchin’s defenders suggest that he was unfairly attacked–that feminist therapists needed to differentiate themselves from the overpowering male ethos of the family therapy zeitgeist, and they lit on him as the most obvious and public target. “Good male demigods to bash were at a premium,” says Walters. Others point out that if he was tough on women, he was no less tough on men–goading, challenging, and jockeying them into taking more responsibility in their families. “He was as arrogant with men as with women,” says Cloe Madanes. “He saw men as not really present in their families, even when physically present. Society itself, particularly the welfare system, has had the effect of setting men aside, making them unnecessary in families, easily discarded. He perceived this, and his way of changing it was to lower the woman a little bit, so the man would step up to the plate.”

Minuchin felt that feminists misunderstood him and misrepresented his therapy, arguing in a 1984 interview that far from trying to squelch the mother by expanding the father’s role in the family, he was actually “creating new possibilities for her to function as a more complex, adult woman.” He grudgingly admitted that always viewing the mother as “overinvolved” and the father as the “potential separator” was a “skewed perspective reinforced by the masculine culture,” but he adamantly denied being a sexist. “If [the feminists] are saying, ‘Minuchin uses that intervention frequently,’ they’re right. But if they’re saying I’m a knee-jerk chauvinist who doesn’t understand the social context in which families live, they’re wrong.”

Eventually, Minuchin made a kind of conditional peace with the feminists, saying in a 1996 interview that “the feminists made me realize that I’d put women in certain narrow categories and that my labels for women had gender biases. . . . I don’t think I do that anymore. I’m more aware of the messages of the labels and I pay attention to what I privilege, [and] I pay more attention now to making sure that her voice is heard, her pain expressed, and her need for respect understood.” But, however much he came to sympathize with the feminist cause, he still insisted that couples comprised a system.“While I feel totally supportive of the feminist political and social agenda,” he wrote in Mastering Family Therapy, published in 1996, “I’m totally committed to a systemic point of view in family therapy. It isn’t that he governs her; they construct each other.”

Band-aids not Revolution

Minuchin had rocketed onto the therapy scene as a revolutionary for whom therapy wasn’t just a clinical act, but an act of social liberation–changing families and changing the world were part of one heroic vision. But in spite of having pioneered a trademark line of family therapy and built up a world-famous training institution, by the late ’70s he saw that the revolution he’d envisioned was as far off as ever. “What we do when we bring psychiatry to the slums is to put Band-Aids on people who require major surgery,” said a chastened Minuchin to writer Janet Malcolm in 1978 for her profile of him in The New Yorker. “We aren’t surgeons. We work with a mother on how to feel more competent with her children when she’s living on an income that makes it impossible to be competent. . . . Psychiatry is the only thing we have, so that’s the thing we give. We aren’t revolutionaries, and we aren’t even reformers; we’re accomodators.”

He was disappointed to see his techniques, which had emerged organically from real-life necessities, being followed slavishly by less inspired practitioners, becoming simplistic, formulaic, and often irrelevant to the goals of therapy. “I began to see people being absolutely literal and mechanistic–move your chair over here, sit there, talk to her, talk to him’–in ways that were absolutely unconnected to the relationships in the family and their communication patterns. I was horrified,” says Minuchin. “I developed a defensive maneuver, telling myself that once you write something, it no longer belongs to you.”

In 1981, the year of Ronald Reagan’s inauguration, Minuchin left PCGC and, with his wife, Pat (a psychology professor at Temple University), moved to England for a year. He was 61. In Family Kaleidoscope, he says that he and his wife enjoyed teaching, but “had the frustrating feeling that we ourselves were learning less.” And, as someone who’d once never been less than certain, he now began to doubt. No longer called upon to be the world-class expert on changing families, he toyed with the possibility that family therapists were just as stuck in their own limited worldviews as the members of any other shared ideology. Watching poor, immigrant families being caught up in the destructive meshes of London’s Family Court system, he pondered how much impact any mental-health intervention, even family therapy, could have on the stony rigidity of monolithic social and legal institutions. Every chapter of Kaleidoscope, which he wrote about his year in England, ends in an argument between the earnest “author” (Minuchin 1) and a skeptical “reader” (Minuchin 2 ) about the entire project of systems thinking–how much good could it really do against entrenched power?

Still, he was revived enough after what he called “a pause in the life of an intervenor” to return to the U.S., now to New York City, with new missions in mind. Besides starting his own training center (now the Minuchin Center for the Family) in New York, he took a look at the vast hodgepodge of social agencies and legal institutions controlling the lives of poor families and set his sights on reforming just one of them–the foster-care system.

Foster care is a basically good idea too often badly managed. In New York, Minuchin found that it frequently dismembered families, excluded biological parents from the lives of their children, and sometimes made things  worse both for children and parents. He proposed a novel approach, one that would allow foster parents and birth parents to get to know one another and work together, the former helping the latter acquire the skills and confidence they need to take good care of their kids. Rather than being rivals and antagonists to the biological family, the foster parents would be trained to become part of the child’s extended “kinship system”–helpful, supportive “second cousins,” so to speak, to the birth parents.

It sounds like a simple, sensible, not very radical idea, but putting it into practice would mean scuttling one of the most entrenched and rigid policies of the foster-care bureaucracy: keeping foster and birth families completely segregated. Usually biological parents don’t even know the phone numbers or addresses of foster parents (frequently different foster families for each child in placement) and see their kids only on bimonthly scheduled visits at the agency, with a social worker present.

Minuchin sent letters to more than 300 heads of agencies that work with children in New York City, offering to train their staffs free of charge in the family therapy techniques that could make this vision a reality. The result: no agency responded. Unbowed, Minuchin wrote to the heads of 30 of the city’s foster-care agencies, and four accepted. With several grants, he began a three-year program training agency workers and foster parents, together and separately, in how to work effectively with the child’s biological families. From this work came Training Manual for Foster Parents (1990), which has been used by agencies and government departments in every state in the country. In the early ’90s, several New York agencies began using his model and, in 1997, the New York Administration for Children’s Services adopted these “family-to-family” guidelines to reform foster care in the city.

The Rabbi in the Consulting Room

In the tapes from this latest major period of his work, a different Salvador Minuchin seems to be emerging. Rather than the cheeky, sardonic look of his youth, he has the face of a slightly melancholy nobleman painted by El Greco. Instead of the Argentine jujitsu master of old, he looks and sounds like a contemplative old rabbi. There are few of the flashing pyrotechnics that made him famous–no ordering anybody around, not even much playing of musical chairs. Always self-reflective, he’s noticed this change in himself. “Through the decades of being a therapist,” he says, “I’ve moved from being an active challenger, confronting, directing, and controlling to a softer style, in which I use humor, acceptance, support, suggestion, and seduction on behalf of the same goals that I once reached with a sharper style.”

If his bold view once touched the wilder shores of social revolution, his attention now seems to have circled back to focus on a more intimate canvas. More than the young Minuchin, with his rebel’s distaste for the past, in the work since the ’90s, he’s helped individual family members explore their personal histories to gain insight into their present problems. He’s  become intrigued by the self of the therapist and the multiple ways personal idiosyncrasies, family background, and attitudes shape the way a clinician views the world and does therapy. “The self is always partial,” says Minuchin. “You’re always a prisoner of your own structure and your own story.”

Today, the lion reposes, but not entirely in peace. He’s aware that the fortunes of family therapy in America, unlike Europe, have slipped considerably since the glory days. He ticks off the many major family therapy institutes in America that have died or are close to dying. “The Minuchin Center is very, very small now,” he says wistfully. He notes that his American workshops draw perhaps 150 people, while in Europe the number is more like 800. Minuchin doesn’t appear to note this decline with a sense of wounded pride or ego, as much as with a profound sense of regret. The loss says more about the difference between America and Europe than it does about the value of family therapy.

Europeans, with their strong collective ethos, regard psychiatric illness as a social problem, and can muster the political will to support subsidized family therapy, while American psychology and psychiatry fixate on individual pathology. “The story of family therapy in Europe is about the present and future,” says Minuchin. “In the United States, the story is about the past and present–there is no future.”

He sees American therapists as overlooking the political ramifications of their work, or too cowed by the political climate to fight the decline. “The culture here demands of therapists that they remain focused on the apolitical, so we don’t have much respect for the political context,” he says. “Maybe it’s not that we don’t respect it, but that we can’t afford to respect it. Maybe the political process here is such that people fear being labeled–not as Communists, of course, because nobody is labeled a Communist anymore–but as Massachusetts liberals, which is exactly the same.”

Consummate diagnostician that he is, Minuchin’s sharp and unsentimental perception won’t permit him the false comfort of platitudinous bromides in the face of society’s resistance to even modest reform, let alone to revolution. Still a brilliant “reader” of people, he accepts that seeing and understanding human dilemmas isn’t the same thing as resolving them. “I can meet with a family and in two, three hours, I get a clear view of how they operate and introduce some novelties and alternatives to them,” he says. “But after many years of practice, I know that isn’t enough–which is, I think, the beginning of clinical wisdom. I failed in many ways, as most clinicians do. But when you fail, then your certainty is transformed into questioning. I still see myself as an expert, but I know that my truths are partial truths and my style of intervening is partial. Perhaps real wisdom is the uncertainty of the expert.”


Mary Sykes Wylie

Mary Sykes Wylie, PhD, is a former senior editor of the Psychotherapy Networker.