From the May/June 1994 issue
THE PAST FEW YEARS HAVE NOT been friendly to psychotherapists. Probably no other contemporary field has suffered so many widely publicized body blows to its professional competence, its ethical standards and its economic visibility in such a short span of time. The mass media fairly subsists on stories of therapists who brainwash or sleep with their clients (sometimes both), turn family members against one another, engage in unedifying courtroom spectacles on behalf of morally bankrupt protagonists, and charge unconscionable fees in the bargain. This year, a gaggle of books, including ones with evocative titles like Therapy Gone Mad, Beware the Talking Cure and A Nation of Victims, has been added to the already growing body of anti-therapist polemic that blames most of society’s ills on therapists. As Networker editor Rich Simon said in his introduction at this year’s Family Therapy Network Symposium, “Somehow, we’ve gone from being the defenders of the noble traditions of humanism to becoming running characters on Beams and Butt-head.”
The 17th Annual Network Symposium, this year titled “Morality and Psychotherapy” and held March 10-12 in Washington, DC, addressed the increasing uneasiness among therapists about professional values, attitudes and truths that used to seem as steady and reliable as the movement of the planets around the sun. It focused on the growing pressures for clinical and ethical accountability that are now requiring clinicians to explain and empirically defend the worth of their pet theories and standard methods to people who do not automatically speak the language of therapy. This year’s theme grew out of the realization that the terrible “M” word-morality for decades associated with the oppressive forces of guilt, shame and self-hatred from which therapists wanted to free their clients has begun to penetrate the cordon sanitaire that once surrounded the therapy room.
Of course, therapists never have been truly “neutral”; a presumably “value-free” or “neutral” stance about sexism, homophobia and class prejudice, for example, was de facto a stance in favor of the status quo. But now, with the status quo visibly unraveling around us, many therapists feel they can no longer afford even the pose of standing on the sidelines. In the expanding free-fire zone of our culture, taking a strong moral stance seems less a professional lapse than an urgent necessity.
And yet, the need for moral “answers” doesn’t negate the difficulty of finding them, as Nobel Peace Prize winner Elie Wiesel made clear in the luminous, subtle and sometimes mystifying keynote address that opened the Symposium. Welcomed with a standing ovation by the 2,500 attendees, Wiesel said he imagined therapy to be a “moral quest” not the process of objectively weighing moral factors, but actively taking sides on behalf of those who suffer. Although there will never be any final answers to the quest for moral certainty, suggested Wiesel, the search itself gives human life both its meaning and its unfathomable mystery. “We are all in a quest-all partners in a quest for truth, for friendship, for meaning, for hope, for humanity,” said Wiesel. “The moment the quest stops, our humanity stops.”
Wiesel’s talk was itself something of a quest a personal exploration through the Torah and traditional Hasidic stories, through his memories of childhood in Transylvania and experiences of the Holocaust, his travels to Sarajevo, Cambodia and other places of death and misery to “bear witness, to be present to people when they suffer.”
Wiesel told the audience that the therapist’s obligation to bear witness must extend beyond the four walls of his or her office. “Simply seeing patients is not enough,” he said. “If, in Somalia, children die of hunger, you cannot simply continue meeting your patients as if children didn’t die. If, in Sarajevo, children are killed in the snow,. . . you must speak about this to your patients. . . . Whenever, wherever death is a victor, we must know about it; even if we cannot help, we must at least know about it.”
Wiesel did not deliver a lecture about morality as much as reveal the contradictions and maddening ambiguities in the age-old human desire to create moral meaning and goodness from chaos. This very desire is, he suggested, a unique human “message” that is passed down from generation to generation through individual families, “a kind of genetic code that may never be fully decoded, that will always remain, in part, a secret.”
IF WIESEL EVOKED THE MYSTERY OF HOW THE MORAL impulse is transmitted through families, Monica McGoldrick, the second-day keynoter and one of the field’s pioneers in establishing the clinical relevance of issues of gender, race and cultural diversity, vividly described the moral blindness to suffering that even the best of families can engender. “I grew up thinking I was innocent that I had nothing to do with racism and certainly not with slavery,” McGoldrick said, telling the story of her childhood caretaker and “second mother,” an African-American woman who neglected her own home in order to serve McGoldrick’s white family. “I also did not know I was Irish, because my family was trying to ‘pass’ for WASP,” McGoldrick said in her fearlessly self-revealing remarks. “And I grew up in a family in which class was never mentioned, though we learned implicitly who was above us and who was below us in class, and rules . . that were totally defined by class hierarchies.”
The “innocent” insensitivity and obliviousness of most family therapists to issues of class, race and gender, as well as their uncomfortable avoidance of them, said McGoldrick, have implicitly pathologized whole categories of people who are “different” from the dominant, white, middle class. “Many family therapists are still trained without reference to the insidious role that hierarchies related to culture, class, race and gender play in the United States,” she said. “They are taught concepts of human development, psychopathology, family functioning from the totally skewed patriarchal, classist framework of the dominant white groups in our society.”
When this chronic pattern of unconscious bigotry is brought to our attention, said McGoldrick, we react with defensiveness, excuses, reactionary backlash. Not only must we change our training, but we must “acknowledge how ‘half-baked'” even our best intentions are: “It will help to acknowledge our prejudices and to know that we will make mistakes …. What we, with our unearned privilege or power, do not realize is how much we have to learn from those who have survived oppression.”
For McGoldrick, family therapy’s task is to help develop a more inclusive vision of home and family. “There are no throw-away people, just as there is no throw-away garbage,” she said. “We need to all stay together to contend with these issues. We need to hold onto each other and at the same time make ourselves and each other accountable so that we can all help each other. We need to create a crucible that can contain us all. We need every voice. We are all in it together.” M.S.W.
MONTHS AFTER THE 6.8-LEVEL earthquake that shook Los Angeles on January 17, Santa Monica psychologist Jeff Whiting remains haunted by memories of that terrifying morning. “If I wake up at night, I think about it,” he says. “I walk through my neighborhood looking at buildings to see if they’re straight or not. When I walk into a room, I think, ‘Where am I going to go if it starts to shake?'”
Whiting’s lingering case of the jitters is typical of the many ways that the Northridge earthquake has become, for therapists and families across Los Angeles, the disaster that just won’t go away. Even to a city fast becoming accustomed to upheaval-after the riots of 1992 and the fires of 1993 this quake maintains its grip on an edgy population that still vividly remembers being jarred awake in pitch darkness by shaking walls and a roar like a freight train. Thousands of people have been forced to leave their homes, and many thousands more are enduring hellish commutes on damaged freeways. In case anyone managed to sleep through the initial jolt, more than 6,000 aftershocks-including a scary 5.3 shaker on March 20 have provided daily reminders that the earth can open up at any time.
Trauma experts say the aftershocks are one reason earthquakes are often harder to get over than disasters like hurricanes or tornadoes. “People have the sense that they’re never out of danger,” says Charles Figley, a professor of family therapy at Florida State University in Tallahassee. “When you can’t predict that the earth will be in the same place when you put your foot out to take a step, everything is shaken. It takes a tremendous amount of energy to be convinced that one is safe.”
Particularly in the first few weeks after the initial earthquake, family therapists had to cope with traumatized clients at a time when many were feeling fragile themselves. “Part of me wondered if only therapists not severely affected by the earthquake should be seeing clients,” says Whiting. One woman in his practice developed an intense fear of being alone in her damaged, but habitable, condominium. She lives close to the epicenter of the quake, and when it hit, her husband began shouting, “It’s the end of the world!” His terror subsided after the shaking stopped, but his wife couldn’t get over the feeling that her home had become an evil, foreboding place. For weeks, her husband had to follow her from room to room, even to the bathroom, in order for her to feel safe.
By suggesting that the woman think of her home as an injured friend who needed her aid, Whiting was able to help her gradually let go of her fears. And he came to feel that having been shaken up by the quake gave him an immediate grasp of reactions that, to a therapist more distant from the disaster, might not make sense.
Some therapists have experienced a delayed reaction to the stress caused by the quake. Because the home of clinical social worker Maggie Shelton in the San Gabriel Valley was unscathed, she was quickly able to set up a crisis counseling program at the California Family Studies Center, close to the hard-hit San Fernando Valley. When the center had no water, she brought in bottled water from supermarkets near her home. When strong aftershocks hit, she tried to calm frightened staff members who wanted to bolt from the building. She consoled colleagues who had lost their houses or whose spouses had lost jobs, or who had every breakable item in their homes destroyed.
Shelton says she felt almost guilty when, around the middle of February, she couldn’t take any more. “Mainly, I thought, ‘Don’t ask me to do one more thing,'” she says. “When all that’s happened to you is books on the floor, you think, “This shouldn’t be bothering me.’ But the psychological effects are very real.” Shelton realized that, although she suffered no physical damage from the quake, the world she lived in had been altered, and she needed to allow herself time and space to absorb the changes. Getting out of town for a few days helped, as did giving herself more time to rest on weekends.
Not all of the aftereffects of the quake have been traumatic. For some clients, the shock made them see old problems with new eyes. Family therapist Lynne Shook, of Hancock Park, tells of a gay man who was mourning the deaths of two friends and a grandfather, as well as feeling uncertain about whether he wanted to stay with his lover of six years. During a major blow-up the night before the quake, his lover threatened to leave. When the earthquake hit, Shook’s client knew with sudden clarity that he wanted to stay with his partner. It was as though he had been holding back, unwilling to risk losing someone else he loved; the earthquake jolted him into realizing that his desire to hold on was stronger than his fear of loss.
The real losses that an earthquake causes can bring clients into therapists’ offices with unanswerable questions. Another of Shook’s clients is an artist who was upset to learn that one of her sculptures, installed on the campus of California State University at Northridge, was severely damaged. She came to therapy struggling with the question, “Why create something if it can be destroyed?”
“It was like, ‘Why live a life if it can be snatched away so quickly?'” Shook says, “Those are the moments when you slip out of the role of therapist and connect as another human being.” Shook told the woman of her own fear of not being able to protect her children. “We’re all brought to our knees by these things,” Shook says. “People need to know that the questions they’re asking and the things they’re feeling are universal.” K.G.