Something’s Missing from Family Therapy

Twenty-Five Years Later, a Poignant Message from the Late Betty Carter Still Resonates

Something’s Missing from Family Therapy

Editor’s Note: This blog is excerpted from a piece that originally appeared in our November/December 1995 issue, Clinical Virtues for the 90s. Do you think its message is still relevant today? Let us know.


When I was a young and enthusiastic family therapist, I thought that there was one key to understanding the truth about a family and I had it. Once I got the family together behind the closed doors in my office, all I needed to do was grasp the nuances and flow of their private, interpersonal emotional system and their three-generational patterns of differentiation, enmeshment and estrangement, and I had their deepest life realities nailed down cold. It never occurred to me that by aiming a laser-beam of concentration solely on the inner dynamics of an individual family, I was missing anything of relevance. I included the extended family, as well as divorced and remarried members in my treatment plans, and always made a multi-generational genogram, a kind of snapshot that caught, in the present, all the emotional legacies of the past. Armed with all this information about the family’s personal odyssey, what more did I need to know in order to help them transform their lives? What else was there?

My first blind stumble over this delusion of certainty occurred in the late ’70s, when I discovered the issue of gender, which refused to confine itself to purely “private” relations between this couple or these family members. I found that in order to understand the particularity of almost any individual couple’s personal experience, I was required to adjust my lens to include not only their private domestic encounters, but the much larger political and social struggle about the politics of male-female relationships in the world beyond the walls of home.

And then in the ’80s, one thing inevitably led to another; challenges to normative gender arrangements led to questions and doubts about all sorts of established standards and definitions about ethnicity, race, sexual orientation and class, all “public” issues that have an enormous impact on the private lives of our clients. It now seemed as inconceivable that we could treat the family in a vacuum, without considering these influences as it did for psychoanalysts to treat individuals without engaging their families. Never again could I imagine I had gotten an adequate picture by focusing on only one level of a multi-layered human system without recognizing its inextricable links with many other levels.

Taking this virtue seriously, learning to pan forward and backward with this adjustable zoom lens of clinical practice, from the personal to the interpersonal, the intergenerational, the social, the political and back has drastically altered the way I do therapy. Recently, Sharon, a woman in her thirties, called complaining that she had drastically cut back her work hours when her second child was born, but now felt depressed, overburdened with childcare and angry with her husband, Gary, a rising young lawyer, for not being more involved in the family. In fact, when the couple came into the office, both agreed that their marriage was heading south, fast.

To Sharon’s grievance that he was never around, Gary admitted that he “sometimes” worked late, that he did travel “occasionally,” and brought work home “sometimes.” In the old days, before my evolution toward a therapy of multiple perspectives, I would not have questioned his busy schedule (not unlike my own, after all), assuming the complete reasonableness of extended work hours for an up-and-coming professional on the fast track, and would have tried to help Sharon change her life get additional childcare help, join some adult-oriented activities, learn to accept the inevitability of his unavailability. But now I shifted my lens beyond the close-up focus on Sharon’s “problem” to the concrete details of the couple’s time line and began putting some pressure on Gary. How many hours a week, exactly, did he work? What time did he get home each night, and how much time, precisely, did he spend with his children, his wife? How much money did he earn? Both were a little surprised by the first questions, downright startled by the last, which Gary ignored, as if it had been a kind of faux pas on my part, better to tactfully ignore.

When Gary estimated his work week at 55 to 65 hours, with only Sunday afternoons and a brisk daily morning greeting for the kids, but virtually no time at all for Sharon before 9 or 10 pm, I said I could do nothing to help him improve his marriage (his stated goal), unless he cut back his working hours. There was no way, I said, that he could both work 65 hours a week and have any kind of marriage or family life. I shifted focus again to questions about his own values and how they approximated or challenged the social norms. What was his definition of masculinity? Did he believe the old notion that a “real man” provided all his family’s material wants, even if it cut him off from his wife and children or even killed him? What had his father’s work life been like? Had his father been a close and loving father?

No, Gary said, he had not. And then came a typical story about a financially successful man who was stern, remote even when he was at home, which was rarely. “I don’t remember him ever doing anything with me alone. It was my mother who taught me everything,” said Gary sadly. “Then, why are you following his footsteps?” I asked. “I’m not like him at all!” Gary exploded, with more force than he’d shown the entire session. I pointed out that whatever his intent, his actions were those of a man who was becoming the spitting image of his work-obsessed father. Gary’s face, stubbornly closed and defensive, began to soften when I said, shifting from an intergenerational and emotional to a social focus, that the relentless pressure on men to succeed and acquire power in our society made it almost impossible to make a choice for a less pressured, more humane personal life. Over a period of weeks, Gary started talking regularly with his father, sliding the subject over to his father’s work life whenever possible. In the beginning, he got the party line that “a man’s gotta do what a man’s gotta do,” but then one day Gary came into the session smiling.

He said that much to his surprise, in their latest talk, his father had gruffly told him not to make the same mistake his old man had made: two brand new cars in the garage didn’t make up for missing your kid’s childhood. Soon thereafter, Gary began cutting back his work hours to spend more time with his wife and children.

Did we now have an idyllic little family? Not by a longshot. Now Sharon complained that Gary didn’t know how to handle the kids he let them have snacks right before dinner, at bedtime he rough-housed with them so they were squealing and excited instead of sleepy, he let them pick out their own clothes in the morning and they went to school looking like ragamuffins, and so on, in a long litany of parenting heresies. Gary, for his part, countered that he wasn’t allowed to do anything with the kids, since Sharon and the nanny were always hovering at his shoulder, telling him he was doing everything wrong and making him look like a fool in front of his own children.

Although I suggested that Gary might benefit from a few lessons from his live-in childcare expert, it was time to shift focus again, away from Gary, his father’s legacy and the cultural norm of white, upper-middle-class male careerism back to Sharon, her values, her family of origin, and the implicit old-time female conditioning that had her in thrall, whether she knew it or not.

Did she really want Gary to be a full-time parent, or was she still invested in the traditional idea that only women know how to take care of children? She said she wanted to get more involved in her own career, but was she ready to seriously commit herself to bringing in money over the long haul? How did her mother juggle work and a family? “She didn’t,” said Sharon dryly. “She was a full-time mother who endlessly complained about the ‘career’ she gave up to take care of us.” So now we have a double perspective, male and female, not only on the personal dilemma of this couple, but on two sacred cows (or a sacred cow and a sacred bull) of white, American, middle-class life and culture that keep marriages stuck in an unhappy groove: the man’s identification with work and career, the woman’s belief that only a primary parent is a good mother.

Eventually, both Gary and Sharon made major adjustments on various fronts personal (relinquishing the old identities that kept them playing the stereotyped parts of Ozzie and Harriet), intergenerational (making more personal adult connections with their parents), and practical (gaining a rough equivalence in the career and household responsibilities) in defiance of the social, political and economic pull to revert to traditional roles. Both feel much better, they like each other again, and spend more time together; even their kids seem happier.

Besides asking clients about their relationships, or what happened in their childhood, or why they don’t get along with their spouses, we must also ask them, are their lives meaningful? Do their relationships beyond the family work? Are they teaching their children what they need to know? Do they like their work? How much money do they really need? Is religion or spirituality or political action important to them? Are they contributing anything beyond their own family circle? Do they and their families belong somewhere, besides sitting around their own dinner tables? As therapists, we are trained to focus our gaze on family relationships, but we need to widen our lens to see whether these family members are connected to community supports as well as to each other.

Today, the connective strands of community are frayed and tattered, and most of the families we see suffer from these torn connections, whether they realize it or not. We can help families and couples achieve insight into their problems, transform their attitudes and alter their behavior, but none of it will stick if they remain isolated little islands in an alien sea of strangers. It is social breakdown—disappearance of community—that is undermining even strong and devoted families. Always, we must help families repair the relationship ruptures to which all human emotional systems are prey, but without helping families re-attach themselves to one another in community, we risk seeing our own work and theirs undone, and we fail to prevent many of the “private” tragedies that are, in effect, the consequences of ravaged community life. In a few years, therapists may need to focus on some other, still emergent and not yet known areas of the constantly shifting human dilemma, but right now, it is this burnt-out emptiness at the intersection of the family and the social landscape that demands attention of the panoramic, therapeutic eye.

Betty Carter, MSW, was director of the Family Institute of Westchester, and the author of Love, Honor and Negotiate: Making Marriage Work. She was well known for the Women’s Project in Family Therapy, a group she co-founded with Peggy Papp, Olga Silverstein, and Marianne Walters. She passed away in 2012.

This blog is excerpted from “Focusing Your Wide Angle Lens,” by Betty Carter in the November/December 1995 issue.

Photo © Stokkete

Betty Carter

Betty Carter was a primary mentor of the Multi-cultural Family Institute and one of 16 founding members of their Culture Conference Faculty.