From the March/April 1994 issue

We have grown used to having front-row seats during natural and political cataclysms like the Los Angeles earthquake or the siege of the Russian White House. But the CNN close-ups only give us a few dramatic episodes, and then the camera moves on to the next cataclysm somewhere else.

While the mercurial media may have trouble finding the kind of material it’s looking for once the drama of a headline-making story is past, it is this often-ambiguous aftermath of large systems change that most concerns family therapists. What happens to families, for example, when the political system around them dissolves? For the past four years, staff at the Family Systems Program at the Institute for Juvenile Research (FSP/IJR) in Chicago have had a rare opportunity to learn first-hand from colleagues from other countries how such changes in society impact on couples and families. During that time, FSP/IJR and The Family Therapy Network, publisher of the Networker, have cosponsored an International Training Fellowship, bringing therapists who would not otherwise have access to family therapy training to Chicago for a three-month training program. The IJR training staff, Betty MacKune Karrer, Richard Schwartz and Peter Thomas, often find themselves surprised by the visiting therapists’ viewpoints on their American colleagues’ theories and methods. “This year, one of the fellowship winners, from Germany, began looking very uncomfortable while we were describing how the therapist needs to take the leadership role with families,” recalls Karrer. “Finally, he told us, ‘The word for leader in German is fuhrer. I don’t think I want to be a fuhrer.’

Chosen from 40 applicants, this year’s fellowship winners all came from societies in the throes of root-shaking change. In Israel, where Israelis and Palestinians are trying to absorb the new idea of peaceful collaboration rather than hatred and violence, therapists are by no means immune to the pervasive anxiety about the future. Shlomo Ariel, a fellowship winner from Tel Aviv, recalls the blurring of his therapeutic role during a recent family therapy session with a Jewish father and Palestinian mother, who had come in complaining about their two sons’ constant fighting. While the oldest son declared that he wanted to be a soldier in the Israeli Defense Force, the younger boy wore a checkered scarf around his head in imitation of PLO leader Yasir Arafat. As the grown-ups tried to figure out why the boys were so polarized, the younger boy drew a picture of the Hamas logo a fist defiantly raised. “This is the most feared symbol for Jews in Israel because Hamas advocates terrorism to wipe out the Jews,” says Ariel. “I saw it and froze. I am ashamed to say, I was terrified of that little boy, even though he probably didn’t know how much hate that fist represented.” The experience reminded him how hard it will be for his clients to absorb the shifting political tides. “We are still dealing with the Gulf War SCUD missile attacks,” he says. “The political landscape changes much faster than the human psyche. We will have to give this time.”

As once-unimaginable economic and political changes transform Russian society, Galina Zuckerman, a developmental psychologist at the Psychological Institute of the Russian Academy of Education in Moscow, has found that children seem to be having an easier time adjusting to the new ideas and uncertainties than their parents, which creates new problems within families. The relative ease with which older teens and those in their early twenties have adapted to capitalism and started new businesses has caused some tension with their elders. “Structurally, everything is reversed when the children know more than the parents, and so there is more fighting between parents and children,” says Zuckerman. “We never had to handle issues like this before.”

For clinicians, one unforeseen result of the social changes in Russian society is that once-effective interventions no longer work as they previously did. To help shy children starting school, Zuckerman and her colleagues used to group the classmates into teams so that when they were asked questions in class, the children would answer together and no child would experience the anxiety of feeling isolated. “All the initial activities in the class were organized as a cooperative, so each shy child immediately had group support,” says Zuckerman. But in the newly capitalist Russia, cooperative solutions have been breaking down in the face of a more aggressive, individualistic social climate, and even young children have a new awareness of affluence. They are competitive about who has new jeans, whose father owns a car or a tape recorder. “The collective approach doesn’t work so smoothly now,” she says. “It’s much harder to get the children to cooperate.”

While the Czech Republic has experienced a relatively smooth transition from communism to capitalism, families have still experienced a bumpy ride according to Sarka Gjuricova, a fellowship winner from Prague, who works in a medical school. Because of a scarcity of jobs and a media campaign extolling the virtues of stay-at-home motherhood, women have left the work force in large numbers. “Our country used to have the highest employment rate for women in the world, but now women are full-time homemakers,” she says. “When I see a woman who is depressed, I am aware that she has had to make a big transition. Often, women themselves don’t recognize the connection between this life change and their emotional state.”

As the economies of Eastern Europe have incorporated the principles of late-20th-century capitalism, the unanticipated social consequences are everywhere. “Now, problems we never had before are showing up, like a lot more prostitution and gambling addiction,” Gjuricova says. “We never had the opportunity to gamble before, but now it is a big thing, and more people are coming in with this problem.” But some of the reflections of the visiting fellows from the East are troubling more for what they say about this society, and problems we’ve become inured to, than their own countries. “Parents and children have much less time to spend together under capitalism; everyone has to work so hard and long hours,” says Gjuricova. “We are becoming more disengaged from each other, like you.”

For more information on the International Training Fellowship, see p. 18.


The Networker regularly publishes first-person stories that prompt some readers to call our office, sometimes a year or more after an article was published, to find out what became of the author. Here are a few brief follow-ups to some of the most asked-about articles.

In the November/December 1993 issue of the Networker, “Emma O’Brien,” a long-time therapy veteran who suffered from agoraphobia, reported on her therapy experience with Eye Movement Desensitization and Reprocessing (EMDR), a cutting-edge intervention for trauma and phobia treatment. “Since my first panic attack at the age of 20, there have been long periods of time when even the simplest, most ordinary routines of daily life have become nearly insurmountable obstacles for me,” she wrote. One major limitation she worked on during her EMDR sessions was her dread of flying on airplanes. O’Brien reported that by the end of her therapy, she felt ready, as a result of the EMDR, to take a plane trip. Many readers have called, curious to find out whether she was able to follow through with the trip she planned.

The week before Thanksgiving, O’Brien was scheduled to fly to Arizona. “I had tickets to fly on American Airlines the very morning they went on strike, of course,” says O’Brien, who wondered if this was some sort of cosmic joke. “Despite a great deal of fluttering in my stomach, I was able to switch to another flight, and it actually went pretty well. I may never enjoy flying, but I was certainly able to endure it with far less anxiety than I ever thought,” she says. She credits her success to a combination of EMDR and Xanax, an anti-anxiety medication. She has several more trips planned for this year, and says she feels fairly confident about going through with them. “When anyone asks me whether I thought the EMDR was a success, I say it was not a panacea, but was definitely very helpful.”

Therapist Martha Manning, in her September/October 1993 article, “The Other Side of the Keys,” recounted the psychological ordeal of being treated with Electro-Convulsive Therapy (ECT) for chronic depression. Many readers have written to us to find out whether the ECT cured her depression. “Recovery from a serious depression is a long ordeal, but after the ECT, my improvement was pretty dramatic,” she says. “The ECT clearly broke the back of the depression, with pretty quick results,” particularly with regard to the vegetative aspect of depression difficulty sleeping, loss of appetite and lack of concentration.

There were some side effects from the ECT mostly memory loss for some of the times immediately preceding and during the ECT. “Certain people tell me they visited me in the hospital, but I can’t remember,” she says. “Then again, as a friend of mine told me, You didn’t miss much.'” A side effect of publishing the article about her ECT experience has been embarrassed silence on the part of some colleagues. “Most of the reservations I have heard have been from nonpsychiatric, mental health people who basically feel I needed better therapy and could have worked it out on my own,” says Manning. “It’s not the general public that is uncomfortable with the fact that I tried ECT and it worked.”

According to Manning, her 12-year-old daughter, Keara, still teases her about the ECT. “If I touch her and there’s static electricity, she’ll talk about me having leftover electricity from the ECT. At Christmas, I asked her to clean out a bathroom cabinet and she found a whole bunch of antidepressants I used to take. She put them on a tray and came out and served them while I was visiting with a friend. ‘Nuts?’ she offered. ‘Antidepressants?'”

Manning has resumed her practice and recently negotiated a contract to write a book for Harper San Francisco that will describe her depression and ECT experience in more detail. “I feel like I’ve woken up from a long sleep in which I found out the nightmares I was having weren’t true at all,” she says with a laugh.

Ronald Pulleyblank, an engineer who was stricken with Lou Gehrig’s disease and became completely paralyzed, wrote a moving article, “My Symptom Is Stillness,” in our March/April 1992 issue. Formerly an avid runner and healthy, active man, he described how he and his family adjusted to his dependence on 24-hour, in-home nursing care and machines to feed him and breathe for him. He wrote about his on-going battle with his health insurance company to maintain this home care rather than having to live in an institution. “My quality of life is fairly good,” he had reported. “I enjoy the independence of deciding what, when and how to do things,” which would not have been possible had he been moved to a hospital. “Our society supports a right to life, but not necessarily the right to a life of quality,” he wrote, frustrated that the insurance establishment didn’t seem to care that he would rather remain at home.

After he published his article, Pulley-blank’s insurance company never did agree to pay for 24-hour nursing so he could be cared for at home. At the same time, the disease progressed even further and Pulleyblank lost his ability to use the computer, which he had used to continue to work throughout his illness, and left him barely able to speak. His wife, family therapist Ellen Pulleyblank, says there were often frightening moments when he could not communicate with his nurse to say he was in pain and needed to be moved. With the loss of his only avenues of communication, he decided, in January 1993, to turn off the ventilator and terminate his life.

“All along, Ron was evaluating the quality of his life and our lives, and as he got worse, our daughters suffered,” says Ellen Pulleyblank. “After eight years of living with the stress of watching his body deteriorate, we were all so tired.” They had talked about the option of death all along, understanding that turning on the ventilator meant that there would come a day when they would turn it off. They consulted with spiritual friends and advisors, family members, physicians and a biomedical ethics committee at Stanford University about ending Ron’s life, and Ron became clearer and clearer that this was what he wanted to do. “It is hard to describe this to people who didn’t go through it, but in a strange way it felt right,” says Ellen. “As Ron moved closer to death, he became more excited about it. He had struggled and given his all to battle the changes this disease had wrought in all of us, and now he was ready to be free of it. Of course, we miss him. But to the very end, he taught us so much about courage and love.”

Laura Markowitz

Laura Markowitz is a journalist, editor and multimedia producer in Tucson, Arizona, and winner of a National Magazine Award for writing and coeditor of The Evolving Therapist: Ten Years of the Family Therapy Networker.