Q: Therapists are supposed to get family members to talk with each other during sessions, but I've found that is not so simple. How do you get family members to talk together productively?
A: Although some families are willing to engage one another directly in therapy, often members have given up on one another and just want the therapist's approval and understanding. In-session dialogues, or what structural therapists call enactments, can be among the most valuable tools for getting a family's communication going. Nevertheless, staging enactments isn't simple. Both beginners and experienced therapists have trouble making them work, but usually for very different reasons. Typically, beginners have trouble structuring enactments and taking charge of them in a way that generates a different kind of interaction. In contrast, experienced therapists often make the opposite mistake—they so overmanage the conversation that they interfere with the ability of clients to become involved in the dialogue and find new ways of interacting.
Beginners should be sure that they give clients clear and explicit instructions. Specify the exact topic for conversation (clients' complaints about one another are a fertile source of material) and indicate how the conversation should go ("See if you can convince her that you're willing to listen to her feelings"). Be clear about the mechanics—turn participants' chairs to face each other, direct them to talk and lean back to remove yourself from the dialogue. (Therapists who make eye contact with the speaker draw the conversation to themselves.)
A crucial guiding principle in sustaining an enactment is that improving the process of communication is usually more important than helping a family reach agreement about the content. Nevertheless, even experienced clinicians who should know better commonly slip into taking sides when the content of the discussion touches a nerve.
Consider the case of a family with a 16-year-old boy on probation for selling marijuana. The therapist has encouraged the boy to talk with his parents about his plans for the future. When the boy says he wants to drop out of school to become a motorcycle mechanic, his parents argue forcefully against the idea, and the boy soon shuts up. At this point, the therapist joins the conversation to support the importance of the boy's staying in school. But if the pattern of their relationship is that the parents nag and the son withdraws, the clinical goal isn't to keep the boy in school, but to help him learn to speak up—to put his feelings into words instead of into dangerous and risky forms of rebellion.
The most important thing a therapist can do to put the burden of responsibility on family members is to resist interrupting their conversations. Sure, clients say mean things, get their feelings bruised and want to withdraw, but as long as they're stuck in the consultation room for an hour, there's opportunity and pressure for them to keep talking—unless the therapist interrupts and bails them out. This can be a harder temptation to resist than it sounds. I recently reviewed a videotape I often use for teaching that illustrates using an enactment with a husband who complains that his wife is a nag. After the couple get stuck, I intervene and point out to the husband that the wife is like the North Wind trying to get him to "take off his coat" with bluster instead of warmth—and that by resisting her, he only makes her blow harder. They both get the point, but on reviewing the tape this time, I was horrified to see how I couldn't seem to keep my mouth shut after I offered my clever metaphor. Instead of letting them struggle to get through to each other, I interrupt every two or three minutes for a lecture.
Resist the urge to preach and teach clients to talk nice, make "I-statements" or come up with solutions. The important thing is that they test their resources, get past the point where they're tempted to give up and feel the pressure to speak up and to listen, if they're going to get somewhere.
If it becomes absolutely necessary to intervene when clients accuse and defend, bicker and quarrel, find ways to help people explore more deeply the feelings that seem to divide them. Ask a nagging father to talk about his own growing-up years or invite an angry wife to talk about her hurt and loneliness. Then, once they do open up, give them back to each other. Avoid taking over. It's the difference between taking the bat out of people's hands to give them a lecture on the science of hitting versus just telling them to choke up, swing a little easier and then see what happens.
This blog is excerpted from "The Art of Enactment," by Mike Nichols. The full version is available in the November/December 1997 issue, People Power for the 90s: Ramon Rojano Has a New Vision for America's Inner Cities.
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