When Every Session Mattered

The Legacy of Braulio Montalvo

Jay Lappin

Braulio Montalvo, one of the originators of Structural Family Therapy and for many years a much-beloved staff member at the Philadelphia Child Guidance Clinic, died on March 31 at age 80. One of his many supervisees and colleagues describes Braulio’s impact on those who knew him, as well as an era in which clinical training received a degree of attention rarely found in the rushed atmosphere of most underfunded clinics today.

I first saw the huge glass façade and walked into the atrium lobby of Children’s Hospital of Philadelphia in 1976; it was like no hospital entrance I’d ever seen. Everything seemed so new and shiny, like the spotless windshield on a gleamingly futuristic car. Wherever you looked, there was sunlight streaming in, indoor trees, lush hanging plants, elaborate sculptures, and—to make sure that you knew this was truly a special place—its very own McDonald’s. With all its bustle and brand-newness, it seemed infused with the ionized air of hope and unlimited possibilities. In a community that was nearly 80 percent African American and poor, that was a quality normally in exceedingly short supply.

Adjoining all this splendor, the Philadelphia Child Guidance Clinic lay at the end of a long staircase that made your footsteps echo as you descended—which seemed right for the headquarters of an underground group of rebels who could never feel at home in the opulence of the lobby. At that time, the clinic was the hub of a dissident movement called family therapy, which was offering a radical new vision of the future of psychotherapy, dedicated to serving people who’d been labeled unreachable with the traditional approaches originally designed for comfortable middle-class clients. The clinic’s director was family therapy pioneer Salvador Minuchin, probably the world’s most imitated therapist at the time, whose theatrical flair and sense of crusading against all the orthodoxies of traditional therapy captured the imagination of young therapists like me. With a wire statue of Don Quixote proudly displayed on his coffee table, Minuchin had already become a celebrated figure in the field by coauthoring Families of the Slums, a widely influential book, based on his work with poor families at the Wiltwyck School for Boys. As the clinic’s director, he was continuing to develop that work, founded on the conviction that, as he put it years later, “we could change the world one family at a time.”

At the time, government money was still available for “promising projects,” and the clinic was in the vanguard of working with the poor, as well as all sorts of other challenging treatment populations who weren’t considered good candidates for the traditional talking cures: clients with eating disorders or psychosomatic conditions, substance abusers, hard-to-treat clients, all who’d never before received such laser-like therapeutic attention. Even more revolutionary was a training program called the Institute for Family Counseling, funded by the National Institute for Mental Health, which epitomized the clinic’s social mission—to serve the poor. It was the first paraprofessional therapy-training program in the world comprised of all nondegreed minority therapists, community people who’d been chosen not because of their academic credentials, but because they were natural healers. Noted family therapist Jay Haley, one of its originators, said of it, “Instead of teaching middle-class people what it was like to be poor, the poor would be trained to be therapists—which is something nobody had thought of doing up until that time.”

The clinic represented a radical departure from the traditional view that therapy should be conceived as a private interaction between therapist and client, as well as from our modern, increasingly legalistic preoccupation with therapeutic confidentiality. Instead, the guiding principle was the importance of making what took place in sessions as open and transparent as possible. After all, how would therapists be held accountable for their work and improve their skills unless observers pointed out their miscues and missed opportunities? Much of the therapy being done at the clinic was directly observed and supervised on the spot, or else recorded on video and reviewed later. The staff gathered regularly to discuss difficult cases and try to figure out the key to making change happen within the most troubled kinds of families. Each and every session mattered, always holding the potential for life-altering breakthroughs, if only the therapist or the team watching were observant and skilled enough to bring them about.

In this highly charged atmosphere, no one on staff, not even Minuchin himself, was more revered for his ability to penetrate to the core of a family’s problem than Braulio Montalvo, who was most comfortable, not as an out-in-front leader, but as a collaborator, a consigliere who saw his job as drawing out other people’s ideas and expanding them, taking their thinking to the next level. Enormously well-read and knowledgeable in a wide range of disciplines, he had the rare ability to pick up on the subtlest clinical nuance without losing sight of the bigger picture of clients’ lives and the everyday challenges they faced.

What set the therapy practice at the clinic apart from the traditional variety was the avoidance of disparaging labels for families and the sense that the responsibility for beginning the process of change lay with the therapist. There was no such thing as an “unreachable” family—just therapists who didn’t know how to reach them. I remember a session I was trying to supervise in which a belligerent father dressed in combat boots and a deerstalker hat was haranguing the therapist, demanding to know her credentials because, in his view, she hadn’t helped his son with school problems. No one else in the family felt free to say a word, and even I didn’t know what to say as I sat watching from behind the one-way mirror.

Braulio just happened to be walking down the hallway when I asked him to observe a bit of the session with me and the supervision group. After a few moments, he asked if he could go into the session and say a few things to the father. Quietly beginning to engage the father, he listened to his complaints about the therapy and sympathized with his frustrations, subtly changing the mood in the session. Then came the curve: Braulio calmly announced, “You are clearly a very strong man with very strong ideas. Now I wonder if you are strong enough to listen to what your wife has to say about this problem.”

Having won the man’s confidence, he’d given him a pathway to another role in the family without having to sacrifice his sense of entitlement and authority. The tone and direction of the session then changed completely. Later, when I asked Braulio how he’d been able to turn around the session so quickly, he simply said, “I just gave him a [new] way to be strong.” Then, characteristically, without calling any more attention to himself, he walked out of the room. It was as if we’d just been shown how to make a skeleton key to an entire city by a master locksmith.

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Topic: Children/Adolescents

Tags: breakthrough | counseling | family counseling | family therapist | family therapy | future of psychotherapy | mental health | psychotherapy | structural family therapy | therapist | therapists

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