The Family As Patient

In almost all traditional forms of psychotherapy, the patient meets alone with his therapist and is expected to tell no one--even his closest kin--about what goes on in his sessions. A major exception to that rule is family therapy, a fast-growing new specialty in which the patient is a whole family. Several relatives spanning two or three generations see their psychotherapist together for treatment, which does not always probe as deeply as individual therapy but costs less in both time and money.

Of the 1,000 or so psychiatrists, psychologists and social workers in the U.S. who now practice family therapy, one of the most innovative is Psychiatrist

Norman Paul of Cambridge, Mass. His theory: family troubles are frequently caused not by a generation gap but by a communication gap, which family members can bridge by sharing their innermost feelings with each other.

Forbidden Subjects. If feelings such as fear, disappointment, envy and grief are concealed, Paul believes, they are distilled and passed on from generation to generation. "As each new set of parents accords its young the treatment it received earlier," he says, "every child is left to traverse life's problems alone." What both young and old need to break out of that pattern, he suggests, is profound empathy.

To promote this understanding, Paul sometimes asks questions about "forbidden" subjects: a death, a family secret, guilty anger at someone close. At first his patients are generally evasive, but eventually most of them reveal their emotions. For some children, Paul says, this is the first opportunity "to see their parents suffering, a situation that reassures them by demonstrating that powerful parental figures also experience intense feelings of helplessness." Adults, too, need reassurance, and Paul provides it by bringing together families with similar troubles so that they can compare their emotional reactions and see themselves through other eyes. He helps this process by allowing patients to see video-tape recordings of their therapy sessions.

Crippling Grief. In one case, a 39-year-old journalist named Lewis, about to divorce his wife to marry a young girl, had broken down in sobs as he recalled his grief over the death of his beloved Aunt Anna. "She was always accepting me as I am. Being with her was like peace," he explained. Reviewing his childhood sorrow as his wife listened, Lewis recognized that his girl friend represented the goal of his lifelong search for another Aunt Anna. This led him to return to his wife, now more understanding because she had shared his secret feelings.

Since then, Paul has used the Lewis tape to diagnose hidden, crippling grief in other families. A brusque father whose son William was in emotional trouble got "a feeling of being half lost" when he heard Lewis' sobs. Then, says Paul, "he recollected the time when he himself had felt intense grief"--when his father remarried. Then, Paul helped him reconstruct what he knew but had blocked off: that when he was four, his mother had killed both his nine-month-old sister and herself. Because he had repressed his sorrow instead of facing it, he had never recovered from the experience. Under Paul's guidance, he saw that he was jealous because his son still had what he himself had lost so early--a mother. That hidden jealousy, it soon became clear, was the real cause of the boy's emotional disturbance.

When divorce threatens to split a family, Paul often uses the "freeze-split technique," advising husband and wife to live apart for a while to find out what emotional problems left over from their premarriage days still need to be solved. In one instance, a woman who nearly broke up her marriage--by beginning a series of affairs just as her daughter turned four--revealed in therapy that she had lost her mother when she herself was four. To Paul, the somewhat fanciful conclusion was inescapable: the first affair "was an attempt to remove herself from her daughter just as her own mother had left her."

The reward for facing the reality of envy and other painful emotions during family therapy, Paul concludes, is "a sense of oneself, a sense of self-esteem and expectant mastery over whatever might be coming down the pike."

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