
- •Isbn-10: 1-4338-0549-9
- •Introduction
- •The Palo Alto Team
- •Murray Bowen
- •Salvador Minuchin and Structural Family Therapy
- •Strategic Family Therapy
- •Solution-Oriented Therapy
- •Narrative Therapy
- •Psychoeducation Family Therapy and Medical Family Therapy
- •Multisystemic Therapy
- •Multidimensional Family Therapy
- •Figure 3.1
- •Figure 3.1 (Continued)
- •The Patient’s Symptom as a Function of Unresolved Family Issues
- •Figure 4.1
- •The “Patient” in Family Therapy
- •Two Against One: Triangulation and Intergenerational Coalitions
- •The Pursuer–Distancer Dance
- •Collaboration and the Role of the Larger System
- •The Role of the Therapist
- •The Role of the Patient and Family
- •Goal Setting
- •Enactment
- •Circular Questions
- •Externalizing the Problem
- •Family Sculpting
- •Positively Connoting the Resistance to Change
- •Genograms and Time Lines
- •Building on Family Strengths
- •Figure 4.2
- •Family Psychoeducation for Schizophrenia
- •Adolescent Conduct Disorders
- •Adolescent Substance Abuse
- •Childhood Behavioral and Emotional Disorders
- •Anorexia Nervosa in Adolescence
- •Alcohol Abuse in Adults
- •Interventions With Physical Disorders
- •Ideas and techniques that cut across models of family therapy
The Pursuer–Distancer Dance
Jorge, 42, and Maria, 33, met through a Puerto Rican Internet dating service and dated for 3 years. For most of that time, they organized their lives around Maria’s genetic testing. She was becoming blind and losing her sense of balance. Jorge said he wanted to have a child with Maria, but only if the odds of repeating Maria’s disorder were not high. “I’ll take normal odds,” he said. Maria was “eternally optimistic,” constantly trying to persuade Jorge on their nightly phone calls that their child would be fine. The more Maria tried to convince him, the more Jorge wanted scientific proof.
Systems theory posits that human behavior is affected, even regulated, by those with whom we interact. Both Jorge and Maria had some worry or ambivalence about a pregnancy, but their interactions led them to polarize so that Jorge became the worrier and Maria the advocate (consistent with their temperaments) for their relationship. This dance, called pursuer and distancer in Bowen theory, is repeated over and over in therapists’ offices (Fogarty, 1976). The family therapist creates space for the couple to speak about their concerns, verifying each position, and working to prevent polarization. Typically, the therapist works to help the pursuer see the pattern as it unfolds and “sit” with her anxiety, in the case of Maria, rather than pursuing her partner.
Therapist: Jorge, I can see how much you love Maria, and yet you are so concerned that you not enter into a partnership involving a child that you cannot handle.
Jorge: That’s true [hanging his head]. I’m ashamed, but that’s the way I feel.
Therapist: You want what’s best for your future family.
Jorge: That’s true. I don’t want to worry all day about my wife and child.
Therapist: Jorge and Maria, I can see that you both are concerned about your future together and you both want what’s best. Jorge, you tend to be the one expressing the worry, and Maria, the optimism, but these are issues you both should talk about. Maria, you don’t want all the burden of responsibility to stay on Jorge’s shoulders.
Maria: That’s really true. I do think it will all be okay, but I think it’s important to listen to the geneticists and address Jorge’s concerns.
Therapist: It’s so important to understand each other’s hopes and fears, and be able to share them in a respectful way. I wonder if it would be useful to spend several weeks without talking about this issue, to try and clarify the many different aspects of the situation for each of you. When you do have a phone call, Maria, you express all the concern, and Jorge all the optimism. Just see how that feels, and what you learn from the exercise . . .
Maria agreed to not try and persuade Jorge during the 3 weeks before their next session. It was she who suggested this might be easiest if they didn’t see each other during this time, an easier way for her to work toward individuation. Jorge started the next session by talking about how much he missed Maria and how he wanted their relationship to be long term. Frequently, when the pursuer pulls back, the distancer moves forward, as if there is a predictable (homeostatic) distance in a relationship that must be maintained. Rather than moving back into an old pattern, Maria was coached to continue her focus on her own functioning, while Jorge was encouraged to take more time to consider this important decision. Many couples must sustain a different pattern of behavior for some time before it becomes a new and healthier homeostasis.