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Families who successfully conclude their treatment |
sessions as they seek assistance during a particu- |
may return years later for a brief retooling set of |
larly stressful period in the family’s life cycle. |
the family is incited to change by means of confrontation, exaggeration, anecdote, or absurdity.
3.A late phase in which increased flexibility in the family necessitates only minimal intervention from the therapist or therapy team.
4.A separation phase in which the therapists and family part, but with the acknowledgment of mutual interdependence and loss. In the final phase, the family uses more and more of its own resources, and assumes increased responsibility for its way of living. With separation—the “empty nest”—there is joy mingled with a sense of loss.2
Symbolic-experiential change-producing interventions have a covert, implicit quality. Symptoms are rarely attacked directly. Insight seems to follow rather than precede changes in feelings and behavior. History taking is occasionally important but not carried out routinely; in any case, it must not be allowed to impede this approach’s major therapeutic thrust—forming a close and personal alliance with the family as a whole and providing an experience that is symbolic to the family but does not reinforce its distress (Keith & Whitaker, 1982). What the family therapist has most to offer, Whitaker believed, is his or her personal maturity; the stage of the therapist’s personal development influences the kind of support or assistance he or she gives to the family. Whitaker maintained that the therapist who does not derive benefit, therapeutically, from his or her work has little to give, therapeutically speaking, to client families. The use of co-therapists adds another dimension; the ability of both therapists to join together, have fun together, disagree, or even quarrel with each other, and perhaps to go off on different tangents—one acting“crazy”and the other providing stability—is a model for spontaneous and productive interaction.
GESTALT FAMILY THERAPY (KEMPLER)
All of the family therapy approaches we are considering in this chapter are, to a greater or lesser extent, existential in character. More an orientation to understanding human behavior than a formal school of psychotherapy, existentially influenced therapies are concerned with entering and comprehending the world as it is being experienced by the individual family members as well as the family as a functioning whole. The therapies have in common an emphasis on the meaning the patient gives to existence, to being. Because people define themselves through their current choices and
2Napier and Whitaker (1978) provide an intriguing full account of family therapy with the Brice family (two parents; a suicidal, runaway teenager; an adolescent son; and a six-year-old daughter) in their book, The Family Crucible.
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decisions, action in the present, not reflection on the past, is the key to understanding for the existentialist. Even the future—what people choose to become—is charged with more influence than the past and the conflicts associated with the past. In existential therapies, clients are urged to examine and take responsibility for their lives. Unconscious material may be brought forth but is not automatically assumed to be any more meaningful than the conscious data of life.
Psychotherapy in this framework is an encounter between two or more persons who are constantly developing, evolving, and fulfilling their inner potential. Technique is de-emphasized to preclude one person seeing the other as an object to be analyzed. In contrast to the common therapeutic belief that understanding stems from technique,
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existentialist therapists believe that technique follows understanding. Formal and conventional doctor-patient roles are replaced by a more egalitarian and open arrangement in which each participant opens his or her world to the other as an existential partner. The emphasis is on presence; in a real, immediate, ongoing relationship between two or more persons, each tries to understand and experience as far as possible the being of the other(s).
If existentialism is concerned with how humans experience their immediate existence, Gestalt psychology focuses on how they perceive it. Having accepted the therapeutic implications of existentialism along with much of the rhetoric of Gestalt psychology, Frederick (Fritz) Perls is generally credited with launching the Gestalt therapy movement in the United States. For Perls (1969), who worked with individuals, change is facilitated when the client’s thoughts and feelings become congruent. A major treatment goal, then, is for the client to achieve greater self-awareness in order to become more self-directed, more centered, more congruous. By removing blocks and especially entrenched, intellectualized thinking patterns, the client often was aided to break through to his or her emotionally rooted inner experiences. (Perls enjoyed putting it this way: Lose your mind and come to your senses.) Extrapolating from the individual focus, Gestalt family therapists focus attention on the immediate— ”What people say, how they say it, what happens when it is said, how it corresponds with what they are doing, and what they are attempting to achieve”(Kempler, 1982, p. 141). Here the goal is to bring discordant elements (within oneself or between family members) into a self-disclosing confrontation and ultimate resolution.
Gestalt family therapy, popularized in the 1970s and 1980s, is likely to appear dated today, but we include it as a forerunner of contemporary therapeutic direction for the following reasons: (1) it encourages open and honest expression of all emotions (hopes, fears, wishes, anxieties), a forerunner of many of today’s therapeutic approaches aimed at achieving authenticity and connection to others; (2) it emphasizes individual growth and the development of the Self, within family systems, again a contemporary view; and (3) it rests heavily on therapist modeling of desired behavior, on being a genuine person, on utilizing the therapist’s personality to effect change, a part of many current collaborative procedures.
Leading Figure
The most prominent Gestalt family therapist is undoubtedly Walter Kempler, whose techniques stem from his adaptation of the individual work of Perls, with whom he studied. Kempler, a physician trained in Texas, practiced general medicine in Los Angeles for several years before returning for a psychiatric residency at the UCLA Neuropsychiatric Institute in the late 1950s. Several years later he established the Kempler Institute for the Development of the Family, first in Los Angeles and later in other areas of southern California. Kempler traveled extensively until his recent retirement, especially in the Scandinavian countries, lecturing and giving demonstrations of his prodding, confrontational interventions with family members. Antitheoretical, much like Whitaker, Kempler’s therapeutic efforts are aimed at helping clients expand their awareness, take responsibility for their actions, and gain a sense of autonomy and authenticity. Again like Whitaker, Kempler contends that the family holds the key to the personal development of its members.
B O X 9 . 4 C L I N I C A L N O T E
A Gestalt Family Therapy Credo
Kempler (1981) insists that an effective therapeutic encounter meet the following four demands:
1.A clear knowledge of “who I am” at any given moment. This requires a dynamic awareness of what I need from moment to moment.
2.A sensitive cognition or appraisal of the people I am with and the context of our encounter.
3.The development and utilization of my manipulating skills to extract, as effectively as I am capable, what I need from the encounter.
4.The capability of finishing an encounter. (p. 38)
The Therapeutic Encounter
Employing a personally interactive way of working with families, Gestalt family therapy represents an effort to blend some of the principles and procedures of family and Gestalt therapies in order to help people reach beyond their customary selfdeceptive games, defenses, and facades. To do so, the therapist relies on the forthright expression of what he or she is experiencing, in order to assist clients to become aware of and release previously unrecognized or bottled-up feelings.
Kempler’s (1981) therapeutic efforts are provocative, highly personal, uncompromisingly honest, and powerful. He presses for self-disclosure by family members, expecting that the wish or need to resolve their problems or improve relationships will give them the courage to expose their vulnerabilities. He actively and directly insists that everyone, himself included, become more intensely aware of what they are doing or saying or feeling. Like the mechanic who would rather listen to a troublesome engine than hear a description of it, Kempler first starts up a family conversation:
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Kempler is interested in what each person wants and from whom, expressed in the most specific terms possible. Participants are forced to talk to each other, in face- to-face, encounter-group-like fashion. If a wife complains to Kempler that her husband lacks understanding or sensitivity, Kempler directs her to tell that to her husband, not the therapist, and to be specific in her complaint. If she argues that it will do no good, Kempler insists she tell that to her husband. If she then breaks down, admits her feelings of hopelessness, and begins to cry—all without provoking a response from her hus- band—Kempler will point out his silence and invite him to answer her. From the initial interview through the subsequent sessions, the focus remains the immediate present. Self-disclosure and open, honest exchanges with others are basic ground rules for family members to follow if they are to untangle a family problem or overcome an impasse.
Viewing the individual within his or her functional context—the family—Gestalt family therapists attempt to help each family member achieve maximum individuation at the same time that they promote more vital relationships among the various members. Thus, the traditional goals of the Gestalt therapist working with an individual client (growth of the individual and the development of a distinct sense of self ) are combined with objectives for the family group as a whole. First helping family members to explore how their awareness is blocked, the therapist then channels the increased awareness so that they may engage in more productive and fulfilling processes with one another (Kaplan & Kaplan, 1978).
The Gestalt therapist facilitates self-exploration, risk taking, and spontaneity. Since such undertakings are all but impossible if an individual or family fears that self-discovery could be harmful, it is essential that the therapist provide an unchecked and unequivocal model for self-disclosure. To strike the familiar pose as a benevolent
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and accepting therapist only plays into the client’s fantasies that disapproval is dangerous, according to Kempler (1982). By contrast, Kempler is emotionally intense, assertive, genuine, challenging, sometimes brutally (if refreshingly) frank; in short, he expresses whatever he is feeling at the moment in the hope of making an impact on the family.
As the following excerpt from a couple’s therapy session begins, Kempler has just completed a moving exchange with the wife, during which the husband remained silent. Kempler now turns to the husband because he wants his participation.
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Kempler’s demand for a complete and honest emotional encounter with and between family members reflects his Gestalt heritage. Although far less popular today than in the heyday of encounter groups and sensitivity training three decades ago, this technique offers a useful counterweight to the currently fashionable concerns