Journal of Marital and Family Therapy 1986, Vol. 12, NO. 2,129-135

FAMILY THERAPY AND IDEOLOGY*

Guillermo Bernal Eduardo Y sern University of California at San Francisco

Contemporary family therapy is examined in terms of its ideological content. The adoption of cybernetics and biological systems theory to the family has led to the erroneous belief that family therapy is exclusively concerned with natural systems, is process oriented, content relative, and above ideology. This article argues that the family and the enterprise of family therapy are social systems and under the influence of the ideologyparticular to a given society. The strategic family therapy treatment of a family with a drug-addicted member serves as an example to clarify the ideological themes of contemporary family therapy. These themes are: (a) family reductionism and blaming; (b) the relabeling of personal injustice into communicational terminology; (c) the assumption that the nuclear family is optimal; (d) the conceptualization of therapy as a commodity; and (e) the model of human relatedness and intimacy supported by family therapy.

The growth of family therapy has been rapid and expansive. Beginning in the 1950’s as an experimental technique of maverick clinical innovators, it grew by the 1960’s into a national movement in the United States with several centers for service, training and research. During the 1970’s this expansion continued into the international arena, most notably in Europe and Latin America. Today, in the 198O’s, family therapy is a well- established field with national, professional organizations, selected journals, a vast literature, and numerous educational centers-in essence, a legitimate shareholder in the mental health enterprise. However, while most of the efforts during these past decades have been directed toward establishing the autonomy of this field, little atten- tion has been given to the ideology that governs the practice of family therapy. In this article, we hope to raise a number of ideological issues that the field may now be ready to face, as it distances itself from its radical past and becomes institutionalized within mental health orthodoxy.

By ideology, we mean the set of values, beliefs and ideals which inform people of their social reality (Lichtman, 1975) and which is, in turn, a consequence of their past actions and history, In this sense, we are not merely designating a set of ideas or constructs in abstraction, but rather, those ideas which are a reflection of reality and

*The clinical research upon which this article is based was supported by a grant from the National Institute of Drug Abuse, Grant #DA03543. An earlier version of this paper was presented at the American Family Therapy Association Meeting, New York, June, 1984. The first author is indebted to the graduate students of the Psychology Program, New College of California, San Francisco for their challenging discussions of family therapy theory and practice which contributed to this article, and to James L. Sorensen, PhD, David Gibson, PhD, and Laurie Wermuth, PhD, for their comments on an earlier version of this paper.

Guillermo Bernal, PhD, is an Assistant Professor of Psychology, University of California School of Medicine, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110.

Eduardo Ysern, PhD, is a Staff Research Associate, University of California School of Medicine, San Francisco General Hospital, San Francisco, CA 94110.

April 1986 JOURNAL OF MARITAL A N D FAMILY THERAPY 129

correspond to the activities of a specific group of people in a specific time and place. The relationship between ideology and social reality is reciprocal and interactive, since each conditions the other, and vice versa. The study of ideology, a subspeciality of sociology, asserts that knowledge is derived from a social context (Berger & Luckman, 1966; Habermas, 1972). Family therapy, a direct descendant of systems theory, is often held to be above ideology, and independent of social forces. Here, we will take issue with this view. Our position is that family therapy cannot extricate itself from social forces and serve as a means towards a given end without being a determinant in the desire of that end.

Family Reductionism and Blaming The major contemporary models of family therapy all share a common heritage in

systems theory (Hoffman, 1981), a paradigm which originated in the field of biology and in the study of organic systems in animal and plant life (Emery, 1969; von Bertalanffy, 1968; Weiner, 1948). The critical paradigmatic shift which was ushered in by family therapy was the transferring of systems theory from the natural to the social sciences and defining the family as the unit of analysis. This shift was not inconsequential. As a result, the therapeutic techniques became oriented towards modifications of family hierarchy and structure, usually through changes in the transactional patterns of the family. With the exception of the intergenerational approaches (e.g., Boszormenyi-Nagy & Spark, 1973; Bowen, 19781, the sources of information become atemporal, “here and now,” ignoring family history altogether. Psychopathology was viewed as either enmesh- ment (overinvolved relatedness) or disengagement (underinvolved relatedness). Nor- malcy was viewed as “differentiation” in the system with clarity of hierarchy and boundaries. At no time, however, was there mention of the normative criteria by which these judgments were made.

An excellent illustration of this systemic approach in its “strategic” variant appears in a training videotape narrated and edited by Haley (1982). The video, titled Heroin, My Baby, documents the brief family therapy of a 25-year-old man and his family of origin. The identified patient had a heroin addiction for over five years. Briefly, the essence of the therapy was to reorganize the family hierarchical structure, placing the parents as “executives”in the hierarchy, and having them jointly make decisions about their problem son. A key intervention was to reinvolve the distant father, placing him in charge of the son and diffusing the intense mother-son relationship. This technique thus implies that the problem of heroin addiction is a result of the vague boundaries within the family and the lack of a hierarchical paternal authority. Herein rests one of the central ideological elements of strategic family therapy, namely, the inherent ten- dency toward family reductionism and family blaming.

In the specific case of the Haley tape, family reductionism is evident in that no efforts are made to understand or draw attention to the social context of drug addiction.‘ While family therapy represents a significant advance to the extent that it expands the unit of analysis to include the family, the practical reality is that the social context of symptomatic behavior is too often ignored, despite provisos to the contrary. In the cited case example, the family is given a clear message that the problem is their inability to separate properly.2 Thus family therapists, in their heroic efforts to de-stigmatize the identified patient, implicitly blame the family and, in the process, exonerate society of its responsibility.

Relabeling of Personal Injustice The second element of this family therapy ideology is the relabeling and reframing

of personal injustice and exploitation into “communicational,” or “hierarchical” terms, Most contemporary family therapists do not address the issue of exploitation in family

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relationships, or of intimate oppression. Instead, such issues are relabeled or trans- formed into communicational “problems” that become the focus of therapy. Family therapists do for the modern family what sociologists and personnel managers have attempted to do for labor-management conflicts, i.e., reframe collective disputes into communicational or hierarchical dysfunctions, and translate ideological differences into technique (Lasch, 1979). The implicit ideological message here is that there are no contradictions or conflicts of interests that cannot be resolved within the existing family arrangements.

The Optimal Nuclear Family Structure Assumption A third ideological element of family therapy is the notion that the nuclear family

structure is optimal, and that deviations or variations are caused within the family (Poster, 1980). Deviations need to be eliminated to bring the family back to the norm. Does contemporary family therapy serve t o glorify the values of individualism in the context of a highly competitive society? Are the techniques and theories of family therapy unwittingly devoted to the preservation of current family forms (James & McIntyre, 1983) because of the needs of the broader social economic system?

The formula for successful outcome of contemporary family therapy is relatively straightforward: Therapists are oriented to support the family hierarchy almost without question. The systemic-strategic treatment of the family with a son addicted to drugs in Heroin, My Baby serves as an example. Successful treatment consisted in reinvolving the peripheral parent (the father) with the problem son and in diffusing the intense emotional relationship between the mother and son. While disclaimers are often made of the “tactical” nature of such interventions, therapists are frequently in a position of exclusively reinforcing and supporting the dominant ideology of male supremacy and patriarchal authority.

Furthermore, in the efforts to negate psychoanalytic concepts, contemporary family therapy has deprived the human being from any agency in the making of his or her history. With the exception of the psychodynamic and some inter-generational approaches, “insight” is rejected as a precondition or even as a postcomponent of change. The individual is not an agent, but an object, of social forces. Indeed, no efforts are made to facilitate the development of consciousness, or of an understanding of how to improve human relationships. Therapeutic change is left as magical, with no cognitive education given to families about the process of change. In fact, such an understanding is consid- ered by some as anti-therapeutic (e.g., Haley, 1976; Palazzoli Selvini, Boscolo, Cecchin, & Prata, 1980; Stanton, Todd & Associates, 1982). Thus, while family systems therapy could be conducted based on the notion that men and women are both the product and the creators of their reality, most therapists do not act on this notion. In particular, the nonhistorical family therapies obscure the second part of the premise, and in so doing do not provide a basis for future social action. The ideological message of a family therapy based on magical change, at best, encourages dependency, and at worst, suggests that men and women are passive objects to be technically reconfigurated by advertising experts and powerful authority figures.

Family Therapy as a Commodity A fourth ideological element of family therapy is the conceptualization of therapy

as a commodity. Contemporary systems of family therapy, for the most part, clearly and unabashedly see themselves as technologies, or as instruments for manipulation in the service of a goal. Their ethic, borrowed unchanged from modern physics and biology, is that of homeostasis or maintenance of the existing order. For example, Haley, the foremost exponent of this viewpoint, notes: “The main ethical issues in the field of therapy tend to fall either within the area of fair exchange, which involves issues

April 1986 JOURNAL OF MARITAL AND FAMILY THERAPY 131

common to any business or profession, or within the area of the control of information , . . Fair exchange is a balance between what one receives and what one gives” (Haley, 1976, p. 195). It is only later, in the same paragraph, that Haley adds the necessary mediator of fair exchange in our society: “When we acknowledge that a therapist can make more or less money for himself or for his agency, depending on how he does his therapy, the ethical issue becomes tied to questions about therapy technique” (Haley, 1976, p. 195). In our society, a central criterion for successful treatment is cost-effec- tiveness, particularly in the public sector. Hence, “how he does his therapy” is judged in this way. Therapy is to be dispensed in the same way as gasoline, fast-foods, drugs, and other commodities in a consumer society.

Models of Human Relatedness and Intimacy

Perhaps one of the most serious ideological questions a t hand concerns the model of human relatedness and intimacy supported by contemporary family therapy. As the values of an increasingly consumer-oriented society permeate the family, will business values of competition and profit motives serve as the “new” model of relatedness? More specifically, family therapy theories are based on implicit theories of relationships rooted in a systems framework. For example, the nonhistorical models, such as the structural, strategic, and interactional models, are centered on concepts of power and authority as the key dynamic of relatedness. Alterations in the balance of power, be it through the communication process or the family’s hierarchy or structure, produce the desired changes. Family relationships are viewed as struggles for power and control, which the therapist aims to correct. Such power struggles within the family are not dissimilar to the competitive struggles confronted in the world of work and business.

The basic ideological question is: “What model of intimacy is the practice of a particular brand of family therapy supporting?” Do some contemporary family therapy theories reinforce a model of intimacy that views family members as basic commodities in a market-economy of relationships? Can family therapy propose an alternative frame- work, or does family therapy support a commercial model of relationships? As Lasch (1979) points out, the intrusion of the market place or business values on the family has resulted in “the perversion of the most intimate relationships by the calculating, manip- ulative spirit that has long been ascendant in the business life” (Lasch, 1979, p. 166).

A commercial model of relationships suggests that how we handle and think about intimate relations may not be dissimilar from how we handle expensive commodities. Since the future brings forth the obsolete, and the past is irrelevant, only the “here and now” is reasonable to consider. Thus, there can be no expectations of commitment, fairness, caring for consequences, and accountability. The basic expectations in close relationships are of “feeling good,” mutual consumption, and equality. The ideological message is of close relationships “free” of commitments; this ideology is one “that registers so faithfully to the psychic needs of the late twentieth century-condemns all expectations, standards, and codes of conduct as ‘unrealistic’ ” (Lasch, 1979, p. 140).

Furthermore, extending to ourselves the strategic brand of family therapy, brings us to its logical absurdity. If, as therapists, we are honest and consistent with our theories of family process and change, then there needs to be some degree of correspondence (or an isomorphorism) between theory, practice and the family therapist’s personal life. Strategic therapy proposes that we consider our most intimate and family-of-origin relationships as something akin to a game of chess. The player with the better strategy prevails. The one with the best moves wins. The ideological corollary here is that we are to treat ourselves and our loved ones as commodities to be discarded or replaced after use since personal freedom is equated with the freedom to consume, and winning is the prime motive for playing.

132 JOURNAL OF MARITAL AND FAMILY THERAPY April 1986

SUGGESTIONS

In presenting these ideological issues, we are aware of running the risk of being misunderstood, in as much as we offer a critique without specific alternatives for action. We trust that the analysis presented here is heard as constructive, critical commentary, or reflections that can serve to guide actions, Below, we offer the following suggestions in the hope that these may contribute to the development of a progressive family therapy.

One way of countering the tendency of reductionism and blaming of the family is for family therapists to incorporate, as part of their armamentarium of interventions, an acknowledgement that “much of what is treated as malfunction occurring within a family is really a consequence of social fragmentation and dehumanizing larger struc- tures” (Boszormenyi-Nagy, Cotroneo & Grunebaum, 1985). Nowhere is this as clear as in the area of drug abuse, where special efforts may need to be made by therapists to free families of the implication that they, or their relationships, are the problem.

Specifically, we suggest three possibilities for action that may be generalizable to areas beyond substance abuse. These are: (a) linking the symptom of family disfunction to social and community processes (Bernal & Diammond, 1985); (b) helping the family identify those factors in the community that contribute to drug addiction; and (c) lending support to the development of community based interventions (e.g., social network and support groups, neighborhood crime-protection groups, etc.). These suggestions are by no means a substitution, but rather, an addition to existing interventions and treatment strategies.

Concerning the relabeling of personal injustice into communicational terms, we suggest that therapists address the issues of fairness, trust and accountability directly in close relationships, while avoiding a judgemental attitude. Here, we find most useful the concept of “multidirected partiality” from the Contextual approach (Boszormenyi- Nagy & Krasner, 1980), where the therapist is free to consider the welfare interests of those at the bottom, as well as those at the top, of the hierarchy.

Furthermore, in our most recent work on the family therapy of drug abuse, we have come to the position of constantly re-examining the values and ideals supported by clinical interventions. The challenge for our clinical and research teams has been to identify and critique the implicit, and often unintentional, support of sexism, racism and classism that may be inherent to the therapy being practiced. It i s this process of ongoing self-reflection and, perhaps, meta-critique that we find essential in a family therapy conscious of its social context.

CONCLUSION

We are sure that the questions raised here have been the subject of considerable pondering by family therapists for some time. What is striking is the paucity of literature and debate on ideological issues within the field. Feminist family therapists were the first to raise these concerns by questioning the reinforcement of stereotyped sex roles in treatment (Hare-Mustin, 1978). Indeed, even behavioral marital therapists recently have raised similar concerns (Jacobson, 1983). Nevertheless, despite years of study by feminist (e.g., Chodorow, 1978; Firestone, 1970; Mitchell, 1971) and social (Poster, 1980; Zaretsky, 1973) theorists, family therapists have yet to contribute to a critical analysis of the field, The overview given in this article is intended as a minimal beginning in acknowledging this dearth in the literature and in clarifying the values that we, as family therapists, may be unknowingly supporting. Perhaps the systems approach, precisely that which gave family therapy its distinctiveness, is what most compromises its original vision. Our view is that it need not do so. The crucial caveat is that we forego the physical and biological roots and keep in mind that we are dealing with social systems. A critical study of family therapy-an analysis that is self-critical and con-

April 1986 JOURNAL OF MARITAL AND FAMILY THERAPY 133

scious about its social context, values and ideas-might move the field beyond the simple affirmation and reproduction of the existing social order, and perhaps toward its trans- formation.

REFERENCES

Berger, P. L. & Luckman, T. (1966). The social construction of reality. Garden City, NY: Doubleday. Bernal, G. & Diammond, G. (1985). Notes on a sociohistorical perspective of family therapy. Journal

of Strategic and Systems Therapy, 4,42-47. Boszormenyi-Nagy, I., Cotroneo, M. & Grunebaum, J. (1985). Standards and guidelines for the

practice of family therapy. Unpublished manuscript. Philadelphia: Institute for Contextual Growth.

Boszormenyi-Nagy, I. & Krasner, B. R. (1980). Trust based therapy: A contextual approach. American Journal ofPsychiatry, 137,767.

Boszormenyi-Nagy, I & Spark, G. (1973). Invisible loyalties: Reciprocity in intergenerational family therapy. New York: Harper & Row.

Bowen, M. (1978). Family therapy in clinical practice. New York Jason Aronson. Chodorow, N. (1978). The reproduction of mothering: Psychoanalysis and the sociology of gender.

Emery, F. E. (Ed.). (1969). Systems thinking. Baltimore: Penguin Books. Firestone, S. (1970). The dialectic ofsex. New York Bantam. Habermas, S. (1972). Knowledge and human interest. Boston: Beacon Press. Haley, J. (1976). Problem solving therapy. San Francisco: Jossey-Bass. Haley, J . (1982). Heroin, my baby. In M.D. Stanton, T. Todd & Associates, The family therapy of

Haley, J. (1984). Marriage or family therapy. American Journal ofFamily Therapy, 12, 3-14. Hare-Mustin, R. T. (1978). A feminist approach to family therapy. Family Process, 17, 181-194. Hoffman, L. (1981). Foundation of family therapy. New York: Basic Books. Jacobson, N. S. (1983). Beyond empiricism: The politics of family therapy. American Journal of

James, K. & McIntyre, D. (1983). The reproduction of families: The social role of family therapy?

Lasch, C. (1979). Haven in a heartless world. New York Basic Books. Lichtman, R. (1975). Marx’s theory of ideology. Socialist Revolution, 23,45-76. Palazzoli, Selvini M., Boscolo, I., Cecchin, G. & Prata, G. (1980). Hypothesizing-circularity-

neutrality: Three guidelines for the conductor of the session. Family Process, 19,3-12. Poster, M. (1980). Critical theory of the family. New York: Seabury Press. Stanton, D., Todd, T. & Associates. (1982). The family therapy of drug abuse and addiction. New

von Bertalanffy, L. (1968). General systems theory: Foundations, developments, applications. New

Weiner, N. (1948). Cybernetics (2nd Ed., 1961). Boston, MA: M.I.T. Press. Zaretsky, E. (1973). Capitalism, the family, andpersonal life. New York: Harper & Row.

Berkeley: University of California Press.

drug abuse and addiction. New York Guilford.

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NOTES

‘We are aware and pleased of Haley’s (1984) acknowledgement of the importance of the social context beyond the “triangle,” which became evident to him by the mid-1970’s. While this recog- nition of something beyond the triangle is probably significant, what is understood by the terms “social” and “context” in this strategic family therapy framework remains rather limited to micro- scopic social units.

*A central dynamic in this case was the separation of the son from the home. Haley (1982) writes, “Although some therapists think of the problem as one of the parents holding on to the child, it is best to keep aware that the child holds on to the parents” (p. 180). Stanton, Todd & Associates, (1982) comment on the limitations of a linear interpretation of causality and note the

134 JOURNAL OF MARITAL A N D FAMILY THERAPY April 1986

advantages of a circular causality emphasized in the systemic-strategic perspective. Stanton states that a linear interpretation blames the parents or the son for the problem because of their inability to properly separate, and, by inference, for the heroin addiction. In contrast, a “non-linear or recursive” (p. 180) logic integrates the contribution of all family members, since each of their actions and reactions is part of a total family system. Thus, while rejecting a linear interpretation of causality, the strategic approach attributes causality to the whole family.

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