Fam Proc 19:367-376, 1980

Multi-Level Couple Therapy: Applying a MetacommunicationalFramework of Couple Interactions

GUILLERMO BERNAL, PH.D,a

JEFFREY BAKER, PH.D.b

aAssistant Professor, Department of Psychiatry, University of California, San Francisco General Hospital, 1001 Potrero Avenue, SanFrancisco, California 94110.bClinical Psychologist, Charles River Hospital, Wellesley, Massachusetts.

Excerpts from a couple therapy case are cited to illustrate the practical significance of a multi-level framework inunderstanding couple interactions. The clinical implications of the metacommunicational framework, as a metaphor forexamining and understanding relational processes, are discussed. Also, the pragmatics of following "process" at avariety of levels when working with punctuational differences, developing therapy strategies and goals, and measuringthe progress of couple therapy are discussed.

In a previous report (5), we presented a multi-level framework to understand couple interactions. This article describesthe applications of the framework for understanding process in couple therapy. The conceptual framework of metaphor, stillin the formative stages, is the natural outgrowth of our research (4, 5) and clinical work (6). Initial applications of theframework with couples in therapy suggest that trainees and beginning therapists, as well as more experienced therapists,find it useful as a cognitive map by which they can follow transactional processes as well as define the stages in coupletherapy.

The framework was derived from the early work of various communication theorists and family therapists on the levelsof communication (1, 2, 3, 9, 14, 16). These contributors referred to two levels of communication. One level was defined asthe "content," another as the "command" or "relationship" component of a message. Because the content of a message islogically contained within the relationship component, the relational message constitutes a higher order of logic. Therelational message defines the relationship (3, 7, 9, 10, 11, 16) and may be nonverbal or verbal. If verbalized explicitly,these relational components become content. When this happens, we may call it interpretation or metacommenting, fromwhich "insight" may or may not follow. Note, however, that even when couples make relationship the content of theirdiscussion, the concept of metalevels continues to apply.

A Metacommunicational Framework1The levels framework to be illustrated in its clinical application has been described in an earlier paper (5). The

framework developed originally from a research study of punctuational differences (15) with couples (4). The classicillustration of punctuational differences is that of the husband and wife who are locked into a pattern in which he withdrawsand she nags or complains. Each sees the other as the stimulus for his or her responses, viewing the other as the cause ofthe difficulties. Each spouse "punctuates" or groups the same set of interactions quite differently.

To establish a punctuational framework for clinical and research purposes, five interactional levels, progressivelyincreasing in abstraction, were defined by content. Capsule descriptions are offered here for ready reference. In addition,Figure 1 illustrates the five levels using Venn diagrams. The interactional content (shaded at each level) is the primarycriterion defining that level.

_____________________________________________________________________________________________________________

1

Figure 1.Levels for understanding couple interactions: Object, individual, transactional, relational and contextual.

Level 1Object: Transactions at this level are focused on an issue. For example, a couple's interaction may be about

_____________________________________________________________________________________________________________

2

finances, in-laws, a stomach or back pain, recreation, division of labor (i.e., who cleans the house), etc. If a member of apair discussing housework were asked to draw his or her transaction, the resulting picture would be one of the houseworkfinished or undone (5). The interactions take the form: "The back pain/housework is a source of frustration"; "The problemis finances," etc.

Level 2Individual: At this level, the content is focused on one of the individuals in the interaction. Often interactionsat this level include mutual accusation and blaming that may be represented as punctuational differences (15), when eachperson views the other as the reason for his or her behavior. "Members of the couple view their own actions as reactions.The individuals now are the content of the transactions, illustrated in Figure 1 as a figure superimposed on a ground ofobject content. Interactions may take the following form: 'I am/you are a nag,' or 'It's your fault the house is a mess,' or 'Youare a spendthrift with our money,' etc. (5). If a member of the couple were asked to draw the interaction, the emergingimage would be of the other person.

Level 3Transactional: The Transactional level represents a change in content from a focus on individuals (i.e., "I amthe problem," "You are the problem," "It's your fault," etc.) to a focus on discussing explicitly the patterns of interaction("It's you and I"). The Transactional level is distinguished from the Individual level by the couple's acknowledgment of aconnection between their behaviors more complex than cause-and-effect, e.g., recognizing "vicious circles" such as, "Younag me about cleaning the house and I keep forgetting to do it," or "You stay out late and I get headaches." At theTransactional level couples may be acknowledging implicitly such dynamics in their relationship as passive-aggressiveacting-out, but not yet explicitly at the more abstract level of generalized relationship dynamics (see Level 4). As Figure1illustrates, "transactions are now the content focus with both individuals as figure for a ground of people discussing issues"(5, p. 295).

Level 4Relational: At this level, the focus changes from an acknowledgment of patterns (Level 3) to a focus on therelationship itself. "Assumptions, definitions, questions, and rules about the relationship are discussed and explicitlynegotiated, e.g., 'Neither housework nor who's right or wrong is really the issue. Let's talk about what this says about ourrelationship,' or 'I'm unhappy with this rule by which I'm the teacher and you're the student,' etc. In Figure 1 the relationship,as content focus, is figure against the ground of specific transactions, the individuals involved, and concrete object orissue." (5, p. 294)

Level 5Contextual: The next shift in content is toward discussion of growth in the context of life goals. Interactionsmay focus on any material that sets the context for the current relationship. This contextual material may bepsychohistorical, political, economic, ethnic, developmental (life cycle crisis), intergenerational, etc. Whatever the nature ofthe material at hand, this level entails an exploration of contextual issues that may relate to marital history or take the formof individual psychotherapeutic work in the presence of a spouse. As Figure 1 shows, "Content at this level subsumesrelationship, transactions, individuals, and the object perhaps at issue." (5, p. 295) Members of a couple may reflect andexamine past incidents, relational debts, loyalty conflicts, etc., in terms of the relationship or perhaps specific incidents orexperiences that set the context for the current relationship, e.g., "My father used to get headaches whenever he felt mymother was ignoring him."

Applying the Frame to Couples in TherapyMaterial from a couple therapy case will illustrate the practical significance of the framework. At the outset, however, it

is important to note that although an immediate goal in the examples to follow has been to help the couple encounter eachother at the same level (so that they may talk directly, for example, and in doing so find confirmation and test the realities oftheir assumptions) this in itself comprises only one possible therapeutic move and need not be an end in itself. What ismore appropriate in one instance may not be so in another. Similarly, just as helping couples meet at the same level neednot imply a therapeutic endpoint, the examples that follow, in which couples are aided to move to increasingly abstractlevels, are not intended to imply that movement up the hierarchy of communicational content levels is movement ascendingtoward health. For example, couples will at times need to find more concrete levels of discourse to overcome avoidance offeeling through overabstraction. Indeed, developing the ability to move flexibly among levels, often meeting and sometimesdiverging, may be the best specific indicator of movement toward health. The model proposed is intended primarily as anaid in enabling therapists to define process, and although some suggestions for its use as technique are offered, its bestapplication remains as a conceptual schema to promote creative experimentation and flexibility of technique.

We begin with some brief details about the couple.2 The clients were a working-class couple from North Philadelphia intheir early thirties. The wife was four years older than her husband. They had no children, had been married for six years,and were high school graduates. Initially, the wife had sought help at a community mental health center for depression.Notes from the intake interview described an obese, diabetic woman who complained about marital problems and wasfrightened by recurring thoughts of her own death. She was diagnosed as a depressive neurotic. Beginning five months afterthe first interview, she was seen individually in "supportive" therapy for four months. During this time there were manycancellations, little progress, and a progressive deterioration that led to hospitalization for an angina attack. Notes from the

_____________________________________________________________________________________________________________

3

final individual session reported "poor sleep," rambling conversations, the "marriage in a crisis," and medical complicationsconnected to the patient's fluctuating blood sugar levels.

Prior to hospitalization, upon the suggestion of the wife's therapist, the husband had requested the services of the clinic.This occurred two months after the wife had entered individual therapy. The husband was described as "casually dressed,unshaven, eager to speak, and appearing older than his age." He attributed his problems to a dishonorable dischargebecause of a mismanagement of funds while he was in the Army. He had difficulty keeping a job and at the time wasunemployed. Further, he openly discussed his aggressive and assaultive behavior toward his wife and reported periods ofbrooding when "everything builds up." He had been taking anti-depressants prescribed by a private physician and wasdiagnosed as having a passive-aggressive personality disorder. After two sessions, he had not returned for other individualtherapy appointments.

Because of increasing signs of deterioration in the wife, her individual therapist3 asked for a marital therapy consultation,and the senior author joined the therapy sessions. The husband was invited to a conjoint interview, and the couple agreed toparticipate in a set of five couple therapy evaluation sessions (16). After the "evaluative" sessions, further treatment wasrecommended. The couple agreed to continue weekly therapy sessions.

At the beginning of treatment the couple complained of frequent fights, some of which escalated to physical violencewith the destruction of household property. They also reported periods of depression, poor sexual relations, and financialproblems. The initial stage of treatment, the engagement (16) or joining (13) phase, was characterized by interactionsoccurring at the Object and Individual levels. The couple repeatedly engaged in heated, mutually blaming arguments aboutfinances, relatives or friends, and their "accidents." The therapists worked at establishing dyadic situations (i.e., where thecouple was instructed to talk to each other rather than to the therapists) and slowing down the process with specificquestions. The therapists were in "side-taking" and "go-between" roles (16), working with basic communicationaltechniques (14).

The following is an illustration of a typical discussion about what the wife called "someone getting hurt," taken from thesixth session (inclusive of the evaluation). The wife tended to accuse and blame her husband, and he blamed her. Thedialogue was as follows:

H: It was an accident, and you don't know the difference between an accident and when something is doneon purpose.

W: You don't know the difference between affection and brutality.H: Yes I do.W: No.H: As far as this morning is concerned, that there was taken out of proportion out of something that was a

pure accident.W: Why is it that every time I reach out to you, you hurt me?H: Maybe your timing is wrong.W: My timing is wrong?H: And when I make wrong moves at the wrong times as you make it, sometimes you wind up getting hurt.W: Do I have to make an appointment?H: No. And don't make a joke out of it neither.There are two salient elements to these interactions. One is that the wife is in an attacking stance, and the husband

defends by focusing the discussion on the accidents. While she blames him for being rough (Individual level), he may attackin return, but ends up by talking about "accidents" (Object level) that are beyond his control. One goal during this sessionwas to synchronize the interactions so that both would be talking to each other on the same level. The immediate therapygoal was to facilitate finishing transactional sequences. To these ends, the husband was encouraged to talk with his wifeabout the specifics of the situation while she listened to him. For instance, the therapists would make comments of thefollowing type: "Instead of talking about who was at fault, let's talk only about what happened." The following illustrates theObject level, where the content of discussion was primarily their "accidents."

H: For instance, OK, I don't know the exact wording used, but we were playing. And I poke my finger andyou said, "Well, I'm going to bite your finger if you stick it in my face again." So I stuck it in your face andyou grabbed hold of it and so, before you could bend my finger, I bent your finger. Then you grabbed itand I bent your hand with my finger before you could bend it. And then you went to hug me. I thought youwere coming after me, so I lowered my head. When I lowered my head, you were coming toward me. Myhead ran into your chest, knocking the wind out of you and everything blew up.

W: No. You hit the bedpost.H: It was taken as if it was done deliberately. I just lowered by head and hadn't expected to make contact

with you. You said, "Well, there's too many accidents." And everything blew up.The four or five sessions following the evaluation phase dealt with the specifics of their arguments (Object and

_____________________________________________________________________________________________________________

4

Individual levels). Both spouses were encouraged to describe concretely each of their views of what happened and,together, to explore each of their views of how events came about. This resulted in certain plans of action resembling quidpro quo negotiations on the basis of which tasks were assigned to the couple. During this period, their fighting diminished,the wife appeared less depressed, and the husband found a job.

The next phase of the therapy, beginning with the tenth session, was less behaviorally focused and dealt with identifyingpatterns of transaction. The therapists commented on how the spouses acted and reacted toward each other. The goal was tomove toward Transactional and Relational levels.

For instance, the therapists repeatedly commented on the process of the couple's immediate and reported interactions,focusing on situations in which the wife "bugged" her husband and he "pulled away" or withdrew. When the couple beganto identify the presence of a pattern, the therapists encouraged them to talk about it. The therapists interpreted the patternexplicitly for the couple to examine more closely when the couple appeared ready to do so. This pattern occurred for themverbally, socially, and sexually. The wife's attempts at affection often ended in heated arguments over her husband'swithdrawal or rebuffs, and they would return to the Individual level of interactions with mutual accusations. Consider thefollowing dialogue from the tenth session:

W: A brief encounter ... we get started out trying to be affectionate and wind up, somebody gets hurt, usuallyme. We both woke up with a cold ... all of a sudden it turns into a disaster. I was totally insulted and I gotbombastically mad. The result was that we were being affectionate and everything was going all rightuntil I was told, "You're bugging me."

H: It was taken completely wrong. You go ahead and explain it your way and I'll explain it my way.W: Well, the way it came out was, you know.H: You explain it your way and I'll explain it mine.W: The way it came out was that I went to hug you and all of a sudden you say, "Leave me alone."H: I told you I had an upset stomach. You don't bug me.W: You didn't say that.H: I told you I had an upset stomach.W: You didn't say that. You said, "You make me sick."As the interactions continued, it became increasingly obvious to the couple themselves that, when the wife tried to get

close, "accidents" seemed to occur. The following vignette illustrates the couple, moving from the Object to theTransactional level: Transactional rather than Relational in that the discussions stop at the specifics of a pattern of behavior.

H: Majority of times you are more passionate than I am.W: But that is as far as it goes.H: Let me finish. You are more passionate toward me than I am toward you.W: No.H: No, wait a minute. We've been talking about this for weeks, and you know you have. And I haven't really

said much. So don't go changing your mind and take the blame for something you aren't to blame for.W: All right, I'll shut up.H: Right. First time we agreed on something.W: It's usually a slight accident, a collision, when it should be a little bit of tenderness, love ...H: (Interrupts) You know what she's telling me? She's telling me that consciously I'm causing these

accidents. That's what she's saying. I'm saying they are not intentional. I don't believe they are happeningall the time, and that makes me feel subconsciously I'm producing these accidents to avoid her. Do youbelieve that?

T: Do they happen all the time?W: The majority of the times.H: Let's see here, how many times have you tried to hug me this week?W: Seven.After they discussed the number of weekly accidents during the previous three weeks, a clear pattern emerged. The tenth

session marked a transition, because the couple was entering the Transactional level by discussing their interactions withhonesty and openness. Their dialogue continued in the following way:

H: I feel that shows a lessening. It shows that the pattern of accidents is going down.W: We were fighting all week over this.H: Right, all week over this.W: Over this one issue, no. This one issue. You haven't been able to recognize it.H: We have been fighting all week over it?W: Yes.H: There is a pattern here.T: Can you talk about it?

_____________________________________________________________________________________________________________

5

H: There is a pattern, true. But isn't the pattern going down?T: It sounds like it is, somewhat. The cycle of you going after him and his blocking you used to happen a lot,

and it happens less now.W: Instead of it being something pleasurable, it winds up in an argument.T: At the same time, it also happens the other way around. This is the same as before, where you bug him

and he pulls away.The couple's interactions moved from the Transactional to Relational levels during a discussion of her feelings about her

husband not sharing more with her. At first the husband would say, "If you weren't so demanding, then I wouldn't withholdso much." She would say, "If you would tell me things, I wouldn't be so demanding." (Although their statements aremutually blaming, the conditional "if" is taken to signify the acknowledgment of a pattern; optimistically and pragmatically,"if" statements that include the behavior of both parties are assigned the Transactional designation.) After they talked abouttheir Transactional pattern, the couple were encouraged to discuss the more general issue of trust. The therapist directlyinquired about trust in one of the following ways: "I wonder what has happened in your marriage that there seems to be solittle trust?" or, "Can you two talk about the lack of trust in your relationship?" The interactions were now focused on thenature of the relationshipthat is, they were at the Relational level. Both acknowledged their difficulty in trusting eachother, and the events leading to the erosion of trust were discussed subsequently. Additionally, the couple were able to workon a plan of action to build relational trustworthiness (8). Their plan was related to issues concerning extended familymembers and involved interactions at the Contextual level.4

Transition to contextual material was facilitated by the therapists' inquiring about the families of origin. For instance, thetherapists asked if certain issues (e.g., trust) reminded either of them of events when they lived with their families. Suchcomments moved the subject of discussion to the context and contributed to the rebuilding of trust in relatedness, becausesuch dialogues are usually characterized by important disclosures, support, and mutual helpfulness.

The following segment is an illustration of interactions at the Contextual level that were extensions of relational issues oftrust, indebtedness, and entitlement that surfaced during the twelfth session. Through the therapists' intervention, thehusband was encouraged to talk to his spouse about his difficulty with his mother, who had abandoned him several timeswhen he was a child.

H: There were arguments and fights with my mother since 1953 when she forced me from my foster homewhere I had lived for ten years. We fought and argued. She put me in a boys' home. Then I came out ofthere. My mother is the type of person with whom you can have an argument and you come back yearslater and she'll act as if nothing happened. Forgive and forget, she says. But I forgave and forgot too manytimes.

W: Not really.H: No. No. No.W: It will always be there.H: Oh, yeah, It'll be there, but I've given too many times.W: Before we got married, everything was terrific.H: I put out and put out from 1953 till now. I had to draw the line.W: I agree with you. But before we got married, everything was terrific between you and your mom.H: For the past year or so. That's all.W: When we got married, there was nothing.H: That only lasted a year and a half. You see, my sister threw me out of my mother's house when I came

back from Vietnam because I visited my foster parents for a couple of weeks. They were my family, too.My sister threw me out of my mother's house, and that led to a silence between my mother and me thatlasted years.

The interactions continued in the above contextual manner, and the couple related a number of issues from their familiesof origin to issues in their relationship. This became an openly acknowledged "reflection" on their lives and history,occurring in an atmosphere of openness and mutual helpfulness.

The contextual interactions added meaning to the couple's difficulties. Both were entitled to have received more fromtheir parents, particularly the husband. Both were parentified children (8) and were remaining "invisibly loyal" to theirfamilies by maintaining a balance of distance by means of the back-and-forth trading of distancer and pursuer transactionalroles. The long-range therapeutic goal with this couple was to enhance trustworthiness in the marriage by helping them towork through their loyalty conflicts. They worked on developing an action plan whereby both could remain loyal to eachother and develop or maintain meaningful connections to their families of origin.

Discussion and ConclusionsApplying the multi-level interactional frame to the transactions of couples in clinical as well as research settings (5, 4)

_____________________________________________________________________________________________________________

6

reveals that distressed couples are often locked into a particular level, demonstrating limited movement among the levels.Specifically, initial work with couples may reveal patterns of mutual accusation and blame characteristic of Level 2interactions. When the intensity of conflict is reduced, movement across the communicational levels is more likely andtherapeutic work leading toward clear relationships, self-understanding, tolerance of differences, rebuilding of trust, andshared responsibility becomes feasible.

Clinical experience with the multi-level framework suggests that beginning therapists and trainees find it useful as aschema with which to follow transactional processes and develop intervention strategies. A therapist may attempt tosynchronize couples at one level (for example, by allowing one member to speak while the other listens) or may choose towork at moving couples, or one or another member of a couple, from one level to another by both implicit and, in time,explicit encouragement, as earlier illustrated. Transition from level to level presupposes an appreciation for the engagementprocess in couple and family therapy (16). In some situations, this movement may require weeks of therapeutic work.

In the case presented, shifts from Level 2 to Level 3 occurred after the contracted five-session "evaluation" period, whichprimarily focused on Level 1 and Level 2 interactions. The couple had to be helped to engage at Level 1 before they couldmove beyond blaming to Level 3. The evaluation phase facilitated the couple's engagement in a therapy process withinwhich a wide range of issues could be explicitly brought up for examination and reality-tested in a relatively safe setting.Movement from Level 2 to Level 3 was further facilitated by comments on the couple's process and other interventions thatmoved the clients toward a position of taking more responsibility. For example, once the couple had engaged at Level 1, thetherapist said, "You two argue a lot about the accidents. And the more you try to get close to your husband, the more hetries to get away and the more accidents happen." Other alternatives might be for a therapist to prescribe more concretely aparadoxical task to make covert patterns more overt. For example, a couple may be asked to go home and do more of thesame (e.g., husband withdraw and wife nag, etc.). Another possibility would involve a role-reversal sequence to exaggeratethe couple's particular pattern or the couple could be provided with video-taped feedback of their process, thus removingthem from the immediacy and intensity of the situation and facilitating their engaging in Level 3 discussions.

In general, "interactional movement may be facilitated by a therapist's offering comments, challenges, tasks, paradoxes,exercises" (5, p. 300) or directives. For example, vituperations at Level 2 may be effectively dealt with by slowing down theblaming process with highly specific questions about the issue or with questions about each member's own feelings. Withthe former, the couple may be moved to interact at the Object level. The behaviorally oriented therapist might stay with thisalternative, working with the couple on quid pro quo negotiations. Asking each member of the couple to talk about his orher feelings may move the interaction to the Transactional, Relational, orthrough associationsto the Contextual level.

Therapists can facilitate interactional shifts from lower levels to Level 4 or Level 5 by direct demonstration, suggestion,or inquiry. With our exemplary couple, movement to Level 4 was achieved when the therapist directly inquired about issuessuch as trust and commitment. At one point, the therapist said: "Your wife wants to talk about your commitment to therelationship, and you tend to shift the topic to the accidents." At another point, the therapist asked: "Can the two of you talkabout your commitment to the relationship?" At the relational level, the focus is on relationship properties; this may revealdisagreements "over existing definitions and/or rules for relatedness" (5, p.300), or differing perceptions of the same, forexample, "You have to understand that my feeling a little gloomy or quiet doesn't mean I don't love you."

The family of origin always plays a role that may become the level of exploration and rebalancing work (8) for one orboth members of the couple. In the above case, shifts to Level 5 occurred when the therapists linked current problematicissues and patterns to similar difficulties in the family of origin. For example, during a discussion of difficulties with trust,the therapist asked: "Does this talk about trust and trustworthiness remind you of anything?" On other occasions, thetherapist made connections between imbalances in the marital relationship and imbalances in the family-of-originrelationships as a way to focus on contextual transgenerational processes. Clearly, shifts to Relational and Contextual levelsmay signify greater degrees of involvement in a therapeutic process, as demonstrated by the case study above.

The clinician new or experienced in working with couples encounters not only a bewildering array of interactionalpatterns and choices of perspectives, but also, as in the case illustrated, rapidly shifting resistances and a high degree ofemotional reactivity. All can contribute to a sense of therapist helplessness as "the monkey in the middle" or an experienceof being "stuck" along with the couple in a recalcitrant therapy. It is hoped that the framework presented here may serveboth a differentiating and creative function for therapists working with couples. Therapists may use the framework inhelping couples to make pragmatic changes and to become more sympathetically self-reflective while consistentlyencouraging in couples an awareness of the multiple levels of interactional meaning.

REFERENCES

1. Baker, J., "Family Systems: A Review and Synthesis of Eight Major Concepts," Fam. Ther., 1, 1-27, 1976. 2. Bandler, R. and Grinder, J., The Structure of Magic: Vol. 1. Palo Alto, California, 1976.

_____________________________________________________________________________________________________________

7

3. Bateson, G., Steps to an Ecology of Mind, New York, Ballantine, 1972. 4. Bernal, G. and Golann, S. E., "Couple Interactions: A study of the Punctuation Process," Int. J. Fam. Ther., 2,

47-56, 1980. 5. Bernal, G. and Baker, J., "Toward a Metacommunicational Framework of Couple Interactions," Fam. Proc., 18,

293-302, 1979. 6. Bernal, G. and Vande Kemp, H., "Marital Therapy: Experiential Perspectives of Two Developing Clinicians,"

Fam. Ther., 2, 1097-122, 1976. 7. Boszormenyi-Nagy, I., "A Theory of Relationships: Experience and Transaction," in I. Boszormenyi-Nagy and J.

L. Framo (Eds.), Intensive Family Therapy: Theoretical and Practical Aspects, New York, Harper and Row, 1965. 8. Boszormenyi-Nagy, I. and Spark, G. M., Invisible Loyalties, New York, Harper & Row, 1973. 9. Haley, J., Problem Solving Therapy, San Francisco, Jossey-Bass, 1976. 10. Harper, J. M., Scoresby, A. L. and Boyce, W. D., "The Logical Levels of Complementary, Symmetrical, and

Parallel Interaction Classes in Family Dyads," Fam. Proc., 16, 199-210, 1977. 11. Karpel, M., "Individuation: From Fusion to Dialogue," Fam. Proc., 15, 65-82, 1976. 12. Langs, R., The Bipersonal Field, New York, Jason Aronson, 1976. 13. Minuchin, S., "Families and Family Therapy." Cambridge, Mass., Harvard University Press, 1974. 14. Sluzki, C. E., "Marital Therapy From a Systems Theory Perspective," in T. J. Paolino, Jr., and B. S. McCrady

(Eds.), Marriage and Marital Therapy: Psychoanalytic, Behavioral, and Systems Theory Perspectives. New York,Brunner/ Mazel, 1978.

15. Watzlawick, P., Beavin, J. H. and Jackson, D. D., Pragmatics of Human Communication, New York, Norton,1967.

16. Zuk, G. H., Family Therapy: A Triadic Based Approach, New York, Behavioral Publications, 1972.

1A word of caution about conceptual schemes in general seems appropriate. All attempts at describing ongoing process fall shortin the depiction of reality. The problem is two-fold. On the one hand, we run the risk of mistaking our abstractions for genuinehuman experience. On the other, we confront the paradox of unitizing information that may not be suitable for a grouping orclassification. For instance, when process is stopped, whether for descriptive or analytical purposes, the act of stopping the processis itself an arbitrary grouping of events; that grouping of groupings, of course, represents still a different process. It is probable thatframeworks attempting to describe human experience are inherently inadequate and cannot do justice to the complexity of thematerial at hand. As we proceed, it may be worthwhile to avoid the tendency to reify by reminding ourselves of the dialecticbetween experience and the description of experience.

2Names and some facts have been changed to ensure anonymity.

3The cotherapist was Ms. Daisy Negroni. The senior author is indebted to her for her helpfulness throughout the year.

4Given the nature of the clinical supervision on this case, the interactional material that emerged in the Relational and Contextuallevels reflected a particular family therapy orientation (Boszormenyi-Nagy and Spark, 1977) which in a sense biased this data à laNagy (e.g. prominance of the concepts of trustworthiness, justice, loyalty conflicts, etc.). Therapists working from other theoreticalorientations (e.g., psychoanalytic, behavioral, etc.) may elicit different material at these levels.

_____________________________________________________________________________________________________________

8