Family Systems Archives - Page 2 of 2

Philip Guerin on Bowenian Family Therapy

Posted on November 6, 2012February 27, 2026 by rezendevknowfully.com

The Family of Origin

Ruth Wetherford: So, Dr. Phil Guerin, give us your background. What is your current situation? How have you gotten into family of origin work?

Philip Guerin: Well, my family of origin work goes way back. I’ve been in practice now about 45 years. I was a medical student at Georgetown, and the program was primarily a psychoanalytic program, so I spent my medical school time using psychoanalytic-psychodynamic models, transference models. I didn’t meet Murray Bowen until I was a resident, and he was my introduction to family of origin work. His whole model is mostly family of origin work, so that was a good introduction.By the time I met him I was already somewhat impatient with what in those days was called “the working through process” in the transferential model. I myself had been in therapy as part of the training and was somewhat dubious about how much the working through process really took place. In my own analytic therapy, I didn’t see much attention being given to it. And in working with patients, I found that things tended to drop off and never quite got through the working through process. And as a result, people often had dredged up a lot of negative affect and feelings about their important objects during their individual therapy and were then left with no place to work that through, other than to hold on to negative precepts about those people which resulted in exaggerated distance and a lot of blaming of those people for their own neurotic hang ups.

RW: That is a common complaint of people in therapy as well as of therapists. We do all this digging, we excavate the woolly mammoth—now what do we do?

PG: Exactly. So I found that trying to find a way that one could put some structure on the family of origin, and then define the field that those people occupied, look at the key conflicted processes, the important triangles, the cutoffs—all those things that we know about from our family system training—and really actually work through some of that process with somebody who knew the terrain. I was fortunate enough to have a guy through my terrain in the person of Bowen. And I did some significant relatively long-term work with him on my own family of origin. So that’s how I got into it. And I have found that it has been a real help in my own personal life. And, on the other hand, difficult to sell to people in terms of being relevant to their everyday lives.So I had to learn to not sell it, but to integrate it somehow around the symptoms of the relationship conflicts that came up so that people could see and learn its relevance. I don’t know what you think, Ruth, but I think in our current culture there’s even less investment in family of origin as an important and valuable asset in people’s lives.

There’s so much fragmentation of families, in particular the multi-generational families, that I think people, now that I’ve been in the business long enough, they kind of self-select in terms of coming to see me. So I either end up with somebody that’s coming in with the family of origin problem or somebody that isn’t awfully interested in it and we end up focusing on their symptoms and maybe working the family of origin in as part of that process.

RW: What are some of the basic concepts that you really like about this approach that help you organize your observations and your moves as a therapist?

PG: I think that the two things that are key, in terms of helping people with this clinically, is that much of the developmental and/or situational stress in our lives emanates from family of origin stuff. You know, you haven’t seen your mother in 15 years and she suddenly has a terminal illness. Something happens to your brother and he loses his job—there’s any number of those kinds of situational things. And the developmental things are obvious—when somebody gets married they are supposed to shift their loyalty from their parents to their loved one as their primary object of choice, but that’s actually very difficult to do.And what that brings up is a triangle right out of nowhere, which you also had when you were a little kid—just born into a family and you started out somewhere caught up between your mother and father. So those kinds of things and contextualizing them into the larger family I find really helpful as a road map to develop people’s treatment plans.

RW: So there’s the concept of the triangle and the other concept is…?

PG: Well, I think the triangle is obviously very central. But when I see a clinical situation that comes to me I make an assumption that it’s based on an increase in stress in the people’s lives.

RW: Stress is a key concept.

PG: That manifests itself in an exacerbation of relationship conflict or some physical symptoms that’s returned or depression or anxiety. And those things are best understood if you can put them into context of a family—the family of their spouse and kids or the family they came from.

Triangles

RW: In your book, Working with Relationship Triangles, which you wrote with Fogarty, Fay and Kautto, you go into great detail about the nature, structure, and process of triangles. It’s a working manual about how to apply your theories and ideas into action. One of the things that you say in the book is that a triangle is not a threesome. A threesome is not a triangle. What is the distinction you’re making here?

PG: I think that’s a distinction that Fogarty makes and it’s something he puts very high on the list of things that people have to be able to do. What it means is that a threesome is three individual relationships in which there isn’t a lot of reactivity among the folks. There’s nobody on the outside looking in. There isn’t an intense conflict in a dyad that the third person is getting distance from. He used to talk about it as an equilateral triangle in which there was calm in each of the three relationships. And if there’s calm, then all kinds of good things can happen.But triangles are very pervasive. You don’t have to put three people together very long before they fall into triangles.

RW: So you’re saying that the term “triangle” itself implies not just that each of the dyads that you’re in with two other people is affected by their relationship with each other, but that it has become dysfunctional in some way.

PG: Yeah, and that can be by excluding one person. The concept of triangle has built into it that it’s dysfunctional and inhibits people in the system from finding ways to uncover and deal with their difficulties.

Differentiation of Self

RW: How much do you use and think about the concept of “differentiation of self”?

PG: Differentiation of self is one of those things that obviously was one of Bowen’s original concepts. And he stuck with that through his whole career and believed it to be of primary importance because he believed that if individuals could increase their level of differentiation—which in concrete clinical terms means that they are less emotionally reactive and can think their way through their problematic relationship road blocks—then everything would fall into place. Symptoms would go away. Functionality in relationships would improve. I find that it’s abstract enough that it’s difficult to stay focused on that.And so one of the things that I developed was the whole idea that we are mostly left with the level of differentiation that we’re born with. We can make some progress on it over time, but mostly by finding ways of working within that to improve our ongoing level of functioning. It’s kind of like functioning in spite of your level of differentiation.

RW: When we add to that definition the internal ability to feel and think what is true for oneself’ separate from the pressures of your closest social environment and separate from coercion, that eliminates many people who are dependent for their survival, their food, etc. on the dominating power of others.But for that subset who can have the freedom to think and feel what might be true for them, and in so doing reduce the emotionality that you were just talking about, that strikes me as something that one can do, slowly and incrementally throughout one’s life if one knows how liberating and freeing it can be. In fact, the first time I was reading about differentiation of self with Bowen, I thought, “What a light bulb for humanity because it rescues us from the prevailing power dynamics in most families—that the rights and needs of the many are meant to be sacrificed for the good of the few.” And this concept that we’re equally entitled to our own subjective experiences, that seemed so new.

PG: I think you put it very succinctly and I think you put it in a way that is very useful for folks. I have been struck over the years by the power of emotional forces and how easily they can overwhelm even the best of strugglers who are trying to get to a differentiated perspective.

RW: Yes, that’s so true.

PG: It’s out of respect for the power of emotionality that I put some qualifiers on differentiation as the central process of family of origin work. I think it’s also one of those things that people hide behind a lot; they talk about how much they’re differentiating themselves but, frankly, I don’t see it, right?From the work I’ve done in my own family, I’ve found how easy it is to kid yourself for five years that you are rolling along increasing your differentiation when it finally hits you over the head that you haven’t been. You’ve been playing the side game, but it doesn’t have much to do with differentiation.

RW: Right. Just following up on what you said about how easy it is to think we’re differentiating, to me the cue of the power of that emotional force is anxiety. I’m getting ready to go visit my family—why am I so anxious? And it’s so helpful to think about who are the two people with whom I feel most anxious and why, and then go into those thoughts. I think you’d call it an application or a “thought experiment.” What kinds of applications have you used that that might help people understand how to go about thinking about this more deeply?

PG: Well, I like to use the concrete behaviors in people’s relationships and develop them into experiments with some kind of modification of a behavioral pattern. And while you’re doing that, pay attention to what’s going on internally. And if you start to get anxious, that’s important information. And pay attention to the reactive behaviors and the important other people in your family. And sometimes you’ll find that the reactivity that they have shuts down your ability to even think.

RW: So you ask for observations.

PG: I do.

RW: And you help people identify what in particular they’re going to be looking for to observe?

PG: You mean like if they’re making a trip home?

RW: Yeah, or a phone call, email, text or any contact with the person who is the trigger for anxiety.

PG: Yeah, or outside of the therapy session as well. Because you often end up working with one family member in a lot of this.

RW: Yes. And you do make a point that the work is best with those people who are open to the approach of taking control of their own calming and who understand that they can try to change their participation and the repeating sequences of interaction. Have you asked people to identify the repeating difficult sequence of interaction that makes their anxiety shoot up?

PG: Well, if they’re going to be going to a family of origin visit, I would be probably more generic than that and just have them go and really try to keep their own anxiety in check and observe what they see around them. And then bring what they observe back and we’ll put it together and talk about it and maybe design something that goes on over time—combination letters, telephone, other visits, etc.And I think that that does help people get a sense of mastery and a sense that they don’t have to be so anxious and frightened about moving into the relationship and changing their responses to difficult interactions.

Techniques

RW: You said in your Bowenian family therapy video that Bowen sneered at the word “technique.” I wonder do you have techniques?

PG: I think that in Working with Triangles and in some of the stuff that I’ve done in the form of chapters in other people’s books, I spell out a number of techniques that I think are important to the method. And I think there’re seven of them. I probably couldn’t even come up with more than three of them now. But I certainly have techniques that I think are just applications of observations and theories about the way relationships work.

RW: Donald S. Williamson, who wrote The Intimacy Paradox, and Betty Carter and others do have explicit sequences of moves to help people identify the toxic triangle and calm themselves, notice the repeating patterns, identify their own reactions to things that are said, and then develop a self-stated goal for their own change in behavior. Then they take a step, however small and metaphoric, toward that goal and report back on how it went. In this way they differentiate themselves gradually and hopefully humorously.When people do this there’s an enormous amount of emotion that’s released which, according to those family therapists, needs to be expressed outside the family—the hurt, the anger, the intensity—so that through the release of pent-up emotion there’s less pressure to have it come out in interactions. How much of that emotional release have you experienced using such a cognitively based therapy?

PG: Well, I think that in all those paradoxical ways if you ask people to put their cognitive apparatus to work and observe and experiment with the relationship process they’re a part of, the emotion surfaces in very dramatic ways. And if it’s going to be external, I hope it’s in a context with somebody who is a coach or a therapist because otherwise, you know—I was just watching a movie over the weekend which was a remake of a 1939 movie called Women, in which part of what was going on was the group of women that surrounded Meg Ryan when she found out her husband had an affair. And they had more opinions about what she should do and ways to deal with her upset. And so that can be somewhat questionable in terms of its helpfulness, but I think if it gets spilled to your coach or your therapist, it can be very beneficial. You somehow neutralize the negative power and then go back into the relationship that is the source of it and get it talked out.

RW: Yes.

PG: That would be the best outcome. But I still think that the emotional vulnerability in each of us that triggers us to respond in an emotional way is very profound. And all the designs that Betty or Donald and myself come up with are ways of helping with this, helping the moment, helping the month—but over a long-term process of life it’s very easy to get pulled back in on an emotional basis and to be unaware of it.And so it becomes kind of a lifetime work. It’s very different than being in therapy for life, you know. I think that the difference is that therapy ties you to the individual, who is the therapist, and that the process of working it through is in that relationship. There’s nothing wrong with that. It works. But if it doesn’t get back into the natural relationships of your system, it’s going to be limited in the impact of that.

RW: Yes. You make the point in the book that when the therapy progress seems to be bogged down it’s useful to look for invisible triangles that may be holding the person’s behavior in a stuck place. And you mention that sometimes it can be the individual therapist or the couple therapist. So you’re alluding to the fact that we therapists ourselves have our own levels of differentiation and sometimes we tend to side with the client or patient against the people they’re complaining about. And what a mistake that is in that the therapist needs to work toward his or her own differentiation. Say more about that.

PG: Well, I think if you don’t develop an ability to empathize with your individual patient about what they’re struggling with and to hear them out and to validate them that the struggle is real and there’s justification for their feelings, then you’re not going to have too many patients for very long.That’s the first phase. And the second phase is, well, now that you know those feelings are natural and that maybe 90% of the folks on the planet would have them, well, how are you going to put them into a context that helps you develop a way to go work them through with that person? We therapists have to watch for that very fine line between being supportive and validating and just providing no real motivation to go do something about it.

RW: That’s right. If I see your point of view and validate your feelings, that does not mean I agree the others also have a point of view and that to do nothing about it. It doesn’t mean you can’t change your own reaction to it.

PG: It also doesn’t mean that part of your response doesn’t have its own negative set in it, you know? That’s a big part of the problem actually.

RW: Yes. You mentioned that this thinking leads you to ask questions that help the person see how their own interaction is negatively influencing the others and that we think of ourselves as innocently going along reacting to others, but we forget that they’re reacting to us. Say more about that.

PG: Well, it’s like the whole concept of constructive criticism. How many people do you know who are good at accepting constructive criticism?So I think an awareness of yourself and the toxic parts of you and how you trigger people into their own stuff is essential as a therapist,

An awareness of yourself and the toxic parts of you and how you trigger people into their own stuff is essential as a therapist.

The Invention of Genograms

RW: You coined the term genogram, is that right?

PG: Well, there’s a rumor to that effect, yes.

RW: Well, talk about the genogram and how useful that’s been to you.

PG: Bowen started using what he called “the family diagram.” And if you look at his writings and you watch his speeches, he never converted that over to genogram. Until the day he died, he talked about the family diagram. When I had left Georgetown and was at Einstein teaching the residents and fellows and medical students and the like, I did a lot of what you were talking about Don Williamson doing. I had what we called “TOF groups”—therapists’ own family groups—which was a practical way of trying to get people to learn the theory and the idea of the impact of the people in your family on your emotional functioning. And part of it was for people to, in seminar style, put their genogram up on a board, either a blackboard or an easel pad. And it just seemed to me that we were also teaching about generational repeats all the time.We were talking about intergenerational triangles and it was impressive how much the issues and the relationship patterns repeated themselves generation to generation. So I just thought people might relate to this and the notion of a genogram might stick in their head. It kind of gives you a structure with the membership of your system and the major issues in your system and the cutoffs and where they are and what drove them.

I think it’s been very helpful to people over the years and it’s probably one of the techniques or structures that people from other therapy approaches use.

RW: So after you create a genogram with people—whether you’re working with one person or a couple or a family—it helps you to understand the different forces that hold the system in place.

PG: Yes.

Functional and Dysfunctional Attachment

RW: In Working with Relationship Triangles, you say, “Quite apart from how people feel about the closeness or distance between themselves and others, we should make another distinction between kinds of closeness and distance. Closeness can be a kind of functional attachment. This allows people in a relationship to preserve their boundaries and their autonomy in thinking, feeling and action while they remain connected in a personal way to each other. Alternatively, closeness can be reactive and driven by anxiety, a kind of dependent clinging or anxious attachment that says implicitly or explicitly, ‘Please don’t leave me. I’ll do anything to keep you. If you leave, something terrible will happen.’ Similarly, distance can be a deliberate and planned exercise to deal appropriately with a developmental or relationship problem” (page 59).I quote this because it jumped out at me as very consistent with what a decade and a half later is the very important focus on attachment and the patterns of attachment—secure versus anxious and avoidant. Because you’re making the point, I think, that once we excavate what the core issue is—and it will often emanate from the marriage that then creates the nuclear family—the dynamic has to do with the tension around closeness and distance, in being able to get access to a feeling of connection or “are you there for me?” Functional attachment, anxious attachment, those are precursors to this new attachment conversation that’s going on. When you work with people, how do you focus on that issue, that struggle in them to find a happy, close enough, but not engulfing, far-enough-away-without-abandoning equilibrium?

PG: That’s a very good question. And I think if you realize that most attachments that people have with one another is of the anxious attachment variety that gets called love—as opposed to the kind of functional attachment where you add to that an ability to be open about your feelings for the other person. That’s different. And that is the root towards the kind of intimacy that all of us are looking for. I was thinking while I was listening to you read that section, “Yeah, that’s pretty good. I agree with that.”You were talking about techniques before—one of the techniques becomes the use of the process question: “Do you think that the importance of being connected to your husband comes from a need for a kind of closeness that will benefit you both in your ability to be intimate with one another and to function as individuals and as a dyad? Or do you think it’s kind of a clingy attempt to hide out behind him or in the relationship itself?” They’ll say, “Will you repeat that?”

I think that you take that notion and you try to get people to think about it. And you try to get people to think about it by asking some fairly brief—a lot briefer than that last question came out—questions to focus them on how much of their attachment is being driven by their anxiety, being driven by a fear of a loss of the other, being driven by a way of toning down what they’re experiencing as criticism. I think that can be very helpful to people.

Each of us has a different allergy in this regard. I mean, some people just have an emotional allergy to somebody who is clingy and wants to have their arm around them all the time and wants to exchange intimacies. Other people have an allergy to too much distance and too much avoidance and an inability to talk about the personal in the relationship itself. And how much of that is testosterone versus estrogen driven or whatever? I don’t think we know.

RW: No.

PG: But it remains something that’s consistent over the decades that that is a part of the problem and also can be a part of what feels good in a relationship. We used to have arguments at Einstein family study section where we’d talk about, “I don’t care if it is emotional fusion; it feels too good to let go of it!”RW: How have you been evolving professionally and philosophically since the publication of your last book?

PG: Well, I’ve gotten involved in a whole bunch of stuff that mainly has to do with being the grandfather of 11 grandchildren.And that has taken away the drive and the energy to write another book. But it’s been worth it. I mean, the kids are terrific and watching them—my oldest grandchild is 19 now and my youngest is 15 months—watching them continues to teach me about myself in ways that are very important. But I’ve been thinking, you know, not a bad idea to start getting back to some of that.

RW: Do you have another book in you? And if so, what would be the message of that book?

PG: I think the ideas that are in The Evaluation and Treatment of Marital Conflict, book that we put out in the middle ‘80’s, and even some of the stuff that was in the original textbook you were talking about before, are only partially developed. I think that the concepts develop most clearly when you’re putting them to the test with your students. And we still do that, but not with the kind of intensity and frequency that we used to. In recent years as managed care has come in, training programs are kind of atrophying. There used to be a battle between five or six models of doing things, and the debate and the discussion and the application to clinical situations of the models were very enriching, very enlightening, very energizing.If I was going to put another portion of my energy into my work as opposed to my grandchildren—they’re going to probably tell me to do that pretty soon—I would try to work towards applying the models that were developed in the late ‘80’s and early ‘90’s and see if they can hold up, you know? Try to make distinctions between ‘70’s and ‘80’s versions of intimacy and attachment and present day. Are they different? What are the differences? Can there be an evolution that provides more refined and sharper models that improve clinical outcomes?

Flying-By-the-Seat-of-Your-Pants Therapy

RW: And would you include integrating the various models?

PG: I think as much as they can be integrated, yeah, absolutely. I think that there’s a need for that. And the question is how do you do the integration without getting the lowest common denominator? And I think that some concepts go together and others don’t. But it’s rare that there’s been one way of thinking about these things. Ego psychologists had a structural way of approaching things just like Minuchin and others have had a structural way of approaching things, you know? And I think that the analytic psychodynamic models really evolved into the multi-generational systems whether it’s Bowen and Fogarty and myself and Carter and Monica and all those folks or if it’s a more strictly psychodynamic approach to things, or Haley and some of those people who really came out with a totally different perspective.So all that stuff that was done kind of side-by-side in the ‘70’s and the ‘80’s. I think if people had time and the interest in the information, more developing could take place. And hopefully that development would provide a refinement that could be taught to people that are doing therapy because it seems like folks are flying by the seat of their pants a lot in doing therapy these days.

Some of therapy has kind of dwindled down to giving advice, you know, from your own particular perspective, which isn’t bad unless it’s the only thing you know. I would love for a day to return where people were working together to define models and refine them and make them reproducible.

Maybe that’s not possible in this time-crunched era that we’re in now, but I would like it.

RW: Many people are calling for a broader dissemination to people. The APA, for instance, is looking for ways to teach psychology outside of clinics, hospitals, private practice and academic settings, using the internet, for example. What are your thoughts about that?

PG: I am intrigued by it. I think folks my age are a little intimidated by the technology, but I think it’s crucially important. What my kids can do with a computer in terms of scope and rhythm and efficiency is so far ahead of what I can do. The grandchildren are even better at it.

RW: I agree and I’m glad to hear it. Are there any final thoughts you would like to share before we close?

PG: Well, I think that making the family of origin work relevant is important, without trying to shove it down people’s throats. A long time ago in our work we saw it as essential to not try to sell a particular approach, but to start with where clients are feeling the pinch, where they’re feeling the pain, and to proceed in a way that first and foremost helps them with their symptoms—whether that’s prescribing medication or using cognitive techniques or incorporating family system theory into the work.And then continuing to check back in with them about what makes sense for them because they’re putting in time and putting in money, so they ought to have some say about where our focus is and where we’re trying to take them.

RW: That makes good sense. Thank you so much. I have greatly enjoyed our discussion and appreciate your body of work and your willingness to share this with us now.

PG: Well, thank you for asking me.

Harry Aponte on Structural Family Therapy

Posted on September 17, 2010February 27, 2026 by rezendevknowfully.com

Putting Therapy in Context

Rebecca Aponte: First, just so our readers are not confused, we should clarify that neither of us knows of any family connection, despite our shared last name.

Harry Aponte: That’s correct.

RA: You primarily practice family therapy. It’s interesting, because family therapy seems to be in danger of disappearing–it doesn’t seem like most therapists do it at all. What’s your sense of the state of family therapy today?

HA: I think family therapy has gone through its phase of fanaticism. It’s like so many other perspectives on therapy: it went through a phase where people made a new discovery, and they got infatuated with it, and that became the answer to it all. I believe the thinking about working with families has matured so that it’s not such an exclusive focus. People are much more flexible about working with individuals and couples as well as families, and people are more flexible in terms of being prepared to work with some unit of a complex family system without necessarily seeing all the members of the family, while maintaining a broader perspective so that they understand that the individual or the couple in the context of not only family, but also of community. So I don’t think it’s dead at all. I just think it’s matured to the point that it’s been incorporated into the very large and complex field of therapy.

RA: Do you think that the perspective of keeping the broader sense of community is as integrated into most therapists’ minds as it should be?

HA: Well, to answer the last part of that question, I think it should be. I believe that we have become much more sensitive and knowledgeable and insightful about the impact of the broader social system on people’s personal functioning: the effect of people’s social economic circumstances, the effect of culture, the effect of people’s spirituality, and how all of those affect in a very intimate way how people think of themselves, how they relate to one another, how they understand their reality. Any therapist who wants to engage with another human being at any level at all–to understand that person, that couple, that family–has a lot of factors to take into consideration. And I think that’s happening. I think people are much more comfortable with looking at their clients from a variety of perspectives at the same time.

RA: Is that something you would actively reflect back to a client–that you have their broader context in your mind–although they might not be thinking about themselves in a broader context?

HA: What I reflect back to a client is what I think will be helpful to the client. I’m not there to give the client a lesson on what therapy should be. I’m there to be helpful to the client. I need to take responsibility for having all of those perspectives in mind and taking them into consideration as I explore what the issue is and the roots of the issue, and what resources are in that client’s life for that client to be able to make the necessary changes to solve the issue. I don’t need to explain that to the client, but I do need to be aware of it and work with it.

RA: I’m asking some of these from the perspective of therapists who primarily see individual clients, because that’s probably the most common today. If someone does come to you as an individual, how might you bring up getting their family more involved in the treatment? Is that something you would suggest right away, or does it happen over time?

HA: I’m a pragmatist, so what I do is I listen carefully to what the client’s issue is, and I try to understand the issue, and I try to understand the context of the issue: who’s involved, who’s touching on that issue of that particular individual, as well as what resources are available to that person in their context. And I will try to pull in whatever and whoever is necessary. Even if I need not pull them in, it doesn’t mean that I’m not going to work from a suspended ego complex or perspective. It’s rare that I not ask clients about the history of their issues. And if I ask about the history of their issues, I’m asking about them in the context of their current relationships, their past relationships, including their development within the family of origin. All of that helps me to get some deeper sense of what they’re struggling with and why they’re struggling with it the way they are.

Structural Family Therapy Defined

RA: Let’s back up a bit. What exactly is structural family therapy? Is the distinction from family systems therapy important?

HA: Structural family therapy is an aspect of systems thinking. You have to understand the origins of structural family therapy in order to appreciate its contribution to systems thinking. The work originated, of course, with Salvador Minuchin, Braulio Montalvo, and other people who were working together at the Wiltwyck School for Boys in New York. They were working primarily with all these youngsters who were black and Latino, and who were institutionalized. These therapists began to include the families of these boys in their efforts to be helpful to the boys, because they found that working with them in an institution, outside of the context of their families, they were not achieving the success that they hoped to achieve. As they included the families, they found their success rate change significantly.Well, what happened? Because they were working with boys and families that came from seriously disadvantaged circumstances, they found themselves working with families that were, more often than not, poorly organized, in that they didn’t have the kind of structure that normally helps families to cope with the challenges that life brings. A typical story for a therapist working with the families I’m describing is you find that when you begin to talk with them, they interrupt each other, they speak over each other, and very often it’s unclear who’s really in charge of the family. And if there is somebody in charge, they may be so totally in charge that other people don’t have a voice in the family. You don’t have an organization there that can identify a problem and come together in a way that can solve it.

It’s really no different from what one would be thinking of in another kind of system, such as a business, where when you see a problem in how that business is operating, you’re going to be thinking of the structure and organization of the people who are working within that business. If they’re not effectively communicating with one another, they don’t have a clear hierarchy, and they don’t have clear responsibilities, you’re going to find that things fall through the cracks and the system fails.

Well, that happens with families, and it particularly happens with families that come from disadvantaged circumstances because they also come from disadvantaged communities that are poorly organized. These families, then, suffer the effects of their community, and they’re not able to organize themselves in a way that normally enables families to meet problems and solve them. Every family has problems, but when you don’t have an effective organization, then it’s hard to talk about the problem, it’s hard to identify the problem, it’s hard to cooperate together, it’s hard to find leadership within the family so that you can work towards a particular goal and solve the problem.

That’s the first experience of therapists who worked with families from disadvantaged circumstances. The gift that Minuchin and his colleagues gave us was that they focused on that organization. They understood individual dynamics; they certainly understood the contributions of other systems therapists at the time. But they were dealing with a particular population that had a significant issue around family structure, and that is an aspect of systems thinking. When you are dealing with families that are well organized that still have problems that they can’t solve, you tend to take the structure for granted. You cannot take the structure for granted when you’re working with these families that come from disadvantaged circumstances and who themselves are not organized in a way that’s effective.

RA: It sounds like one of the things that they found was that the pathology of the boys they were working with existed within this much larger environment, far beyond what would have been within the control of the boys or even the therapists.

HA: That’s correct.

An Ecostructural Approach to Family Therapy

RA: You’re talking about major social issues that are much bigger than families as well. How do you overcome those obstacles in a family therapy situation?

HA: Early on, I wrote about an ecostructural approach to family therapy–“eco” referring to the social ecology of the family, highlighting how so many of these families’ problems had their roots in the community they lived in. You have schools that have not only poor resources, but that themselves may have gangs organized within them, that are physically dangerous places for the children there, that make it difficult for the teachers to run the classrooms and create an effective learning environment.When you are working in some of these neighborhoods, the street itself becomes a place that is dangerous. It becomes a place where children just cannot go out and mix together and play together and do the kind of social learning that is important for their development. They’re dealing with drug dealers and other kinds of factors in the community, in the street themselves, that affect how these children think about themselves and how they think about the world. They have to cope; they have to survive. They may have to be more aggressive than children under other circumstances. All of that affects their personal development. And in these neighborhoods, you have problems with getting proper healthcare as well as educational resources. So you have a lot of social factors that are impinging in very direct ways upon the ability of families to function well.

And these families cannot just put all of their energy into nourishing the family environment. They have to be thinking about how to deal with protecting themselves vis-à-vis the community, so they put energy out there that should be put more into the family itself. They’re dealing with difficult environments, and that affects the ability of the family to function successfully.

RA: It’s a lot to think about.

HA: It is a lot to think about. And when you’re thinking about the environment, and you’re thinking about the family, you really cannot offer families coming from these circumstances a service that is exclusively focused on the family unit itself. You have to take a broader perspective that says, “I’m dealing with a child that’s in the context of a family, that’s in the context of a community. So when I then conceive of the work that I’m doing with these families, I have to take all of these into consideration and organize my services so that I can mobilize various aspects of that complex ecosystem to support the goals that I have with this particular family.”My point, though, is that this work with disadvantaged families gave a gift to the whole movement of therapy. It highlighted the importance of this complex social ecosystem– its effect on individual functioning–and the need to be more sophisticated about the dynamics of these various levels, in terms of understanding how they work, and in terms of working with them so that we can achieve our goals. It opened up a whole area of thinking that had to be taken into account. I think it’s been incorporated naturally, and I think people today think in those terms much more readily than they used to.

If we go back historically to the psychoanalytic movement, that was a very intense focus on the individual and what was happening in the individual’s psyche. And that provided critical and wonderful insight. Then we realized, “Well, that’s not the whole person. We need to expand our perspective.” So we expanded it to the families. Then we worked with this particular population and said, “My goodness, we really need to be thinking about the context in which this family is developing.”

So it just broadens our perspective. And we’ve learned ways of understanding these dynamics so that we can actually work with them, not just as sociologists, but as therapists who can be quite focused on trying to obtain a particular objective.

RA: Particularly now that therapy is not just the realm of white, middle-class clients, as historically it has been, there’s a more focus on tailoring therapy to fit people from a multitude of different ethnic and economic backgrounds. Do you have specific advice for therapists who have worked primarily with middle-class individuals, on branching out and working with people who have these bigger issues? One aspect is just being cognizant of the fact that there are many aspects of someone’s development and someone’s selfhood that extends beyond them. But what do you do with that awareness?

HA: I think what we’ve seen now, as a very normal part of therapist’s training, is the therapist being more conscious of the factors of values, world views, culture, spirituality, how these affect the way they see their problems, and how they view a solution that is acceptable to them. We have a much more complex society today than we had 50 years ago or further back, where there was a generally accepted norm of what a family is, how a family should function, and what is acceptable behavior.Today, we have a society that is much more fragmented and often in conflict with itself about what is acceptable in terms of lifestyle and behavior. That changes what one may consider to be a problem, and it certainly affects what we think of as appropriate solutions to problems. That thinking–which was expanding already back in the ’60s, when The Families of the Slums was written by Minuchin and colleagues about the work at Wiltwyck–all of that has been incorporated into everyday, normal therapy.

Nowadays, I don’t know what therapist training doesn’t include some courses that say, “You need to be sensitive to race and culture, and sensitive in such a way that you understand how race and culture directly affect not only how we view the issues and how we work with them, but the very nature of our relationship with our clients, and how we join with our clients.” Therapists will have their own culture, they’ll have their own values, as well as certainly their own personalities and life experience. But how do these therapists relate and connect to clients who are always going to be different in some particular way or another, in a society that says we need to be more accepting of the differences among us? So we’re working in a more complex world today as therapists than we did in the past.

The Person of the Therapist

RA: Certainly. And it sounds like you’re saying, too, that it requires therapists to be more sensitive to themselves and to their own world views, and really have a clear idea of their own personalities and backgrounds and how they appear in the therapy.

HA: If you’re not aware of what you’re bringing to the therapeutic relationship and the therapeutic process, you can’t take responsibility for it.

RA: Is that essentially what “the person of the therapist” means?

HA: That’s exactly what “the person of the therapist” means. The therapy of today is a therapy in which therapists are certainly much more actively engaged with their clients or patients than what would have been the model in the psychoanalytic world. And certainly, if you read the writings on structural family therapy, you would see how therapists use themselves very actively to influence the dynamics within the family, and how they engage with individuals within the family. What I’ve done with the “person of the therapist” model is to try to take that a little deeper and say to therapists, “It isn’t just a matter of how you use yourself.” It starts with understanding yourself, not only from a psychological perspective, but also from a cultural and spiritual perspective. As a therapist I have to get in touch with what’s inside of me–and not only what’s inside of me, but because these are living, active dynamics, I have to get in touch with what I struggle with in my own life, what I struggle with psychologically, what I struggle with in my relationships with people, what I struggle with spiritually. I need to understand that, I need to be in touch with that, because all of those factors are active when I engage with the client. They’re going to affect how I see the client, how I hear what they have to say, how I connect with that person, how I even conceive of how we’re going to try to find some solutions.These factors are active even beyond our normal awareness as therapists. We need to get the kind of training that makes us experts on who we are and what’s happening within us, so that even as we are working with our clients, we’re conscious of what’s going on within ourselves, and we can take responsibility for what we communicate about ourselves and what we try not to communicate about ourselves and how.

RA: How do you practice that? Does that mean therapists do their own therapy, or is it more self-reflective?

HA: It’s a specific kind of training. Traditionally–certainly in the psychoanalytic world–therapists needed to undergo their own therapy. But that objective was one that said, “I need to try to solve my own personal issues so that I am freer to work more effectively with my clients. I’m not going to put on my clients my own hang-ups.” That way of approaching the work of the person of the therapist was continued and picked up by Virginia Satir and Murray Bowen, but again from the point of view of, “Let me identify my issues and try to resolve them so that I will become a more effective therapist.”What I’ve been emphasizing is that all of that is absolutely important and useful, but the simple reality is that we never resolve all of our personal issues. We struggle with ourselves the rest of our lives. We need to go through training programs where we become aware of ourselves in the context of doing therapy, not to resolve personal issues, but the primarily to understand ourselves in vivo: When I’m engaged with my clients, what’s going on inside of me? How do I get in touch with it? How do I decide how to use what’s going on within me in order to understand and empathize better with what’s going on in the client? How can I relate in a way that’s specifically useful to the client at this particular moment in time?

So it’s an approach to preparing the therapist to use this instrument that is me, in a way that is much more effective. Then I can use all of what I’ve learned technically and theoretically of other models of therapy, and I can use it through the person that I am in a way that amplifies the effectiveness of my work.

RA: So this model rejects the psychoanalytic idea of being a blank slate or completely neutral, and focuses instead on the therapist’s personhood.

HA: It certainly does. The advantage that classical psychoanalysis had was that the analyst was sitting behind the couch out of the view of the analysand, and wasn’t engaging eye-to-eye with the patient. Today, most all of our therapy is eye-to-eye, and we feel each other. We and our clients are engaged personally in the therapeutic process, and that’s a simple reality. The question is, how do I engage personally within the boundaries of my professional goals so that I can be of use to this person?

The Role of Spirituality in Therapy

RA: You’ve mentioned a couple of times the role of spirituality in therapy. How do you bring spirituality into the therapeutic relationship in a way that’s safe for clients who might have different views?

HA: It’s not a matter of bringing it into the process as much as it is of being aware that it’s there. Spirituality is just a normal aspect of who we are. We all have a morality of one sort or another. We all have a world view–a philosophical perspective on life and what’s important in life, what’s meaningful about life, what our goals should be in terms of moral principles. And that will certainly affect how we think about the issues that come up for us. A simple example that’s very relevant today is the postmodern view of reality, where reality is something that you cannot know directly, but only through what you sense–meaning that you cannot prove a truth, so truth is only in the eyes of the beholder. That’s a spiritual perspective; that affects the way we look at life.And if you do believe there is a reality that we can perceive, and that there is an objective truth that we can relate to, that’s very different from somebody who comes from a perspective that says, “It’s really what you perceive, more than it is what you think is out there.” That affects how we think of our problems; that affects how we’re going to try to solve our problems.

RA: So you’re trying to understand how clients perceive themselves and their problems, and having knowledge of yourself is primarily to keep you from being closed off from their world view when it’s different from yours?

HA: If I’m going to understand them, I need to try to understand them from an emotional perspective, but also from a cultural and spiritual perspective. So I’m listening for all of that. But I can’t listen to that and understand it unless I am aware of that within myself.You cannot see spirituality in somebody else unless you can see it within your life. How is it real for me? How does it affect me? The better I understand that, the more insight I’m going to have, and the better I’m going to be able to see how it relates to their lives. So that becomes something I normally look for as people present their issues. It also influences what kind of questions I’m asking them, so that I don’t just assume what their moral stance is on things.

For example, when you’re working with adolescents and their families, and their sexuality is an issue–which is almost inevitable when you’re working with adolescents–what is their moral view about sex outside of marriage? What is acceptable? What is not acceptable? That’s going to influence the work that you do; it’s certainly going to influence the goals that you determine are part of your work.

RA: I understand that you worked for some time with Sal Minuchin, and I’m sure some of our readers would like to know what he was like. How was it to work with him?

HA: Sal is a fascinating personality. The man is intellectually so bright and so original in his thinking, but he’s also very much a dynamic human being, and that influences his style of therapy. He always engaged with the clients very fully and emotionally–not only intellectually. It made his model a very dynamic approach to life, so that it could be challenging to therapists who tended to be much more reserved in how they relate to people. But Virginia Satir and Carl Whitaker were also individuals who had dynamic personalities, and used that dynamism in the way that they conducted their therapy. Sometimes people lost perspective and confused the dynamism of the individual with the theory and the technique that they were trying to teach.

RA: What’s your sense of yourself as you developed your own personal style of working in this frame of mind?

HA: Sal was more likely to be confrontive than I would be. My particular personality and style is that I tend to be very direct with people, but I also tend to be more inclined to want to join with people and relate empathically with them. You would get a very different feeling with me than you would have from Sal. Sal, as you see in his writing, talked more about unbalancing the system, and he would often unbalance that system in a more forceful way than I would. I would also unbalance it, but not in the same style.

This really emphasizes the importance of knowing one’s self personally and saying, “I’ve got to work through the person that I am, and not through the person of the guru that I admire.”

RA: Absolutely. You’ve been doing this for quite some time now; do you have a sense of your personal evolution and what’s changed? Do you feel yourself becoming more confrontive over time or less so, or just more refined?

HA: I think what has changed is that as I’ve matured, I’m more confident about myself when I’m with people, and I’m more confident about what my thinking is, so that I can risk being direct with people about what I see and what my opinions are about what’s going on, always allowing for the feedback and room for them to challenge me back. But the challenge is not so much a matter of me confronting as it is a matter of being able to state, “This is the reality that I perceive right now. Now give me your reality and react to what I’m suggesting to you.” That doesn’t work with certain clients, but I find it tends to work with people who are looking for results, and they say, “I can see what you’re saying and I can see why you’re saying it, and it does or does not make sense to me, but now I can give you back some feedback and we can work actively together to make something happen.”

RA: Do you have a sense of where you feel yourself being pulled in the future?

HA: As I look towards the future, I’m now continuing to focus on the person of the therapist and trying to develop that further, not only as an aspect of training therapists, but also as an integrating principle in the therapeutic process: we are integrating our technical and theoretical thinking around who I am and where I am in my life, so that when I do the therapy, it becomes very much my therapy. Even as I’m learning from other people, I’m moving more in that direction. But that also says to me that the common factors work being done by people like Sprenkle is an important contribution. I’m looking more at the common factors among the various models of therapy, and including these factors among the various views of the use of self. I’m thinking about how to highlight those common factors to encourage therapists to extract the essential elements of the therapeutic process, rather than having to choose between various camps of therapy, which I think is such a waste of time.

RA: We’ve definitely covered a lot of ground. Do you have any concluding thoughts you’d like to share with our readers about any of the topics we’ve discussed?

HA: We ended on the note that I hoped we would end on, which is the importance of therapists training to understand themselves more profoundly than they have in the past, not only from a psychological perspective, but also from a cultural and a spiritual perspective, so that they can use all of themselves more effectively in their therapeutic work, on the one hand; and on the other hand, the usefulness of thinking about common factors among the various therapeutic models so that people will not blind themselves to the contributions of the various models because they need to adhere to some particular school of therapy. From my perspective, there is no model of therapy that does not offer us an insight that is useful to all of us. I think it’s important that we open ourselves up to learning from the various schools and approaches to therapy, and then take that and integrate it within ourselves so we become effective therapeutic instruments.

RA: I think that’s sound advice. I appreciate you taking the time to talk with me today. I’ve very much enjoyed it.

HA: Good, I’m glad you did. It was a pleasure, Rebecca.

Monica McGoldrick on Family Therapy

Posted on August 19, 2010February 26, 2026 by rezendevknowfully.com

Monica’s Coffee Shop Transformation

Randall C. Wyatt: Monica McGoldrick, LCSW, family therapist, teacher, writer, and so much more, that’s what we’re here to talk about. Good to have you here.

Monica McGoldrick: Glad to be here.

RW: Monica, how did you first get into the field of psychology and social work?

MM: Well, I was studying Russian in graduate school and then I kind of dead-ended because I didn’t see myself becoming an academic. The day I finished the program, I met a guy in a coffee shop who was studying psychology, and I thought, “Wow. That’s the perfect field for me. I could study the life of Dostoevsky, my hero, and then could do something with it.” I really do think you could study Dostoevsky and learn most of what you would ever need to know about human psychology.

Victor Yalom: Who was this guy you met?

Monica McGoldrick: Yeah, actually, you probably know him. His name is Lowell Cooper.

VY: Lowell Cooper, of course. He was a professor at the California School of Professional Psychology where we both went to school. He teaches group theory and Tavistock groups.

MM: So, he was studying psychology at Yale, and we just started talking. And before the day was out, I went home and told my parents that I wanted to study psychology. My mother had always wanted to be an anthropologist but her mother wouldn’t let her do it. She was otherwise very difficult but when I told her about psychology, she just said, “If that’s what you want, you just have to pursue what you want. Do it.”I met with a psychologist, Jack Levine, who also part of the Yale system. And he said, “To make sure you really want to do this, why don’t you go work at the mental health center?” It was 1966, and they were just opening the first community mental health center in New Haven. I went and applied for the job with a nurse named Rachel Robinson who was the wife of the first African American ballplayer named Jackie Robinson. He was my hero from childhood because I come from Brooklyn and Rachel became my first boss.

All the boundaries were down. I was a psychiatric aide working on this brand new unit in the mental health center. And during the time there were quite a few people who said, “Why don’t you think about social work? It’s a lot more practical.”

The psychologists didn’t seem to do anything very interesting. They wrote psychological reports that nobody read.

VY: What do you mean nobody read them?

MM: Anytime we had a really hard patient, we’d send them to psychologists for a report. We had a really famous psychologist who did the assessments. A client would be raging around the clinic and after two weeks the psychologist would pass out the copies of the test report which said how rageful the patient was. There’d be some discussion about how messed up the client was; then the psychologist would leave and we’re still be left with the raging patient. What good was that? (laughter)

VY: Right. What are you going to do now? We know he’s raging? He’s a 4.9 on the test and we know his IQ. Hopefully, we have come forward from those days.

MM: And the psychiatrist would be there in the morning for the sort of group psychotherapy with the patients and would act very important and we’d have big meetings discussing what that person thought. But the psychiatrist had not seen the patient all day, the psychiatrists would know very little.

RW: So the people who knew the least and did the least had the most power, the psychiatrists and the evaluating psychologist. What a system!

MM: That’s right. Finally an overwhelmed social worker who had responsibility for all the clients and families on our unit, said, “Any psych aide who wants to help me, I’ll supervise you.” And I was like, “Me!” All afternoon and evening we would see the patient, and then we’d see the patient when the family came to visit. And it would be just unbelievable the things you would learn.And then the next morning, the psychiatrist would appear again knowing nothing about the patient and just spout off again about what he thought was going on. And I thought, “God. I don’t get it.”

RW: It’s obvious now why being a social worker was so attractive to you.

MM: Exactly. The social worker had the most interesting work because they got to actually work with families. So, I signed on to work with families and I just never looked back. I thought, “I’ll be a social worker and I’ll work with families.” So, I went to Smith College for social work and I worked. But in order to stay in New Haven, I had to either be married or in therapy. And I wasn’t married and had no prospects.

RW: Why did you have to be married?

MM: Well, if you were married they wouldn’t separate you from your husband. If you were not married, they could send you away for a summer program and they might send you to Denver or anywhere in the country.

RW: I see, but where does therapy come in?

MM: Psychotherapy was the other best alternative. I signed up for therapy, telling the guy the very first session, “I need a letter telling them that I need at least two years of your help, and that I can’t leave New Haven.” He agreed to do it. And I had a great social work experience because I worked at the Yale-New Haven Hospital unit, which was absolutely fabulous. Very family oriented.

RW: At that time, what was the state in the ’60s of family therapy when you entered into it?

MM: It was the most exciting time. And on this unit, probably of all the places I could have ever been, families were seen three times a week. This was for the rich and famous as well as anybody else. It was remarkable and it was totally integrated into whatever happened with the patients.

Where Have All the Families Gone?

RW: Nowadays, it seems like – at least in California, Northern California – it’s not easy to get a family in. Parents, even those who are together and have kids, they’re running around so much. Oftentimes it’s hard to get everybody in at once. What does it mean for family therapy, that it’s hard to get everybody in?

MM: I think what’s really made it terribly hard for family therapy, in my own experience, is not the families themselves. It’s what’s happened with managed care, insurance, the drug companies. The drug companies have totally taken over psychiatry. And managed care has totally taken over how mental health services take place, and they have no interest whatsoever in family therapy because it is not as short and sweet as seeing one person three times. Or, you know, medicating them up and being done with it. Yes, it’s true that we do have a high rate of divorce, and we do have parents who are working in different places. Nothing supports paying attention to the family issues that contribute to kid’s problems.

RW: So it’s much different than the heyday of family therapy when the idea of treating families was the way to go. There’s one or two managed care companies in California that actually support couples therapy and family therapy. And they actually have it in their manuals. Basically, most companies seem to support medication or groups, many of which can be helpful, of course, but nowhere near the gold standard of caring for people.But lets move to what you love, and that is family therapy. What kind of therapy practice are you doing now?

MM: About 14 years ago, 1991, I basically got kicked out of the medical school, you might as well say. I mean, they couldn’t exactly fire me because it’s a faculty position I had. But they took away my secretary. They told me I was going to have to see 28 clients a week in the emergency room.So the training program in family therapy was just basically moved out of the system. And in its own very small way, it still survives. We have a small family institute in the town where I live. A very little house in a very little town. We’re a very small group, and we have very small classes also of people who want to study family therapy. And every year we wonder, “Are we going to have a class?”

RW: So, how would you characterize how your work is similar or different to other family therapists? Your approach, your ideas?

MM: Okay, well, along the way—and this is probably important in terms of where I ended up—in 1972, I went to a family therapy conference where I heard Murray Bowen. And I was completely blown away. He was talking about getting a relationship with your mother, and I just thought that was ridiculous because my mother was so impossible. Even though I was into family therapy, I wasn’t into family therapy for my family. So, I really could hardly hear what he said, but he was basically saying as strongly as he could express it that you’re nowhere if you haven’t worked it out with your mother. And I kept thinking, you know, “This guy is a real idiot.” Because he certainly never met my mother.

RW: What was your mother like?

MM: She was very difficult, very difficult. And anyway, during that conference, I met one of Bowen’s students, a guy named Phil. And we hit it off very well. And he was just starting a family institute, and I asked him if he would coach me on working on my family. And he asked me if I would work at that institute. So, I really became a Bowenite and I would say that I’m still very much of a Bowenite. And there aren’t too many of us. I don’t think I have met any Bowenites on the West Coast. But, you know, you recognize them when you hear them talk about families.

RW: What’s a giveaway?

MM: Well, they don’t believe in cut-off. They pay a lot of attention to family of origin. They do genograms, for example. I mean, I’m known for genograms.

RW: Can you explain cut-offs?

MM: Cut-off.We don’t believe that if you don’t like your mother you should just say, “Enough of this. I’ll find somebody else.” They believe that everybody should try to work it out with their mother. They basically believe that you never give up.

RW: So, did you work it out with your mother?

MM: I did work on it a good while. It changed my life.

RW: How so?

MM: Well, the power of being able to think systems and realize that we are all part of the system. So I kept trying to change my mother, and really, I was trying to get her to change her relationship with her mother who she had hated before. I stopped… I learned that you can’t change the person. You can only change yourself. And so to change how I was in relation to her and also to change other relationships in the family… to just change.Now I would think of it as taking my power back. That if I gave her the power to put me down and feel put down by her, that was something I actually had control over. And so if I flipped that around and did something different with it, instead of feeling wounded every time, and thought about what might lead her to do that, that it might be her problem, not my problem. It just transformed everything.

Bowen and Haley Throw Stones at McGoldrick

So I did change my relationship with my Mother. And I just saw systems through that lens. Some years later Bowen didn’t like a lot of my ideas although I liked all of his ideas.

RW: Do you recall the ideas of yours that Bowen didn’t like?

MM: We got into doing work on the life cycle and he didn’t really think that that was a very good idea. Betty Carter and I wrote a book in 1980, The Expanded Family Life Cycle (Third Edition). And he did it sweetly, but Bowen basically said, “Eh, this is kind of an… eh idea, but hey, you could read it, whatever.”

RW: Did you keep the foreword?

MM: Oh, yeah. We did. Yeah.

RW: Your ideas certainly got a reaction worth noting instead of being ignored.

MM: Well, his wasn’t the worst reaction, actually. Jay Haley was even more critical. You see at that time nobody had written anything on the life cycle from a family therapy point of view. And so we searched the literature for anybody who had ever said anything about the life cycle.But Jay Haley had written this thing about Milton Erikson (though it had little to do with the family) which was about a life cycle perspective. So we thanked Jay Haley for his contribution to our thinking in life cycle terms. And after we published that book on life cycles and families, Haley wrote a nasty article on the right to choose your own grandchildren, saying that he rejected us as his grandchildren. He had nothing to do with us or our ideas.

RW: You were kicked out. Seems Haley was into cut-offs.

MM: Yes, Haley kicked us out. Yeah, he was.

RW: Well, it’s good to see that the old Freudian idea of just getting rid of all competition was alive and well in the family therapy world!

MM: But later on, Bowen didn’t like the culture stuff, either. He didn’t like the gender stuff. He didn’t like any of it.

Never Run Logic Through an Emotional System

RW: Let’s come back to that later, for now, lets go more into the work itself, working with families. How do you or Bowen see the idea of cut-offs with families and dealing with your parents in adult life? Should you just confront your parents like some therapists suggest?

MM: Your parents always matter. Bowen felt so strongly that it’s all about getting a personal relationship with your parents. But you have to pay exquisite attention to what’s going on in the emotional field, because to do exactly that, write a tell-all letter to your parents disregarding, you know, where you are with them—what’s the possibility they could possibly hear such a message and not feel hurt and insulted or shot down by it? He would say that’s outrageous. And you’re going to cause years of conflict.

RW: That’s good to hear, since I am certainly an advocate of not just wailing on parents without dealing with the complexity of the situation and the likely consequences.

MM: Well, you should read our paper that we wrote on coaching. Because we lay out Bowen’s theory as well as we can. I mean, I lay it out every chance I get.

RW: Well, I want to see that. Most parents are defensive anyways, to say the least, since they often, rightly or wrongly, feel unappreciated and blamed for their kids problems.

MM: One of the rules of thumb is never run logic through an emotional system. If your family is in an emotionally reactive place, why in the world would you take what we would call an “I” position and say, “This is where I stand.” He would say that is outrageous and abusive to your family to do that.

RW: I may be a closet Bowenian then.

MM: Well, you just might be, so here we go. You’d be the first west coast Bowenian we ever had! (laughter)

RW: Perhaps it’s because I am in California or because of my upbringing, but I have always been troubled by theories and practices of therapists who so easily suggest that clients individuate from their families, without considering the many layers and meanings of family relationships. Of course autonomy and individuation have their central place in life, but so do connection, family, community and the like. It seems western psychology too often forgets this part of the life equation.

MM: Absolutely.

Genograms: More Than Just Squares and Circles

RW: What is the importance of genograms in your work with families or individuals?

MM: A genogram is just a map. You know, squares and circles. But what’s important is paying attention to where people come from, who they are, where they’ve been, where they’re coming from. And genograms are just a way to map that. So the point is, it’s important to consider people in historical context. That’s why genograms are important. It’s just to say, “Who are you? Where did you come from? What was it like?”

RW: What are your roots?

MM: Yes. Exactly. And to be respectful of that.

RW: And not going into one’s history, what is the problem with not doing it?

MM: We would say there’s no way to understand who a person is if you take an ahistorical approach to it. If you don’t say, “Where have you been? Tell me about yourself. Who’s your grandfather? When did your family come to this country? What struggles have you had?” To know if your father committed suicide or something. I mean, how could that not be relevant about a person?

RW: It makes sense. If somebody knew me, and they didn’t know about my grandfather who came over from Italy at the turn of the century or my other family roots, then I would not feel that they really knew me well. We don’t want to be reduced to our roots, but we like them to be appreciated as part of us.

MM: Exactly.

RW: It’s not rocket psychology.

MM: Exactly. It’s just common sense. Anybody would know that. (laughter)

VY: Monica, I want to ask about the work you did in your video. A lot of therapists focus on the past, in almost a stereotypical way, but it often stays up in the head. It stays intellectualized. And what impressed me in your video, is that you use that information, but it’s all about connecting with the family in the moment.

MM: That helps change the future. I really believe it. I recall that the first time I heard Bowen speak, he said: “It doesn’t matter how much you’ve analyzed your mother’s psychological problems or whatever, if you can’t sit in a room with her and be generous, you’re not there. So, don’t kid yourself.” But it is all about what are you going to do now.

RW: Right. You’re saying that understanding the past can help you connect in the present and vice versa.

MM: I think so. Well, and also think about what’s your responsibility to the future. It might not be too apparent on that video, but I really think that we as therapists can help people position themselves to make choices about what they are going to do in life. And that we make the best decisions if we pay attention to where we’re coming from and we pay attention to what’s ahead. So, you know, what do we owe to our children’s children? As well as what do we owe to our ancestors who struggled before us?

Autonomy and Connection

RW: It’s a very honoring position and approach, and refreshingly so.

VY: It’s hard to find anybody who doesn’t want to be honored.

RW: You use the concepts of love, respect, honor, forgiveness, spirituality. These aren’t words that are commonly used to talk about goals in psychotherapy. Where do you come from in using these kinds of words?

MM: I think it resonated in me. I got it from Bowen. You know, the basic Bowen theory is that differentiation for the mature person means getting our connectedness to everyone and everything. And respecting that. That it’s about making our own decisions about how we are going to relate. That I have to go into my heart and choose my relationship, choose how to relate to you.But Bowen’s idea was also about the autonomy part, in that you don’t live your life according to anyone else’s values. That you have to go into your own heart and figure out what your own values are and then live it out. But that we are all connected. I mean, that’s totally basic to Bowen’s theory, and it’s so different from those who focus on autonomy as, ” I’ve got to do for me.” But I’m in it with you. We’re in life together. That’s just the deal.

RW: This is not some abstract idea, but a reality that exists in our lives. It seems every therapist we have interviewed here has approached this idea: We are connected, we are separate, both are true and how we deal with it is everything.

MM: It’s not that I can only pretend that I’m not connected to you because I am actually. Something could happen right now and I could this minute be dependent on you to save my life because you’d be the one here. And if I do something to hurt you, that could come back to hurt me. Because that’s just our nature, that we are interdependent.

RW: But then how does autonomy play into this for you?

MM: In a way, it is a philosophical stance that there is no such thing as autonomy. The only autonomy is about our decisions of how to live. You know? So, it’s so basic to our way of thinking, systemically, about our connectedness. Respecting each other in some kind of spiritual understanding that we are a part of something larger than what we can see, including our ancestors, including those who are going to come after us, all that.

RW: This must be the kind of approach you use with clients, too. Talking this way, and sharing these things with them.

MM: It is. I do. Yeah.

RW: Do they ever want to rebel against it?

MM: Oh, sure. Yeah.

RW: Can you think of an example?

MM: Oh, not my clients. They just come in. I say, “Listen, you have to get a relationship with your mother first thing. Could you bring her in next time?” And they say, “Oh, sure. That sounds good.” (laughter)They say, “Go fuck yourself. I told you, my problem is I want you to fix my wife.”

RW: Or my mother or my father or…

MM: My mother. Yeah. You get them to stop drinking, no problem.

McGoldrick’s Work with Families

RW: How do you get people to turn to themselves and what they can do? Can you give an example of how a person starts with the position of “it’s them, it’s not me,” and you get them to turn it around?

MM: Well, if you take the example of the video I did with that family. I think that’s a good example where he wanted me to fix the daughter and, for many reasons, wanted to push away his part in that because of his own grief about the wife and the other things he didn’t deal with in his own way. And something about getting the stepmother out of the way to focus in on the daughter, to really hear her, and then also bringing in the son because that I see as relevant, too. That sometimes, as with that guy, a person can hear it more powerfully if two of the children say that it matters. And that something makes a person hear it differently.

RW: Any other examples of this playing out in therapy?

MM: I was thinking of one guy; he was very negative, sort of talking suicidally. I raised questions about that. And he’s says, “How else is there to be?” And I said something about culture, and he says,

“Oh, don’t give me that bullshit. If you’re going to tell me that this is about culture, then I’m out of here.”

RW: What was his background?

MM: Irish. And then, he said… It was all his mother’s fault. Blah, blah, blah. And she was this witch who had been controlling, you know, whatever. So, I said couldn’t we talk to her? Because she was alive and around. And he said, “No, we’re not doing that, and I’m not coming back if we even think about that. I came here to solve my marital problems with my wife and this is it.” A number of months later I was at it again: “You tie my hands behind my back and then you’re frustrated that I haven’t helped you yet. Bring in somebody. Who would you be willing to bring in?” So he brought in his brother, which was really interesting. I learned a lot about the family, and we talked about the sort of suicidal feelings and whatever.

RW: And what about the mother, did you ever get her in?

MM: Eventually, somewhere we had a big argument about his mother and I said, “You know, well, I hate to be a broken record, but we could go back to that?” And he says, “If you had her in, what would you say to her?””I don’t know what I’d say to her. I’d have a chat with her about whatever’s been bothering you. Or you’d have a chat with her.”

“No, but I want to know what would you’re say to her.” “I don’t know,” I told him. And then I remembered. I had just been looking in this book that I wrote, You Can Go Home Again, this is a book for the public. At the end of the chapters, I actually have questions that you could ask you parents. So I said, “Well, come to think of it, you know, if you asked 100 therapists they wouldn’t be able to tell you, but I actually wrote a book and there you can see the type of questions I might ask her.”

“No, I want to know the exact questions.”

Whatever…

RW: The whatever approach.

MM: So, I said, “You know, you do whatever you want to do.” And finally he said, “Next week I’ll either bring in my mother or I won’t.” So, I said, “Well, that’ll be good. Okay.” So the next week he brought in his mother, and it was the most amazing thing. I don’t think I said a word the whole time, and he worked out so many things with her. It was so interesting. She was phenomenal.

RW: You being there helped. And she was phenomenal.

MM: Well, you can’t count on the parent being phenomenal. But that he did it would have been good enough because he took all the responsibility. It’s like he knew what he had to talk to her about. He said to her, “I’m a 51 year old man. I feel like I have to talk to you about some things that happened so long ago, and I feel like it’s stupid but these things are kicking my ass, and I’m taking it out on my wife and my two year old and I don’t want to be like this. I’ve got to talk to you.” And she just listened which worked out so well.

VY: What I really like about such stories is that on so many videos or therapy stories, they show the therapist being brilliant and making great interpretations, but instead sometimes it is best to shut up and listen.

RW: Anti-brilliant. Just to be there.

MM: Get out of the way.

VY: Get out of the way. When the clients are doing the work, you don’t need to be there, you go to the background.

Jackie Robinson’s Wife, Culture and Family Therapy

RW: Lets go back to something you brought up earlier. What led you to get into culture and ethnicity and why are these so important in your work?

MM: I suppose at some emotional level, I was raised by an African-American caretaker who worked for our family and was the person I was closest to growing up, I am sure at some level—because I loved her—at some level what was wrong there about race was at the interior of my own family. I’m sure that had an impact. But I don’t know really.

RW: You noted earlier that Bowen did not like your cultural work either. How come?

MM: Well, it was kinda surprising that Bowen did not like these new ideas about culture, but he came at it from another angle. Bowen had this idea about triangles and family. And then he took it to the level by analyzing societal level systems in terms of triangles. We feel better if the enemy’s a really good enemy, but if the enemy’s not a really good enemy then we start fighting with each other. This is the process by which nations and social systems basically join together and scapegoat a third party.So culture would make great sense from that point of view. And Elaine Pendehughes, an African-American therapist, took his theory and used it to analyze slavery and how that system operated. And she did a really brilliant, basically Bowenian analysis of slavery.

RW: What was his critique of your work then?

MM: I remember one conference where he chose to speak out against my work on culture. He could be an ornery person at times. We had recently published the ethnicity book, Ethnicity and Family Therapy and Bowen said, “Those people who want to waste their time studying, you know, the differences between the Irish and the Italian, let them waste their time.” And he was talking to me, clearly. And everyone in the room who knew anything about it, I’m sure, knew just who in that room was wasting their time studying the difference between Irish and Italians.

RW: Back then there were not as many ways to talk about culture in psychology. To bring this home, I’m teaching a course in ethnicity, diversity and psychotherapy next semester for the first time. What kinds of things do you think would be important to attend to? I’m going to use your book as one text, so I’ve got that going.

MM: Well, this is a whole subject in itself. Because I think there is a lot about white privilege, heterosexual privilege, gender privilege that really we need to pay attention to and think about how it organizes us. And that would be good to deal with in your class. I think it important to deal with it multi-dimensionally. That ethnicity most of the time, not always, helps people get centered a little bit if you urge them to think about what it means. Who we are culturally and what are the values we grew up with and so forth.I didn’t grow up thinking anything about any of that. I didn’t know I was Irish, never mind, you know, white. I mean, honestly, I knew nothing. I was just a regular person, or so I thought.

RW: You found out you were white later?

MM: I found out I was white really later. I didn’t know I was a woman, never mind that. I mean, I just thought I was a person. And I never thought about gender. I never thought about race. I didn’t think Irish meant anything. It was not even a category.I knew my name was Irish. If you asked me, I could have told you that my ancestors came from Ireland. But if you said, “Does that mean anything?” It’s like, “No. That was like 150 years ago. It’s like, it means nothing to me.”

Now I would say, it has organized my family for that entire 150 years, and right now many things about how I react to a situation have to do with the power of that history. Only just recently, maybe like the past year or so, I started thinking about some of my experiences in college and realizing that I think now it probably had to do with being Irish. The ways in which being at an Ivy League school, Brown—I knew I didn’t belong, and I knew I didn’t fit. But I didn’t know what the rules were and I didn’t know that that was because I wasn’t a WASP. I didn’t get that. I was very naive about it. So I think there were all kinds of things that I didn’t understand.

RW: And at that time there were few women in the therapy world. How did that work out for you?

MM: There were lots of things in family therapy that I didn’t understand about being a woman; there was so few male mentors who could take me. I was quite a follower of Virginia Satir. She was the only woman. And I would go anytime she was going to be there.

RW: So you went from all that to writing a book on ethnic diversity in family therapy. That’s quite a ways.

MM: Well, ethnicity came first. Ethnicity came in by doing my own genogram there came a point where it was like, “Yeah, but what does it mean to be Irish?” And my family never wanted to talk to about it. They could pass for the dominant group. They had gone to Ivy League schools. They were pretending they weren’t Irish, you know. And so they taught us that. And so when I started asking questions, my mother, especially, was distinctly uninterested.My mother kept saying, “We’re Americans, Monica. Leave it alone. What do you care where we came from? We’re Americans.”

And because I hated her I would always pursue anything that she didn’t think was good like asking her about our background. She would say, “They were just peasants. They were just peasants. Could you just leave it alone? They were nothing. Here we are. We’re fine now.” You know, but then that got me interested. And that book came out of going to Ireland in 1975. It totally transformed my life. I was already married to a Greek, so I knew ethnicity meant something.

RW: What do you mean about his being Greek?

MM: They do maintain it. My husband grew up in Greece, so he was seriously ethnic. But you know, that didn’t relate to me. But we went to Ireland and it was like, “Oh my god. Everybody’s like my family.” And I had four years of psychotherapy where I had analyzed the shit out of my family of origin and thought about it differently. But nobody said, “It’s culture!”My mother would make fun of people – that was her typical way. It wasn’t really an angry thing; it was subtle. So, humor was a way that she would put you down. She would make you feel stupid. She would make a joke. She’d wait for someone else to come into the room and then she would make a joke about you. So, you would just feel humiliated.

Well, going to Ireland I saw that that’s what the Irish do. The Irish wait until another person comes into the room and they make a joke at your expense. And yet, the way humor operates, I thought that that was just my fucked-up mother. But it’s like, oh my God, they all do this. How come nobody talks about these things? I came back to the medical school and I couldn’t stop thinking about it.

One of the First Diversity Classes

RW: Did you ever talk about culture and ethnicity in your training?

MM: Yes, we did these little presentations, six of us, 15 minutes a piece on different ethnic groups: Irish, Jewish, Italian, African American, Puerto Rican, and Asian. It was very short, 15 minutes each. And even in the 15 minutes, we’re be, “Well, I can’t speak for all Irish, but-” And then say a few stereotypes. And it was mind blowing to me.I remember the Jewish one and the WASP one. The WASP one went first and she makes all the apologies and then she says, “Well, you know, if I’m going to say something about WASPs, they kind of believe everything in moderation and decorum and they’re not too big on expressing any feelings too strongly. Everything in moderation. Leave a little on your plate. Never get too enthusiastic about the food.”

And her best friend was this Jewish therapist who went next and she said, “Well, you know, you can’t speak for all Jews because…there are German Jews and there’s European Jews and anyway, you know, Hungarian Jews are completely different. Then you have Los Angeles Jews and they’re different from New York Jews. And Brooklyn Jews are different from, you know, Bronx Jews,” and so forth. Then she finally said, “But anyway if you are going to say something, Jews kind of believe in expressing your feelings and actually talking a lot about analyzing your feelings and expressing them. And food is very important, and guilt is very important. And eating more and getting your children to eat more is very important.”

Then we had a little conversation, and so the Jewish woman said to the WASP, “I’ve always liked you, but I have to say that I’ve always found it a little irritating that you’re so smart but you never speak up in a group. It’s really like you are withholding. And now when you’ve expressed this about how, you know, in your culture, it’s like in moderation and you shouldn’t…it’s like you hide your light under a bushel, and I never really understood that. I just found it irritating.”

So the WASP woman says, “Well, okay, if we’re going to be sharing like this. Actually, I’ve often wished you would hide your light under a bushel, because you never hesitate to say what you think in a group.”

RW: And what did all this mean to you at the time?

MM: My thought was that even though I had worked with them for several years, I had reacted to them both in terms coming from my Irish point of view, which is different, and I had just judged them as if they were wrong and I was right. Why did one always speak up? And why did the other always seem to hide her light under a bushel? And I never thought before that moment, wow, this is really cultural meaning.

RW: Well, that makes sense then. What you’re also saying is that it is a good idea to get in touch with your own roots. And that enlivens you and engages you.

MM: Right.

RW: I was also concerned more about how early multicultural ideas seem to use stereotypes or oversimplifications. Say Asians are just into shame or Blacks feel suspicious in society because of oppression, and so on.

MM: My thought would be to use the ethnicity book to help people understand something about where they might be coming from, because what we tried to do is lay out caricatures that help, you know, tell the story. And to try to tell it so that the characteristics are put into some kind of historical context of why Italians might be suspicious and why African-Americans might be a certain way and why the Irish might have developed the characteristics that they have.

RW: So, instead of just the trait outside of history.

MM: Right. Because if you think systemically, of course, there has to be a reason why people would develop these different ways. But one thing that I do think is very important and I think is very hard to teach about is, when you come from a place of privilege, it is so hard to be aware of what the implications are of that in the interactions with the other. It would be easier for me to tell you about the ways that I felt inadequate as a woman, and didn’t know about it. Or felt inadequate as Irish and didn’t realize it.It’s harder for me to talk about—which I’m struggling to be aware of—the ways in which as a white person, I have so many privileges. And feel free to talk about so many things in a context without even realizing that others don’t. I don’t think the issue is apologizing for it. It’s getting conscious of it and the doing work and then following it through. What are the implications of that?

“I Feel Like I Fell Into Heaven”

RW: A wrap up question. You’ve been practicing quite awhile. What keeps you going as a therapist? What still juices you?

MM: I love it. You can probably tell. I feel like I stepped in, that day when I met Lowell Cooper, I feel like I fell into heaven. I love what I do. I love these ideas. I feel like family therapy may be dead here in this country because of all the things that we talked about, but family in all different forms is still there.

RW: And family still matters whether they all come in or one at a time.

MM: Yeah. How do you help people and what can we do and what makes a difference. And every family is a great challenge. And I love mentoring students, and trying to put ideas together… I love all of it.

RW: Well, I wish we had time to go into a lot more. Maybe another time. Some of them we only touched on, because your background is so rich and your ideas are a piece of heaven. Thanks so much for sharing them with us today.

MM: Thanks for talking to me.

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