A Family in Therapy

Peter McCallum & Moshe Lang.
McPhee Gribble/Penguin, Melbourne, 1989.  Soft Cover, 291 pages, $14.99.

Given the immense mystification that has enveloped the traditional psychoanalytically-orientated psychotherapies over several decades, the advent of a mode of therapy whose practitioners regard it as crucial to their enterprise to expose their work to direct scrutiny is striking, even startling.  Virtually from the inception of family therapy practice, therapists have deployed the one-way screen and videotaping as a means to achieve this admirable development.  Indeed, it has become de rigueur to operate in this way.

Somewhat less immediate and direct, but in no way less useful, is the transcribing of the therapy session.  Many a journal article or book chapter in the family therapy literature contain examples of such material.  Much less common is the transcript of a series of therapy sessions with one family, and even more exceptional one accompanied by erudite observational commentaries.

We are offered that very combination in A Family in Therapy.  Fortunately for us, the Black family agreed to the videotaping of their sessions for teaching and research purposes.  Following the termination of therapy, Moshe Lang, the therapist, and Peter McCallum, studied the tapes and then sought the views of a team of experts on the material.  The result is a most engaging and thought-provoking volume.

In essence, we are invited to accompany the Blacks on their therapeutic journey, with Moshe Lang at the helm, from the initial contact via the family doctor to their celebratory farewell five sessions later (there were an additional six sessions of marital therapy with Mr and Mrs Black between the fourth and fifth family sessions but these were not taped and are not discussed in the book).  The family comes alive from the first moments, as indeed does the therapist.  As the story unfolds, we witness the family’s passage from their initial position of pessimism and hopelessness, through their joint effort to grapple with the forces that have buffeted them adversely, to their ultimate triumph.

The transcript tells it all but we have in addition brief commentaries at regular intervals, penned by the authors in order to clarify or elaborate.  Virtually nothing in the way of explanation is offered, this on the premise that the purpose of the book is to offer the reader a “window on therapy”.  It is tantamount to being a fly on the wall.  It must have been tempting for Lang and McCallum to contribute considerably more comment given their exhaustive study of the tapes.  Fortunately, they have disciplined themselves and rather than imposing their ideas on us, we are left to ponder for ourselves the rationale for the various steps followed in treatment.

The more formal commentaries by an invited group of experts are available, however as an appendix and serve well as a means of comparing one’s own observations and reflections with those of a variety of perspectives.  I found this exercise as rewarding as the transcript itself and was particularly impressed by the sharpness and astuteness of the commentators.

Inevitably in a book in which a therapist “exposes” himself, the temptation is to examine in fine detail how he goes about his task and to imagine how one would be dealing with the family if one were in the therapist’s chair.  Among the issues that struck me in this context were Lang’s flexibility, humanness, sense of humor and honesty.  An underlying theme is the apparent eschewing of theory as the cardinal requirement of working with families.  Indeed, a quote by Charcot that “theory is good, but it does not prevent things from existing” is at the head of a coda.  There the authors mention how with the close study of the tapes, theoretical questions “subsided into the background of our attention, to be replaced by an increasing fascination with the material of the transcript itself”.

I am reminded here of Goethe’s comment on theory:

All theory, dear friend, is grey, but the golden tree of actual life springs ever green.

I frequently resort to this wise observation when I am becoming overly enveloped by theory in clinical encounters, or witness the same in colleagues.  It is almost a necessary ingredient of our work as therapists that we constantly remain aware of the potentially restrictive nature of theory.  This is especially salient when the adherent of a theoretical position is so insecure as not to permit any possible elaboration, refinement or modification of that position and doggedly and inflexibly applies its tenets.

On the other hand, the absence of any theoretical framework is bound to result in a rudderless therapy, one typified by vagueness, bewilderment and lack of direction.  Moreover, an atheoretical stance inevitably retards the conceptual progress of psychotherapy and limits the emergence of appropriate questions for empirical examination.  As Hans Strupp, the doyen of psychotherapy research in the US contends, therapists are obliged to take a deep interest into the inherent nature of what they do and also endeavor to make it explicit.

So, how are we then to judge the “Langian” approach as so clearly evident from the transcript?  By recognizing that at the heart of his therapy with the Blacks, he applied a systemic view of the problems facing the family.  The fact that a range of elements were incorporated into this systemic framework should not perturb or confuse us.  Lang exhibits a considerable flexibility but remains attached to his fundamental theoretical position.  We can easily detect interventions derived from pure Milanese, structural, strategic, even behavioral traditions.  The interplay of these interventions tends to be fruitful with the Black family without any evident contradictoriness or bafflement.  The paramount attitude throughout remains systemic.  As Bryan Lask has proclaimed, “all family therapy is systemic, by its very nature”.

Finally, a caveat.  It may not be a claim of the authors but rather a desire on the part of the publisher to boost sales; on the front cover we read that A Family in Therapy is the book for those “yet to be convinced” inasmuch as it demonstrates “that therapy works and a family can start to heal”.  The Black family were indisputably the beneficiaries of family therapy.  Alas, one swallow does not make a summer!  Whilst the family approach constitutes a potent tool in the hands of the mental health professional, it is not a panacea.  And we should desist from conveying too bold a claim for its efficacy to the fledgling therapist trainee or to the client-family.  We are still in need of substantial research evidence in order to establish how effective family therapy is and more particularly for what sorts of problems.  Until that evidence accumulates, it would be prudent for us to conduct our work humbly and modestly.

That little “sermon” aside, let me reiterate the value of McCallum and Lang’s enterprise, as well as the contributions of the panel of commentators.  The book deserves a wide audience, particularly among trainees in the field.

Review by Sidney Bloch. First Assistant in Psychiatry, University of Melbourne.

Bloch, S. (1989). A Family in Therapy. Australian and New Zealand Journal of Family Therapy, 10(3), 199.

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