Systematic Marital-Family Examination – part 2

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At this halfway point in the marital-family examination, we shall jump ahead a bit to look at what ‘normal’ might be. Then, we’ll get on with the remaining diagnostic themes. Finally, we’ll tie it all together with a historical discussion on the follies of categorization.

SEARCHING FOR NORMAL

Parents are the architects of their own family. That’s been said – and it contains some truth. But let’s gently modify it: Parents are the architects of their own family – within the constraints, that is, of the culture in which they live. Most people, sort of, vaguely, know what ‘normal’ is. But, any clinician assigning the label ‘normal’ is clearly making a diagnosis, a complex judgement-call. Normality may suddenly be obvious or gradually emerge during assessment. Happy, normal, well-functioning families and marriages, while hard to pinpoint, are assessed step by step, schematically, like any other. Full ‘functionality’ is relative. That is, even the happiest of families has its flaws. A ‘normal’ family or marriage is rarely seen in MF work, but is not at all uncommon in general medical practice. A spot to check off normality is at the bottom of the schema.

Now, it also has been said that, “Happy families are all alike; every unhappy family is unhappy in its own way.” Just think about that! It is the first sentence of Anna Karenina, Tolstoy’s nineteenth century masterpiece about families. Fifty years ago, when I first read the words, I had no particular thoughts about them. They sounded good. And they came from a towering literary genius. So, the idea they conveyed must be OK. As the years rolled by, however, and I saw more and more couples and families (many happy ones in the course of general medical practice; unhappy ones in psychiatry), doubts came. Then one day it dawned on me that Tolstoy must be wrong.

Happy families are not all alike at all. They have an almost infinite flexibility in their dealings with life. Their ways of approaching both pleasures and pain are rich in diversity. Their outlets in religion, recreation, and work can be deep and varied. Every happy family is happy in its own way. By contrast, unhappy – sad, scared, angry – couples and families are in several ways always alike. They are strictly limited in the ways they deal with the stresses of life. These ways can be counted on two hands; only a few habitual patterns of action are called upon by unhappy partners in their unhappy families. These patterns are commonly shared by other unhappy families; they are similar in family after dysfunctional family. These patterns are rigid and inflexible. And these tired patterns repeat monotonously over and over and time and time again. They are entirely predictable, directly observable. Thank goodness for that! If distressed families were not similar in this fashion we would never be able to untangle them, to assess and treat them in any rational way. We would be forever plunging into an ocean of confusion.

So how do we distinguish happy normality? Total normality is not seen very often in marital counselling or family therapy. Over the years, while doing general medical practice, I tackled the nature of normal families and marriages in two ways. First, every seemingly happy family seen was assessed in detail. This was done, bit by bit over time, during house calls and as family members came to the office for physical complaints. Second, many people from diverse backgrounds, often at social gatherings and parties, were casually asked (as if in an entertaining little game), “What do you think is most important in marriage?” In response to my question some said love is paramount. Others insisted that it is trust. Other ideal ingredients suggested, and even hotly espoused, ran the full gamut: Sex. Understanding. Equality. Protection. Obedience. Good food. Respect. Compatibility in general. Religion. Commitment. Being on the right side of the law. In the same social class. Taking time together. Time apart. Having children and parenting. Lots of touch. Money. A business partnership, marriage based in economics. A nice home, cars, a boat. Family camping out in the wild. Perhaps a marriage should be a safe haven from the cruel world, a place to recharge one’s batteries.

Ideal Marital Ingredients – western style

It was a long list. Responses, subjective ideals, were documented, rated and weighted, added and subtracted, and plotted against the running record of seemingly happy, normal families. Surprisingly or not, it was confirmed that happy families come from contented marriages. Ordinary people vaguely know what this kind of marriage is like. Here is my diagram of its ideal ingredients:

Most people do have an idea about what makes up a good marriage. This varies, as might be expected, from culture to culture. In the West, the core of these spousal expectations is being a lover, a friend , and a companion as depicted. (With a bit of ingenuity, the diagram can be modified for other parts of the world.) The ideal marital qualities that most contribute to happy, normal families are shown in the diagram above. TLC-2 stands for Talk, Laughter and Courtesy, the basic ingredients of modern western world friendship. Many other ideals are quite spurious and almost impossible to find. [24] TLC-1 is the old-fashioned ‘Tender Love and Care’ of nursing lore. TLC-1 is a critical component of being a companion as well as being a lover.

Thomas Fuller MD put it well in 1632: More belongs to marriage than four legs in a bed.

Most of the time, contented couples and happy, well-functioning families deal with their various roles, emotional exchanges, and problem solving with amazing grace and adaptation. Good humour characterizes them. But happiness should not be a goal in itself nor does it have to be continuous; more likely it comes in interludes. Most importantly, spouses are friends, lovers, and companions to each other. Friends talk, laugh and are civil and polite. Companionship is simply enjoying one-another’s company. Lovers are ‘romantic’ and sexually considerate and faithful. Mutual commitment is not measurable except by a clear ‘yes’ or ‘no’ to the question, “Are you committed to your marriage?” Commitment cannot be qualified. If I am committed to my spouse it means that I’ll stick through thick and thin, permanently. When both partners independently affirm that they are committed the outlook for a marriage is very good. If one partner is not fully committed the other can be in for hard times. When a couple is functioning well overall, all is happily reflected in their children. Religious affiliation, if present, cements closeness.

The strength of a ‘happy normal’ family enables it to cope effectively with all kinds of difficulties within the family. If members ask for counselling at all, it is usually for a medical problem such as Alzheimer’s in a parent, or a bad car accident, or cancer, or the birth of a child with Downs syndrome, etc. They work with their doctor within a medical framework rather than taking recourse to the mental health field. But they are not at all emotionally isolated. They may seek out their minister or priest or other cleric. A severe, unexpected crisis (e.g., a house burning at Christmas time) occasionally brings them directly to the marital counsellor or family therapist.

HINTS: Taken in conjunction with use of the more objective Diagnostic Schema, a couple’s subjective view of their own marriage can be invaluable. A marital self-evaluation questionnaire or scale, based on the above diagram, is possible. You can translate the above diagram and draw up your own if the idea appeals to you. (Mine is on the back of the centrefold in the book, Cracking the Family Code.) It’s not a bad idea to make two copies and hand them out to the marital partners at the end of the first or second assessment session. They should be instructed to separately complete their own form – as essential MF homework – before returning to the next session.

Now we’ll return to the systematic step by step marital-family examination. The Diagnostic Schema is again reproduced below for your ongoing reference.

THEME 7 – Power functions and autonomy

This theme is a cluster of authority functions falling along a spectrum that ranges from autocratic control to independent freedom and autonomy. The older, static methods of evaluating power will be reviewed first, and then a sleek modern communication concept—symmetry-complementarity—will be clarified.

Note the little circle (lower right schema). Power and authority should reside above the heavy black line. Crossovers in either direction ‘pervert’ this essential power function. That is, parents are ill advised to jump below and share power with their children. Only in play is this OK as in a father’s sharing the steering of the family car with a toddler on his lap. (That’s from my childhood – not a wise idea nowadays.) What do you do with a teenager who tries to climb up into the parental authority compartment? Younger children, when siding with one parent against another, have leaped the line. Or, has the parent, in pseudo-coalition with the child, encouraged and enabled it? In a marriage, power allocation is usually pretty much outside of awareness. The sharing or confiscation of power above the line, between married partners, evolves haphazardly, and is rarely nicely decided as in a conference. When it is suddenly usurped, the displaced party screams foul.

A descriptive, if static, way to look at power within a marriage is to categorize it five ways as follow:

Type-1, husband dominating, an authoritarian dictatorship;

Type-2, wife dominating, an authoritarian matriarchy;

Type-3, husband the accepted leader, a participatory democracy;

Type-4, ditto, wife leading democratically; and

Type-5, laissez faire (anarchy).

This formulation was developed at McGill in the 1950’s in a study that equated student mental health with the type of authority in their families. The best student mental health stemmed from type-3, the worst from type-5, with type-2 a close runner-up. These results are probably time-bound and are less likely to apply in today’s less discriminating more tolerant society. The laissez faire style, however, is an unsound model at anytime. It is often deliberately set up by semi-sophisticated couples (college professors) as a pseudo-democracy with no one giving any orders or direction, ever. They confuse it with openness and freedom. But it provides no model for leadership or decision-making. In such a climate children grow up hardly able to make the simplest decision. They all, parents and children both, leap back and forth across the internal horizontal power barrier. You can sketch this sort of chaos in a little circle. Further, ask yourself: How are controls-discipline working out in this entire family in front of me? Not just with children, but between husband and wife. What methods are being used by the adults to keep each other in line, too? Coercion, persuasion, reason? Is there physical or verbal abuse?

A more sophisticated and dynamic way of assessing MF power allocation is to evaluate relationships in communication terms. The fourth premise is particularly important to a basic understanding of what goes on between two people.

There are just two patterns: symmetrical (egalitarian) and complementary (authoritarian).

Every relationship at any one point in time is either one or the other. In the symmetrical stance husband and wife are coequals (H=W). That is, they form a little democracy with an element of tit for tat competition. In a complementary relationship a pattern prevails in which the parties are one-up and one-down (H/W or W/H). One voluntarily submits to the other’s authority. The second half or response within each symmetrical or complementary loop feeds back as a control that also reinforces the first half. This cybernetic aspect, characteristic of all human communication, renders it far more effective in power allocation and learning than any simple linear stimulus-response (SR) paradigm, especially when colored by emotion.

Excessive competition in a hostile symmetrical relationship may lead to mutually angry exchanges, escalating fights and violence. Such is called a symmetrical runaway. Healthy symmetrical escalation, conversely, can lead to progressively warm exchanges of love and affection. By the same token, healthy complementarity takes the form of one partner assuming leadership while the other happily follows along. Of course, the person who defines the nature of this pattern is still one-up. The prototypical complementary relationship is that between a mother and her baby (M/B). Later, during the teen years, the youngster is trying to move up toward symmetrical equality (P/T)(T=P). And, of course, we all know how difficult this transition can be.

While many marriages are primarily one or the other of symmetry or complementarity, all healthy, functional and workable adult relationships slip easily back and forth between the two stances as circumstances require.

The flexible interchanging of these two fundamental patterns is mediated by a parametric switch function. (H/W)-psf-(H=W) It is necessary for efficiency and stability. If, in a symmetrical marriage, one partner is better at, say, finances than the other, the most skilled conveniently assumes leadership with full approval. Hot disputes in an egalitarian relationship can be defused by one person backing down. In this instance it is a clear safety switch. There are no disputes in firm complementarity! Both of the parties usually are contented with the arrangement, so it is harder to switch from complementarity to symmetry than the reverse. Without timely switches, either pattern can run away or run down into dangerous or cliff-hanging extremes. As already noted, the symmetrical pattern can episodically spiral up into wild sex or open hostility and domestic violence. On the other hand the complementary pattern tends to grind down into stubborn rigidity. Extreme complementary relationships can become fixed and grind on as stultifying states such as gruesome twosomes and sadomasochism. Although complementarity affords security and stability, it is inherently rigid. While symmetry affords equality and more freedom, it is inherently fragile and unstable. Critical switch functions may be automatic or rarely fully conscious. If a switch is delayed or lost, some terrible things can happen. A husband, before his wife can back down, may convert a symmetrical runaway into a pattern of criminal complementarity with his fist – repeatedly. Such is the essence of wife-battering. A psychopath will impose ‘sick complementary’ compliance upon a helpless child in serial sexual abuse. And so on…

Definition of pattern and the processes involved usually are outside of conscious awareness. Almost the minute we first meet another person we begin to jockey around subconsciously while determining which pattern – symmetrical or complementary – will dominate our relationship. As time goes on and a pattern is firmly established, we hardly ever think of it. If it works well, like a good car, it runs us well. It is quite simply just part of the nuts and bolts of the relationship. But we do not have the same familiarity with these kinds of relationship patterns as we do with cars. If the pattern goes wrong, we are perplexed, and hardly know enough to take it to a good mechanic. We just grin and bear it or fight it out.

In evaluating any relationship, marital or otherwise, note whether it is chiefly symmetrical or complementary. That between young children and parents is always complementary (unless there is a role reversal). Teenagers, as noted, progressively try to move up to power symmetry; some parents hope for and facilitate this growth, while others try to thwart it. Some demand it, which is really, when you think about it, undermining it. For, the very act of demanding by a parent presupposes immaturity in the teen, the very thing not wanted. If parents insist upon adult behavior from a teen and then knock it, it can really put a young person into a tailspin. Smart teens then cry foul. Some teens want to be treated in an adult fashion, then act like babies. Then parents are permitted to cry foul. The permutations are interesting and revealing, and seem like deliberate perversions, but teens are simply experimenting with switch functions.

If one partner in a marriage defines their relationship as complementary, “I’m boss,” while the other simultaneously considers it as symmetrical, “We’re equals,” the relationship is aptly termed, with a very big word, metacomplementary. And that means it is very sick. Open conflict or simmering resentment is virtually inevitable. Some behavior, by its very nature, is spontaneous and cannot be ordered up. When it is, a dysfunctional paradox is created. Examples: Love between equals is naturally spontaneous. If one person starts getting one-up, complementary, and insists of the other, “You must love me,” it is a hope bound to fail. “You must respect me,” is another. “Trust me?” Must trust always be earned? Or, only after it’s once lost? What about the endless exhortation, “Be spontaneous!”? As you can see, this all has to do with misplaced power. Such all too common paradoxical injunctions are technically classified and termed as variants of metacomplementarity. They are inherently dysfunctional. They are often quite frustrating and infuriating mainly because the entrapped participant rarely can understand what, exactly, is going on. The complaint may be, “Something isn’t quite right, but I can’t put my finger on it.”

As the philosopher, Thomas Hora, said:

To understand himself man needs to be understood by another,

To be understood by another he needs to understand that other.

If you are familiar with Transactional Analysis try to figure out Berne’s basic PAC transactions in scientific communication terms. Also try to work out where the five styles of the McGill study fit in terms of symmetry and complementarity. [25] Once you become adept with this sleek modern communications concept in assessing power functions, you will begin trying to apply it clinically much of the time. It very obviously is also useful in role behavior. It could even become a basic part of your understanding of all relationships. But not at parties, we hope. While you might not want anything else for diagnosis, TA-PAC, a la Eric Berne, is still very practical and easier to apply in therapy.

Finally, a word about autonomy: Autonomy does not mean ‘doing your own thing’. Doing your own thing, beyond reason, is an abrogation of the implicit marriage contract which calls for a commitment to cooperate, to bury many of one’s own personal desires, etc., for the better good of the partnership. On the other hand, a person’s autonomy may be infringed and personality bent by demands or coercion by another person to conform to his/her own hang-up or thing. Ask yourself, is the individuality of each person, including children, respected? Do not confuse autonomy with freedom. Children usually have only partial freedom because they are not ready for full responsibility, but their autonomy as separate human beings should be assured. For example, symbiosis between a mother and a child denies autonomy. Dysfunctional ‘fusion’, too much simpering love or cloying proximity, between husband and wife also undermines normal autonomy.

HINTS: What to document in the schema is strictly dependent upon what is seen. Now that you know what you see, whatever is relevant will pop right out at you. Obviously, if a power struggle in the marriage is paramount, the application of Theme 7 should finally reveal its subtleties. At minimum, getting an initial impression of whether the marital relationship is primarily symmetrical or complementary and if a normal switch function is working is most important. How the parent-child and child-child relationships stand in terms of symmetry-complementarity is also quite valuable. But it may be easier, at this early stage, to draw a TA-PAC diagram, or use the old McGill protocol. If power issues are not of primary concern, such should be clearly noted.

THEME 8 – Role behavior

The statement, Role now precedes goal, by Marshal McLuhan (of medium is message fame), is probably one of the most important philosophical-sociological observations made during the 20th century. [26]

Before about 1950 people worked toward concrete goals of survival and security. In school and work, performance took precedence; reward for effort was considered a fillip. It was a day’s pay for a day’s work. You pass if you study. Few people expected a pat on the back beforehand. The same applied to marriage; people got married and stayed married. It was safer. After 1950 three things began to change all that: 1) increasing affluence, 2) progress in human rights (for women and children as well as minorities), and 3) TV, which displayed a fanciful world of wonderful things. Because survival and security were pretty well assured, how one was treated and what one could get began to become increasingly important and subtly took priority. Recognition as being someone of individual worth started to beat out a sense of mutual responsibility. This new world became known as the Identity Society and the people residing in it most recently have been labelled as Yuppies.

Now, in marriage, if one partner feels unappreciated or poorly stroked (in TA terms), it is seen as OK to depart for greener fields. Unhappy partners always have an eye out for someone new who impossibly combines all the talents of a small village. Children are less automatically respectful at school and home. TV assumes an enormous role in everyone’s lives, opening up fanciful vistas of freedom and material things in all directions. The Internet now extends it further yet. All institutions in our modern, role-before-goal, society have concurrently become less stable. These existential changes affect all marriages and families almost completely outside of conscious awareness. It is a huge problem and few people can even start to voice it as underlying all of their other MF difficulties.

You should be aware of McLuhan’s dictum as a pervasive existential factor, but there is no point in discussing it with any couple – nothing can be done to change it. If you talk about it you will likely be seen as philosophically maudlin and not businesslike. All therapists, however, must adapt to it to be effective. Therapists can no longer get away with being secretively aloof (like old-fashioned analysts); they simply have to assume a ‘friendly stance’. Friendliness fits into the new reality. Friends talk, have a few laughs and a bit of fun, and absolutely must treat each other civilly, politely, and with undue respect. That is what every partner in a modern marriage openly or secretly expects of the other, even while treating the other miserably. Both partners and every other family member will expect no less of you, without saying it. It only sets the stage for effective therapy. If you fail to deliver at this basic level the family will promptly cool you out or ‘divorce you. Of note, this familiar, friendly stance, so massaging of the Western heart, is not all that appropriate when dealing with traditional, old world and ethnic people. They tend to find it intrusive and hypocritical, and prefer some respectful distance and formality.

In addition to the modern Western identity trend, there are traditional roles and special idiosyncratic roles. Each adult person, as life goes on, learns to wear these parallel roles: 1) as an individual person with career, private interests, autonomy, etc., 2) as a spouse (as a concession to ideal ingredients we include ‘c/f/l’ for companion/friend/lover) and finally, 3) as a parent (mother, father). These roles are carried out quite outside of everyday awareness. [27] Idiosyncratic roles appertain to embedded behavior (black sheep, scapegoat, relayer) or caricatures of sickness (the sick-one, hysteric, asthmatic). If a member carries a bona fide psychiatric diagnosis it is noted and cited. Certainly, sufferers of depression or schizophrenia, etc., do affect the whole family quite profoundly. Virginia Satir [28] once aptly defined the traditional roles in question form. “How is the husband doing his husbanding? The wife her wifing?” “How are you doing your fathering? Your mothering?” These roles may be defined in nostalgic and enhancing “old fashioned” ways, as above, or in more modern, often pejorative, terms. In a recently popular book male and female roles were encapsulated as equating with Mars and Venus. This is quite OK as long as stereotypes do not become ingrained. Pejorative appellations include male chauvinist pig (women describing men), or barefoot and pregnant in the kitchen (women describing themselves). When such terms come out, are expressed by one or the other partner, they give strong clues about bias in role expectations. The counsellor, at this early point, needn’t ask too many questions, as much of role behavior is right out front to see and hear.

As well, each child has clearly defined roles, 1) as a growing, developing, autonomous individual, 2) as a son or daughter. Are you being a good son? A good daughter? What is meant by good? Honouring one’s mother and father? And, 3) as a sibling (brother or sister). Children and young people also have a special societal role as student. Teens have a developmental ‘marginal man’ role—neither child anymore nor adult quite yet.

The concept of role behavior can be dynamically assessed (and counselled) with Eric Berne’s transactional PAC approach. Structural [29] and Transactional Analysis makes the old, static, purely descriptive traditional role-behavior stuff come alive, transitive.

HINTS: T8 is one of three important asterisked areas of the schema. Determine by your observation of family values and problem solving just how wrapped up in the Identity Society the couple is. In this marriage or family, is role before goal? Then evaluate role behavior. Document how both traditional and idiosyncratic family roles are played out. Remember grandparents. Transactional Analysis comes into its own in T8. Sketch the various transactions reflective of role behavior on the back of the assessment guide if the space allotted is too small. TA is so useful to the MF counsellor in both assessment and therapy that familiarity with Berne’s work is strongly encouraged.

THEME 9 – Emotional exchanges

Affective exchange is expression and reception of feelings. Cohesion is mutual affection, love and sticking together. Simple feelings fine-tune relationships. That is, the ability to pick up another’s subtle emotional signals and act tactfully in return, fine-tunes social relationships faster than words ever could. It saves marriages. It makes family life fun.

In MF work we consider the bio-spectrum of core emotions – arousal, happiness, sadness, fear, anger, disgust, even lust and other appetites – and all their permutations and combinations. This is hardly to speak of the range and complexities of higher emotion (feelings that ‘evolve’ socially, encrusted with memories and thought): affection and love, hate and rejection, jealousy, loyalty, etc.

The diagnostic schema contains two little organizing tools – miniature sets of axes: We may carefully discern how any kind of feeling, simple or complex, is being expressed and exchanged: directly or indirectly, clear or masked. These dimensions are easily broken down into four quadrants: 1. clear and direct, 2. clear and displaced, 3. direct and masked, or 4. indirect and masked. Specifically for anger we can hit, yell or constructively talk, clearly and directly, as in quadrant 1. In quadrant 2, by picking a scapegoat, punching holes in walls, or, better, doing a vigorous housecleaning, we take anger out indirectly on something or someone else. That is, we displace it. Or we can mask anger directly with wit and sarcasm (quadrant 3). Projection or suppression of feeling (quadrant 4) is the ‘sick’ variant of emotional expression.

Getting at feelings: Most people in everyday life limit themselves to two ‘mentally unhygienic’ ways of probing for others’ private feelings: mind-reading and mind-picking. Mind-picking ranges from simple questioning to intense interrogation. If you find yourself using sentences ending with a question-mark you are mind-picking. Questioning is legitimately used by teachers and doctors. Interrogation is essentially a police method – for solving crime. While often effective in prying out answers, questioning per se does not contribute to a therapeutic environment. Even well-intentioned questioning, especially about feelings, is unpleasant and has no good place in diagnosis let alone treatment. Mind-reading (“I can always tell when you’re angry!” “I know you’re fibbing – you’re a bad little girl.”) is fine for mothers. Infants need an all-seeing mother and very small children love magic. Otherwise it also is irritatingly intrusive and unwelcome in therapy.

A reflection of feeling is a reliable, effective, and harmless method for getting at inner feelings. It is indispensable in the practice of family therapy and marital counselling Few people know about the technique. It is an all purpose ‘hygienic’ method, good for children and adults alike. It was pioneered with impulsively aggressive little children in residential treatment. These children translated their inner rage so quickly into action that they were unable to identify it. So a reflection of feeling was used to help them label what they basically felt. The object was to help them create an inner emotional signal to make time to get their conduct under control.

Examples of reflections of feeling: You look as if you’re kind of down. You seem as if you’re irritated. You act as if you are upset. You seem as if you’re sad, scared, disgusted. Etc.

The as if phrase is crucial. It gives any person, especially teenagers, a comfortable and face-saving way out if not yet ready to open up and talk. It allows any hurting person to deny private feelings until they feel safe in acknowledging them. The patient might at first grump (lie), “I’m OK! (meaning, Leave me alone.) But that is OK too, for now. The as if phrase makes it possible and permissible for a therapist to come back to the subject another time.

Tone of voice (metamessage) accompanying the words must be compassionate, accepting and gentle. One’s posture and facial expression should harmonize to convey interest and concern. Sit back relaxed – open – with arms apart and palms up. Do not make this openness too obvious. Use the word ‘irritated’ instead of the word ‘angry’. (In most cultures the admission of anger will be denied even if the person is foaming at the mouth.) Use ‘upset’ at other times. Dump the euphemisms and get more specific as time goes on. This use of words is tactful on the part of the therapist and face-saving for patients. Use your discretion about semantics.

Reflection of feeling takes practice. It must be tried over and over again with gentle persistence and patience, with an acceptance of repeated temporary failures. In the long run, however, the method does work. When hurt feelings that are denied or suppressed are finally acknowledged and clearly labelled, perhaps with some emotive ventilation in the process, the door to subsequent discussion and real change in behavior is opened. Thus, this empathic labelling is not just diagnostic, it is healing by its very nature, for it conveys, in an acceptable way, that someone understands and cares. Primarily a therapeutic tool for eliciting blocked or unlabelled feelings, reflection of feeling is also helpful in everyday adult social intercourse. If you are not too obvious about it, in addition to opening up wider vistas of other people’s minds, it will subtly leave them with warm feelings about you.

There are some cautions to bear in mind: Encouraging the release of pent-up feeling, as in time-honoured ‘ventilation’ therapy, may give temporary relief in crisis situations, but is not generally recommended in MF work. Normal grief and ‘dry’ depressions are exceptions and the very constricted person may be cautiously coached to be normally, socially expressive. ‘Getting it all out’ indiscriminately, however, especially deep-seated rage, may be quite dangerous. The brittle, poorly controlled, internally roiling, frustrated (postal) worker might just translate rage into action. The same with loner high school students. It is well to heed the surgeon’s old adage, “If you are going to open up someone’s belly, make sure you can get out without complications before you start.” The same applies to someone’s mind. In fact, people who habitually act out in rage can start misbehaving after dumping. If opened up, they not only need to be heard out, but to be taught to contain it.

Focusing exclusively on feelings in marriages and families can result in a merry-go-round of such self indulgent games as ‘greenhouse flower’ or ‘ain’t it awful?’ or ‘ain’t he/she rotten?’ It is better in the long run to help the distressed person – or both partners in a marriage – to label, understand, and deal sensibly with the outer causes of any excess inner feeling. But how? Seeming obstacles and paradoxes arise. Again, in therapy, the person who just pours out feelings may need some help tamping down; for dumping, in an outside social sense, is foolishly intrusive – like talking about operations to a bored captive audience. And most inhibited people should be encouraged right from the outset to appropriately confine the discussion of their personal feelings to therapy, at least until they become more adept at social expression. It is so easy to reify feelings and emotions! The rule for advising patients is: never, unsolicited, roil in feeling with others – and maybe not even then. The rule for therapists is: deliver feelings as gently as a doctor does a baby! And advise patients to avoid deliveries in the homes of casual friends. In marital and family work it is not the therapist’s proper end-goal to personally use reflections of feeling with spouses. (Once or twice is enough, else you’ll get into the greenhouse flower game.) It is the therapist’s job to show partners how to use the technique to elicit, hear and understand each others feelings, so that their relationship will improve. With children it is different. The good family therapist will take any opportunity to reflect and draw out children’s feelings and in the process demonstrate and encourage its use by the parents also. Doing so is metaphor in action.

Child psychiatrists for decades have extolled the virtue of ‘unconditional overtures of affection’ as the best means of children developing ‘controls from within’ and good self-esteem. Most modern parents would automatically agree with such sentiments. But, if we dig deeper it doesn’t often happen. Love is usually given conditionally – if a child behaves as wanted. When discipline, the real measure of love, is brought up, well-informed parents will indeed disclaim punishment and claim to use rewards only. But even they, when pressed, will admit to shaming ‘time-outs’ as a ‘natural consequence’ of unwanted behavior. What I am saying is: The best and most hygienic control is neither reward or punishment, nor any euphemisms for such, but unconditional love and acceptance under all circumstances. This is not pollyannish. Laid-on consequences are akin to closing the barn door after the horses are out; unconditional love is true prevention. The only means of immediate control needed are anticipatory diversion, ‘touch control’ and other simple, on-the-spot, guiding techniques. If the family climate is truly in harmony with this not-so-radical philosophy, children will behave and perform and grow up contented.

HINTS: Evaluating the expression and exchange of emotion in marriages and families – along with problem solving and role behavior – is the core of classical assessment. It is critical that MF therapists not reify feelings! By allowing feelings to acquire a ‘life of their own’ many therapists fall into a trap that inhibits the active correction of problems. We need to acquire a balance between empathy and a hard-nosed pressure to encourage decision-making and action.

THEME 10 – Patterns and organization

T10 is the real core of specific marital and family diagnosis. It requires a good practical understanding of the basics of human communication: paradoxes and binds, dyads, triangulations and wider coalitions. Some knowledge of transactional script analysis, as well as ordinary TA, is highly recommended. Skill with metaphorical interpretations and therapeutic injunctions enables treatment to start promptly and deliberately at first contact. Reductionism at this advanced stage seems silly. Synthesis is necessary. But we still maintain analytical rigour. To convey the flavour of T10 we will take a selective look at a few triangular and dyadic patterns.

In terms of dyads, or two-person interactions (spousal, mother-daughter, father-son, parent-teacher, even boss-employee), we need to discern symmetry, complementarity, metacomplementarity, and straightforward parametric switches.

Those couples locked into symmetry may experience lengthy, ‘egalitarian’ exchanges of hostility that are kept track of in a barely (sub)conscious tally sheet. Such a relationship is brittle and tends to become emotionally labile. When disagreement cannot be tolerated and agreement cannot be reached, even the most loving pair may escalate out of control and suddenly spiral up into open aggression. Often the husband’s fist abruptly ends such a perverse H=W runaway, hammering it, split-instant, into H/W dominance.

Consider the three-part, so-called DDA Sequence: Any substantive issue may give rise to 1) a disagreement. Disagreement normally is resolved by polite argument, sometimes persuasion. Even hot dispute is okay. It is always possible to end disagreement happily and voluntarily. The ordinary rules of debate apply. The subtle transition to 2) disconfirmation is ominous. Legitimate disagreement becomes ad hominum discreditation which is characterized by mutually spiralling personal put-downs. Voices may be raised. Hurt feelings and anger are generated. Once two people are well into disconfirmation, ‘healthy’ escape is increasingly difficult. At the transition from disconfirmation to 3) alienation there is a sudden switch from verbal abuse to physical aggression and/or withdrawal—from escalating symmetry to criminal complementarity. The DDA sequence is the main source of marital violence and the commonest ‘cause’ of murders of passion. To recognize it is pretty important.

Furthermore, if we can pick out overall, repeating dyadic patterns such as an ‘infinitely oscillating’ series, we have it made, at least in terms of assessing and diagnosing. Here is the common IOS clinical paradigm:

A husband, when accused by his wife of withdrawing (hiding behind his newspaper or reclining on the couch watching TV), defends himself by labelling his withdrawal as the only defence left to him against her nagging. She, in turn, considers this a gross and wilful distortion of what “really” happens in their marriage and points out that it is precisely his withdrawing from her which makes her angry and critical of him. She says, “I nag because you withdraw.” He says, “I withdraw because you nag.”

He sees himself as the passive, one-down victim of her nagging – W/H. But, she also is a victim, H/W, of his seemingly passive withdrawal. It may be more active than it appears. Regardless, there is no safety-switch over to H=W, symmetry, and their relationship has ground down into a rigid, but cycling, metacomplementary flip-flop or Gruesome Twosome. Each personally identifies different starting and ending points, a blaming contest of who does what first. If the whole thing originally did start with the husband withdrawing, then the sequence is 1) he withdraws, 2) she nags, 3) he withdraws, 4) she nags, till death (or divorce) do us part. But, he sees the punctuation as 2-3-4, 4-5-6, 6-7-8, etc., while she sees it as 1-2-3, 3-4-5, 5-6-7. Both stick tenaciously to their own perceived sequence of punctuation. Punctuation, or what really happened first, eventually becomes spurious and pointless (but people don’t like that, they like to lay blame, they have to find or know the ‘cause’) and the vicious circle of alternating nagging and withdrawal, withdrawal and nagging, will go on and on in what is known as an infinitely oscillating series. [30] This form of circular, idiosyncratically punctuated, metacomplementary argument between spouses can, and in fact does, go on ad nauseam. Each considers his actions only as a response to the other, but is blind to the fact that his behavior is also a cause and a reinforcement. It is enough to recall what Hegel said that history repeats itself as tragedy and farce.

Now for some triangles: Everyone is familiar with the ‘eternal triangle’ between a wife and husband and an outside lover, with all the rejection and disgust entailed. But the most important triangles involve children within families. When both parents love each other and are in close harmony they automatically create a framework for optimal development, growth and intensified learning.

Nurturance and care of their baby is smooth. Feeding problems are minimized and growth potential optimized. The emergence of language skills is on a firmer footing. Furthermore, unconditional mutual parental love leads to the child’s developing high self esteem. A child feels valuable, contented, happy. Parents in harmony also congruently assert agreed-upon control and restrictions over their child’s behavior. They may disagree in other areas, but are on the same wavelength when it comes to their offspring. [Love + Guidance = the most Essential Emotional Vitamin].

Fortunately for most children, such an early setup is the prevailing mode. It seems almost wired in genetically. It is the nexus for rapid primary learning and it predisposes to healthy and constructive thinking, feeling and acting. This universal love triangle usually holds up even in the face of such apocalyptic extremes as famine, disaster and disease. But, there is more. Most people erroneously think that family environment (or nurture) is the same for all children in the same family, the only source of difference being of a genetic nature. Not so. Contrary to often voiced parental claims, no two children in the same family, even identical twins, are ever treated exactly the same. Parents subtend as many parent-child triangles as there are children in the family. As a result, each child essentially grows up in its own unique family environment. To convey the notion of clinically ‘perverse’ triangles:

A schoolchild finds it difficult to sit still, can hardly concentrate and attend to the task at hand and is constantly reacting to every little thing going on. Marks are poor, conduct aggravating. It doesn’t take long for a smart teacher to boil such behavior down to the medical-psychological trio of ‘hyperactivity, distractibility, and short attention span’. A light turns on in her head, “Eureka! This must be ADHD.” A trip to the family doctor is set up – for Ritalin.

The teacher in this scenario has a 25 to 1 chance of being wrong. The reason: A newly discovered clinical entity accounts for the vast bulk of hyperactivity. It shares almost identical symptoms with neuro-ADHD, but no brain malfunction. From it flows a number of logical alternatives to reflexively routine drug therapy. The new source stems from outside the child; a ubiquitous process incubates in the family and spreads to ‘infect’ the child’s wider social milieu. The school is a major, if innocent, player. Socially Induced Hyperactivity or SIH, as I call it, is generated through a unique biphasic mechanism.

PHASE 1: A mother and father are in hostile disagreement with each other. They no longer are talking about some key issues that are also important to their child. Such a covert conflict is termed a split social field. While failing to speak directly with one another, each parent does so with their child, who in turn relays the adverse message on to the other parent. This setup is a Split Field Relayer System or SF:RS. A dysfunctional family triangle, it entraps all three actors. The SF:RS induces anxiety and mild hyper-activity in the child-relayer.

PHASE 2: If a child is caught in more than one SF:RS, the degree of hyperactivity progressively increases. This easily happens when a parent is at covert odds with a teacher, or any significant person outside the immediate family. Suppose a child is in temporary protective care … then, as the number of care-givers increases, so also does the number of potential split fields between them (1, 2, 3…n). For a child at the nexus, intensity of hyperactivity goes up in proportion to the number of entrapping split fields. This augmented setup is termed Multiple Split Fields (MSFs). Result: hyperactivity with a large ‘H’!

The SF:RS was reported in 1972. [31] The biphasic SF:RS-MSF mechanism, summarized above, is detailed in forthcoming full-sized book, also called Cracking The Family Code. Both mechanisms are untenable for the child. Parents are perplexed and entirely oblivious to source. In general, Triangles are malleable early on, initially inducing various basic emotions—fear, anger, sadness, disgust, even contentment and happiness as in the universal rearing setup. In the presence of a paradoxical metamessage a triangle becomes perversely dysfunctional and may become fixed and specific in its behavioral outcome—primary fear turns into anxious hyperactivity whereas anger may escalate through rage to violent acting-out. [32]

HINTS: Theme 10 is the core of truly expert MF work. It is the nexus of several other overlapping themes, T7 (power), T8 (roles) and T9 (emotions). The Diagnostic Schema format makes almost automatic the task of integrating the various themes into a cohesive picture. The bigger picture jumps right out. But, it is best not to label a family as a whole. Small diagnoses (such as a family SF:RS and anxiety), however, are quite possible and indicate advanced competence. Otherwise simply select the most relevant dysfunctional themes and list them in priority order at the bottom of the schema. Develop a rational treatment plan on the back of the schema.

INTEGRATION: Tying it all together

We now refer again to the family theorist’s most important diagram. It reveals the rationale behind the schema. It portrays family structure and functions within the context of time and circumstance (situation). It encompasses all of the themes we have examined.

The marriage or family (little yellow circle) is shown in a dynamic, integrated context. The horizontal axis represents time, the family’s history (1) and its future in terms of its goals (4). In the present (3) the marriage or family’s circumstances and developmental stage intersect and come together with (2) its structure and functioning. Structural organization, which is relatively static, is tied in closely with the various fluctuating family functions. Communication links all as the construct moves slowly to the right in time. The various themes we have examined fit nicely into this overall picture. But the schema is not fixed in stone. Add your own pet themes – one, perhaps, is the family’s teaching function.

Now let’s see how our theory and its practical application compares with other branches of science.

Physical science has progressed by studying smaller and smaller elements of large and often unwieldy systems. In recent years, the opposite to reductionism, looking at systems as a whole and as part of their surrounding environment, has also been rewarding to science. Climatology and naturalistic studies of plants and animals are examples. Astrobiology, or the search for ET, is the ultimate, cosmic, example of anti-reductionism. Good science does not always entail quantitative experimentation. Quality work often stems from imaginative observation leading to discovery and synthesis. Does such a dynamic and ecological approach help us with the family? The reader can be the judge.

Next, let us look at some shortcomings of the applied schema as ordinarily used.

The schema enables us to do ‘in vitro’ cross sections of a couple or a small family group, isolated in an office. A series of observations over time adds a dynamic perspective. But the marital partners or family members are still isolated in an ‘artificial’ setting. In vivo, in real life, families have a very human ecology, they live in ever-expanding circles of people – in natural surroundings. These circles consist of relatives, neighbours, work, school, government, police. Their influences range from democratic controls to outright tyranny, from freedom of artistic expression to repression, from good PR to nasty gossip, from poverty to economic opportunity, from restricted to universal health care – the whole gamut of social structure and activity. From the geographical perspective, life varies between jungle, snow and desert dwellers, the farm, cities, hill and dale. The schema is not the be-all or end-all. But it’s globally applicable.

Finally, let’s see what others have done.

The modern, widely acceptable diagnostic label in medicine combines: 1) a thumbnail clinical description of the problem, 2) a notion of etiology and thereby 3) a hint about treatment. It should also be 4) categorically classifiable for 5) statistical and epidemiological purposes. This is a very good set of benchmarks. When applied properly, doctors usually know what they are talking about when they say someone has tuberculosis or epilepsy or H1N1 flu.

Just as doctors do diseases and botanists do plants, for some half-century, family theorists have vainly tried to define marriage and families by labelling and systematizing them (this is dealt with in detail in my book, Cracking the Family Code). But, categorical diagnosis, as done in medicine, is difficult with marriages and families! By the late 1970’s it was recognized that no single system of classification or system of systematizing or unifying existing classifications of marriages or families was completely practical.

As we are still largely at a descriptive level in dealing with disturbed marriages and families, a clinically useful, all-encompassing, typological classification system consisting of clearly distinct, mutually exclusive ‘types’ with specific etiologies, cannot yet be established. At this point in our understanding of marriage and the family group, the devising of a single, prominent classification may be more restrictive than helpful. It seems that labelling a marriage or a whole family to fit into some kind of pigeonhole may indeed be even silly.

This does not mean that ‘diagnosis’ is impossible! The astute clinician may pick up hostile escalating runaways between spouses and so prevent violence (Themes-7+9+10). And various perverse family triangles may be observed (T10) and true ecological diagnoses of child anxiety, hyperactivity, rage-delinquency, etc., emerge that make treatment rational. Or, developmental variations (T2) and deviant values may be pinpointed (T6). In other words, no marriage or family should be labelled as a whole, but specific ‘diagnoses’ within themes are quite permissible – when assessment is thorough. Then it may justifiably be called ‘diagnostic assessment.’

The final question is, do we really need pathological nosologies as in medicine? A time-lined dynamic ecological arrangement (as in the family theorist’s most important diagram) is far better. It is an overall picture. Then, if one is research oriented, it is best to buckle down and systematically, comprehensively gather data – to tease out small pieces of the overall picture. The best use of the schema is to discover discrete little diagnoses, here and there, that can be applied step by step as guides in clinical treatment.

SUMMARY

The diagnostic schema is a new clinical tool. Its main purpose is to facilitate accurate observation. It concentrates the clinician’s mind. The schema also doubles as a thorough clinical record by ensuring that all relevant facts are documented. The schema is akin to the physician’s general outline for a physical exam. It was first rationally conceptualized, invented, and then honed into shape by ongoing research over almost five decades.

A workable clinical tool incorporates the premises behind it, as rules of thumb. One is: therapists should be able to assess marriages and families every bit as capably as a doctor examines a patient. The schema enables it. A tool should not support observations predicated upon preconceived notions. But a good tool may have the scope to incorporate any pet method (e.g., TA) or a sound background theory (e.g., Communication Theory). The diagnostic schema manages that too. A workable tool should also be versatile. An ‘open’ category expands versatility and is included in the schema at bottom right.

Families and marriages, unlike individual patients, should not (cannot yet) be diagnosed, categorized and labelled as a whole. That restriction should be observed in using the schema. But, specific focused ‘mini-diagnoses’ within particular themes are possible! The themes themselves reflect both visible and patterned structure and a variety of related marital-family functions which are neither premise nor hypothesis. They are solid fact based on long-standing research studies by many clinicians and a few sociologists. Simply put, the schema has pulled this material together and tempered it into a logically sound tool. As we see only what we know I suggest you try it. Try to improve upon it.

Finally, it is interesting that the current plea in medicine is to move beyond cold competence back to empathy. The thematic method of assessment, doing cross-sections that accumulate longitudinally over time, is workable and will enable any kind-hearted helper to become, while remaining empathic, a very hard-nosed yet ‘subjectively-objective’ and dynamic MF diagnostician. This is what paying customers really want – an empathic and competent counsellor

NOTES & REFERENCES (24-32 of 32)

[24] Glasser, William. Reality Therapy in Child and Marital Counselling. Audio-digest Psychiatry CA, Vol. 2 No. 17, 1973. This seminal audiotape is a humorous introduction to decision making in marital contracts. Many spouses nowadays expect a galaxy of unspoken ideals – ‘all the skills of a small village’ – in their partner. Impossible! Such an irrational fantasy is a sure prescription for disappointment and possible marital failure when the partner is found unable to stand muster. S/he may be discarded and a blind search for another candidate is started on the ‘green side of the fence’ leading to a cycle of affairs and repeated divorce.

[25] Analysis of the McGill study: The first two categories are complementary. The first might be quite functional in a couple from the ‘old country’, but the second is usually dysfunctional anyplace. Three and four are probably primarily symmetrical with a democratic decision to delegate authority. The last is abdicated metacomplementarity. In Berne’s TA-PAC there are some discrepancies: Parallel transactions between equivalent ego states [P-P, A-A, C-C] are not ‘complementary’ but correctly, symmetrical. Parallel transactions between different ego states [P-C, P-A, A-C] are indeed complementary. Crossed transactions are really metacomplementary in communication terms.

[26] Ibid. Glasser. This audiotape also interprets Marshal McLuhan’s seminal notion of our present ‘role now precedes goal’ Western world. Since about 1950 (influenced by television and the otherwise salutary progress in human rights and increasing affluence) many people tend to place their immediate self-recognition (role) before planned responsibility to others (goal), and thus incorporate impossible expectations of others in many areas of life including marriage.

[27] Caution: Freudian depth psychology is inherently biased against women. Its concept of role behavior is tainted with notions of ‘penis envy’ and female ‘inferiority’. Thus, so-called dynamic therapy, a watered down version of psychoanalysis, should be avoided in marital counselling

[28] Satir, Virginia. Conjoint Family Therapy, Science and Behaviour Books, Palo Alto, CA 1964. Ignore the publication date. This book is a small, 200 page, classic. It is applicable today.

[29] Berne, Eric. Beyond Games and Scripts. Grove Press, NY 1976.

[30] The Arab-Israeli conflict is an example of this sort of almost hopelessly endless cycle at the international level. Efforts of one diplomatic mediator after another have come to nought over the years and decades. Thus, and by the same token, MF therapy may or may not be made easier merely because we can understand what is really going on.

[31] Hogg, William. The Split Field Relayer System as a Factor in the Etiology of Anxiety (A matched study of 48 cases), Psychiatry (Jr. for Interpersonal Processes), Vol. 35, No. 2, 1972.

[32] Hogg, Wm. MD & J. E. Northman Ph.D. The Resonating Parental Bind in Delinquency, Family Therapy 1979.

Questions? Please contact me. wilfhog@gmail.com