1983 therapist responsiblity

8/14/2019 1983 Therapist Responsiblity

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Joumul of Family Therapy (1983)5: 199 218

The therapists responsibility: a systemic approachtomobilizing familycreativityHugh Jenkins* and Michael Donnellyt

Three techniques, sculpting, geneograms, and family drawing are consideredwithin a systemic approach to therapy. Frequently, emphasis is laid on eitherthe activity of the therapist r the behaviour of the family in treatment. Wefocus on ways in which the therapist draws on the clients creativity, relying fthis on a correct assessment of their language or idiom. Certain assumptionsare proposed, and case illustrations are used in their support. Our approach ithat any material, or apparently no material, produced when using thesetechniquesepresents ssentialnformationwhich anbeurnedotherapeuticdvantage bymeansfositiveeframing.Althoughframework within which to practise is viewed as essential, a game-plan willalmostcertainly esult nsterilityand mpasses n herapy.Therapistflexibility, it is proposed, is a prerequisite for creativity. We prefer to labelresistance to treatment as failure by the therapist to recognize the clientsneeds.

IntroductionIn a radio dramatization of War and Peace , one of the characters re-flected: I am beginning to realize the total impossibility of changinganothers convictions with words.$ This paper deals with some alter-natives to words as the main vehicle in psychotherapeutic treatment.

Psychotherapy is, among other things, to do with language, and theattempts to reconcile the language of treatment with the language ofdistress.Impasses n therapy may result from the therap& failing torecognize the language or idiomf the client. And justs people in istress

Received 14 July 1981; revised version receivedJune 1982.* DepartmentofChildren,MaudsleyHospital,DenmarkHill,London SE 3 8AZ.t Gloucester House, Southmead Hospital, Bristol, BSlO 5NB.$ B.B.C. Radio 4, 15 July 1978.

(Formerly at The Young Peoples Unit, Velindre Road, Cardiff, CF4 7JG.)

1990163-4445/83/030199 +20$03.00/0 0 983 The Association fo r Family T herapy


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200 H.Jenkins an d M . Donnellymay resort to ime-honoured butunsuccessful solutions to their roblems,so too therapy can founder becausenly a limited range of time-honouredtherapeutic alternatives are employed. The therapist needs to be able tooffer thefamily in treatmentawiderrange of responses o familiarproblems. I t is this act of creative encounter, this bringing into being(May, 1972) whether through sculpting, geneograms or family drawingthat can activate the potentialn families to explore, share, and change.The mportance of encounter May,1972) especially in relation omaterial generatedby the family tself should not be underestimated, andis the primary focus of this paper.

Misunderstandings in human relationships can arise out of a failure bythe parties concerned to respond to thealient component of the message.The girl whoweakly resists the amorous advancesf her admirer may ellbe disappointed when he desists. His response would be to the verbal,digitalcomponent of themessage, an d not o hemoreambiguousanalogic paramessages (Grinder and Bandler, 1976)f the submissive eye-closing and unassertive tone of voice in which theverbal injunction No sgiven. At times, i t may only be possible to communicate allegorically oranalogically that which would be unacceptable if stated explicitly, asFreud (1922) recognizedn his pioneeringwork on the meaningf dreams.

Our focus is to considerways of directing the attentionf families to heproducts of their own creativity, so that learning akes place both at inter-personal and individualevels, and that in either case, learnings systemsoriented. The techniques described do not rely for their impact on thespoken word, n the belief that words can bea barrier to, ust asmuch as avehicle for clear communication. However, any attempt to communicatevia one language arocess which relies for its mpact on another, cannlyapproximate to the reality as experienced in the moment. Whenas here,the focus is on action techniques, the discrepancy will be considerable.Any attempt to confuse, the wo languages, digital and analogic wouldresult in aconfusion of conceptual levels (Watzlawick et a l . , 1967),runningounter to the physiological reality of our two brains(Watzlawick, 1978) and thewo modes f communication that they repre-sent.

Some observers have labelled as resistant to treatment those patientswho do not improve within the framework f the therapy offered (Davisand Oskerson, 1978). Others have commentedn psychoanalytic terms onnon-verbal techniques used to detour defences and to find ways aroundthe ituals ndhabitual responses of the family (Wadeson, 1980;Kwiatkowska,1971)but hisdiffers romproposing hatone of theresponsibilities for herapists is to focus n mobilizing the great supportive


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M ob il iz in g fam ily creat iv ity 201and therapeutic potential f the family tself (Skynner, 1976). In order toachieve this goal, the therapist must be able to discern ways in whichverbal communications can be modified, amplified, or disqualified, bynon-verbal or paraverbal communicational sequences (Breunlin, 1979;Scheflen, 1972; Grinder and Bandler,976). At any oint in anyrelation-ship, or set of relationships, touch, proximity, posture, gesture, facialexpression, eye movements, direction of gaze, all play a central part n acommunicat ion gestalt that continuously nfluences,maintainsandregulatesnteractional processes (Cade, 1975). The therapist anmobilize this knowledgen his use of interventions while remainingwary ofbeing so seduced by technique that the amilys needsare ignored (Bodinand Ferber,1972). Techniques are means to ends (Dale, 1981), to be usedas integral adjuncts to theprocess and aims of t reatment.

Focus of paperWe propose that there are in therapy two primary, although comple-mentary modes of activity. Both are present in any piece of therapeuticbehaviour, although onewill always predominate. They are identified as( l ) , herapist-oriented activities, and (2) , c lient-oriented ctivities.

(1) Therapist-oriented activities may be seen to have two components,being(i) where the therapistersonally engages in ringing about changesas a direct result of his interventions and his creativity, where he is pri-marily a choreographer, not a participant (Minuchin, 1974; Street andTreacher,1980);andbeing (ii) where he herapist actively engageshimself through techniques such as coaching, doubling, rble reversal, oreven to the extentf enacting the partf a family member who may not bephysically present n the ession. In (ii), the therapist becomes morevertlya partic ipant in the family scenario that hes attempting to change. Bothcomponents raw explicitly onhe therapists own creativity andresources. Not only does the therapist initiate, but he remains central infocusing attention on the family, or on some partf it.

(2) Client-oriented activitiesdiffer n emphasis. The therapist ascatalyst emphasizes family members inherent ability to initiate the thera-peutic material, drawing onheir own creativityand resources, producingtheir own shared material from which they work, being guided by thetherapist who is accordingly less central . The herapists creativity lies incalling on the potentials dormant in the family, commenting on or re-framing what they have manifestly produced.Thispaper focuses on thoseactivities that we have dentified asprimari ly client-oriented. When the familys actively involved in the pro-


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Mobilizing fa m i l y creativi ty 203of this paper aims to demonstrate theses and complementary nature fsculpting, eneograms, ndamily rawing in theight of theseassumptions.

Family sculptingFamily therapy borrows freely from many sources, one being psycho-drama. We learn from psychodrama the importancef warming up to anew situation. Unless the individual or family is able to experience thefamiliar in a new light, there will be little chance of change, for therapyinvolves the ntroduction of flexibility intopeoplesproblem-solvingpatterns. In systems terms, what commonly happens is that a familybreaksarule of its own system . . . while in astate of spontaneity(Schaverien, 1978). In family sculpting, the space between people andtheir physical postures become a part of the statement about relation-ships. Physical changes can then be used to represent visible shifts inrelationshipsDuhl et al. , 1973;Walrond-Skinner, 1976)with be-havioural change capable of being carried over into the daily life of thefamily as the aim of such interventions. Interpersonal communicationbecomes more direct, and new opportunities for solving interpersonalconflicts are opened up (Papp t al . , 1973). A statement about relation-ships and feelings, reviously onlypartially perceived, through sculpting,or spatialization Uefferson, 1978) can have great impact. It allows allmembers of a family to participates sculptors in a manner appropriate totheir age. The ery young can be includedn the sculptsof others; i t maybe significantwho holds the baby, and young children can be engagedysuch questions as: Where would you like to sit for a good cuddle? orWhere do ou go if you are unhappy? Thessue is never about right orwrong, but about how each member sees family relationships at thattime. Individual statements cannot be denied, and however painful ordifficult the tableau that emerges, family members must needs experiencetheir own part in the overall whole.

All sculpts provide potential therapeutic material, and theres a sensein which a sculpt cannot fail. An apparently nil response will providematerial, although all responses will also be influenced by the degree towhich the therapist is comfortable with the medium:. . . therapists to whom spatialization is a familiar tool realise that apparentfailure may not be failure at all; sometimes use of a technique that produces noapparent response is, in fact, a significant part of a softening up process.Newinsights are not always easy for clients toadopt; old defences o not necessarilymelt away at the first assault Uefferson, 1978).


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204 H . J e nk ins and M . Donnel lyT h e following illustrations from treatment demonstrate some of thesepoints.

Case il lustration lExperience with the P, amily provides an example of a family sculpt where atthe time much emained unresolved, (Jefferson, 1978). The part of the family intreatment by a co-therapy team were, father, mother, and the youngest of sixchildren, Hilary, a girl inher mid-teens. She had been referred initially becausefnon-attendance atchool to child guidance setting, where onef the authors, H.J . , worked for one session a week. She spent most f her time on her own, rarelygoing out or mixing with people beyond her immediate family. When she didventure out, i t was invariably with another family member, andmost frequentlywith her mother. During the third session the therapists felt that theywerestruggling. A s words continued to fail, the family were asked to sculpt theircurrent situation in urn, in order to help both themnd the therapists,who con-fessed to feeling stuck. Mothers view, and then fathers view were sculpted. Infathers sculpt, the three memberswere placed in three corners, asar away fromeach other as possible. Again the therapists felt stuck. Where now?here was nopossibility of physical contact, nor of direct communication. Hilary was askedwhere she thought members would be in five yearsime. She thought she wouldbe involved in more outside activities,nd that y then hermother would have heinterest of more grandchildren. She and her mother were then placed facingtowards the outside of the group, signifying differentand wider interests. She asasked where herather would be. She would not sayr commit herself to anythingat all. Her father was left in limbo. In fact, at the time he was unemployed,diabetic, and it seemed, an emotionally peripheral figure.New themes were raised for the family nd therapists, some of which were nottackled at that point. But new dimensions of father/daughter conflict and diffi-culties which seemed to mirror some of the marital dilemmas were broughtforcibly into the session and the subsequent treatment in a way that hours oftalking might have failed to achieve. Subsequently Hilary becameday-patientand finally, in order to deal more forcibly with separation and independenceissues, she became an in-patient in an adolescent unit for a short while. Theturning point for herppeared to be when sheas helped in the active realizationthat she did not have to be responsible for the lack of emotional involvementbetween her parents, but had a separate life to ead. She left he unit no longerhephobic person when first seen inut-patient treatment.A card received from hereight months after discharge while she was involved in a Youth OpportunitiesProgramme finished: Thanksfor helping me toe able to gout and about againwithout a second thought about going. I dont know where I would be without(everybodys) help. Sheow has a permanent job, andother news indicates thather parents too are less phobic about each other, and that all concerned havebeen freed in some degree from the frozen isolation of the initial sculpt. That


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Mobilizing fa m ily creativity 205sculpt allowed family members to make explicit their relationshipshat had ongremained covert, including a family rule that no one should acknowledge thefact. Hilarys anger towards her father (on behalf of her mother?), was thenvisible, and from a now clear position f mutual isolation it became easier for thetherapists to plan strategies that could deal with this.

Case illustration 2Material of a different order arose froma sculpt with the S. family, who in thissession were, the stepfather, the mother, andher thirteen-year-old son, Simon.The therapist, H.J., noticed how the family almost huddled together when theycame to their ppointments. Simon said this was howhe family always was. Theywere asked to sculpt their family relationships. It was not the c o n t e n t of eachpersons sculpt that highlighted a family theme, since there were large areas ofagreement, but therocess of the sculpting itself. Repeatedly Simon managed totake over and to rearrange the two adults so that neither of them was able tocomplete an individual statement. The therapist became awarehat this was artof the overall family nteraction pattern. At this point t was possible o intervenemore effectively in the light of this information, to support the adults in theirstruggle to retain some authority, and to help them support each other moreappropriately. Part of the process was to facilitate more disengagement betweenthe mother and Simon, and validate the stepfathers61e. It also meant excludingSimon physically from parts of subsequent sessions, in the face of dire threatsabout what he would do to himself because he was now beingreated more firmlyand consistently. In this instance the manner of the familys interaction in thesculpt was systemically more important than the individual final statements.Sculpting can help family members toee how it s for themselves, and inrelation to others. As people broaden their range of experience, so theycan extend the repertoire of behaviours open to them. It is the rigid,repetitive sequence of a narrow range that defines pathology (Haley,1976). At the same time that the repertoiref behaviours is extended, sothe familys unspoken rules that their members shall be as theylways havebeen will be challenged.The important issue revolves around how muchchallenging will be useful to the amily.I t is not stress itself that needs to be analyzed, but the degree of stress anyparti-cular system can accommodate inorder to thrive. Stresss a given and serves asapropeller in movinga system into action. In the old homeostaticmodel, stress isseen as deviant . . . something for the system to fend off. In a morphogenicsystems model, stress is seen as an important variable for moving a system intoaction (Freeman, 1976) .Provided the therapist ensures that the amilys threshold t o stress is notexceeded, he will be harnessing a force for change that originates withinthe family.


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206 H.Jenkins and M . DonnellyFamily sculpting techniques have broader applications than those of

the immediate treatment setting. Our contention is that the same tech-niques can be usedn training professionals to etter understand theirwnprofessional helpingnetworks (Jenkins, 1977), and o understand herealityof a familys needs y recreat ing their scenario and the influencingfactors of the therapists inputs in academic trainingsettings (Simmondsand Brummer, 1980). Although considerable space has been devoted tothe creative potential of family sculpting, many of the general themesraised apply equally to the se of geneograms and family drawing.

Family geneogramsIn the same ay that a family sculpting experiencerovides new informa-tion about family relationships, andew perspectiveson old information,so too the judicious se of geneograms (Lieberman, 979a, b ) may providea context marker when working with clients individually, or with thewhole family group present. Work withindividuals is wholly consistent infamily therapy practice whenhis is viewed as an orientation or treatment(Haley, 1976). Just as absent members can be brought into a family byother members taking their part ory using chairs o represent them in asculpt, so too the geneogram can powerfully bring absent members andpast generationsntohe urrentherapeutic process. Wemightcategorize hese two techniques as predominantly hree-dimensional(sculpting) and predominantly longitudinal (geneograms), while sharingthe common aims of identifying family structure, of finding out who isimportant, of tuning into repetitive family themes or transgenerationalscenarios, and f introducing alternativeways of perceiving and behavingfor the participants.

Families transmit ritual themesr scripts from generation to generation(Palazzoli e t a l . , 1977) and haveways of knowing about past and currentevents while not knowingclearly how this is so (Byng-Hall, 1973). Familymembers are often unclear about ow they themselves fit into theoverallpicture, and what that family pictureeally is. In general, t is importantto establish at some point a minimum networkf information concerningthe three generationsf grandparents, parents, and children, whethert isan individual or family group whichs physically present. The potentialcomplexity of even so few people is enormous, where a system of eightpeople involves the possibility of fifty-six different triangular elationships(Haley, 1967). Th e geneogram is a useful way of gaining informationwhich can involve all family members. It is available from session tosession, when new information can be added, thereby helping to provide


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Mobilizing fa m ily creativity 207continuity to the therapeutic process. John Byng-Hall* says that he alsofinds ituseful to bring the geneogram outs a way of re-engaging familymembers in a joint task when some form of unhelpful polarization hasoccurred during therapy.A geneogram may be constructed early on in therapy, both to helpestablish baseline information, and to speed up the engagementf familymembers in the therapeutic process, or at a later stagehen therapy hasbecome blocked. Frequently, family discussion is sparked off, or strongfeelings aroused,so that the geneograms put on one side s the therapisthelps the family deal with the particularssue. There are noet rules abouthow to construct a geneogram, butt helps f the therapist is consistent inusing defined conventions. He must also be flexible enough to accom-modate to the structuref the family. Somef the impactof a geneogramcomes from its apparentsimplicity in representingrelationshipsandevents. Sometimes the materialooks stark, and therapist and family maybe pitched into the middlef re-awakened grief s events re-unfold n thesession. A t other times there is a feeling of relief for members who seethings for the first time. Whatever the response, family membersill goaway with material to think about independently of the use that thetherapist makesof it in the session. Equally, the family may not be able tomake, and the therapist not succeed in making such a medium fit forthem, at which point the therapists creativity lies in opening up othe ravenues in order tolicit and use the same required information. Suchasthe case in the following illustration.Case illustration 3The family consists of John, his wife Maralyn, and the three children Marcia,sixteen, Helen, fifteen, and Martin, eleven. John was referred by his G . P . to apsychologist based in a Health Centre for individual psychotherapy. He had ahistory of anxiety and depression with obsessional and ritualistic features pre-dominating. He was described as resistant to all formsf drug treatments, andhad been told hat his last option was tondergo a leucotomy. While n in-patientfor assessment to see whether thisas appropriate, he discharged himself sayinghe did not wish to have surgery and re-presented himself to his G . P . asking forsome kind of psychotherapy.The exact nature and xtent of his obsessional symptomsad never really beendetermined, and some doubt had been expressed by previous clinicians as towhether he really experiencedhem, since no one had observed them directly. Heclaimed that they onlyhappened at home, enerally when he as doing domestictasks, thereby preventing him rom leaving the house.

* Workshop at the Annual Conferenceof the A.F.T.. Exeter 1978.


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208 H.Jenkins and M . DonnellyJohn was moody and irritable in the session, while Maralyn was cheerful ndaccepting of his elusive obsessions. He claimed that he did nothing about thehouse just in case he became obsessional, but would sit still all day reading,smoking, and making the occasional cup of coffee. Maralyn subtly encouragedthis behaviour by always making sure that all the household tasks were donebefore she went to work.ohn had not worked for some yearsut stayed at homewhile his wifead become the breadwinner and established a social lifeway fromthe family, even going awayn holiday with her colleagues without herusband.He claimed in defencef her behaviour that he did not go just in case he becameobsessional and spoilt the holiday for her. l . 2.

S ? m / M a r r ! d

(alcoholic) 1955)

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6lD , (d ie d at b i r th ) Morolyn JohnM. age 23

MorioelenartinFigure 1 . Familygeneogram.

The therapist, M.D., planned to engage the family by constructing a geneo-gram (Lieberman, 979) as aoiningmanoeuvre (Minuchin, 1974), in the secondsession. The couple, who at first saw no reason for the children to be involvedagreed to them attending for this session.he geneogram, Figure 1,highlighted anumber of important family issues. These were, on Johns side, the facthat hisdead fatherwas an alcoholic, who kept his wifehort of moneyand would becomeviolent from time to time. They were a small family withohn, his sister Patricia,and his mother remaining when his father died. When Johns sister married hewas left to look after his mother. She was suffering from a terminal illness, butcontinued to work as aleaner, a job which John wouldo with her in the eveningsas shewas unable to do it without his help. He did this until herdeath two yearspreviously. On Maralyns side of the family was a much larger family with threegenerations still alivend active. Maralynsmother, Mabel, had left her husbandwhen Maralyn was eight, and went to live with her mother, Mary (Maralynsmaternal grandmother), who had herself twice beenmarried. The women in thefamily, Mabel and Mary, considered men expendable, with no real function


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210 H.Jenkins and M . Donnelly

he

hv


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M obil iz in g fam ily creativi ty 211familys reality, a language of a different order was necessary. It couldwell have been a family sculpt, butn this nstance, the drawing seemed tooperate in the space between a formal geneogram and such a possibleconcrete non-verbal enactment.

Family drawingThe use of drawing and pictorial representation has aell-established r6lewithin other therapeutic modes, and has great potentialor family work,but is largely undeveloped in the U . K . so far . One of the main areas ofdevelopment has beenn ways of engaging childrenn the therapeutic pro-cess (Guttman, 1975; Muller, 1966; Kwiatkowska, 1971), while otherpractitioners have developed techniques for use with couples (Kwiat-kowska, 1967; Bing, 1970) and with couples groups (Wadeson, 1980).Some have placed an emphasis on the diagnostic nature of the drawingprocess in revealing either core problems (Sherr and icks, 1973), or inestablishing an evaluation of thefamily(Kwiatkowska, 1971; Muller,1966; Zierer et al. , 1966). Some work has been undertaken with multi-family therapy (Wadeson, 1976), where two or three families are seen atthe same time. Theres also an interesting description of the use of ar t withrespect to families being seen within a Multiple Impact Therapy frame-work (Kraft and Austin, 1966). In a different context, Feinstein (1981)uses historical drawing as part of a family reconstructionprocess.

As a general rule, art therapists have adapted their existing skills andheritage to f i t within the theoretical orientations and practical methodsused in the particulargencies where they work. his has produced a ten-dency for therapists to develop particularkills to meet individual needs,while having nooverall theoretical philosophy emerging with espect toart and amily therapy thatwould justify its se as a separate therapeuticmodality. Within a systems theory approach, family drawing serves thesame purposeas other action techniques. Thats, i t is aimed at thewholefamily system, either to clarify the nature of the system, or to producechange in it.Case illustration 4Family drawing with the H family illustrates some of the ways that drawingwithin a systemsapproach can be used in therapy. Mr and M rs H.were married in1950, and had two children, Valerie aged twenty-seven, andKevin,agedseventeen. At the time theamily came into treatment, Valerie had marriedandmoved a considerable distance from her familyf origin, and was not included nthe family sessions.The reason the family were in therapy was that Kevin had to


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212 H.Jenkins and M . Donnellybe placedon probation on the ondition that he receive someorm of psychiatriccare.There were a number of events that precipitated this family into crisis. Thefamily home was burgled and L1200 worth of goods were taken. This eventprompted a nervous breakdown in Mrs., and a few days ater Kevin committedhis first offence. n a single day e took and drove away hree motorcycles whichhe claimed to be test driving. Heas disqualified for threemonths and fined. Heimmediately paid his fine out of his own savings. When he regained his licencethree months later, he took and drove away three cars on two separate days. Hewas unable to explain any of these events.During the first session t transpired that Mrs H. was veryangry at her husbandfor being passive,oth at home and in their marital relationship. They eachom-plained of living separate lives, whileat the same timeuniting to labelKevin as aslow starter, who had difficulty in communicating. Whenever he tried, theywould interrupt him.The drawing task was introduced near the end of the second session, with thetherapists asserting hat this was usual at this point in therapy. Each memberasgiven a drawing board with two pieces of paper, and a range of coloured waxcrayons. They were encouraged to view this activity as one in which they couldbegin to help themselves with theirproblem. The therapists then asked them torepresent with the materials (not to draw, nor to imply that this was art) theirfamily ast is now. When this had been done, the therapists asked them to use thesecond piece of paper to represent their family as they would liket to be. Thefamily was neither encouraged to look,nor not to ook at each others picturesatthe time. The completion of the task signalled the end of the session, with thefamily being clearly told that their pictures would provide the basis of the next

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(a) (b)Figure3 . Kevins response toa) your amilyas it isnow; b) as you would like your familyto be.


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M obil iz ing family creat iv i ty 213session. The time between sessions was usedby the therapists and supervisors toconsult together about the issues raised by the pictures.At the beginning of the third session the pictures were returned to theirorigina-tors. The therapists then encouraged them to look at each others drawings. Asspace prohibits reproduction of all the material produced, only Kevins pictureshave been used, Figure 3(a) and (b), with a brief description ofhis parentspictures.Mr H.s response tohe first taskof drawing the family ast is now waso drawthree disconnected unidentifiable figures, far apart in a room, watching tele-vision. MrsH. drew herself t a cooker, boxed ff from he rest of he picture in thebottom corner. She placed Mr . (in the opposite corner) in his garden shed, withKevin and his car in theupper centre of the page. In response to the second taskfrepresenting the family as you would liket to be, Mr . used the same scene, inroom with a television, but this time all three figures were playingards, with thetelevision turned off. Mrs H. said shehad felt unable to contemplate the future,and had not drawn anything.After listening tohe comments that the encounter with the pictures produced,the therapists directed he familys attention to the first setof pictures and encour-aged them to describehy theyhad represented he family the way theyhad. Bothparents, amid their tit for tatstyle of constant sniping, agreed that theirs was notreally a family. They all livedeparate lives, this forMr H. being typified by theway the television discouraged conversation, and for Mrs H. by the way she wastaken for granted and was expected to do everything, including repairsaroundthe house and managing the familys financial affairs. Kevins drawings (Figure3(a) and (b))are of a different order. When he spoke bout his pictures he com-municated an understanding of the separateness of all their lives, but he alsodescribed the nature of the relationships in the family, with him in the r61e ofintermediary between hisparents. He described t like this: Motherells me to goand ask my ather when will he repair the cupboard, andmy father tells me to saythat he will do it when he is ready. This first picture, Figure 3(a), had thetherapists and the amily looking and talking about how the family was in effectlooking at itself. Kevins picture also aised the issueof familyhierarchy(Minuchin, 1974; Haley, 1976; Haley, 1980) with mother placed on top, fatherunderneath, and him describing his discomfort in the middle. The use of thedrawing confirmed the therapists view of the family as being disconnected,andKevins r61e s communicator beingenied by both parents who labelled him asslow starter, withdifficulty n communication. More importantly however,therapists and family were ble to begin to hare the same reality f the family asits members experiencedt. After looking t the first pictures, he therapists drewthe familys attention to the second pictures. Herehe emphasis wason the possi-bilities for change, and how things could be. Mr H. showed and described hisdesire for change in that he wished all the family to do more together; Kevin(Figure 3(b)) suggestedsimilar restructuring, but with himon the outside, freedfrom the position between is parents, and eady to leavehe family. He also told


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214 H .Jenkzns and M . D onnellythe therapists that he had given his father a pipe, as mother needed someonestrong to lean on. Implicit in Kevins drawings was a desire to shift froma deniedcomplementary family tructure to a more symmetrical one which would considerhim as more adult.Paradoxically, although Kevins pictures seem to be the most insightful of thefamily predicament, it was Mrs H.s blank viewof the future which activelychallenged them. Her blank icture was carefully reframedas being a very honestresponse, one that must have taken reat courage to describehe future in suchadirect and uncompromising way. The therapists encouraged Mr and Mrs H. todiscuss their future, and why she saw it as so blank. I t emerged from their dis-cussion that Mrs H. was unhappy with a future n which Kevin might be leavinghome, when she would be eft with that man.This produced valuablematerialfor both the therapists and family. It enabled the therapists to focus on theparental dyad, ando allow Kevin he opportunity to free himself from the familysystem which sought to keep him asdependent child. Here, the pictures enableda previously silent or censored member of the family to have voice. They high-lighted the areas where change was considered most possible, and they enabledthe whole family to share the fears they all held as they began to deal with thedevelopmental crisis it found itself in. Mrs H. drew attention by using the blankpage to her fears of being left with her husband, and this now became the realfamily problem rather than Kevins earlier acting out behaviour.

ConclusionClearly we have not covered, nor attempted to account for,ll the thera-peutic possibilities of the range of interventions open to the therapist.Flexibility and the ability to respond intuitively to theclients idiom aremore important than the learning by rote of a limited range of well-rehearsed techniques. Any technique which is used out of context by thetherapist will be experienced by the family as an emotional assault. Anysystem which feels itself to be under threat will respond in the mostfamiliar way it knows in order to retain ts integrity. At all times, and invarying degrees, therapys about changing theystem. It is a delicate taskfor the therapist to gauge the fine balance between being inducted into tfamily system, healthily stressing hat system, and overloading its copingabilities. The mo repathological and rigid the system, the greaterwill beits tendency to perceive threat to itswholeness.

Whetherheherapist chooses sculpting, eneograms or familydrawing, or any combination, a common theme seems to be his or herability to take familiar or negative material, and to createn opportunityfor the family to erceive itself differently. Hence, therocess of a sculpt incase illustration 2 , the lack of immediate relevance for the family in thegeneogram n case llustration 3 , and the blank sheet of paper , that


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M ob ilizin g fam ily creativi ty 215apparently nil response, n case illustration , all become creative materialto open up ew possibilities for he family and therapist toork on. Thetherapist who approaches the family with aet game-plan n his mind willtransmit his consequent anxiety to the family when treatment takes anunexpected turn, at which point the dissonance between his plan andtheir expectations will result ina failureof encounter, and ll too asily thefamily will be labelled resistant to therapy.

None of these techniques alone areolutions in themselves, nor are theyshort cuts toeffective treatment. Their use will always provide informa-tion for the therapist, including information which from another con-ceptual framework might be viewed as therapeutical ly non-productive.We have included an example where a formal geneogramailed to fit iththe familys language but where an alternative approach through familydrawing proved successful in eliciting material useful to both therapistan d family. When however, a therapist fails to gain co-operation with aproposal, he shouldirst review whether he hasuccessfully joined with thefamily before deciding that the family is resistant, which of course it is.He will know that resistance is the propertyof a relationship, and that thetherapist plus family relationship needs to be examined. Attendance forsessions, whether home- or clinic-based, and a commitment tory to bringabout change between family and therapist are not necessarily synony-mous. This is particularly true when treatment is under duress from athird party, or theres no consensus in the family that any problem what-soever exists. The therapist shouldalso consider whether hes moving toofast or too slow for the family, ince both will create difficulties ingainingthe familys trust. He should ask himself whether he has used his or thefamilys language when introducing techniques unfamiliar to them. Ifthe therapist finds that he has not beenyntonic in one or more of theseareas, this allows him to modify his approach in o rder to respond moreappropriately to the familys current status.We suggest that these techniques can sefully be employed y therapistsstruggling withwo different kinds f families, both in order to provide thelevels of information already described in this pap er , and to change thepredominant tempo of such families. They are the overly verbal, super-reasonable families whowill discuss and counter-discussvery side of everyissue, and by contrast, those families lacking in verbal skills and charac-terized by a high degree f under-organization (Minuchin and Montalvo,1971). In both instances, non-verbal action-oriented techniques canlay auseful part in treatment. They help change the atmosphere andevel of in-formation made available,s well aslacing all members on the sameevelin having ocopewith heunfamiliar.Such echniqueshelp focus


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216 H . Jenkins and M . Donnellyattention on the minutiaef process, increasing theikelihood of creatingtherapeutic intensity. A primary gain n both instances is for the therapistto win back some leverage in order to workmoreffectively with theamily.

A numbe r of themes have been considered inhis paper which may helpthe therapist in is attempt to beuseful to those who come, or are ent tohim for help. In thenterests of clarity, we have isolated and concentratedon certainactivities whichwe identify asprimarily client-oriented. Inhiswe have also beenfaithful o he process of therapy, since we findincreasingly in our work the usefulness of isolating and concentrating onspecific issues as a way of encapsulating a wider reality, and f giving ussomething over which we can help the family change.he therapist shouldalso be highly sensitive to the needs of his clients in order to help themgenerate the flexibility and the energy to solve their difficulties. To thisend, the therapist becomesdirectly involved. In attempting to introduceflexibility into the ives of his clients, the therapistfinds that he too mustdevelop his own flexibility and willingness to experiment. Whenhis takesplace, we believe that it is possible for the encounterwe discussed at thebeginning to bereative forall those involved. f the particular techniqueswe have described achieve this, they can justifiably besed in therapy.

ReferencesBING, . (1970) The conjoint family drawing.Family Process, 9 : 173-194.BODIN, . and FERBER,. (1972) How to go beyond the use of language. In: A . Ferber,M. MendelsohnandA . Napier(Eds) T h e B o o k o f F a m i ly T h e r a p y ,pp. 2 7 2 - 3 1 7 . NewYork. Houghton Mifflin Co. Sentry Edition.BREUNLIN,. (1979) Nonverbalcommunication nfamily herapy.In: S . Walrond-Skinner (Ed.)Family and M ari tal Psychotherapy: a C nizcal Approa ch,p. 106--131.London. Routledge and Kegan Paul.BYNG-HALL,. (1973) Family myths as defence in conjoint family therapy.rzizjhJournal

o Med ical Psychology, 46: 239-250.CADE, . (1975) Family sculpting. roceedings o th e Association f o r the Psychiatnc Studyo Adolescents , Cardiff, pp. 3-57.DALE, . (1981) Family therapy and incomplete families.Jounml f F a m i l y Th er a p y , 3:

DAVIS,. H. and OSHERSON,. (1978) Modified techniques for therapy with inarticulateadolescents. Amer ican Journa l Psychotherapy , 32: 533-543.DUHL, F. ., KANTOR,. and DUHL, B. . (1973) Learning, space, and action in familytherapy: a primer of sculpture. In: D.A . Bloch (Ed.) Techniques o Family Psycho-therapy: a Przmer,pp. 4 7 - 6 3 . New York. Grune and Stratton.FEINSTEIN, H.. (1981) Family therapy for the historian? The case of William James.Family Process, 20: 97-107.

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FREEMAN,.S . (1976) The family as a system: factr fantasy?Com prehensive Psychiatry,17: 735-747.


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218 H . Jenkins and M . DonnellySKYNNER,. C. R. 1 9 7 6 )Family and maritalpsychotherapy. British Jour nal of HospitalSTREET, . and TREACHER,. ( 1 9 8 0 )Microtraining and family therapy skills- towards aWADFSON,H. ( 1 9 7 6 )The fluid family in multi-family art therapy. Th e American JournalWADESON, . ( 1 9 8 0 )Art Psychotherapy. New York, John Wiley.WALROND-SKINNER,. (19 76 ) Family Therapy:TheTreatment of Natural Systems.

London. Routledge and Kegan Paul.WATZLAWICK,. (1978) The anguage of Change: Elements of Therapeutic Communi-cation. New York. Basic Books.WArZLAWICK, P., BFAVIN,J.ndJACKSON,D . (1967)Pragmut icsofHuman Communica-t ion. A Study of InteractionalPatterns, Pathologies andParadoxes. New York.

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1983 therapist responsiblity

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