Amanda La Guardia University of Cincinnati Judith A. Nelson Sam Houston State University

An Adlerian Family Therapist Reflects on Theories and Mentors

James Robert Bitter has more than 38 years of the first author in 2015 at Bitter’s home in Ten- teaching experience and has authored numerous nessee. With his integrative approach to family publications focused on marriage and family therapy and his advanced training in multiple tra- therapy. Bitter credits Adlerian therapy and the ditions, Bitter provides a very personal look at early pioneers of marriage and family therapy the history and changing landscape of efforts to for his professional development in the field. help couples and families. His theoretical ori- Mentored and heavily influenced through his entation has its foundation in Adler’s individ- training with master therapists, Virginia Satir ual psychology, but he has received advanced and Michael White, Bitter reflects on the history training from and worked with some of the most of family therapy, its theories and practices, and important family therapists of the past half cen- his anticipation of future developments. tury, including Oscar Christensen and Manford Sonstegard, pioneers in Adlerian family therapy; Virginia Satir, a founder of the family therapy After more than 40 years of teaching and train- movement; Erv and Miriam Polster, the mas- ing family practitioners around the world, James ter Gestalt therapists; and Michael White, the Robert Bitter discussed with the authors theo- cofounder of . ries and the fields of family therapy and family counseling.1 This interview was conducted by The Beginnings Interviewer: How did you get interested in School of Human Services, University of Cincinnati, 2610 family therapy? McMicken Circle 460 U, Teachers Dyer, Cincinnati, OH 45221 ([email protected]). Jim: The very first family work I did was Key Words: Family therapy, interview, theory, historical per- at Idaho State University under the guidance of spectives. 1James Bitter is Professor of Counseling and Human Dr. Tom Edgar. Tom had gone to a conference Services at East Tennessee State University in Johnson in Denver, I think, and he had watched a man City, Tennessee, where he has taught couples and family from the University of Oregon named Ray Lowe therapy for 22 years. Before that, he spent 8 years teach- (Dreikurs, Corsini, Lowe, & Sonstegard, 1959) ing in the Marriage/Family/Child Counseling Program at demonstrate Adlerian family therapy—an actual California State University at Fullerton. He started his teach- demonstration in an open forum (Bitter & Byrd, ing career at the West Virginia College of Graduate Studies 2017). Edgar returned to [Idaho State Univer- in Charleston, West Virginia (13 years), after he graduated from Idaho State University’s Counselor Education program sity], saying that we should do open-forum fam- in 1975. His book Theory and Practice of Family Therapy ily therapy at Idaho State: By “we,” he meant and Counseling (2014) is in its second edition. his graduate students should do the counseling. Journal of Family Theory & Review 9 (September 2017): 391–402 391 DOI:10.1111/jftr.12200 392 Journal of Family Theory & Review

So, we started to listen to audiotapes of Ray in Charleston, West Virginia. Sonste was the Lowe and Oscar Christensen (2004) and read- chair of the counseling program there. We spent ing books by Adler (1927) and Dreikurs (1948; 13 years together in West Virginia; in addition Soltz, 1964). Gradually, we pieced together the to five family education centers that we started structure and process of these counseling ses- in the state, Sonste was responsible for setting sions. The whole approach of an open forum up an additional seven family education centers fit with my 1960s perspective on life: Itwas across the United States and Canada. He took community-based, inviting participation by peo- me with him to most of these places. It was not ple in the audience; it was open, observable, and uncommon for him to use a trick on me he had its crowning glory was that it made common learned from Dreikurs: He would introduce me sense. Nothing could be offered to a family that to a group as his colleague and then announce did not have the support of the larger commu- that I was going to do the demonstration coun- nity group—and this was true whether we were seling that day. It did not matter whether it was working in communities rich or poor; predom- family therapy, group counseling, or individual inantly White or communities of color; or with lifestyle assessment. Suddenly, I was on stage people young or old. In these public demonstra- with him, and later he would usually sit in the tions, what was lost in confidentiality was gained audience, available for backup. in accountability, support, and encouragement. It was a thrilling time to be working in the public Learning From the Greats domain. Tom Edgar opened the first open-forum fam- Jim: Toward the end of 1970s, a friend of ily education center in the state of Idaho; he mine went to a monthlong training experience would go on to open others—one in Boise, and with the woman many called the “Christopher some in more rural parts of the state. Some Columbus of family therapy,” the late pioneer of of these centers offered parent study groups as communication-based family therapy, Virginia well as family therapy, but all of the services Satir (1983). The month seemed transforma- were focused on helping parents and commu- tional to my friend, so the following summer, I nity leaders understand children’s misbehaviors think it was in 1979, I sold my old car and went and on teaching parents methods of prevention just north of Montreal, Canada, to a wonderful and remediation with skills like encouragement, mountain community where 100 of us partici- active listening, and the use of natural and logical pated in another monthlong training with Satir consequences. I conducted the first open-forum as the leader. She had a couple of partners work- family therapy session ever done at Idaho State ing with her, and the entire experience was con- University. I think it was in 1973, and we actu- ducted in both French and English. I learned a ally did it in a television studio at the ISU pub- great deal about myself and a great deal more lic broadcasting station. Fortunately for me, not about the role of communication in a systemic many people watched public broadcasting in orientation: We literally spent 8 hours a day, Idaho in those days, because I did one of the 5 days a week, for a month working with fam- worst four-hour counseling sessions ever. ily maps, examining modes of communication, In the spring of 1974, we held a conference embracing the power of congruence, and learn- on Adlerian psychology at ISU, and we invited ing to support others in the process of change. Ray Lowe back—for the fourth time—as well as Satir herself was the most amazing role model I the developer of the DUSO (Developing Under- have ever had in my life: She did not just teach standing in Self and Others) kit and later the her model; she lived it. She and Manford Son- STEP (Systematic Training for Effective Par- stegard both demonstrated in every part of their enting) program—Don Dinkmeyer. But the two beings how life could be lived more abundantly. stars of that conference for me were Heinz Ans- At the end of the month. I went back to teaching bacher, who many consider to be the dean of in West Virginia. I changed how I taught every Adlerian psychology, and the man who was to course, making it much more experiential and be my friend, colleague, and mentor for the next beginning the process of integrating Adler and 36 years, Manford Sonstegard (or “Sonste” as he Satir in my family work (Bitter, 1987). was called by his close friends). Over the following couple of years, I did I left Idaho in 1974, taking a position at additional training with Virginia Satir, and in the West Virginia College of Graduate Studies the late 1980s, I was asked to be one of nine An Adlerian Reflects on Family Therapy 393 trainers at her Process Community in Crested that fit with an Adlerian orientation, still the the- Butte, Colorado. That was probably the summers oretical foundation of my work. An Adlerian from 1987 to 1989, 1989 being the year she lifestyle assessment (Powers & Griffith, 2011) died. But I got to learn something with her every is just a process for developing a clear picture year for 10 years. Losing Virginia, to me, was of the story that individuals and their families like losing a parent or your best friend, a loving are living so far. It is a great tool, but up until partner. I did serious grieving after her loss for I began to study White’s (2007, 2011) approach, at least 3 years. As I look back on it now, Satir I was unclear about how to help people change gave me two special gifts: She wrote with me their stories. (Satir, Bitter, & Krestensen, 1988; Satir & Bitter, My friend Jon Carlson introduced me to 2000), and she introduced me to lifelong friends Michael White at an ACA convention in Atlanta, who still give me hope for the world. Georgia. Jon asked me to introduce Michael In the mid-1990s, I spent two monthlong before his workshop at that convention, and training experiences with the master Gestalt because of that, I got to spend a couple of hours therapists Erv and Miriam Polster (1974). Their just talking to him in advance. Like Satir and focus was less on family and more on the indi- Sonstegard, he was another one of those people vidual, but they looked at individuals as parts who lived his life in harmony with his therapeu- of much larger systems, as part of the systemic tic beliefs: He was both a marvelous therapist and cultural wholes that made up individual life. and a truly great human being. In the fall of 2008, This fit with both Satir’s model and the Adlerian my wife had a sabbatical that took her to Aus- model. Most of all, it was exactly what I needed, tralia; while we were there, I went to spend a with their focus on immediacy and the present, week at a workshop with Michael. While it was and awareness, contact, and experiments. only a week, I thought it was a powerful train- The Polsters had widened the stance origi- ing experience. I loved the focus on narrating the development of family stories over time. I nally espoused by . The here and now began to integrate a great deal of what Michael was still important, but they recognized that the talked about in terms of narrative development, present was often supported by the “there and especially the ability to focus on those points then.” More important, they brought a real con- of entry to unique events that can then be built centration to what came next, the next most into larger stories for families and the individu- interesting question, the next most likely move- als within them. ment in life, and the opportunities that existed I had begun to write Theory and Practice of just past stuck (beyond the feeling that therapy Family Therapy and Counseling (Bitter, 2009) is not progressing): Erv Polster, especially, was before I went to Australia. I decided to write a focused on tight therapeutic sequences, a focus textbook for a number of reasons. I wanted a even more important, I believe, in family work textbook that was reader-friendly in the same than in individual. way that Gerald Corey’s (2017) textbooks were. Miriam Polster (Polster & Polster, 2016) used I wanted a family therapy textbook that gave to say that awareness was the alpha and omega, Adler, Satir, and Whitaker separate chapters and the beginning and end, of experience. Without the full development that their models deserved. awareness, experience often becomes random I wanted a family therapy textbook that included events and reflection on meaning is lost. So, a chapter on parenting. And after I spent a week I began to think of my work with families as with Michael White, I wanted a chapter that having a kind of rhythm. I used the acronym gave a full presentation of his work. The second PACE to stand for purpose (my Adlerian roots), edition of the book (Bitter, 2014) added both awareness and contact (a Gestalt orientation), a genogram of family therapy and a chapter and experience (the Satir human validation pro- on the history of family therapy based on that cess model) (see Bitter, 2004). genogram. What I most wanted to convey in Sometime in the early 1990s, I picked up this that textbook was the excitement counselors remarkable book by Michael White and David and couple and family therapists can have Epston (1990) called Narrative Means to Ther- about systemic methods as well as a knowl- apeutic Ends. This was the book that introduced edge of the people and events that unfolded me to concepts of externalization and reauthor- over time to bring the profession to where it is ing. There was so much of what they were doing today. 394 Journal of Family Theory & Review

Theory and Practice encourage the family to move in a preferred or desired direction? Interviewer: You have had a lot of different experiences: How do these experiences shape Interviewer: Given your experiences and per- your current perspective on your theoretical ori- spective on work with families, talk more about entation and how you view therapeutic work with the field of family therapy and how it has pro- families? gressed.

Jim: A theoretical orientation to me is just a Jim: I became interested in family therapy thinking model, so at the heart of everything I am and counseling in the early 1970s, and to be sure, an Adlerian, because the thinking model origi- the groundwork for family therapy had already nally developed by Adler still fits my own way been laid. By the mid-1970s, however, family of looking at life better than any other theoreti- therapy just exploded on the therapeutic scene, cal model. I use Adlerian theory as a foundation in no small part to the people like Salvador Min- for integration: Satir asked me to focus on being uchin, Jay Haley, Cloe Madanes, Lynn Hoffman, present with clients and being fully engaged; my and other practitioners of the structural-strategic work with the Polsters taught me to pay atten- models. After 20 years of development (some tion my own internal dynamics, to those of the would say 50 years), family therapy practice client(s), and to what was happening between held out the promise of helping everybody with us. Erv Polster used contact within and contact everything. There was such great hope. Family between as markers in the more or less constant therapy was going to cure schizophrenia; it was flow to his therapy. Virginia, too, did this and saw going to reshape all our work with substance it as a foundation for peace: Peace within, peace abuse; it was going to be the treatment of choice between, and eventually peace among. Indeed, it for eating disorders. It held out the promise of was a sense of being at home with being human being a model that could transform everything. and being at peace in the world that informed Over the past 20 years, there has been clear her therapeutic experience. Taking all of these evidence that family therapy is effective with together, there is a PACE to life, a rhythm to a wide variety of difficulties (e.g., Pinsof & therapy—thus, the acronym, P for purpose or Wynne, 1995). It is a particularly good model presence, A for awareness, C for contact, and E when working with families in which one or for experience. That’s literally how I think about more people have severe psychological disor- moving through therapy with clients. While I’m ders. If a family counselor can get a family listening to them, I pay a great deal of attention to interact effectively, there is a chance of to what it is like to be with this family at this changing the repetitive patterns the disorder moment in time. Immediacy is important: How has enacted in the family, a chance of over- I am feeling? How they are feeling? What kind coming the environmental factors that wind up of contact are we having? All of those things get supporting the continuation of the pathology. wrapped into it, and as I work to increase their Even if additional—perhaps individual inter- awareness, I’m also working at what I think of ventions or medications—are needed, there’s as the “Satir level,” hoping to increase their con- always some value in changing the relation- tact through congruent communication, trying to ship the family system has with the disorder. create within the family a new experience. The I have seen the power of family therapy in idea of PACE is intimately related to the rhythm the lives of families struggling with a bipolar of therapy, and it also has to do with the move- disorder or schizophrenia or any of the more ment of one’s mind through therapy: I start to severe emotional problems. Now, can I say that ask myself what purpose does the family have family therapy is the best treatment model for in coming for help? What is it like to be present everything and for everyone? Absolutely not. with them? Of what am I aware? What parts of Different people and different systems will need their process or our process are in awareness and different things at different times in their lives. what parts are out of awareness? How are things So, from my perspective, the field started going between us? What kind of contact are we with the open-forum family therapy of having? What kind of contact do family mem- Adler in the 1920s; it went dormant with bers have with each other? And finally, what kind the rise of Nazi Germany and the advent of of experience could all of us create that might World War II. After the end of that war, the An Adlerian Reflects on Family Therapy 395 pioneers of family therapy went to work, and before Frank Dattilio (2010) merges cognitive here, I include Rudolf Dreikurs, Nathan Acker- behavioral approaches with a systemic orien- man, Ivan Boszormenvi-Nagy, Murray Bowen, tation to create cognitive behavioral family Virginia Satir, Don Jackson, , therapy. , Jay Haley, Lynn Hoffman, At the time of this interview, there is only one and Cloe Madanes. Especially in the late 1970s of the original family therapy masters still alive, and 1980s, the structural-strategic people were and that is Salvador Minuchin. Even one of the earth shakers. originators of the social constructionist models, I really love Lynn Hoffman’s (2002) personal Michael White, died at only 59 years of age, biography of family therapy—and in essence, a terrifically sad loss for the field. All models her own autobiography. She started out with Jay of therapy that survive their originators adapt Haley on the West Coast at the Mental Research to a constantly changing world, to a constantly Institute in Palo Alto, California, and she is changing field of practice. In some cases, that is responsible for helping Virginia Satir bring her already happening. In other cases, the models are original Conjoint Family Therapy (Satir, 1964) not so much in the processes of dramatic change to fruition. Eventually she follows Haley east, as they are expanding in use and intervention. continuing her work with Haley while he is with The people who come next and then next again Minuchin before moving to Washington, DC, always make a difference. Monica McGoldrick where Haley and Madanes opened the Strategic (1997, 2011, 2016; McGoldrick & Garcia-Preto, Family Therapy Center. At this point, Hoffman 2015; McGoldrick, Gerson, & Petry, 2008; is still practicing strategic interventions, espe- McGoldrick, Giordano, & Garcia-Preto, 2005; cially focused on the use of paradoxical inter- & Hardy, 2008) is a very important example ventions, and she joins the Ackerman Institute in of a person who both advances family therapy New York, one of the oldest family therapy intu- in general and contributes to the expansion of itions in the United States. What makes the rest a certain model, Bowen’s model in her case. of her professional journey so fascinating is that Bowen’s model, in fact, has a lot of people car- she evolves, like so many other counselors and rying his work forward: Titelman (1998, 2014), therapists do as they age and become more expe- Papero (1990), Kerr (Bowen & Kerr, 1988), rienced. She starts out as a leading spokesperson and Bregman and White (2010). The same can for the strategic model and ends up doing social be said for the structural-strategic models, the constructionist work. Along the way, she is influ- solution-focused models, and narrative therapy. enced by Tom Anderson of Norway; Harlene And some models, like the Adlerian model, Anderson and Harold Goolishian from Galve- Satir’s human validation process model, and the ston, Texas; and the work of Michael White structural-strategic models have organizations and David Epston. In so many ways, her per- that support model development and provide sonal journey is the journey of the family therapy training for future therapists. But this is not field. true of all of the systems models. It remains Like most therapeutic models, family theory to be seen in which ways object relations fam- and therapy was somewhat slow to develop; ily therapy, Whitaker’s symbolic-experiential then, it catches fire at its peak. That happened approach, or some of the social constructionist in the 1970s and 1980s. When something new models will evolve. fires up, there is always great hope that one true So I don’t know what will happen with those cure will have been found. People working in models. I think they could lessen in impact and neuroscience are hitting their firing peak as we power unless people who are really devoted have this conversation. The higher the hope, to those models help them to expand. There the more there is a sense of disappointment is a high tendency in new and often young when not everything hoped for is realized. Then, practitioners to choose eclecticism rather than something else comes along: Some models train in a single model. It takes time to grow into adapt to change; some disappear. Cognitive competence in the helping professions, and behavioral therapy can be traced back to the young people are often impatient; they just want 1930s and 1940s, but it doesn’t really develop as to know, “What do I do when ‘this’ happens?” a systems or family model. It stays an approach Or “if this kind of couple or family concern is to individual therapy and then a group therapy presented, how can I do something with them in the 1960s. It is the late 1980s and early 1990s that I know will work?” There is an allure to 396 Journal of Family Theory & Review eclecticism with its promise of freedom and after the deaths of Adler and Dreikurs, and it will flexibility. Perhaps the collective hope for cer- happen with other models too, but there are ways tainty will eventually lead to a generic singular get beyond orthodoxy, and integration from a model of family therapy; there have already been starting foundation is one of them. several models proposed (Breunlin, Schwartz, & MacKune-Karrer, 1992/1997; Sprenkle, Davis, & Lebow, 2009). Application Interviewer: So, it sounds like you’re saying Integration you think it is very important for people to have Interviewer: And what do you think about certain knowledge in one particular approach, those proposed models? and then branch out?

Jim: I am at heart an integrationist myself, Jim: I think you need at least a base of certain and so for me, something has to be a foundation. values or guiding principles, and a process if In my work, Adlerian therapy is that foundation; not an intended outcome. It is not enough, to it is the perspective from which I judge whether me, to intervene just because it felt like the I want to add principles of practice, models right thing to do, because what if your feeling for understanding human nature, or therapeutic system is off? Then you might do anything and interventions. It does not have to be originated call it therapy: There has to be some kind of by Adler or Adlerians for me to use it, but it does value system, and every single one of the major have to be compatible with the guiding concepts systems approaches has a value system. Even in Adlerian thought of movement, purposeful- Whitaker’s most spontaneous interventions are ness, holism, unity of the system from the person guided by the value of intimacy and the desire to the family to society. It is this kind of integra- to create experiences that are real and honest. If tion, rather than random eclecticism, that brings you are a structural family therapist, you may use consistency to one’s work and that supports evo- any number of interventions, but they are guided lution rather than mere trial and error. I have by your understanding of hierarchy, and your watched Minuchin evolve his approach over the belief that that parents ought to be the leaders of years; he seemed to find ideas and practices in the family; that subsystems have their own rules, the work of Carl Whitaker, Michael White, and tasks, and boundaries to be respected; and that others that he liked, and he integrated them into alignments can be either useful or problematic, his work. In the early years, he took much less and you have to pay attention to them. These time to get to know the families than he does are fundamental orientations in structural family now. I am just guessing, but I think Michael therapy, and if you accept them, you can conduct White’s (2007) understanding of stories and how structural family therapy, integrating whatever stories structure human experience influenced fits with those beliefs. part of that change. The evolution of work in the There is very little that the great masters did great masters is so important, because it reminds later in their lives that they also did on the first all of us that we, too, must evolve, or we will day of therapy: I suspect that on day one, at least become extinct. some of them were just like me: They stayed Here is the great danger in having dominant as quiet as possible for as long as possible, and figures in a field of endeavor, people who have when they did say something, they hoped with personalities that seem larger than life, people all their heart that it was okay. Still, over time, like Dreikurs, Bowen, Satir, Whitaker, Erick- they took chances, and I think the chances they son, Minuchin, Haley, White, and Epston: These took were to risk doing the next most possible brilliant people initiate change, and newness thing to do. They stepped a little bit out of flows from the work. After a while devoted fol- their comfort zone, and they tried something lowers gather around them—or gather in their else. Satir, for instance, spent a great deal of names—and then everything that is original and time just speaking to adolescents when she first dynamic and evolutionary too often comes to got started as a social worker. One day, she a halt. An orthodoxy develops: If something noted, it dawned on her that maybe a female wasn’t said by the master, it doesn’t count. Way adolescent had a mother; so she asked her, and too much of that happened in Adlerian circles sure enough the young woman had one. So she An Adlerian Reflects on Family Therapy 397 brought the mother in, and what Satir noticed Mentors was that when the mother was present, the very talkative teenager stopped talking. The mother Interviewer: Talk a little bit about what your took over and talked about everything. It took a mentors meant to you and your career. number of sessions for the mother and daughter to start talking with each other. Then, Satir asked Jim: All of them were kind people. All of if maybe there might be a father in the family. them lived what they believed. Manford Sonste- Again, there was, and Satir invited the father to gard and Oscar Christensen were the two best join them. The next thing you know, the two Adlerian family therapists I ever knew. They women who had been talking to each other quit, were like fathers to me, the kinds of fathers a and then the father was the only one who talked. boy always wished to have. They were magical This is literally how Satir reported beginning her around children and adolescents. They were sup- work as a family therapist. portive and challenging at the same time. I never We can also look at Minuchin’s early work. saw them overreact to anything. They had highly He started with poor kids at a school. Over time, differentiated selves. he started working with their families. He did When I was in Satir’s presence, I knew I was the same while he was in Israel. His structural in the presence of the most congruent human work begins with team efforts to address some being I ever met. When I talked to Erv Polster, somehow my awareness of self, others, and the of the most difficult types of disorders, eating world was enhanced; I had the sense that I was disorders for example, and the most difficult the only contact that mattered in that moment. social situations (e.g., poverty). The same can be When I was watching Michael White, he worked said of Bowen and Haley and their early attempts similarly to Sonstegard, transforming problems to solve schizophrenia—and Whitaker’s work into goals, into things people wanted for their in hospitals. All of these masters, whether they lives, movement and action in the service of pre- called it such or not, were engaged in ongoing ferred stories. People may have been stuck in a participatory, action research: They were fully problem-saturated story when they arrived, but aware that they were participants in the process; they always had a preferred place both person- they made little claim to detached, objective ally and systemically that they would like to be: observation; and they spent a great deal of time You can count on that, listen for it, and then add knowing themselves, learning about themselves, substance to that narrative. These people were and paying attention to what happened between profound to me, because they believed in every- themselves and their clients. thing they taught and because they lived it. Their Studying yourself and your work is the single very lives called on those of us who studied with most important thing you can do to become a them not just to become good practitioners but to really good therapist. Anybody who has tried to become better people. Every single one of them do the Satir model exactly the way Satir did it thought we should improve ourselves in order to generally failed. There was only one Satir, and be more valuable to someone else. Much of what there is only one Minuchin—or any of the others. I got from them came with the belief that it was If you can learn what these people did, you can possible to live more effective lives, more useful take it into your own life and you can incorporate ones, and that what we were learning was not it in your approach. You won’t look exactly like just for the people we might help, but also so we those people when you do it, but they will be could be more fully human ourselves. in the room with you. I am absolutely certain that Adler were around today and watched me Interviewer: It wasn’t just information they doing therapy, he wouldn’t think I’m doing work were giving you; it was something personal too. exactly the way he did, but his work would have evolved if he were still alive. His work Jim: Yes. There is a huge world of differ- would definitely have evolved into something ence between telling you what congruence is else. It is highly unlikely that Adler would not and watching someone live it. Satir had this have assessed genetic predispositions or would emotional honesty; she never backed down from have failed to prescribe the medications of today. telling someone the truth, but she always found These are common practices now that wouldn’t a way to tell that person the truth in a way she have been considered in his day. or he could hear it. With her, people never felt 398 Journal of Family Theory & Review blamed or approached from a superior position. enough personal to keep up, he said, “I can’t They always felt she was really there for them, deal with that; I can only deal with this person and she would tell them the truth. You could say in front of me, and I can deal with the next two the same thing about all the others too. Each in behind him. That is what I can handle at any his or her own way was very good at letting peo- moment in time.” I think his perspective will ple know that they were not in this world alone, be a useful one for all counselors: We cannot that they had purpose, and that purpose would resolve many of the issues that face families; lead to a better way of living. we cannot change the politics of everything from race to gender issues to socioeconomic conditions and the large amounts of disparity in Challenges for the Future our country. These are problems that have been Interviewer: I think our perceptions of life going on since before I was a child and continue and work tend to be influenced by both the con- unfortunately late in my life. texts and the time periods in which we live. When I was in college, I remember thinking, “Wow! What a wonderful time to be alive; we Jim: Yes, which means we don’t really know will see the end of racism and sexism (we didn’t what will be important in family therapy in even talk about heterosexism back then), and we 50 years. will see the end of it in my lifetime.” Well, we will not see the end of it in my lifetime. We will Interviewer: Given where we are today as a be lucky if we will see the end of it in my chil- culture, what challenges do you think families dren’s lifetime or my grandchildren’s life times. are facing in the 21st century, and what is the And still, these conditions, these malfunctions role of the family therapist? of the human spirit that arise from fearing oth- ers, have real psychological and systemic effects. Jim: Some of the challenges that are most sig- Racism, sexism, heterosexism, poverty, disabil- nificant to families in the 21st century are not ity, and age discrimination: They have real psy- going to be resolved through family therapy: I chological effects. What we can do is make a include here the increasing disparity between the difference with the people in front of us—and rich and the poor, and the shrinking of the mid- with the next two or three coming in line. If each dle class; the significantly high number of fam- counselor would take that seriously, that the per- ilies that have to work two, sometimes three, son, couple, or family sitting in front of them jobs to be at or slightly above poverty levels: It needs the counselor’s full concentration, her or is heartbreaking, and it has real effects on indi- his full presence, then it will be possible to make viduals and families. Family counselors will be a difference without getting discouraged. asked to deal with children who are caught up I still believe that a prevention orientation is in the distress of all this; they will be asked to essential. If we can succeed in creating a thera- help adults with anxiety and depression. And peutic community for couples and for families, given the amount of money that frontline coun- the same thing we do in group counseling, these selors make these days, they may be affected by people in these communities become the ther- poverty themselves. Counseling cannot fix the apeutic support for change and development. disparity of wealth in the United States—or in Even when working with a single couple or fam- much of the industrialized world for that matter. ily, I believe part of the work should be helping Even though the pay will not increase dra- the partners or family members to become matically, there will be an increasing need and therapeutic agents with each other. When we demand for family services. As Satir used to say, can support the development of caring and family therapy will not make you rich, but you congruence in others, we send them off with will never run out of work. Family counselors in the real possibility that further therapy with a rural areas, especially, won’t be able to meet all counselor won’t be necessary, no matter what of the needs; they will have to do what they can happens to them in real life. In everyday fami- do, focus on prevention, and let the rest go. lies, there are both external forces and internal I am reminded of a medical doctor who forces at work; neither set can be ignored. was working with Ebola in West Africa: When Knowing how life outside of the family is someone noted that there were thousands of affecting the internal processes is essential to people that had this disease, and there weren’t helping people cope. That is one reason I love An Adlerian Reflects on Family Therapy 399 the therapeutic process advocated in Metaframe- at me with such a special smile: “Oh, I’m sure works (Breunlin, Schwartz, & MacKune-Karrer, you are more than that.” There it is: At one and 1992/1997). You cannot use that approach the same time, she acknowledged and validated without considering internal processes, internal me as a person and also suggested that I didn’t family systems, and the external pressures that need to limit myself. There was room to be me result from development, diversity of culture, and add more. That is the attitude that should be and a consideration of gender issues. at the foundation of every session. No change Sometimes we can act on the external forces ever happens without acknowledgment, accep- by naming them, reframing them, or confronting tance, and validation of things just as they cur- them head-on; but most of the time, we are rently are. And nothing has to stay the same for- mobilizing the internal forces of couple or family ever. If a client comes to you in distress with anx- members, supporting them in the generation of iety or anger or depression, if a family has ini- preferred ways of living: That’s the challenge of tiated dysfunctional sequences with each other family therapy today. or are unable to cope with external forces: These are just starting points, beginning points of entry. Interviewer: I often supervise counselors who Somewhere in each person and in the couple or see many clients every week. After a while, some family as a system are the resources needed to of them start to feel that every family is the overcome. In my own life, I know what it is like same; the problems are the same; the difficulties to be with a family member who has a severe in addressing the problems are the same; and psychiatric disorder. I know what it is like to feel then, these counselors begin to burn out. I would stuck, to come to believe that everything the fam- appreciate hearing some of your thoughts on ily tries will simply not work. At that point in this. time, staying present (acknowledgment, accep- tance, and validation) is so important, especially Jim: There is a phrase to which when the disorder is in full evidence. At those (1933) often referred: “Everything can also be times, the couple or family can’t think of any- different” (p. 7). Burnout will surely happen thing else. The problem absorbs them. I am when counselors lose contact with that value. really quite open to that feeling of being stuck To be sure, not everyone can bring their full or lost; those times happen, but they don’t last. attention and focus to couples or families when It is important to remember that couples and they are seeing eight to 10 clients a day. You families were not always stuck. At some point, have to know how many individuals, couples, they had hope and movement toward the future. or families you can handle in a given time They may even have had lives that were rich and period. For me, I am not that present after full. How did those parts of the couple or family three or four clients in a day. Other counselors get lost in this problem absorption? What can we I know can handle more, some less. I expect do to reactivate that hope? I have never met a any person, couple, or family with whom I troubled adolescent who couldn’t be helped by work to be at the moment in time stuck, but being loved more. I really think that families, if being stuck is not a crime. The optimism that they are supported and can move away from fear, comes from a belief that everything can always have the capacity to love wastefully, to literally be different is the antidote to discouragement. overwhelm someone with love. The counselor So, that is my starting point: I want to be has to believe that families can get to a better more optimistic than the clients are themselves. place before the family can believe it. So, what People can always be more than they are at I want in a counselor is faith in people when present. they have nothing else and hope for a family Years ago when I first met Satir, I was at a when that family is feeling lost. There are all conference, and we were passing in the hallway. sorts of skills and techniques that may go with She stopped and looked at me. “Now, who are that, but it starts with an attitude that is at odds you?” she said. with the pessimistic, at odds with the experience I replied that my name was Jim Bitter. I was of hopelessness, and at odds with the belief both star struck and fumbling for words. “I am that there is nothing you can do in the face of really happy to be here,” I said. “I should prob- trauma. ably tell you I’m an Adlerian.” That’s always a I think it is important in family therapy not to good opening with a famous person. She looked focus on the problem, but on the way the couple 400 Journal of Family Theory & Review or family handles the problem. You can say well Conclusion isn’t that about getting each member to cope? As we authors reflect on this interview and on No, I don’t think so. We live in communities, Dr. Bitter’s journey guided by his many teachers and the coping of any single individual is heav- and mentors, we think about our own journeys ily influenced by the relationships she or he has and how the difference in our years and longevity within the system and within the larger commu- of experiences might impact how we, and our nity. Wouldn’t it be something if we could har- readers, view this extraordinary professional and ness the strength of the community to shore up his passion for the family therapists of the past, families in distress? present, and future. For me (Nelson), a recent Starting with Adler’s work with families retiree, I am struck by how much satisfaction Bit- counseled in front of an audiences or Satir’s use ter has found in the profession of family therapy, of large groups processes, these early practi- and I can identify with that satisfaction. I worked tioners sought to make a difference in human in public schools, private practice, and higher life. The opening up of therapeutic process to education, and I am grateful for all of those a larger community has been one of the most experiences and how the systemic approach pro- useful aspects in the evolution in family therapy, vided me with a world view that worked in every even when that community is small. Whitaker instance. Changing my theoretical perspective to made use of co-therapists, and Minuchin and a systems approach after being trained in the Haley often involved multiple therapists; Tom more traditional counseling theories impacted Anderson created reflecting teams, as did me and my clients in the most positive ways. Additionally, as I look back on my career, like Michael White in his use of outside witnesses. Bitter, I can identify the professionals who influ- All of these processes are an expansion of enced me, such as Harlene Anderson and Sue family therapy in which multiple people are Levin at the Houston Galveston Institute, and brought into connection with and influence in how much I owe to them for their wisdom and the life of the individual, the couple, or the guidance and willingness to let me come to terms family. with my own ideas about families and family Every 4 or 5 years, Jeff Zeig and the Erick- therapy. I also appreciate the collaboration and son Institute in Arizona put on another Evolution comradery of like-thinking professionals who of conference: I have been to all dedicated so much time and energy to helping but one, and they are wonderful. I have heard families of all circumstances and walks of life. many of the presenters there say that they do As for the future, I had the privilege of teaching some of their best work there in front of thou- therapists in training and counselor educators for sands of people. That makes perfect sense to me, 16 years, and I marvel at how much initiative, because while you’re doing therapy with thou- intelligence, and dedication they bring to the sands of people watching, there is a whole com- field. munity that supports the person who’s on stage. In thinking about the future of family therapy, The audience brings their attention and interest, it may be important to think about how prac- encouraging the person to be real and honest titioners can become active participants in our with the therapist. Both the client and members communities. When not working in a commu- of the audience learn that they are not alone, that nity setting or agency, it can be difficult to find effective ways to engage with families and cou- there is a whole group of people there willing to ples beyond the walls of a private practice. Com- support whatever changes someone might want munity engagement is a value and a process that to make. In the early days in family therapy, the can be taught in training programs so as to set up 1920s, Alfred Adler was already doing this kind an expectation that family therapists be involved of open-form family therapy. The most impor- in advocacy, education, and training efforts in tant therapeutic agent was always the commu- their practice communities. Unfortunately, not nity. If I could suggest a major role for coun- all families and couples will have access to ongo- selors in the next 10 years, it would be to bring ing outpatient therapeutic intervention. Thus, their counseling out in the open again, to make community-based programs designed to provide therapy available within larger groups of people, low-level intervention on a paraprofessional or and to involve more of the community in thera- peer level may help destigmatize services for peutic processing. families and couples, reach more individuals An Adlerian Reflects on Family Therapy 401 who have a need for services in our communi- Dinkmeyer (Eds.), Systems of family therapy: An ties, and serve to advocate for more formalized Adlerian integration (pp. 109–142). New York, therapy when it makes sense for a family or cou- NY: Brunner/Mazel. ple to seek services (Mier, Boone, & Shropshire, Bitter, J. R. (2004). Two approaches to counseling par- 2009). Therapists have a special role to play in ents alone: Toward a gestalt-Adlerian integration. the community and can develop, advocate, and Family Journal, 12(4), 358–367. educate families on the importance and needs for Bitter, J. R. (2009). Theory and practice of fam- supportive mental health care. Providing open ily therapy and counseling. Belmont, CA: Brooks-Cole/Cengage. groups, education sessions at community cen- Bitter, J. R. (2014). Theory and practice of family ters, and paraprofessionals trainings on basic therapy and counseling (2nd ed.). Belmont, CA: supportive techniques for families is potentially Brooks-Cole/Cengage. preventative but also useful for engaging the Bitter, J. R., & Byrd, R. (2017). Adlerian open-forum community in developing a support network that family counseling. In J. Carlson & S. B. Dermer is both culturally relevant and geographically (Eds.), The SAGE encyclopedia of marriage, fam- convenient. Research that highlights the efficacy ily, and couples counseling. Thousand Oaks, CA: of community-based family and couple educa- Sage. https://doi.org/10.4135/9781483369532.n5 tion prevention programs would be important to Bregman, O. C., & White, C. M. (2011). 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