THE PAPERS OF PHILIP J. GUERIN, JR., M.D. Edited by Leo F. Fay 1 PART I: History and Development of Family Therapy Family Therapy: the First Twenty-Five Years The Development of Family Systems Theory in Family Therapy We Became Family Therapists Contribution of Nathan Ackerman to the Theory and Art of Family Therapy Bowen: The Man and his Theory The Man Who Never Explained Himself Family Therapy: Style, Art, and Theory System, System, Who’s Got the System PART II: The Three Guerin Models of Systems Therapy Marital: The Envelope of Marital Conflict: Social Context and Family Factors The Stages of Marital Conflict Triangles in Marital Conflict The Social-Network Feminist Triangle: A Triangle of Influence The Treatment of Stage III Child: Trees, Triangles, and Temperament in the Child-Centered Family Temperament as a Transgenerational Issue: A Case in Point Theory in Therapy of Families with School-Related Problems Individual: Coaching and Direct Intervention with Triangles in Individual Therapy PART III: Mentor: Theoretical Aspects and Clinical Relevance of the Multigenerational Model Evaluation of Family System and Genogram Study Your Own Family Family Process in the Alcohol System 2 PART IV: Theory and Applications The Use of the Arts in Family Therapy: I Never Sang for My Father Becoming A Triangle Doctor Differentiation and the Adaptive Level of Functioning Markers in Therapy and in Life 3 THE GUERIN PAPERS As of this writing, Phil Guerin is still doing what he’s done for the past 50 years: taking care of patients. His identity as a physician-psychiatrist is second only to that of husband and father. A master therapist since he was a psychiatric resident, in recent years he has evolved his own version of combining family systems psychotherapy with the latest advances in psychiatric medicine. Guerin was influenced by some of the greatest pioneers of the family therapy movement, and he himself became one of its best theoreticians, spokesmen, and teachers. He taught and influenced thousands of mental health professionals by lectures, demonstrations of therapy sessions both live and on tape, and by three books and numerous papers. He founded the Center for Family Learning, which trained many professionals in his theory and methods. The Center’s publications and family systems education for the lay public spread the word far beyond the Northeast. Many of Guerin’s ideas about coaching individuals, the therapy of couples, and treating the families of symptomatic children have become a standard of care in the field of psychotherapy. His historical writings about the field are among the most frequently cited papers in the family therapy literature. These writings, papers, and selections from his books are reproduced below for anyone who wants to read them. ________________________ PART I: THE HISTORY AND DEVELOPMENT OF FAMILY THERAPY Guerin has long been interested in the history of the family therapy movement, and has always believed that, for the movement to grow and prosper, its practitioners need to build on what has come before, and to share their ideas with the people who come after them. It is only by doing this, rather than ignoring everyone else and insisting that the “my” approach is the final answer, that family systems theory will become part of the psychiatric armamentarium over the long haul. These beliefs are incorporated in the following eight papers. Family therapy made its early appearance in professional journals in the 1950’s. By the 1970’s and into the 80’s, it had become a, if not the, major new element in psychiatry, psychology, and social work. In the mid- 1970s, the American Orthopsychiatric Association asked Phil Guerin to assemble and edit a volume that would illustrate the development of the family therapy movement from its origins to that time. For the first chapter of this volume, Family Therapy: Theory and Practice (Gardner 4 Press, 1976), Guerin wrote a history of the ideas and the key figures in the development of family therapy since the 1950s. Guerin's essay is a definitive description of the first 25 years of the effort to widen the lens of psychiatric theory from a focus on the individual to a focus on the context, especially that of the family, as the explanation for neurotic and even psychotic symptoms. Guerin's history is also a demonstration that the very principles the movement was discovering about how families operate also govern how systems like the family therapy movement operate. "Family Therapy: The First Twenty-Five Years," is the first piece reproduced below. Family Therapy: The First Twenty-Five Years Philip J. Guerin, Jr., M.D. This chapter is written in the spirit of the freedom of information. Most of the information is one or another person's particular version of factual events, and as such should not be construed to represent the absolute truth, but rather many different people's version of the truth. The reports of historical happenings included here, in addition to being personal versions, also represent the way human relationship systems operate, and are not a function of malice and/or paranoia on the part of any one individual or group of individuals. The years from 1950 to 1975 may be said to constitute the first quarter-century of the field of family therapy, and it is within this chronological framework that I propose to explore the history of the movement. My main purpose is to clarify the developmental history of the field so as to enable future students of family therapy to organize and distinguish between old and new ideas. I will focus on three major areas: the context determinants that went into the formation of the family movement; the professional network of people and their interconnections with one another throughout the United States; and the theoretical classification of the family field. Historical Development The family movement had its beginnings in the late 1940s and early 1950s in different, somewhat isolated areas throughout the country. At that time the nation was going through the aftermaths of World War II, the Korean conflict, and the bomb; one of the noticeable reactions was an increased amount of family togetherness, a backlash to the separations of World War II. Psychiatry had become an attractive specialty; and psychoanalysis, having become firmly established as an ideology, was moving from the sanctuary of its institutes back into the medical schools. As soon as any ideology becomes established, professional outsiders – "change merchants" – in the field become impatient with its limitations and set out to establish new frontiers and new ways of thinking. The major thrust of the development of the family perspective was due to frustration on two counts, namely, from the attempts being made to apply conventional 5 psychiatric principles to work with schizophrenic families, and from the attempts to deal with behavior difficulties and delinquency in children. All of the important work in the family movement was being done under the rubric of research. Murray Bowen emphasized this in an article about developments in the field for the American Handbook of Psychiatry. A psychoanalytic principle may have accounted for the family movement remaining underground for some years. There were rules to safeguard the personal privacy of the patient/therapist relationship and to prevent contamination of the transference by contact with the patient's relatives. Some hospitals had a therapist to deal with the carefully protected intrapsychic process, another psychiatrist to handle the reality matters and administrative procedures, and the social worker to talk to relatives. In those years this principle was a cornerstone of good psychotherapy. Finally it became acceptable to see families together in the context of research. Family research with schizophrenia was the primary focus of a majority of the pioneers in the family movement: Bateson, Jackson, Weakland, and Haley in California; Bowen in Topeka and Washington; Lidz in Baltimore and then in New Haven; Whitaker and Malone in Atlanta; Scheflen and Birdwhistle in Philadelphia. Nathan Ackerman, perhaps the most widely known pioneer in the family field, came to the family movement by a different route. A card-carrying psychoanalyst, he was also a child psychiatrist; and as early as 1937, at the age of 28, he published a paper on "The Family As a Social and Emotional Unit." Donald Bloch, now director of the Ackerman Family Institute in New York, has described Ackerman's paper thus: The 1937 paper appeared in the Bulletin of the Kansas Mental Hygiene Society; indeed it was the lead article. Its title was "The Family As a Social and Emotional Unit." It was written while Ackerman was a staff member at the Southard School, the children's division of the Menninger Clinic. The paper is short, barely 5 pages long; to read it now illuminates the spirit of the man, his awareness of human interrelatedness, his compassion, and above all, his intuitive feeling for the ambiguous quality of intimate networks. The first paragraph has a grand architectural quality: "None of us live our lives utterly alone. Those who try are doomed to a miserable existence. It can fairly be said that some aspects of life experience are more individual than social, and others more social than individual. Nevertheless, principally we live with others, and in early years almost exclusively with members of our own family." Ackerman saw his work and the work of his colleagues in the Child Guidance movement as the "real" beginning of the family movement. In a 1967 paper, "The Emergence of Family Diagnosis and Treatment, a Personal View," he said: The family approach arose in the study of non-psychotic disorders in children as related to the family environment. The relative prominence of recent reports on schizophrenia and family has somewhat obscured this fact.