The American Journal of Family Therapy, 38:5062, 2010

Copyright Taylor & Francis Group, LLC

ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926180903430030
A Family Therapy Narrative
FLORENCE W. KASLOW
Palm Beach Gardens, Florida, USA
The evolution of the eld of family therapy since its inception in
the 1950s is traced in this article. Major contributory forces as
well as key pioneers in the rst generation and leaders in successive
generations are highlighted. This is followed by anelucidationof the
conceptual foundations and basic principles undergirding almost
all of the main theoretical schools. Expansion in this now vast eld
is underscored through attention to the proliferation of the number
of books and journals addressing family therapy/psychology topics
as well as mentionof the internationalizationof the eld. Atypology
of extant theoretical models is also presented. The article closes with
a discussion of contemporary issues and trends.
EARLY HISTORYTHE ILLUSTRIOUS PIONEER GENERATION
Family Therapy, as a distinct eld, crystallized in the 1950s. Theoreticians and
clinicians who were in the vanguard of those experimenting with treating
family members conjointly were motivated by several factors: (1) They were
disconcerted by the slow progress made when doing individual psychoanal-
ysis or psychotherapy; (2) They recognized that changes in the patient and
his/her attitudes and behaviors could have a strong impact on other family
members, and that if signicant others had no one with whom to explore
what was transpiring and their reactions, they might sabotage treatment,
It is important to note that the emphasis by any author on the history of a eld will reect
his or her particular exposure to various leaders, streams of literature, and points of view and
this bias is acknowledged herein.
Florence W. Kaslow, Ph.D. is in Independent Practice as a Life & Executive Coach and
Family Business Consultant in Palm Beach Gardens, Florida. She is a Visiting Professor of
Psychology at the Florida Institute of Technology in Melbourne, Florida and a Clinical Pro-
fessor of Psychiatry and Behavioral Sciences at Mercer University Medical College in Macon,
Georgia.
Address correspondence to Florence W. Kaslow, 128 Windward Drive, Palm Beach Gar-
dens, Florida, 33418 USA. E-mail: drfkaslow@bellsouth.net
50
A Family Therapy Narrative 51
overtly or covertly. Thus, they reasoned, it would be better if these impor-
tant others were also involved in the process. (3) There were huge waiting
lists at agencies post World War II, so seeing couples or families together
seemed a viable way to decrease the patient backlog and the waiting time
for therapy.
Family casework, an approach developed in social work interventions
with distressed, multi-problem families (Richmond, 1917) was one early fore-
runner of family therapy. This often entailed home visits by the caseworker,
rather than having families come into the agency. In the 1950s ofce-based
treatment evolved in family therapy as the preferred and more time efcient
practice model and this has continued to be true. (For history of the eld
see Guerin, 1976; Kaslow, 1982, 2004; Kaslow, Kaslow, & Farber, 1999.)
Nonetheless, since the early 1990s there has been a resurgence of interest in
home-based treatment, both in the United States (Lindblad-Goldberg, Dore,
& Stern, 1998) and abroad (Sharlin & Shamai, 1999) with poor and multi-
problem families who are unable to go to therapists ofces. This approach
recognizes that not all families can mobilize their members to travel to an
ofce for therapy and that this inability is not necessarily an expression of
resistance.
The Child Guidance Movement was another tributary, begun in Chicago
in 1909. It was nurtured further in Boston, beginning in 1917, when psychi-
atrist William Healy established the Judge Baker Guidance Clinic. The usual
procedure followed in child guidance clinics was for a psychiatrist to see
the child alone and a social worker to interview the parent, perhaps con-
currently, but not conjointly. Frequently parent meant mother. Few clinics
had evening or weekend hours to accommodate working parents, especially
those with xed work schedules.
Some concepts that evolved from the psychoanalytic movement com-
prised a third historic force; especially the pressure exerted early on for
family diagnosis. Flugel, for example, wrote in 1921 it is probable that the
chief practical gain that may result from the study of the psychology of the
family will ensue from the mere increase in understanding (of) the nature
of, and interactions between, the mental processes that are involved in fam-
ily relationships, (Flugel, 1921, p. 217). Not all of the early analysts were
exclusively individually oriented. The intrapsychic concepts that are imbed-
ded in attachment theory (Bowlby, 1988) and object relations formulations
(Fairbairn, 1952) are interactive ones and have been subsumed into the psy-
chodynamic school of family therapy/psychology, which includes objective
relations (See typology later in this chapter).
The discontents already alluded to had begun rumbling and jelling in
the minds of various clinicians by the early 1950s. By then they had started
to be expressed by some courageous, outspoken theoreticians/therapists in
various parts of the United States. Research into the patterns of interaction
between those diagnosed with schizophrenia and their signicant others led
52 F. W. Kaslow
to speculation about and recognition of the key role family members may
play in the psychogenesis and maintenance of the illness. One agship group
formed in Palo Alto, California, in 1952 with Gregory Bateson at the helm.
John Weakland and Jay Haley joined him in 1953. Their initial interest in
metacommunication, i.e., the message about the message, the intent behind
the content, steered them toward developing a theory of communication that
could perhaps enable them to unravel the origin and nature of schizophrenic
behavior, particularly as it evolves in the milieu of the family (Bateson,
Jackson, Haley, & Weakland, 1956).
Shortly thereafter these pioneers formed the Mental Research Institute
(MRI). Other theoreticians and clinicians who became part of the early
MRI group included Paul Watzliwick, Virginia Satir, and Don Jackson. Con-
ceptualizing the phenomenon of the double bind was one of their core
contributions (Jackson & Weakland, 1959). Two of their other basic contri-
butions were that destructive patterns of relationships are maintained through
repetitive, self-regulating interactive patterns within the family constellation,
and that there are multiple and often contradictory levels of communications
occurring simultaneously.
Murray Bowen, a psychiatrist who initially specialized in the treatment
of schizophrenia in the l940s during his years at Menninger Clinic, became
intrigued by the dynamic of mother-child symbiosis. His working with this
pattern of attachment led to his generation of the theory of differentiation of
self (Bowen, 1978). During the 1950s he worked at NIMH concentrating on
analyzing family of origin dynamics before moving to Georgetown Medical
School, where he continued to do his pioneering work from 19591990.
Among Bowens lasting contributions are his elaborations of the cycle of
emotional reactivity of family members to one another evidenced when they
are seen conjointly, and that feelings bubble up and overshadow thoughts
creating a chaotic milieu. Bowen described his awareness of how the dis-
traught families he saw tended to try to draw him into their undifferentiated
family ego mass He stressed that it is imperative for the therapist (con-
ductor) to resist this pull and remain neutral, objective and external to the
familys enmeshed interactions. He also formulated the parallel concepts of
triangulation and detriangulation, which continue to undergird or inuence
the work of many family therapists (Bowen, 1988).
By 1952, Lyman Wynne, who was a psychiatrist and a psychologist,
also had begun working with families with a loved one with schizophrenia
at NIMH. He became aware of the unreal, as if perfect nature of these
disturbed families and developed the still current concepts of pseudo mutu-
ality, pseudo hostility and the rubber fence and connected the constructs of
communication deviance, thought disorders and a continuum of severity of
pathology (Wynne, 1984).
At Yale University, psychiatrists Theodore Lidz and Steven Fleck inves-
tigated the dynamics of families with a member with schizophrenia focusing
A Family Therapy Narrative 53
on the destructive impact of pathological fathering styles. Their underlying
assumption challenged the then-prevalent assumption that maternal rejection
was the major causative factor. These clinician-investigators invariably found
that the parents of the schizophrenic person had a disturbed relationship.
They elaborated upon two primary types of disturbance: (1) marital schism,
the repetitive inability to build mutual accommodation and no achievement
of role reciprocity, and (2) marital skew, a pattern which evolves when one
spouse has serious pathology and controls the other more dependent part-
ner/parent. They noted that the child with a serious mental disorder was
pulled into trying to stabilize the parents rocky marriage (Lidz, Cornelison,
Fleck, & Terry, 1957).
These early theories of the families etiological role in the develop-
ment of schizophrenia spectrum disorders have been seriously challenged in
recent years. While there is evidence to support the notion that family pat-
terns, such as high levels of expressed emotion (EE) (Leff & Vaughn, 1983)
may contribute to the maintenance or exacerbation of symptoms, it has now
become apparent that neurobiological and genetic variables are also main
contributors in the development of these disorders.
In New York, child psychiatrist Nathan Ackerman, who had, like Bowen
and Wynne, trained at Menninger Clinic, started seeing the family together
as the basic patient unit for diagnosis and treatment (Ackerman, Beatman,
& Sherman, 1961). For the 1955 meeting of the American Orthopsychiatric
Association he organized one of the rst sessions on family diagnosis. At this
conference Ackerman, Bowen, Jackson, and Wynne learned of each others
separate but similar efforts to treat entire family units and realized they
shared a sense of common purpose. Ackerman founded a Family Institute
in Manhattan in 1960. It was renamed the Ackerman Family Institute in 1971
as a tribute to his legacy after his death. Ackermans work emphasized the
intrapsychic and the interpersonal, the unconscious and the conscious, and
confronting and challenging the defense mechanisms. He was well aware of
the complex interplay and dances of selves within systems.
Carl Whitaker was one of the most imposing, intriguing, playful, irrev-
erent, and daringly innovative of the founders. From his work with children
and with psychotic inpatients he had come to comprehend a great deal
about craziness and this seemed to give him entr e into the inner world of
his patientsallowing his unconscious to connect to theirs, doing what he
named psychotherapy of the absurd (Whitaker, 1975). His unique blend of
warmth and emotional chiding enabled him to get patients who had frozen
their emotions to slowly defrost. As early as 1943, he and colleague John
Warkentin invited spouses and children to join in patients therapy sessions
in their work in Oak Ridge, Tennessee. Whitaker introduced the use of
cotherapy, based on the premise that having a colleague engaged in the
treatment enabled either therapist to interact spontaneously without fear of
getting over involved, as the co-therapist was available to pull him/her out if
54 F. W. Kaslow
need be, and that they could each assume or switch supportive, exploratory
or confrontational roles as needed. The experimental brand of provocative
psychotherapy that he and his colleagues at Emory University Medical School
Department of Psychiatry forged there and in their private practice in Atlanta
between 1946 and 1965 and later at the University of Wisconsin in Madison
was quite controversial. Whitaker believed the therapist had to win the battle
for structure in the rst session of therapy yet pushed patients to take charge
of and be responsible for their own decisions and lives. Consequently, he
believed that the family needed to win the battle for initiative. The Family
Crucible (Napier & Whitaker, 1978) provides an excellent portrait of his style
known as experiential family therapy and of the co-therapy he and Augustus
Napier conducted together.
In Philadelphia two active groups of therapists emerged. One group
originally joined together at the Eastern Pennsylvania Psychiatric Institute
(EPPI). This group included Ivan Boszormenyi-Nagy and Geraldine Sparks,
who were co-therapists and co-authored the now classic Invisible Loyalties
(Boszormenyi-Nagy & Sparks, 1973) which articulated an ethical/existential
ledger of balances within the intergenerational family system. Others in this
group, most of whom also were initially trained in the psychoanalytic tra-
dition, included James Framo and Ross Speck. Speck, along with Carolyn
Attneave, fashioned the original version of network therapy which took
into account and utilized sociocultural and racial diversity and the natu-
ral networks within families with schizophrenic or drug addict members.
Their work did not resemble psychoanalytic treatment, but it did reect their
knowledge of intrapsychic processes (Speck & Attneave, 1973). In the mid-
1970s Boszormenyi-Nagy moved to Hahnemann Medical College in Philadel-
phia to direct a graduate Marriage and Family Therapy Program and his career
intersected with several others, including Israel Zwerlingthen Chair of the
Department of Mental Health Sciences. Zwerling was an energetic, dedicated
community and family psychiatrist. Boszormenyi-Nagys work also has been
inuential in Eastern Europe, particularly in his native Hungary.
Many from the EPPI and Hahnemann groups formed the Philadelphia
Family Institute as a loosely afliated forum for interchange of ideas and to
provide stimulating workshops and later, to do training for edgling family
therapists. The Institute evolved into a strong professional support network
which lasted for many years.
The Philadelphia Child Guidance Clinic was located on the other side of
the Schuykill River. When Salvador Minuchin, a brilliant charismatic pioneer
like most of the others already described, left Wiltwyck School for Boys in
New York to assume the directorship in 1965, he brought Braulio Montalvo
and Bernice Rosman with him. They were joined in Philadelphia by Jay Haley
in 1967 and subsequently by many others. Minuchin, a psychiatrist, divided
troubled families into those that were enmeshedtoo tightly intertwined and
chaotic, and those that were disengagedisolated, indifferent, seemingly
A Family Therapy Narrative 55
uninvolved with one another. His early work was with Families of the Slums
(Minuchin et al., 1967) and he has long continued to focus on inner city, poor,
underserved populations. He believes the hierarchy in these families often is
in need of restructuring with the parents being helped (or pushed) to assume
their rightful position as the architects and executives of the family and that
the therapist must join the family before being able to restructure and change
it. Out of the heady golden years at Philadelphia Child Guidance came Min-
uchins Structural Family Therapy and the groundwork was probably laid for
Haley and Cloe Madanes to evolve Strategic Family Therapy (Haley, 1973).
The two major groups in Philadelphia held very different views on
treating families and supervising trainees and they rarely came togethera
pattern that unfortunately has been repeated in other cities and countries,
when those espousing the efcacy of their approach over all others have
been unable to even meet together for conferences. Fortunately, some of
the less doctrinaire and ethnocentric members of the profession have been
able to intermingle and exchange ideas in a mutual learning process.
At Georgia State University, Luciano LAbate developed a graduate pro-
gram in Family Psychology, a term he coined to connect this eld to de-
velopmental and clinical psychology and to have it rooted in basic research
(LAbate, 2008). A prolic teacher and writer since the 1960s, he has been
inuential in the United States and his country of origin, Italy. He has been
one of the pioneers in manualized treatment of patients (LAbate, 1983, 1985,
1997).
There are many more notable individuals who have made signicant
contributions but space limits restrict discussing everyone. Therefore, the
foregoing has been an attempt to highlight some of the most illustrious
(great) grandparents in the family therapy eld.
CONCEPTUAL FOUNDATIONS AND BASIC PRINCIPLES
The word and concept family as used herein broadly encompasses nuclear
and extended/kinship families, stepfamilies, adoptive and foster families,
and gay and lesbian couples and families. It includes those who make a
mutual commitment to regard one another as family, and to assume certain
responsibilities to and for each other on a sustained basis.
In addition to some of the basic principles of family therapy already al-
luded to in the discussion of the pioneers, there are additional core assump-
tions that have evolved over time and which remain salient. The evolution of
family therapy contained overlapping periods of development; which have
been elucidated as follows (Kaslow, 1990).
Generation Ipre 1969 The Pioneers and Renegades formulated and re-
ned the premises
56 F. W. Kaslow
Generation II19691976 The Innovators and Expanders
Generation III19771982 The Challengers, Reners and Researchers
Generation IV19831995 The Integrators and Seekers of New Horizons
Generation V1995Present: Researchers for an evidence based real-
ity. Post modernism, social construction of reality and personal narrative
approaches.
CORE ASSUMPTIONS UNDERGIRDING FAMILY THERAPY INCLUDE
Members of a family constitute a system, with all parts interdependent and
interrelated
Change in any part (member) of the system usually induces corresponding
changes in some/all other members of the system; pain in one mem-
ber of the system causes pain in all members of the system. (Satir, 1964,
1967)
All families have rules and expectations, implicit or explicit; and stories
about their histories and their family heroes; myths and secrets (Imber-
Black, 1998). Each member of the family may perceive and tell the family
story or narrative differently (White & Epston, 1990).
Families range on a continuum from dysfunctional, through mid-range, to
functional and healthy (Lewis, Beavers, Gossett, & Phillips, 1976; Walsh,
2003). Certain characteristics typify the various categories of families, and
knowing these characteristics can help clinicians in their assessment and
treatment.
Healthy families exhibit good problem-solving and decision-making skills,
integrity, and open communications styles (Lewis et al., 1976).
Many dysfunctional families are characterized by rigid alliances, schisms,
and high conict.
Boundaries between generations and among members of the same gener-
ation should be clear and should not be crossed inappropriately (Minuchin
& Fishman, 1981).
Many patterns of behavior and interaction are transmitted intergenera-
tionally; these can be detrimental or healthy, depending on the pattern.
(Kaslow, 2004).
Many techniques in addition to verbal ones can be useful in assessment and
treatment, such as genograms (Bowen, 1988; McGoldrick & Gerson, 1985;
Kaslow, 1995; Shellenberger, 2007), and family sculpting (Duhl, Kantor, &
Duhl, 1973; Papp, 1983; Satir et al., 1991).
Use of paradoxical techniques may be benecial in some situations. (Haley,
1976; Selvini-Palazolli, Boscolo, Cecchin, & Prata, 1978).
The core tenets presented here comprise a representative sample of
some of the foundational beliefs; however, this list is far from exhaustive.
A Family Therapy Narrative 57
A signicant event connoting recognition of the maturation of family
therapy was the birth of the journal, Family Process, in 1961. It is still a
premier publication 49 years later. Daniel Araoz started the Journal of Family
Counseling in 1973. It has continued into the present, having been renamed
The American Journal of Family Therapy many years ago. The Journal of
Marital & Family Therapy was launched in 1974 as the ofcial Journal of
AAMFT. Since then at least a half dozen other major family journals have been
founded in the U.S., including the prestigious empirically based Journal of
Family Psychology, which debuted in 1987. The number of books published
in many countries on this ever expanding and multifaceted eld also has
proliferated rapidly, heralding the prominence of the eld.
Since the 1960s, the movement has expanded rapidly, with therapists
coming from everywhere to observe the masters at work in their own settings
over one-way mirrors or to hear them present at workshops and conferences.
Trainings sprung up at newly formed Family Institutes in such places as
Boston and Chicago, in addition to those already mentioned, and in graduate
and professional schools.
In the United States several organizations have been formed that are
dedicated to the eld of family treatment and research: (1) The American
Association for Marriage and Family Therapy (AAMFT), begun in 1942 as the
American Association of Marriage Counselors, a name which represented
its primary focus at that time. It began as an interdisciplinary organization
of marriage counselors, physicians, clergy, social workers, etc., changed its
name to AAMFT in the late 1970s, reecting its newer focus which included
treating families, and that there were then more psychologists and psychia-
trists in its membership. (2) The American Family Therapy Academy (AFTA)
was founded in the mid-1970s by many of the family therapy pioneers and
was originally known as the American Family Therapy Association. (3) The
Division (now Society) of Family Psychology (#43) of the American Psycho-
logical Association (APA), formed in the mid-1980s. (4) The American Psy-
chiatric Association (ApA) has a separate small section focused on the family.
Family therapy began to spread to other countries by the 1970s. Ini-
tially clinicians from many lands traveled to the United States and England
to get training. Universities and organizations in far-ung countries invited
acknowledged leaders to come to present workshops to interested practition-
ers. Subsequently, many countries and regions have established their own
family focused organizations and training programs. Today credentialing is
a key concern in many regions of the globe.
There are two major contemporary international organizations which en-
compass diverse members practicing in various arenas of this disciplinethe
International Family Therapy Association (IFTA), created in 1987, and the
smaller International Academy of Family Psychology (IAFP), founded in 1990,
plus many extant regional associations, like the European Family Therapy As-
sociation (EFTA). Utilizing organization memberships, journal subscriptions,
58 F. W. Kaslow
and the number of books published annually as a quantitative measure of
the elds signicance, family therapy/psychology is thriving throughout the
world.
Theoretical Models
Over the past six decades numerous schools of family therapy have evolved
and been elaborated; (Becvar & Becvar, 1996; Nichols & Schwartz, 2006);
each model has had its major progenitor(s), generation leaders and staunch
followers here and abroad (Kaslow, Kaslow, & Farber, 1999). Each theory has
posited and promulgated its idiosyncratic perspective as to the denition of
therapy and how treatment should be conductedthat is, the processes and
techniques that it advocates. Each school is predicated upon ideas about what
contributes to pathology or dysfunction and what promotes and maximizes
change, and each should delineate the interventions to be used to achieve the
desired outcome. These should be consonant with the theorys underlying
assumptions and beliefs.
Previously I have divided and organized the theories into categories
and subsumed the most prominent of the current approaches under the
major headings that appear most appropriate. (Kaslow, 2004). The various
theories have uctuated in their popularity; once having waned, a revival
of interest has been generated in several and they have again come to
occupy a central place within the spectrum of available explanatory theories
of family dynamics, structure, functioning, and treatment. Different theories
have attracted followers and proponents in different countries, depending on
where they were propagated initially, which leaders have come to that region
to present workshops on their approaches, and which therapeutic styles
and treatment methodologies are most compatible with a specic cultural,
psychosocial, religious, political, and economic context. The typology, now
updated follows (Kaslow et al., 2001):
I. Transgenerational Models
Psychodynamically informed (including Object Relations and Attachment
approaches)
Bowenian
Contextual/relational
Symbolic/experiential
Emotionally focused
II. Systems Models
Communications
Strategic
Structural
Systemic
Brief and solution focused
A Family Therapy Narrative 59
III. Cognitive and Behavioral Models
Behavioral
Functional
Cognitive behavioral
IV. Post Modern Models
Narrative
Social constructionist (including linguistic approaches)
V. Miscellaneous
Psychoeducational
Integrative (including Comprehensive and Multi-Modal Models)
CONTEMPORARY ISSUES AND TRENDS
The eld has witnessed the ascendance of various charismatic leaders, some
of whom achieved guru status, garnered disciples, and been featured in mas-
ters presentations and on videotapes. They have convincingly taught and
demonstrated their models and intervention strategies at family institutes,
in graduate school classrooms, at conferences and in workshops, some-
times before there was any research conducted to validate the efcacy of
their assumptions and intervention approaches. However, in the last two
and a half decades at least part of the eld, primarily the more research-
oriented professionals, has pushed for evaluation of what works through
both qualitative and quantitative research on process and outcome variables,
reaching beyond clinical experiences and personal testimonials. In these
25 years pressure for having empirically validated and/or evidenced based
treatments, such as functional family therapy, has mounted (Alexander &
Sexton, 2002) in the ranks of researchers, practitioners, third party insurers,
and in academic and other training institutions and from certifying boards.
A frequent controversy arises as to whether graduate students of family
therapy should be trained broadly initially, learning many of the theories,
and then proceeding to gain competence in one or several theories and a
set of techniques they believe have greatest value, or whether they should
become immersed in one theory and its accompanying techniques, and once
that is mastered, then be exposed to multiple approaches. Some see this
latter training model as akin to indoctrination with a rule book of absolute
dicta, yet others deliberately select such a specic unidimensional curriculum
and model. This tends to lead to doctrinaire thinking and practice, akin to
ethnocentric politics that hold our way is the only right way and is the
antithesis of the strong trend toward integrative family therapy (Kaslow &
Lebow, 2002; Lebow, 2005; Pinsof, 1995).
Family theoreticians and practitioners, supervisors, consultants, and re-
searchers continue to be drawn from the elds of psychology, psychia-
try, social work, marriage and family therapy, sociology, counseling and
60 F. W. Kaslow
guidance, pastoral counseling, and nursing. Such diversity of discipline of
origin enriches the eld, yet also contributes to interdisciplinary tensions and
rivalries around competency issues, such as how much education and train-
ing is needed, what should be included in the curriculum and in internships,
and at what degree level; and around licensure, i.e., who can use the title
and who can legitimately practice marriage and family therapy; as well as
who can receive third party payments for these services. These turf battles
are apt to continue.
Since the new millennium began, family therapists have been practicing
and teaching in an expanding variety of venues, including primary health
care settings, with family physicians, and with other kinds of specialists. Their
expertise is also valued beyond the health /mental health arenas in such
settings as school systems, and in elds like family business consultation
(Kaslow, 2006). Some family practitioners specialize in the forensic arena,
focusing on intimate partner violence, child custody, divorce and myriad
other issues (Kaslow, 2000). Others are engaged in the domains of healing
family trauma, assisting military families, and family public policy (Heldring,
2008). Competence regarding gender and multiculturism has become crucial
in this expanding eld.
Given that we are each born into a family, grow up in a family of ori-
gin, and grow up in our own family of origin, adoptive or foster family and
that most people later move on to create their own families, the fascination
with the family as a system which warrants and commands professional and
societal attention, will continue unabated for decades to come. Clinicians
from various professional backgrounds and theoretical dispositions share
this fascination and many nd being engaged in family therapy/psychology
challenging, stimulating, growth enhancing, frustrating, rewarding, and usu-
ally gratifying.
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