7 wnuctment

rootedblossomer' tree,gtreat O Chestnut or the bole? Are you the leaf,the blossom glance' brightening of music, to O bodyswayed dance? How can*. ktto* the dancerfrorn the W. B. Yeats In family theraPY,Yeats' questior know the dancer from the dance' T gd.iaf ' entwined inextricably lg1[h separate one from the other is, as ir in order to hear it more clearly. It disappearsll into the But the family members stop the danging -w.bpn.-they-9,0-R[e
t ,

:li ii

l;

ll

to th e lhQ$Pist hovv e, cg+r4ent' 3Iu4-QEp.tAt$ sggsloLauq-,try--io--describ quality tiie musicand the dancearg.gfrme. This limits the arnountand r"ppii"a lo iit.-tubjective memoryand the descrip;i;;nmm;" "f tive ability of the informants.
,r When the therapist asksthe family\q control what they are presenting.In@ nicate, they frequently !ry-haul-to-pu! *ith each But when thu th.rupisi getr the family members to @g9 some oltnu problems that they consider dysfunctional other,r.trangr-gtin$
ulDvvvu^v-.v v-_-Et

i,

I I t

li
li

I ir
I

as in trying to establishcontrol over a L disagreements, u"a fuglglp) eYoA[Lthe, quences fa4 l L**ltlgl s se "h disobeEen:lc hild, he unleashe
rules take over, and transactionalcomponentsmanit'est The accustomed
78

:.

{3F

79

Enactment

themselveswith an intensity similar to that manifested in these transac-

orrs" nq_ti_o-naL .f"ransacJi emol * faruly membersare-played-Qul,This transaction occursin the context of the session, in the present,and in relation to the therapist, While facilitating this transaction,the therapist is in a position to observethe family rnembers' verbal and nonverbal ways of signalingto eachother and monitorffithe range of tblerable transaciiol in the processby utq.f:e*?_qg+,gllg_ig[9n

asks-lLe if.t ths-rh,e,rqp-t-sr -fe]B$LJo qn in!-9p.9_rgg1{ t* _."-oq$tlg!F .pge-

possibility of alternative modalities ---- ft"*;*;E. about --.-qhed the family comesinto therapy, there is usually consensus iq'JrgJis the identified patienti@ is the problem, and tipooTffiroblem affectsother family members.The members'prior attempls to find solutions on their own have centeredtheir transactionstoo much around the "problem," making it the backgroundagainstwhich all other aspectsof their reality are played. 'Iheir experience of reality has narrowed down from overfocusi.re. ex-p.erienc-e,uaround*thesympTbg.inlq_{rgi_tfqf-th-etr
,,. t \.

tgg1glS_tlglrypt91-b-,earerhascaused.themto.iguor_e_oihensigaifp_e
as-p-gc-t-F-9*t,t!gii...!ranga-cj"i9_l]g. The family has framed the problem and 3m as the relevant reality for therto gather information that the fam-6ow nt, and evCn inor6:afficift. to

tions, and listen again.They pay attention to the content of the rnaterial elicited, to the ways in which the different elementsof the plot relate with each other, to the qualifications of and the disparities between theseelements,and to the affect of the presentation.T_:q rqsdLqtg_tlheling information cannot,provide therapists -ruit-h lrrj-p:m.ationllr-al-the members do not have. A corollary of the therapist's over-reliance family on content is a concern for completeness. The therapist tracks the pa-

Lbs

80

Family Therapy Techniques

tient, requesting further information on the themes that the patient has already presentedas central, being careful not to intrude into the mateThe therapist rial, so that the history follows its own selectivesequence. helps in the unfolding of the material until he has enough information. This mode of inquiry preservesthe myth of the objectivity of the L+,":t"a tb an tneiep-lstandthe reality-.of the patient. Th-e-!!rgrapis!.i.s ge! all q!-jective re-portingof what is liqtodan oI=gSg-gJg-glsj.t1ying,.tg process has developed "fg3lly__thqp. This frqming_gf the lfr-erape.utic in,therapy for fear of distortt-he-ms-elves theiap-iJtswho hesitate to qqg_ arate ca-mps: the observed,and.iiyF;"

intg two sepcontgxt itt": orealizs-tLr.e !,lerap.gutic ingftre-i:ie6.[i1y,';"in[ 'l!ttuy;'

of who have beentrainedl"Glhqqqitaftmnn& zr:B"ttTfi"tapists' ((U"o^municationknowth"tt@llgn*[rfl rrenqesJb-e*-qafuial andprs-Laobserved,pqllrz$-llrsy-gre-atarays--de"alrneJuithapproxinates.

ble-realities. Dismissing the fantasy of an objective therapist and a permanent reality, tbe-haily-6-eranirf creates.in-the"semigs-4L.9-tle*{gqrdvsfunctional. transac-ti,aeamong:.the.-ftmily sonal scenario in which a 1dy-sJu-r-r-c-t!-o.naltransac-ti,ax-among:Jh*thmlllr Instead of taking a history, the therapist admembers i areasthat the family has framed as relevant to

onlv sincc"Jbef.agtlfig.-dygfUneiqnalinto the session. @ particular argaswill nrovitle iq ,gII4" glgas, payins attention to_lillege

i'@Lt_*r"

-that t-he u$-and" fffi y struct ii" b@ine s-rrg.Adfgq! tr-+asaqtiq .!q Ltlgse
,heiapi-st will tli-ereforecatch a of the te

'. rbg_e!:y_*slr":-q-Lp! !X"

tE;6mily'Prob-l9sl.ap--well^a*.artennatives-t-hus--beffi mdin-r:.elationtothe.theIAHl cotoeuuuilableln-t,s3lesqnif

con-

trol their behavior tet* Fd*ith ^" u{1c$44llv-:ilgilg:9% Bu@sit* a!-hsne. manifestcdiqthgryggflng.. tralgactions
t,'

ntrol of the context, he can test the erentially with family membersor by er members.The theraPist can also (.Qbttt@ ry to the family mernbers, neattempts of other familY members Jhprapist to shorten the enactment. Ip..!h-is*'puocegs".Jhe. ch+nLe the affiliation of family lrembers with each other temporarily, ':Busbss="

This tlresrete-m testins-lhe-fl-e+ib:lihrci -t-he-1gitst rv*bS-Tr!lt-e abouttttg ggp"-.i!y-qrw maneuver @ w_r!hr:q_a-pa$ieulaltb,@.Enactmentlgqg-1-e139=19:tt*

lr i l l . i I ; ' I

r:r i,i

l!i
i i

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81

Enactment

sinceno,
cclntext, there is a 4 concomitant vvrrvv'.r/drllu c

ffiTariifii medbutt u""ti their a;"." i" l;;;"" to the rherapist, who o"ly u:.:bserver,but alsoa musician and dancer himself. Hot \ffiiecond, while the family is enactingits reality within the therapeutic
"tt3!ug;g y. Fami_

trH#i

to the family'sideaof what itpronrem is. ,#i advantage of enactment q is that, sincemelnbers of the theratl"ther =til;"i"s

is"-uqlry*-s-Spsrlv"-r+-ad-"sfrdp"ti;.naGtuafle-;:"Edt*;r,t -tl-e-fo-cs uugir,, challenge.

c,udenotonv"#;lTilT;H$FHS"J*:*T;il'#:T : va.tionand inrervention expands. IggtgAd__of

a._pgg_ig-l_!. yt-t_lr__pg!_t qlsgy,

li.,t bunchoT-Iiealeis

or helpers. Bui

ntified patient and a

ff *flff-f

T:

*"LoJv e d, .y_r!h -e 4ehithelil:-Eag ;i m;r

a-!I-Qlls' I nrs context rs decidedlyadvantageb'ffiTbtt ,n iffiffiG;; or ar differenrdevelopmentat stages, andwith I::lg^:hPuT, "j:h{e.n

utilization of therapeutic directives and concrete ranguageand metaphors drawn from the transactionsamong family members facilitates 4l aUd age.boundaries. lation to the therapist, it may also fa_ ent. Families have great power to in_ ling to the rules of the family. They r into a centrality that robs him of

farnilies of cuitural backgrounds that differd;;il;ffi;ru,s.

The

tong f4lqdy"m-e.,Bb,e{s.^. W.hile-the.famch other, lhe. th,erapist' can.:distance

reutic leverage.

of !he sl+ples-t -tsgbptggsp_&*drer-

familvanddecides whichdystunctionar areas ro highlt*ii.t" ri-Eiffj

)ho

82

Family Therapy Techniques

o. yglqg5rtof enactment, the therapist organizesscenariosin which the family members dance their dysfunctional dance in his presence. of enactment, the therapist suggestsalterAnd in tn. @_:=1fu)movsrnent innative ways of transacting. This last -mQ-vq{r_rpnt_mgy-,gve.Bredie-tr-ve lorolr-o-uand-bring-hape-f.othe-family. The three movementsof enactmentare illustrated in the treatment of the Kuelili family, the family who came to the clinic becausePatti, age four, is a "monster." She is so uncontrollablethat the parentshave taken to locking her into the bedroom at night. Otherwise,she will run downstairs and light the stove, or run out into the street. The parents are at their wits' end. The father, a burly though gentle and unassuming man, can control Patti adequately by himself. But his wife, a soft-spoken woman, is nonplused by her daughter. Patti is an alert little girl whose quick and lively temperament make her a striking contrast to her somewhatplacid parents. The therapist's The family has been in therapy for seven sessions. for these interviews has been to have all of the family members slLrategy present, including the two-year-old daughter, Mimi. But usually Patti a:ndher sister have been sent to the playroom after disrupting the session, and her parents have remained to talk about their problem with her. In the eighth sessionMinuchin joins them as a consultant.

T'HE FIRST MOVEMENT: SPONTANEOUS T'RANSACTIONS

after the episodeof joining reported Three minutes into the session, earlier, dysfunctional family transactions are framed. Patti: Is that mine? (She takes Minuchin's papersl. Minuchin; No! That's mine. (Patti sits on the table.) Iltother: Don't sit on the table, Patti. What is that? Patti: That's the table. Mother: Okay. Don't sit on the table, okay? You sit on chairs. Okay, honey? (Continues to repeat this in the backPatti: DocJoc--dociocground us she runs around the room, hitting the back of each chair.) Il:[other: She seems pretty wound up lately. (Mimi begins to follow Patti.) No, Mimi. No, Sweetie. E'atti: I want to play with-here, Mimi, You play with the dragon. Do you have any paper?

{tI

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Enactment

Iltother: No, not today, sweetheart. No, put that back,we don,t have any paper to draw on. Put them back, patti. patti, do what you were told. Put them back. Her belligerence is so_ Minuchin: Is that how you run your life? ILfother:What's that? fu.[inuchin: Is that how patti and you spendyour time together? Iufother:Yes-yes. ILfinuchin; It takes just a minute and a half to see it. UAAe**ss*-eont*&*s etl ihe infermatisn neceser:r ferthe definition of the problem. During this period.,the mother makessevenineffective controlling staternents to patti, whose amount of hyperactivity is rnatchedby the mother's intensity of ineffectivecontrol. To the family's definition of the problem-that patti is uncontrollable-can now be acldedanother definition, that the mother is hyper-responsivein her controlling request, that her control is ineffective, and that she feels helpless. Minuchin allows a spontaneous interaction betweenthe family mernbers to take place; this is essentialto seehow the family functions. Allowing such interactions to occur may seerillike a simple thing, but it often proves difrcult for the beginning therapist, who frequently confusescentrality with therapeutic power. Mother: It's a continuousbattle, at least for me. Minuchin: Who wins? Mother: It varies.If I'm up to fighting with her, at that point, sometimes I do. You know, I let her win sometimes, too. (?o husband.)But we do try to get her to do what we say even if it is a fight. Doh't we? Fq,ther:I make her. Minuchin (to father); What was your answer? Fcvther:I make her do it. Mother: Right. Fcr,ther:I always win. P ct tti (in the ba ckgr ound); Doc--doc-doc--do cMinuchin: I feel there is a little differencethere. you do make her, but your wife doesn't.. M,other: No, not all the tim+-no. The definition of the problem is expandedhere. The mother defines herself as understandingand helpless;the father defineshimself as ef-

&hL

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Family Therapy Techniques

fective and authoritative; and they both define the daughter as uncontrollable. With this information, the therapist is ready to implement the enractment of a transaction around control. The therapist guides his interventions here by a diagnostic assumption: When a preschoolchild cannot be controlled-when, in effect,he is taller than one of his parents, he is sitting on the other parent's shoulders.This diagnosticaxiom, though not necessarilytrue with older childten, seemsto hold true with preschoolers. The parents can be expected to be in disagreement about the ways of controlling the child. The therapist doesnot yet know the patterns in which this dysfunction is expressedin this family, but he has all the information necessary to frame the area of control as dysfunctional,and to decideto bring that area into the session. He asksthe family to take their usual stepsto amelioratethe problem, thereby underlining dysfunctional transactions.

THE SECONDMOVEMENT: ELICITING TRANSACTIONS

Minuchin; Do you find this presentarrangementa difficult one?For example, the two girls going around while we talk? How do you respond -\ to that? Mother: How do I respondto it? I get tense. Minuchin; You get tense? Mather: Yeah, I do get tense. Minuchin; So, you would prefer that she stay in one place? Mother: No, I can seethem walking around when there are toys for them to play with. Minuchin; What would you like? Mother: Right now? Minuchin: Yes, what would make it more comfortable for you? Mother: For them to sit over there and play with the puppets. Minuchin: Okay. Do that. Make it happen. Minuchin tells the mother, "Make it happen."The stageis now set for a changed sequenceof interaction. Rather than Patti and her mother playing their accustomedparts, in this scenario the script has been changed.The therapist-director has given the mother a new part: she will now act to get her four-year-old daughter to behave in such a way that the mother is more "comfortable." JBysaying to the mother, "Make it happen," Minuchin has also conveyed an important messageto her; that is, she is in fact capable of

Aql

85

Enactment

making Patti behave.It would have been quite different if he had said, "why do you ask your daughter okay at the end of eachcommand?Are you concernedwith hurting her?" Both interventions,no d.oubt,would bring up information about the mother-child transaction;one, however, is a homeostatic maintainer, and the other introduces a destructuring chrallenge to the mother-child holon.
I

Mother: Patti, go over there and play with the puppets,okay? Go ahead. No, not here.No.

trmrt: EFhy?
Mother: Go over and play with the puppets. Patti: I don't love you. Mother: I love you. Go ahead,go play rvith your puppets. Ptttti: I don't want to play. Fu,ther: PattiMother: Mimi is playing with themFctther:Patti, will you sit down? (Speaksfirmty and patti looks at him.l Minuchin (to father): Let Mother do it. You know she's the one who does it when you are not there. Father: Yeah, yeah. Minuchiu So, let her do it. When the family enactsa controlling transactions, the three mernbers ac.tivateeach other in their usual role function. The mother enactsher helplessness, and this activatesthe father to take over control, to be effective in his authoritarian style, so that the definitions of each family member in the family are confirmed. The daughter is irnpossible;the mother is helpless; the father is authoritarian. The therapist is inter:ested in testing the limits. He wants to explore the flexibility of the farnily to function in unusual ways. Can the mother be effective in the presenceof her husband?Can the father not be activated by his wife's momentaryhelplessness? Can Patti respondto her mother? 'The rashness by which the therapist organizesthis enactment rnay questions,and the creation of this scenariomav seernrushed on his rai.se

Jhq

86

Family Therapy Techniques

dogs not know. The secondcriticism has to do with the narrownessof the exploratory search.But ttre episodedemonstratesa generic concept of gathering information. Through the processof creating a scenario, the bherapistelicits information by pushing the family membersagainst the l;hresholds of their usualtransactions. The therapist then observes the responseof the family membersto this pressure.This is a transactional metlhodfor gaining information, in which the therapist gathers the information by experiencingthe resistanceof the family members to his prod. This technique makesfor an immediacy of experienceand givesa cross-sectional knowledgeof the way in which family membersfunction ordi:narily,along with additional information on how they function when the 1;herapist is producing pressures through his scenarios. This transactional information provides a biopsy of the family. The transactiorN' as demonstrated !y ttt_gptQ"t are an experientiat distillation of the family history. The,'advantageof the approach is that, in this small area, the therapist cari3ain--ri.intensive knowledge of the way the family functions.

TH]I THIRD MOVEMENT: ALTERNATIVE TRANSACTIONS

Minwchin: Make it happen.What you said should happen.Make it happen. trt'snot happening. Mother: Patti, what were you told to do? (patti whines.)No.Go sit down and play with the puppets. Patti: Come on, I want to play with this. Mother: okay. PIay with that then, but why don't you try to play quietly, okay? While we talk. okay? Go sit down with Mimi now. pull up your socks. Patti (pulling up her sochs): These always fall. (Both girls wand,erouer to the mirror.\ Mother: Sit down, Mimi. Get off that mirror, patti. Patti: Is this a mirror? Mother: Yes. Don't touch it. Patti: Now, Mimi, don't you dare.You daren't do this-you know what? The last time she caught her finger in the door and I caught my thumbMinuchin: It's not happening. Mother: WeIl-

LL1{

87

Enactment

Minuchin; Find whatever way you need to, but make it happen. organize the two girls to be in one corner playing so that you feel comfortable. Mother: The only way I could do that would be to put them in a corner with thePatti: Mimi, put that back! Mother: -toys and me to stay with them. Minuchin; Do it the way in which it is necessary for them to occupy themselvesand for you to be here with us. Make it a differencebetween the g"srniGps iltat are talkrag and tite eh*drer-rtitat are playi*g. Make it happen. Mother: All right. Patti, come here. Patti: Doc? Mother: Go ahead,sit down and play with the puppets. Patti: I want to play with these. Mother: Okay, sit down and play with them, then. Patti (looking at the puppetsl: I can't find the woman and the little girl and the baby. Mother: well, maybesomeone elseis usingthem today. okay? There are plenty of other toys over there for you to play with. Okay? Patti: Okay, you play with this, Mimi. In this segment there are four interventions by the therapist, all of which represent a variation on the theme: it's not happening,make it happen.The therapist, seatedon the periphery of the scenariothat he has created,experiences the way in which the mother and Patti activate each other, but he doesnot interpret or comment on what he is observing: the transaction between the grls; Patti's acting like her mother in relation to Mimi or the mother's finding somethingwrong with the socks when Patti doesobey.His interventionsare presented in such a way that he maintains the membersof the dyad working with each other around the area of the enactment.An intervention that cornmentedon the nature of the transaction between the mother and Patti would have induced the mother or Patti to establish a dyad with the therapist and would have interrupted the mother-Patti dyad. The therapist is pushing the mother and thereby gathering information about the flexibility of the systemto respondwith his help. The therapist then exploresthe possibility of the developmentof an unusualtransactionin this family, one in which the mother becomesef-

248

Family Therapy Techniques

fective in controling the daughter without the intervention of the father. Minuchin: Make it happen. Mother: AII right. Mimi, put that back. Patti, come here. (Gets up, goes toward the girls, and takes a toy awaryfrom Patti.) Patti: Mimi gave the toy to me. Mother: I know she did. Come on. I want you to bring all the toys over and play. Patti, bring all the toys over here. Patti: Why? Mother: You and Mimi are going to play. Okay? Patti: Where? Mother: Right here. (Stands and ushers the girls into a corner.) Right here. Why don't you play? Play mommy and daddy with the puppets and the baby. Okay? Patti: Huh? Mimi: I want a puppet, too. Patti: Mimi, here's the father. In here are the two girls. Minuchin; Very good. Now, relax-feel comfortable. Mother: But, I know it is not going to last. Minuchin; No-no, no. Relax. If you really feel that it will last, it will Iast. Patti: Come on, Mimi, play. Come on, play. I want to take the cradle away. Minuchin; You know, you have been successful at this point. The gfuls had a way df distracting you so that you say that something should happen and then you forget, and I seePatti being an experienced person in the distracting technique,you know, so that you ueall the time busy with her. The enactment of this situation finished with the mother being effective. Of course,this outcome is an artifact of punctuation. The therapist selectsa moment at which the mother has been able, with his help, to organizethe behavior of the two grrls, and at this particular moment he declaresthe end of the enactment.The purposeof this strategyis to help the mother to experienceherself as competent in the presenceof her husbandand in the presenceof the therapist without the husbandtaking over or becomingauthoritarian. The therapist assumes that it is possible for this mother to be competent with Patti, and he helps the family

J h\L

89

Enactment

enacttheir reality with certain variations,sinceif the mother is effective, then the daughter'slabel of impossiblewill disappearas well. ts perinheral so that interactions be-

declaring!.hpUg 'tnjh g-s-e-qsipn, _import;ant,and encour.ag.e-s. ii*i* anO t"hefamilr.t.o-*arscUg-IeJg,.!-hg.Brgbl**, he*u149_!_tf"g -:ts* Bv-Ussklpgl-he-ht-be-rls.-en!-mrrce, *".H1=qgd-p_-qlrrt fo_r_c_!-q1g_tlte.,msther-and.Pgt!.i.tq e=o.b,ey_o-nd,,.!h."9*.9.-"_.Ss!om9d 1mgg"99iUte, lrS-L":ml-q!hg.pgtqt".whet'e_tt19m-.o=t[er-ac-tually^assds-s=opjr,q.l.',-Th tfenapis'r, iherrlabelshe1-eftgs"ueeessfui, ef undertiqing-gl_ g&_e,geirp- g9ggk"ce,andg-ug&q-sjure.that.a.b*a,rge*tq*mible. sg!q9!mes&rqdy_!lg!qb.9r-s--en!.-el "rn-.s-,t-r,a-nsaq--tlags3tgt=!!rs*Sl-qrgpsrt g4_q-freme as hlg.lIghts-qftheir-danee_ts:rediatety. rn t-hb*-c-ass*jlrgff_t jy-rds-e-c_qnd of.enac.tmenL.ean__b_e_ggmbined*._ .1r-r-ev-9._r-r-ren!S ]FIIGHLIGHTING A SPONTANEOUS INTERACTION
The Hanson family consistsof father and mother; Alan, age 19, who has been an inpatient in a psychiatric center for six months; Kathy, 17, rvho is closeto Alan; Peg, 21, the parental child; and Pete, 12. The segment occurswithin the first five minutes of the session.Minuchin, again acting as consultant, has just been introduced to the family. Minuchin; Do you have a boy friend, Kathy? Rathy: Yes. Minuchin; Alan, do you have a grl friend? '\lan: No. Minuchin: How long have you been goingwith him, Kathy? Kathy: One and a half years,now. Minuchiu My goodness. So, you started young. Alan, is her boy friend your friend? Alan: Yes. Kathy: He wasn't when I met him. I didn't meet him becausehe was Alan's friend. IVlinuchin: But at this point, AIan, he is your friend. What is his first name? .Alan: Dick. .Minuchiu How old is he? .Kathy: Nineteen.Alan (answering simultaneously) : I don't know-nineteen?

)rLa[_*p_*bj"",1rjp

h-e.:=e';

248

90

Family Therapy Techniques

Minuchin: You are helpful, Kathy. I asked Alan how old Dick was, and while he was thinking, you said nineteen. She didn't wait for you to ask her, Alan. She volunteered.Is that somethingshe frequently does? Alan: Yes. Minuchiu Anticipating you? Alan: Yes. Minuchin; So, she takes your memory. Alan: I guessso. Minuchin; Who else in your family acts like Kathy? tr saw your mother with Pete, just outside. Pete wanted to go to the bathroorn,and your mother almost entered the bathroom with him, as if he couldn't find the men's room by himself. Did you notice that, Pete?Did you notice she went half of the way with you? The therapist notices that Kathy first amplified Alan's statement and then anticipated and preemptedhis answerto the questionabout Dick's age. Adding an isomorphic transaction that he observed between the mother and Pete, the therapist frames all of thesetransactionsas a family pattern that handicaps the individuation of family members. Again the speedwith which the therapist interprets such scanty data ,,1mayraise a question about his reliability. It is also true that highlighting l/ a dysfunctional transaction so early in his contact with the family might I upset them. But the therapist's intervention is soft, supportive, hurnotous, and oblique, allowing him to join the family at the same time that he frames a dysfunctional pattern. Having recognized the intrusive quality of the family's transactions and hypothesizedthat this is a central issuein the family, the therapist continues to underline intrusiye transactions. The next segment occurs 'fifteen minutes later. The therapist dir6bt's-Alan to changeseatswith his mother so that he can sit next to his father and discussa problem. Alan moves, and then reattaches his lapel microphone. His father reaches over, picks up the wire that is draped over the chair, and moves it for Alan. Minuchin: I want to show you, AIan. (Getsup, stands in front of father and son, takes the cord, and reproducesthe father's act.) Your father took the cord and moved it over. Why did he do thrat?What was he doing? AIan: I don't know. Trying to correct something,I guess. Minuchin: Do vou have two arms?

2t/

91

Enactment

Alan: Yes. Minuchin: Do you have two hands? AIan: Yes. Minuchin (taking Alan's arm): This arm finishesin a hand. Could you do that? (Puts the cablefrom the original position to the place where father had located it.) Alan: Yes. Minuchin: At nineteen,I assume, you can do that by yourself? AIan: Yes. Minaehin; Why did }re do thet? Isn't it sti'arrgetlrat he sh+i:ld dc that, ae if you don't have hands? AIan: Well, he doesthat a lot. Minuchin: How old do you think he thinks you are? Three? Seven? TweIve? Alan: Twelve. Minuchiu So, that makesyou a little bit younger than Pete. Can you help him? Can you help him so that he grows up-so that he lets you use your two hands? AIan: I don't seehow. Minuchiu Well, if you don't help him to change,you will not be able to use your hands. You will always have ten thumbs-you will always have two left hands-you will always be incompetent becausehe is doing things for you. He is paralyzingyou. Talk with him about that, becauseI think that's very dangerous what your father did just now. The therapist balloonsa noneventinto a moment of drama. An automatic, helpful movementof the father is framed as the spontaneous enactment of a dysfunctionaltransactionthat is seenas isomorphic to the previousones.This techniqueof framing a spontaneous and unattended event usually gains salience,since the family mernbers are surprised when their attention is calledto the fact that they are acting unwittingly and frequently in conflict with their wishes.In this segment,the therapist incieasesthe intensity of the intervention by standing closeto the dysfunctionaldyad, by affiliating with AIan, and by using a seriesof concrete metaphorsabout individuation and coping.He finishesthis maneuver by suggesting the enactmentof a changein the father-son transaction in which AIan, who is alwaysin a position of incompetence, becomes the father's helper. Now the therapist beginsto enact alternativesin this family. The first time, the family rules prevail.

250

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Family Therapy Techniques

Alan: Well, I think I know what he means,like sometimesFather: I know what he means,too, Alan, and it's the truth. Alan (to mother); He doesthings for me. Minuchiu Go beyond that, AIan. I think your father needshelp, and I don't think that anybody can help him in that better than you. Alan: I don't know what to say. you see,and I can't help because Minuchin (to Alan); I am a stranger, I don't know you two. If you need some help, you can ask someonein the family to comeand join you, but if you don't needto, I want you to try first by yourself. Futher: Do you want Peg to help you? Minuchin (to father): Why did you selectfor him? Why did you select for him? You just now did exactly the samething. You see,Alan, he is so absolutely hooked into being helpful that he cannot help himself. Now I want you to think if you really want Pegto help you or anybody else<r nobody. rer'scomplementarity:Alan's hesitaness, which is also control and intruntains the son's incompetence.The ained. The therapist now has information about the level of rigidity of this subsystem.He knows experientially that at this juncture, his participation alone is not sufficient to introduce alternatives. He must changestrategiesor bring up reinforcements.He can have one or more family membersjoin the dysfunctional dyad; he can maintain the sameframe but exploreit among other family members; or he can shift attention to a different aspect of the family dynamics and return to the sameissuelater on at a point where he finds himself in a more powerful position within the system. Not all families plunge into their usual transactionswith such alacrity. quesThe tlgrap_Sj mqy t *lt_!q .fke a,poqiJ,iog9f leadersh.-ip,-.asking tions and activating indiyldu_a!famil*.nemhersn in an atternpL to get gsg;ded, tryt!1psl started. In -s.o-41e--9a-s-qp*-famrly-q]-e.m-be-{q-s*r-a&.re.-rrrain p_qbli_cther.apist is prgqgnt iryj-1g1gq-e*lys.Jhslr faqage.Bqt be-caus-e-the and transactionsarg""1g,!a.!9d.tq.him, he gap !_4c1e4sg the inin the room '6-s;i;siine-;ii{l;il,p;il-

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p tlrp_pame a continuationof the enagtme-nt suggesting a.LulUqggbyays. ss_ The therapist 91n4gterygig_e=!"be_p-alameters-noLonly ef -theproH-e.ul availahle.-testin&thejcJlib-ility_*o_f it existsbut alsoof the alternatives _-t_h.g,

oi the-tretqqc11eLle b'sbtghtor by

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and gathering pledictive information about the pgqqibility that Fy_gtgm lhis family can function in different ways. In some families the first two movementsof the dance of enactment are quite easy to elicit, but eliciting transactionsin an unusual way is this movement requires an active participation on the parb not, because of the therapist in affiIiation with some member before it is possibleto determine what alternativesare available to the subsystem. The Gregory family consistsof a mother in her mid-twenties and her five-year-old daughter, Patrice. As in the Kuehn family, the mother is unabie to controi her daughter, but sFreis aiso aftaid 'thai she might physically harm her when she gets angry. Fifteen minutes into the secthe gful is hanging onto her mother and not responding,in ond session, spite of numerousrequestsfrom her mother to sit quietly. Minuchin (to mother); I think that Patrice has a way of making you dance to her tune. (Patrice gets up and starts walking around the room.) Tell her to stay there becauseI'm going to talk to you. that a controlling The therapist createsa scenariowhere he assumes transaction will need to occur. He can use any number of simple situations, like this one,as a context where the family membersare forced to enact their transactions. The simplest situation would be to have the parents ask their young children to do or not to do something different from what they are doing. Mother (in u soft uoice):Patrice. Patrice, come over here and sit down. (Repeatsit louder, since Patrice did not respond the first time.) Patrice, come over here and sit down! Minuchin: I like that toraeof voice. That is your music. (Patrice conxes and hangs on to mother.')You seewhat she'sdoing now? She knows your number and she makes you dance. Mother: Sit down, Patrice. Minuchin: Patrice has absolute control over 5rou! The therapist, who has joined previouslywith the mother in an affiliathe mother to take an executiveposition. tion of adults, challenges Minuchin (stunding up): Mrs. Gregory,can you stand up? Have Patrice stand next to you. See,Patrice is much smaller than you. Can you pick

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Family Therapy Techniques

her up? (Mother picks up Patrice.) And you're,strongeralso. (To Patrice.) Hold my hand, tight. Let's see how strong you are. Very tight. (To mother.) Can you do that with my hand? No doubt you are stronger than she is. The therapist usesa number of concreteoperationsdesignedto high// light the ditrerencei" power rud function betweerrpareRt auclghild. He expectsthis operation to unbalancethe system,stressingthe mother to join with the therapist and distancingher from her young daughter. Minuchin: So, how is it that she controls you? (Patrice again puts her arms around mother and hangs on to her.) Mother: Stop! (No response.') Stop itl (DisengagesPatrice and tells her to sit in the chair. Patrice obeys.) G You are Minuchin: She needsto hear that voice.This voice is necessary. afraid of your stern voice,but this voice is good.At times it's soft and loving and at times ib'sstrong, and she needsto hear both ranges.She needsto danceto vour music. - The mother enacts effective control within a context in which the therapist supports her and puts the daughter down. This maneuver tends to be distasteful for many therapists,and it is so for the therapist in this session.But it is necessary to create distancebetweenthe members of this overinvolveddyad, to avoid the danger.ofchild abuse,and to support the development of autonomy in Patrice, even in an aesthetically distasteful operation. The therapist's behavior in this transaction is very different from that in the Kuehn family. There his participation is minin'ral, which facilitates the enactment of a functional transaction between mother and daughter.In the Gregoryfarnily, the mother needsthe therapist'sparticipation as an active member of the therapeutic system before enacting an alternative transaction.

EXAMPLE A "HOW-NOT.TO-DO.IT"
The Adams family consistsof 24-year-oldmother and her two children, ages eight and five. The problem is that five-year-old Jerry is abusedby the mother. The mother at times losesher temper and beats him severely.The mother has referred herself to the therapist because she is concernedthat she might harm her son. This is the initial interview.

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Enactment

The family enters and sits down. The eight-year-old,Molly, goesto the corner and quietly starts coloring. The boy immediately walks around the room, starts shouting, and giveshis mother numerous commands.The mother, for her part, givesthe boy various commands,such as, "sit down and be quiet" or, "Don't say a word." Afber grvingeach of these commands,the mot;herquickly losesinterest and doesnot follow through, even though the boy does not seem to hear her. At another time, the mother tells the boy to do a puzzleby himself. The boy takes the puzzleand hands it to the mother, who absent-mindedlycornpletes ihe piizzie. As the interview continues,the boy commandsmost of the mother's attention and scarcelylets her either talk to the therapist or attend to the ghl. For most of the interview, the boy hollers so loudly that the mother and therapist can not hear one another.At other times,when the mother's attention is not directed toward the therapist, she is busy giving the boy numerous instructions. When the mother's attention is directed to the therapist, she and the therapist discusssuch matters as how the mother can be more effectiveat home. The only communicationbetween the mother and the gful occurs at one point when the girl is busy doing a complete-the-dotpuzzle.The mother looks down at the girl, seesthat she is not doing it correctly and ,hollersat her, "You're doing your puzzleall wrong!" The therapist again capturesthe mother's attention, and they go on talking about how things can be better at home. After about ten minutes, with Jerry grossly disobeyingthe mother, and the mother half-heartedly grving commands;the mother losesher bemper. She hollers at the boy, getsup, grabshim, holds him by his waist so his head is hanging down unsupported, and brings him over to her chair. She then puts him on her lap, holds both his hands, at one point covershis mouth, and goeson talking. At this time, the boy is allowedno freedom of activity whatsoever,exceptbreathing. This sessiondemonstratesa serious failure on the therapist's part. The therapist joins well with the mother and with the children. He speaksto the mother and joins with her around how difficult her life is. He speaksto the kids and has a similar rapport with them. He carefully observes the interactionsin the family and notes a sequen(:e of behavior that may and very probably does lead to the boy's being abused.He notes that the mother givesinstructions and doesnot follow through on them. He notesthat the rnother either demandsthings that are inappropriately mature for a child of this age,such as sitting still and not mov-

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Family Therapy Techniques

i'g, or ignores behavior that is grossly immature on the boy,s parb. He notes that the mother doesnot react irnmediately in an appropriaue way to set limits for the boy. Instead, the mother waits and waits for her limit-setting to be obeyed.when it is not, she continues to wait, while the boy persistswith his infuriating and antagonisticbehavior.Suddenly the mother's threshold of patience is reached and she overreacts. The therapist, noting all this, then tries to set up a situation at horne where the mother can be a more effectivecaretaker.But instead of talking about the situation at home, the therapist could have realistically arssumed that the sequence which transpires at home is essentiallythe same as what he has just witnessed.He could then intervene to change the way the mother and chrildreninteract in the session,with the sanguine assurancethat the changed sequencewould cury over to the home situation. In order to enact a changed interactional sequence,the therapist could, for example,say to the mother: "You have a very high tolerance fcrrnoisefrom your children. It would help our work here if you could get ttrem to be more quiet so we can talk. Do you think you would be able to do that?" If the mother says yes, then the therapist can say, "Fine, do it." If the mother says no, then the therapist can say, "Try, and t will arlviseyou if necessary, but you need to do it." There is a tremendoustemptation on the part of the therapist to enter into a situation and produce the desiredchangehimself. Had the therapi,stin this casesaid to the child, "Be quiet, your mother and I are trying tc' talk," he probably would have been effectiveto some extent, but the opportunity for therapeutic changewould have been lost. The goal of threrapyis, after all, to increasethe complexity of the family's transactions and to facilitate their utilization of more competent transactions, not to develop a comfortable therapeutic holon. This therapist lost an opportunity to turn the sessionfrom a therapy of history, cognition,and affectinto a therapy of experience. Much vitality and intensity were therefore lost. And with a problem as severeas chrildabuse,the therapist needsall the intensity and leveragepossible. These examplesof therapeutic sessions might give the impressionthat enactment is used only to createthe major brush strokes,but this is not th.e case.Enactment is ubiquitous in all the small strokes,the srnall interventions that are repeated countlesstimes in the courseof therapy, such as blocking the mother and then listening and respondingintently as the daughter finishesher own sentences, telling the teenageboy to negc,tiate with his father for the use of the car rather than letting his

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Enactrnent

mother do it for him, or encouraglngthe parents to continue their conversation and not let their son intrude. Enactment is not a rarefied event that punctuates the course of therapy only occasionally.On the contrary, it should becomea part of a therapist'sspontaneous way of being, a pervasive attitude that insists on being there, when the family would be satisfiedwith just telling him what has happened.

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