QUALITY CONTROL MARK
FAMILY THERAPY IN CHILD PSYCHIATRY Introduction John F. McDermott, Ir- M.D.
MI\R 1 5 1979
The undeclared war between child and family therapy may be winding down! The original combatants are retiring from the field, while newer and younger professionals entering the scene are unconvinced that the struggle is justified at all. Signs of rapprochement are everywhere. The editor of Family Process declares that it is time that family therapy have a diagnostic system (admittedly spurred by DSM III problems of third party payment and inevitable national health insurance) (Bloch, 1977). Family therapists are thinking developmentally throughout the life cycle, so that all members of the family may be attended to and children are no longer sloughed in order to reach into the "heart of the problem," i.e., the marital couple, of which the child is only a "symptom." Furthermore, the new Essentials of Training in Child Psychiatry (AMA, 1977-78) includes family therapy as a required experience. Integration between internal and external forces, balancing of the here-and-now with the historical development of problems, are all serving to reduce the distance between family therapy and child psychiatry. Perhaps one of the most significant signs is this section on family therapy in this journal, which could not have occurred only a few years ago. We hope it presents a coherent and logical progression of articles from diagnosis to treatment. Consider the mix of indi-
Dr. Mrlsermott is Professor and Chairman. Department of Psychiatry. School of Medicine, University of Hawaii (1356 Lusitana Street, Honolulu. Hawaii 96813), where reprints may be requested. Dr. Mclrermott was responsiblefor editing this special section. 0002-713817911801-001 $00.46 e 1979 American Academy of Child Psychiatry.
2
John F. McDermott, Jr.
vid uals in the series, for it represents a new era and developing interface in the field . Charles Malone, who writes an overview of the field, has been regarded as the child psychiatrist most deeply involved in the family therapy movement from its beginning without having lost his identity as a child psychiatrist or his commitment to the individual child. The heart of his overview ties together family therapy and psychoanalytic concepts. Tseng is a general psychiatrist who presents the latest in a series of papers based on his group's research into famil y interactions originating from work with children which could lead to an organized and reliable diagnostic system. Claude Villeneuve is a young Canadian child psychiatrist representing the new generation who has combined intensive training in family therapy with an identity as child therapist. He outlines for us the newest techniques such as "family sculpting" which are unknown :0 most child psychiatrists because they are found emerging in the journal Family Process, one that is rarely read by us. John Weakland represents the "communications" school which originated at the Mental Research Institute at Palo Alto , California. In 1956, Bateson, Jackson, Haley, and Weakland reported on a research project they had undertaken to formulate and test a new view on the nature of schizophrenic communication and postulated the concept of the double bind. Most of the descriptions in that monumental paper referred to mother-child interactions, and while their applicability to schizophrenia has largely faded, there have been other applications of this theory to particular syndromes. Weakland reviews the double-bind theory, which was perhaps the most seminal one in the development of family therapy, and traces it to the present, applying it to child psychiatry's most current controversial syndrome, MBD. Next, Alberto Serrano, a certified child psychiatrist (as opposed to Mr. Weakland, who does not have a degree as a mental health professional) presents his group's research on child abuse . utilizing the family as the important variable and pointing the way for treatment and future research . Salvador Minuchin, who is currently considered the most influential leader in the new generation of family therapists, describes his "structural" approach which focuses on changing stereotyped relationship "habits" in the family, boldly attacking psychosomatic problems which have confounded the child psychiatry field over the past few decades. Finally, John Werry, an American-trained ch ild psychiatrist working in New Zealand, known for his involvement at the cutt in g edge of new movements and for the rigorous scientific research a pproach which
Family Therapy in Child Psychiatry
3
he applies to them (e.g., psychopharmacology), emphasizes the need for combined rather than either-or thinking, and reviews the application of behavioral approaches to family problems. In spite of the efforts of such an illustrious group of workers, problems still remain. Theory stemming from the treatment approach itself is an apt description of the development of the entire field of family therapy which has been characterized as a "method in search of a theory" (McDermott and Harrison, 1977). By the same token, the family therapy tendency to ignore the individual's psychobiological system, focusing on the systems theory truism that knowledge of the individual parts does not explain the whole, too often neglects the self-evident converse truism that knowledge of the whole does not guarantee understanding all of the parts, particularly those individual parts that are developing and changing most rapidly (McDermott and Char, 1974). For no matter how thoroughly the observer understands each of the subsystems within the family, it is not tantamount to understanding the family as a unit because it is more complicated than adding up the sum of the parts to make the whole. But we in child psychiatry are well advised to look with a different perspective and to organize our data of observation within a systems theory framework. That is, we may find an alternative theoretical frame of reference into which our own clinical experience with children and their families can be fit. The following section is dedicated to the growth of our theoretical and therapeutic heritage by incorporating the best from the family field. We hope it can be read with profit. Finally, the Journal is grateful for the generous support of Psychiatric Institutes of America, Psychiatric Institute of Washington, D.C., and Commonwealth Psychiatric Center of Richmond, Virginia, who helped to make this Special Section possible.
REFERl':NCES
BATESON. G., JACKSON. D. D., HALn', .J., & WEAKLAND • .J. H. (1956), Toward a theory of schizophrenia. Behau. Sri., 1:251-264. BLOCH, D. (1977). Notes and comments. Fam. ProCPS.I, 16:511-514. McDERMOTT, .J. F. & CHAR, W. F. (1974), The undeclared war between child and family therapy. This journal, 13:422-436. _ _ & HARRtSON, S. (1977), Psychiatric Treatment of the Child. New York: Jason Aronson.
FAMILY THERAPY IN CHILD PSYCHIATRY Introduction John F. McDermott, Ir- M.D.
MI\R 1 5 1979
The undeclared war between child and family therapy may be winding down! The original combatants are retiring from the field, while newer and younger professionals entering the scene are unconvinced that the struggle is justified at all. Signs of rapprochement are everywhere. The editor of Family Process declares that it is time that family therapy have a diagnostic system (admittedly spurred by DSM III problems of third party payment and inevitable national health insurance) (Bloch, 1977). Family therapists are thinking developmentally throughout the life cycle, so that all members of the family may be attended to and children are no longer sloughed in order to reach into the "heart of the problem," i.e., the marital couple, of which the child is only a "symptom." Furthermore, the new Essentials of Training in Child Psychiatry (AMA, 1977-78) includes family therapy as a required experience. Integration between internal and external forces, balancing of the here-and-now with the historical development of problems, are all serving to reduce the distance between family therapy and child psychiatry. Perhaps one of the most significant signs is this section on family therapy in this journal, which could not have occurred only a few years ago. We hope it presents a coherent and logical progression of articles from diagnosis to treatment. Consider the mix of indi-
Dr. Mrlsermott is Professor and Chairman. Department of Psychiatry. School of Medicine, University of Hawaii (1356 Lusitana Street, Honolulu. Hawaii 96813), where reprints may be requested. Dr. Mclrermott was responsiblefor editing this special section. 0002-713817911801-001 $00.46 e 1979 American Academy of Child Psychiatry.
2
John F. McDermott, Jr.
vid uals in the series, for it represents a new era and developing interface in the field . Charles Malone, who writes an overview of the field, has been regarded as the child psychiatrist most deeply involved in the family therapy movement from its beginning without having lost his identity as a child psychiatrist or his commitment to the individual child. The heart of his overview ties together family therapy and psychoanalytic concepts. Tseng is a general psychiatrist who presents the latest in a series of papers based on his group's research into famil y interactions originating from work with children which could lead to an organized and reliable diagnostic system. Claude Villeneuve is a young Canadian child psychiatrist representing the new generation who has combined intensive training in family therapy with an identity as child therapist. He outlines for us the newest techniques such as "family sculpting" which are unknown :0 most child psychiatrists because they are found emerging in the journal Family Process, one that is rarely read by us. John Weakland represents the "communications" school which originated at the Mental Research Institute at Palo Alto , California. In 1956, Bateson, Jackson, Haley, and Weakland reported on a research project they had undertaken to formulate and test a new view on the nature of schizophrenic communication and postulated the concept of the double bind. Most of the descriptions in that monumental paper referred to mother-child interactions, and while their applicability to schizophrenia has largely faded, there have been other applications of this theory to particular syndromes. Weakland reviews the double-bind theory, which was perhaps the most seminal one in the development of family therapy, and traces it to the present, applying it to child psychiatry's most current controversial syndrome, MBD. Next, Alberto Serrano, a certified child psychiatrist (as opposed to Mr. Weakland, who does not have a degree as a mental health professional) presents his group's research on child abuse . utilizing the family as the important variable and pointing the way for treatment and future research . Salvador Minuchin, who is currently considered the most influential leader in the new generation of family therapists, describes his "structural" approach which focuses on changing stereotyped relationship "habits" in the family, boldly attacking psychosomatic problems which have confounded the child psychiatry field over the past few decades. Finally, John Werry, an American-trained ch ild psychiatrist working in New Zealand, known for his involvement at the cutt in g edge of new movements and for the rigorous scientific research a pproach which
Family Therapy in Child Psychiatry
3
he applies to them (e.g., psychopharmacology), emphasizes the need for combined rather than either-or thinking, and reviews the application of behavioral approaches to family problems. In spite of the efforts of such an illustrious group of workers, problems still remain. Theory stemming from the treatment approach itself is an apt description of the development of the entire field of family therapy which has been characterized as a "method in search of a theory" (McDermott and Harrison, 1977). By the same token, the family therapy tendency to ignore the individual's psychobiological system, focusing on the systems theory truism that knowledge of the individual parts does not explain the whole, too often neglects the self-evident converse truism that knowledge of the whole does not guarantee understanding all of the parts, particularly those individual parts that are developing and changing most rapidly (McDermott and Char, 1974). For no matter how thoroughly the observer understands each of the subsystems within the family, it is not tantamount to understanding the family as a unit because it is more complicated than adding up the sum of the parts to make the whole. But we in child psychiatry are well advised to look with a different perspective and to organize our data of observation within a systems theory framework. That is, we may find an alternative theoretical frame of reference into which our own clinical experience with children and their families can be fit. The following section is dedicated to the growth of our theoretical and therapeutic heritage by incorporating the best from the family field. We hope it can be read with profit. Finally, the Journal is grateful for the generous support of Psychiatric Institutes of America, Psychiatric Institute of Washington, D.C., and Commonwealth Psychiatric Center of Richmond, Virginia, who helped to make this Special Section possible.
REFERl':NCES
BATESON. G., JACKSON. D. D., HALn', .J., & WEAKLAND • .J. H. (1956), Toward a theory of schizophrenia. Behau. Sri., 1:251-264. BLOCH, D. (1977). Notes and comments. Fam. ProCPS.I, 16:511-514. McDERMOTT, .J. F. & CHAR, W. F. (1974), The undeclared war between child and family therapy. This journal, 13:422-436. _ _ & HARRtSON, S. (1977), Psychiatric Treatment of the Child. New York: Jason Aronson.
