Recommended Reading for Family Therapists

A few weeks ago, one of my blog posts received a comment that was worth a whole post:

“I am also a therapist (though I’m still in training). I’m wondering if you would be willing/able to recommend some family therapy books you’ve found helpful. My program is very focused on the individual and I’m trying to fill in some gaps and find your perspective on therapy to be very resonant with my own.”

I’d love to recommend some family therapy books! My program was extremely family-systems focused, which I’ve been grateful for since leaving school. If you want to see an exhaustive reading list (I can’t remember having been assigned a real dud), you can see reverse-order lists of everything I read in my first year here and my second year here.

I’ll try to create a bare-bones list for you here—much more useful for you and a good exercise for me. I should warn you before I begin that I am super nerdy when it comes to family therapy reading and I can imagine many in my cohort rolling their eyes at my “must-read” list. If you are nerdy like me, though, here goes:

Pragmatics of Human Communication: A classic and profound book by Bateson’s MRI team, the first and probably still the best attempt to apply system theory to human relationships.

Susan Johnson’s books The Practice of Emotionally Focused Couple Therapy and Emotionally Focused Couple Therapy for Trauma SurvivorsJohnson combines system-thinking, Rogers-style experiential therapy, and attachment theory, creating one of my most-used therapy models.

John Gottman’s books, especially The Marriage Clinic and The Science of Trust. Gottman has taken up the project started with Pragmatics, largely abandoned by family therapy, and is doing it in fine style, with solid science.

Metaframeworks: This book presents my favorite meta-model of family therapy, combining the best parts of the many family therapy models.

A major work by each family therapy model-builder is also important reading: Haley, Madanes, Satir, Whitaker, Minuchin, Bowen, Selvini-Palazolli/Milan group, Weakland/Fisch/MRI group, deShazer/Insoo-Berg, Epson/White, and Hubble/Duncan/Miller. Keep in mind that their books are presentations of informed opinion, not science. Every one of these folks have got some things right and some wrong. They have also advanced the field significantly, and are the largest part the conversation on how to think about families.

Finally, a couple things that I was not assigned in school, but I found extremely helpful in making sense of the flood of information. First, a grounding in systems/complexity theory: Family therapists think of themselves as system-theory experts and throw around a lot of lingo that they may or may not really understand. It’s easy to get confused in this situation. The best introduction to modern system thinking is still Capra’s The Web of Life (though we’re overdue for an update). Also, check out Bateson’s books Steps to an Ecology of Mind and Mind and Nature.Second, familiarity with Wilber’s integral theory really helped me navigate the heated arguments about modernism vs. post-modernism and intervention at the level of individuals vs. family systems vs. larger systems. Check out Integral Psychology or A Theory of Everything.

(Originally published as “Family Therapy Books I Recommend to Individual Therapists,” on Nathen’s Miraculous Escape.)

Emotion Coaching Vs. Emotion Dismissing Parenting

John Gottman is best known for his research on couples (which I’ve written a few things about here) but I think that some of his most important work has been distinguishing two distinct parenting styles: emotion coaching and emotion dismissing. I’m reading his new book, The Science of Trust, right now, and he goes over these findings because it turns out these styles of relating to emotions have big ramifications on building or losing trust in one’s partner. I’ll write more about that as I come to understand it better. (And by the way, if you are a serious couples therapy nerd like me, this book is great. Check it out.)

The basic idea is that parents have different reactions to emotions in their children. We call these reactions “meta-emotions” because they are emotions about emotions. “Emotion coaching” means when an emotion shows up in your child, you treat it as useful information, you engage your child around it in a way that tells them it is OK to have that emotion. “Emotion dismissing” is the opposite. You communicate that they are choosing to have this emotion that you find unpleasant and that making that choice is unacceptable. (This is similar to a problematic parenting technique called “mystification” which I wrote a little about here.)

Clearly this is a potentially complicated phenomenon, because we can have different emotional reactions to each emotion in our kids. We may, for example, have a coaching reaction when a child shows, say, pride, but a dismissing reaction when they show anger. Or vice versa. And our reaction may be different in different contexts, like at home versus out shopping. And other cultural factors are at play, too, like gender or age of the child, which can cause us to react differently. For the following lists, Gottman is using the coaching/dismissing distinction with a broad brush. The list items are direct quotes from pp. 181-188, but the list titles are my paraphrases (note that “affect” is psych-speak for “emotion”):

What Emotion-Dismissing Parents Do:

  • They didn’t notice lower-intensity emotions in themselves or in their children (or in others, either). In one interview we asked two parents about how they reacted to their daughter’s sadness. The mom asked the dad, “Has Jessica ever been sad?” He said he didn’t think so, except maybe one time when she went to visit her grandmother alone and she was 4 years old. “When she boarded the airplane alone,” he said, “she looked a little sad.” But all children actually have a wide range of emotions in just a few short hours. A crayon may break, and the child becomes immediately sad and angry. These parents didn’t notice much of Jessica’s more subtle emotions.
  • They viewed negative affects as if they were toxins. They wanted to protect their child from ever having these negative emotions. They preferred a cheerful child.
  • They thought that the longer their child stayed in the negative emotional state, the more toxic its effect was.
  • They were impatient with their child’s negativity. They might even punish a child just for being angry, even if there was no misbehavior.
  • They believed in accentuating the positive in life. This is a kind of Norman Vincent Peale, the power-of-positive-thinking philosophy. This is a very American view. The idea is: “You can have any emotion you want, and if you choose the have a negative one, it’s your own fault.” So, they think, pick a positive emotion to have. You will have a much happier life if you do. So they will do things like distract, tickle, or cheer up their child to create that positive emotion.
  • They see introspection or looking inside oneself to examine what one feels as a waste of time, or even dangerous.
  • They usually have no detailed lexicon or vocabulary for emotions.

What Emotion-Coaching Parents Do:

  • They noticed lower-intensity emotions in themselves and in their children. The children didn’t have to escalate to get noticed.
  • They saw these emotional moments as an opportunity for intimacy or teaching.
  • They saw these negative emotions–even sadness, anger, or fear–as a healthy part of normal development.
  • They were not impatient with their child’s negative affect.
  • They communicated understanding of the emotions and didn’t get defensive.
  • They helped the child verbally label all the emotions he or she was feeling. What does having words do? They are important . With the right words, I think the child processess emotions usually associated with withdrawal (fear, sadness, disgust) very differently. I think it becomes a bilateral frontal-lobe processing. Withdrawal emotions still are experienced, but they are tinged with optimism, control, and a sense that it’s possible to cope.
  • They empathized with negative emotions, even with negative emotions behind misbehavior. For example, they might say: “I understand your brother made you angry. He makes me mad too sometimes.” They do this even if the do not approve of the child’s misbehavior. In that way they communicate the value, “All feelings and wishes are acceptable.”
  • They also communicated their family’s values. They set limits if there was misbehavior. In that way they communicated the value, “Although all feelings and wishes are acceptable, not all behavior is acceptable. (We had other parents who did everything else in coaching but this step of setting limits, and their children turned out aggressive.) They were clear and consistent in setting limits to convey their values.
  • They problem-solved when there was negative affect without misbehavior. They were not impatient with this step, either. For example, they may have gotten suggestions from the child first.
  • They believed that emotional communication is a two-way street. That means that when they were emotional about the child’s misbehavior, they let the child know what they were feeling (but not in an insulting manner). They said that was probably the strongest form of discipline, that the child is suddenly disconnected from the parent–less close, more “out.”

Teaching by Emotion-Dismissing Parents

  • They have lots of information in an excited manner at first.
  • They were very involved with the child’s mistakes.
  • They saw themselves as offering “constructive criticism.”
  • The child increased the number of mistakes as the parents pointed out errors. This is a common effect during the early stages of skill acquisition.
  • As the child made more mistakes, the parents escalated their criticism to insults, using trait labels such as “You are being careless” or “You are spacey.” They sometimes talked to each other about the child in the child’s presence, as in: “He is so impulsive. That’s his problem.”
  • As the child made more mistakes, the parents sometimes took over, becoming intrusive.
Teaching by Emotion-Coaching Parents
  • Gave little information to the child, but enough for the child to get started.
  • Were not involved with the child’s mistakes (they ignored them).
  • Waited for the child to do something right, and then offered specific praise and added a little bit more information. (The best teaching offers a new tool, just within reach. Then learning feels like remembering.)
  • The child attributed the learning to his or her own discovery.
  • The child’s performance also went up and up.
Outcomes for Children of Emotion-Coaching Parents
  • They had higher reading and math scores at age 8, even controlling statistically for IQ differences at age 4.
  • This effect was mediated through the attentional system. Coached children had better abilities with focusing attention, sustaining attention, and shifting attention.
  • Coached children had greater self-soothing ability even when upset during a parent-child interaction.
  • Coached children self-soothed better, delayed gratification better, and had better impulse control.
  • Parents didn’t have to down-regulate negativity as much.
  • Coached children don’t whine very much.
  • Coached children had fewer behavior problems of all kinds (aggression and depression).
  • Coached children had better relations with other children.
  • Coached children had fewer infectious illnesses.
  • As coached children got into middle childhood and then adolescence, they kept having appropriate “social moxie.”
  • Emotion-coaching parents also buffered the children in our sample from almost all the negative effects of an ailing marriage, separation, or a divorce (except for their children’s sadness). The negative effects that disappeared were: (1) acting out with aggression, (2) falling grades in school, and (3) poor relations with other children.
  • As Lynn Katz, Carol Hooven, and I reported in our book Meta-Emotion, coached children, as they develop, seem to have more emotional intelligence.
Steps to Learn Emotion Coaching
  1. Noticing the negative emotion before it escalates.
  2. Seeing it as an opportunity for teaching or intimacy.
  3. Validating or empathizing with the emotion.
  4. Helping the child give verbal labels to all emotions the child is feeling.
  5. Setting limits on misbehavior, or problem-solving if there is no misbehavior. If the parent doesn’t do this last step, the kids tend to wind up becoming physically or verbally aggressive toward other children.

(First published March 1, 2012 on Nathen’s Miraculous Escape.)

Idiographic Vs Nomothetic Family Therapy

I’m taking a couples assessment class this summer, and right now I’m reading about a tension between family therapy models that Sciarra and Simon (in Handbook of Multicultural Assessment) call either idiographic or nomothetic.

Nomothetic models say that families have problems because they get out of whack in ways that families do. That is, each nomothetic model has its own list of ways that families can get out of whack and a therapist using that model is to keep a sharp lookout for those things. Structural therapists look for dysfunctional boundaries, for example. Strategic therapists look for incongruous hierarchies. Bowenians look for emotional reactivity. Emotionally-focused therapists look for maladaptive attachment styles. Each nomothetic model says that the therapist needs to assess for these underlying problems, treat them, and therapy should be successful.

Idiographic models call nomothetic models “cultural imperialism.” That means nomothetic therapists are just teaching (or tricking) their clients into thinking, feeling, and acting like them. Nomothetic therapists are forcing their culture on their clients. Calling someone a cultural imperialist is about as close to an accusation of pure evil as a post-modernist will make. Further, idiographic models say that culture (any culture) is oppressive of individuals, and that this oppression is the only reason families seek therapy. The ideographic therapist’s job (Sciarra & Simon list language-systems, solution-focused, and narrative therapies as idiographic) is to have a conversation with families about the ways they are being oppressed by their culture.

There are a couple of funny things going on here, but to understand it, first you need to know that nomothetic models are mostly “old-school” models that emerged in the 1950s and 60s, while ideographic models are newer, postmodern, all the rage, and emerged as a consequence of this nomothetic/ideographic conversation. In the 1980s, postmodern family therapists started saying that family therapy was arrogant and hierarchical and created the idiographic schools.

The first funny thing is that the old-school, nomothetic family therapy models emerged in much the same way, as a reaction to the arrogant and hierarchical field of psychiatry. The founders of family therapy said to psychiatry, “Human problems exist in the context of families. Your pathologizing medical model is not appropriate here.” Now the ideographic models are saying to the nomothetic founders, “Human problems exist in the context of cultures. Your pathologizing medical model is not appropriate here.”

Who is right? Well, that depends on your epistemology. So far, the nomothetic models have more experimental evidence to support them, and they are undeniably effective. To be fair, they have had more time to collect evidence, so in time things may go either way. And to be extra-fair, real post-modern idiographs can reject experimental evidence on philosophical grounds; experiments are so modern, so medical-model. What value system produced your research questions, anyway? That’s funny thing number two.

Funny thing number three is that, as Ken Wilber says, everyone may be right. Perhaps problems happen at every level of complexity, from our bodies to our minds to our families to our larger social systems, and nomothetic models just specialize in the family level, while idiographic models specialize in cultures. It’s a neat idea, possibly too neat, and difficult to tease out. I’ve written a little about it here.

The fourth funny thing is that the idiographic models, while broadening the scope of consideration in some ways, put the focus back on the individual in therapy. They say that culture is intrinsically dehumanizing, and that dehumanization is what an idiographic therapist talks about, but the other parties in the process are not part of the conversation. If I’m a narrative therapist and you send your depressed son to me, we will talk a lot about that depression. We will externalize it, maybe give it a name like “Mr. Funky,” talk about how Mr. Funky speaks with the voice of oppressive culture, talk about times when your son was able to overcome Mr. Funky’s influence and work on ways of increasing that ability. In the end, if I’m a good therapist, we have probably helped your son, but we’ve also focused on how your sonthinks, feels, and behaves, where a nomothetic therapist would have been focusing on the whole family–how do they interact? Do the parents get along? How might this symptom of depression make sense in your son’s immediate system of relationships? Who all has a stake in this behavior and can we get them in the room too? And so on. There is a way that by ostensibly moving the location of pathology out of the family to the larger culture, ideographic models have brought the clinical focus back to individuals, which may seem like regression to the founders of family therapy.

[First published on Nathen’s Miraculous Escape, July 3, 2010.]

Meta-Worry Man

Doing therapy is all about “going meta,” which basically means taking a one-level-up perspective. In my  couples and family therapy program that usually means talking or thinking about the process couples or families are involved in (are they, for example, acting out a pursuer-distancer pattern?) versus the content of their conversations (the specific complaints, “He never takes out the trash,” “She’s always on my back,” etc). Talking about talking is “meta-talking.” Thinking about thinking is “meta-thinking.” This is an idea I had during a lecture:

[First published on Nathen’s Miraculous Escape, December 8, 2009.]