Open Book

The Triumph of Collaboration

Has postmodernism reshaped psychotherapy?

Jim Naughton
Magazine Issue
January/February 2002
The Triumph of Collaboration

Family Therapy: An Intimate History

By Lynn Hoffman

W. W. Norton. 277 pp. ISBN 0-393-70380-0

There may be no more engaging way to familiarize one’s self with the history of family therapy than to read Lynn Hoffman’s new book. Family Therapy: An Intimate History is an intellectual memoir, and it is the reader’s good fortune that Hoffman came of age as a thinker in the early 1960s, just as the family therapy movement was picking up steam. Hired as an editor to help Virginia Satir finish Conjoint Family Therapy, she eventually became a therapist herself, and emerged as one of the leading explicators of modern therapeutic methods.

Along the way, Hoffman’s path crossed those of Jay Haley, Salvador Minuchin, Peggy Papp, the Milan team and many other therapeutic pioneers. She had a knack for getting jobs at cutting-edge institutions. As an editor, she worked at the Mental Research Institute. As a therapist, she worked under Minuchin at the Philadelphia Child Guidance Center before joining the fledgling Brief Therapy project at the Ackerman Institute in New York City at the invitation of Olga Silverstein.

Although initially in awe of dynamos like Haley, Hoffman was a quick study. She soon became restive assisting therapy’s titans in articulating ideas she did not fully agree with. Her determination to seek her own truth gives the book a narrative energy that sometimes flags, but usually not for long. Perhaps because she began her career as writer, Hoffman is able to discuss complex theoretical issues in an accessible way. She is also adept at placing therapeutic developments in a broader intellectual context, and explaining how the ideas of thinkers like Humberto Maturana, Jacques Derrida and Michel Foucault influenced the practice of therapy.

The book is at its best when Hoffman is seeking and sampling. She has a sure feel for the strengths and limitations of various therapeutic approaches. The book reaches its intellectual high point when Hoffman recounts her conversion from a directive, systems-oriented, Milan-style approach to a more collaborative, narrative-based brand of therapy that values the experience of the client more than the expertise of the therapist. On reading this book, Michael White, whom Hoffman largely credits with developing the narrative approach, may feel that not even his mother understood him so well.

But having embraced post-structuralism as an intellectual creed and an improvisational, narrative style as its therapeutic embodiment, Hoffman succumbs to triumphalism. The account of how proponents of the “new paradigm” chased away the nasty old authoritarians who believed in repressive “meta-narratives” is sophomoric–too many “demigods” being “pushed off pedestals” by brilliant young thinkers, too many insouciant theoreticians “cheerfully beheading” various psychological “myths.”

Like many advocates of collaborative therapies, Hoffman can’t be content with her approach’s being effective, and suited to her strengths; she wants the reader to accept that it is morally superior to other therapies as well. The virtues of the collaborative approach, and the dexterity required to employ it well, shine through in the cases she relates, as does the humanity of the therapists whose sessions she describes. But the theoretical discussion of how collaborative therapy distributes authority more equitably between clinicians and clients is unpersuasive. (Clients pay therapists to help them. There is little value in conversations about therapeutic authority that don’t confront this relationship-defining condition head on.)

The postmodern cheerleading gets thicker as the book wears on. A reader relying solely on Hoffman’s account would never learn that the ideas of Derrida and Foucault have engendered ferocious hostility in many usually tolerant quarters, nor that the triumph of postmodern thinking is far from complete. The second half of Family Therapy is not as strong as the first, but despite ideological overkill, it remains a perceptive, personal account of how the discipline evolved.


Retelling Violent Death

By Edward K. Rynearson

Brunner-Routledge. 146 pp. ISBN 1-58391-363-7

Seldom does a book on psychotherapy have the devastating relevance of Edward Rynearson’s work on “retelling” as a means of coming to terms with a loved one’s violent death. His examples deal primarily with suicide and individual homicides, but Rynearson’s wisdom is equally applicable to those grieving, at whatever remove, the victims of the mass murder committed at the World Trade Center and the Pentagon.

Rynearson, whose wife Julie committed suicide almost 30 years ago, believes that survivors can neither repress nor simply ventilate their sorrow and rage in the wake of a loved one’s violent death. Nor can they merely wait out their profound feelings of loss and dislocation. Rather, he writes, they must actively engage the narrative of the lost life, reshaping it and locating the death in a fuller and more hopeful context–a context that keeps the memory of the loved one alive, even as it gives survivors the ability to continue the narrative of their own lives.

The book includes personal stories, suggestions for treating groups and individuals, a review of the brief and spotty literature on this subject and a discussion of the public health issues confronting a society in which so many citizens are mourning the victims of violent death.


Supervision in the Mental Health Professions: A Practitioner’s Guide

By Joyce Scaife

Brunner-Routledge. 238 pp. ISBN 0-415-29714-2 (pbk)

Warning: Reading Supervision in the Mental Health Professions may make you want to work for its author. Joyce Scaife’s sensitivity to the individual under supervision informs and enlivens what might easily have been an arid book. That’s no small accomplishment, because much of the time she is establishing a philosophical framework, reporting on the latest research and discussing the merits of various methods of observation, including video and audiotape.

The book’s philosophical sophistication, moral seriousness and clinical savvy are best demonstrated in a chapter on ethics in supervision, which begins with a brisk discussion of Aristotle, Immanuel Kant and John Stuart Mill, enumerates recurrent types of ethical dilemmas and closes with an analysis of several ticklish hypothetical situations. Supervisors looking to add to their skills will be interested in Scafie’s discussion on the uses of audio and videotape, and in a chapter of group supervision contributed by Francesca Inskipp and Brigid Proctor.


Living with Anxiety: A Clinically-Tested Step-By-Step Plan for Drug-Free Management

By Bob Montgomery and Laurel Morris

Perseus Publishing. 257 pp. ISBN 1-55561-306-3

Montgomery and Morris have combined psychoeducation with cognitive-behaviorism in this useful, if occasionally tendentious, book. They have a flair for explaining complex psychological conditions in language that is easily understood, and their discussion of how to recognize various kinds of anxiety disorders should be particularly useful to therapists with an interest in client education. The “plan” mentioned in the subtitle is more accurately described as a collection of cognitive-behavioral techniques, some of which will be familiar to readers of other books on anxiety. Montgomery and Morris are at pains to persuade readers that they are not “anti-drug,” yet they say so with such frequency that one begins to believe that they protest too much.


Adolescents, Alcohol and Substance Abuse

By Peter M. Monti, Suzanne M. Colby and Tracy A. O’Leary, et al

Guilford. 338 pp. ISBN 1-57230-658-0

This book serves three purposes: providing statistical evidence that the epidemic in teen drinking is not a figment of anxious parents’ imaginations; arguing against a “just say no” approach to adolescent alcohol abuse; and offering alternative, developmentally appropriate, techniques for “harm reduction” based on a public-health oriented model. Some of these strategies, such as skills training and motivational enhancement, will be familiar to therapists involved in campus-based alcohol reduction programs, but the application of other techniques, such as Integrative Behavioral and Family Therapy, in situations involving teen drinking may not be. The book’s principle strengths are its manual-like chapters on interviewing that can serve as a guide to therapists who need to immerse themselves in this field in a hurry. One caveat: many of the articles repeat similar statistics on adolescent alcohol abuse and rehearse the same arguments against what the authors’ label “moral” or “disease” approaches to the problem.


Fault Lines: Stories of Divorce

Edited by Caitlin Shetterly

Berkley Books. 354 pp. ISBN 0-425-18161-8

This is a peculiar, but potentially comforting, collection of short stories–many of them involving divorce, but others with the dissolution of relationships. Caitlin Shetterly has included the works of such masters as John Cheever, John Updike and Alice Munro, and younger writers including Michael Chabon and Sherman Alexie. Few of these writers are represented by their best work–Raymond Carver is especially poorly served by his story “Intimacy”–and Shetterly provides no information on how she made her selections. Her own contribution to the book is a brief–and thin–introduction about the comfort she found in stories after her parents were divorced. That said, “Separating” by Updike remains the most exquisite way to have your heart broken, and the main character in “Beautiful Grade” by Lorrie Moore is plaintively hilarious.


Rent Two Films and Let’s Talk in the Morning (Second edition)

By John W. Hesley and Jan G. Hesley

John Wiley and Sons. 342 pp. ISBN 0-471-41659-2

The Hesleys have mined more than 200 films for their therapeutic content, and “scripted” many of them for use in therapy. They recommend Shadowlands, for instance, for “couples with communication difficulties” and “adults dealing with the death of a parent.” Hoop Dreams, they suggest, may be helpful for “parents who push their children too hard” and “clients who have trouble sticking with their goals.” There’s even hope for therapists trapped in a health maintenance organization: Patch Adams, they say, is palliative for “those who are mired down in red tape.” One can’t always tell how seriously to take these recommendations–Patch Adams?–but this book sure is fun.