Transcript for:
Exploring Family Psychotherapy with Dr. Butler

Hello and welcome to Family Matters. I'm Dr. Mariana Martinez, your host. Have you ever gone through an old box of photographs and enjoyed the feeling of the pieces of your past coming together in a new way?

My guest... Dr. Jack Butler did exactly that, but he did not go through a box of old pictures. Instead, he meticulously sorted through the handwritten notes of Dr. Murray Bowen about his seminal research at the National Mental Health Institute. Institute. The research project, which involved families with a member with schizophrenia, was central to the birth of the family psychotherapy movement.

Dr. Bowen was a careful researcher. He systematically recorded his keen observations and his thoughts. Dr. Butler has organized them into a recent published book, The Origins of Family Psychotherapy, the NIMH Family Study Project. Dr. Butler is a social worker and a marriage and family therapist. He has published extensively about Bowen theory and will take us in a journey of rediscovering the process from a set of observations to the development of a whole new theory on human functioning.

Dr. Butler, thank you for being here today. Welcome. You're welcome. Thank you for having me.

So let's begin with you describing the NIMH project. What was that about? It was a four-year project.

project from 1954 to 1958, beginning in 1959, conducted at the NIMH campus in Bethesda, Maryland. Dr. Bowen, who is a pioneer in family therapy, began it by having inpatients, hospitalizing first small family units, mothers and daughters, later on small families, both parents, the child that had the disease. had schizophrenia, and a sibling who lived on the unit 24-7. What was so unique about this exercise or this research project? Why was it so different than what had been done before?

Well, I don't think anybody had had entire families on the unit 24-7. Now, the average length of stay, which you have to to think about for a moment given the length of stay now was a little over a year. These people stayed a long time.

Not just sort of what happens now with length of stay which is very short and then inpatients are moved to a follow-up program. And I I think a number of things really came out of it that I think are here today. So it's not just history.

As you spoke about it, these photos, I think, mean something today. One thing is family. diagrams started during the project.

Can you describe what a family diagram is? Well, it's factual information on the family. These today are known as genograms, which is an interesting term.

I was researching that and I wanted to find out where that term came from. The term genogram? Yeah, where did that come from? Well, a person that has published a lot about this that have several books Monica McGoldrick.

I even sent her an email and I said, where? You've written all this. Where did this come from?

And her response was very short. I don't know. So I began to dig and dig and it was actually one of Dr. Bowen's students, Phil Guerin, that originated that term.

But family diagrams are factual information about families. They're functioning, health, education, emotional health. kinds of things, relationship history, factual information. It's a lot more than roots or the kinds of things that you see go on now.

But the information is there and reflects emotional functioning in the multigenerational family. So it started there. I found the first one that he did. Uh-huh. And...

With the circles and squares are the same. Circles and squares, I think as I've been able to piece it together, you know, that was kind of standard with genetics. Uh-huh. And, but there...

they were, there was the first family diagram, and that continued as a way to record information about families. I do a family diagram on every family I've seen. So it was the shift... of looking from looking at the individual as the focus of the attention to looking at the family family graphic as an emotional unit three generations and so that was started during the project it's a staple today whatever term you use if you use genogram or family diagram we tend to use the the term that was started family diagram but people family therapists all kinds of people use that today And so that's still here. So tell me about the idea behind a family diagram.

That's a tool to use, which is very useful. But it has a whole understanding of individual and family functioning behind it that emerged from those observations of the families at the NIMH Research Project. Well, the main idea was the family is an emotional unit.

And the best way to capture that is to look broadly at the family. to see the functioning of at least three generations in the family, and that the family's functioning is assumed to reflect emotional processes that are apparent. Mike Kerr, Dr. Kerr that you have interviewed is fond of saying, you know, given enough generations in the family, you're going to see the full range of human functioning, health-wise, emotional-wise, educational-wise, career-wise. That's true in my family.

I think it's true in yours, although I don't know your family. I think it's true in all families. So that's a pivotal way, I think, to evaluate families, especially with children.

Children know a lot about their families and they can help do that. I've never heard how Dr. Bowen and his team incorporated the multi-generational process in the research project itself. I have a sense that they observed the father, mother, and siblings.

And how did they incorporate the multigenerational piece? Well, I think it's evolving. You know, there's one sketch of this.

When people come in, you learn more with the passage of time. People tell you more. More facts emerge. People don't lay all the cards on the table in initial interviews.

But it does help highlight theory and emotional processes in families. And it takes it from the realm of somebody with a problem to you have this family emotional system. One person of this may have a significant difficulty.

By going through all these files and reports that were written in those four years of the NIMH project, how does the idea that the family works as a system emerge? What sort of things did you discover that highlighted that, whoa, they were really onto something different? Well, the reciprocal nature of interactions.

One person acts one way, the other person acts another way. I mean, something from my own practice, because I often ask families, can you describe for me what the relationship is like? mother-daughter, father-daughter, so I can understand this.

Sometimes a picture's worth a thousand words. And I remember one mother, and I won't forget this, having quite a bit of difficulty with her daughter. It was in vitro fertilization. because she was not fond of males.

But the girl was 13 and having significant difficulties, and she said, well, I can tell you exactly what it's like between us. And I said, excellent, tell me. And she said, when she has her period, I have the cramps.

I understand that. And so that's the kind of emotional connection, I think, that Dr. Bowen was about, and that he was really studying. And then he found that the father had a part in that. And it wasn't.

a diet and the sibling of the other sibling normal quote unquote. had a part in it too. They were all acting as a system and I remember reading some of the reports that it was like the the illness of the child you know would kind of hop and and and the other sibling would would sort of be bothered while their functioning would go down. So it just it was it was sort of a teeter-totter.

It wasn't just a person with difficulties surrounded by other people that weren't involved with them. I think that only through having people there available to be observed for such a long time long period of time, as you mentioned at the beginning, those type of patterns, you could observe those type of patterns. Because if you see someone or even a family for a short period of time, it's easy to miss those kind of dances.

Right. You would just not see it. It afforded that opportunity to be able to do that.

So the reciprocal nature of interactions in family. And certainly, you know, we see that. I see a lot of people who go through enormous sacrifice and expense to go home for the holidays. And within several hours of arriving home, they're sick. With, you know, with various kinds of things.

Wishing, or they're on their cell phone, wishing that perhaps they should have stayed at home. So, you know, however you cut it, however you label it, you know, it is an emotional unit. And I think that's a concept that is present today, you know, in theory and flushed out, but it is an important one that can be missed.

What did you find in those papers? that could highlight the idea that it's not the family who's causing a problem or the toxic family that sometimes we hear, but that it is just what it is. It's the dance and the coming and going of a group of people that is interconnected.

Yeah, I think, you know, Dr. Bowen talked about that, that these are well-meaning people really trying hard and they don't know how they got into this and they don't know how to get out of it. They're stuck. stuck. Families are also, they get into the same thing.

It doesn't do any good to point fingers. We've had a period of, well, it's always the mother's fault. That's too simplistic. Just like you could flip it the other way and say, well, 100% of this is the child's fault. I think that misses the interaction and the contributions of the other people.

You have four family members, everybody has a a guard. So it's, you know, I think that that is important. Certainly family diagrams are important.

That concept of the family is emotional unit. And then what impact does this have on providers? What, how does it guide, you know, how does it guide clinical work? Your work, my work, other people that do this.

And one thing, it's not so much about who's in the room. room. And I think we've gone through a period of that.

Family therapy means I'll kind of combine the people and that's family therapy. And I'll see the child, that's individual therapy. I think it's more about the model in your head.

And if you have one eye on the family emotional unit, then you're going to have a different perspective of this. It would be an interesting study if we could pull it off to cert, which I think we probably. they could to survey people interested in family systems theory.

Who did they see? Who really is in the office? Is it whole families? Is it individual couples? And I've talked to several senior people, the people that have coached me, and many times it turns out it's individuals.

But it's still within the framework is that they're part of that. So, you know, I think I think that's important. And Bowen wrote in the papers, the one we were talking about during the break, this thing about the risks about being over-helpful, how you can over-function as a clinician.

And there are some cautions with that that may have implications for the person. And the other thing about then what do you do with children? Bowen theory has a different perspective about that then and today.

So let me take those two ideas and then... talk about it separately. First, being overly helpful that I think is still very current in so many professional fields that you want to do for people and be helpful. So what did he observe in those early years in that? research project about that and how that can get in the way?

Well, I think especially during the second, third, and fourth years, when they were seeing the family units daily, they had these multifamily groups helping the parents to sort of understand. How their actions might affect the children, but yet sort of taking a position that, you know, the doctors, therapists were not all knowing and all seeing. They could contribute.

They could be therapists for their children. They could be leaders. But that was a shift, going from individual to family therapy.

Because if I'm not going to take the place of a parent, if I'm not going to do that, then patients need that. So who does that? Who, who, say who does that?

And I think Bowen's answer then and I think the current theoretical understanding as I understand it is, it has to be the parent. What's the role of the therapist then? You just took away half of my job.

Well, that is an interesting question, isn't it? What do people do? And I think it's this idea.

of about being neutral, about being present with people, managing yourself, and not getting spooked and not getting anxious, and to hang in there with people and be with them, and not to be over-helpful. I mean, one of Bowen's little phrases was that I've heard people talk about is, you can't make a flower grow by pulling on it. And the same thing applies when you're dealing with kids in the family. But it is a much different role to walk along with people and be present with them, not being patronizing like you have all the answers. And both of us, I think, early in our careers have had a lot of really good answers for people.

And then they come back and say those three, the little three words, it doesn't work. And then you have to. to reach in your bag of tricks. So, but that's how that started.

So that was observed that early in the project that if the clinicians would take a different angle to it and think about themselves differently as what was their role, it made a difference to the family. Right. Is that what you're saying? Right.

So let, now tell me about the other piece that you were bringing up to the conversation about the when children present a symptom and a problem and how family therapy and coming from that perspective of Dr. Bowen's observations, what do we do? You can't replace parents. You can perhaps coach the parents to coach their children, but and and I know I'm not faulting people who do that.

I have a lot of colleagues excuse me who do play therapy but I I don't think, I try not to replace parents because I can't. I'm their therapist, their doctor. I, you can't, I just don't go there.

And I think that view may be shared by others, certainly by child analysts who spend a lot of time with parents and children before they take on the child as a parent. And then of course that begs the question, well then. then who is it?

And it's to try to lift up family leaders to not to make them so helpless that they can function better for self. And sometimes that's one person, could be mom or dad. It's generally not two people at the same time.

And was that described in those early observations, how one or another parent Would take on more of the leadership? Well, certainly, yeah. The parents were responsible for the kids on the unit, and if there was some behavior problem, instead of throwing up their hands, the staff could sort of assist, but they weren't there to fix it.

And if there was an incident downtown as there was and the kid was cavorting or doing something on pass, well the parents had to sort of stand up and fix that and or try to fix it. They could get some help. but not too much help that the providers sort of pushed the parents away and sort of took over and did it. So you were saying that many learnings came from... from those four years of the research project and of course the whole theory evolved from that from there but you were able to identify things like the the realization of the families as an emotional unit the importance of the family family diagram seeing the multi-generational family the position of the therapist and the new therapeutic role right so those are very important shifts in what used to be And they're still current because we still see so many types of therapies based on the individual as the unit of observation.

So that's pretty current. How many decades later? Six, seven? I mean, you know, his observations.

And then I think that certainly was a boon to him to help him develop his theory. And I think it has enormous practical. clinical implications today. Dr. Butler, what did you learn about the effort of going back and as I said at the beginning bringing that old box of pictures I know they were not pictures but what was it there for you? I think you know I I was in a postgraduate program for five years my own adult children say why five years I told them I was sort of in the remedial group.

And I needed more coaching. But I think that was one slant. But reading those original documents, and of course, listen to Catherine Rakow, who is just excellent. I mean, she's the premier person on the planet who has gone through everything, you know, in the project. But somehow that gave it, supplemented the training I had.

And I don't think I missed. anything in the postgraduate program, but the papers, I mean that's why I went to the trouble to sort of put them out, gave this sort of new meaning in terms of the family's emotional unit, how to function more effectively as a clinician, what is this thing about being too helpful for people, how do you be more neutral, how do you, how does the therapist manage themselves? because these are complicated issues. We're not neutral about some of these things, a whole range of things. I know part of my practice is dealing with kids and adults that have sexual touching problems.

People aren't neutral about that. Families aren't neutral about that. So how does the person who sits where you and I do and other people, how do you manage yourself the best that you can do in that situation?

the midst of this and it is a challenge. And in those writings you were able to discover the challenge, the tribulations of going through that experience and not having a theory to guide you and then developing that theory into a map so people could do something about it. It is a map and of course that's what Dr. Bowen taught.

If you know the theory and study the theory and get clear about your own family and some challenges you've had and work with your own family it will help your clinical skills enormously it's not the other way around you don't learn a couple of techniques to do things that the that the way out of this the clinical way out of it is to understand the theory and work on yourself and manage yourself the best that you can do what about the other team members that were working in the project. What was it like for them? Did you have a sense from reading those? Well, it was new and innovative.

I think it was a challenge. I know each of them wrote individual papers. One, the social worker Betty Bestmania, one of her phrases was that in working with a family unit, you could dilute, I love that word, dilute transferences.

You could calm this down by working in this way. And of course, he was very attuned to that. How do you manage this intense emotional reactivity that these people have and the family?

And I think that was very important. And she was also big on not replacing parents or the risks inherent in doing that. You know, what that means for parents if you take that on. And I'm not saying to my colleagues who do play therapy, and I And I have a lot of them that that's not helpful. It's just a different way to work.

What a journey for you to spend a couple of years really going back to the original writings and seeing for yourself what was there and how it came about, all this new field of family psychotherapy. And to make these available to others so they could read them and you know think about them. And yeah I worked several years on it.

In fact my wife called it my mistress, which probably is true. accurate so she's happy to see that but they are I think anybody that reads those that's a clinician is is going to be engaged by those and and think about things in ways that you know they might not have thought about before well thank you for for the work of course but thank you for being here describing your learnings and your experience of going through those original papers well you're welcome thank you for being patient and having me I'd like to remind you that the Bowen Center for the Study of the Family offers the community affordable psychotherapy in both English and Spanish. If you would like more information about our topic or the services at the Bowen Center, please visit the website at www.thebowencenter.org or send me an email at familymatters at thebowencenter.org. You can find us on Facebook and Twitter or call 202-968-7000.

Thank you for watching and I invite you to join me again for another edition of Family Matters. I'm Dr. Mariana Martinez and your family does matter.