Harry Aponte on Structural Family Therapy

Harry Aponte: That's correct.

HA: I think family therapy has gone through its phase of fanaticism. It's like so many other perspectives on therapy: it went through a phase where people made a new discovery, and they got infatuated with it, and that became the answer to it all. I believe the thinking about working with families has matured so that it's not such an exclusive focus. People are much more flexible about working with individuals and couples as well as families, and people are more flexible in terms of being prepared to work with some unit of a complex family system without necessarily seeing all the members of the family, while maintaining a broader perspective so that they understand that the individual or the couple in the context of not only family, but also of community. So I don't think it's dead at all. I just think it's matured to the point that it's been incorporated into the very large and complex field of therapy.

HA: Well, to answer the last part of that question, I think it should be. I believe that we have become much more sensitive and knowledgeable and insightful about the impact of the broader social system on people's personal functioning: the effect of people's social economic circumstances, the effect of culture, the effect of people's spirituality, and how all of those affect in a very intimate way how people think of themselves, how they relate to one another, how they understand their reality. Any therapist who wants to engage with another human being at any level at all--to understand that person, that couple, that family--has a lot of factors to take into consideration. And I think that's happening. I think people are much more comfortable with looking at their clients from a variety of perspectives at the same time.

HA: What I reflect back to a client is what I think will be helpful to the client. I'm not there to give the client a lesson on what therapy should be. I'm there to be helpful to the client. I need to take responsibility for having all of those perspectives in mind and taking them into consideration as I explore what the issue is and the roots of the issue, and what resources are in that client's life for that client to be able to make the necessary changes to solve the issue. I don't need to explain that to the client, but I do need to be aware of it and work with it.

HA: I'm a pragmatist, so what I do is I listen carefully to what the client's issue is, and I try to understand the issue, and I try to understand the context of the issue: who's involved, who's touching on that issue of that particular individual, as well as what resources are available to that person in their context. And I will try to pull in whatever and whoever is necessary. Even if I need not pull them in, it doesn't mean that I'm not going to work from a suspended ego complex or perspective. It's rare that I not ask clients about the history of their issues. And if I ask about the history of their issues, I'm asking about them in the context of their current relationships, their past relationships, including their development within the family of origin. All of that helps me to get some deeper sense of what they're struggling with and why they're struggling with it the way they are.

HA: Structural family therapy is an aspect of systems thinking. You have to understand the origins of structural family therapy in order to appreciate its contribution to systems thinking. The work originated, of course, with Salvador Minuchin, Braulio Montalvo, and other people who were working together at the Wiltwyck School for Boys in New York. They were working primarily with all these youngsters who were black and Latino, and who were institutionalized. These therapists began to include the families of these boys in their efforts to be helpful to the boys, because they found that working with them in an institution, outside of the context of their families, they were not achieving the success that they hoped to achieve. As they included the families, they found their success rate change significantly.

Well, what happened? Because they were working with boys and families that came from seriously disadvantaged circumstances, they found themselves working with families that were, more often than not, poorly organized, in that they didn't have the kind of structure that normally helps families to cope with the challenges that life brings. A typical story for a therapist working with the families I'm describing is you find that when you begin to talk with them, they interrupt each other, they speak over each other, and very often it's unclear who's really in charge of the family. And if there is somebody in charge, they may be so totally in charge that other people don't have a voice in the family. You don't have an organization there that can identify a problem and come together in a way that can solve it.

It's really no different from what one would be thinking of in another kind of system, such as a business, where when you see a problem in how that business is operating, you're going to be thinking of the structure and organization of the people who are working within that business. If they're not effectively communicating with one another, they don't have a clear hierarchy, and they don't have clear responsibilities, you're going to find that things fall through the cracks and the system fails.

Well, that happens with families, and it particularly happens with families that come from disadvantaged circumstances because they also come from disadvantaged communities that are poorly organized. These families, then, suffer the effects of their community, and they're not able to organize themselves in a way that normally enables families to meet problems and solve them. Every family has problems, but when you don't have an effective organization, then it's hard to talk about the problem, it's hard to identify the problem, it's hard to cooperate together, it's hard to find leadership within the family so that you can work towards a particular goal and solve the problem.

That's the first experience of therapists who worked with families from disadvantaged circumstances. The gift that Minuchin and his colleagues gave us was that they focused on that organization. They understood individual dynamics; they certainly understood the contributions of other systems therapists at the time. But they were dealing with a particular population that had a significant issue around family structure, and that is an aspect of systems thinking. When you are dealing with families that are well organized that still have problems that they can't solve, you tend to take the structure for granted. You cannot take the structure for granted when you're working with these families that come from disadvantaged circumstances and who themselves are not organized in a way that's effective.

HA: That's correct.

HA: Early on, I wrote about an ecostructural approach to family therapy--"eco" referring to the social ecology of the family, highlighting how so many of these families' problems had their roots in the community they lived in. You have schools that have not only poor resources, but that themselves may have gangs organized within them, that are physically dangerous places for the children there, that make it difficult for the teachers to run the classrooms and create an effective learning environment.

When you are working in some of these neighborhoods, the street itself becomes a place that is dangerous. It becomes a place where children just cannot go out and mix together and play together and do the kind of social learning that is important for their development. They're dealing with drug dealers and other kinds of factors in the community, in the street themselves, that affect how these children think about themselves and how they think about the world. They have to cope; they have to survive. They may have to be more aggressive than children under other circumstances. All of that affects their personal development. And in these neighborhoods, you have problems with getting proper healthcare as well as educational resources. So you have a lot of social factors that are impinging in very direct ways upon the ability of families to function well.

And these families cannot just put all of their energy into nourishing the family environment. They have to be thinking about how to deal with protecting themselves vis-à-vis the community, so they put energy out there that should be put more into the family itself. They're dealing with difficult environments, and that affects the ability of the family to function successfully.

HA: It is a lot to think about. And when you're thinking about the environment, and you're thinking about the family, you really cannot offer families coming from these circumstances a service that is exclusively focused on the family unit itself. You have to take a broader perspective that says, "I'm dealing with a child that's in the context of a family, that's in the context of a community. So when I then conceive of the work that I'm doing with these families, I have to take all of these into consideration and organize my services so that I can mobilize various aspects of that complex ecosystem to support the goals that I have with this particular family."

My point, though, is that this work with disadvantaged families gave a gift to the whole movement of therapy. It highlighted the importance of this complex social ecosystem-- its effect on individual functioning--and the need to be more sophisticated about the dynamics of these various levels, in terms of understanding how they work, and in terms of working with them so that we can achieve our goals. It opened up a whole area of thinking that had to be taken into account. I think it's been incorporated naturally, and I think people today think in those terms much more readily than they used to.

If we go back historically to the psychoanalytic movement, that was a very intense focus on the individual and what was happening in the individual's psyche. And that provided critical and wonderful insight. Then we realized, "Well, that's not the whole person. We need to expand our perspective." So we expanded it to the families. Then we worked with this particular population and said, "My goodness, we really need to be thinking about the context in which this family is developing."

So it just broadens our perspective. And we've learned ways of understanding these dynamics so that we can actually work with them, not just as sociologists, but as therapists who can be quite focused on trying to obtain a particular objective.

HA: I think what we've seen now, as a very normal part of therapist's training, is the therapist being more conscious of the factors of values, world views, culture, spirituality, how these affect the way they see their problems, and how they view a solution that is acceptable to them. We have a much more complex society today than we had 50 years ago or further back, where there was a generally accepted norm of what a family is, how a family should function, and what is acceptable behavior.

Today, we have a society that is much more fragmented and often in conflict with itself about what is acceptable in terms of lifestyle and behavior. That changes what one may consider to be a problem, and it certainly affects what we think of as appropriate solutions to problems. That thinking--which was expanding already back in the '60s, when The Families of the Slums was written by Minuchin and colleagues about the work at Wiltwyck--all of that has been incorporated into everyday, normal therapy.

Nowadays, I don't know what therapist training doesn't include some courses that say, "You need to be sensitive to race and culture, and sensitive in such a way that you understand how race and culture directly affect not only how we view the issues and how we work with them, but the very nature of our relationship with our clients, and how we join with our clients." Therapists will have their own culture, they'll have their own values, as well as certainly their own personalities and life experience. But how do these therapists relate and connect to clients who are always going to be different in some particular way or another, in a society that says we need to be more accepting of the differences among us? So we're working in a more complex world today as therapists than we did in the past.

HA: If you're not aware of what you're bringing to the therapeutic relationship and the therapeutic process, you can't take responsibility for it.

HA: That's exactly what "the person of the therapist" means. The therapy of today is a therapy in which therapists are certainly much more actively engaged with their clients or patients than what would have been the model in the psychoanalytic world. And certainly, if you read the writings on structural family therapy, you would see how therapists use themselves very actively to influence the dynamics within the family, and how they engage with individuals within the family. What I've done with the "person of the therapist" model is to try to take that a little deeper and say to therapists, "It isn't just a matter of how you use yourself." It starts with understanding yourself, not only from a psychological perspective, but also from a cultural and spiritual perspective. As a therapist I have to get in touch with what's inside of me--and not only what's inside of me, but because these are living, active dynamics, I have to get in touch with what I struggle with in my own life, what I struggle with psychologically, what I struggle with in my relationships with people, what I struggle with spiritually. I need to understand that, I need to be in touch with that, because all of those factors are active when I engage with the client. They're going to affect how I see the client, how I hear what they have to say, how I connect with that person, how I even conceive of how we're going to try to find some solutions.

These factors are active even beyond our normal awareness as therapists. We need to get the kind of training that makes us experts on who we are and what's happening within us, so that even as we are working with our clients, we're conscious of what's going on within ourselves, and we can take responsibility for what we communicate about ourselves and what we try not to communicate about ourselves and how.

HA: It's a specific kind of training. Traditionally--certainly in the psychoanalytic world--therapists needed to undergo their own therapy. But that objective was one that said, "I need to try to solve my own personal issues so that I am freer to work more effectively with my clients. I'm not going to put on my clients my own hang-ups." That way of approaching the work of the person of the therapist was continued and picked up by Virginia Satir and Murray Bowen, but again from the point of view of, "Let me identify my issues and try to resolve them so that I will become a more effective therapist."

What I've been emphasizing is that all of that is absolutely important and useful, but the simple reality is that we never resolve all of our personal issues. We struggle with ourselves the rest of our lives. We need to go through training programs where we become aware of ourselves in the context of doing therapy, not to resolve personal issues, but the primarily to understand ourselves in vivo: When I'm engaged with my clients, what's going on inside of me? How do I get in touch with it? How do I decide how to use what's going on within me in order to understand and empathize better with what's going on in the client? How can I relate in a way that's specifically useful to the client at this particular moment in time?

So it's an approach to preparing the therapist to use this instrument that is me, in a way that is much more effective. Then I can use all of what I've learned technically and theoretically of other models of therapy, and I can use it through the person that I am in a way that amplifies the effectiveness of my work.

HA: It certainly does. The advantage that classical psychoanalysis had was that the analyst was sitting behind the couch out of the view of the analysand, and wasn't engaging eye-to-eye with the patient. Today, most all of our therapy is eye-to-eye, and we feel each other. We and our clients are engaged personally in the therapeutic process, and that's a simple reality. The question is, how do I engage personally within the boundaries of my professional goals so that I can be of use to this person?

HA: It's not a matter of bringing it into the process as much as it is of being aware that it's there. Spirituality is just a normal aspect of who we are. We all have a morality of one sort or another. We all have a world view--a philosophical perspective on life and what's important in life, what's meaningful about life, what our goals should be in terms of moral principles. And that will certainly affect how we think about the issues that come up for us. A simple example that's very relevant today is the postmodern view of reality, where reality is something that you cannot know directly, but only through what you sense--meaning that you cannot prove a truth, so truth is only in the eyes of the beholder. That's a spiritual perspective; that affects the way we look at life.

And if you do believe there is a reality that we can perceive, and that there is an objective truth that we can relate to, that's very different from somebody who comes from a perspective that says, "It's really what you perceive, more than it is what you think is out there." That affects how we think of our problems; that affects how we're going to try to solve our problems.

HA: If I'm going to understand them, I need to try to understand them from an emotional perspective, but also from a cultural and spiritual perspective. So I'm listening for all of that. But I can't listen to that and understand it unless I am aware of that within myself.

You cannot see spirituality in somebody else unless you can see it within your life. How is it real for me? How does it affect me? The better I understand that, the more insight I'm going to have, and the better I'm going to be able to see how it relates to their lives. So that becomes something I normally look for as people present their issues. It also influences what kind of questions I'm asking them, so that I don't just assume what their moral stance is on things.

For example, when you're working with adolescents and their families, and their sexuality is an issue--which is almost inevitable when you're working with adolescents--what is their moral view about sex outside of marriage? What is acceptable? What is not acceptable? That's going to influence the work that you do; it's certainly going to influence the goals that you determine are part of your work.

HA: Sal is a fascinating personality. The man is intellectually so bright and so original in his thinking, but he's also very much a dynamic human being, and that influences his style of therapy. He always engaged with the clients very fully and emotionally--not only intellectually. It made his model a very dynamic approach to life, so that it could be challenging to therapists who tended to be much more reserved in how they relate to people. But Virginia Satir and Carl Whitaker were also individuals who had dynamic personalities, and used that dynamism in the way that they conducted their therapy. Sometimes people lost perspective and confused the dynamism of the individual with the theory and the technique that they were trying to teach.

HA: Sal was more likely to be confrontive than I would be. My particular personality and style is that I tend to be very direct with people, but I also tend to be more inclined to want to join with people and relate empathically with them. You would get a very different feeling with me than you would have from Sal. Sal, as you see in his writing, talked more about unbalancing the system, and he would often unbalance that system in a more forceful way than I would. I would also unbalance it, but not in the same style. This really emphasizes the importance of knowing one's self personally and saying, "I've got to work through the person that I am, and not through the person of the guru that I admire."

HA: I think what has changed is that as I've matured, I'm more confident about myself when I'm with people, and I'm more confident about what my thinking is, so that I can risk being direct with people about what I see and what my opinions are about what's going on, always allowing for the feedback and room for them to challenge me back. But the challenge is not so much a matter of me confronting as it is a matter of being able to state, "This is the reality that I perceive right now. Now give me your reality and react to what I'm suggesting to you." That doesn't work with certain clients, but I find it tends to work with people who are looking for results, and they say, "I can see what you're saying and I can see why you're saying it, and it does or does not make sense to me, but now I can give you back some feedback and we can work actively together to make something happen."

HA: As I look towards the future, I'm now continuing to focus on the person of the therapist and trying to develop that further, not only as an aspect of training therapists, but also as an integrating principle in the therapeutic process: we are integrating our technical and theoretical thinking around who I am and where I am in my life, so that when I do the therapy, it becomes very much my therapy. Even as I'm learning from other people, I'm moving more in that direction. But that also says to me that the common factors work being done by people like Sprenkle is an important contribution. I'm looking more at the common factors among the various models of therapy, and including these factors among the various views of the use of self. I'm thinking about how to highlight those common factors to encourage therapists to extract the essential elements of the therapeutic process, rather than having to choose between various camps of therapy, which I think is such a waste of time.

HA: We ended on the note that I hoped we would end on, which is the importance of therapists training to understand themselves more profoundly than they have in the past, not only from a psychological perspective, but also from a cultural and a spiritual perspective, so that they can use all of themselves more effectively in their therapeutic work, on the one hand; and on the other hand, the usefulness of thinking about common factors among the various therapeutic models so that people will not blind themselves to the contributions of the various models because they need to adhere to some particular school of therapy. From my perspective, there is no model of therapy that does not offer us an insight that is useful to all of us. I think it's important that we open ourselves up to learning from the various schools and approaches to therapy, and then take that and integrate it within ourselves so we become effective therapeutic instruments.

HA: Good, I'm glad you did. It was a pleasure, Rebecca.