Behavior: The Family As Patient

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In almost all traditional forms of psychotherapy, the patient meets alone with his therapist and is expected to tell no one—even his closest kin—about what goes on in his sessions. A major exception to that rule is family therapy, a fast-growing new specialty in which the patient is a whole family. Several relatives spanning two or three generations see their psychotherapist together for treatment, which does not always probe as deeply as individual therapy but costs less in both time and money.

Of the 1,000 or so psychiatrists, psychologists and social workers in the U.S. who now practice family therapy, one of the most innovative is Psychiatrist

Norman Paul of Cambridge, Mass. His theory: family troubles are frequently caused not by a generation gap but by a communication gap, which family members can bridge by sharing their innermost feelings with each other.

Forbidden Subjects. If feelings such as fear, disappointment, envy and grief are concealed, Paul believes, they are distilled and passed on from generation to generation. "As each new set of parents accords its young the treatment it received earlier," he says, "every child is left to traverse life's problems alone." What both young and old need to break out of that pattern, he suggests, is profound empathy.

To promote this understanding, Paul sometimes asks questions about "forbidden" subjects: a death, a family secret, guilty anger at someone close. At first his patients are generally evasive, but eventually most of them reveal their emotions. For some children, Paul says, this is the first opportunity "to see their parents suffering, a situation that reassures them by demonstrating that powerful parental figures also experience intense feelings of helplessness." Adults, too, need reassurance, and Paul provides it by bringing together families with similar troubles so that they can compare their emotional reactions and see themselves through other eyes. He helps this process by allowing patients to see video-tape recordings of their therapy sessions.

Crippling Grief. In one case, a 39-year-old journalist named Lewis, about to divorce his wife to marry a young girl, had broken down in sobs as he recalled his grief over the death of his beloved Aunt Anna. "She was always accepting me as I am. Being with her was like peace," he explained. Reviewing his childhood sorrow as his wife listened, Lewis recognized that his girl friend represented the goal of his lifelong search for another Aunt Anna. This led him to return to his wife, now more understanding because she had shared his secret feelings.