Twenty Years on – Water under the Bridge

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<ul><li><p>Twenty years on water under the bridge</p><p>Robin Skynnera</p><p>My paper in the first issue of the Journal of Family Therapy outlined someideas which have continued to form the basis of my practice of family ther-apy ever since. Using the psychoanalytic concept of counter-transferenceI suggested that opening themselves to the emotional interaction of thefamily will usually lead to a reproduction of the essential basic familyconflict within the therapists own psyches. In this way the therapist takeson the role assumed by many family scapegoats, expressing someemotion for the family which other members dare not articulate or evenentertain.</p><p>Introduction</p><p>Looking back to my first paper for the journal (Skynner, 1979), Inote that it still forms the basis of my techniques for family therapytoday. The essential point in it was that provided the therapist wasable to expose him or herself to the dynamics of the family, counter-transference responses would ensue which would generate vitalinformation about the family problem and would point to thenecessary intervention to resolve it.</p><p>Subsequent work revealed that the counter-transferenceresponse as experienced by the therapist tended to take the formof two opposed feelings, depicting more or less the underlyingfamily problem as manifested by the scapegoat in the family,together with a fear of expressing this, representing a familytaboo.</p><p>The main issue still to be solved was how to express this discoveryto the family without alienating family members (in the way that thefamily scapegoat was alienated from the family acceptance) andlosing their confidence and trust and any therapeutic alliancewhich they had built up during the session.</p><p> 1998 The Association for Family Therapy and Systemic Practice</p><p>a 17 Belvedere Court, Lyttleton Road, London N2 OAG, UK.</p><p> The Association for Family Therapy 1998. Published by Blackwell Publishers, 108 CowleyRoad, Oxford, OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.Journal of Family Therapy (1998) 20: 20721001634445 </p></li><li><p>Working models</p><p>In attempting to find a simple formulation for the scapegoat ideas,I gave a central place to the word model. This was being used atthat time in connection with behavioural therapy by Bandura, whospoke of certain kinds of learning as modelling, learning by exam-ple, demonstrating and inviting imitation. Bowlby, a psychoanalyst,had been using the words working model to signify internalizedinteractions observed between others or between the subject andanother person to mean an internalized pattern of behaviour whichcould provide information to the person concerned whenconfronted with similar circumstances. He had substituted workingmodel for the more usual analytic term internal object which wasused in a similar way but had less clear, and some undesirable, impli-cations.</p><p>Using this language, family therapists, if they can relax theirdefences and expose themselves to the family dynamics, can incor-porate an internal working model of the essential problem under-lying the difficulties for which they were referred, which then givesinformation about what is required by the family to resolve thefamily difficulties.</p><p>Case example</p><p>Some years ago, a man was referred to me by his general practi-tioner because he was haunting her surgery and she could notfind any way of dealing with him. He suffered from both hyperten-sion and diabetes, so that any variation in weight, up or down, ledhim to fear that he would die. I saw him, as requested, on his ownfirst of all, and could make absolutely no progress of any kind,telling the general practitioner that I thought nothing could bedone. Three months later the GP wrote to me again, saying he wasstill haunting the surgery and begging me to make another attemptto help him. I said I would, provided he came with his wife.</p><p>At the first session with the couple the husband repeated hisbehaviour of the individual session a long rigmarole of symptoms,and anxieties about their implications. After some time I noted thathis wife had said almost nothing during this period, and turned toher to say it might help if I knew a little bit about her backgroundtoo. At this she burst into tears, whereupon the husband immedi-ately reverted to his account of his symptoms and worries. This</p><p>208 Robin Skynner</p><p> 1998 The Association for Family Therapy and Systemic Practice</p></li><li><p>pattern was repeated several times, and I formed an image of thetwo of them on a see-saw, with the husband alighting at one end andthe wife crashing to the ground at the other. I told them about thisimage, describing their relationship to them in terms of the way heprotected her against some depression related to her early life bykeeping his anxieties in the foreground to distract her from herown worries. I said they were both aware of the danger if one persongot off the see-saw without warning, leading to possible injury in thecase of the person at the other end; it was obviously important forhim not to cease to keep her up by keeping himself down.</p><p>But I cant go on like this!, he said. I said I quite understood,and that his concern to save her from harm and distress onlyshowed how much he loved and cared about her. I suggested hemight allow himself to let down his side of the see-saw a little (i.e.diminish his recitations of his own anxieties slightly), but if henoticed that she was getting upset again, as she had in the interview,he should resume his recitations of his symptoms and anxieties withincreased vigour in order to help her up again. By this time theywere both looking at me as if I was crazy, and I began to wonderabout this myself. They attended only two or three more sessions,each resembling the first, without obvious sign of improvement,and then we terminated by mutual agreement. Six months later Iwrote to the general practitioner, who reported that the man was nolonger haunting the surgery, she saw much less of him, that themarriage seemed to be more satisfactory and her patient seemedless anxious than before.</p><p>Application of Milan interventions</p><p>In the foregoing example, the reader will recognize the influence ofthe Milan School (Palazzoli et al., 1978) on my work which occurredsoon after that first paper was written. Until that point I had had torely on humour to help me to present the essential family conflictin a way that avoided rejection by the family and the breaking ofcontact. Soon after the 1979 paper appeared two members of theMilan team, Boscolo and Cecchin, visited London and presentedtheir method. I was quickly convinced that the success of their para-doxical descriptions was due to the fact that they were based on anaccurate recognition of the essential family dynamics. After watch-ing one case I put this to Gianfranco Cecchin and he replied, Yes,but we dont like to think in that way anymore. I found that the</p><p>Twenty years on water under the bridge 209</p><p> 1998 The Association for Family Therapy and Systemic Practice</p></li><li><p>Milan method of neutrality, positive connotation and avoidance ofany comment that might be regarded as criticism was ideal for inter-ventions to convey the essential dynamics of the family I recognizedthrough my counter-transference response without arousingintense resistance.</p><p>For those wishing for a more detailed examination of this partic-ular approach to treatment, I refer them to my chapter in TheHandbook of Family Therapy by Gurman and Kniskern (Skynner,1981) which also offers a good illustration of how awkward andembarrassing as well as productive using the method can sometimesbe.</p><p>Conclusion</p><p>Lowering ones defences and exposing oneself to the family inter-action, as described in the original paper, is a very quick way tounderstand the family problems, provided one can sustain oneselfthrough the disturbance the internalizing of the family problemmust evoke. It is not a suitable method for people who are inexpe-rienced or who need to be in control of the therapeutic situationat the time or who like to follow any kind of set routine, or who holdon to a set of principles as if grasping a lifeline on a boat to avoidbeing washed overboard. A secure sense of ones own identity is thesurest safeguard against feeling washed overboard and some formof analytic therapy is one of the most helpful ways of finding this,although meditation or following some other form of spiritualdevelopment may be equally valuable.</p><p>ReferencesPalazzoli, S. Boscolo, L., Cecchin, G. and Prata, G. (1978) Paradox and Counter-</p><p>Paradox. New York: Jason Aaronson.Skynner, A.C.R. (1979) Reflections on the family therapist as family scapegoat.</p><p>Journal of Family Therapy.Skynner, A.C.R. (1981) An open-systems group-analytic approach to family ther-</p><p>apy. In: A. Gurman and D. Kniskern (eds) Handbook of Family Therapy. New York:Brunner/Mazel.</p><p>210 Robin Skynner</p><p> 1998 The Association for Family Therapy and Systemic Practice</p></li></ul>