Sign In
Sign Up
Home
Groups
Case Consultations
Internships/Jobs
Events
Library
Videos
Papers
Classified
Members
Melissa Bridges
Melissa Bridges's Documents
Search Documents
Melissa Bridges's Documents
Hypothesizin..
1 comment | 0 likes
Constructing ..
0 comments | 1 like
The Logical C..
0 comments | 0 likes
More »
Social Share
Archives
2015
Communication Theory and Clinical Change
Created by
Melissa Bridges
March 12, 2015
- Category:
Other
- Tags:
#Weakland
#Communication Theory
#Change
0 comments, 1,027 views, 0 likes
Communication Theory and Clinical Change
CHAPTER 5 Communication Theory and Clinical Change* John Weakland I. "THE READER IS WARNED"—JOHN DICKSON CARR Titles, like other labels, are often best met with critical wariness, includ- ing this one. "Communication Theory and Clinical Change" is accurately descriptive, since I will indeed discuss both communication theory and clinical change—here taken as purposeful intervention into problems on an individual and family scale, although the view involved is also more broadly applicable to human behavior and change. The apparently insignificant little word and, however, is perhaps the most important and potentially troublesome part of the title. It indicates, but probably does not adequately caution, that I will here be fundamentally concerned with the relationship between theory and practice. Since family therapy is increasingly a field of practice, and theorists and practitioners are, ordinarily, two different and separate breeds, discussion focused on this relationship may seem labored and beside the main point to many family therapists. The matter may be made still worse by the fact that "Communication and Clinical Change" is a large subject to cover in a small compass, requiring severe selection and condensation. Accordingly, detailed information and illustrative examples will be minimal here—though amply available elsewhere (1, 2, 3); rather, I will outline the ideas and relationships I see as most basic, because they are general—not in the sense of "vague," but of "broad relevance." My aim here, that is, is not to get down to cases, but to get down to basic ideas and how they relate to getting down to cases. But since very different conceptions of communication and family therapy co-exist today, what *Note: The views expressed in this article are the formulation and responsibility of the author individually. Nevertheless, it is certain that they reflect long experience at Mental Research Institute and it is probable that most of the author's Institute colleagues would generally agree with them. 777 772 Communication Theory and Clinical Change seems basic and clear to the author and some of his colleagues may seem to others interested in theory to be on the wrong track, or to oversimplify complex and serious matters. In short, the communicative task proposed here, even if it is possible, may be rather fruitless. But let us get on with the attempt, and since the going will be difficult in any case, start with the relationship of theory and practice in general. II. THEORY AND PRACTICE Theory has various meanings. As used here, in a broad but particular way, theory refers to whatever general concepts and principles a person holds in connection with some area of knowledge and action—in essence, a view or mental model of some matter. A theory, in this sense, may be less explicit, comprehensive, and systematic than the scientific ideal; indeed, people may even claim their ideas and behavior are atheoretical. Yet even in such cases, a general view or model, often quite systematic and consistent, can usually be readily inferred from a reasonable amount of observation of their behavior—that is, specific actions and related statements. And such a model is always important in understanding the area of behavior to which it relates. It outlines what is taken as important or not important, logical or illogical, to be pursued or to be avoided, even what is possible or impossible. That is, we do not think and act in direct relation to reality, but in relation to some theory, view, or model—the term chosen is not important —of reality. Accordingly, any theory held, whether it is explicit or implicit, simple or complex, neatly organized or a melange of bits and pieces, has important practical consequences. To take an obvious example, if a therapist believes pathology is located within an individual, he may prescribe drugs or do analytic work, but he will not practice family therapy; this would not "make sense." And despite common complaints about the illogicality of human behavior, it seems more generally the case that people, including therapists, do behave logically in terms of their own premises— often, when the premises are questionable, all too logically, whatever the outcome. It is, of course, common knowledge that theory can and has obscured as well as clarified, has caused difficulty as well as been helpful. Many and varied examples of this exist in history generally and the history of science in particular. In our own field, the family therapy movement itself has in considerable part arisen out of criticism of theories of individual psychopa- thology and treatment. It would appear, though, that theory is apt to promote difficulty or error Weakland 113 in practice not because of its inherent nature—and in any case practice necessarily involves theory as defined here—but primarily under certain circumstances: 1) When theory is neglected—usually by being left largely implicit. Then it is more difficult to make any critical examination of the kind of premises held, or of their consistency, or any comparison of expecta- tions with observable events. 2) When theory is exalted—taken not as a useful view and tool, but as "reality" or at least a close approach to this ideal goal. Then theory tends to become an ultimate standard according to which all else must be decided, done, and judged. 3) It is curious to note that these two apparent opposites are both likely to occur in relation to the same situation—the downgrading of the immediate data of observations and statements from primary to secondary importance, and a corresponding elevation of interpretation, as the means to some deeper and more profound knowledge. In the one case, this usually involves emphasis on the clinician's empathy or intuition; that is, special personal insight that is not open to being challenged. In the other, theory reached via elaborate constructs and chains of inference becomes so grand and complex that if any discrepant data appear, these often are easily explained away or incorporated by fur- ther theoretical elaboration of similar kind, rather than revising and simpli- fying the theory (4). On the view of theory stated earlier, no theory can be complete or perfect. A theory by this definition is a simplification, a tool for use in facilitating understanding and action (including transmission of ideas and techniques to others), and therefore is to be judged only by the results of its use. Generally, however, it appears best to have one's theory made as explicit as possible, and as simple and as closely related to data of direct observations as the subject of interest permits. The basic ground for this preference is that the terms and implications of such a theory, and its results in use, can be most readily subjected to critical survey. In the more specific situation where one is involved, as we all are, in acting in some field as a practitioner, the importance of considering the relationship between theory and practice only becomes intensified—since professional work specifically implies deliberate behavior and operational expertise based on some general understanding. And what this understand- ing is, the view held of the field, largely determines what actions will be taken, the results of these actions, and even their evaluation. Our own field, for instance, might be most broadly defined as concerned with dealing professionally with human events and actions that—being seen as strange, deviant, or destructive—present problems either to others, or to the actor himself. The corresponding basic questions are: What is the nature of such situations? What is their cause? What should be done about them? Historically among laymen and professionals there have been two main lines of explanation for such difficult or puzzling human situations, both for 774 Communication Theory and Clinical Change individuals and for groups of persons seen collectively—general views, with variations on each theme. On the one hand, human events and especially problems have been seen as the consequence of powerful impersonal forces, external to the realm of human behavior. Such forces may be supernatural, physical, or even social in so broad a sense as to be not personal—fate, God's will or demons, climate or geography, the economic system. To this class of large and powerful forces, in our day might be added certain minute but powerful factors, such as microbes and drugs. Alternatively, human problems have been seen as the consequence of inherent personal factors—physical, mental, or moral attributes character- istic of an individual, or of a group of individuals, that determine their bad or mad behavior. And in some instances, such as with climate and racial character, or genetic theories of behavior, these two broad lines of interpre- tation may overlap. These broad theories have correspondingly broad implications and ex- pectable consequences which often are similar despite the apparent polarity of the two views. On the nature of human problems, both are concretistic. That is, they lead to seeing problems in an external and isolated way, apart from the viewer and from the flow of his ordinary life, as separate phenomena, existing in themselves. Correspondingly, the nature of such a problem is apt to be seen as rather plain or self-evident. The important question is then not its what, but its why. As to cause, such isolated and external viewing of problems is naturally accompanied by simple linear cause-effect theories; at the extreme (but a common extreme), "What is the cause of this problem?" Also, the cause is predefined as external to the person or persons defining the problem. The cause is "out there" in the external world, or in someone else, except—which is hardly a real exception — when it is in me, but not of me: I am doing something, but only involun- tarily. Finally, there are corresponding implications about the handling of problems. To the idea of a single ultimate cause, there corresponds a search for overall or final solutions. The impersonal forces view leads either toward resigned acceptance—"Nothing can be done"—or to a call on some other external and higher power—God, a leader or science—for a major coun- tereffort. The "someone is bad or mad" view may also lead to helpless pessimism, but it is more apt to lead to some combination of blame plus attempts, either hostile or supposedly benevolent, to change that other someone or ones, usually in a major way. Of course there are human difficulties for which one of these views may be most appropriate, such as the kinds of concrete and practical difficulties immediately consequent on storm or earthquake, economic depression, accident, or sudden physical illness. But the problems people typically bring to psychotherapists are not like these. Clinical problems may arise out of such concrete difficulties, although more often no striking or dramatic Weakland 175 origin is apparent; but in either case what is characteristic is helplessness, manifested either by inaction or confused activity, in the face of persisting difficulties that are escalating or have reached an impasse. Here a model of problems based on the idea of communication and interaction may be more appropriate. Certainly such a model is fundamen- tally different in focus and implications from both of the views outlined above. From such a view, problems are seen as primarily involving ongoing behavior and interaction between persons in some system of social relation- ships. The relevant questions concern what is going on, which is not taken as self-evident; how does this continue when people want things to be different; and how can the functioning of the system be altered for the better, though no solution will be final or perfect? All this is abstract and general, but has profound human implications. Problems are not conceived as sepa- rate, but on a human scale related to everyday behavior, and as interactive, a matter of joint responsibility: "All in it together" rather than "sick versus well" or "bad versus good" or "wrong versus right." While this spreads the burden of dealing with problems, it also implies a spreading of any gains. A joint enterprise has potential mutual benefits, rather than winners versus losers. But this is only a broad outline of a view, a conception to be tested by its usefulness. In order even to approach such critical appraisal, it is neces- sary next to pursue matters much further—to indicate, at the least, how this view developed, to spell out its terms in more detail, and to state more specifically what such a view leads to in practice. III. COMMUNICATION THEORY—DEVELOPMENT AND DELINEATION Even the very general communicative view just sketched, let alone the specifics to be added shortly, did not spring into being fullblown, like Venus from the sea-foam. Rather, the view being presented here represents a distillate of a long developmental process involving a variety of interrelated observations and ideas. A brief account of this development may be useful in two ways. For a more extensive account, from a somewhat different viewpoint, see (5). In the first place, a view of the circumstances out of which this view of communication and interaction arose may help clarify and delimit what we are talking about more concretely than formal definition alone can. Com- munication has become a catchword and a catch-all. It means one thing to people interested in the mass media. It means another to communications engineers, who are largely concerned with clear and economical transmis- 776 Communication Theory and Clinical Change sion of rather simple messages. And it means a variety of different, usually ideal, things to patients who complain about "poor communication" as a family problem—or even to various family therapists hoping to promote " good" communication. All these are different from our primary concern with the nature of observable face-to-face communication, verbal and non- verbal, among members of a family or other ongoing social group, and its significance for the shaping of actual behavior. In the second place, a developmental account gives further perspective on the relation of practice and theory by presenting a concrete example of how the interaction of a few basic ideas and a variety of exploratory observa- tions led to the present view of communication, problems, and their han- dling, which is quite different from the view of problems and therapy held originally, and may be expected to alter further in the future. This develop- mental summary may appear somewhat disorderly. In this also it reflects an actual relationship between theory and practice, rather than the fitting of events to a myth. In a view common among scientists as well as laymen, science develops according to an orderly scheme, involving the formulating of hypotheses based on existing knowledge, testing these out empirically, affirming or altering the hypothesis in line with the results, and repeating the process. This may be so somewhere. It is not how communication theory and family therapy grew up in close relationship, at least in Palo Alto, to which this account mainly refers. One thing did lead to another, but not in so orderly and planned a way. Certainly at times, theory—a systematized view—was distilled from practice post facto, rather than lead- ing to it, although the converse did occur at other times, if often not altogether clearly and deliberately. The beginning of this present view of communication and interaction may be referred—as always, somewhat arbitrarily—to Gregory Bateson's research project on communication. This began in late 1952, and involved Jay Haley, John Weakland, William F. Fry, Jr., and later Don D. Jackson. Initially, there was nothing specifically clinical about this research, though it was housed in the Palo Alto VA Hospital. Rather, it was broadly con- cerned with communication in general, and especially with communica- tional paradoxes. For example, Epimenides the Cretan says, "All Cretans are liars." If he is telling the truth, he must be a liar, and vice versa. Drawing on the idea of Logical Types, which Whitehead and Russell had developed and used in Princi pia Mathematica to explain certain contradictions in mathematics, such paradoxes were seen as related to the existence of multi- ple levels of abstraction in language. This simple but basic idea was kept in mind while examining a wide variety of actual communication, ranging from the conversation between a ventriloquist and his dummy to the play of otters observed in the zoo. The otter studies led to the conclusion that even animals must be able to give classificatory or framing messages equiva- Weaklanc/ 117 lent to "What I am doing is play," and this led from the original idea of multiple levels of abstraction to the view that, in human communication especially, there is no such thing as a simple message. Instead, people are always sending and receiving a multiplicity of messages, by both verbal and nonverbal channels, and these messages necessarily modify or qualify one another. That is, not only must all messages be interpreted, but the significance of any message singled out for attention cannot be determined from that message alone. It always depends also on how it is qualified—modified, reinforced, contradicted, specially framed ("When you call me that, smile!"), or whatever—by other simultaneous, preceding, or following messages. These (along with the setting, the relationship between the communicating parties, and so on) form part of the context which must be considered in interpreting any such message. Moreover, the significance of a message is not just a matter of meaning, in the sense of information, but of behavioral influence. There is some message that indicates whether it is a serious bite or a playful nip, but this also largely determines whether more play or a fight will be the response. It is, of course, no discovery to note that messages can affect behavior; this is only common knowledge. It is an important further step, however, to insist that rather than some messages being informative and some directive, all messages have the two aspects labeled in the earlier work of Ruesch and Bateson (6) as report and command. This key idea has been elaborated and discussed in other terms as well, including the expressive and effective aspects of messages, information and influence, and content and process in communication. Regardless of the specific terminology, this served to focus attention on the pervasiveness of communicational influence, which may be most important to note and understand precisely when it is complex, subtle, indirect or covert, rather than obvious. Another important idea was the recognition that unlike physical influence, in which a passive object is moved by and in proportion to the magnitude of an external force, com- municational influence operates by activating and directing the energy of the receiver of a message. Therefore, small signals may easily have large effects, and still further multiplication of effect can occur when one signal frames the interpretation of many others, as often occurs. For these two reasons, then, the potential importance of communicational influence on behavior is great, and should never be neglected. The project next took its first step from concern with communication in general toward involvement with clinical matters, by beginning to exam- ine the communication of schizophrenics, being surrounded by this fas- cinating material in our VA Hospital setting. Schizophrenic speech (like their "crazy" behavior) was then generally thought to be incomprehensible nonsense. But the matter began to look quite different when actual samples 778 Communication Theory and Clinical Change were tape-recorded for repeated study and examined in context, with atten- tion not just on the schizophrenic's words in isolation, but also on those of the interviewer, and the institutional environment as well. A new view was also promoted by having in mind our prior insight that most communica- tion does not consist of simple declarative statements (an ideal of normality to which schizophrenic talk ordinarily was implicitly compared), but of a complex of mutually qualifying messages, including some which indicate how others should be interpreted—again, whether as a serious bite or a playful nip. This, too, is not really a new idea. Everyone knows that there are humorous, ironic, sarcastic, playful, and other kinds of messages as well as simple factual statements. But this knowledge had not been applied to schizophrenic communication, presumably because this, defined as " crazy," was viewed as separate and different in kind. Once we began to examine it in the same way as other communication, using the same general ideas, it appeared that if regarded as metaphoric in style—only lacking in the usual signs of metaphor, such as "It's like . . ." or the use of conven- tional, familiar metaphors—much schizophrenic speech, otherwise unintel- ligible, made comprehensible sense. Even this lack of clear interpretative signs might be explained by considering that hospitalized patients could well be cautious and defensive, like members of the underworld relying on their private argot. These notions received further support when we found that if we re- sponded to patients' statements as metaphorical—instead of the common response of taking them literally, and trying to get the patient to acknowl- edge their illogic or unreality, a covert form of arguing with the patient— they then spoke more plainly. Different communication led to different communication. Somewhere along the line we began to see, perhaps aided by our prior insight that report and command are matters of analytic distinction rather than separate kinds of messages, that communication and behavior are not separate and different, but essentially the same thing viewed from different perspectives. Communication occurs only through the observation and interpretation of behavior, while all behavior in the presence of another is potentially communicative. (As a special case, one person can be both sender and receiver.) Which aspect is emphasized or seen as primary is only a matter of the point of view and purpose of the observer at a given moment. In short, one thing had led to another until at this stage the research was already pursuing the study of the relationship of communication and behavior into the realm of "pathological" communication and behavior. But it was doing so on the basis of the same ideas about the complexity of communication, and its related ubiquitous, powerful, and complex behav- ioral influence as before, and with similar methods of close observation and study. That is, we were conceptually treating the abnormal the same as the Weakland 179 normal, and moving progressively toward explaining things positively by inclusion—how does schizophrenic speech make sense in relation to speech in general—rather than negatively and by exclusion—how is it "illogical." Although this is a basic principle in scientific explanation, the principle is often breached in dealing with the abnormal, which is set apart, beyond the pale. In avoiding this, we were helped by the anthropological background of some of the research team. Anthropologists have traditionally been involved in the task of making sense out of apparently strange or bizarre behavior by viewing it in relation to other behavior, building up a view of a patterned whole within which each item has an understandable place and function. In any event, although many of our basic ideas were not novel, we were now involved in pursuing them toward wider limits: Just how much and what kinds of behavior (in the widest sense, including speech, actions, feelings, even bodily functioning) might be understood and accounted for on a basis of communicational influence, before having recourse to other avenues of explanation such as instincts or other genetic factors, biochemis- try, early childhood events, or whatever? This line of inquiry, in fact, is still far from exhausted. With our new view of the nature of schizophrenic communication, we next approached the question, "How is it that patients communicate in this fashion?" One part of our answer to this is implicit in what was said about the hospital context—quite possibly, such speech serves a defensive or protective function. Our other concern was with how schizophrenics might learn to communicate in such a way—essentially, "To what pattern of communication would such speech be an appropriate response, in some sense?" This also arose naturally out of our anthropological background, since by training and experience anthropologists commonly look for how behavior is learned in structured contexts of social interaction. This inquiry about learning was pursued in part speculatively, by apply- ing general knowledge about learning principles and multiple levels of messages to our characterization of schizophrenic speech; and in part by further empirical study. Since we had no way to reliably observe the past communicative background of our subjects, we started with what was di- rectly observable, the communication of currently schizophrenic patients with their family members, especially young adult patients and their par- ents. Again this involved tape-recording and repeated close study. Out of such work came the concept of the "double-bind" (7), which described schizophrenic speech and other symptomatic behavior as a response to incongruent messages of different levels, within an important relationship, and where both escape from the field and comment on the incongruity were blocked. In the present context, the details of this formulation are less important than its general nature (8), which is an attempt to produce a communicational explanation of crazy behavior by relating it to an identifia- 720 Communication Theory and Clinical Change ble pattern of communication within the family system from a functional view—that is, how the patient's behavior fits in and makes a certain kind of sense within a certain peculiar but observable communicational context. In fact, things seemed to fit together so well in the here and now that we felt little need to move back toward the preschizophrenic days of the patient and family. Rather, our focus on the present system increased as we studied the interaction of schizophrenics and their families Up to this stage, we had mainly studied dyadic interaction. Even in this, it had soon become evident that ordinary distinctions between "sender" and "receiver," or " stimulus" and "response" were also analytic artifacts, essentially a matter of imposing punctuation on an ongoing system of communicative interac- tion. Since we describe and explain mainly by means of language, which involves discrete units and linear structure, such punctuation may be analytically useful or necessary. Certainly, it is important to recognize that the participants in any system of interaction regularly impose similar punc- tuation (which could also be seen as a larger scale example, applied to sequences, of that interpretation which is always involved in communica- tion), and in ways that can be of major practical importance. For instance, many clinical problems involve punctuation directly paralleling that very commonly seen in children's quarreling: "You started it!" ("I'm only react- ing to what you did.") "No, you started it first!" From a broader viewpoint, however, such punctuation, as well as being a source of conflict, is inaccu- rate and inappropriate. There is no "starting point" in an ongoing stream of interaction; the simple linear model of cause and effect is not appropriate. When we began to examine the more complex, yet highly patterned and repetitive interaction occurring in families, it became even clearer that the relevant epistemological model is one derived not from mechanics, but from cybernetics, where the focus is on the structure of interaction within some ongoing system. Rather than pursuing our family studies into the preschizophrenic past, then, if this were possible, we concentrated on present functioning, and rapidly also became involved in looking toward the future. That is, moti- vated both by positive hopes, and by feeling the danger of being engulfed into their system while interviewing such families, we began attempts to change the going system in schizophrenic families for the better. These attempts were also promoted by observations that hospitalized patients who improved with individual treatment and were sent home often soon reap- peared for further hospitalization, as well as by some early experience of Dr. Jackson with various members of patients' families. This, then, was the beginning of family therapy in Palo Alto based on a communicational view of behavior (9). (At about the same time, of course, various others were also beginning to work with families from a variety of backgrounds in experience and viewpoint.) While neither our ideas nor our Weaklano' 727 related techniques were f ully and clearly formulated at this point, they appeared promising. And it was only a modest and natural next step— especially since schizophrenia was both a most difficult problem and one whose varied manifestations seemed to include much that was also charac- teristic of other kinds of clinical problems—to explore the relevance and use of family therapy as a general treatment approach. Where this has led, in terms of clinical practice and related theory, can now be described. IV. PROBLEMS, PERSISTENCE, AND CHANGE The communicational view of behavior and related ways of dealing with problems developed gradually, with one thing leading to another, and ac- tion at times preceding formulation. In addition, some ideas—and certainly many specific terms—that were important or necessary as part of this development in retrospect no longer have the same importance. Put bluntly, a sizable part of our work on communication now appears related to digging ourselves out of individual-centered, depth-psychological views of behavior, problems, and therapy in which we originally were imbedded, rather than to any elaborate creation of new views. Once perceived, the ideas about communication and behavior basic to a communicational approach to treat- ment appear as rather few and rather simple, if not obvious. This, of course, is not to say there are no difficulties involved in sticking to these ideas in areas where one has learned well to understand matters in another way, or in applying them in specific, often apparently chaotic or confusing situa- tions. The two central ideas—of equal importance and closely interrelated— from which all else logically flows are: 1) that specific behavior of all kinds is primarily an outcome or function of communicative interaction within a social system; and 2) that "problems" consist of persisting undesired behavior. On this view, unless there exists clear and clearly relevant evidence— not just a possibility, or ambiguous signs—of some other significant causal factor such as organic pathology, observed behavior should be considered as structured and maintained primarily by current communicative interac- tion within some ongoing system of social relationships. This means all behavior, good or bad, voluntary or involuntary, normal or pathological. Indeed, if anything, this view should be applied most deliberately to unusual or abnormal behavior, for it is behavior labeled as such that most needs explanation—as a therapist once told an inquisitive patient, "Neither you nor I need to explain what is normal"—and that is most apt to be explained by different and special means. The relevant system of interaction is usually 122 Communication Theory and Clinical Change the family, but other systems such as school or work organizations may be important in some cases. Clearly, this view puts an emphasis on observable communication— statements and actions—in the here and now. Similarly, the kinds of prob- lems that people bring to therapists are seen as matters of currently persist- ing (or worsening) difficult, deviant, or symptomatic behavior. (Transient behavior may be unpleasant, but nothing need be done about it; by defini- tion, it will pass.) Two closely related but distinguishable elements are involved in this: the more or less objectively observable behavior, and how it is judged and labeled by the patient or others associated with him. This distinction is important because in some cases—for instance, parents' over- anxious concern about ordinary childish mischief—the judgment, more than the behavior it labels, makes the problem. In either case, though, we see the problem as one of interpersonal behavior—what is being done, or how something is being labeled—neither as something more internal and personal, nor more external and impersonal. This view of the nature of behavior and problems has several immediate and profound implications for treatment. First, the question, "What is wrong with this particular patient?" is largely irrelevant. This question is based on an individualistic view of problems, while from a communicational viewpoint the relevant question is, "What is going on in the system of interaction that produces the behavior seen as a problem?" or "How does this behavior fit in?" Second, the concern common in many treatment approaches, "What is the underlying problem?" also is not relevant. If behavior is seen as primary, this "tip of the iceberg" idea no longer makes sense. Rather, the behavior complained of (or perhaps, as mentioned, its labeling as something requir- ing change) is the primary focus of treatment. This is not to say that other related behaviors may not need attention from the therapist. In fact, the communicational view clearly implies that the problem behavior must be considered in relation to other behavior. Nor does it mean that feelings, or past traumatic experience, for example, are simply to be neglected. It does mean that such factors are to be considered in relation to present behavior, not as somehow deeper or more fundamental, and are to be dealt with by appropriate changes in present behavior. Somewhat similarly, the search for a root or original cause of any problem is foreign to the communicational view. This presumes a linear view of causality: A causes B, which then causes C. Such a view also subtly influences one to seek a cause corresponding in magnitude to the eventual problem. For instance: Schizophrenia is a dread syndrome, so somewhere behind it there must be great trauma, genetic deficiencies, biochemical abnormality—something big. But the picture is quite different on a cyber- netic epistemology, which a view based on communication and interaction Weakland 723 directly implies, and which indeed constitutes the most basic and general difference between interactional and individualistic approaches. From a cybernetic view, attention is focused on the structure of the system of interaction, and especially on its feedback loops. And where there is positive feedback—more of A leads to more of B, which leads to more of A, and so on—large effects can readily arise from minimal initial events. In more ordinary terminology, problems arise by snowballing, or vicious circles (10, 11). Similarly, though this has received less consideration and investigation, the cybernetic epistemological view also raises the possibility that there may be no necessary or close relationship between the origin of a problem and its particular nature as ordinarily conceived—that is, the "diagnosis." For both size and shape of problems, any original precipitating event or diffi- culty may be of minor importance, and how it was dealt with in the environing system the main thing. From this point of view, for the fullblown problems that reach thera- pists' offices, the central question is not one of origins, but one of organiza- tion and persistence: "What behaviors in the ongoing system of interaction are functioning, and how, to maintain the behavior seen as constituting the problem?" This also fits with the idea that problems consist of behavior; that is, a problem is not something that simply exists in itself, a passive concrete object, but something that exists only in continuous or repeated perform- ance. Furthermore, such a view centers on matters open to current inquiry, with a minimum of inference about unobservable past or intrapsychic events. For example, if a person says "isolation" is a problem, it is highly pertinent to consider how he behaves to avoid other people and to keep them from making contact with him, and to inquire, of course judiciously, about this. Finally, at this general level, the resolution of problems correspondingly appears as primarily requiring a change of the problem-maintaining behav- iors so as to interrupt the vicious positive feedback circles, and the thera- pist's main task as promoting such changes. Such alternative behaviors are always potentially open to the patient and other members of the system, but ordinarily it is not possible for them to change their usual but unsuccessful problem-solving behaviors on their own; those who can, do so, and there- fore do not reach our offices. The therapist's job, accordingly, is to find and apply means of intervention that will help them make such changes, and the test of both specific interventions and the general approach is highly pragmatic: Do beneficial changes occur? This outlined interactional approach to problems and treatment is clearly different from that of individual psychodynamic therapy, but the principles stated are still broad and general. A number of rather different views of family interaction and techniques of family therapy, involving different explicit or implicit emphases on structure, on good versus bad 724 Communication Theory and Clinical Change communication, on process versus content, and so on could largely fit with these principles. Discussion of such variants would be too lengthy here, and perhaps confusing. Instead, only the particular approach developed by MRI's Brief Therapy Center will be specifically described. The members of the Center see this particular approach as exemplifying a further refine- ment, boiling-down, and direct application of the most essential principles of the communicational view—though others, of course, may see it as a departure from the classic mold of family therapy. Two further specifications of views already stated are important in the Center' s approach and practice. First, while the origin of problems is not a vital question on the communicational view, one important aspect of the genesis of problems seems related to the crucial question of problem maintenance. In our experience, it appears that the problems brought to therapists commonly arise from difficulties of everyday life that have been mishandled by the parties concerned. Although such difficulties may at times involve special or unusual events—accidents, sudden illness, unexpected job loss— most commonly they involve adaptation to an ordinary life change or transition, such as marriage, childbirth, entering school, and so on. The mishandling involved may range from ignoring or denying difficulties on which action should be taken, to attempts to actively resolve difficulties that need not or cannot be resolved, with a wide area between where action is needed but the wrong kind is taken. Bad handling certainly does not correct, and usually increases, the original difficulty, which is then apt to be relabeled as a "problem," which is usually met by more of the same or similar inappropriate handling, leading to exacerbation or spread of the difficulty —and so on and on. That is, instead of viewing the cause and the nature of any problem as separate and different, we see the same essential process involved in problem formation as in problem maintenance. Rather similarly, we do not sharply separate chronic from acute problems, but see chronic ones as merely involving mishandling for a longer time. In short, the central focus of this view is not on difficulties as such—life is full of these, even for the most normal—but on their handling, for better or for worse. Second, though quite consonant with the first point, our clinical obser- vations indicate that usually it is precisely the ways people are trying to handle or resolve their problems that constitute or include those behaviors which are maintaining the problem in question. This of course is unrecog- nized by the participants in a problem situation. While we recognize that there are some payoffs from any system of interaction, even one full of problems, we do not see these as central in problem maintenance, nor as any major obstacle to change. The situation is not that bad—though in a way it is worse. Rather, our view is that people generally are well-inten- tioned and trying to improve things as best they know how; but what they Weakland 725 see as the right and logical thing to do in the circumstances—often the only right thing and often supported by prevailing cultural views—is not work- ing. The therapist's job, then, is apt to be the unenviable task of getting people to change that which they are apt to be clinging to most strongly. Correspondingly, to produce beneficial results, the therapist may have to promote remedies that might appear quite illogical to those most immedi- ately concerned, and perhaps to many others as well. Our overall treatment plan and procedures follow directly from these basic principles. Since our treatment focus is symptomatic, in a broad sense, we want first to get a clear statement of the presenting complaint, in terms of the specific, concrete behavior involved, and how this constitutes a problem. We attempt to get this information primarily by simple means such as direct questions, requests for clarification and examples, and asking for order of importance if a number of complaints are mentioned. Where more than one person is present, we ask each to state the main problem as he sees it, assuming their views may differ. Next, we ask in a similar concrete way what the patient and any in- volved others are doing to try to handle the problem, based on our view that problems only persist if somehow maintained by other behavior, and that the locus of this ordinarily lies in peoples' efforts to deal with or resolve the problem. In our experience, when specific information on problem handling is obtained, and is considered in this light, problem-maintaining behavior often appears rather evident. For instance, it does not take any special skill, but just some objectivity and perspective, to see that the person with a sexual problem who works at performance is likely to make things worse rather than better by seeking to do the spontaneous voluntarily; or that the parents who tell a truant child what a wonderful experience and oppor- tunity school offers are producing alienation rather than compliance. In some cases, of course, problem-maintaining reinforcements may be more difficult to perceive. They may be more complex or subtle; they may involve contradictory messages by the same or different persons; or the therapist's own accepted views about sensible behavior may obscure his observation of actual interaction and its effects. Third, we ask all parties involved to state their minimal goal of treat- ment—that is, what observable behavioral change, at the least, would sig- nify some success in the therapy. This is a difficult question for most patients to answer concretely, but an important one. Just to pose it conveys that change is possible, that it should be judged by observable behavior, and that small changes can be significant. According to our cybernetic view, if a small but significant change can be made in what appeared a major and hopeless problem, this is likely to initiate a beneficient circle and lead on to more progress. In contrast, pursuing vague or global goals is apt to lead only to uncertainty and frustration. 726 Communication Theory and Clinical Change In addition to these three specific questions, two other matters are important from the outset, although information on these is gained more from close attention than direct inquiry. It is important to decide who is the main client—the "customer" for treatment. This means the person who most wants to see real change in the problem situation, usually because he or she is most concerned or hurting from it. This need not be the identified patient, or the person who makes the initial contact with the therapist. A wife may call to arrange an appointment for a drinking husband, or parents bring in a child who is failing in school. In such cases, unless the identified patient clearly indicates he personally is seriously concerned about the behavior in question, which often is not the case, we would if possible arrange to work primarily with the complainant—the wife or the parents. If one takes the idea of interaction in systems seriously, it follows that effective intervention can be made through any member of the system. Family therapy in this view does not consist of having everyone present in the therapist's office (although this may at times be desirable for informa- tion gathering or strategic purposes), but in working from an interactional viewpoint. And usually intervention can be most effectively made with the chief complainant, the person concerned enough to do something different. For a similar reason, we attempt as soon as possible to grasp each client's "language"—the ideas and values that appear central to him. If people are to be moved to change their behavior, especially rapidly and in regard to behavior they believe is already logical and right, the therapist must perceive and utilize existing motivations and beliefs. Otherwise, his advice, however good, is likely to be ignored or opposed. Once these inquiries and observations have been made, the therapist plans a related treatment strategy. That is, he concisely formulates the main presenting problem, and judges what behaviors are most central in main- taining it. He decides on a goal of treatment, estimating what concrete behavior would be the best sign of appropriate positive change. In all of this he of course takes full account of what the patients and others have said. But since on this view the therapist is an active and deliberate change agent — someone being paid to exert influence expertly and beneficially—the responsibility for final decision is his. Even if his formulations agree with the patient's, it is the therapist who is deciding to proceed on this basis. Once the goal of treatment is determined, the therapist must consider intermediate steps, and the means to achieve them. What changes in the behavior of the patient, or others involved in the problem, are needed to approach the goal; and what interventions might be effective in promoting these changes? In general, the therapist will aim to interdict the problem- maintaining behaviors he perceives. The substitution of opposite behaviors for these will often be promoted, both to insure appropriate and adequate change, and because it is difficult for anyone just to stop doing something Weakland 727 And since patients are already doing what they consider right, such changes can only rarely be accomplished by giving direct behavioral instructions on what to avoid or what to do. Instead, effective intervention usually requires reframing. That is, the problem situation must be redefined in such a way that the original motivations and beliefs of the persons involved now lead toward quite different behavior. Beyond this, intervention rapidly becomes too particular a matter to be pursued further here. There is no "good intervention" as such; what is effective and useful always depends on the circumstances of the particular case. Of course this is true of every aspect of actual practice. One must get down to particulars, and often in difficult circumstances, with people who are confused, anxious, angry, or dogmatic. Even in the first and simplest matter of inquiring what the problem is, practical difficulties may arise, and special techniques or interventions may be needed just to get necessary basic information. More has been said about the practice of change elsewhere (2, 12), and despite its importance, this is not the main focus here. Rather, I have outlined a communicational view of behavior and problems, to show how certain general principles and procedures relate to this view—a framework for guiding and evaluating the more specific thought and action that prac- tice necessarily involves. REFERENCES 1. Paul Watzlawick, Janet H. Beavin, and Don D. Jackson. Pragmatics of Human Communication: A Study of Interactional Patterns, Pathologies, and Paradoxes. New York: Norton, 1967. 2. Paul Watzlawick, John H. Weakland, and Richard Fisch. Change: Principles of Problem Formation and Problem Resolution. New York: Norton, 1974. 3. Paul Watzlawick, and John H. Weakland (eds.). The Interactional View: Studies at the Mental Research Institute, 1965-1974. In press. 4. Thomas S. Kuhn. The Structure of Scientific Revolutions. Chicago: University of Chicago Press, 1962. 5. Jay Haley. "Development of a Theory: The Rise and Demise of a Research Project," in Carlos E. Sluzki and Donald Ransom (eds.), Double Bind: The Foundation of the Communicational Approach to the Family. New York: Grune and Stratton, 1976. 6. Jurgen Ruesch, and Gregory Bateson. Communication: The Social Matrix of Psychiatry. New York: Norton, 1951. 7. Gregory Bateson, Don D. Jackson, Jay Haley, and John H. Weakland. "Toward a Theory of Schizophrenia," Behavioral Science, 1 (1956), 251-64. 8. John H. Weakland " 'The Double-Bind Theory' by Self-Reflexive Hindsight," Family Process, 13 (1974), 269-77. 9. Don D. Jackson, and John H. Weakland. "Conjoint Family Therapy: Some 728 Communication Theory and Clinical Change Considerations on Theory, Technique, and Results," Psychiatry, 24 (1961), 30-45. 10. Magoroh Maruyama. "The Second Cybernetics—Deviation Amplifying Mutual Causative Processes," American Scientist, 51 (1963), 164-79. 11. Paul H. Wender. "Vicious and Virtuous Circles: The Role of Deviation Ampli- fying Feedback in the Origin and Perpetuation of Behavior," Psychiatry, 31 ( 1968), 309-24. 12. John H. Weakland, Richard Fisch, Paul Watzlawick, and Arthur M. Bodin. " Brief Therapy: Focused Problem Resolution," Family Process, 13 (1974), 141-68.
0 comments
Share
