A BRIEF OVERVIEW OF COGNITIVE THERAPY

©2004 by Dr. Charles Stanford, CCBT

INTRODUCTION

The cognitive approach is shows that the ideas or beliefs we hold about certain issues are the key to change and/or self-improvement. It is only when the person can make these beliefs conscious that they can be examined and help up to scrutiny.

From a conceptual standpoint, the Freudian terms such as "Superego" are useful as they are widely used even by the general public. However, in approach to the Superego, a rational disputation of its contents can be successful and it is not necessary to employ the terminology in practice. In other words, the therapist could employ the Freudian terms but in dealing with a client it is best to discard the terminology. (It is worthwhile pointing out that recent graphics of the human brain have actually located activity in different centers of the brain while the “Ego, Id, and Superego” are active.) It remains, however, a helpful conceptual framework, but not an effective guide to treatment.

The approach favored by Ellis (REBT) is the most well-known, though his personality and misconceptions about him seem to confuse the issue. Beck and Meichenbaum also contribute to the cognitive approach, but a search of the site cogprints contains a wealth of others and the National Association of Cognitive Behavioral Therapists is a definitive group.

It is preferable to help the client to identify the irrational beliefs as this process is important from a cognitive standpoint and helps in disputing them. For this reason, a Socratic technique that allows the patient dispute is more effective than active disputation. Any other techniques that would forward this goal should also be used.

VIEW OF HUMANS

Good vs. Evil

Carl Rogers (the Rogerian approach) believes in the ultimate goodness of humanity and, if one is to be a counselor and subscribe to moralistic notions, this is the best view to have. One can hardly imagine the converse as an effective starting point for counselors. However, it is ultimately counter-productive to carry our own notions of good and evil into the counseling process. While it is possible within particular societies to reach some sort of consensus on these issues, it is best not to impose our abstract beliefs on our clients. Furthermore, since most psychological problems people have is a result of their accepting irrational and unverifiable beliefs, we can not help them if we are constantly judging them as well. We can retain our own moral and religious beliefs, but it is necessary also to understand and empathize with the client's beliefs. If our own biases interfere with this process, we can not help the client. In addition, such terms usually tell us more about ourselves than they do about the client. Therefore, we must suspend the notions of good and evil while counseling. "Productive" and "Counter-productive" seem to me better terms.

In this context, I remember talking to a friend of mine who was almost entirely left-brained if one subscribes to the left-brain vs. right-brain hypothesis as described nicely by Carl Sagan in Dragons of Eden. One time, while reflecting on what seemed to me very strange behavior on the part of a large number of students, I told him that it seemed to me that most people had an inferiority complex. I'll never forget his response: "Of course, exactly half have an inferiority complex and half have a superiority complex. That is what the normal curve is all about." He did not have much grasp on the implications of what he said, but certainly when we evaluate humans we must use something against which to measure them. So, to what are they to be compared? Animals? Mark Twain once said "Man, we are told, is the reasoning animal -- Now I wonder who found that out?"

Determinism

One of the logical problems with the strict Freudian approach, a deterministic, approach is that if our entire personality is determined by the ages of six of seven, it seems futile to do anything about it later. On the other hand, it is important to distinguish between Freud the theoretician and Freud the practitioner.

Perception

Each individual perceives the world differently. Adler was quite right to shift the focus to Individual Psychology. After all, we can start with the most basic concepts of perception and illustrate quite clearly that these differences exist. For example, on a test once given for color perception, I tested color-blind in two out of the three areas. In a later, more extensive test, it was five out of six. Still, I can point to an object and say it is blue or red (different ends of the spectrum) and others will agree with me that the object is indeed that color. Obviously, my perception of color is different than that of someone who was able to "pass" all three sections of that test and therefore has a different perception of reality even though we may use the same terms (such as "blue") to describe it. How much further must we be apart when we use terms such as "depression," "sadness," "fear," and "happiness?" The counselor must be a very attentive listener and use empathetic abilities to be able to understand as much as possible the inner world of the client.

Beyond That?

People are influenced greatly by early events, but are able to change and improve through an understanding of them. Furthermore, if the simple matter of color perception as a result of cones and rods in the physiology of the eye makes a difference, what an incredible difference must a completely different culture make. Gender, place in the family, income level, all these combine to make each human unique. If we remember that, we are in much better shape than someone who attempts to apply a theory blindly.

DEVELOPMENT AND STRUCTURE OF NORMAL PERSONALITY

I do not see much contradiction between any of the theories in this respect although the adherents of the various approaches undoubtedly do. For example, progression through the oral, anal, and phallic stages of the Freudian approach parallels Eriksson’s growth stages. Indeed, Eriksson built his model following Freud's but shifted the emphasis from an exclusively sexual one. In any Human Development textbook we see the stages of normal development as well.

Other theorists also have their own stages of development. For example, Adler believes that ones place in the family determines personality and that all people have the desire to become socially integrated. Glasser indicates that all people develop with the need to gain control.

Whatever the theory, however, "normal" is generally defined in relation to the standards, or norms, of the society. In some cultures, for example, suicide is a noble endeavor -- ancient Rome, Japan, and certain Alaskan tribes hold this view. In our culture, such an idea is considered an example of abnormal thinking. The important goal in therapy is that the individual function well and take satisfaction in his or her life, although some religious sects seem to believe that misery is the intended lot of humanity. I assume, however, that even in such a case they are happy if they are miserable -- an interesting paradox.

The main point is that "normal" development is defined by either the society or the individual. So long as the individual is able to define his or her own normality without arousing the ire of society, that individual is fully functioning. The personality that is "normal" in all respects is not likely to need counseling.

DEVELOPMENT OF ABNORMAL PERSONALITY

This is of far more interest. Freud invented some very interesting and useful terms to describe what is going on inside the mind. It does not matter if we think of the terms as actually representing physical reality, processes, parts of the brain, or use them to clarify some concepts. For example, in his theory, the libido manifests itself in the id of the newborn. It is the drive of the libido (for our purposes not representing sexual drive, but some sort of life-force without any metaphysical ramifications) that needs to be satisfied. But the newborn soon finds that there are restrictions on the expression of purely libidinous desires and develops the ego in order to mediate between the external world, or reality, and the drive. The external world finds the individual difficult to control at all times but manages, through the development of the superego, to implant certain "dos", "don'ts," and "musn'ts" into the individual’s mind -- so much so, that at times the superego's strength is able to overcome the combined will of the id and the ego and make it nearly impossible for the individual to function.

(Again, I would not use the Freudian terminology in dealing with a client, but it helps provide the framework for diagnosis.) Essentially, people with emotional and psychological problems generally hold at least one irrational belief and these beliefs are in the part of the mind Freud referred to as the Superego. Sometimes these beliefs can be deeply submerged into the sub- or un-conscious, a distinction that seems useless. All of these beliefs usually have at their root some sort of self-blame. This blaming or shaming can be directed inwardly ("I am no good") or projected outwardly ("you are no good"), and are entirely irrational and unverifiable.

These beliefs can be inserted into the mind at any time. Perhaps the Freudian are right when they say that fear of the father is the root of a problem. Perhaps Erikson is right when he says that the individual never resolved the trust vs. mistrust issue from early childhood. Perhaps early religious training inculcated the belief that all humans are sinners. Perhaps the individual has unrealistic expectations from herself or from life. Perhaps it is a combination of all these plus a self-indoctrination that perpetuates these beliefs. The source of them is not as important as bringing them to the surface and analyzing them.

GOALS OF COUNSELING

The first and foremost goal is to determine what the client really wants out of counseling and then attempt to facilitate the process. The goals, then, are as varied as the clients. In short, we must find out why the person is in counseling.

There are diverse reasons why someone comes to counseling. They range from a simple straightforward desire on the part of the client to achieve some goal such as loosing weight to having been forced into the situation by our legal system. In all cases, however, counseling is supposed to help the client.

Listed under this subheading are some interesting entries for some of the approaches. In the Freudian approach, we decided, the goal was to make the subconscious become conscious. In Adlerian Therapy, motivations and the overcoming of infirmities was mentioned. In Person Centered Therapy, "Client solves problems" is what is definitive. A problem is that these items could be listed under any of the next two sections ("Role of counselor" and "Diagnosis and Assessment."

ROLE OF THE COUNSELOR

A cognitive approach is generally conceded these days to be most effective. However, a Rogerian approach could be far superior, especially in the early stages where the counselor is trying to learn as much as possible about the client. The advantage of the Rogerian approach is that the stated problem may not be the real one. The counselor needs to listen and sometimes ask questions, indicating all along positive regard for the client, in order to understand the problem as deeply as possible.

Indeed, perhaps the entire first session should be devoted to this approach, depending upon the attitude the client seems to harbor.

But once we find the problem, what then? Rogers believes that continued positive regard and a warm relationship will eventually lead the client to solving the problems on his or her own. Perhaps, given enough sessions, this will work, and with some patients it may be sufficient for the relatively short period of time currently afforded counseling by economic forces. Perhaps the client can identify the irrational belief or beliefs, dispute them, and substitute a more healthy, sane outlook for themselves.

Such clients are rare. Most of them need some guidance for this task. However, while it is effective to use a didactic, confrontational style, it will not work for all patients. Nor is logic alone sufficient. A combination of logic and rhetoric in the classical sense of the term is more likely to be effective. Rhetoric seeks to persuade and uses logic as one of its tools and can be very powerful and effective if used properly. Today Rhetoric is used as a synonym for what someone you disagree with says, but it has a long and honorable tradition. It is supposed to allure the listener or, in this case, client towards accepting a more effective belief.

For this reason, I think in many cases the more Socratic method suggested by Beck would be more appropriate. Through asking questions, one can eventually elicit from the client a statement of the irrational belief. But this is a technique.

DIAGNOSIS AND ASSESSMENT

The DSMV-IV is the official or generally accepted manual for diagnosis. In this era of HMO domination of the field and the HMOs' aversion to treating mental and/or emotional disorders, it is necessary for practical purposes to use this manual in a formal diagnosis. Of more importance, however, to the client is finding out what the problem really is (and by this I mean to imply that it might be different than the formal one). Isolating the irrational belief, bringing it to the conscious level, and helping the client dispute it is the most effective focus. TECHNIQUES OF THERAPY

Once the irrational belief is out in the open, so to speak, the next step is to dispute it. How one goes about this depends a great deal on the client and also on the counselor. In other words, it is the relationship between the two that is the determining factor. In addition, one finds great difficulty in determining a counselor's theoretical approach by observing the techniques used. In other words, a strict Freudian may use a technique developed by the Behaviorists, a Rogerian may wind up in a philosophical discussion with a client or use role-playing. The distinction might well be why the counselor chooses to use that particular technique at that particular time with that specific client.

As I stated above, first the Rogerian approach should be used to formulate a diagnosis. Once the irrational belief is brought to the conscious level, it needs to be disputed. The question now is how and that depends on the patient.

One of my patients was concerned about getting married again because his first marriage failed. Through asking questions, I determined that he actually believed that "all women were the same." Now, this is a deeper problem than meets the eye. An immediate approach would be to point out that this woman was not the same as the first woman and he was not the same as before. There is no rational justification for believing that one marriage would fail simply because the other did. QED. Session over!

This client, moreover, was a rather truculent "macho" personality. Direct disputation might have been fun, but unlikely to succeed given his pride at his "intellect." However, knowing that he actually believed that "all women were the same," I asked more questions:

Q: They are all exactly the same?

A: Yes, exactly.

Q: In every way?

A: Yes, every way.

Q: Are all men the same?

A: Oh, no, of course not. Men have ideas. They think for themselves. They are all different.

Q: Why are they all different?

A: The way they are raised.

Q: I see. Are all men raised exactly the same?

A: No, of course not!

Q: Are all women raised exactly the same?

A: Ah, I see what you’re getting at!! Yes?

This is condensed, but it is accurate. The next step was to give a homework assignment. Mine was as follows: "What you have now is a hypothesis. Let's test it. Without letting anyone know what you are up to, I want you to study women, making a list of hard facts as to the ways they are different and the ways they are similar. Let's see if you can verify it."

Role playing could be important in some instances. Suppose a client thought that his boss was so intolerant that she would not let him lodge even a minor complaint. The irrational belief may be an idea that if his complaint were rejected, he would be crushed, it would be the end of the world. In this case, it might be helpful first to play him while he played her. He might eventually role play the worst possible outcome. At least that is now defined. Would that outcome really be so terrible? Would it really be a reflection on him or on her? To further reinforce the message, reversing the roles, based on his interpretation of her, helped. This actually led to a different outcome once he saw an alternative way of picturing her.

Obviously, much more can be said, but this is only intended as a brief, introductory, remark to help define “cognitive approaches.”

FIGURING IT OUT

Politics in the 21^st Century

Or

God is Dead

Actually, the earth is an extremely silly planet. It is made so because it is bespeckled with creatures who refer to themselves as Homo Sapiens. This is a term from a language that none of them speak and only a few read. It means, more or less, wise men, or thinking men, or indicates that being wise is something that they all have in common. Sort of like when you visit the grocery store – you will see clearly labeled “Homo Milk”. The planet is the third from the sun in a solar system with eight planets. It used to be nine, but a group of the more sapient Homo Sapiens banished it. Sic Transit Glorius Mundi.

Every four years, these Sapiens choose one of their least sapient members to be their military and spiritual leader. The current one is the hope of many others to be raptured, an issue not fit for this forum. But hey, get raptured, you all!

As you may remember, these notices started when we were promised a pandemic of bird flu. The last I heard, 49 died in Indonesia. Mad cow disease isn’t mentioned much except on Boston Legal, a television show. Monkey pox has completely disappeared from the media. It leaves one feeling terribly abandoned.

Our corporate owned media, however, will not take on our government, for it is also corporate owned.

So what has been covered since the promised pandemic has been abandoned? Well, the latest is that a polygamist was captured. (We all feel safer now.) Before that, a great deal of paper, ink, and electricity and bandwidth was spent on a fiasco that had the net effect of informing us that Jon Benet Ramsey was still dead. (R.I.P.) All of this interrupted the fact that we had Israel attack the civilians of Lebanon so they would force Hezbollah to be nicer. This massive attack, killing, displacing, and starving over a million took attention from Iraq where about 200 people per day die under our occupation (occupation forces are responsible for the lives of those under occupation, btw).

So, I’m leaving you all with the pre-eminent political question. This is the one question you should ask of any politician who wants your vote, if you vote: “What have you done for me lately?” I mean, freeing the slaves was a long time ago (Republicans) and so was The New Deal (Democrats), which saved capitalsim. I mean, lately.

Meanwhile, I’ll post something on instinct on Contemporary-Awareness.Blogspot.com before I put this up.

Take care, and maybe you will see or hear a sneezing bird. Now is the time to look before most of them head south.

A COGNITIVE RUMINATION ON INTUITIVE COUNSELING

©2006 by Charles Stanford,Ph.D., C.C.B.T.

[Author’s note: Cognitive therapy does not exclude any other approaches, and the following is an attempt to illustrate how instinct is crucial in the process. A strict cognitive analysis of the phenomenon would also include analytical and rational explanations for its success, and some of that is attempted here. It is curious to note how the style-sheet used as a template for her work is so rigidly “scientific” that it almost becomes a parody of it. For my own part, I saw a parallel to the so-called “Uni-Bomber,” Ted Kazinski. While his remarks were sociological and often gleaned from Marcuse and others, the style or organization was clearly one that a scientist would learn, at the latest, while doing a Master’s Thesis. It later turned out that he was a brilliant mathemetician while authorities were stating that he had a high-school education. Additionally, psychologists were pointing out that he could not be schizophrenic as those afflicted by the disease loose about 30 I.Q. paints as a result. It turned out that he had started out with an I.Q. of 180, so he could easily loose 30 points and still be in the genius category. I mention this simply to illustrate the cognitive dissonance one could experience in comparing Satir’s writing with her practice.]

Introduction

Virginia Satir is known as a communications theorist, but her approach is not theoretical in the generally accepted sense as she defies the scientific paradigm. The concepts and assumptions are difficult to separate from her view of maladaptive behavior, much the same way as Yin and Yang or right-brain and left-brain are difficult to separate -- one can not exist without the other. It is almost as if one expected to have a north pole without a south pole.

Self-esteem, or maturation, a sense of ego-integrity or identity, a feeling of being comfortable with ones own uniqueness and that of another, is at the heart of being a health human being. Her Conjoint Family Therapy forms the basis for much of the discussion of the basic assumptions or concepts behind her theory. Early family life can lead to a lack of self-esteem through a series of "double-bind" relationships and messages and produce dysfunctional behavior that can be measured by the degree of indirect communication people utilize to the exclusion of direct communication. When adults with low self-esteem marry, they pass along their insecurities to their children, at least one of which becomes an Identified Patient (IP).

An important goal of therapy is to help establish people as "centered" through effective communications patterns. These patterns are taught through a series of well-known techniques until each person is able to communicate clearly, concisely, and effectively.

Throughout her writings, one senses a warm, caring human being, perfectly centered and spontaneous.

Against the Linear Paradigm

These words are typical of what one finds in reading Virginia Satir: "Around any well-integrated person there is a circular field that is about three feet in diameter. At the edge of this field, you can feel vibrations -- at least I can! When a person is relatively well put-together, those lines feel like elastic." (Satir, Conjoint Family Therapy, 257). She continues to describe "energy fields" around various people: those who are out of contact with themselves have small ones and the violent have very large ones. The vibrations people give off are a clue to their state of mind.

Although one might be tempted to dismiss such writing and thinking as "west coast," or "new age," there is absolute truth in what she is saying. Her method of communication, however, does not emulate the scientific paradigm and style. Her prose is that of a warm and caring human being who, above all, is trying to share experiences with the reader.

Perhaps this energy field can be described another way, as a heightened sense of awareness in the approaching individual, an awareness of the other person's body language, movement, eyes, etc. For example, after I read her description of the "energy field," I told a group of patients about it. When I am speaking to a group, I am very conscious of just about every movement and twitch of each member to start with, and mentioning that I was about to test this on them simply heightened this awareness. I then approached them, one at a time, "feeling" for the energy field.

I did not tell them exactly what I was trying to learn about them, but I did notice significant differences, especially in two cases. One person seemed not to react at all and I was able to move my hand within a few inches of his face without any reaction. On the other end of the spectrum, another became increasingly hostile looking as I approached and I could not get closer than five or six feet. I "felt" the "energy field" myself. I later checked their diagnostic charts. The first was referred to the group by the psychiatric unit as chronically depressed and the second had very violent tendencies with very many issues to work on. In other words, the "energy field" is a metaphor, a helpful way of communicating her experience. There is absolutely no scientific measuring device that can detect the presence of an energy field or an "aura", but a person in a sensitive state of heightened awareness can "sense" it. "Left-brain" and "right brain" are like that as well. Even though scientists have noticed that certain functions seem to be predominate in certain areas of the brain, the concept of the left half of the brain doing certain things and the right brain the others is best used as a metaphor for certain ways of perceiving and thinking.

Her theory works this way as well. Although she studied the literature and obtained the necessary credentials to practice, her theory is built on her own experience in which she displayed an uncanny, instinctive, way of knowing how to relate to people. As she says in Conjoint Family Therapy, "the process still -- and always -- is the relationship between you and me, here and now." (243)

Concepts and Assumptions

So how does one approach a theorists who says, in effect, the theory is not important, that it is only a guideline to be used if it helps, who does not mention paradigms, quote from scholarly journals, and does not present abstract notions that subject themselves to reification and thus abstract analysis and discussion? How does one talk about concepts in such a situation?

Satir's main concept from a theoretical standpoint is that concepts are the product of experience and experience is only as valid as the reliability and validity of the perceiver. All therapy is a relationship between people and at the base of relationships is communication. We communicate in many ways, but the best communicators are those with the best sense of self esteem. Still, as she points out, "thought and feeling are inextricably bound together; the individual need not be a prisoner of his feelings but can use the cognitive component of this heeling to free himself."(125) If we examine this notion carefully we see how the first clause unites thought and feeling into a composite inseparable unit and that the second clause divides thought and feeling again so that one part can modify the other. Yet, she is saying that these are two parts of a single whole that function together. One does not easily divide the two into separate sections for analysis, nor should one.

Fortunately, for those who insist upon a linear discussion of family therapy, Conjoint Family Therapy works towards that end. The book begins with a discussion of why family therapy is needed. The Identified Patient (I.P.) is a symptom of family dysfunction. This reality came to the surface as individual therapists noticed that "schizophrenic" patients showed increased symptoms during and immediately after a family visit and upon observing how other family members interfered with therapy. It became clear that they were actually trying to change the behavior of the entire family through treating only one member so revised their approach to include the entire family and, through this process, found that mental illness had an interpersonal nature. The process usually starts when an external force labels the I.P. as "disturbed," but that behavior was actually serving a homeostatic function within the family. The locus of difficulty could usually be located within the marital dyad, with low self-esteem of both members as a cause and this lack of self-esteem the result of their own families' functioning. (1-6)

People with low self-esteem tend to be, in David Riesman's terminology, extremely “other-directed” and have not reached a position of equality with them. Although hoping for a great deal from others, they expect disappointment. Such people all-too-often choose one another as mates, putting one another in charge of their own self-esteem, attempting to create a stronger identity for themselves through the mate. In short, they both were seeking the "good parent" from each other. (7-12)

After being married a short while, however, disillusion sets in. Neither expected to give and they notice such annoying realities such as hair curlers and snoring. In addition, what Satir calls "differentness" becomes threatening, such things that make people individuals are seen as evidence of being unloved. A lack of trust also arises from this low self-esteem. These two things, low self-esteem and mistrust expresses itself in maladaptive forms of communication. (13-24)

Soon, children enter this family and the parents expect to "get" from the child which will obviously have nothing other than self-interest at first. For example, they make economic and emotional demands which each party may see as deflecting from their own needs. (24-28)

In addition, social forces are at work placing further strains on the relationship. The Industrial Revolution (although Satir does not use the phrasing) quantified the worth of an individual through the monetary system while simultaneously mechanizing the person's work environment and specializing it to the extent that a basic alienation from the existential construct occurred. This alienation is especially debilitating to an individual who is already suffering from low self-esteem. Roles began to shift rapidly with the rise of psychoanalysis urging greater freedom and autonomy for children while patriarchal notions became outmoded. The individuals with low self-esteem looked to the family for a "reason for being" while the family no longer was able to provide it to those very individuals. (29-33)

A child growing up in such a situation faces considerable difficulties. Not only are they growing up in the same external world, but they are being raised by parents who themselves have difficulty adjusting. In fact, "family theory postulates that outside forces are important mainly as the affect the parents." (36) Part of the "getting" mindset of parents with low self esteem is to look to the child as a vehicle of expressing their own self-worth, as a way of bolstering their own self esteem, and as an extension of their own selves. (35-36)

The therapist should see "...himself as a resource person." (125), a "model of communication" (125), and as a teacher. These aspects are modeled below under "techniques."

View of Maladaptive Behavior

In discussing Satir, separation of a view of maladaptive behavior from basic conceptions is difficult. It also seems counterproductive in that she intertwines these so carefully that to force a separation of the two is contrary to her practice and way of thinking. Indeed, in the section (above) on concepts of assumptions, maladaptive behavior was already introduced and discussed. Here I wish to view maladaptive behavior as the concrete manifestation of dysfunctional relationships caused by the juncture of individuals with low self-esteem with one another and the offspring. Generally speaking, there is an inverse relationship between one's self-esteem and the indirectness of ones communication.

As mentioned, the parents with low self-esteem look to the child as a mechanism for enhancing their own self-worth. Thus comments, both positive and negative, from the external community reflect upon their own self-worth. They have an inordinate need for approval from the child and this makes discipline difficult. In addition, they also look to the child as an ally against the other parent, a messenger between the parents, a pacifier of the mate, and eventually place the child in some sort of conflict that demands of choice of one parent over the other. This militates against identifying with individuals of one sex or the other and thus against the child's own sexual identity and sense of self. 61-59) The parents are not aware of these subconscious behaviors on their own part and, when the child exhibits dysfunctional behavior, they tend to attribute it to external factor because their very lack of self-esteem makes it difficult for them to realize that they have a profound effect on the child. (36-24)

Eventually, this double-bind situation takes its toll on the child who comes to the attention of the therapist as the Identified Patient. The double bind is not merely the inability to satisfy both parents at the same time, but the inability to satisfy conflicting sides of the same parent. An example given is that of the father who demands that his son obey him in all things and then objects to the son's lack of manliness in failing to stand up to him. The I.P. actually acts out the conflicts within and between the parents and helps maintain the family homeostasis until the community objects to or at least points out the child's behavior and may even take the child away from the parents. If parents are alert to this possibility, they may seek therapy for the I.P. (24-55)

Throughout, Satir (1983, 1988) and Satir and Baldwin (1983) identifies four distinct forms of defensive and indirect communications and provides alternatives. Later (1991), she generalizes on being "centered" in providing a consistent and congruent manner of communication. This theme, however, runs throughout her career.

She divides dysfunctional communicators into four categories: placaters, blamers, computers, and the distractor. The placater is unable to communicate for fear of getting the other person angry, so the message becomes "whatever you want is okay." (People Making, 63). The blamer is aggressive and even violent at times so that the other person will regard him or her as strong, but who inside feels lonely and unsuccessful. (1972:66) The computer gives the impression of being ultra-reasonable and even evokes envy in the other, but inside feels vulnerable (1972:68) and hides behind intellect, all the while feeling vulnerable. The distracter is never on the point, but goes off in different directions at once, feeling that they do not belong anyway. (1972:70)

Therapeutic Goal

The therapeutic goal is recognized by the fifth category, leveling, and her therapy focuses on this. She is very succinct and clear on this point in her discussion of criteria for terminating treatment.

Family members need to be taught how to interpret hostility, complete transactions, see themselves as others see them [sic], see how they see themselves, tell one another how they appear to them, express hopes, fears, and expects from the other. In addition, the should be able to disagree, make choices, learn through practice, free themselves from the negative aspects of the past, and communicate congruently. Their language and communication pattern is delineated, meaning having a sense of ego integrity, a knowledge on the difference between the "you" and the "I", and be clear.

In one of the best, most succinct, and meaningful statements I have seen in the literature of Psychology, she summarizes it by saying "in short, treatment is completed when everyone is the therapy setting can use the first person 'I' followed by an active verb and ending with a direct object." (227-228)

Techniques

Most of Satir's techniques seem to have been invented on the spot to communicate a particular problem to a particular family. After awhile, they have become associated with her and, in my opinion, run the risk of becoming reified into a "cookbook" approach -- that is to say, a new therapist may decide, "Well, sculpting is supposed to work, I guess I'll try that." The point is that these techniques may become useful as they are, but it is more important to understand the process and goals of them. In general, her techniques are ways of communicating visually what has not been effectively communicated orally. In all cases, they are designed as a way to break through to the clients.

Since "Family sculpting" seems to be a trademark technique, I will start with that. When observing a dysfunctional family interacting, and being unable to explain in words what is going on, or when one of the member is unable to express what is going on, it may be successful to have one of the members to place the other members in postures that they think best illustrates how each member is relating and communicating. The visual representation is then processed and discussed. Other family members may be very surprised to see how that members views them, this having been the only time that member was able to communicate that fact. Through the discussion, more effective ways of relating and communicating can be taught.

Let us take the example of a family with a hyperactive child. In this particular case, depending of course on my assessment of the cognitive levels of the parents, I would actually use the body sculpting technique and I would have the hyperactive child do the sculpting. This would allow me to visually see the child interact with the parents and also illustrate how the child sees the relationship.

After that, there would be a general discussion of the situation. I would point out that, barring physiological reasons of course, the hyperactivity is the child's way of reacting to the family structure. Much would depend on the here and now of the child's sculpture and how the parents related to it.

One possible sculpture would be both the parents facing one another with their fingers pointed. This would indicate a blaming communication pattern within the parent's relationship to which the child is reacting. After discussing the reframed situation as establishing it as the real problem (after all, it would be the I.P.'s vision of how things were and how the I.P. reacts to it that they are concerned with -- namely, the hyperactivity), I would then proceed to teach both a "leveling" form of communication.

I think that answers the question on the academic level, but I want to add that for one to apply Satir's method, one must be a keen observer, very involved, and able to establish close and caring relationships with all involved. What technique would work would actually depend more on how the therapist applies it within the therapeutic relationship. Often new techniques are invented on the spot and then later integrated into a theory or approach for formal presentation. The real work is done instinctively -- with preparation and a belief in the importance of human communication every present, but instinct is the guide.

The division of the self into distinct entities (which results in double bind messages) can be addressed through "parts parties." Each member has parts of the personality labeled and written on a piece of paper. Then, two members assume the identities of one of their own parts and role-plays. They can then see how the various parts of themselves interrelate and relate to various parts of the other's personalities. Again, after the exercise, the results are processed and the experience is used for illustrating more effective communications techniques.

Another technique might address the topic of hidden rules within a family. Sometimes the rule is adopted that no one is supposed to talk about certain things, such as the fact that the youngest child was born without an arm (1972:99). You may have the family, independently or preferably together, start to make a list of these rules so that they better understand their subconscious inter-relating processes. Then, as usual, process the exercise, discussing the rules.

Perhaps my favorite is the strings. Get a ball of yarn or string and cut it into five foot strands. Attach each family member to another family member with one of the strands. Eventually, you will have a grid-like layout showing direct lines of communication between each member, but also triangles showing how each set of three are linked to one another. This is helpful in introducing the concept of the family system and discussing how each member affects the other. It also allows for discussion of the roles of each member with one another, with the group, and within the triangle -- after all, in a triangle, the third person needs to fulfill some function, is it helpful and how? In a five member family, there will be forty-five triangles. (1972:148-149)

To continue with this technique, it is also helpful in explaining to families what happens when one member changes considerably while the other members remain static. One way of modifying this techniques, which I developed on the spot when dealing with an alcoholic family which had developed all the classic roles of the alcoholic family (drinker, enabler, hero, scapegoat, lost child, and mascot), was to explain that father would be a different person. This was done after the lines were drawn and discussed. Then, to illustrate the need for adapting, I said, "It is as if he moved here" and then moved him to a different position, between two different family members. All the lines became confused, overlapped, tangled. This illustrated the need for new communication patterns and then I cut the strings. I sensed a tangible feeling of relief and liberation.

This afforded me the perfect opportunity to introduce the use of the "I" statement, emphasizing that it was both an opportunity to assert one's differentness and to take responsibility for ones own feelings.

One final technique (there are many) can be used with a family that seems to be making demands on one particular member. Each member of the family grabs one part of that member’s body and then pulls in opposite directions. Again, a physical demonstration of what is going on. This one may not be a very good one to use with people who are skittish about being touched and Satir's own penchant for hugging people is not very likely to be productive today with professional concerns as they are, but a Virginia Satir would know when and how to use these techniques and when to invent others.

Conclusion

Ones first impression of Virginia Satir is bound to be disappointing if one expects and clinical, linear, scientific presentation. On the other hand, I have tried to illustrate, through my own experience with her works, from my first impression through utilizing her techniques and discussing them, how she presents a coherent view of how to work with families. In fact, her view and approach is so coherent that it is nearly impossible to rear it apart into constituent pieces. I think this is one of her greatest strengths. If a family is a living, organic, system, composed of constantly evolving human beings, and a therapist is someone who grows by adapting to new situations while remaining centered, certainly a theory that reflects this dynamism both on the levels of theory and practice is necessary. Such is what Satir has offered and I hope this short paper has at least provided enough background for those who are not familiar with her to make a start in that direction.

References

Satir, V. (1983). Conjoint family therapy (third edition). Palo Alto, CA: Science and Behavior Books.

Satir, V. (1972). Peoplemaking. Palo alto, CA: Science and Behavior Books. A 1988 edition of this book, titled The new peoplemaking was issued by the same publisher but was unavailable at the time of this writing.

Satir, V. & Baldwon, M. (1983). Satir: step by step. Palo alto, CA: Science and Behavior Books.

Satir, V. M. & Bitter, J.R. (1991). The therapist and family therapy: Satir's validative process model. In A. M. Horne & J. L. Passmore (Eds.), Family counseling and therapy (2nd ed.). Itasca, IL: F. E. Peacock. 47-75.

Friends:

I will send my own analysis when I write it, but I thought it appropriate to send you some sentiments that express the situation clearly. The first is by Ralph Nader and is about Lebanon. The second is a rumination on what Tom Paine would have said about George Bush. Hm, at the time the despot was George III of England. I think Georgie is our third President named George. The first was O.K., so far as I can tell, but the last two – well, maybe it’s about time to stop letting people named George run things.

P.S.: I understand, from Public Radio International, that bird flu is still rampaging Indonesia, death toll reaching 47 this year, so be careful!

Finally, comments are welcome!

*ZNet | U.S.*

*Bush -- "Take Your Time"*

*by Ralph Nader; August 23, 2006*

Open letter to President George W. Bush:

The widespread destruction of a defenseless Lebanon -- its

civilians, its life-sustaining public services, its environment

-- is a grim and indelible testament to your consummate cruelty

and ignorance. Nearly two weeks ago when your tardy Secretary of

State met with the Israeli Prime Minister, the message she

carried was summarized in a large headline across page one of an

Israeli newspaper, "TAKE YOUR TIME."

Yes, take your time, says George W. Bush, pulverizing fleeing

refugees in cars full of families, bombing apartment buildings,

hospitals and the poor huddled in large south Beirut slums.

Take your time, says George W. Bush, in destroying bridges,

roads, gasoline stations, airports, seaports, wheat silos,

vehicles with medical supplies, clearly marked ambulances taking

the wounded to clinics, even a milk factory .

Take your time, says George W. Bush, while shelters are

demolished with bodies of little children together with their

mothers and fathers buried in the rubble.

Take your time, says George W. Bush, while the number of fleeing

refugees nears one million Lebanese, many exposed to hunger,

disease, lack of potable water and medicines. All this in a

country friendly to the United States, which played by your

rules, protested the Syrian army back into Syria and was trying

democratically to put itself together.

Take your time, says George W. Bush, while he speeds more

supplies of precision missiles containing deadly anti-personnel

cluster bombs which will claim the lives of innocent children

for years into the future. The phosphorous bombs laying waste to

fields growing crops and horribly burning innocents come from

the U.S.A. under your direction.

Do you think the taxpayers of America would approve of such

shipped weapons were they ever asked?

Are there words in the English language suitable for the

impeachable serial war crimes you are intimately involved in

committing not only in Iraq but also now through your

encouragement and supplying of the once again invading Israeli

government?

Are there words to describe your strategic stupidity which will

further increase opposition and peril to the United States

around the world and especially in the Middle East? Your own

Generals and former CIA Director, Porter Goss, among others in

your Administration, have declared that your occupation of Iraq

is a magnet attracting the recruiting and training of more and

more "terrorists" from Iraq and other countries. And so now this

will be the case in Lebanon. All this is a growing "blowback,"

to use the CIA word for a boomeranging foreign policy, that is

endangering the security of the United States.

The calibrated Israeli terror bombing of Lebanon comes in three

stages. With its electronic pinpoint precision bombing and

artillery, the Israeli government goes after civilians, their

homes, cities, towns and villages.

Then after telling some to abandon their neighborhoods, it cuts

population centers off from each other by destroying

transportation facilities into and inside Lebanon, making both

refugee flight and delivery of emergency relief efforts either

impossible or very difficult. Then its planes, tanks and

artillery endanger or destroy what food, water and relief

efforts manage to get through to the injured and dying.

Warehouse food supplies are incinerated. About four hundred

small fishing boats north of Beirut on the oil-polluted

coastline were demolished as well.

All the above mayhem and much more have been reported in the

U.S., European, Lebanese and Israeli media. The bulk of the

fatalities in Lebanon have been civilians. The bulk of the

fatalities on the Israeli side have been soldiers. Very

fortunately for the Israelis, the Hezbollah rockets are very

inaccurate, the vast majority falling harmlessly. Unfortunately

for the Lebanese, the precision American armaments of the

Israelis are very accurate, which serves to account for why the

total casualties and physical destruction are 100 times greater

in Lebanon than in Israel.

Most of these accurate munitions come from your decision to send

them. Knowing they will be used for offensive purposes,

including the lethal demolition of a long-established UN

compound, in violation of the Arms Export Control Act which you

have sworn to uphold, places the responsibility of being a

domestic law breaker squarely on your shoulders.

There is another law that is not being enforced -- the

Humanitarian Aid Corridor Act of 1996 sponsored by then

Republican Senator Robert Dole. Foreign aid is supposed to be

cut off to any nation that obstructs the provision of

humanitarian aid to another country. As one example, press

reports that two tankers, each with 30,000 tons of diesel fuel

critical for operating Lebanese hospitals and water pumping

stations, are idling in Cyprus from fear of the totally dominant

Israeli navy and air force.

There are only a few days left of fuel in Lebanon, which is

heading for a larger wave of secondary casualties. They and

other critical suppliers need safe passage which the U.S. Navy

in the area can readily provide, should it receive orders from

the Commander in Chief.

You heard high Israeli officials accurately say on the day the

massive bombing of Lebanon began, followed not preceded by

Hezbollah rockets, that "nothing in Lebanon is safe." That huge

over-reaction to the recent Hezbollah border raid, in addition

to many more previous air, sea and land border violations by the

Israeli government, certainly put you on public notice.

Since you view yourself as a reborn Christian, and since you

have the power to stop the Israeli state terror assaults on

Lebanon, you may wish to reflect on Leviticus 19:16 "Neither

shalt thou stand idly by the blood of thy neighbor." Lebanon was

a friendly country to you and you have stood by not just idly,

but willfully aiding and abetting its devastation.

*ZNet | U.S.*

*What Might Tom Paine Have Said About George Bush?*

*by Sherwood Ross; August 23, 2006*

Peculiarly, a lot of what American patriot Tom Paine wrote in

1775 about the British Crown seems to apply to President Bush today.

For example, Paine believed, "any excuse can be made to serve

the purpose of malignity when it is in power." And when ever was

there a more deceitful example of this than Bush's lie that Iraq

had WMD?

As historian John Keane wrote in his excellent "Tom Paine: A

Political Life" (Little, Brown and Co.) despots --- as Paine saw

them- plunder "the pockets and lives of their subjects, since

that is the most effective way of raising and feeding armies and

making their subjects afraid, obedient, and willing to pay

taxes. Wars between despotic states thereby tend to increase

rulers' lust for power over their own populations. War, wrote

Paine, is 'the art of conquering at home.'" (Original italics.)

And so we are, indeed, conquered at home. We live under a regime

that can arrest and imprison any of us for as long as it likes,

one that denies our privacy, scraps our international treaties,

and shreds our Bill of Rights.

Having been given no honest reason for launching the war on

Iraq, the real reason most probably is oil, just as Paine wrote

the reason King George III made war on America was because "her

crime is property."

As President Bush confiscates our taxes for Iraq, and squanders

the lives of our troops, let's recall Paine's words about the

crimes of the Crown: "Hath your property been destroyed before

your face? Are your wife and children destitute of a bed to lie

on, or bread to live on? Have you lost a parent or a child by

their hands, and yourself the ruined and wretched survivor?"

These words ring true in thousands of American homes tonight,

where loved ones have been killed or maimed in Iraq; where

millions of people are sliding into poverty as a result of

Bush's anti-compassionate policies; and where 40-million people

have no health coverage. The bell tolls even louder for millions

of Iraqi families whose nation Bush has turned into a veritable

charnel house.

And what would Tom Paine have made of the wanton cruelty that

George Washington forbid his soldiers to engage in but can now

be described as "routine" under Commander-in-Chief George Bush's

military?

"It is time to have done with tarring, feathering, carting and

taking securities for their future good behaviour," Paine wrote

charitably of British sympathizers. "Every sensible man must

feel conscious shame at seeing a poor fellow hawked for a show

about the streets." What Paine might have said of men stacked in

human pyramids or hung from chains until dead!

Paine inveighed against the death penalty. Condemning the

excesses of the French Revolution, he said, "as France has been

the first of European nations to abolish royalty, let her also

be the first to abolish the punishment of death, and to find out

a milder and more effective substitute." What would he have said

about the ever-sizzling Texas electric chair under Governor Bush?

As for all citizens bearing government's burden equally, Pain's

view was very different from President Bush's call to ditch the

"death tax." According to Keane: Believing as Paine did the

earth is "the common property of the human race," it followed

"the propertied have an obligation to help the poor, not by

charity alone, but by accepting a government-administered

inheritance tax system designed to redistribute and equalize

income."

As for Bush's boasting about "freedom," let us recall these

words by Paine: "When it shall be said in any country in the

world, 'My poor are happy; neither ignorance nor distress is to

be found among them; my jails are empty of prisoners, my streets

of beggars; the aged are not in want, the taxes are not

oppressive'--- when these things can be said then may that

country boast of its constitution and its government."

With two million men in jail, and the poor growing by the

millions, Bush has precious little to boast about. Speaking of

jails, when do you suppose Bush might pardon the hundreds of

thousands of Americans imprisoned on flimsy marijuana

convictions while he, who tramples the law of nations, whose

tongue spills lies, and whose hands drip with the blood of

hundreds of thousands, enjoys the run of the White House?