I became a family therapist because I wanted to “help” people. I believed that family relationships provided the background to understand someone’s distress and to leverage resources for healing. Back then, I didn’t use the word, healing. We called it treatment. But spending decades across many settings have led me to see the power of attachment and how attachment wounds can be a common denominator that plays
To this end, family therapy became a twentieth-century profession, licensed in each U.S. state. Originally, psychiatry moved from Freud in 1900 to an array of psychotherapeutic modalities by the 1970s. Within these innovations, maverick practitioners left medicine, psychology, social work, and clergy to develop an interpersonal view of problems that became known as marriage and family therapy. In this view, the family and social environment was the unit of focus to understand a person’s experience and engaged members of these social systems in problem-solving. Thus, symptoms and behaviors were not reduced to diagnoses; they were expanded to be problems for the social environment to address.
In the most traditional sense, therapy might be for couples or families. In the most innovative sense, multifamily psychoeducational groups actually help those with schizophrenia to improve their functioning. Groups of 6-8 families receive education and help for problem-solving and conflict resolution. In the process, each group becomes a “tribe” of support for members and a “community frontal lobe” in which all members participate in brainstorming and problem-solving, functions the brain often lacks during schizophrenia. This doesn’t look like “therapy” or act like “therapy,” but these communities of healing get therapeutic results.
Inspired by these projects, I refer to my own practice as ecosystemic practice. Social ecology examines the interpersonal and cultural world that surrounds a person, similar to a biological ecosystem. But one may ask, what about genetic predispositions? This concept is quickly shrinking in importance as genetic studies accumulate large databases that show the power of environmental factors. This leads to a rethinking of many serious health and mental health conditions such as substance abuse, post-traumatic stress, obesity, depression and bipolar disorder, to name a few. This new information shows how attachment can be a matter of life and death.
Although the American mental health establishment is financially and conceptually dependent on psychiatric diagnoses, in practice, family therapists quickly move beyond diagnoses to the context within broader interpersonal and social realms. Symptoms without this context provide a narrow range of possible solutions. Instead, we ask, “how does this behavior make sense?” We look at the intersection of cultural factors such as institutional racism, social class, gender, and attachment quality in the intergenerational family. Behavior is multidetermined, and resources for healing should draw from multiple layers of development. Once the behavior makes sense in context, we can learn about the root intention of the behavior and negotiate safer attachments that foster a sense of identity and belonging.
My father’s story illustrates some of these concepts. As a boy and young adult, he was the brunt of cruel racism toward Japanese Americans before, during, and after WWII. Raised in Albuquerque by parents from Japan and Kentucky who could hardly read or write, he looked outside his family to find the American dream. Hired and trusted by some wonderful Hispanic grocers at the corner market, he gained the skills to open his own store as a self-made man. This was a great blessing to our family, but it didn’t help him heal deep humiliation. When I learned more about his violent father, I was able to see that his hypervigilance was the heroism of a young boy trying to protect younger siblings who were victims. Then, his first wife’s parents paid for an abortion because they didn’t want a Japanese child. Basically, he never felt good enough.
Looking back, in family conflicts, he needed to show that he was better and smarter than “they” thought, whether this was family or friends. We were merely stand-ins for the early perpetrators of micro-aggressions in his youth. His conversational style was an animated effort to prove himself. His parenting style rewarded respect and punished any egalitarian discussion. Upon spending a day with him, one of my friends deemed him “narcissistic.” I believe this is an overused concept. I had come to understand that he was really having an imaginary conversation with those who had devalued him. His unspoken intent was, “I’ll show them.” In adulthood, these were the “ghosts of humiliations past” left with no first aid. They looked like bravado, but instead of a diagnosis, dad really needed compassion, empathy, safety and affirmation.
Dad’s social environment became a healing resource as he aged. Besides his wonderful Hispanic mentors, he joined the Masons. When his family was judgmental, he had the customers at his store who loved the special orders for gourmet foods they could place through him. He found solace outside our family with his coffee buddies. In his generation of WWII veterans, he found “real men” and validation. In retirement, a niece and nephew were more attentive than his own children. His strict morning and afternoon coffee schedule assembled a surrogate family of “regulars” and waitresses who spoke at his funeral. Despite a tragic childhood and young adulthood, his social network was a matter of life and death, and he found secure attachments. He lived to be 95.
In family therapy, no one is blamed or criticized. Instead, behaviors stem from relational dilemmas that are the real culprit. They may lead to wounds, and those may be stumbling blocks that slow us down.
Regardless, the beginning of healing will need large doses of systemic empathy and sympathy (how does this behavior make sense?). If a person acquires the label of narcissistic or sociopathic personality disorder, I will ask, how were empathy and sympathy not available to this person? Empathy is understanding interpersonal dilemmas. Sympathy is validation from family or friends of a loss or wound. In this way, relationships become the medicine. Injustices can turn to challenges, and those with wounds can be acknowledged as unsung heroes. These lead to important levels of love, safety and belonging. Without sufficient doses of these, our health and mental health are at stake. Yes, relationships are a matter of life and death.
- Hanna, S. M. (2019). The practice of family therapy: Key elements across models. New York, Routledge.
- Hanna, S. M. (2021). The Transparent Brain in Couple and Family Therapy: Mindful Integrations with Neuroscience. New York, Routledge.
- McFarlane, W. R. (2011). "Prevention of the first episode of psychosis." Psychiatric clinics of North America 34(1): 95-107.
- Somashekhar, S. (2014). Promising new approach helps curb early schizophrenia in teens, young adults. The Washington Post. Washinton, DC.