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Leaving home: The therapy of disturbed young people
Book Reviews
266
mined as are differences between abusit-e and neglectful and marginal families. The author’s interpretation of the meaning of the “findings” amounts to little more than a summarv of them and drvells heavilv on a review of the results of other studies with similar objectives. in the reviewer’s opinion this study contributes little to advance our knowledge toward identifying factors associated with discontinuance of child abuse and neglect. It appears the study, even within the confines of a retrospective, was not designed to maximtze variation in service strategies which is necessary to move us toi\.ard the stated objective. Add to this the questions about the representativeness of the sample and the reliability of the data, and the reader has serious cause for caution in basing any service policy decisions (which are not especially obvious) on the results of this study.
Virginia
James Cornrnonwealth
R. Seaberg CTniuersity
Leaving Home: The Therapy of Disturbed Young People By Jay Haley New York: McGraw Hill Book Company, 1980, 280 pp., $16.95 In this latest, most beautifully written book, Jay Haley provides enough commentary to challenge almost everyone regardless of professional identity, level of graduate work, or area of study. Proponents of family therapy should welcome this most subversive and anti-establishment work. Haley takes on the mental health practitioners, particularly those psychiatrists who medicate and fail to help. At the same time he clearly argues against laissez-faire celebration-of-madness nontherapy. In a book which reads like a page-turning thriller, Haley.sets forth the very simple premises of this therapeutic approach to treatmg young people. Haley’s is the next paradigm shift for family therapists. He places his therapy in comparative and historical contexts. His philosophy of therapy transcends communication disorder theories and goes beyond naive family systems theory. Although he seems reluctant to identify or align his theory with systems theory, this is in fact what Haley presents. His theor) describes a sophisticated system of hierarchical organization gone astray. For the purposes of therapy, the elements of the fami!y system. he argues, are and should be unequal. (Haley, p. 8, clearly indicates that what one does to mend, such as place a cast on a broken leg, is not necessarily what is best to promote the growth of an otherwise healthy leg.) The hierarch! of parents over children is the one Lvhich allows the family members to disengage from each other. When the hierarchy is violated, the disengagement becomes problematic and the result for young adults about to leave home may include bizarre behaviors and institutionalization.
Book Reviews The strategy of intervention which follo\vs from this theory is straightforward in Haley’s presentation but not necessarily easily achieved. In the first phase of therapy with the family, Haley puts the parents in charge of decisions and rules for the problem young adult. This strategy begins to realign the family organization, with the parents on top. It means that the parents, since they are the executives, must talk to each other directly instead of through the child. The child’s problems have stabilized the family and made it center around the child. Now the parents must focus on what they want, what makes them comfortable. Once the child begins to behave, the second phase of therapy must begin, this time centered on the marital problems. The therapist works to prevent the troubled .y,oung adult from rescuing the parents from their disagreements and hosAt): with each other. The now destabilized family must come to grips with the marital issues without making the young adult responsible for the parents’ unhappiness. Haley makes clear the many pitfalls involved in succeeding with his rather simple idea of therapy. At the outset, the therapist will encounter problems with the mental health community. In order to succeed, the therapist must be in charge of the course of therapy in the eyes of the professional community. This precondition is not always easy; to achieve: Psychiatrists and staff in hospitals do not like to think of themselves as agents of social control, but rather as healers of the sick. Their problems come when financial needs or community pressures require them to heal the sick whether the sick wish it or not. IVhile accepting the burden, the psychiatric profession expresses the idea that they would rather not have responsibihty for the marginal people of society. For humanitarian reasons, however, the); would rather not let anyone else have that burden. (p. 53) If control is put in the hands of the family therapist other obstacles remain. One barrier is the therapist’s own previous training, such as psychodynamic or feelings oriented approaches. Haley’s is a therapy centered on actions, rules, and behaviors, not on feelings. Virtually all of the examples involve not onlv the primarv therapist but a supervisor who watches sessions from behind a mirror’ and w.ho intervenes Lvhen necessary to keep things on the right track. The therapist in the thick of manipulative, demanding family members needs to have the perspective of one who is removed from the complex and intense interactions of the session. The family, Haley makes clear, will resist: To move the, young
person out of the triangle with his parents without misfortune is a challengmg endeavor. The therapist who enters that system will find himself receiving more of an education there than with anv other type of therapeutic problem. As change is threatened, the therapist wiil find his or her character tested by the intensity of the involvement. (p. 82)
The verbatim transcripts with Haley’s interpretive comments make abundantly clear the kinds of testing the therapist will undergo. FVith difficulties stemming from the professional community, within
Book Reviews
the therapist, and of course, from the family. is it L\.orth it? Halev offers evidence of success for this approach, success u.hich includes anorexics, addicts, and those whom many professionals v~~~ulcl label schizophrenics. There are aspects of the therapeutic approach vv.hich might have been clarified in the last chapter on special issues but vt.hich were not. For whom is this therapy appropriate? .At the beginning, Haley defined the therapy as suitable for families in the life stage where the young adult leaves home, or where the issue concerns leaving home. X troubling feature of the way the therapy is presented is that it is conducted on intact families only, families with both parents still present in the home. I kept waiting for a discussion of the special case of madness in the single parent family. Surely, the young adult in single parent families may feel responsible for that parent’s happiness particularly since the spouse is absent. The hierarchy may be in greater shambles here than in intact families. But the triangle vqhich is treated in intact families is generally missing in single parent families. How would therapy proceed? This is an important question for those who would like to use Haley’s approach in practice when as many of the caseload may be single parent as intact families. The special case of the step-parent family deserves Haley’s attention as w.ell. The premise that leaving home is the transition of young adults which is implicated in madness is simply that, an assumption. In a very close span of time, with some mutual dependencies among them, young adults finish school, find a job, marry, establish a household and leave home. The clinician’s experience may well be right. Leaving home may be the transition most directly involved in madness. It is not Halev’s problem that research has failed to address this issue. Given that he ‘has alerted researchers to the importance of the leaving home transition. it may be timely and fruitful for scientific studv of the leaving home transition. Before summing up I have a minor quibble v\ith the format of the book. I would like to have had the references brought together at the end of the book in a bibliography. I find it frustrating to go back through a book to find that reference which I believe vvas in the middle of the book on the bottom of a page, maybe on the right. Haley has presented us with another in a series of landmark works on family therapy. By describing, illustrating and guiding us through the therapy, Including the mistakes, he makes an extremely valuable contribution to those who are dissatisfied with conventional, nonworking therapies for the treatment of disturbed young people. For the lone professional who v\.ould like to employ Halev’s approach, I’m not sure a book, even one as superb and detailed as this one, is enough. A second therapist serving as supervisor v%.ould seem to be crucial to remaining on-target. Thus, I would recommend this book to co-therapist teams and only those teams vvho can assure control of the course of therapy v\ithin the therapeutic community. Judith L. Fischer Texas Tech L’nislersitj
266
mined as are differences between abusit-e and neglectful and marginal families. The author’s interpretation of the meaning of the “findings” amounts to little more than a summarv of them and drvells heavilv on a review of the results of other studies with similar objectives. in the reviewer’s opinion this study contributes little to advance our knowledge toward identifying factors associated with discontinuance of child abuse and neglect. It appears the study, even within the confines of a retrospective, was not designed to maximtze variation in service strategies which is necessary to move us toi\.ard the stated objective. Add to this the questions about the representativeness of the sample and the reliability of the data, and the reader has serious cause for caution in basing any service policy decisions (which are not especially obvious) on the results of this study.
Virginia
James Cornrnonwealth
R. Seaberg CTniuersity
Leaving Home: The Therapy of Disturbed Young People By Jay Haley New York: McGraw Hill Book Company, 1980, 280 pp., $16.95 In this latest, most beautifully written book, Jay Haley provides enough commentary to challenge almost everyone regardless of professional identity, level of graduate work, or area of study. Proponents of family therapy should welcome this most subversive and anti-establishment work. Haley takes on the mental health practitioners, particularly those psychiatrists who medicate and fail to help. At the same time he clearly argues against laissez-faire celebration-of-madness nontherapy. In a book which reads like a page-turning thriller, Haley.sets forth the very simple premises of this therapeutic approach to treatmg young people. Haley’s is the next paradigm shift for family therapists. He places his therapy in comparative and historical contexts. His philosophy of therapy transcends communication disorder theories and goes beyond naive family systems theory. Although he seems reluctant to identify or align his theory with systems theory, this is in fact what Haley presents. His theor) describes a sophisticated system of hierarchical organization gone astray. For the purposes of therapy, the elements of the fami!y system. he argues, are and should be unequal. (Haley, p. 8, clearly indicates that what one does to mend, such as place a cast on a broken leg, is not necessarily what is best to promote the growth of an otherwise healthy leg.) The hierarch! of parents over children is the one Lvhich allows the family members to disengage from each other. When the hierarchy is violated, the disengagement becomes problematic and the result for young adults about to leave home may include bizarre behaviors and institutionalization.
Book Reviews The strategy of intervention which follo\vs from this theory is straightforward in Haley’s presentation but not necessarily easily achieved. In the first phase of therapy with the family, Haley puts the parents in charge of decisions and rules for the problem young adult. This strategy begins to realign the family organization, with the parents on top. It means that the parents, since they are the executives, must talk to each other directly instead of through the child. The child’s problems have stabilized the family and made it center around the child. Now the parents must focus on what they want, what makes them comfortable. Once the child begins to behave, the second phase of therapy must begin, this time centered on the marital problems. The therapist works to prevent the troubled .y,oung adult from rescuing the parents from their disagreements and hosAt): with each other. The now destabilized family must come to grips with the marital issues without making the young adult responsible for the parents’ unhappiness. Haley makes clear the many pitfalls involved in succeeding with his rather simple idea of therapy. At the outset, the therapist will encounter problems with the mental health community. In order to succeed, the therapist must be in charge of the course of therapy in the eyes of the professional community. This precondition is not always easy; to achieve: Psychiatrists and staff in hospitals do not like to think of themselves as agents of social control, but rather as healers of the sick. Their problems come when financial needs or community pressures require them to heal the sick whether the sick wish it or not. IVhile accepting the burden, the psychiatric profession expresses the idea that they would rather not have responsibihty for the marginal people of society. For humanitarian reasons, however, the); would rather not let anyone else have that burden. (p. 53) If control is put in the hands of the family therapist other obstacles remain. One barrier is the therapist’s own previous training, such as psychodynamic or feelings oriented approaches. Haley’s is a therapy centered on actions, rules, and behaviors, not on feelings. Virtually all of the examples involve not onlv the primarv therapist but a supervisor who watches sessions from behind a mirror’ and w.ho intervenes Lvhen necessary to keep things on the right track. The therapist in the thick of manipulative, demanding family members needs to have the perspective of one who is removed from the complex and intense interactions of the session. The family, Haley makes clear, will resist: To move the, young
person out of the triangle with his parents without misfortune is a challengmg endeavor. The therapist who enters that system will find himself receiving more of an education there than with anv other type of therapeutic problem. As change is threatened, the therapist wiil find his or her character tested by the intensity of the involvement. (p. 82)
The verbatim transcripts with Haley’s interpretive comments make abundantly clear the kinds of testing the therapist will undergo. FVith difficulties stemming from the professional community, within
Book Reviews
the therapist, and of course, from the family. is it L\.orth it? Halev offers evidence of success for this approach, success u.hich includes anorexics, addicts, and those whom many professionals v~~~ulcl label schizophrenics. There are aspects of the therapeutic approach vv.hich might have been clarified in the last chapter on special issues but vt.hich were not. For whom is this therapy appropriate? .At the beginning, Haley defined the therapy as suitable for families in the life stage where the young adult leaves home, or where the issue concerns leaving home. X troubling feature of the way the therapy is presented is that it is conducted on intact families only, families with both parents still present in the home. I kept waiting for a discussion of the special case of madness in the single parent family. Surely, the young adult in single parent families may feel responsible for that parent’s happiness particularly since the spouse is absent. The hierarchy may be in greater shambles here than in intact families. But the triangle vqhich is treated in intact families is generally missing in single parent families. How would therapy proceed? This is an important question for those who would like to use Haley’s approach in practice when as many of the caseload may be single parent as intact families. The special case of the step-parent family deserves Haley’s attention as w.ell. The premise that leaving home is the transition of young adults which is implicated in madness is simply that, an assumption. In a very close span of time, with some mutual dependencies among them, young adults finish school, find a job, marry, establish a household and leave home. The clinician’s experience may well be right. Leaving home may be the transition most directly involved in madness. It is not Halev’s problem that research has failed to address this issue. Given that he ‘has alerted researchers to the importance of the leaving home transition. it may be timely and fruitful for scientific studv of the leaving home transition. Before summing up I have a minor quibble v\ith the format of the book. I would like to have had the references brought together at the end of the book in a bibliography. I find it frustrating to go back through a book to find that reference which I believe vvas in the middle of the book on the bottom of a page, maybe on the right. Haley has presented us with another in a series of landmark works on family therapy. By describing, illustrating and guiding us through the therapy, Including the mistakes, he makes an extremely valuable contribution to those who are dissatisfied with conventional, nonworking therapies for the treatment of disturbed young people. For the lone professional who v\.ould like to employ Halev’s approach, I’m not sure a book, even one as superb and detailed as this one, is enough. A second therapist serving as supervisor v%.ould seem to be crucial to remaining on-target. Thus, I would recommend this book to co-therapist teams and only those teams vvho can assure control of the course of therapy v\ithin the therapeutic community. Judith L. Fischer Texas Tech L’nislersitj