Virginia Satir and Family Therapy
Virginia Satir is one of the best-known and most successful practitioners of family therapy: dealing with entire families, rather than seeing patients solely on an individual basis. She discusses her theories about families and how they become dysfunctional (or functional) as well as what a skilled therapist can do in Conjoint Family Therapy and PeopleMaking.
PEOPLE OPERATE IN A SOCIAL CONTEXT
The theory behind family therapy is an attempt to deal with the social contexts of our lives. People are not just individuals; they interact with, influence, and are influenced by other people. Thus, when someone in a family develops symptoms (assumed to show mental or emotional distress), the family therapist assumes these symptoms serve NOT ONLY needs for that individual, but also a family function.
Family therapists (and others) have long noted that troubled children will often regress or get worse after visits home, that family members will often call and attempt to influence the therapy course of one member, and that when one child or family member starts to improve, another member may begin to develop symptoms. Thus, it seems logical to assume that the troubled member’s symptoms are important to the family and not just an individual (intra-psychic) case.
Families appear to operate under “homeostasis,” a tendency to keep things the same. This balance is maintained overtly and covertly within families. The communication patterns in a family, which are generally repetitious, circular, and predictable, help to reveal the homeostasis process.
MARITAL RELATIONSHIP SEEN AS BASIS FOR FAMILY PROBLEMS
Ms. Satir assumes that the marital relationship is the axis around which all other family relationships are formed. Thus, she concentrates heavily on the family assumed to have an adult male and adult female with x number of children. Variations receive little attention, which limits considerably the scope of her discussions.
Ms. Satir sees one-parent families as incomplete and lists the following as special problems for them: giving accurate messages about departed members; giving adequate attention to the need of the children; problems in sorting out roles and teaching proper attitudes in regards to roles. (Her books are somewhat dated since PeopleMaking came out in 1972 and Conjoint Family Therapy in 1967.) She also sees special problems for “blended” families (involving adoption, step-parents, etc.): learning to trust new members; giving consistent messages (including encouraging children to express conflicting messages); being honest about the past and realistic about the present; giving children freedom to love whom they choose (even if it’s not the new spouse); allowing adequate time for visiting for all; developing acceptance and understanding between natural and foster parents.
THE IDENTIFIED PATIENT
The family member labeled as “disturbed” or “troubled” by others is called the “Identified Patient.” This term is used because, on occasion, the identified patient may shift from child to child, etc. Ms. Satir assumes the symptoms of the Identified Patient are a message that s/he is distorting his/her growth as a way of attempting to absorb and lessen the pain of his/her parents. She emphasizes that everyone gets something out of the symptoms, but tends to place the causal origin in the parental relationship.
MATE PROBLEMS DUE TO LOW SELF-ESTEEM
In further tracing the roots, Ms. Satir assumes that people in troubled marital relationships tend to have low self-esteem. They are extremely sensitive to how others see them. They tend to have unrealistically high hopes and expectations for others, while simultaneously ready to expect disappointment. Two such low self- esteem people often find one another, and project their hopes (and fears) on one another. Each focuses overtly on what s/he hopes the other will be for him/her, while focusing covertly on what s/he fears the other will be.
Due to their insecurities and low self-esteem, the mates tend not to communicate their fears and expectations with one another. Each wants qualities in the other they feel lacking in themselves, but are afraid to ask directly (lest they be rejected). Each wants an extension of him/herself. Each wants the other to be the omniscient, all good parent which s/he never had.
MATES HAVE DIFFICULTY HANDLING DIFFERENTNESS
The mates tend to react negatively to perceived differentness in the other. It reminds them that they are separate, not one. They tend to fear open disagreements, so send their differences underground and begin covert communications. Each is trying hard to be what s/he thinks the other wants. Each gives control, power and responsibility over to the other, and then resents it. They seem unable to have more than one strong, adequate person in the relationship at one time. They take terms being strong, adequate (parent role) versus weak, helpless (child role). They deny their own individuality.
The birth of a child is an additional stress, and often is an extra burden on the marital relationship. Other stresses include family shifts (e.g. grandmother joining family, older sister or brother going away to college, etc.); outside stresses (earthquakes, unemployment, and so on); biological changes (adolescence, menopause, etc.).
CHILDREN NEED TO DEVELOP SELF-ESTEEM
According to Ms. Satir, a child needs a variety of things in order to develop self esteem. Children need physical comfort; some continuity in relationships; to learn how to influence and predict the responses of others; to learn how to structure the world; to esteem themselves as competent and as sexual beings. These last require validation from the parents, not constant and unconditional, but reasonable and realistic notice and attention to children’s attempts at mastering the world. Satir feels children require validation from parents of both sexes about their ok-ness as a sexual being. This is not just accepting the child’s sexuality, but also how the mates relate to one another as males and females.
If children see parents do one way, yet say another, they are apt to be confused. Children will attempt to clear up their unexplained contradictions. Often, the conclusions they reach are incomplete and inaccurate. They may over-generalize, or distort certain aspects of their experience.
According to Satir, the Identified Patient often begins his/her behavior as a way to side-track parents who are having problems. The I.P. fears if the parents continue to fight, argue, whatever, s/he will lose one or both parents. The symptoms of the I.P. become a way to draw the focus away from the parental relationship.
One of the worst results of this, Satir feels, is that children fancy themselves omnipotent. They begin taking responsibility for their parents, feeling that they are in charge of protecting their parents from one another.
POOR COMMUNICATION IN DYSFUNCTIONAL FAMILIES
One of the major outcomes of dysfunctional families with low self-esteem is poor communication. Improving communication is of major importance in Virginia Satir’s therapeutic work. In fact, she defines therapy as being completed when, “everyone in the therapy setting can use the first person ‘I’ followed by an active verb and ending with a direct object.” (p.177, Conjoint Family Therapy) ERRORS IN COMMUNICATION
Satir defines communication as giving and getting information. Clear communication is necessary in order to find out about the world and survive. All of us tend to fall prey to various errors in communication. 1. We may assume one instance is an example of all cases (over generalize). This is particularly common with who, what, where and when. E.g., “All Americans are...” “Nothing is right...” or “Everywhere I go, that happens...” or “This always happens to me.” 2. We may assume other people share our perceptions, feelings, and thoughts. “Do it the RIGHT way.” 3. We may assume our perceptions are total and complete, we already know all we need to know. 4. We may assume static (unchanging) conditions rather than process (potential of change). “Yes, he is like that.” 5. We tend to dichotomize. “It’s either right or wrong.” 6. We tend to assume that qualities we attribute to other people and to things are actually part of those people or things. “He is so selfish!” “That picture is gorgeous.” 7. We assume we know what is going on inside others and can act as their spokesperson. “I’ll tell you what she really means.” or “I know what you’re thinking.” 8. We assume others can get into our skins, and allow them to act as spokespeople for us. “You should know what I really mean.” “You know how I feel.”
When people communicate in such dysfunctional ways, the receiver of the message will not know to what s/he is agreeing or disagreeing. But disagreement, at least, MAY provoke further feedback and the possibility of clarification. However, dysfunctional communicators tend to discourage feedback and shut out requests for clarification. They may do so by outright rebuffs; just repeating their original over-generalized case; re-emphasize what they said, without changing it; accuse the questioner (of being nitpicky, etc.); or evade the question.
THE FUNCTIONAL COMMUNICATOR VS. DYSFUNCTIONAL COMMUNICATOR
Thus, the functional communicator can firmly state the case; clarify and qualify what s/he states; ask for feedback, and be receptive to feedback. The dysfunctional communicator will over- generalize a lot; be unaware of the assumptions under which s/he operates; send incomplete messages; use pronouns vaguely, and leave out whole connections in their messages. They may even act as if they sent a message when none was sent (expecting others to “mind-read”)
Of course we all generalize. Some codes and condensations are useful, and help us cope with life more effectively. It is only when generalizing is over-used and chronic that it becomes a problem.
Another form of communication is what Virginia Satir calls meta-communication. This is a message about the message, and may be contained in the context, the body language, gestures, facial expressions, etc. Meta-communications may disagree with one another (friendly smile, tight body) or with the verbal content of the message (“Come closer, darling” in an unfriendly tone of voice). This is called incongruence.
People can also deny messages while sending them. Jay Haley and other have divided messages into four parts: I (the sender); am saying something (the message); to you (receiver); at this time, in this situation (context). Someone can deny that s/he sent the message; ( I didn’t ask you to help me.) deny that was the message sent; (I didn’t ask for any help.) deny sending it to that person; (I didn’t ask YOU to help me) deny sending it in that context. (I don’t need help NOW.) Such denials can be in words, or in body language, etc.
All of us do some indirect, unclear messages, necessitating that receivers guess and fill in the blanks. We protect our self esteem by not directly asking people to validate us or want what we want. The more dysfunctional the communicator, the more indirect and denying s/he will tend to be. Again, marital partners often have trouble recognizing and dealing with their differentness. They tend to deny it, so make covert requests, trying to avoid any direct rejection.
TROUBLED CHILDREN REACTING TO DOUBLE BIND MESSAGES
Satir assumes that children who adopt the role of I.P. are exposed to double-bind messages over a long period of time by people who have survival value to the children. A double bind message is one which is incongruent, asking for one response on one level, and a contradictory response on another level. The receiver cannot “win,” no matter what s/he does, s/he must reject one of the levels. Dysfunctional families also tend to have unspoken “rules” against questioning such double-bind messages. One cannot win or leave the game!
MATURITY A THERAPY GOAL
Satir labels maturity as one of the goals in therapy. The mature person, she sees as able to accurately perceive the world, make choices, accept personal responsibility for those choices, and communicate clearly. Such a person is unique, and recognizes s/he is different from others, but reacts to differentness with eagerness as a learning opportunity, rather than a threat. A mature person is aware of inner thoughts, feelings, can let him/herself and others know what is going on.
A dysfunctional person tends to communicate incongruently. Such a person sees the present through labels fixed from the early part of his/her life. S/he strengthens these labels with each subsequent use. The present will be forced into the model of the past, or expectations (fears) of the future, rather than dealt with as it is. Dysfunctional people tend to have low self esteem, and unclear communication becomes a defense against dealing with and facing their low self esteem.
THE ROLE OF THE THERAPIST
What then, is the role of the therapist in all of this? For Satir, the therapist functions as an observer. S/he tries to see all interactions, and not get caught up in one point of view. The therapist acts as a model communicator and as such needs to be very aware of her/his own prejudices and unconscious assumptions. The therapist role models clear communication, and spells out rules for the family, in order to communicate more functionally. S/he emphasizes checking out whether the meaning intended was the meaning received. The therapist helps clients see their covert, incongruent and confused messages. The therapist strives to be as clear as possible, to help the family move in that direction. S/he encourages the family to question, to seek feedback and clarification, to test invalid assumptions that are used as facts.
Virginia Satir uses a variety of steps and techniques in her family therapy. She generally begins by taking a family life chronology. This helps to structure the therapy initially, and often gives security to the family. It gives Ms. Satir a clearer picture of the family and its background. It helps family members get in touch with past models which they may still be playing out. It helps take the focus off of the I.P. and starts the focus on the marital relationship.
As time goes by, the therapist introduces the idea of differentness, and that it is OK. Disagreement is also seen as normal and human. The family therapist expects pain to be looked at and commented on, rather than hidden. The therapist also stresses having fun. Discrepancies between what parents do and what they tell their children to do are pointed out by the therapist. She often compares one mate’s experience with the other’s, helping to bridge the gap.
Virginia Satir likes to accentuate the idea that the parents were mates first, and encourages them to recover their marital relationship, separate from their roles as parents. She uses the past to help explain the present, and lessen feelings of guilt and blame. She works to get expectations, fears and hopes communicated openly. She emphasizes the idea of good intentions (everyone means well) but poor communication. She often labels assets (even things the family may not have seen as assets). She builds self-esteem. She tends to interpret anger as hurt and look for ways to communicate and deal with it. She will often exaggerate expectations or fears, to help the family overcome them. She searches for missing pronouns, and fills in other communication gaps, striving constantly to clarify.
Ms. Satir uses a lot of communication “games” in her work. She will utilize role plays. One of her games involves the use of the roles she has named Placater, Distracter, Blamer and Computer. She feels these roles run through a lot of families. The Placater always agrees, in an attempt to avoid anger. Beneath the surface is generally frustrated rage. The Blamer hides fear by blaming others before they can blame him/her. The Computer searches for security by intellectualizing everything, lest a real emotion break through and s/he “fall apart.” The Distracter protects him/herself by distracting, changing the subject, shifting the frame of reference, etc. (“If I break up their concentration, I’ll be safe.”) Satir will often have families try on all the roles and rotate them, so each family member gets a feeling for the different roles. It is often revealing to play an opposite role, or a role one has generally seen performed by another family member.
Virginia Satir has used family role plays to train professionals, but also in working with actual families. E.g., one time, mother may role play her conception of how son is while daughter plays father, etc. Or, in a family which tends to favor one child and scapegoat another, they may role play where the scapegoated child is favored, etc.
Similar to the placater, blamer, distracter, Ms. Satir discusses the use of four basic interactional “rules” in families. With the first rule, the family member eliminates him/herself, by always agreeing with the system regardless of how s/he feels. Under the second rule, the family member eliminates others by always disagreeing, finding fault, blaming. With the third rule, the family member eliminates self and other by distracting, being irrelevant, so open negotiation is impossible. With the fourth rule, a healthy option, the individual negotiates clearly and openly, allowing both self and other.
Building on the above “rules”, Ms. Satir uses four sets of games. The first she calls rescue games. In them, rules one, two and three are played. One family member agrees, one disagrees, and one changes the subject. Generally, the same member sticks with a role. Satir feels this interactional pattern is common in families with a schizophrenic member.
The second set she calls coalition games, which are based on rules one and two. That is, two people always agree and a third disagrees, or two disagree and a third always agrees. Clearly, this can result in “disturbed behavior.” It requires considerable mental and emotional gymnastics for someone to disagree with two people when one is agreeing and the other disagreeing; or to agree with two people who are disagreeing, etc.
The third set she calls lethal games, and finds common in families with high incidences of psychosomatic illnesses. This system is based totally on rule one. Everyone agrees with everyone else, even at the expense of his/her own needs.
The fourth set she calls growth, vitality games, which allow open expression by oneself and others. In these games, people can both agree and disagree, from moment to moment, are flexible. They are able to act appropriately in different situations. They are not “locked into” one way of being.
TOUCH AND BE HERE NOW
Satir also uses other games. She stresses the importance of touch in human relations, and uses games to heighten awareness, so people can truly see, hear, feel one another. Ms. Satir feels it is extremely difficult to be incongruent, or to argue when we are in physical contact and in eye contact with the other person. She has exercises to illustrate this. She also feels standing more than three feet apart (at least in our culture) is a strain on the communication and relationship.
Virginia Satir emphasizes that these games are not for sunny, southern California alone. She feels therapists should use any and everything available to help clients focus on clearer communication. The important issue, she stresses, is the here and now relationship between you and me. Everything she does is centered around getting people into that here and now (away from there and then) or into clear recognition of the you (other person) and the me (themselves). This means clearing and cleaning up our openness to our own inner thoughts and feelings, and willingness to share them with others, as well as keeping communication channels open, ready to receive messages and feedback from others.
Another of her definitions of when therapy is complete is when family members can: complete transactions, ask, check; interpret hostility; see how others see them; see how they see themselves; disagree; make choices; learn through practice; tell others how they are manifesting themselves; tell others what they expect, hope, fear from them; be free of harmful past models; give clear messages with a minimum of hidden messages and a minimum of incongruency.
One drawback I find to Virginia Satir’s work is reading about it. From everything I have ever heard, Virginia Satir is a dynamite therapist and an incredible woman. Unfortunately, that does not come across to me in her books. I found them dry, and textbookish. I can trust many of her theories and suggestions, but the life was lacking. I believe she is able in person to really impact families and get them to change, to examine themselves, to clarify and so on. In the examples I read, I didn’t feel any vibrancy or bounce. I felt as if, had I been there, I would have been bored, and ready to leave, not to learn. I suspect part of this is the limitations of the medium. I would love to see her in action in person or on a videotape, where more of the flavor might come through.
Another small quibble I have is with her somewhat dated perspective, which is an outgrowth of the books available. Though she puts emphasis on a systemic approach to families (everyone influences everyone), she still comes across as preaching that the parents do it to the children. (An I.P. reacts to the troubled relationship between the marital partners.) Current work is family therapy is focusing on the CIRCULAR nature of all interactions. Our linear, causal notions just do NOT work in families. They are totally interactive, interdependent. To say one action CAUSES another is misleading. I think Virginia Satir is also in agreement with this; it is unfortunate that it is not clear in these early works.
I am tired of psychology’s outmoded blaming the parents (especially mothers) for the state of the children. Increasingly, psychologists (and people in general) are coming to terms with personal responsibility. If this truly is an interactive, circular world (as I believe it is), we all influence one another. We all are a part of the same game. The most useful position is one of personal responsibility. If I assume responsibility for myself, I give myself the option of control and power. The more I give responsibility over to others, the less control I have over my own life. The last chapter in the revised edition of Conjoint Family Therapy certainly moves in this direction, and I believe Virginia Satir is here in her work. It just is not as emphasized as I would like in her earlier writings.
Perhaps the best summary is to end with some of Virginia Satir’s own words, on a poster distributed by Celestial Arts:
“THE FIVE FREEDOMS
To See and Hear
What is Here
Instead of what should be,
was, or will be.
What one feels and thinks
Instead of what one should.
What one Feels,
Instead of what one ought.
For what one wants
Instead of always waiting for permission.
To Take Risks
In one’s own behalf,
Instead of choosing to be only ‘secure,’
And not rocking the boat.”
I think these are five freedoms many of us would happily share with Virginia Satir.