DATE: April 1995
EDITION: Volume VII, Number 1
CONTENTS
In each issue, we will include reviews of publications about network intervention and social network analysis, Editor's reports, and correspondence and articles from subscribers. With a more consistent publication schedule, we hope that NETLETTER will serve to link up the international network of network therapists, together with interested colleagues from the field of social network analysis.
In future issues, readers will see reviews of G. Clare Wenger's Support Networks of older people: A guide for practitioners and of Herman M. J. Baars' Sociale netwerken van ambulante chronisch psychiatrische patienten. There will be an Editor's report on the Charles River Hospital-West (Massachusetts) 1995 conference, "A family/network approach to psychiatry with Latino patients," including excerpts from a paper by Marcelo Pakman, Medical Director of the Charles River Latino Program, and an Editor's report on my return visit to Stockholm and first visit to Helsinki for network therapy conferences. We will read Gunnar Forsberg's report on the September, 1993, Swedish network conference, and Astrid Hultkrantz-Jeppson's address in Athens of April, 1994.
Help NETLETTER link together the network of network therapists. If you know someone practicing network intervention (or larger system intervention consistent with the network approach), please give them a photocopy of this issue, and ask them to subscribe. If you are a network analyst subscriber, please link us with network analysts interested in mental health, social welfare, diffusion of innovation, etc.
Please send us your reports and correspondence, from pages to a paragraph, particularly if we have not heard from you before. We look forward to hearing from you all!
THE NETWORK AS TREATMENT TEAM FOR SUBSTANCE ABUSE: A REVIEW OF GALANTER'S BOOK
Galanter, Marc. (1993). Network therapy for alcohol and drug abuse: A new approach in practice. New York: Basic Books.
In this, the first North American book on network therapy we have found in over a decade, Galanter provides a practical guide for treatment of substance abuse. Clearly written, with abundant case material illustrating his approach, Galanter's book is useful for substance abuse specialists unfamiliar with network therapy, or for network therapists working with substance abuse.
The primary aim of treatment is to establish and maintain abstinence; the longterm goal is a life no longer organized around substance use. The patient's social network is recruited to support treatment. Unlike other network therapists, Galanter does not see the network itself as the target of intervention, but rather as a collaborative resource for meeting treatment goals. Galanter promotes his approach as simple, not requiring specialized knowledge of family or group therapy, because his tight focus on abstinence takes most other treatment issues off the table. Nevertheless, it requires considerable skill to treat substance abuse, manage collaborative teams which include network members, and integrate several treatment modalities, "weaving together a fabric of interventions, none of them with a certain outcome, but all directed at protecting the patient from the risk of relapse" (p. 176). The emphasis on management is particularly suited to psychiatrists experienced at directing treatment teams. Psychiatrists also have the advantage of prescribing disulfiram (Antabuse) for alcoholics and the narcotic antagonist naltrexone (Trexan) for opiate addicts.
Galanter's form of network intervention is well-suited to treatment of addiction, which requires a high degree of therapist control. Control is necessary because of the compelling tendency toward relapse. Addiction involves a powerful conditioning process, which patients' denial and rationalization make difficult to address. The therapist, although directive, collaborates respectfully with patient and network members; everyone has specific responsibilities for the success of the treatment. In the first of three sections, "Rethinking the treatment of addiction," Galanter discusses issues of substance abuse treatment and the relevance of the network approach. "Network therapy in action" and "Principles of network therapy" then provide increasingly systematic exposition of his network approach The book closes with an appendix, "The rules of network therapy summarized." This organization, and the clarity of presentation employing case illustration, make the book quite accessible as a practical text.
Galanter (like most North American substance abuse specialists) sees abstinence as fundamental to effective treatment. He describes the pernicious power of "conditioned withdrawal," which persists long beyond initial physiological withdrawal, leaving the addict vulnerable to relapse. Homeostatic physiological processes engage whenever a drug is ingested, counteracting the drug's effect. This adaptation is conditioned to cues associated with drug ingestion (e.g., a neighborhood where drugs were once purchased, feelings such as frustration or shame). When the sober patient is exposed to these cues, the conditioned physiological response can set off powerful cravings for substance use. The core of Galanter's treatment is cognitive-behavioral training, in which the patient learns about conditioned withdrawal and overcomes denial, avoidance, and rationalization to recognize those cues which stimulate craving. The patient learns to avoid cues when possible, and to prepare alternative responses to unavoidable cues. Antabuse fits within this approach, not only because of the unpleasant effects of ingesting alcohol when on Antabuse, but also because the patient's knowledge that s/he is on Antabuse helps make cues for relapse both salient and aversive, thus helping to extinguish the conditioning.
Early in his substance abuse work Galanter integrated Ross Speck and Carolyn Attneave's pioneering work in network therapy with his own research on contemporary American religious movements to develop his network approach, which serves as a vehicle for his cognitive-behavioral approach to addiction. At the outset of treatment, network members help the patient commit him/herself to the goal of abstinence, and confront the patient's characteristic denial of the severity of the substance abuse problem. Substance abusers are notoriously poor informants, and network members are indispensable in constructing accurate, detailed histories of substance abuse. Network members help hold the patient in treatment, providing a realistic and supportive context for recovery, whicll is far preferable to inpatient treatment (which separates tlle patient from the context in which many of the cues for relapse are embedded). The variety of personalities and logistical opportunities available in the network gives the therapist many resources for creative treatment strategies. The network provides "cohesiveness, cognition, and coercion (p.23-27)." Early in treatment, family and personal relationships can provide more trust, goodwill, collaboration, and commitment than the brand-new relationship between patient and therapist. The therapist recruits network members who have position and capacity to be helpful to the treatment effort. The network's cohesiveness, and its norms of mutual support and commitment, help the patient persist in the difficult process of achieving abstinence, and natural feelings of obligation influence the patient's action. The network counteracts the patient's impulse to withdraw from treatment, and network members' participation in psychoeducation influences the patient to incorporate into his/her reality the therapist's view of addiction.
Galanter's network intervention and psychoeducation begin with the initial telephone contact. The therapist requests that the patient arrive at the first session "clear-headed" and substance-free (This requirement enables the therapist to administer Antabuse in the initial session). The patient is questioned about typical situations which cause substance use. The therapist suggests that the spouse help married patients avoid these situations on the day of the appointment, and that the spouse attend the first session. If available, the spouse goes over these arrangements by telephone. In the session, the therapist continues psychoeducation, and further recruits the spouse into the treatment effort by requesting that s/he observe the patient take his/her daily Antabuse. The point is emphatically made that the patient is responsible for taking the medication; the spouse is responsible only for observing and reporting compliance to the therapist. Careful articulation of respective responsibilities throughout treatment assures that the patient retains the initiative for recovery. The therapist sets the focus on abstinence, engendering an atmosphere of collaboration, task-orientation, and hope. The treatment is not oriented toward restructuring of relationships, as it is in family therapy. In the case of an "unloving spouse," who may not be interested in the marital benefits of sobriety, the therapist searches for a fitting motive for collaboration, e.g., an improved family experience for the children.
Although sometimes Galanter works with spouse and patient alone, usually he decides to recruit more network members. In the first session, patient and spouse (or unmarried patient alone) construct(s) a list of network members who can serve as an action set for patient sobriety, to be convened at the next meeting. This group, which Galanter refers to as "the network" usually consists of no more than four or five trusted friends and relatives with close relationships of long standing. The therapist assures that the group is balanced to include both intense and somewhat less engaged (therefore more objective) relationships, and helps screen out members who may be problematic, e.g., current substance abusers, family members in toxic relationships, workplace superiors or subordinates, members whose anger can disrupt the collaborative group atmosphere, etc. Participation of boy/girlfriends can be particularly problematic There are ethical issues involved in applying social pressure on a lover to support an addict who may not have much to offer in return. If the relationship breaks up during treatment, it is unlikely that the lover would continue to participate in the network intervention. This disruption would place strain on a small group which may meet weekly for the first month of treatment, biweekly for the next few months, and then every month or two. In some cases, the therapist may decide to include potentially disruptive individuals, such as a spouse or parent, because they are so close or important to the patient that it is better to have some handle on them in network sessions despite their disruptive potential. A speaker phone in the office may be used to secure balance by including a friend or relative from out of town.
Galanter begins every network session with a review of information about relapse, and between sessions network members are expected to tell each other and the therapist about relapses. Each session ends with specific planning to protect against relapse before the next meeting. From the outset, the patient, therapist, and network members are expected to be open and forthcoming on all matters related to substance use and abstinence. The therapist maintains an atmosphere of task-oriented collaboration, guarding against recrimination, impugning of motives, or psychologizing. Relapses are addressed in a psychoeducational context as evidence of the power of addiction and conditioned withdrawal; each incident is treated as an opportunity to recognize and understand cues for relapse, and to develop alternative responses to unavoidable cues.
Each member of the team has responsibilities for maintaining network stability. The patient recruits network members, and secures their attendance at each meeting. Network members attend each session, and engage in other supportive activities between sessions. The therapist sets the meeting times, may summon network members for emergency sessions between scheduled meetings, and orchestrates action to secure abstinence. S/he may step in to assist the patient to maintain network stability and continuity.
While in treatment in network therapy, the patient also meets individually with the therapist for reinforcement of cognitivebehavioral training and consultation and coaching on management of the patient's network relationships. Individual treatment addresses characterological and other issues of individual psychopathology. The patient is encouraged to attend AA or other self-help programs whose social support, feeling of belonging, and transcendent spiritual experience facilitate reconstruction of reality within a framework of sobriety. The power of such group experience for emotional commitment helps the patient persist in the difficult and protracted process of recovery. The therapist's role with regard to AA includes addressing psychological resistances to participation. The therapist respects and does not pathologize the transendent spiritual beliefs which may emerge through the patient's participation in AA.
Galanter makes no reference to the field of network therapy beyond the early work of Speck and Attneave, which he incorporated into his substance abuse work. At times, I was jarred by his applying the term, "network," only to the action set assembled for regular meetings, and "network therapy" only to his own approach, without reference to the possibility of other network approaches. NETLETTER readers may remember Ross Speck's rather bemused reaction in his correspondence (VI, 1) which included a press clipping quoting Galanter as saying that network therapy does not require specialized skill. Although experienced network therapists would take exception to such an assertion, there is some merit to Galanter's claim that his particular network approach can be applied without family or group therapy expertise, and I find it a very useful application of the network approach to addiction. The one time I recall trying to assemble a full-scale assembly for a subsance-abusing patient, the intervention was, mercifully, cancelled because of the risk of homicide among violent, alcoholic relatives. At several full-scale assemblies I have conducted, alcoholism in a family member was uncovered; in these cases, a network "committee" would work toward getting the family member into Alcoholics Anonymous, spontaneously forming the kind of action set which Galanter systematically assembles for his approach. Having read Galanter's book, I would now be likely to seek to follow through with the substance abuser, collaborating with him/her and network members to sustain abstinence along the long and painful road of recovery. I know that some network therapists have begun corresponding with Galanter since his book was published, and I look forward to seeing further elaboration of Galanter's work with substance abusers, making use of the wide repertory of network intervention techniques which have evolved since the pioneering work of Ross Speck and Carolyn Attneave.
NETWORK ARRANGEMENTS by KERSTIN MARKLUND-HALLGREN and ASTRID ULTKRANTZJEPPSSON (Stockholm, Sweden)
[Manuscript received December, 1993]
The authors of this article have been working with larger systems for over 10 years. In 1989, together with old colleagues and friends from network therapy research, we developed our own institution, the Crisis Unit for Children's Networks. The authors' backgrounds include education in family and individual therapy and experience from social work, child guidance clinics, and adult psychiatry clinics. In addition to our work at the Crisis Unit, we supervise and train treatment staffs in different contexts.
It all began with great interest in developing new strategies among therapists working in a multicultural, very poor suburb south of Stockholm, called Botkyrka. We who worked there were meeting people in severe trouble. We found that family therapy, which had given us therapists such hope, was not enough to keep children out of foster care. We started to look for a broader context in our efforts to help these "multiproblem families," whom we relabelled as "multi-agency families."
From 1985 to 1988, we conducted a research project, "Network work with multi-problem families,'' publishing our report in 1988. Results were good. Through network mapping and network meetings the social workers, families and therapists involved in the project had totally changed the foster care situation. Child placements had not decreased, but changed. Instead of stranger families taking care of other people's children, we now had families within the network taking care of relatives' and friends' children, with the consensus of the rest of the network. In 1986 and 1989 we (Klefbeck, Bergerhed, Forsberg, Hultkrantz-Jeppson, and Marklund) presented our research in family therapy congresses in Brussels.
In response to the results of our research, the authorities of Botkryka commune [municipal government] and the Swedish National Board of Health inspired us to develop our own Crisis Unit for children's networks in Botkyrka. The Unit has been in operation for three years and is now, after many "ups and downs," the only part of the human service sector in Botkyrka which remains stable in these times of welfare cuts.
A short introduction to the authors: For years, I (Kerstin) put my energy into developing and documenting new ideas about our work with larger systems. After shifting my larger systems view to the very narrow view of spending a year with my baby daughter, I returned to the Crisis Unit. After two years working with Children's Rights in Yemen and Ethiopia and introducing network methods to an adult psychiatric clinic in the north of Stockholm, I (Astrid) returned to join the leadership at the Crisis Unit.
We would like to present some of the ideas that guide us in our systems therapy with networks or parts of networks. Examples will come from the Crisis Unit, from Kerstin's work at a child guidance clinic, and from Astrid's work in adult psychiatry. We will give you our versions of different treatments by describing problems, intervention arrangements, and their results. What we will present is network arrangements from our different but connected points of view.
Anyone worried about someone is welcome.
Unlike other psychiatric agencies, we are quite content when people call us on behalf of someone else. We learn more about the problem system and its resources, although perhaps not as much about the problem in the system. We never say, "Ask that person to call us by him/herself." We say, "You are welcome to visit us with the people you are concerned about. If that is impossible, visit us by yourself so that we can work out a strategy together for involving more of the people suffering from the problem in our discussion ."
For example, a school teacher calls us about a pupil who, due to bad conduct, is no longer allowed to visit the school area. His lessons take place in a special setting outside school. He comes to school regularly, making a lot of fuss, leading to police reports. He has hit a teacher, and he is the fuse for other pupils' rebellions. The husband of one of his former teachers has threatened to kill him because of the severe problems the boy causes his wife. The Crisis Unit makes sure that the headmaster is informed of the plan for help, then asks the teacher to bring with her important people connected with the problem. The teacher comes with the boy's mother and the school nurse. The three women gossip about the conflicts between school staff and agree that the school should be treating the boy differently. He is really a good boy. Some teachers are acting more than improperly.
If possible we like to meet close enemies.
We then ask them to send along the other side -- that is, their male antagonists. The headmacter, the boy's father, and a male teacher arrive for the next discussion. Their affect level is not as high as that of their female friends. They are concerned about both the boy and the school, but they are not sure that the boy would like to participate in a large meeting between those who are in conflict.. At the men's request, the next meeting is in the home of the boy and his family. Therapists from the Crisis Unit visit the family -- mother, father and son -- and get the son's permission to lead a meeting concerning his problems at school and the school's problem concerning him. He will attend together with a friend.
Later, the large meeting has two themes: "Could this boy leave school without having only bad memories?" and, "How could the headmaster handle a staff with so many conflicts about much more than this 16-year-old boy who soon will leave the system?" The meeting was dramatic in two events: The headmaster's speech about his loneliness and helplessness, and the opened dialogue between the boy and his former teachers. The result was that the boy went back to school and received his final certificate. We believe the school still has problems, but the staff is more aware of them. Conventionally, this could have turned out as a family therapy treatment; meanwhile, the school could have lived on being a conflictual system with new pupils engaged as bad-conduct saviors.
The therapist being loyally unfaithful.
We don't expect ourselves to be neutral, moving together with this complex client. We talk about being unfaithful in a loyal manner. This is not so strange; it is what therapists do in families. One question might seem to side with the woman, but on another level it is a move that the man will geun from. The bonds between family members are stronger, of course, than the bonds between family and school -- it takes a lot of intuition and guts to manage this with our widened client focus. It is a piece of art, and has to be done with much humor and refinement to be accepted by all parts of our client. By all means, it is not easier to pull in kin either, if the bonds between the family and their relatives are loaded with old conflicts, as the next example will show.
We politely ask people to trust us to meet the people they hate the most, sometimes together, sometimes apart from the contact we have. We talk about close enemies -- so we ask those who have come to us to trust us to accept our being loyally unfaithful. We then of course imply that more people are suffering -- even those who are on the other side of a broken dialogue.
The following example comes from the context of a child guidance clinic, where Kerstin was working: Grandmother and granddaughter come together to the clinic. Grandmother is desperate on behalf of her daughter and granddaughter. Her granddaughter, 15 years old, is doing very poorly at school. The girl herself believes she is untalented, stupid. At home she tortures Eve, her mother, for hours with her homework. She forces Eve to pose hundreds of questions about her homework, and she is always unable to answer them. After a day's studying she blames her mother for her stupidity. We ask the women to fill in the missing generation, that is, the mother. We meet the three women for many sessions, trying to make clear their loyalties to one another. A very juicy story is exposed. Eve, the mother, ran away from home at only 16 years of age, went to a foreign country, and married secretly. Newly married, she got pregnant by another man, ran away from both men and finally returned to Sweden and her parents. For several months, she seemed unconscious of her pregnancy. Her parents helped her through and got her an apartment, where she has lived with her daughter ever since. Nobody in Sweden knows that she has been married. She has a lover, a police officer, about whom she is very ambivalent. He has helped her to fix her registration papers so that her teenage marriage has been erased from the files of the Swedish authorities. The two therapists are women, 55 and 35 years old (psychotherapist Kerstin Sjoblom, at the child guidance clinic of Sodertalje, south of Stockholm, and Kerstin Marklund-Hallgren), modelling a mother-daughter, daughtermother team. We have a range of lovely sessions, which help the three helpless women enjoy life more and look at each other a little differently. But the symptom doesn't change. Interpretations such as: the granddaughter nagging the mother to keep her out of bed and her severe depressions, and the granddaughter helping grandmother to keep her daugher alive -- are taken seriously, but do not bring about change. Three helpless women have become five helpless women.
Grandfather is a hated person. We introduce the thought that we, the therapists, need his help. After long discussions, we are allowed to meet him separately. The women do not want to take part. Grandmother, daughter Eve, and granddaughter all believe that he won't come. He does come, and gives the therapists an impression of a fairly nice man wanting to help his daughter and granddaughter. Of course, he doesn't know how, and we introduce to him the concept of gathering the invisible but important men of the extended family. He agrees with joy, and we turn back to the women to ask for permission to extend our knowledge by having a meeting with the men involved. Now, the women think this is a funny idea, and let us know that they trust us with this. Grandfather, Eve's sister's husband, the only son of the grandparents, a cousin, and Eve's secret lover are invited. Grandfather, sister's husband, and the cousin come. The therapists tell the men that we are helpless and need the men's point of view on the problem. What could make granddaughter get in touch with her intelligence and talents? The men give us the whole family story. Sister's husband tells us that his wife when young had tried to kill herself on several occasions. Now he has has moved with her and their children to the north of Sweden to break the closeness between his wife and her mother. Grandfather complains about never being listened to, not even when his daughter was suicidal. The men think that Eve should have a good man, not the one that was invited here and didn't come. They say he acts like a thief -- coming to her in the dark and and getting out of bed before daylight.
We report the men's opinions to the women, who are surprised about the concern that the men have shown. Shortly afterwards, daughter Eve breaks up with her lover, explaining to us that he is not worth loving.
Now the time has come for us to invite grandfather together with the three women. Grandmother and daughter Eve still hesitate. We agree that maybe he has fooled us by being nice and showing so much concern in our meetings with him, but still he always used to come and pull daughter Eve out of her bed during her depressions when granddaughter and grandmother asked for help. After long discussions, the women agree, still a bit nervous that he will charm us women therapists into abandoning them. We meet with grandmother, grandfather, daughter Eve and granddaughter. This session is used solely to feel the bonds betwen the participants; we don't talk much. We use Virginia Satir's rope-knitting and help the family members to walk around, feeling how far they can move without being pulled back. All family members are very nervous, and the therapists have to back up a lot and be very close to everyone.
The therapy is now interrupted for the summer. The older therapist meets with daughter Eve, discussing boarding school arrangements for the granddaughter. In that discussion, the therapist also involves the social agency needed to pay for the boarding school. Daughter Eve and her daughter come to us in the autumn. Summer has been dramatic. Daughter Eve has made her daughter agree to placement at a boarding school. The school is quite close to home, only half an hour's journey by bus. On weekends the girl comes home to her mother. School provides special teaching for daughter. We comment on this different running away from home, which, compared to Eve's running away at the same age, is closer to mother, and is more protected and agreed-upon between mother and daughter. We congratulate the two women for finding a suitable solution. Then, we ask about grandmother.
The system takes over responsibility.
Daughter Eve tells us the following: Every spring for the last ten years, grandmother has travelled together with female friends to a hotel in the mountains. This year during the traditional trip, she found herself sitting next to a very attractive man. They immediately fell in love. Coincidentally, the man lived in the same town as the grandmother, and during the summer their relationship had deepened. Grandmother was still hesitant, however, about leaving her husband. The lover then telephoned grandfather, who became desperate. Then grandfather, very late in the evening, called up daughter Eve and his son and gathered them to a family session including grandmother. That night's session resulted in the separation of the grandparents. Grandfather moved to their summer house, not far from their apartment. Since then, Grandfather's and daughter Eve's relationship has been closer.
Amazed as we were, the therapists tried to get consensus for another family gathering at the clinic. The answer was no. Maybe the extended family members thought that no gathering could be more severe than the gathering that grandfather had initiated. Grandmother visited us once, telling us about her new, happy life. She had this new man, and she still had her shop going, which meant that grandfather had not frozen her out economically. Daughter Eve and her daughter continued to come to us, further discussing their relationship and Eve telling her daughter about her real father. They also started to search for him in the foreign country.
You might say the granddaughter's symptom helped to bring about a divorce between grandparents; a divorce that many had waited for (and feared) through many long years of suffering. We believe that the broader context we managed to bring in, relatives as well as boarding school and social authorities, helped to loosen the stiffened bonds in and between generations.
Creating role confusions
We often use the female/male theme in larger network meetings. If we have a problem concerning an adolescent, we might ask everyone who ever was a teenaged mother to step forward, sit in an inner circle, and discuss the situation of raising adolescents. The interesting thing with this simple intervention is that the social worker and the psychiatrist have also been teenaged mothers. By admitting this and participating in the inner circle, they become insiders. When the professionals become less professional, the other participants -- neighbors, friends, relatives -- become more professional. As the professionals lose distance, "nonprofessionals" gain distance from the presenting problem. We believe that people, being shaken a little out of their ordinary position, gain creativity.
Emotional linking rather than problem-solving
These created role confusions help emotional linkage between meeting participants. Our firm belief is that emotional linkage, strengthening of bonds, is needed before problem-solving is possible in the severe conflictual situations with which we are dealing. In similar ways we ask for men's or fathers' point of view.
Other role confusion techniques we use include, for example, having an empty chair for people missing from the meeting or for small children unable or unwilling to speak their minds. We don't ask people to pretend that the chair is the child; instead, we put the chair in front of quarrelling, separated parents, and ask anybody who wants to to sit in the chair trying to feel that they are the child involved and speak to the parents from the child's point of view. Of course, professionals step forward and sit in the chair, sharing what they think the involved child feels. But also, friends, neighbors, and relatives are surprisingly willing to sit in the chair and speak freely from their seven year-old hearts. Members of our team also sit in the chair addressing special topics they think are important. In this way, through emotional linking, we create new alliances and openings for the lost dialogue.
Another example of role-position-shaking comes from a meeting with a drug-addicted, anorectic mother and those involved in her childraising situation. She goes to an institution where individual therapy is available. Many people, most of all her father, are afraid of the projections and accusations of guilt that will come out of her therapy. We ask all the participants at the meeting, "Which of you has been in individual therapy?" Both professionals and nonprofessionals raise their hands. Those who don't are also a mix of professionals and nonprofessionals. We ask those who have raised their hands to share how they think their networks were influenced by their individual therapies. These kinds of simple, structure-changing questions are limited only by the courage and fantasy of the therapists conducting the meeting.
All this sharing and emotional linking leads to the mourning that is vital for further problem-solving. We firmly believe in the network spiral, as defined by Carolyn Attneave and Ross Speck in their now classic book, Family networks We call the spiral the metatheory of networking. We define the mourning process, called the depression phase, as the most important phase of a meeting. If the suffering people involved in the problem are not allowed to mourn their failures, misfortune, lost dreams and lost self-confidence, they will have problems drawing power for further problem-solving. Some of the interventions already mentioned (for example, the hot seat) lead directly to shared mourning, which the team deepens as much as we can. We don't mind leaving a network in the midst of mourning. Our experience reassures us with the knowledge that the solutions can be worked on later, together with the professionals that attended the meeting, or by further visits of parts of the networks at the Crisis Unit.
Constructing network maps in a dramatic custody conflict.
This Crisis Unit case shows how using network maps can contribute to healing broken dialogue in a network. Mother, a 35 year-old woman, brought her 8 year-old son to the Crisis Unit. She worried about the boy acting out in school. She wanted us to examine the boy and his symptoms, which she did not at all understand. He had always been a good boy.
We wanted to hear something about their present life, and current changes. Mother's story was quite dramatic. A month ago, her husband, the boy's father, had moved out of their home. His "best friend," the mother's lover, moved in. The boy's father got furious, smashed the lover's car, telephoned and shouted loudly outside his former house. The police considered him a dangerous person and he was forbidden by authorities to see his children. Now, the boy lived with his mother, stepfather, brother and beloved dog. His contact with father was broken.
The Crisis Unit decided to meet all people involved and set up a team of two male and one female therapists. The female and one male therapist went to mother and son in their home to draw their network maps. The two women sat in the kitchen; the male therapist and the boy were in the children's room. Instructions for both mother and son were to draw the son's network map; the mother thus drew her view of her son's network. They were told to put in all important people, closer and further away from the boy, who was in the middle of the map, according to emotional closeness and distance. They were also told to link the people together if they knew each other and to mark conflicts with broken links. At the same time, the other male therapist met with the father, who was very happy to be contacted. He gave his version of the son's network. The network maps differed a lot from each other. Mother's map showed a broken dialogue among father's kin and between father's and mother's relatives. Father and son did not comment on these conflicts, or perhaps commented by not linking the people together at all. The interesting thing about the conflicts is that authorities had done their best to widen the gap by supporting no contact between father and son. Seeing this broken dialogue across generations, the team set the intention to heal the dialogue somewhat by inviting relatives on both father's and mother's side to involve them together in the boy's life.
According to the maps, both parents agree that each of them is important to their son. Mother thinks that stepfather is quite important. Father includes stepfather in the map -"although I don't like him, I think he is all right with my son." The boy himself had put father into the family sector, as if he had never moved out (The instruction had been, that "family" are only those who live together.). The boy felt that father was the closest person, and that father's relatives are close, too. The stepfather is not in the boy's map.
Bringing in the concept of support persons.
Our next step would have been to let the parents study all the map versions together. We like to ask questions like, "What do you think when you see the maps?" "In what way do your awarenesses differ from each other?" "In what way are your versions alike?" "What does each of you find interesting in the others' maps?" But this former couple refused to meet and talk with each other. So we could let each of them only look at their own map and the boy's, and discuss and compare them together with the therapist. This led to the parents agreeing to meet together in the presence of support persons. The father brought his mother's woman friend and neighbor who had worked all her life in adult psychiatry. She had seen father grow up, and she could verify that he was sane. The mother brought her best woman friend, who was also her neighbor and colleague at work.
Through this meeting the team found the time ready to expand the scene. They suggested a big network meeting. The couple hesitated. Their relatives hadn't met for years and years. "If you meet them, there will be terrible, awful conflicts," mother and father told us. "But, sure, you can meet with them -- if they will come."
Expanding the scene further
Mother and father at last agreed to invite important people to a meeting with the therapist team. Though they both thought it might be helpful, they decided not to take part themselves. The parents successfully gathered a meeting. The team thought that this meeting revealed that the parents concurred on mother's version of son's network regarding the conflicts between the relatives.
The meeting took place at the Crisis Unit. Father's parents arrived, the grandfather with his "new" wife (of 15 years) and his former wife. Grandfather had not met his son for 15 years, and the grandparents had not met either since their divorce. The mother's father appeared. His wife had died a year ago. The family priest also came. He had married the parents, baptized the children, and so on. No other sector of the network was represented. The older generation started expressing their sorrow that they had never met during all these years, not even at their grandsons' birthday parties. The mother's father said, "Only death is acceptable as a reason for separation." The woman who was now married to the paternal grandfather suggested that the boy's mother should move away for half a year with her new man to test their relationship. Meanwhile, the boy's father could move back into the house which he had built with his own hands and live there with the children. The group decided that the priest should bring the meeting's proposal to the boys' parents. Mother refused the proposal, but acceded to the father taking care of the children every second weekend. At this stage, you could say that both parents agreed to the father's and the son's own version of the son's network -- that is, how important the father is to the son.
The team now turned to the father's former best friend -- the lover and stepfather. We proposed that he should meet the boy's father and a male therapist. So far, this man had not realized that he played a part in this story. The men met. The lover told how he had been abandoned by the boy's father in a World Cup sailing contest. He was very close to winning the prize when his friend suddenly left the boat to go home to the woman who was then his wife (the boy's mother). He never forgot, never forgave. He wasn't conscious of any relationship between the betrayal and the present situation. During this meeting, they told the therapist that the two men had known each other longer than either of them had known the woman involved. The lover/stepfather had been a father figure to the husband/father.
The team now intended to assemble the men and the women together, but did not succeed. The boy's mother did not turn up, saying she was ill. Surely, it was too tough for her. The team then participated when the couple met before the court to make arrangements for the future care of the children, the financial arrangements, etc. The father told us he got strength when we treated him as a person suffering from the effects of an awful situation, instead of as a maniac. The mother did not comment at the time.
During the time of the network's contact with the team, the boy's symptoms had disappeared. One and a half years later, the father contacted us to tell us he and his new wife had a baby boy. The mother phoned, asking if she could bring her colleagues from the hospital for a study visit to our Crisis Unit. Have we helped break the social heritage of conflicts and abandonment through opening a dialogue in the boy's network? Perhaps, this boy will not copy his father's life by not having a father-son relationship. The boy will perhaps be able to meet and have his own relationship with each parent, even if they have chosen to live with other partners.
Construction of network assemblies in deinstitutionalization of adult psychiatry patients
Adult psychiatry clinics in Swedish societies have tended to cut off the networks of patients, either because they have been considered harmful, or from lack of awareness of the importance of networks and roots. The network approach, on the contrary, is intended to repair and mobilize the longtime patients' nets. A broken net might create illness and symptoms, or will at least not be supportive in a positive way.
As most clinics in Sweden, the psychiatric clinic where Astrid supervised is undergoing great changes. Many of the old hospitals are closed and the patients are cared for in outpatient clinics. Some smaller wards, a rehabilitation center, a "meeting point," and a work cooperative are components. Astrid's task was to introduce thinking from a network approach -- to train and supervise the staff to help heal the patients' broken networks.
Many of the mainly male schizophrenic patients now live in households of their own, so-called group living, where some patients get a small flat, each in the same house. There is a team of supporting personnel, who visit them regularly and help them in daily activities. Sometimes, work cooperatives are formed for those able to work. The clinic tries to explore the present network, to help create a new one, and to revitalize the old one. Network meetings are arranged involving both professionals and informal contacts - friends, relatives, neighbors. One of the important questions is, how to support each other.
The rehabilitation center can offer activity groups like painting, gymnastics, cooking, and so on. The main point is to guarantee network continuity, a supportive external structure as foundation for the feeling of security which makes growth possible.
Briefly, the network assembly model is as follows: Five people from the informal network and four people from the professional network meet every third week. We think the meeting has a good balance when professionals are fewer than the informal people. Together, they make an agenda discussing different issues and writing protocols. Every meeting begins with checking old protocols; what has been done and what has not. Backed up by this secure network, the patient will be able to find new pathways to participation in society. This means a long reintegration process, instead of a life within closed wards where there are no possibilities for contact with the so-called normal society.
We hope that this has given the reader a fairly good idea of our work with larger systems in different contexts. We have, so far, seen no organizational context where network therapy can't be used. Our examples in this article come from social welfare work, and child and adult psychiatry. Whenever there is a problem system where others than the family are deeply involved, our experience is that network therapy can be useful.
Wellman, B. (1990). The place of kinfolk in personal community networks. Marriage and Family Review, 14, pp. 195-227.
This article describes the structure, composition, and content of the kinship sector of the "personal community networks" of white, North American, middle-aged married people. For network therapists working with such folks, the article offers a normative picture to clarify problematic deviations in network structure and function, and guide network intervention strategy. Barry Wellman, a NETLETTER subscriber and founder of the International Network for Social Network Analysis, has long studied social support in personal community networks (networks of active and intimate ties, corresponding roughly to what network therapists call family networks). This description of kin in personal networks derives from an extensive literature review, including his own studies of personal community networks in suburban Toronto (Wellman, 1979, 1982; Wellman, Carrington, & Hall, 1988; Wellman & Wortley, 1989a, 1989b).
Wellman offers several useful terms and concepts. "Social and physical foci" are settings in which people come together and form ties, e.g., churches, workplaces, civic groups, marketplaces, etc. Kinship groups include "kinkeeping persons" -- usually mothers or daughters - - activists who maintain kinship ties by arranging gatherings, keeping in touch with everyone, and reinforcing or repairing ties in the group. "Amity" is a kinship norm which contrasts with the one-for-one reciprocity norm governing supportive exchanges among friends. Among kinfolk, support is given, or taken, without an assumed obligation to return support in kind within a relatively short time, immediate kin in particular are simply expected to provide support.
"Active ties" involve frequent sociable contact, exchange of support, and/or feelings of connectedness. These ties include "frequently seen interactors," neighbors or workmates encountered often in everyday life; "intimates," who have distinctively close and supportive ties; and "confidantes, ... the 1-3 network members to whom people pour out their hearts"(p.202). Confldante ties are multiplex. "Immediate kin" are parents, adult children, siblings, and parents- and siblings-in-law (spouses and dependent children are not included, as they are part of the households whose personal communities are under consideration.). "Extended kin" are all the rest: aunts, uncles, cousins, grandparents, etc.
In broad terms, personal community networks include kin and nonkin sectors, each with different structures and functions. The nonkin sector includes a) nonintimate, nonvoluntary ties to frequently seen interactors with whom one has routine contact; and b) friendship ties, which make up about half of most intimate networks, and exchange about half of most nonfinancial support. The friendship sector is less densely interconnected than the kin sector; friends are more likely to interact "voluntarily" as pairs of individuals or couples for sociability, pleasure, and pursuit of common interests. Friendships require more maintenance for exchange of support, constrained as they are by norms of reciprocity. For this reason, and because friendships are often unsupported ties (i.e., not reinforced by common ties to other network members), people will often avoid asking a friend for support so as not to overload the relationship. Because the friendship sector is less interconnected, ties with friends can provide access to a variety of resources, and to social circles beyond the existing community.
The more densely interconnected kinship sector forms one or two clusters in personal community networks. The stronger the tie, the greater the proportion of kin. Thus, kin are a sizable minority of active ties, and make up about half of intimate ties. Immediate kin are more likely than extended kin to be intimates or confidantes, and more likely to exchange two or more kinds of support. Kinship ties are likely to be maintained over geographical distance. Kinship influences ties interactively with- strength of tie, shared interests, and physical access. Yet, structurally close kinship bonds can override distance and even, in the case of the parent-adult child bond, mutual dislike. In contrast, sibling relationships, like friendships, tend to be more influenced by common interests and affection. Still, because of its structural density, normative amity, and longer history, members of the kinship sector who would not otherwise choose each other's company engage with each other in group encounters several times a year or more. Extended kin who may not be intimates or even in active ties, prove to be important resources when one is migrating to a new setting inhabited by kin, or seeking information about a job or some other resource not available directly within one's immediate community.
Wellman's account of kin in personal community networks applies to a very specific group: "the networks of white, Northern-European ethnicity, employed, once-married, North American 40-year old (sub)urban women and men with a child in primary school" (p 197). For this group, using the broad inclusion criterion of all people with whom one can currently have an informal relationship, there are about 16,000 adults potentially available: 2,700 directly available (most through foci), and more than 13,000 indirectly available through existing ties. Estimates of the actual numbers of people in personal community networks range from 250 to 1,000; Wellman's work yields an estimate of 400. Within these 400 are 20 or so active ties, or about 5% of the total network. Kin make up 2% of all potential directly available ties, and 9% of all actual ties. The closer the relationship, the higher the proportion of kin; kin are about 30% of active ties and about half of intimates. Kin make up less than half of the I to 3 confidantes, but the closest confidante is often kin. These closer relationships are predominantly immediate kin; extended kin are a small minority. Most potentially available kin ties become actual ties; most immediate, and some extended, kin have active or intimate ties. Among "people in general," the distribution of networks with immediate kin making up many of the closer ties is bimodal; people tend either to have few or many kin in these close positions. People with a higher proportion of kin ties include married people (marriage yields in-laws); women who juggle paid work, domestic work, and community networking; and working-class people. Rural residents, lacking opportunities for voluntary, interest-based connections, also tend to have a larger proportion of kin.
Structurally, in networks of active and intimate ties, about one-third to one-half of potential interconnections are actual ties. Kinship is inherently interconnected; most kin with active or intimate ties are also linked with each other. In Toronto, three-fifths of all possible intimate links between kin are actual, compared to one-fifth of all possible links between intimate friends. It follows that kinfolk predominate in high-density networks, while friends predominate in low-density networks. Twothirds of active kin, compared to one-third of active nonkin, gather in groups (dinners, holiday gatherings, picnics). The density of the one or two distinct kin clusters in personal community networks provides a "structural basis for coordinated action" (p.205), be it sociable, supportive, or controlling. Marriage increases the number of kin, but dilutes the density of personal networks, as in-laws tend not to form ties with each other, and although spouses tend to become friends with each other's friends, the two sets of friends are less likely to form new friendships with each other. Marriage and children tend to draw the couple inward; with less energy available to maintain.friendships, some of these high-maintenance ties attenuate and drop off.
Neighbors and kin provide most of the support and companionship in personal networks. Strong ties defy distance, especially for kin. Modern transportation and communication technology compensate for physical distance. In Toronto and in San Francisco (Fischer, 1982a,b), threequarters of active ties extend beyond the neighborhood; onefifth extend beyond 100 miles. Intimate ties are less likely to be local; in Toronto, seven-eighths of intimate ties lay beyond the neighborhood and one-quarter beyond the metropolitan area. An important minority of kin with active and intimate ties live close by; one quarter of kin with active ties, including one or two intimates, live in the neighborhood, and most of this group are significant sources of support. The following data demonstrate that kinship withstands the obstacle of distance more than friendship: In the San Francisco area, one-half of kin but fewer than onequarter of friends live more than one hour away. In Toronto, fewer than one-half of kin with active ties, but only one-third of friends live more than thirty miles away. In Toronto, for the set of active ties with personal community members who live more than 30 miles away, people have at least one contact a month with 55% of immediate kin, 46% of extended kin, and 26% of friends.
Frequency of contact follows similar patterns: One interacts with intimate immediate kin more frequently than with intimate extended kin, and with intimate extended kin more frequently than with intimate friends.
The content of ties again demonstrates the importance of kin in personal networks. The parent-adult child (particularly mother - daughter) relationship involves the most emotional and material support. This relationship is the primary source of informal care for the elderly. In Toronto, 84% of the parent-adult child ties observed involved exchange of emotional aid, and 39% involved exchange of major services, as compared with all active ties observed: 62% exchanged emotional aid and 16% major services. The parent-adult child tie "transcends intimacy, different stages in the life cycle, and physical access"(p 216). Parents and adult children usually support each other, even when they don't enjoy each other. There is more variation in sibling relationships, and when there are more than two siblings, not all pairs are as strongly bonded. As many families have more than two siblings, the total amount of support from siblings is more than from parents, although individual siblings provide less than do parents.
Friends remain important as sources of support. They make up half of most active and intimate networks and provide half of most nonfinancial support. Although they offer less variety and quantity of support than exchanged between parents and adult children, friends are as likely as siblings and more likely than extended kin to provide support. Friends can take the place of kin in networks with no active kin ties; one or two intimate friends can provide a wide range of support. Ties with neighbors are less voluntary than ties with chosen friends, yet neighbors are important sources of routine companionship and aid.
Wellman's work on personal community networks offers an alternative to the "community lost" versus "community saved" debate in sociology. Critical analysis of community studies has challenged the idea of the single community as a proper unit of analysis, noting the historical trend for power which shapes community life to come increasingly from outside the geographical community. The discovery that people construct networks of voluntary relationships relatively independent of the geographic neighborhood offers the modern individual a new, more flexible "liberated" community (Wellman & Leighton, 1979). Reflecting on his findings on the place of kin, Wellman suggests that personal community networks may indeed represent a more mixed picture, with a "community saved" cluster of kin "efficiently structured for communicating needs and coordinating support" (p. 218) and a "community liberated" network of friendship ties, less densely interconnected and providing both companionship and access to diverse resources and relationships in the wider world.
Readers should bear in mind that Wellman's revtew is specifically restricted to "white, Northern-European ethnicity, employed, once-married, North-American 40 year old (sub)urban women and men with a child in primary school." Please send NETLETTER your suggestions for review of research literature on populations differing in race, ethnicity, class, geography, etc.
REFERENCES:
Fischer, C. (1982a). The dispersion of kin ties in modern society. Journal of Family History. 7, 353-375.
Fischer, C. (1982b). To dwell among friends. Berkeley: University of California Press.
Wellman, B. (1979). The community question. American Journal of Sociology. 84, 1201-1231.
Wellman, B. (1982). Studying personal communities. In P. Marsden & N. Lin (Eds.), Social structure and network analysis (pp.61-80). Beverly Hills, CA: Sage.
Wellman, B. (1988). The community question re-evaluated. In M. P. Smith (Ed.), Power. community. and the City (pp.81107). New Brunswick, NJ: Transaction Books.
Wellman, B., Carrington, P., & Hall, A. (1988). Networks as personal communities. In B. Wellman & S.D. Berkowitz (Eds.), Social structures: A network approach (pp.130-184). Cambridge: Cambridge University Press.
Wellman, B., & Leighton, B: (1979). Networks, neighborhoods, and communities. Urban Affairs Quarterly. 14, 363-390.
From Ross Speck (Mount Joy, Pennsylvania, USA), July 25, 1993: Once more a wonderful Netletter with lots of news. Your memoriam on Carolyn was excellent. We retire when my lease expires October 31, 1993. However, I am very active with the Union Institute and enjoying it .. Enclosed is a check for Netletter dues. Maybe you should raise the rates.
From Gunnar Forsberg (Stockholm, Sweden), September 19, 1993: ...Last week we had the first Swedish Conference in Network work and therapy, 360 participants, and I was given the honour to give the welcome speech reflecting on how things were when you came here 15 years ago and what has been going on in the field since then. We've had a breakthrough of network therapy into both Children and Adult Psychiatry which seems promising indeed. But the process of dismantling our welfare system has been speeded up during the bourgeois regime - and of course this hits hard at the schools, hospitals, and social bureaus. People get evicted from their apartments like in the 30's; violence and racism are now an almost everyday phenomenon. It is easy to become a pessimist and stop appreciating what we still have.... I enjoyed the Netletter, it looks elegant with its new layout and design. Thanks to you and Jodie for keeping it up. If and when I get the time I'd like for you to have at least some abstracts from our latest report from the Crisis Unit. By the way, Johan Klefteck is writing a book together with a Norwegian fellow Tenje Ogden on children's networks.... Next month we are having a course in a little village outside Trondheim in Norway and probably also leading a meeting focusing on a local crisis with sexual abuse of children. Teachers, policemen, and other professionals are accused as offenders and most people seem to know everybody else. So this may be a complicated task....
From Eva Bergerhed (Ronninge, Sweden), September 28, 1993: ...For one, or maybe it's two years, I've had your netletter and subscription renewal in the bunch of papers on my desk. Last year I changed money in dollars to send to you. But I think that's how life is - you think of important people in your life, but sometimes they get lost for a while. But for most of the times not forever....
I've been into a lot of different networking since we last met in Miami. After 3 - 5 years at the Crisis Unit for Children's Networks I got an inquiry from the National Board of Health and Welfare in Sweden to do an investigation concerning children in kinship foster homes. The project I'm responsible for started in September, 1992. So right now I'm on leave from the Crisis Unit to do this research. In our last report from the Crisis Unit (1992),1 wrote an article about "Mobilization of the social network when placements are in discussion -- When the personal and professional network meet."
Part of my study is a follow-up study of our first Network Project between 1984-86. When we mobilized the social network around families in crisis situations, where placements of children were in discussion, many of the children went on living within their network, most of them with kin. I've made interviews with children/youth, their parents and relatives. During the interviews I've drawn network maps with the children as a method. Apan from the follow-up study I've also interviewed families in Botkyrka and Gothenburg, where they haven't specially used network-methods in the placement process. The final repon is coming in February, 1994.
There has been a great interest in my study on kinship foster homes both in Sweden and in other countries in Europe. I presented some of my ideas at the 5th World Family Therapy Congress in Amsterdam in May, 1993.
In July, I had a workshop at the 8th International Fostercare Conference in Dublin, Ireland. The participants were also interested in network therapy as a way of prevention work with networks in crisis. One of the panicipants at my workshop was the director of the Child Welfare League of America. She became very interested in these ideas.
So back home in Sweden again I got a letter from Temple University in Philadelphia, PA. I was invited to the 3rd Annual Symposium on Child Abuse and Neglect, on October 15th and 16th! I was overwhelmed by it all and when they-wanted me to sit in a panel on "Global Perspectives" I nearly fainted. So now I'm coming soon to your country! I told the coordinator for the symposium that network therapy staned over 20 years ago at the Child Guidance Clinic, in his city, by Ross Speck and Carolyn Attneave. But he hadn't heard about it. "You never know what happens in your back yard," he said.
My own reflection is that "experts" are people that come from very far away. You don't look in your own neighborhood. It's difficult to be a prophet in your own close surroundings. That we also have experienced in Botkyrka.
Apart from the research and all the conferences, I supervise in network therapy and there is lots of interest in training in network maps and different network work in different professional contexts. Last year Gunnar, Johan, and I ended a three year network therapy training in Finland. Right now I'm supervising directly in network meetings, for a group of social workers who are on their 2nd year of training. I also have different groups in shorter, 10 day training, both in Stockholm and around Sweden.
And the most fun of all is that we had our first Swedish network conference in Stockholm on the 13th and 14th of September, 1993! It was the Crisis Unit, a Social Service Office, and a Child Guidance Clinic (Lennan S ), who arranged it. There was a lot of interest and finally we were about 360 people all together! People came from all over Sweden and from Finland and Norway as well. There were people from many different professional contexts and many people made presentations of their different kind of network work. I think we had about 32 different presentations in the seminars. That was great. I 'm sorry to say that Lennan couldn't participate because he fell badly and hun his backhead, so he had to stay in bed. But he is better now.
The last day we had a role-played network meeting, with two different teams leading the meeting. I conducted the whole assembly, with people sitting in their different professional contexts (four groups) and people sitting in different groups in the private network (four groups). All these groups were reflecting their feelings and thoughts around the network meeting. It was a great new experience to conduct a group of 360 people. And there were interesting discussions afterwards. People became touched by the network forces and also surprised by the complexity of network meetings. We have had a lot of positive feedback afterwards and many people would have liked to continue for several days.
So this was briefly what's going on in my networking life. Otherwise I've been introduced to the schoolworld, when our son, 7 years, recently started. It's a great experience to see how school has changed positively, in one sense. They support the children's own creativity. But in another sense, they cut down resources in school and everywhere in caring services in the name of economical crisis. So the people in the welfare state Sweden, now have hard times as well....
From Don Lugtig (Winnipeg, Manitoba, Canada), December 11, 1993: Thank you for the very thorough review of our Project in the Netletter. Both Don Fuchs and I are very appreciative of it. We have had many responses from the review and have had to print more Final Reports. I really regret that a more in-depth statistical analysis was not carried out by the Project team. But I am still hopeful that the data can be reviewed more thoroughly. In the meantime, I continue to work in the two neighborhoods to promote the development of resource centres. I teach an MSW course, "Networks, Communities, and Neighborhoods," in the clinical practice sequence. I am very hopeful that we can really get grounded in network therapy and look forward to participating in the conference this spring. I feel somewhat inadequate to the network therapy task and hope through the classes to get people interested who can build a program that can be used in community settings....Enclosed please find a contribution for the Netletter. Should be more!
From Diane Pancoast (Portland, Oregon, USA), December 13, 1993: I'm back at the Regional Research Institute for Human Services, Portland State University, where I'm doing some program evaluations. For one of them, I'm collectirig social network data on homeless families using the Whittaker/Tracy instrument.
Has there been any thought to going "on line" via Internet? I know just enough about the information highway to ask the question; I have no idea what the answer entails. [ED: I don't think it is possible to send NETLETTER, which is formatted with an old Microsoft Publisher, through the Internet, which I believe reduces text to the "lowest common denominator" (ASCII) among the computers in the network. Correspondence to NETLETTER can be sent to dtrimble@world.std.com.
From Branko Gaveic (Belgrade, Yugoslavia), December 15, 1993: Since I could not find any Christmas card here, I use the fax to wish you and your family as well as the other colleagues Merry Christmas and a Happy and Prosperous New Year. Also, I would like to thank you for your understanding of my situation and I sincerely hope that things will improve and that we shall continue our cooperation in 1994.... P.S. Each issue of "Netletter" you sent me was a special event for me!
From Jodie Kliman (Brookline, MA USA), April 19, 1995: With network methods permeating everything I teach in family therapy and social context, 1 am now leading a seminar, "Culture, Class, and Gender," at the Family Institute of Cambridge. It explores how race, ethnicity, class, gender, sexual orientation, and religion combine to structure family experience and family therapy.
In June, 1995, I am co-chairing a large Symposium in Cambridge, Massachusetts: "Clinical Dimensions of Migration, Immigration, Culture, and Class," for the American Family Therapy Academy. The network stories of migrants, immigrants, and refugees will play a prominent part in the symposium.
Network Assessment as Intervention Review of an Essay by Mary Youngquist
Mary Youngquist's essay, "Network assessment as intervention: Theory and praxis," reviews the contributions of system theory, network analysis, and social support research to social network intervention. Mary expands on the late Gerald Erickson's argument (1988) that family therapy be considered a subdomain of the field of network therapy. This argument describes family therapy as restricted to a synchronic (acontextual, ahistorical) mode of analysis, in contrast to diachronic analysis, which takes history and context i nto account [ED: In my review of Gerry's article (NETLETTER, IV, 1(1989)), I disagreed with this characterization of family therapy. While strategic and structural family therapies may be restricted to the synchronic, Bowenian, Systemic, Contextual and Narrative therapies all draw heavily on diachronic as well as synchronic analysis.] In expanding on Erickson, Mary shows how the full-scale network assembly inevitably requires attention to history and context, for example in the polarization phase, when old stories and contextual information widen the discussion beyond consideration of the current functioning of a family within its own household.
Mary describes the range of network intervention techniques (full and partial assembly, network construction and community network therapy), emphasizing the use of network assessment as an intervention in its own right. Assessment interviews gather network information, facilitated by the uses of the eco-map (Hartmann, 1978) and genogram. Information is available for both diachronic and synchronic analysis. The process of information gathering begins a dialogue about the client network generating new insights and altered perceptions, which lead to emergent strategies for change.
Mary's essay was one of three finalists for the Thuss award for outstanding scholarship in Ph.D. candidacy essays at Saybrook Institute in San Francisco, where Mary received her Ph.D. in September, 1991. Copies of the essay are available from Mary Youngquist at 1204 Harmon Place, Suite 4, Minneapolis, MN 55403 USA.
Erickson, G. (1988). Against the grain: Decentering family therapy. Journal of Marital and Family Therapy. 14, 225-236. Hartmann, A. (1978). Diagrammatic assessment of family relationship. Social Casework 59, 465-476.
Please note the following typesetting error in Carolyn Attneave's obituary in the last issue (VI, 2): The erroneous passage reads (on Page 1): "She was one of the first in family therapy..." (On Page 5)..."Long before it was fashionable, she addressed the family and community experiences of people of female and multi-cultural leaders. . . " The correct passage should read: "She entered psychology when it was a male province. She was one of the first female and multi-cultural leaders in family therapy and community psychology and one of the first psychologists of note in family therapy. Long before it was fashionable, she addressed the family and community experiences of people of color and the poor, in Native American reservations, rural hamlets, and inner cities."
New listings:
Eva Bergerhed, Ronninge Skolvag 6, S- 14462 Ronninge SWEDEN. Tel: 46-(0)8-53253280. Psychotherapist(family and networks); responsible on a project at the National Board of Health and Welfare. (On leave from Crisis Unit for Children's Networks, Botkyrka).
Center for Preventive Psychiatry, 19 Greenridge Avenue, White Plains, NY 10605 U.S.A. Interdisciplinary outpatient not-for-profit therapeutic agency - community and disaster intervention, children of the mentally ill, homeless children and adults, school consultation, interagency consultation, etc.
Bea Chorover, 262 Clinton Road, Brookline, MA 02146 U.S.A. MSW - Brookline Mental Health Center [Family therapy training supervisor].
Jay Cross, Bancroft Hall #612, 509 West 21st Street, New York, NY 10027 U.S.A.
Susan Evans, 434 Orondo Avenue, Wenatchee, WA 98801 U.S.A. MSW - Social work and ecology, private practice, air quality coalition, Artists in the Forests, building sustainable communities in North Central Washington, network interventions for mental health problems.
Family Institute of Cambridge, 51 Kondazian Street, Watertown, MA 02172 U.S.A.
Janice Furlong, Community Counseling Center of Blackstone Valley, 10 Asylum Street, Milford, MA 01757 U.S.A.
Zoy Kazan, 102 Gawler Place, First floor, Adelaide 5000 SOUTH AUSTRALIA. (08) 232-5776.
Lanssjukhuset, Vulenpsykiatriska kliniken, 801 87 Gavle SWEDEN. (Birgitta Ericson, Ulla Gidlof, Birgitta Sterner) We are working in a psychiatric clinic and have studied to become network therapists. Our work consists of leading full-scale network assemblies, training other staff and working on a network project together with voluntary associations for patients and their relatives.
Massachusetts School of Professional Psychology, 221 Rivermoor Street, Boston, MA 02132 U. S. A.
David McGill, 4 Wright Street, Cambridge, MA 02138 U.S.A. Psy D. - Multicultural practice Supervisor at Cambridge Hospital: Bilingual teams and couples and families center.
Tyreso Psyk Mott, Industrivagen 20, S-135 40 Tyreso SWEDEN.
Changes:
Richard Bailey, M.D., 2433 Blacksmith Way, East Petersburg, PA 17520 U.S.A.
Julia Halevy, Dott. Ped., 159 Maplewood Circle, Amherst, MA 01002 U.S.A.
Geza Patkai, M.D., Jarva PBU, Rinkebysvagen 70, 163 74 Spanga SWEDEN.
Paul Schoenfeld, Ph.D., Brief Therapy Centers of the Northwest,
9108 Lakewood Drive SW, Tacoma, WA 98499.
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