DATE: May, 1989
EDITION: Volume IV, Number 1
David Trimble, Editor
Jodie Kliman, Associate Editor
CONTENTS
---I am very sad to report the sudden death by heart attack of Gerald Erickson on February 13. Gerry was an enthusiastic contributor to the development of the social network perspective in mental health practice, and a warm, witty, and thoughtful colleague. Those of us who knew him will miss his distinct personal presence, and all of us who are committed to the network perspective have lost an important advocate and theoretician. Gerry was born in Wisconsin in 1935, moving to Canada in 1969, where he became a citizen in 1980. Formerly Director of the Psychological Services Centre at the University of Manitoba and the School of Social Work at York University, he was at the time of his death Director of the School of Social Work at University of Windsor. He received his M.S.W. from University of Michigan, and his Ph.D. from the University of York, England. Since his 1975 article in Family Process, he has been a consistent contributor to the theoretical understanding of the network perspective in the clinical literature. In this issue of the NETLETTER is a review of his 1988 article in Journal of Marital and Family Therapy. It is being translated into German and will appear in Familiendynamiks, Zurich in the spring. A set of responses, along with Gerry's posthunous rejoinder, "Linear Hisses and Systemic Cats" appears in the April, 1989 JMFT.
---Don Lugtig is now well under way with the beginning of his project in Winnipeg, Manitoba, Canada, with key staff hired and preliminary research on his target neighborhoods under way. His project promises to demonstrate the utility of the social network intervention approach in reducing the incidence of child abuse in two inner-city districts of Winnipeg. Diane Pancoast and I have each visited to provide staff training. Shirley Rodecker, the professional primarily responsible for clinical intervention for the project, attended the Ortho Conference with Jan Rodgers, a colleague from a Family Daycare Center in one of the target neighborhoods.
---Jodie and I had a visit since the last NETLETTER from Tom LaChiusa, a graduate student at the University of Southern California School of Social Work. He is working on developing a computer graphics program for mapping personal networks. Some of his ideas for spatial represention include the length of the line between network members denoting the significance or depth of the relationship between them, the size of the square or circle representing a network member denoting the frequency of contact between the member and the person at the center of the network, and the thickness of the line representing a quality of the relationship (e.g., agressiveness). Tom is at 2629 Portland Street, #201, Los Angeles, California 90007.
---Mauro Croce, from Verbania, Italy, is producing a newsletter, Pratica Social, a 16 page document with 2000 copies distributed to mental health professionals and others. He hopes to dedicate a special issue to network intervention. Still working in the drug addiction field, he is at Boscolo and Ceccin's family therapy institute in Milan. He may do a thesis on network intervention, if my long overdue mailing of The Guide to the Network Therapies arrives on time. Mauro last year worked on a team translating Howard Becker's Outsiders into Italian.
---Ross and Joan Speck have moved to rural Lancaster County, Pennsylvania. Their address is Janet Drive, R.D. #1, Box 344, Mount Joy, Pennsylvania, 17522. Telephone 717-653-2694. Their temporary office address is c/o Richard W. Bailey, M.A., 5505 Main Street, East Petersburg, Pennsylvania, 17520. Telephone 717-569-1151. Ross reports that they have already trained a local team, who have started to do interventions. He described an intriguing invitation to conduct a network intervention in New York state for an apparent case of cult entrancement. We'd love to get a description of the intervention! Ross and Joan will be leaving for Europe in May, to attend a conference convened in Brussels by Mony Elkaim.
---This year at the American Orthopsychiatric Association (Ortho) Conference (April, 1989), Jodie Kliman convened a workshop, "Social Network Intervention in the U.S., Canada, and Scandinavia."
Panelists were Anne Coppard of Toronto, Gunnar Forsberg of Stockholm, Live Fyrand of Oslo, Larry Ruhf of Holyoke, Massachyusetts and David Trimble of Boston. Gerry Erickson's participation was sorely missed this year - his contributions have always been stimulating. Anne presented two case descriptions from the Community Occupational Associates (COTA) program, illustrating case assessment, coping with a large chaotic network (about 11% of their caseload), linking a multitude of settings by visiting them all, and coaching assembled members of a network. Ann noted that they are running out of occupational therapists to train in the COTA network approach, and have begun to train social workers. Once again, she provided copies of the COTA bibliography, an excellent referece for anyone who wants to embark on network intervention for chronic schizophrenics. The COTA network intervention program, by the way, is a permanent and reliably funded component of that organization.
Gunnar presented some of the findings from his group's child welfare demonstration project, and described the new enterprise of a crisis center in Botkyrka, Sweden, a project which includes the same group of colleagues (Johan Klefbeck, Eva Bergerhed, Gunnar Forsberg, Astrid Hultkrantz-Jeppson, and Kerstin Marklund). News from this group is summarized below, in the CORRESPONDENCE section, as is the news from Live's work in Norway.
Larry's rousing presentation conveyed the enthusiasm and optimism of the Mount Tom group, who continue to use network intervention for "highly stuck cases" in the human service system of the Holyoke, Massachusetts area. He emphasized the importance of shared emotional experience during the connecting phase of the assembly. The team is exploring the use of network intervention with divorce and with AIDS (see Jodie Kliman's contribution, below). A very exciting moment for me was when Larry introduced two therapists and an administrator from Norwich, Connecticut, where Larry had done some training. They have a one-year interagency demonstration project going, with three teams of three members each, conducting from five to ten network assemblies per year. The enterprise is "funded" via each agency donating a set number of staff hours per month; each team is composed of members from different agencies. They report that, once a critical minimum number of administrators were willing to commit their resources, it was relatively easy to get administrators from other agencies to join in. The early impetus came from the state mental health agency, whose administrators were under heavy pressure with scant resources to serve their patients, and who were impressed by their own professional staff's willingness to volunteer more than their alloted work time to do network intervention. This pooling of agency resources is a good model for getting network intervention established in a local human service system; Jodie Kliman and I described a similar phenomenon in "Ocean City" (Community network therapy: Strengthening the networks of chronic patients. 1981. International Journal of Family Psychiatry, 2, 269-289). The Norwich project is the latest in a series of efforts in that region of Connecticut (e.g., Terri Eblen in Willimantic) undertaken by trainees of Mount Tom or Paul Schoenfeld; I get the impression of accumulating momentum. Perhaps Larry could get someone from Norwich in touch with me for a NETLETTER subscription? My contribution to the panel was a whirlwind tour of network intervention methods, emphasizing network coaching using the David Todd mapping approach.
On the eve of the workshop, Jodie hosted a gathering for the network therapists in town, including the workshop participants, alongh with Odd Haugen from Norway, Kathryn Kaminsky from Mount Tom, Claudia Blumberger from COTA, and Shirley Rodecker and Jan Rodgers from Winnipeg. It was a great feeling of retribalization for all of us, working in so many places, to share our common commitment to working with networks. I look forward to future tribal gatherings.
The workshop was scheduled for the afternoon of the last day of the conference, which I believe explains the sparse attendance of 14. Next year the Swedish, Norwegian, Mount Tom, and COTA groups all plan to apply for separate presentations; I understand that Mount Tom will offer a role-play simulation. I will apply for another panel-style workshop. Because each group will, I hope, be presentating elsewhere at the conference, I need to change the format from what has become the traditional review of works in progress. I am thinking of something along the lines of, "Network intervention - Principles of application," with representatives of each group presenting their view on the utility and application of their choice of specific principles of the craft. We have agreed informally among ourselves to include a cover letter with our applications to Ortho to say that, should Ortho want to combine our efforts, we would be happy to do so in a one or two day Institute. Next year, the Ortho conference will be held in Miami, from April 25-29. I hope to see you there!
I don't have a particular issue this time for this section of the NETLETTER; I hope that in time this will be the place for discussion, argument, or, to quote Gerry Erickson, "interpretive polemic." Perhaps in the next edition someone will respond to Gerry's JMFT article, or to my review of it below. I would be grateful for readers' comments on issues such as future direction for network intervention, problems with the network approach, or particular issues associated with particular populations, e.g., AIDS, substance abuse, child abuse, incest, etc. Speaking of substance abuse, do any of our readers know of the historical link between the network assembly and a method used for substance abusers known as "Intervention?" Given the fact that both involve assembling network members and both use the term intervention, I think it is fairly likely that they both originated from Ross Speck and Carolyn Attneave's pioneering. Has anyone participated in both forms of intervention? Could someone contribute a critical comparison of the two approaches? Mary Youngquist has contributed a piece on network intervention with a family with an incest history; in that case the intervention was productive without ever assembling the network (NETLETTER, May, 1988). Has anyone else used network intervention for incest situations, and, if so, how did you deal with the resistance to exposing this family secret? In the Boston area, the problem of shame has become very fashionable in psychoanalytically-oriented professional education. Perhaps someone could try to integrate work on the concept of shame with the use of network assembly to confront sexual exploitation in families.
My pessimism about the future of network intervention in the United States has been alleviated somewhat by the enthusiasm at the Ortho conference, together with the news from Ross Speck and from Norwich, Connecticut. Once our youngest son has entered school in a few years, I plan to devote substantial effort to establishing opportunities for network intervention in the Boston area. Our local group, Network Consultants, lapsed into inactivity just after we completed the early stages of a marketing strategy (see NETLETTER, May, 1988). I hope to see if I can get the eastern region of Massachusetts Department of Mental Health to follow the example set by the Mount Tom team in the west. I will also explore the development of network intervention programs for child welfare agencies. Just recently, I ran into the opportunity to keep my hand in through my small private practice. I have started getting requests to serve as an expert witness in child custody cases, which has allowed me to reactivate a method I found useful years ago for one such case. In conducting an evaluation, I first interview each parent alone with the child(ren). I then ask each parent to bring to a second meeting at least three people who are or will be involved with the welfare of the child. These members of that parent's household support system might be friends, the parent's spouse, extended family, etc. By the time I have to render an expert opinion, I have fairly good data about each parental household and its support system.
Erickson, Gerald D. (1988). Against the grain: Decentering family therapy . Journal of Marital and Family Therapy, 14,225-236.
In what Gerry described as an "interpretive polemic" challenging the "hegemonic circular- systemic paradigm," he asserted that family therapy is informed by a system model which is primarily an extension of structural linguistic theory, combined with some use of a metaphor of self-regulating machinery (i.e. cybernetics). He then criticized that model as essentially antihumanistic, and incapable of addressing issues of class, gender, or history. He forecast a future in which a social network perspective informs our thinking about therapeutic change, with family therapy seen as but one form of social network intervention. The family system model would no longer be at the center, but simply one of a number of alternative constructions of therapeutic intervention. The article combines some of the best of Gerry's scholarly stance, conceptual clarity, and rhetorical wit.
Gerry saw the core of the family system model to be the synchronic mode of analysis, originally developed by de Saussure, an early 20th century linguistic theorist. Synchronic analysis entails an exclusive focus on the simultaneous relations among the constituent elements of a system, at the moment of analysis. De Saussure's approach includes also a diachronic mode of analysis, which addresses development and history. The synchronic and diachronic modes are employed separately; neither can be reduced to the other. Gerry noted the extension of structural theory into other domains, e.g., literary analysis, anthropology, and, particularly, into Bateson's systems theory. His position was that the synchronic mode of analysis is at the core of family system theory. Because synchronic analysis excludes persons (focusing instead on the patterning of relationships among persons), context (dealing only with relations among constituent elements of the system), and history (restricting itself to the moment of analysis), one can find no basis for interpretation of meaning or for intervention within the system itself. Meaning and action are therefore generated by the therapist as interpreter of the system. Theoretically, the synchronic stance itself sets no constraints on the therapist's interpretation. Constraints come from the therapist's "interpretive community" (i.e. particular school of family therapy). In therapy sessions, the family's narrative is treated as manifest content. "The correct and true understanding is latent in the simultaneous relations and can be grasped only by those adepts who have a special vision, a synchronic vision, in fact, a special ability to conduct systemic analysis"(p 230).
Having thus characterized the field of family therapy, Gerry criticized it sharply. The family therapy approach empowers the therapist, as maker of meaning, at the expense of the family, whose utterances are only the raw material for an understanding which is inherently unknowable for them as family members. Gerry asserted that family therapists in fact never attempt to educate family members to the systemic view. The narrow domain of synchronic analysis excludes too much of what should be important to the family therapist. "If events in childhood 'matter' for adult functioning (not to speak of mattering for children), if gender matters, if actual events in adulthood matter, if actual social/political/ideological situations matter, then any notion that a general synchronic basis for family therapy is possible is swept away and no amount of theoretical cosmetics will be able to save the system"(p 232).
Gerry forecast the ultimate collapse of the family system approach as the center of social psychotherapy, with the systemic approach shifting to a place among equals within a social network intervention framework. Because networks are open systems, whose spatial and temporal characteristics are continually changing, they cannot be grasped within the synchronic mode of analysis. The network perspective generates information about persons, about relationships, about the structure of relationships, "and how structures, persons, and relationships have changed over time in particular contexts." For Gerry, the network concept was inherently diachronic, since an historical account is necessary to understand any current state of the network.
I found the piece to be very clear and entertaining, and the intellectual history of the synchronic mode to be quite informative. Insofar as one sees the family system approach as limited to a synchronic and cybernetic perspective, Gerry's criticism of its narrowness of view and of its empowering the therapist at the expense of the family is cogent and effective. Certainly, any of us can bring to mind family therapists who are proponents of such reductionistic systemic ideology. I do have two problems with Gerry's argument against the family systems approach. First, I think there are many systemic family therapy approaches which are not restricted to a synchronic/cybernetic perspective. Theory from the Milan group, strongly informed by psychoanalysis, takes individual psychology into account. Although Boszormenyi-Nagy no longer claims that his contextual therapy is systemic, one can argue for its systemic character, and it embraces issues of moral value and of history. Bowen's systemic family therapy addresses history. One can't conduct family therapy from a social learning perspective without taking a careful history. And one of the primary intellectual sources of general systems theory, the work of von Bertalanffy, came from developmental biology. Second, family therapists are clinicians, and any good clinician is able to reach beyond the constraints of his/her therapeutic paradigm to frame an intervention fitted to the persons, the situation, and their history.
I have to disagree with Gerry's description of the network perspective as inherently historical and respectful of the person qua person. If we take network analysis as the theoretical base for network intervention, then, I think, we encounter some of the same problems with structuralism. From my (admittedly rather limited) reading of the social network analysis literature, I find a fairly strong structuralist movement among its theoreticians. These network analysts challenge traditions within sociology which explain action as the consequence of norms, values, or beliefs internalized by persons. Stated in its most radical form, their assumption is that action can be explained by the actor's position in a particular pattern of relations among social entities. Perhaps Barry Wellman or Susan Greenbaum might agree or disagree with this characterization of network analysis. If it is appropriate, then the network therapist can be as embarassed as the family therapist over "antihumanistic" theory. I discussed this problem earlier (NETLETTER, April 1987 ) in my critique of Halevy-Martini et al.'s 1984 Family Process article. Again, in practical terms, I think that network therapists respect persons and history in their work, as do most family therapists.
I do hope that Gerry's polemic will be effective in challenging the intellectual constraints of some proponents of family systems therapy. I believe that it does point to the danger of training "professional family therapists" who are not otherwise educated as mental health clinicians.
--Gunnar Forsberg has sent the final report of his group's project at the Alby Social Bureau in Sweden (Natverksarbete i multiproblemfamiljer (1987). Johan Klefbeck, Eva Bergerhed, Gunnar Forsberg, Astrid Hultkrantz-Jeppson, Kerstin Marklund. Botkyrka Kommun Kommungemensam Socialtjanst Natverksprojektet 147 85 Tumba. Tel. 0753 - 61 00.) I have asked him to provide a summary review in English for the NETLETTER. In his letter accompanying the report, Gunnar compared it favorably with the book, Natverksterapi, in recounting how their team has been influenced by the Mount Tom (Massachusetts) people, and in its extensive discussion of mapping. The project includes thorough studies of 62 individual child welfare cases, and a statistical study of 300 cases treated in the two years of field work. They demonstrated a reduction in the frequency of placement of children out of their family homes, through interventions which activated the families' networks, which in turn helped the families to find new ways to handle their children. When children did leave the family homes, they were usually placed within their networks in ways which kept their ties with their families active. Network mapping was a productive way to mobilize client networks in less critical cases which did not require network assemblies. At the Ortho conference, Gunnar presented some raw data suggesting a linear relationship between the amount of social network intervention with a case and the degree of relief from symptoms, using clinician rating of symptoms. He also reported evidence that social network intervention eliminated repeat child welfare reports for those cases which had network therapy.
Gunnar and his group have been very active teaching the network approach around Sweden and Norway, and in May went to a family therapy institute near Lyons, France, where they met with social workers from southern France and Switzerland. Johan Klefbeck, Astrid Hultcrantz-Jeppsson and Kerstin Marklund have been active in the Botkyrka region teaching the network approach to social bureaus and institutions.
At the conference, Gunnar reported that the same group who conducted the child welfare project has now secured government funding for a crisis unit in the city of Botkyrka which is linked to residential homes for children and teenagers, local child guidance clinics, schools, preschools, family daycare homes, health centers, a child psychiatric clinic, five social work districts, an emergence social bureau, emergency foster families, substance abuse programs, volunteer, childrens' rights, and AA organizations, and walk-in clients. The project has supportive ties with city, county, and national governments, as well as a local university school of social work. With this wide a range of potential referrals, they should be quite be quite busy and productive. I hope that they will be able to arrange to present their work at Ortho next year.
--- The following letter comes from Live Fyrand (June, 1988)...
I went to the Sunbelt conference no. VIII (Social Network Conference) in San Diego, Feb. 11th- 14th, 1988. It was an impressive program, and the structure very imposingly organized During these days, approx. 100 papers were presented, dispersed on 25 main topics. The topics covered the broad area of network-analysis and some areas of the application field. Topics as: "Social Support," "Gender, Ethnicity, and Aging," "Networks and AIDS," "Exchange Networks," there were presentations of papers both on the analytical and applicational level.
My impression is still that there was a lot missing in this conference, such as the professionals working with application of the network theory, especially in the area of health and social work. Where do the different professionals get the opportunity of having a dialogue between the network analysts and the professionals that are using this theory in practice?
However, I am not going to send you a 'traveling letter.' I will now tell you more about my project.... Let me first introduce myself. I am an assistant professor at the Lutheran School of Social Work in Oslo, Norway. For the time being I am a project-leader for a two-year project, with the goal of developing network intervention methods on the curative and preventive level.
The project started in August 1987. The school is cooperating with seven agencies in the health and social field, woho have selected a cross-professional group from each agency to join the two-year project. We have 26 professionals from these agencies.
The goal is to:
-Teach the agencies different kinds of strategies in developing social network methods.
-Help the project participants in developing small projects in their agencies, to try out and
develop further
what they have been taught from experienced experts.
The project-group with health and social workers, is meant to be 'a pool' of practical network
experience
and knowledge with this approach to the broader field of health and social professional network
in
Norway.
The first step is to learn about what Froland & Co. calls the 'personal network strategy.' Next step is to continue learning about network-methods with volunteers (called 'volunteer linking'). These are the topics for the first year in the project. I have called it 'Network-process on the individual and family level.'
The goal for the second project-year is, firstly to learn about what Froland calls 'mutual aid strategy,' as I understand it: Different kinds of self-help groups. The second goal is to learn about preventive network-methods in the neighbourhood. I have called this topic the second year for 'Network- process on the group and community level.'
The program for the project is as follows: Each project year (in the Autumn) begins with an open Nordic Conference for health and social workers. The aim for this seminar is to give an overview introduction to the field. The number of participants can be from 80-250 (Last Autumn we had 230 from Iceland, Denmark, Sweden, and Norway).
This seminar will be followed by a closed seminar for the project participants only. The goal for this seminar is to go deeper into the topics from the first seminar, theoretically and with skills training on the practical level. The intentions with these four days will be to give the project participants a kind of basic starting point for developing their own projects.
From their agencies, clients and the problem situations the clients are presenting, the project- participants shall 'try out' the methods they have been taught during the seminars.
The next step in the program is then to give them consultation on the project they start in their agencies, in order to increase the learning effects and help them in the project-process. So I need teachers both for the seminars and for the 'follow-up' consultation over a year.
On the one hand I want the project participants to 'try out' the methods they have been taught, which are relatively clearly developed, and on the other hand I want to make further developments of these methods. I think they will focus differently on the various methods depending on the characteristics of the agencies, type of client and the problem. We intend that the speeches from the Nordic seminars should be published in a book if the teachers want that. I have an agreement with a publisher about this possibility. The project participants are regularly writing reports from their projects. At the end of the project they also will present the results in a book. The intention is also to get this book translated into English, because I know that this would be of great interest for many people.
The project agencies are as follows:
-Psychiatric clinic for adults, VI A, Ulleval Hospital
-Tasen aftercare psychiatric institution for adults
-Larkollen psychiatric institution for young people
-The Lutheran Somatic Hospital - the department for elderly and chronic illness
-Grunerlokka Service Center for the Elderly
-Grepperod residential psychiatric treatment agency for young people
-Moss social welfare office
The agencies cover many of the sectors in the health and social field, which has been an important goal with the project, for spreading this approach to the other institutions in the same sector of Norway. (Live Fyrand, Oslo, 1988)
Live reported on this project at the Ortho conference. She reported that, with each agency having an interdisciplinary project group with a total of only about 30 professionals in the seven agencies, the network perspective has already pervaded among all the staff at all the institutions. Some of their early technical findings include the utility of mapping for working with unemployed adolescents, and the utility of assembling networks in reducing clients' projections. Some professionals have had to struggle with the challenge of relinquishing their control needs in initiating self-help groups. General effects of the project include the following: a stronger orientation toward resources; more focus on relationships; constructive effects on the agencies themselves; organizational development through greater integration; and a focus on the needs of the clients, rather than the particular strengths of the agency.
Live is hoping to assemble an international conference on network intervention after completing her project. Stay tuned for further news on this.
It is a tremendous challenge for mental health professionals to address the complex and frightening psychological issues raised by the AIDS epidemic. Unfortunately, many of the efforts in this area have been fragmented. For instance, one professional may lead groups for people with AIDS (PWA's), another for families of PWA's, a third for lovers of PWA's, while yet another works preventively to educate young people or IV-users about safer sex. While all these efforts are important, most do not address the interconnections between the experiences of these different groups. As network workers, we can help make these interconnections visible and usable to our clients and to our colleagues.
Of particular concern is the tendency for the networks of many PWA's (and the networks of people at high risk of getting AIDS) to polarize along a number of social and psychological lines. For instance, a gay PWA's family may polarize against his gay and lesbian friends, blaming their participation in his life-style for his illness. At the same time, his friends may the encourage the PWA to distance from his family, for fear they would not be understanding or supportive. The net result may be that a very sick and increasingly dependent man may literally have to choose between sources of support and intimacy rather than benefitting from their cooperation. Such polarization can be further intensified when the PWA comes from a culture (e.g., Hispanic or Fundamentalist) which is epecially unaccepting of homosexuality but has himself moved into a primarily gay personal network. Similar polarization is possible when AIDS is acquired through sexual contact with IV drug users. For instance, a female PWA may feel forced to choose between her family, who disapproved of her addicted partner to start with and who may be trying to remove her children from her care, and her partner, who may also be dying.
A network approach has a great deal to offer in such polarized situations, as the case that follows will demonstrate. Network techniques can be used to heal rifts and decrease the emotional toxicity of relations among different segments of the network of a PWA so as to offer more support to the the PWA him/herself. Convening the networks of PWA's may also offer a significant therapeutic and preventive benefit to all those who participate. Trimble, Kliman, Villapiano and Beckett (1984) have demonstrated the powerful positive effect that participating in the network of a suicidal client can have for that client's friends, relatives, and helpers. There is every reason to expect similar benefits for the networks of AIDS patients. AIDS is a disease which demands too much of tis direct victims and of its indirect victims (those who care for and love the PWA, including those who have reason to fear it may claim their own lives as well). When many network members are psychologically drained, fearful, and involved in anticipatory mourning, the healing and mutually supportive possibilities of network intervention can be enormous.
Last spring, the Mt. Tom network team in Holyoke, Massachusetts organized a full-scale network assembly for a client who was dying of AIDS. I was interested in learning how to apply network principles to psychological work with AIDS, and asked to join the team as an observer- participant. This collaboration was important to me both because there was so much I wanted to learn about network approaches to AIDS and because it was the first time in years that Eastern and Western Massachusetts network therapists had had the opportunity to learn from each other by working directly together as a network team. The network intervention was very meaningful and gratifying on both counts.
Before describing the assembly, it is necessary to point out that I will be describing it using the conceptual lens with which I am most familiar, that of the six-stage spiral model developed by Speck and Attneave (1973). The Mt. Tom team's work with this case was informed by their own three-stage model of convening-connecting-shifting locus of responsibility (Halevy, 1984). The assembly could be accurately described using either model; I am using the six-stage model only because I use it more easily than the three-stage model.
Unfortunately, by the time it was posible to convene the network, the identified patient was already very close to death and unable to leave his bed in the hospice where the assembly was being held. Despite the anguish and frustration this situation presented to all concerned, the assembly went on as planned, which turned out to be a good decision. The assembly was conducted by Kathryn Kaminsky, whose medical expertise as a nurse made her the natural choice for that role. Much of the pre-assembly work involved Kathryn's contact with health professionals and those friends who were responsible for monitoring the patient's care. Larry Ruhf and Liz Hemley were team members. I worked at the periphery of the team, observing more than participating.
Because the man whose network was assembled was a human service professional who could be easily identified in his own community, I will keep identifying material to a minimum. "Art" was a gay man in his 30's who came from a large Catholic family. He did not have a current lover, but former lovers were included among his many friends and caretakers. He was professionally interested in networks and he asked for a network intervention to support his family and friends. It rapidly became clear to the network team that he was a remarkable man who had been immensely supportive to his friends, colleagues, and much of his family. He was both loving and well-loved. His relationship to his family was complex, largely because some of his older siblings did not accept his homosexuality and held it responsible for his illness. They presented for the most part as overtly hostile to his homosexuality and to his homosexual friends. His younger siblings ranged from neutral to confused about their brother's homosexuality but struggled more effectively to stay emotionally connected to him than did their elders. Some of his friends were somewhat hostile in the way they "protected" Art from his family; others stood outside the family-friend polarization. Friends rather than family were doing most of the non-professional caretaking and checking in with health professionals, at Art's request.
Because Art was too weak to attend the assembly, two network activists--a friend and a brother-- were designated ambassadors between the assembly downstairs and the patient up in his bed. Art's original plan had involved his active participation in helping his family, friends, and caretakers grieve his impending death together and to help bring together the polarized factions of relatives vs. gay friends. He was too weak even for network members to visit him at bedside; nevertheless, he, the network team and some key activists determined that much the same work could be done even without his presence. Much of this work was accomplished, but I did wonder if an earlier assembly might not have given Art enough of a boost to gain a temporary reprieve from his rapidly approaching death. Harold Wise, M.D., at an American Orthopsychiatirc Association conference presentation in 1981, described such short-term benefits from the network assemblies of terminal cancer patients.
The network was assembled for one meeting, which took place at the hospice where Art spent his last weeks of life. About 15 people attended, including his siblings and in-laws, a few cousins (including two who appeared to be gay), friends (including colleagues who had become close friends), some colleagues from work around AIDS, a couple of health professionals involved in Art's care, and a volunteer helper/buddy to Art. Several network members had also been in contact with various health professionals and some friends who were out of town but quite involved in planning the assembly. Art's elderly, widowed father, who was being "protected" from the knowledge that his son was gay and dying of AIDS, was not invited.
Parts of the network were significantly polarized in a way which was unhelpful to Art, who needed the comfort of a network less marred by tension and anger. This polarization could easily interfere with the necessary process of Art and his network letting go and grieving. At the assembly, two of Art's sisters expressed feeling excluded, angry and resentful because Art had chosen to be taken care of by friends rather than relatives. These expressions were heightened when relatives learned that Art had chosen to give two friends power of attorney and executorship of his will.
Although the network was polarized (and, of course, depressed as well, given the circumstances), retribalization gave network members with conflicting positions a chance to recognize each other's love for Art. Friends and relatives who had never met had a chance both to air their differences and acknowledge shared concerns. Late in the meeting two of Art's older sisters were able to acknowledge their intense pain over Art's illness and over his turning outside the family for support. This communication of grief helped begin to break through some of the anger that was interfering with the sisters' anticipatory grieving and with their ability to stay connected to their brother. It also broke down some of the polarization, in that it was easier for gay friends to respond empathically to the sisters' feelings of loss and rejection than to their angry judgments about homosexuality and Art's choice of friends.
By the end of the meeting, although great sadness was shared by all, a shift had occurred away from polarization, and there appeared to be more mutual appreciation and respect among the people who had come together out of love for Art. While there was no sense of radically altered viewpoints or newly evolving relationships between the "camps," cooperation now seemed more possible. Certainly, many network members seemed further along in the grieving process, as well as more respectful of the legitimacy of each other's feelings about Art.
Art died only a few weeks after the assembly. Some team members attended his funeral; Larry Ruhf reported that there was no evidence of strengthened ties between family and friends, but that the network was still considered helpful. I believe that intervening into the networks of PWA's early in the course of illness could be far more therapeutic for all concerned. I urge readers to consider such interventions and bring them to the attention of NETLETTER so we can develop this work together. I also invite my Mt. Tom colleagues to discuss this case from the perspective of their three-stage model, which I could not do with confidence.
Halevy, J., Hemley-van der Velden, E., Ruhf, L., Schoenfeld, P. (1984). Process and strategy in network therapy. Family Process,23, 521-23.
Speck, R., and Attneave, C. (1973) Family Networks. New York: Pantheon.
Trimble, D., Kliman, J., Villapiano, A., and Beckett, W. (1984). Follow-up of a full-scale network assembly. International Journal of Family Therapy, 6, 102-13.
---This edition should have been finished in the fall of 1988; we bought our first home late that summer, and our Jacob turned two in October. NETLETTER joined the pile of unfinished projects on my desk. I think that the best I will be able to do for the next few years is to prepare two editions per year, issued in the late fall and early spring. I will update the Directory every two years, and ask for subscriptions on the same schedule. Please note that not everyone on the current mailing list has paid for subscription ($5 per year is still a bargain, even for two issues) or filled out a directory listing form. If you get a form with this edition, please respond!
---As you can see, the NETLETTER is gradually accumulating contributions from its readers, either as letters or as brief articles. I welcome your contributions; remember that NETLETTER does not claim copyright, which remains with the contributor. You might want to utter your opinions in VIEWS, review a book or article (particularly one in your language if it is other than English) for REVIEWS, write a letter on your network project for CORRESPONCENCE or send us a draft of an article you might be considering for a future submission to a "real" journal for CONTRIBUTIONS. If you need information/access to resources, I will print your request in RESOURCE EXCHANGE. I'm looking forward to hearing from you!
---In the following updates of the NETLETTER Directory, my descriptions are in parentheses, and the subscriber's self-descriptions are in quotes:
- The following are new subscribers: Herman Baars and Hans Uffing Department of Social Psychiatry, University of Limburg, P.O. Box 616, 6200 MD Maastricht, THE NETHERLANDS. tel 043-882231/882232. (Gerry Erickson sent me their names in October, 1988, after two days consulting with them on their research project, and promised to send me a copy of their publication. I recall that one of the Ortho panelists also mentioned them. The NETLETTER would be happy to hear from you!)
Eva Bergerhed Svartensgatan 5, 11620 Stockholm, SWEDEN. (A member of the Botkyrka group).
Walter Driedger 637 Kilkenny Drive, Winnipeg, Manitoba R3T 3E2, CANADA. tel (w)204 474- 9224 (h) 204 269-9873. (A professor at University of Manitoba, colleague and friend of Gerry Erickson, who teaches and practices network intervention).
Family Networks, Inc. 1009 Lowry Avenue, N.E., Minneapolis, Minnesota 55418, USA. "Mental health day treatment programs for adolescents. Network therapy with client families."
Susan Greenbaum Department of Anthropology, University of South Florida, Tampa, Florida, 33620 USA (New Editor of Connections).
Astrid Hultkrantz-Jeppson Reymersholmsgatan 65, 11740 Stockholm, SWEDEN. (A member of the Botkyrka group).
Johan Klefbeck Hogbergsgatan 72 og, 11653 Stockholm, SWEDEN. (A member of the Botkyrka group).
LaChiusa, Tom 2629 Portland Street #1, Los Angeles, California 90007 USA. (Social work graduate student working on a computer graphics program for mapping networks).
Kerstin Marklund Blommensbergsvagen 168, 12651 Stockholm, SWEDEN. (A member of the Botkyrka group).
Diane Pancoast 12843 SW Iron Mountain Boulevard, Portland, Oregon 92719, USA. (Pioneer in work with natural helpers in the community).
Carin Roberge 300 Highland Street West Newton, Massachusetts 02165, USA. "Psychology; Doctoral candidate..Final project at Massachusetts School of Professional Psychology in the area of single mother's social networks. A longstanding interest in the area of social networking."
Shirley Rodecker 57-2090 Pembina Highway, Winnipeg, Manitoba, R3T 2G8, CANADA. tel 204 944-4184 "Social worker" (Primary clinician in Don Lugtig's child protection demonstration project).
Jan Rodgers 691 Beresford Avenue, Winnipeg, Manitoba R3T 1J9, CANADA. tel 204 289- 1753. "Family Daycare Centers...Community Groups within inner city."
-The following subscribers have sent in self-descriptions on the Directory listing form:
Mauro Croce "Psychologist and criminologist...(Working with) Drug addicts, adolescents."
David Duboff "Student-University of Michigan School of Social Work. Volunteer work: Ann Arbor Tenants Union...Intervention in network of mental health consumers as indigenous self-help group leader. Networking with Midwest Regional Network of National Tenants Union." Barry Wellman "Sociology... Causes of social support - Analysis of interviews and surveys."
-The following subscribers report changes of address:
William Beckett 250 Copeland Street #3, Quincy, Massachusetts 02169 USA. "Private practice (LICSW)...Subscribing to the newsletter."
Live Fyrand Henry Lehresv. 33, 1310 Blommenholm, NORWAY tel 2/544291.
Gilbert Kliman Director, Preventive Psychiatry Service, Department of Psychiatry, Saint Mary's Hospital, 450 Stanyan Street, San Francisco, California 94117 USA. tel 445 567-6287.
Ross and Joan Speck Janet Drive R.D. #1, Box 344, Mount Joy, Pennsylvania 17552, USA. tel (h) 717 653-2694 (w) 717 569-1151.
---Tom LaChiusa (2629 Portland Street #201, Los Angeles, CA 90007) asks if anyone can direct him to any validity or reliability studies of Pattison's Psychosocial Kinship Inventory.
---Gilbert Kliman (Department of Psychiatry, Saint Mary's Hospital, 450 Stanyan St., San Francisco, CA 94117, tel 415 567-6287) is looking for a clinician qualified to conduct network assemblies for children hospitalized psychiatrically at Saint Mary's, as a way of mitigating the traumatic effects of the separation and of preparing the network for the child's reintegration into the community.
---The University of Manitoba School of Social Work is looking for a new Department Chair.
---Is there any news from Minneapolis? Last we heard, Mary Youngquist was hoping to study shamanism in network healing as part of her graduate studies. Now that Paul Ruff has left Family Networks, NETLETTER no longer has a contact person there.
---I ran into a number of interesting titles in a recent Sage Publications mailing (Post Office Box 5084, Newbury Park, California 91359 tel 805 499-0721; add $2.75 for postage and handling.
Biegel, D., McArdle, M., & Mendelson, S. Social Networks and Mental Health - An Annotated Bibliography 1985. $27.50.
Gottlieb, B. (Ed) Marshalling social support In press. $32.50 (hardcover), $16.95 (paperback).
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