So here it is: the fortieth anniversary of the Association of Family Therapists. A good time for reflection. I’ve been re-reading parts of a series of commentaries and notes I wrote for this Newsletter in the early 1990’s and came across these passages (slightly modified):

“I’m trying to reconstruct the past, the beginnings of this organization, in fact. Getting the historical record straight isn’t easy. Like family members, some remember the facts one way, others another. The harder I try to find out the true story, even though I was there, the more obscure the peripheral details seem. Why didn’t someone write it down at the time? Or if they did, where are the records?”

Here is the first telling of the story. It’s as I remember it with the help of phone calls to Marty Kirshenbaum and Joan Herrick who were also there at the beginning.

The context

In the early 1960’s family therapy was in its earliest pioneering phase. At the Mental Research Institute in Palo Alto, Don Jackson, Virginia Satir, Jay Haley, Paul Watzslavick and John Weakland were originating the foundations of theory and practice. At Yale, Stephen Fleck, Theodore Lidz, and Alice Cornelieson were reconstructing the family dynamics of schizophrenics. Gregory Bateson was delineating the grand design of systems theory, Bowen was innovating in the East, and everyone was studying with Milton Erickson.

Several therapists in the Bay Area were recent graduates of the first Intensive Course offered by Jackson, Satir and Haley, and wanted a forum for further study, teaching and clinical sharing. I had come in from Yale.

There was a zeal and enthusiasm for the possibilities of using systems theory in many different clinical settings and working with the problems of the individual in the context of their family, work and society. The theory and practice had (and has) embedded in it a value system that is inclusive rather than exclusive. We all understood that; ‘When in doubt, bring everyone in.’

Family therapy was direct and active, we eagerly embraced the experiential and there was a value placed on self-disclosure. We were simultaneously beginners and experts, students and teachers. The idea of an informal group was inevitable.

The place

Where did poor clinicians hang out (before hanging out was something we knew we were doing)? San Francisco’s North Beach.

It was the era of the Beatniks. Rexroth reading to Jazz in the Cellar, Ginsberg getting busted for ‘Howl”, Kerouac’s ‘On The Road” and revolutions roiling the social fabric. I achieved slight notoriety by playing a Bob Dylan tape at a case conference at UCSF. Do I mythologize and romanticize? Oh, yes. If not now, when?

The Green Valley restaurant was a good quiet place with dark varnished tables the color of cloudy midnight. Upstairs was a private dining room that was perfect for our founding meeting. Their premium, three-course dinner was $2.50 and included a glass of house red that dissolved plaque.

The founders

So there we were, in 1963 talking about starting a dynamic, inclusive association of people who worked with or were interested in families. That was the only test for membership. We would meet monthly at members’ homes to discuss clinical issues. We would have annual meetings. (Early meetings featured Fritz Perls, Stan Kellerman and Richard Korn.) Our goal was to stay local and as informal as possible.

And now, the mothers and fathers that fateful night: Joan Herrick, Shirley Luthman, Daniel Kahn, Ben Handelman, Marty Kirshenbaum, Marty Steiner, Samuel Slipp and me.

The values

“Systems follow out the pattern implicit in their beginnings. The Association is a good example. When we founded it we wanted to be inclusive, generous and clinically oriented. There were many discussions about going National all of which were countered by our desire to stay local and personal. Being inclusive meant that we were open to anyone who worked with families, period. Being generous meant that people shared their homes for meetings, gave administrative time, and offered teaching. The clinical orientation guaranteed that the focus would be on the work, not certification, or hierarchical political power. We had the luxury of being a small group. It appears that those values continue today.”

Have the original, idealistic values continued to shape the Association, its members and the general therapeutic community? Yes and no. What seemed revolutionary in applying the systems approach to understanding problems in mental health and functioning seems to have become part of the accepted scheme of therapy and to fade at the same time. Clinicians were seeing more families and more couples while good training in family therapy has seemed to wane. At the founding meeting, there were three psychiatrists (Steiner, Slipp and me); now psychiatrists are psychopharmacologists and psychiatric residents get scandalously little training in psychodynamic individual or family therapies. In the 1960’s community mental health was strong, San Mateo County was one county that won awards for providing continuity of care and gave powerful support to our kind of work. Then Ronald Reagan became governor and promised to support local community mental health, while dismantling the State Mental Hospital system. The hospitals were scaled down, but so were funds for local services, setting the pattern for creating our homeless, mentally ill population that has come to be serviced by the justice system rather than public health.

A further attack on our goals has been the intrusive effect of the HMOs on the way most clinicians practice. Beyond the aggravations of paper work, and phone calls are the twin evils of ‘authorization’ and ‘ record reporting’. Clinical decisions have become based on ‘cost effectiveness’ for the insurance companies regardless of the individual needs of families and individuals. Pharmacological treatment and brief therapy approaches have been rewarded and long-term psychodynamic methods have suffered. We have yet to discover the full dangers of having huge quantities of previously confidential personal information now filed in databases. Third party payers have become witnesses and judges in our offices: often adversarial. In the spirit of our origins, some clinicians refuse to take insurance reimbursement and instead negotiate fair fees based on a sliding scale so that therapy is available to all without any intermediaries or loss of privacy.

The rifts

Two factors lessened the participation of the founding members in AFTNC after the first

several years. The founders began to develop their own teaching and therapy centers. Marty Kirschenbaum and Shirley Luthman started a clinic and school. Joan Herrick continued her association with the Mental Research Institute in Palo Alto. Ben Handleman, Eva (Hitchcock) Leveton and I began the Family Therapy Center (Dan Kahn and many others became Associates.) At the Family Therapy Center we were able to teach many courses in family therapy and provide consultation to agencies. We were smaller and less organizational than the Association.

Second, as time went on, there was a split in the theoretical orientations of the early members between brief therapy and long-term or depth therapy. At times this was conflict: the brief therapists scorning the long term therapists as encouraging dependency with their patients and the long-term therapists dismissing the brief therapists as superficial and manipulative. In the absence of a middle ground, separate groups went their own way.

The outlook

I am concerned that the mental health, educational, and social needs of our society are once again being neglected in our crazed response to terrorism and our capitulation to corporate power. I worry that individual privacy and rights are being lost. The political right doesn’t believe in interdependency, but only in unilateral power.

Family therapy was a small-scale revolution in clinical thinking that was fostered by small, enthusiastic groups like the AFTNC. I continue to hope that our humanism and respect for the individual and the family, our understanding that health and growth flourish in a supportive, loving, economically secure environment will have some influence through the next forty years.