©2010 BY Dr. Charles Stanford, CBT

Introduction

Virginia Satir is known as a communications theorist, but her approach is not theoretical in a linear sense. In this paper I first attempt to give a background sketch as to how she defies the scientific paradigm. The concepts and assumptions are difficult to separate from her view of maladaptive behavior, much the same way as Yin and Yang or right-brain and left-brain are difficult to separate—one can not exist without the other. It is almost as if one expected to have a north pole without a south pole.

Self-esteem, or maturation, a sense of ego-integrity or identity, a feeling of being comfortable with ones own uniqueness and that of another, is at the heart of being a health human being. Her Conjoint Family Therapy forms the basis for much of the discussion of the basic assumptions or concepts behind her theory. Early family life can lead to a lack of self-esteem through a series of “double-bind” relationships and messages and produce dysfunctional behavior which can be measured by the degree of indirect communication people utilize to the exclusion of direct communication. When adults with low self-esteem marry, they pass along their insecurities to their children, at least one of which becomes an Identified Patient.

An important goal of therapy is to help establish people as “centered” through effective communications patterns. These patterns are taught through a series of well-known techniques until each person is able to communicate clearly, concisely, and effectively.

Throughout her writings, one senses a warm, caring human being, perfectly centered and spontaneous.

Against the Linear Paradigm

These words are typical of what one finds in reading Virginia Satir: “Around any well-integrated person there is a circular field that is about three feet in diameter. At the edge of this field, you can feel vibrations—at least I can! When a person is relatively well put-together, those lines feel like elastic.” (Satir, Conjoint Family Therapy, 257). She continues to describe “energy fields” around various people: those who are out of contact with themselves have small ones and the violent have very large ones. The vibrations people give off are a clue to their state of mind.

Although one might be tempted to dismiss such writing and thinking as “west coast,” or today “new age,” there is absolute truth in what she is saying. Her method of communication, however, does not emulate the scientific paradigm and style. Her prose is that of a warm and caring human being who, above all, is trying to share experiences with the reader.

Perhaps this energy field can be described another way, as a heightened sense of awareness in the approaching individual, an awareness of the other person’s body language, movement, eyes, etc. For example, after I read her description of the “energy field,” I told a group of patients about it. When I am speaking to a group, I am very conscious of just about every movement and twitch of each member to start with, and mentioning that I was about to test this on them simply heightened this awareness. I then approached them, one at a time, “feeling” for the energy field.

I did not tell them exactly what I was trying to learn about them, but I did notice significant differences, especially in two cases. One person seemed not to react at all and I was able to move my hand within a few inches of his face without any reaction. On the other end of the spectrum, another became increasingly hostile looking as I approached and I could not get closer than five or six feet. I “felt” the “energy field” myself. I later checked their diagnostic charts. The first was referred to the group by the psychiatric unit as chronically depressed and the second had very violent tendencies with very many issues to work on. In other words, the “energy field” is a metaphor, a helpful way of communicating her experience. There is absolutely no scientific measuring device that can detect the presence of an energy field or an “aura”, but a person in a sensitive state of heightened awareness can “sense” it. “Left-brain” and “right brain” are like that as well. Even though scientists have noticed that certain functions seem to be predominate in certain areas of the brain, the concept of the left half of the brain doing certain things and the right brain the others is best used as a metaphor for certain ways of perceiving and thinking.

Her theory works this way as well. Although she studied the literature and obtained the necessary credentials to practice, her theory is built on her own experience in which she displayed an uncanny, instinctive, way of knowing how to relate to people. As she says in Conjoint Family Therapy, “the process still—and always—is the relationship between you and me, here and now.” (243)

Concepts and Assumptions

So how does one approach a theorists who says, in effect, the theory is not important, that it is only a guideline to be used if it helps, who does not mention paradigms, quote from scholarly journals, and does not present abstract notions that subject themselves to reification and thus abstract analysis and discussion? How does one talk about concepts in such a situation? Satir’s main concept from a theoretical standpoint is that concepts are the product of experience and experience is only as valid as the reliability and validity of the perceiver. All therapy is a relationship between people and at the base of relationships is communication. We communicate in many ways, but the best communicators are those with the best sense of self esteem. Still, as she points out, “thought and feeling are inextricably bound together; the individual need not be a prisoner of his feelings but can use the cognitive component of this heeling to free himself.” (125) If we examine this sentence just quoted carefully we see how the first clause unites thought and feeling into a composite inseparable unit and that the second clause divides thought and feeling again so that one part can modify the other. Yet, she is saying that these are two parts of a single whole that function together. One does not easily divide the two into separate sections for analysis, nor should one.

Fortunately, for those who insist upon a linear discussion of family therapy, Conjoint Family Therapy works towards that end. The book begins with a discussion of why family therapy is needed. The Identified Patient (I.P.) is a symptom of family dysfunction. This reality came to the surface as individual therapists noticed that “schizophrenic” patients showed increased symptoms during and immediately after a family visit and upon observing how other family members interfered with therapy. It became clear that they were actually trying to change the behavior of the entire family through treating only one member so revised their approach to include the entire family and, through this process, found that mental illness had an interpersonal nature. The process usually starts when an external force labels the I.P. as “disturbed,” but that behavior was actually serving a homeostatic function within the family. The locus of difficulty could usually be located within the marital dyad, with low self-esteem of both members as a cause and this lack of self-esteem the result of their own families’ functioning. (1-6)

People with low self-esteem tend to be, in David Riesman’s terminology, extremely other-directed and have not reached a position of equality with them. Although hoping for a great deal from others, they expect disappointment. Such people all-too-often choose one another as mates, putting one another in charge of their own self-esteem, attempting to create a stronger identity for themselves through the mate. In short, they both were seeking the “good parent” from each other. (7-12)

After being married a short while, however, disillusion sets in. Neither expected to give and they notice such annoying realities such as hair curlers and snoring. In addition, what Satir calls “differentness” becomes threatening, such things that make people individuals are seen as evidence of being unloved. A lack of trust also arises from this low self-esteem. These two things, low self-esteem and mistrust expresses itself in maladaptive forms of communication. (13-24)

Soon, children enter this family and the parents expect to “get” from the child which will obviously have nothing other than self-interest at first. For example, they make economic and emotional demands which each party may see as deflecting from their own needs. (24-28)

In addition, social forces are at work placing further strains on the relationship. The Industrial Revolution (although Satir does not use the phrasing) quantified the worth of an individual through the monetary system while simultaneously mechanizing the person’s work environment and specializing it to the extent that a basic alienation from the existential construct occurred. This alienation is especially debilitating to an individual who is already suffering from low self-esteem. Roles began to shift rapidly with the rise of psychoanalysis urging greater freedom and autonomy for children while patriarchal notions became outmoded. The individuals with low self-esteem looked to the family for a “reason for being” while the family no longer was able to provide it to those very individuals. (29-33)

A child growing up in such a situation faces considerable difficulties. Not only are they growing up in the same external world, but they are being raised by parents who themselves have difficulty adjusting. In fact, “family theory postulates that outside forces are important mainly as the affect the parents.” (36) Part of the “getting” mindset of parents with low self esteem is to look to the child as a vehicle of expressing their own self-worth, as a way of bolstering their own self esteem, and as an extension of their own selves. (35-36)

The therapist should see “...himself as a resource person.” (125), a “model of communication” (125), and as a teacher. These aspects are modeled below under “techniques.”

View of Maladaptive Behavior

In discussing Satir, separation of a view of maladaptive behavior from basic conceptions is difficult. I would add that it also seems counterproductive in that she intertwines these so carefully that to force a separation of the two is contrary to her practice and way of thinking. Indeed, in the section (above) on concepts of assumptions, maladaptive behavior was already introduced and discussed. Here I wish to view maladaptive behavior as the concrete manifestation of dysfunctional relationships caused by the juncture of individuals with low self-esteem with one another and the offspring. Generally speaking, there is an inverse relationship between one’s self-esteem and the indirectness of ones communication.

As mentioned, the parents with low self-esteem look to the child as a mechanism for enhancing their own self-worth. Thus comments, both positive and negative, from the external community reflect upon their own self-worth. They have an inordinate need for approval from the child which makes discipline difficult. In addition, they also look to the child as an ally against the other parent, a messenger between the parents, a pacifier of the mate, and eventually place the child in some sort of conflict that demands of choice of one parent over the other. This militates against identifying with individuals of one sex or the other and thus against the child’s own sexual identity and sense of self. (61-59) The parents are not aware of these subconscious behaviors on their own part and, when the child exhibits dysfunctional behavior, they tend to attribute it to external factor because their very lack of self-esteem makes it difficult for them to realize that they have a profound effect on the child. (36-24)

Eventually, this double-bind situation takes its toll on the child who comes to the attention of the therapist as the Identified Patient. The double bind is not merely the inability to satisfy both parents at the same time, but the inability to satisfy conflicting sides of the same parent. An example given is that of the father who demands that his son obey him in all things and then objects to the son’s lack of manliness in failing to stand up to him. The I.P. actually acts out the conflicts within and between the parents and helps maintain the family homeostasis until the community objects to or at least points out the child’s behavior and may even take the child away from the parents. If parents are alert to this possibility, they may seek therapy for the I.P. (24-55)

Throughout, Satir (1983, 1988) and Satir and Baldwin (1983) identifies four distinct forms of defensive and indirect communications and provides alternatives. Later (1991), she generalizes on being “centered” in providing a consistent and congruent manner of communication. This theme, however, runs throughout her career.

She divides dysfunctional communicators into four categories: placaters, blamers, computers, and the distractor. The placater is unable to communicate for fear of getting the other person angry, so the message becomes “whatever you want is okay.” (People Making, 63). The blamer is aggressive and even violent at times so that the other person will regard him or her as strong, but who inside feels lonely and unsuccessful. (1972:66) The computer gives the impression of being ultra-reasonable and even evokes envy in the other, but inside feels vulnerable (1972:68) and hides behind intellect, all the while feeling vulnerable. The distracter is never on the point, but goes off in different directions at once, feeling that they do not belong anyway. (1972:70)

Therapeutic Goal

The therapeutic goal is recognized by the fifth category, leveling, and her therapy focuses on this. She is very succinct and clear on this point in her discussion of criteria for terminating treatment.

Family members need to be taught how to interpret hostility, complete transactions, see themselves as others see them (sic), see how they see themselves, tell one another how they appear to them, express hopes, fears, and expects from the other. In addition, the should be able to disagree, make choices, learn through practice, free themselves from the negative aspects of the past, and communicate congruently. Their language and communication pattern is delineated, meaning having a sense of ego integrity, a knowledge on the difference between the “you” and the “I”, and be clear.

In one of the best, most succinct, and meaningful statements I have seen in the literature of Psychology, she summarizes it by saying “in short, treatment is completed when everyone is the therapy setting can use the first person ‘I’ followed by an active verb and ending with a direct object.” (227-228)

Techniques

Most of Satir’s techniques seem to have been invented on the spot to communicate a particular problem to a particular family. After awhile, they have become associated with her and, in my opinion, run the risk of becoming reified into a “cookbook” approach—that is to say, a new therapist may decide, “well, sculpting is supposed to work, I guess I’ll try that.” The point is that these techniques may become useful as they are, but it is more important to understand the process and goals of them. In general, her techniques are ways of communicating visually what has not been effectively communicated orally. In all cases, they are designed as a way to break through to the clients.

Since “Family sculpting” seems to be a trademark technique, I will start with that. When observing a dysfunctional family interacting, and being unable to explain in words what is going on, or when one of the member is unable to express what is going on, it may be successful to have one of the members to place the other members in postures that they think best illustrates how each member is relating and communicating. The visual representation is then processed and discussed. Other family members may be very surprised to see how that members views them, this having been the only time that member was able to communicate that fact. Through the discussion, more effective ways of relating and communicating can be taught.

Let us take the example of a family with a hyperactive child. In this particular case, depending of course on my assessment of the cognitive levels of the parents, I would actually use the body sculpting technique and I would have the hyperactive child do the sculpting. This would allow me to visually see the child interact with the parents and also illustrate how the child sees the relationship.

After that, there would be a general discussion of the situation. I would point out that, barring physiological reasons of course, the hyperactivity is the child’s way of reacting to the family structure. Much would depend on the here and now of the child’s sculpture and how the parents related to it.

One possible sculpture would be both the parents facing one another with their fingers pointed. This would indicate a blaming communication pattern within the parent’s relationship to which the child is reacting. After discussing the reframed situation as establishing it as the real problem (after all, it would be the I.P.’s vision of how things were and how the I.P. reacts to it that they are concerned with—namely, the hyperactivity), I would then proceed to teach both a “leveling” form of communication.

I think that answers the question on the academic level, but I want to add that for one to apply Satir’s method, one must be a keen observer, very involved, and able to establish close and caring relationships with all involved. What technique would work would actually depend more on how the therapist applies it within the therapeutic relationship. Often new techniques are invented on the spot and then later integrated into a theory or approach for formal presentation. The real work is done instinctively—with preparation and a belief in the importance of human communication every present, but instinct is the guide.

The division of the self into distinct entities which results in double bind messages can be addressed through “parts parties.” Each member has parts of the personality labeled and written on a piece of paper. Then, two members assume the identities of one of their own parts and role-plays. They can then see how the various parts of themselves interrelate and relate to various parts of the other’s personalities. Again, after the exercise, the results are processed and the experience is used for illustrating more effective communications techniques.

Another technique might address the topic of hidden rules within a family. Sometimes the rule is adopted that no one is supposed to talk about certain things, such as the fact that the youngest child was born without an arm (1972:99). You may have the family, independently or preferably together, start to make a list of these rules so that they better understand their subconscious inter-relating processes. Then, as usual, process the exercise, discussing the rules.

Perhaps my favorite is the strings. Get a ball of yarn or string and cut it into five foot strands. Attach each family member to another family member with one of the strands. Eventually, you will have a grid-like layout showing direct lines of communication between each member, but also triangles showing how each set of three are linked to one another. This is helpful in introducing the concept of the family system and discussing how each member affects the other. It also allows for discussion of the roles of each member with one another, with the group, and within the triangle—after all, in a triangle, the third person needs to fulfill some function, is it helpful and how? In a five member family, there will be forty-five triangles. (1972:148-149)

To continue with this technique, it is also helpful in explaining to families what happens when one member changes considerably while the other members remain static. One way of modifying this techniques, which I developed on the spot when dealing with an alcoholic family which had developed all the classic roles of the alcoholic family (drinker, enabler, hero, scapegoat, lost child, and mascot), was to explain that father would be a different person. This was done after the lines were drawn and discussed. Then, to illustrate the need for adapting, I said, “It is as if he moved here” and then moved him to a different position, between two different family members. All the lines became confused, overlapped, tangled. This illustrated the need for new communication patterns and then I cut the strings. I sensed a tangible feeling of relief and liberation.

This afforded me the perfect opportunity to introduce the use of the “I” statement, emphasizing that it was both an opportunity to assert one’s differentness and to take responsibility for ones own feelings.

One final technique (there are many) can be used with a family that seems to be making demands on one particular members. Each member of the family grabs one part of that members body and then pulls in opposite directions. Again, a physical demonstration of what is going on. This one may not be a very good one to use with people who are skittish about being touched and Satir’s own penchant for hugging people is not very likely to be productive today with professional concerns as they are, but a Virginia Satir would know when and how to use these techniques and when to invent others.

Conclusion

Ones first impression of Virginia Satir is bound to be disappointing if one expects and clinical, linear, scientific presentation. On the other hand, I have tried to illustrate, through my own experience with her works, from my first impression through utilizing her techniques and discussing them, how she presents a coherent view of how to work with families. In fact, her view and approach is so coherent that it is nearly impossible to rear it apart into constituent pieces. I think this is one of her greatest strengths. If a family is a living, organic, system, composed of constantly evolving human beings, and a therapist is someone who grows by adapting to new situations while remaining centered, certainly a theory that reflects this dynamism both on the levels of theory and practice is necessary. Such is what Satir has offered and I hope this short paper has at least provided enough background for those who are not familiar with her to make a start in that direction.