Journal of Family Therapy (1980) 2 : 389-399

The family sculpt as an educational experience: an exploration of appropriate professional involvement

John Simmonds* and Nadine Brummer*

The paper focuses on the importance of the unconscious interaction between therapist and family as a factor of continuance in treatment. Previous research on continuation in treatment is reviewed, within which mutual expectations and social class factors are highlighted as being significant.

The issue is then reviewed as it effects family therapy and the theme is illustrated through an extended example of a family sculpted by a seminar of social work students. In this, particular attention was given to the interaction between the worker and the family.

It is concluded that the family’s pressure on the worker to meet their expectations in reality, may be an important aspect of therapeutic breakdown.

Introduction

Family Therapy is arousing considerable interest and excitement in social work thinking and practice at the present time. I n doing so it raises im- portant issues for social work teachers and students faced with making sense of both the complexity of the many different approaches already developed as well as those in the process of being developed. However, the issues raised are not just those of making sense of theories external to the individual but of matching these with the experiences of family life that exist within us all. Indeed, the powerful reality of these experiences and the prospect of understanding anew the complexities of one’s own family life and finding a more secure and creative place within it, must be im- portant in the recent rapid growth of interest. The recognition of the latter point in no way invalidates the usefulness of family therapy through a charge of subjectivity. Indeed one of its strengths has been a willingness to acknowledge common themes in family life for both patient and therapist.

* University of London, Goldsmiths’ College, Applied Social Studies Course, St Donatt’s Road, New Cross, London SE14 6NW.

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0163+4445/80/040389+12 $02.00/0 0 1980 The Association for Family Therapy

390 J . Simmonds and N . Brummer

However, problems can arise when this interest is hidden and secret and vicariously satisfied through the lives of client families. The rich source of insight which can be derived from the therapist’s experience of being a temporary member of a client family can then become an area of difficulty. His own personal identity, as a family member, and the defences he uses to support this, become challenged. Defences have to be adopted to cope with this ?nd the therapist’s integrity as a professional person becomes compromised by the experience within the client family. The therapist is open to being drawn into, and being required to fit, the family’s own ways of relating. Instead of this then being available to the social worker and in turn to the family as a resource for change, it becomes a source of confusion and, probably, rejection and failure.

From the family’s point of view, confusion and eventual breakdown in the therapeutic relationship may also exist as a problem. For them, the reason for referral may well seem well-defined and self-contained. At the point of referral, somebody, often a child, has been labelled ‘patient’. The family expects a straightforward diagnosis of the problem together with a prescription for treatment. The expectation is in the form of a ‘remedy’ rather than interaction with another human being. This expectation varies in degree but even with those families who might be expected to have some understanding about psychiatry or social work and might appreciate the kind of treatment offered, surprise is expressed at the offer of a family interview. Many families find themselves, therefore, in a new and often very frightening and confusing situation.

This is quite unlike any other professional relationship. Client family and worker do not share an explicit agreement on the actual problem or the problem solving process. The client presents the child as the problem while the social worker suggests that the family look at itself for the problem. The client family expect the social worker to provide the cure while the social worker suggests that the family engage in its own curative processes. This problem has been explored in respect of individual treatment by a number of researchers (Mayer and Timms, 1970; Heine and Trosman, 1960; Overall and Aronson, 1964; Goldstein and Shipman, 1961). All point to the negative effect on continuance in treatment, when the expec- tations of client and worker are different. Mayer and Timms (1970) sug- gest that these differences are in part related to class-based differences in problem solving technique and suggest that attention be given to this in the form of ‘anticipatory guidance’ (Orne and Wender, 1968), re- socialization or re-education. While not disagreeing with this thesis in principle, we wish to explore the nature of this issue of mutual expectations at a dynamic level.

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One of the problems in exploring this issue is getting hold of the material that might be relevant. The depth of the thoughts, feelings, impressions and fantasies that operate in this beginning period, and might influence its course, are not readily tapped. As a result we will present a simulated exercise in the form of a family sculpt that we undertook with a group of post-graduate social work students. The aim of the session was presented to them as follows:

(1) to explore the problem of engaging families in family therapy ; (2) to consider the research cited above on mutuality of expectations,

between worker and client and their effect on continuance in treat- ment ;

(3) to explore the effect of the worker’s intervention on family inter- action;

(4) to identify commonly identifiable themes of family life and their effect on family functioning.

One of our primary aims in preparing the seminar, was to integrate the theoretical formulations discussed previously, which can be presented in lecture format, with the experience of an actual family. I n this way we were attempting to combine cognitive learning with affective and experi- ential learning and in order to do this we presented the research above, followed by a description of the case below. In describing the case, we asked students not to take notes but to try to enter into the situation described, in their imaginations, in order that they might sculpt the family*.

The reason for using the sculpt is that the image created through the physical configuration of bodies in the sculpt makes a considerable impact and creates both a shared and easily memorized experience for the student group to explore. The process of making an image and the use of imagin- ation in responding to it fuses both thought and feeling. What is created is a three-dimensional ‘object’ that is also capable of being changed in time. Its meaning exists on many levels and the work of the group is to share its observations, thoughts, feelings and fantasies in order to analyse the threads that hold the sculpt together.

Case presentation

The case presented was of Jill, aged ten, referred by a neurology depart- ment of a children’s hospital, after extensive investigations for a suspected

* It should be noted that for many students this was their first experience of family sculpting.

392 J. Simmonds and N . Brummer

brain tumour which had proved to be negative. The family had been seeking medical advice for Ji11 for two years, ever since she had manifested extreme personality changes. She had previously been a happy, cheerful and loving child and the family said of her at that time, ‘Every family should have a Jill’. Since then, Jill had grown gradually more depressed, withdrawn and fearful-these moods being punctuated with outbursts of angry temper-tantrums whenever she was frustrated. Her relationship with her sister Joan, aged thirteen, had undergone a change too, from being very close to a situation where Jill could not tolerate being in the same room with her. Her standard of school work had also deteriorated from above, to below average.

Besides this behavioral deterioration, Jill had complained of a myriad of physical symptoms which were the focus of the parents’ anxiety. These included frequent headaches, pains in the chest and insomnia.

Jill’s father conveyed a passive and depressed air, although he could be warm and sincere like Ji11. He suffered from weekly headaches and a heart condition which required a special low cholesterol diet. He was employed as an engineer.

Jill’s mother was warm and more extrovert and outspoken than her husband. She said that she was happy at just being a housewife. Joan was a demure and budding adolescent. The whole family impressed as being ‘extremely nice’ which made Jill’s illness even more inexplicable.

What was particularly noticeable in this family, was the contrast between the general passivity and calm of Joan and her parents, and the aggressive- ness of Jill. It was this contrast that led to the worker’s decision to suggest to the family, that a series of family interviews be arranged to clarify the position of Jill and her illness within the family. However, this was a very different suggestion from that which the family hoped the workers would make. The family were certain that the problem was physically based and very much hoped that the workers would prescribe medication. Jill herself was also disappointed with their suggestion, as she hoped that the workers could operate to remove the tumour that she felt was causing her to be so ill.

Before describing the students’ sculpt, it is important to note the pos- sible divergence in the pre-occupations and motivations of the student group and those of the family described. In asking the students to use their imagination to get in touch with this situation and then to sculpt it, we would hypothesize that at least some of the following factors must be considered, in understanding the sources of the imagination that the students are drawing on:

(1) the student’s experience in his or her own family of origin;

The family sculpt as an educational experience 393

(2) the student’s perception of other students as possible family mem- bers, at both conscious and unconscious levels of perception;

(3) the student’s experience, in the present, of the seminar and the seminar’s own dynamic within the context of the course as a whole.

As a consequence, the learning that takes place is more in terms of the students’ learning about themselves and themes of family life than about the actual family whose problems were initially presented*. The impli- cations of this will be drawn out in the light of the following description and analysis of the sculpt that took place.

The first sculpt

The first person to volunteer to participate in the sculpt was the person who acted as the mother. In turn she chose the designated patient, then her sister who chose the father. He, in turn, selected the social worker.

We asked the social worker to sculpt the family. He placed the parents facing one another and holding hands. Jill was placed in front of them on her knees with one of her father’s hands applying pressure to her head. Joan was placed on the other side of the room and told to half look towards her parents and half to look away. The social worker after placing the family members sat down adjacent to the configuration.

The participants were asked to report their feelings sequentially. Jill said that she felt frightened and confused. She could not see what was going on behind her and did not know what people were saying. Eventually she fell over as she felt so uncomfortable and reported feeling in a state of collapse. The parents complained that they did not have time for each other and father found it difficult to apply constant pressure to Jill’s head. He reported it as being a mixture of pressure and caress. Joan said she felt totally out of the situation, although she liked where the social worker was sitting because he could see her. The social worker did not have any- thing to say at this point.

One of the most significant points about the sculpt at this point was the position of the social worker. Having completed placing the family members as he saw them, he took up a fairly passive and almost unnoticeable position. In many ways it was quite easy to disregard him. He seemed not to be a part of the sculpt, although clearly his imagination and feeling for

* At this point while we go on to explore the students’ sculpt, the actual family that this presentation was drawn from, becomes less important. We were not attempting to replicate the actual family or to explore the therapy that did take place. While there were similarities, this neither adds nor detracts.

394 J . Simmonds and N . Brummer

the family was being demonstrated. It seems to us that this is analogous to the expectations one has of a professional-detached, objective, slightly at a distance and unreal. The family had not commented on his position or presence, much as real life families think it strange to have it suggested that somebody they have not met before can become so immediately sig- nificant by his or her presence. In order to explore the social work involve- ment further, it was suggested that the family place the social worker as they saw him in relation to themselves.

The second sculpt

There was a hiatus at this suggestion and nobody seemed to know what to do. Finally, it was Jill who took control of the situation and placed the social worker on a chair between her and her parents looking down towards her with his hands restraining her parents. The rest of the positions remained the same. When asked to comment on their feelings, Jill reported that she liked the social worker like that. He was hers alone and she had his individual attention. She was particularly satisfied with the fact that the social worker was restraining her parents. Joan said that she did not like the new position of the social worker as he now had his back to her and was out of her orbit. The social worker said that he felt very un- comfortable on the chair. However, he also reported having a feeling of wanting to take Jill out of the sculpt in the sense of being a ‘saviour’. Jill wanted the social worker from his position on the chair to scoop her up in his arms and carry her away. A picture was emerging of a damsel in distress, looking for her knight in shining white armour; a common enough fantasy in itself but perfectly capturing the distress of a very ill and lonely child desperately in need of a seemingly unavailable parental figure.

This theme was also taken up by Joan, although on a slightly different level. Clearly, she also had a need for closer contact with a parental figure although the developmental theme of adolescence would suggest that to some extent at least she would be establishing a more independent identity in the family.

In the seminar discussion, it was felt that the family was beginning to demonstrate that there were considerable feelings about the closeness or distance of their relationships with each other, and about the content of these relationships.

This was taken up by one of the student group in commenting that the parents’ hand holding seemed to be an empty gesture. Mother said that while she was interested in looking at her daughters she found it very

The family sculpt as an educational experience 395

uncomfortable to look at her husband. Father also said that he felt closer to his daughters than to his wife whose hand he was holding. He also showed ambivalence towards his daughter expressed through his hand on her head-a caress but pushing her away too. While clearly expressing her need for a close relationship, Jill’s inability to face anybody throughout the sculpt, again illustrates the conflict inherent in this. The burden this placed on her was suggested by both her symptoms and her collapse in the first sculpt.

There is a problem resonating clearly throughout the family. Nobody seems sure about being close and in their present, unhappy state they all need to be close and cared for by somebody.

On closer examination of the sculpt one deeper aspect of the family structure and dynamic became clearer. Each of the relationships in the family was expressed as exclusively a two-person relationship. The exis- tence of a third person only served to bring about rivalrous and jealous feelings. Jill expressed a wish for an exclusive relationship with the social worker. Joan similarly expressed such a wish in the first sculpt. Both parents found it difficult to relate to each other when they were relating to their daughters.

Developmentally, the resolution of the problem of triangular relation- ships, is crucial from early childhood onwards. As Meyerson (1975) points out, it is a central issue in the development of an individual’s personal and, particularly, his sexual identity and this will intimately involve the degree of distance and involvement that an individual has in these relationships.

For Ji11 the resolution of this problem was quite crucial in establishing her own sexual identity; for mother, the unsatisfactory resolution of this problem may well have been a significant contributory factor in an in- explicitly, although strongly suggested, sexual problem in her own marriage. For Joan too, with the developmental crisis of adolescence, earlier feelings about her mother and father will have been important in charting the course of the establishment of her adult and sexual identity.

Complex as this may have been for the family, as noted above, it was a complex area for the social worker too. He had clearly become an integral part of the family structure and dynamic. This was expressed by his position in the sculpt. The problem for him, was.that while he might have thought out ideas about appropriate professional distance and the use of genuineness, accurate empathy and non-possessive warmth (Truax and Carkuff, 1967), these are qualities that the family was also struggling with. Whatever notions regarding involvement and closeness he might have, he also had become a part of the family dynamic: having been required to

396 J. Simmonds and N . Brummev

adopt a r61e that complemented the unconscious necds of the family. From being a distant, peripheral figure in the first sculpt, Jill had used him to demonstrate her own particular wish for an exclusive and idealized two-person relationship that would protect her from the pain of her triangular relationship with her parents. (The social worker held the parents back from Jill in the second sculpt.)

From the social worker’s point of view, this might have been an appeal- ing position in which to have been placed. I t had protective, strong and quite powerful qualities, that were parental at one level and professional at another. However, the boundary between understanding and actually meeting Jill’s wish/expectation was clearly very important for the social worker, as a helping person (see Salzberger-Wittenburg, 1970). I t was not that it was inappropriate for him to have been seen in this way or even to communicate it to the family, as it clearly contained crucial elements of the family’s problem. However, this would have been quite different to the social worker actually adopting the r61e and acting it out by being distant, perfect and omnipotent in his professional activity.

The social worker was clearly put under pressure. It was not surprising that the family should have looked to him to rescue them from their very painful problems, but they seemed to have meant by this that they actually wanted him to be theirs, each one separately, in an ideal two-person relationship. The social worker reported in the sculpt that in fact he had felt very uncomfortable and stuck in this position. The unreality and precariousness of this family’s wished-for relationships must have felt very powerful to him. As such, it was an important diagnostic and therapeutic indicator.

T o summarize, therefore, from the social worker’s point of view:

(1) He has to be able to be open to the psychological pressures to take up a particular position in the family structure. In the sculpt these pressures were expressed in physical terms.

(2) This involves him in a temporary and partial suspension of the objective part of his professional rBle and then the mobilization of his personal responses to the ‘feeling’ of the family.

(3) This ‘feeling’ will produce a ‘sense’ of the family’s present position and particularly the hidden feelings and the defences against those feelings (Malan, 1979).

(4) This ‘feeling’ will also produce a ‘sense’ of the family’s ‘stuckness’ as the social worker considers how he might move to find a more comfortable and acceptable position within the family. He will also be subject to very powerful pressures not to move and disturb the equilibrium,

The family sculpt as an educational experience 397

While all this is clearly invaluable material in thinking about the family’s problems, it cannot fail to stimulate the social worker’s own per- sonal pre-occupations about these themes and his own defences against them. His ability to make sense of the family and to be able to communicate with them openly and honestly will therefore be dependent on the extent to which he feels at ease with himself in this respect. For example, if he has unresolved and unrecognized feelings of jealousy and rivalry in three- person relationships in his own nuclear family, he may collude with Jill in an attempt to resolve his own problems in this area.

T o summarize therefore, it is possible to identify a number of inter- related themes for the family and these are very generalized themes in family life for the social worker too :

(1) the need for closeness ; (2) the stress on two-person relationships and the rivalry this induces

(3) the subsequent defences against closeness and rivalry by distance.

That these are general themes and must, at some level, be applicable to the worker is an essential part of the argument being developed. Whatever the model that guides the intervention, there is a dynamic interplay between worker and family. This is so, notwithstanding the fact that we have little information on the way that the worker responds to the projections ex- pressed by Jill or whether they did produce any counter-transference reaction in him. Whether it is acknowledged in the model or used in the treatment, this dynamic will be present. The importance of this is in the effect that it has on the social worker and his capacity to remain focused on the work with the family in an open and involved way. Clearly if the themes in the dynamic are threatening to the worker and result in him being defensive, then the likelihood of him acting inappropriately either by avoiding the family’s difficulties or in becoming thoroughly enmeshed in them are heightened.

Whatever might have developed out of the sculpt in practice, the power of a family’s projections to seduce the worker into the rBle of saviour and coerce him into a rBle reciprocal to that in the family system, are made very clear. It is this, we are suggesting, that might lead to the family breaking off treatment as the worker anxiously cannot find the right degree of detachment/involvement for the family’s needs. His difficulties in the counter-transference will undoubtedly communicate itself to the family and one would not be surprised if the family interpreted this to themselves as ‘the worker was not interested in them, did not trust them, lacked the authority to take appropriate action and so forth‘ (Mayer and Timms, 1970). As these authors go on to comment, ‘By leading clients to become

with the third ;

398 J. Simmonds and N . Brummer

angered or resigned, these various imputations undermined the worker’s effort to help and served to drive the two parties further apart’. We are suggesting, therefore, that breaking off treatment might occur not so much for class or cultural differences between clients and workers but because issues around these areas of intimacy, distance and involvement are prob- lematic for help-seekers and help-givers.

Clearly this one case discussed through the use of a simulation exercise hardly constitutes overwhelming evidence as far as the theoretical and practical problems of the effect of expectations on continuance in treat- ment is concerned. However, the basis on which the discussion has taken place is well founded in the psychodynamic literature. As such we feel that there is clear evidence that attention needs to be given to the nature and dynamics of the worker’s experience with the client or family rather than on questioning the validity of ‘insight-orientated procedures for the problem solving methods of the working class’. Insight is essential in the worker in order to negotiate a problem-definition with a family, work breaking off at this stage not because of the family’s inadequate socialization into a different conceptual and linguistic framework but because the worker has insufficient understanding of the unconscious wishes and fears in the family dynamic.

In terms of training for family therapy, the sculpt demonstrates the problems Skynner (1976) so aptly describes as an intense transference to a passive therapist; a situation he advocates dealing with by the almost universally adopted active interventions and natural responses of family therapists. However, we feel that the sculpt demonstrates that even here it is essential that therapists be able to distinguish the natural response from counter-transference. To have solved the problems of the latter by calling it natural as it might have been very attractive for the social worker in the second sculpt to have done neither serves the cause of the family or, in the long run, of family therapy.

References

GOLDSTEIN, A. P. and SHIPMAN, W. G. (1961) Patient’s expectations, symptom reduction and aspects of the initial psychotherapeutic interview. Journal of Clinical Psychology, 17, 129-133.

HEINE, R. W. and TROSMAN, H. (1960) Initial expectations of the doctor patient interaction as a factor in continuance in therapy. Psychiatry, 23, 275-278.

MALAN, D. (1979) Individual Psychotherapy and the Science of Psychodynanics. London, Buttenvorths.

MAYER, J. and TIMMS, N. (1970) The Client Speaks. London. Routledge and Kegan Paul.

The family sculpt as an educational experience 399 MEYERSON, S. (1975) Adolescence and sexuality In: S . Meyerson (Ed.), Adolescence;

The Crisis of Adjustment. London. Allen and Unwin. ORNE, M. T. and WENDER, P. H. (1968) Anticipatory socialization for psycho-

therapy: method and rationale, American Journal of Psychiatry, 124, 1202- 1212.

OVERALL, B. and ARONSON, H. (1964) Expectations of psychotherapy in lower socio-economic class patients. In: F. Riesman (Ed.), Mental Health of the Poor. Glencoe Free Press.

SALZBURCER-WITTENBURC, I. (1 970) Psychoanalytic Insight and Relationships; A Kleinian Approach. London. Routledge and Kegan Paul.

TRUAX, C . B. and CARKUFF, R. R. (1967) Towards E’ective Counselling and Psychotherapy. Chicago. Aldine.

SKYNNER, A. C . R. (1976) One Flesh; Separate Persons. London. Constable.