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REVIEWS: Psychotherapy Tales



Psychotherapy Tales
The Making of a Family Therapist
With Foreword by Maurizio Andolfi, MD.

Aldo Gurgone


Published: October 2018
Length: 136 pdf pages (6'' x 9'')
ISBNs: 978-1-938459-69-6; 978-1-938459-72-6

Reviews

Aldo Gurgone has been doing psychotherapy for over 45 years and this book is a pearl of wisdom and humanity in dealing with individuals’ dysfunctions, as well as family life difficulties and conflicts. The title Psychotherapy Tales: The Making of a Family Therapist reflects fully what is in the book: ten chapters with the description of a therapeutic story in each of them. The issues presented are very challenging and varied: from long-term hospitalized psychotic adult patients, to bulimic or suicidal adolescents, to grief and loss in the family, as well as multicultural couple and family dilemmas.

Aldo demonstrates many skills, among them a great sense of humour and creativity (see the long fairy tale he wrote in dealing with a six-year-old girl and her mother, or the use of the biblical metaphor “Jesus travelled through the desert” to help a dehydrated patient drink water) and a variety of techniques from the use of paradoxical injunction to the exploration of the family genogram and the preparation of family rituals to heal grief and loss.

He is comfortable in working in a hospital ward or in his consulting room, as well as in home visiting. He has the wonderful ability (which is not often present), to learn from his own mistakes. For example, he experimented and found that certain metaphors can work with a client in a specific context, but that they are useless if repeated in other situations.

Using Dante’s metaphor in the Divine Comedy, in his introduction Aldo describes his move from Hell (studying law) to Paradise: becoming a Psychotherapist. This image gives the sense of a profession which is also very enriching for us therapists if we are able to show humanity and accept the lessons of life from the people who choose to share the most intimate and vulnerable part of themselves with us in therapy.

Excerpted from the Foreword by Maurizio Andolfi, M.D.


Journal review: Book Review of Psychotherapy Tales: The Making of a Family Therapist, by Aldo Gurgone (2018).

This book is most appropriately titled; each chapter takes us into a new client story, documenting Aldo Gurgone’s work with the family system and beyond. As is common, some of these clients begin as a solo visit, and family are involved in a variety of ways, including, occasionally, separate sessions. In the true spirit of family therapy, as it was envisaged through a variety of prisms from the ‘golden days’ of the 1960s and 70s, the author begins each new case seeking to understand the uniqueness of the client/s, their important relationships, and the impact and implications, not only on the person who instigated the therapy, but for all those who participate.

Reading this book is a delight on many levels.

First, because it is packed with learning opportunities: not just new ideas, also insight into a variety of subtle and vital skills, particularly the use of self, in very challenging family situations. The author did not choose easy tales to share.

Second, in the family therapy field Aldo Gurgone, a clinical psychologist, is known to be thoughtful and generous to those who seek his counsel. I am pleased that many who don’t have access to such a mentor, one who has developed his skills over 45 years of sensitive work, and practised in many places across the globe, will now have access to his wisdom. I am sure this is a book that will be a source of constant reference for all who purchase it.

Third, and this is especially important to me (so I apologise for this self-indulgence), at front and centre of this book are the values and beliefs of the original family therapists, who presented varied ways in which to structure understanding of the whirlpool that intimate relationships can become. They did not assume that similar presenting problems indicate similar patterns of relationships, nor warrant similar interventions.

This is not the case today. Leading family therapy training organisations offer courses to address particular diagnostic situations and scholastic family therapy journals focus on quantitative research conducted by academics who may not even be practitioners and may be funded by organisations with an interest in a particular result. In general psychotherapy, the reliance on ‘rational’ application of diagnosis and related treatment is the norm; emotion and intuition are words which are rarely uttered. Psychotherapists advertise their skills based on the diagnostic categories in which they specialise.

Professor Irvin Yalom (2017), in an interview after the release of his memoir, Becoming Myself (2017), opined, ‘Hardly anyone does Family Therapy any more.’ But Aldo Gurgone does! His book has the potential to be a practical and inspiring guide for all those who aspire to follow in the footsteps of the founders of family therapy. They challenged ‘the establishment’ and found creative and respectful treatment for many whose prior treatment options were often limited to debilitating drugs, incarceration, or years of ‘discussion.’

The first DSM was published 1952, over a decade before family therapists began to publish, yet I don’t remember any who referenced the diagnostic bible, and I read widely. The family therapists of the 60s, 70s, and 80s were passionate; they sought to connect with the unique qualities of the family (or the family member) who came to them. They prioritised the value of the therapeutic relationship. They demonstrated that this relationship needed to be meaningful and trustworthy, to enable clients to risk the change they had been avoiding, to embrace the scary shadows which inhibited their wellbeing. It needed to be sincere, or ‘congruent’ as Virginia Satir Satir (1988) frequently reminded us. You can’t achieve this if you are mimicking the style of others. You can borrow ideas and techniques, but unless your behaviour (physical and emotional) reflects how you behave in your own family or when facing your own challenges, it is not a deep and reliable relationship.

Aldo Gurgone expresses it beautifully in his preface:

Psychotherapy: is it science or is it art? This a vexing question, and I am sure there is no definitive answer. Despite the fact that there are now many training courses which highlight standardised processes regarding how to interview a client, and how to work from a particular therapeutic model, I struggle to see psychotherapy as simply a set of techniques and processes that can be manualized and simply followed like a recipe. My belief is that psychotherapy is not just something the therapist does, Psychotherapy is a process between therapist and clients, it is something that involves a relationship between the two. It requires trust, honesty, hope, resilience, belief, commitment, and preparation to work together.

Of course, Gurgone acknowledges the need for formal qualifications, training, and experience, but ‘that alone, will not necessarily result in doing good psychotherapy. It also requires the therapist to have a good level of self-awareness and an ability to relate to clients on a human level through the process of psychotherapy.’ I fervently agree.

Psychotherapy Tales documents the stories of 10 families through their therapy, and the corresponding journey of the author, as their therapist. For example:

Matteo was enraged at his daughter for sneaking out her bedroom window to attend a celebration of finishing her secondary schooling. Her Australian born mother was sympathetic but unable to influence him to allow her to attend. He lost his temper and attacked the daughter, who responded by locking herself in the bathroom, and attempting suicide. The family were referred to family therapy after the daughter’s discharge.

Matteo angrily announced at the beginning of the first session, ‘Doctors are dickheads, they say I can’t hit my kids! If you say this I will leave!’ Father’s exit would have further entrenched the dangerous tensions in this family, yet the violence could not be condoned or ignored. Aldo’s sensitive connecting to Matteo’s outbursts finally resulted in him realising that his daughter could not feel loved when he was so aggressive, and he broke down and apologised.

Beryl has spent the last twelve years in a closed psychiatric centre — having had only two weekend passes in that time; both were truncated, as she couldn’t cope. Her husband has divorced her, and her sister was raising her child in a stormy relationship. Beryl was consistently unresponsive throughout eight sessions, and she did not take up the offer for more. Working with her was hard work; Aldo thought he had had little impact . . . until 3 years later when Beryl phoned him! She had already dialled his number and hung up ‘about a hundred times.’

She told him about the complete turnaround in her life; she was now a full year into successful living in the community, and calmly reconnecting with her stormy sixteen-year-old daughter. ‘Her unresponsiveness in the sessions had made it easy to assume that she wasn‘t emotionally present, in fact she was acutely aware of what was happening.’

Marco 15, and his parents, were referred to family therapy after he began lapsing into weird psycho-babble that he could neither explain, nor cease when it took over. His parents were at a loss to understand or contain this strange behaviour. By the fifth and final session, Marco’s babbling had ceased, and he no longer felt any urge to do it. However, this was not directly addressed in the sessions. Aldo had enquired about the mother being dressed entirely in black, this revealed a pall of grief overshadowing the family; mother’s three brothers had been murdered, at eleven month intervals from each other. Aldo’s encouragement for the family to visit Italy was firmly rejected. Gradually Mafia connections, and the ominous risks of such a visit, emerged. Aldo acknowledges the wisdom of Social Worker Nada Miosevic in increasing his sensitivity to differing cultural traditions about grieving, and Steve de Shazer’s insight: ‘When clients resist, the therapist is doing something TO the client, not WITH.’

These three are merely a sample, and not the most difficult: there are stories about the complications of family businesses, the recall and long-term impact of paedophilia, bulimia, and the history of an unhappy teenager across the world from her family, the first gathering together of a family shattered and scattered forty-eight years ago, and the destructive questioning of paternity.

Looking over the therapist’s shoulder, and being included in his thinking, it becomes clear that each family is greeted as a new challenge; there is no generic formula, nor specific responses for particular presenting issues.

However, if you look at the fundamental structure of Gurgone’s approach, there are strong underlying processes and tenets that shape all of his work. Before I outline these, I ask the reader to consider, as they peruse, how much of their own family therapy training focused on these issues, in contrast to repeat patterning of expectations and application.

While gently exploring and connecting to the specific issues that have brought the person or family to therapy, he is also looking more broadly, at the small indicators of who are these people who make up this vital constellation; responding to much more than the problem that has brought them. ‘Joining’ with them is the foundation on which all therapeutic change and growth is built. This requires an appreciation of the idiosyncratic characteristics of this family, at this time, and the ability of the therapist to convey this understanding to the family members in an equitable manner. This may involve a variety of different perspectives, as seen by the different participants.

His calm offering of strength and wisdom, when there is fear, uncertainty, and/or resultant anger, reveals his self-awareness, his own emotional intelligence, and his acceptance and modelling of himself as a human being — not as an omniscient therapist. When he doesn’t know, or he makes an incorrect assumption, he owns that. Quickly, he empowers and inspires the family to speak, and listen to, their own wisdom, and together, with the therapist’s support, develop meaningful strategies which move them towards the path of joy and happiness. As these are ‘owned’ by the family, they are far more likely to be sustainable.

Anger, which may be overt and aggressive, or passive and defiant, is often present in therapy, as are fear and massive insecurity. High levels of emotion, especially in conflictual situations, are widely avoided or poorly handled in the general community. Competency in managing oneself and staying calm in the centre of calamity is an essential skill for family therapists. This book offers the opportunity to ‘watch’ a master at work, and ‘hear’ his inner thoughts as he deals with potent emotions. While this doesn’t guarantee growth in the necessary skills, it is a banister to assist. The actual acquisition is a personal journey.

No matter how wise the insights developed and shared, change is at risk of being undermined by old habits; Gurgone offers a range of ways to anchor the directions begun in the therapy session. When old destructive patterns need to be left behind, he offers guidelines for a ritual burying of the past. What is buried, where it is buried, and what is planted over it are all decided by family members; and enacted by them.

To maximise the work done within the session, homework is assigned — each ‘project’ being an individually crafted guideline: containing ‘things’ to prepare, to discuss, to consider. These may be concrete or ephemeral. In one case he wrote a long fairy story, about a princess who was wooed by a visiting prince from a faraway kingdom, and her difficulties adjusting to the new kingdom’s ways when she went there as a new bride. He gave a copy to the six-year-old daughter, and one to the mother who was warring with her ex-husband, father of the little girl. The story reaches out to each of them in different ways. Aldo comments ‘when we are emotionally distressed we are just grown up little children.’ Note the first person ownership; this applies to therapists too!

He takes great care to develop responses that fit the individuality of the client/s. In one tale, Aldo talks with a psychiatric patient who is refusing to drink anything. Assuming she was religious as she was silently muttering while holding her rosary beads, he talks about Jesus in the desert and how he needed clean water to survive and continue his teaching. This seemed to have little impact on the patient; however, as soon as he left her bedside (he was later informed) she immediately downed three glasses of water! Impressed by this spectacular success, the ward staff asked him to apply his approach to another patient also refusing to drink. It had no impact whatsoever. This didn’t surprise Aldo: ‘(it) demonstrated to me that it’s not the intervention or the technique which determines the success. It’s not just what you do. It is more to do with what happens between the therapist and the client.’

In summary, this gem of a book, a mere 116 pages, is packed full of wisdom and compassion. It offers new family therapists invaluable guidance, and people who have been around for ‘yonks’ (like this reviewer) a delightful refresher. It is a timely addition when the true spirit of family therapy is lagging, at a time when its benefits are most sorely needed.

Keep writing Aldo!

References
Gurgone, A. (2018). Psychotherapy Tales.
Satir, V. (1988). The New Peoplemaking. US: Science and Behaviour Books.
Yalom, I. (2017). Interviewed by Dr Victor Yalom, Psychotherpay.net.

Glen Barnes
Director, Breakthrough Consulting P/L
glen@breakthroughconsulting.com.au

Australian and New Zealand Journal of Family Therapy, 2019, vol. 40, pp. 277-281.


 
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