H. Peter Laqueur, M.D.
Transcribed from the SANDOZ Video
By Lewis N. Foster
July 28, 1992
"I should like to describe what we are doing with Multiple Family Therapy techniques here in Vermont. On the first chart you can see three institutions who work together with the Vermont State Hospital. In MFT we usually have five or six families brought together with a variety of disturbances. Our therapeutic team consists of a therapist, co therapist and observers. Here we try to show in individual therapy the patient and the therapist are alone together and everything else, the family and society, are on the outside. The therapist depends on what the patient tells him about what he has experienced. In peer group therapy we have patients and other patients and a therapist together and they derive better mutual understanding, but their families and society are still on the outside. In conjoint family therapy the patient, the therapist, and the patient's family are together, and there is a good build up of mutual understanding within the family, but the relationship to society is still unknown, because, society is on the outside. In Multiple Family Therapy we have four factors together. The patient and his family, the therapist, other families, and through the other families outside society is represented. The understanding that is brought about here in this case gives us the widest possible range of understanding for future action."
"Mothers respond to the deepest mutual feelings of the patient and get a deeper understanding of their own." Inter-family codes (which exclude further communication) pass messages and sometimes block the expression of emotions. For example a daughter cries producing guilt in other family members letting them know not to express themselves. Laqueur calls this a security operation. "It makes it clear to the family that vulnerable times must remain covered and must not be exposed to other people. This is a sure way of avoiding that sleeping dogs can be awakened if the family is in contact with other people, or therapist."
Laqueur talks about Phases of treatment.
Phase One = Initial Release, crying, etc. The family feels relief because finally "something is done" to improve their intolerable situation. They have a chance to observe other suffering (and improving) families and this gives them hope, making them cooperative.
Phase Two = Resistance, where they have to face up to painful subjects and they don't know how to deal with it yet. (IP might say, "I think I need to keep my mouth shut.")" A period of high resistance with a plateau of slow progress." Resistance appears when the family begins to understand that a serious change in attitude and behavior is required not only of one member of the family but of all of them. There is a tendency to say, "If you change, I can modify my own attitude but until you do what I need, I can't change."
Phase Three = Much less resistance and more at ease and can be useful to others. Jokes and may behave like a fairly independent person. This phase is reached, when the family clearly understands the need for simultaneous change of attitude and behavior in all members and starts to help each other, as well as other families. This is when most of the learning by analogy, modeling, and indirect interpretation occurs.
"Co therapists are important in the work that is being done. Co therapist can support trends that are set by the therapist."
"As a therapist with patients and families I like to help solve the problems of dissonance with the environment and internal conflicts caused by disturbing habits. This means working simultaneously from the outside in and from the inside out.
"I feel that Multiple Family Therapy can offer something that is in addition to what we can do with other tools, namely, we can in the first place avoid that the patients have to be hospitalized or returning to the clinic as often as they do. We can produce a great deal of more hope and less despair and hopelessness in the family. We can use our therapeutic manpower much more efficiently, because, we can do many things for many people without making it less efficient. And I think we can increase our potential for avoiding future crisis."
"What we try to do when we bring new families into MFT is to fill a position that has been vacated by another family that has finished treatment. We like to keep this open ended, because, in this way we have families that can profit in the beginning from families that have been there already for a while and are more advanced in the treatment. We also, would like to keep it as random as possible, have young and old in there. We like to have different levels of education, housewives, minister, teacher, public relations man, cab driver, for the purpose of having as many varied interests as possible rather than having them all talking about their common interest at the expense of other problems that are more important. Most important thing to me seems that we are keeping it differentiated and fast moving because there's always somebody who’s already a little bit further advanced than the other persons."
"This is the point where we have to help shape the future of you."
SECURITY OPERATION in Sullivan's theory, an interpersonal device that a person uses to minimize anxiety and enhance security.
SECURITY in Sullivan's theory, a state of emotional well-being, self-confidence, and optimism in which there are no painful feelings or emotions.