“Without communication, we cannot survive.”Virginia Satir
All human interaction can be thought of as communication that follows the rules of a general system: time as a variable, hierarchical relationships, wholeness, feedback, and equifinality. As such, it has been said that humans cannot not communicate (Jackson, 1968), because all interaction involves behavior, and all behavior is communication. This tends to indicate that behavior, and thus communication, is an innate part of human interaction. On the other hand, I feel its importance is often overlooked precisely because it is so basic.
The word “communication” refers to verbal and non-verbal behavior within a social context among persons who are giving and receiving messages (including symbols and cues). According to Haley, if any person or element of behavior is discounted during a communication attempt, there can be no relationship.
In a social context, the difference between a human and a stone is the stone has no choice but non-behavior. For the human, non-behavior is by choice, and as the Zen saying puts it, “Not to choose is to choose.” To choose not to communicate is to communicate, nevertheless.
For our purposes, we will define therapy as intervention (by the therapist, an “outsider”) into a communication system. Therapy is perceived as being necessary because of the style of behavior developed by the identified patient in response to others in the system. This sheds a very relativistic light on the presenting problem. From the point of view of the therapist, however, the patient’s communication is considered functional within the system. The therapist’s intervention into the life of the patient is, in reality, an intervention into the family system (Haley, 1978).
Modes of Communication
The study of communications centers around three “modes:” verbal, non-verbal, and context. The distinction between verbal and non-verbal has also been expressed as the difference between digital and analog (Bateson and Jackson, 1968), overt and metacommunication, report and command, and content and process (or relationship). No matter what words are used to describe it, the context in which the communication takes place can drastically alter the meaning of the communication.
Verbal communication allows humans to time-bind, to communicate experiences, ideas, and feelings at times different than when they first occur. Time-binding is a critical distinction between humans and animals. Verbal communications, however, end at the speaking or writing of the word. For the purposes of the study of communication, “verbal” communications are considered to follow a set of rules that makes the message unambiguous. These rules, however, may or may not be known to the speaker. For example, most English-speaking people would not say;
“Cat Poland knife are.”
“I thinking I going happy now.”
“Please take my feet out of my ears.”
Each word in these examples is certainly easy enough to define, yet because of the rules of verbal communication, they can not be said together in the order here presented with any hope of communicating information.
Verbal communication uses words that more or less represent the topic of communication. Words are called the digital aspect of communication, as they are abstractions of the objects or ideas they represent. These abstractions are multi-ordinal. That is, there are different levels of abstraction. The more abstract the digital communication, the less specific it is, and the farther removed it is from the actual object or idea it represents.
Non-verbal communication is the analog aspect of human interaction. Basically, the analog component of a message is everything that is not verbal. All inflections, context, and body language that accompany the spoken word are non-verbal. Tone, inflection, sequence, rhythm, and cadence are all examples of analog communication. The degree of complexity possible (with this many variables) is staggering. Fortunately for the practicing therapist, communication can be viewed as a continuum, so that dealing with the major issues is usually sufficient to effect change in the interaction.
Gesture, body language, and facial expression are all part of non-verbal communication, the study of which is known as kinesics. Fast (1970) points out that body language is not only different from person to person but from culture to culture, as well. Non-verbal communication of this sort obviously started well in advance of any type of verbal communication. Because of this, we must assume that the significance of non-verbal communication is far-reaching. (Watzlawick, Beavin, and Jackson 1967)
The context in which communication takes place can alter or reinforce the meaning of the communication. Even silence, which is usually considered an absence of communication, can have a variety of different contextual meanings, although the messages are ambiguous in nature.
Let’s compare the messages given in three different communications in which silence plays a part. For the first message, we’ll take the example of two apartment-house neighbors who pass in the hallway. One says hello to the other, who returns the greeting with a blank stare. Is this a snub, or did the one neighbor venture out without her contact lenses? In the uneasy silence between two lovers, is the unfaithful party trying to hurt the other person, or merely ashamed of his actions? The true message cannot be guessed without knowing the environmental, contextual, interpersonal, and individual variables.
Another example of context can be found in Berne’s work. (1967) He put forth the theory of ego states, in which Freud’s id, ego, and superego are represented as three interacting “ego states”: the Child, the Adult, and the Parent. Berne states that the messages are influenced by the way the different ego states interrelate. In other words, a parent-child interaction between two people is going to be much different than an adult-adult interaction between the same two people.
The verbal, non-verbal, and context modalities are inseparable in human communication. Furthermore, like the lotus flower that produces blooms and seeds at the same time, each human communication is both a cause and an effect. It is important for the therapist to remember that communi|cation is simultaneously a stimulus, response, and reinforcement.
As important as communications are for the therapist, the study of communications and therapy hardly takes place in a vacuum. Communications theory, as it applies to family systems therapy, draws from a great number of other disciplines such as semantics, syntactics, mathematics, linguistics, mass communication, information processing, and telecommuni|cations.
Communication theorists are often referred to as the Palo Alto Group because of the influential work done in this field by Bateson, Haley, Weakland, and Jackson in the Palo Alto area. Satir, although not a founding member of the Palo Alto Group, is important in this field as a practitioner, as opposed to the others, who are theoreticians.
Anthropologist Gregory Bateson was initially attracted to the study of communications by the theories of cyberneticist Norbert Weiner. They eventually co-sponsored a series of conferences and were jointly responsible for many of the key postulates of communication theory. In 1952, Bateson was awarded a grant by the Palo Alto VA Hospital to study patterns and paradoxes of communication.
Jay Haley joined Bateson while still a graduate student in communications. Haley defines relationships as power struggles that occur during attempts to determine what messages or behaviors are to take place, and who is to control what takes place. Haley’s therapeutic method is one of modeling new ways of relating, in an effort to produce change in the system through education of its members.
Psychiatrist Don Jackson signed onto the research project that already featured Bateson, Haley, and Weakland. Jackson’s application of systems thinking to family therapy, and his painstaking work in communication theory influenced Satir, Haley, and many others. Jackson emphasizes the cognitive aspects of communication, in contrast to Satir, who is concerned with feeling, and Haley, whose focus is power.
Jackson avoids looking at the “why” in interactions, instead preferring to describe the “how” in terms of circularity, and then applying wholeness, nonsummativity, equifinality, and feedback concepts. He developed these axioms of communication:
- One cannot not communicate
- The three levels of communication are the report, command, and context levels. (Lederer and Jackson, 1960)
- The circular nature of the relationship makes the punctuation of that communication sequence of prime importance.
- Digital communication works best for “facts.” Analogic communication tells more about relation|ships, but it is highly ambiguous.
- Communication is either symmetrical (between equals) or complementary (between unequals). Symmetrical exchanges are open to competition and escalation between the parties involved. Complementary exchanges (such as dominance/submission) can lead to ridigity or frustration.
Jackson observed that family homeostasis was usually disturbed by a violation of unwritten, usually unconscious rules. He would then focus the family’s awareness on the rules, and negotiate a new quid pro quo (Jackson maintains that insight is not essential for this process.) Jackson often disturbed the homeostasis himself to discover what the rules are.
Virginia Satir joined Jackson after he had left the Palo Alto Group. She views inadequacies in communication as the cause of all illness. Her approach is to teach improved communication methods, and to help people stop repetitious sequential roles, such as communicating the victim role. (Satir, 1976)
Satir stresses the feeling aspect of communication. Satir further suggests that intrapersonal behavior can be reliably deduced from the subject’s communication techniques.
There are four major tools used by communications therapists to describe the functioning of a family system: family homeostasis, double-bind, message sent/message received, and family pain.
This is defined by Jackson as the tendency for a family system to use negative feedback to restore the status quo in the event that behavior falls out of the “comfort range.” The comfort range is composed of the rules for joint behavior that helps perpetuate the family unit as a steady state system. Negative feedback is the family’s method of enforcing the rules.
Occasionally, of course, the status quo must change, necessitating the formation of new rules before balance can be restored. One difference between functional and dysfunctional families is that functional families are better able to adapt to the changes, while dysfunctional families rigidly cling to the status quo.
Bateson is credited with originally putting forth the “double-bind” hypothesis. For the double-bind to take place, there must be two or more people involved; there must be a primary injunction, a secondary (and contradictory) injunction, and a tertiary injunction (that requires comment); and the experience must be repeated. The person being spoken to is called upon to make some response, but he is doomed to failure. Whatever response he chooses, he is caught in a paradoxical situation. Note that this paradox is more than a simple contradiction.
The victim of such interactions, which are prevalent forms of relating in families with a schizophrenic patient, is caught in a double-bind, with no way to go without leading to trouble. (In fact, Bateson originally put forth the double-bind theory to put schizophrenic behavior in context.) The victim sees he has only four choices:
- He can become obsessed with the search for the information he feels he is missing.
- He can comply with all injunctions.
- He can withdraw
- He can act out or act in.
These choices are also the description of schizophrenic behavior, which is perfectly valid as a response to the double-bind. Because of the multi-ordinal nature of communication, the double-bind effects all of us, all the time.
Recent thinking on the double-bind stresses that it is simply a process that repeats reflexively unless somehow interrupted; without a victim, and without cause-and-effect.
Message sent/message received
Later in his work in communications, Jackson theorized that the messages we receive are often not the same as the messages that are sent, resulting in major breakdowns in the relationship. Worse, there is no infallible way of determining what the other person really means because most messages are not explicit. Thus, most responses appear unconsciously motivated because neither the action nor the reaction of the other person is understood, and because the sender and receiver interpret these messages in terms of different contexts.
Satir zeros in on the pain in the family, which she sees coming from the stress of maintaining homeostasis when communication is incongruent (when the denotative and metacommunicative levels contradict each other). This incongruent communication is caused by low self-esteem.
Satir identifies four dysfunctional styles of communication:
- Compute (discounts feelings)
Satir also identifies the one functional style of communicating as “leveling,” in which all parts of the message are coordinated.
Use of Techniques
Traditional psychotherapy deals with clients mostly on an analog level. Both free association and dream analysis rely heavily on the analogies the therapist can draw from what the client says.
Behavioral techniques, on the other hand, offer more of a balance between the analog and digital messages. On the digital level, the behavioralist changes the words to change the feelings and/or actions. There is another analog level, however, in which the therapist analyzes the client using analogies, and utilizes behavior modification strategies to bring the second level of communication in line with the first (digital) level.
The behavioralist does this by changing the context in which the patient’s communicative style was developed, and to which it must adapt. The patient’s style cannot be changed only by “working on the communication.” There must also be organizational changes made in the patient’s situation (Haley, 1978).
The therapist has many tools at his disposal, including sensory modalities, metaphor, “I” messages, “why” messages, neuro-linguistic programming, punctuation, double-bind, therapeutic double-bind, paradoxical intervention, pre|scribing the symptom, and relabelling.
Bandler and Grindler exhaustively studied the client’s speech patterns, tonality, and phrases in hopes of understanding communication and resolving the patient’s problems. They found that framing a problem in a different “sensory modality” facilitated its resolution. The client is asked to conceptualize and communicate his problem using all the sensory modalities (e.g., what does it feel like, what does it sound like, look like, etc.). Bandler and Grindler maintain that framing a problem in a different modality facilitates its resolution. Bandler and Grindler further speculate that the therapist can learn to resolve problems by understanding the client’s use of message and metaphor (Hoffman, 1981; Weeks and Abate, 1982).
According to Campbell (1981), “Metaphorical language is a form of primary process thinking.” Many therapists like Minuchin use metaphor to hasten the therapeutic process. The therapist is able to do this by identifying the metaphors used by the family and then adopting them. The family recognizes their own metaphors, allowing the therapist to begin working with the family as if they were friends of long standing.
“I” messages are a Gestalt therapeutic technique, in which the patient is encouraged to stay in the here-and-now by verbally taking responsibility for the events that are happening in his life. For example, instead of saying, “My mother is always angry at me,” the patient might be encouraged to say, “My behavior drives my mother crazy.”
Another Gestalt technique involves discouraging the patient from using the word “why.” This is done to keep the patient’s thought processes focussed on himself and on the reality of the situation.
NLP is a collection of techniques designed to further the communication process; first between the patient and the therapist, and then between the patient and the confusing elements of the interactions in his life. One such technique is called “mirroring,” in which the therapist mirrors the speech patterns or physical actions of the client in such a way that the patient feels a kinship with the therapist.
In keeping with Jackson’s view of the circularity of communications, the therapist can invoke change into the system by altering the “punctuation” of the communication. This preserves the circularity of the system while halting repetitious and negative communica|tions patterns.
The patient is given permission to meta-communicate about the incongruities between the verbal and non-verbal messages he is receiving. If the receiver of contradictory messages can acknowledge his confusion and comment on the contradictory messages, the mystification disappears and so does the double-bind.
A therapeutic double-bind is an attempt to fight fire with fire. The conflict between the two double-binds serves to punctuate the circularity of the communication at a different point, thereby changing the system.
Prescribing the symptom
The therapist suggests that the patient continue to behave as he already is, making use of reverse psychology. This is called a “first-order change,” because the patient does “more of the same.”
If the patient has a logical mind, the therapist can use paradox to help expose the illusory alternatives and the invalidity of the choice itself. This gets the patient to step outside of the pattern by communicating a metamessage that hints that there is an end to the game. This is called a “second-order change.”
The therapist forces the family to change its thinking about the presenting problem by replacing its previous pejorative name with a new, positive name. An example of this would be relabelling “nagging” as “concern.”
Because communication is so intimately involved with therapy, it is difficult to determine where to end the study of communications. Even with the limited boundaries I have imposed upon this paper, the amount of information covered was nearly overwhelming.
From this vast universe of knowledge, I found there were three concepts that I keep coming back to. These are double-bind, message sent/message received, and “I” messages. In my experience, I have found many cases in which the double-bind and message sent/message received problems co-exist in a family’s communication. While doing the research for this paper, I was able to develop a better grasp of the individual points of each concept, thus making me better able to help families resolve their problems. “I” messages I found to be a very helpful technique to use when faced with months or years of stored up, negative feelings in relationships. Rather than allowing family members to dwell on old problems, I would encourage the use of “I” messages to keep the family in the here and now.
Of all the reading I did, I was most influenced by the work of Satir. I have always been sensitive to the feeling tone in a relationship, and Satir’s focus on family pain as a method of discovering conflicting messages in family communication struck a responsive chord. I find that my style of therapy also follows Satir’s, in that I am most comfortable taking an active, directive part in the therapy, teaching my clients to use new techniques to help alleviate their pain and suffering.
Satir’s influence was so strong that I have since begun to look at other theories and techniques with an eye toward integrating them into my own feeling-level therapy. For example, Berne’s ego states and life positions, I found, were excellent vehicles for exploring family pain.
All in all, I found that studying this virtually infinite field was instrumental in expanding my concepts of what I can accomplish in therapy.
I will be discussing the case of a couple married for fifteen years. The husband, Sam, is a very successful forty-five-year-old personal manager for entertainers, and his wife Sandy is a forty-one-year-old advertising executive. They have a child who is nine years old.
Sandy is attractive, with an out-going personality that is a great asset to her profession. At home, however, she rarely, if ever, asserts herself. Sam is handsome, with a quiet, passive personality. He is a powerful businessman, however, with a logical, sensible approach to his work.
Prior to coming in for marital therapy, Sandy had been in individual therapy with Dr. Fleming for eight months. She insisted that if Sam did not go into individual therapy, she would seek a separation. This was the first time she had made a strong demand in their relationship. As a result, Sam has been seeing a therapist for the past four months.
The presenting problem was that Sandy felt her husband was uninvolved with her and their daughter. Sandy was becoming increasingly distraught and angry at Sam, but she was not ready to end the relationship. For his part, Sam had no overt complaints about their relationship.
The first excerpt will deal with my ability to help this couple understand how to think in specific terms about the problems in their relationship, along with beginning to understand how their communications patterns affected one another in the relationship. In the second excerpt, I will further demonstrate how I began to alter this couple’s faulty communication on the verbal and non-verbal levels. I will also demonstrate my understanding of how to focus communication to help clarify feelings and demonstrate strategies for better communication. The third excerpt is focussed on how important it is for the therapist to understand her own counter-transference in marital therapy because of the profound feelings stirred up during the therapeutic process.
The clinical characteristics I will use in this case are:
- clinical self-awareness
- marital therapy strategies
- clinical process
- communications skills (for this paper only)
Prior to the first excerpt, I had had one session with this couple in which they had described their problems in an unfocused manner. The wife did most of the talking while the husband listened. During this first session, Sam exhibited quite a variety of non-verbal communications using looks and body posture.
Case Excerpt 1
I asked Sandy and Sam if they could describe what the strengths were in their relationship. They both sat in silence. I said, “It appears to be hard for the two of you to come up with something.” Sandy said, “That’s because we hardly ever talk, and I don’t think we think about these kinds of issues.” I turned to Sam and asked him what he felt about what Sandy had said. Sam replied, “I think we enjoy each other. And we like to go to movies and plays together.” He had a hard time coming up with anything more than that.
I showed my clinical self-awareness by observing Sam’s denial of Sandy’s feelings. Sam made a statement of his feelings and thoughts instead of exploring Sandy’s feeling that they as a couple “hardly ever talk.” This also provides an example of how communication must be viewed in its context. By itself, Sam’s statement is completely valid. In the context of their communication, however, Sam’s statement represents a failure to focus on Sandy’s feelings.
This excerpt also demonstrates my understanding of how silence can be an important non-verbal communication. I was able to learn a considerable amount about this couple’s discomfort thinking about problems in their relationship by watching Sam as he struggled with my questions, or as he listened to Sandy’s complaints while staring off into space. I also feel Sam’s response to my question about Sandy’s feelings was an example of message sent, message not received.
Overall, I demonstrated clinical self-awareness, the ability to focus client’s problems, and my understanding of human communications.
Case Excerpt 2
I turned and said to Sam, “I have a feeling that you thought things were fine until your wife mentioned she was unhappy,” Sam agreed. I then turned to Sandy and said, “It appears that Sam recently has been able to hear what you are saying about being unhappy in the marriage.” Sandy said, “I think he is beginning to understand what makes me unhappy in our marriage, but that is only because, after being in therapy with Dr. Fleming, I have started talking about the things that are bothering me.”
“I would like to ask you both some questions that I think would be helpful in further understanding the problems that couples seem to have when they are having difficulties in the marriage,” I said. “Do both of you feel that you have mutual interests,” I asked. Sam said, “I think we get along well in some of these areas,” but he did not come up with any specifics. He then stopped and again had no more to say. His wife said, “I don’t agree with Sam. I don’t think we’re compatible in any area. Most things, Sam and I feel differently about.” I turned to Sam and said, “How do you feel about what your wife said?” Sam said, “I didn’t know that. This is all very new to me.” Sam was silent. He turned his head away from his wife and stared off into space.
This said to me that Sam was really struggling with his wife’s response. I said to him, “As you turned away you looked uncomfortable.” Sam said quietly, “Even though I’m beginning to understand that Sandy has been very unhappy, there is more dissatisfaction than I was prepared for.” I said, “Sam, that must feel difficult.” He nodded. I then looked at Sandy’s face. She was nodding, “Yes.” I said, “Sandy, the look on your face tells me you have a lot of feelings about what Sam just said.” She said, “It’s sad, but it makes me feel good that Sam would even consider that maybe I’m struggling with a lot of things in the relationship. And to answer your question, one of my sadnesses is that we just don’t seem to be compatible. Sam hasn’t shown much of an interest in our daughter, or in spending time with me. He isn’t interested in the same people who interest me, he doesn’t like to talk, and he doesn’t understand what it means to be empathetic.” I said to Sam, “Do you agree with what Sandy is saying?” Sam said, “I have begun to realize Sandy is much more unhappy than I knew, and I can’t say she is wrong about those issues, but I’m beginning to want to try and change.” I said, “Sandy and Sam, this really sounds important, but very hard.” They both sat very quietly with their heads down, and non-verbally, one could feel the impact of this conversation.
I saw that Sandy had been unhappy for years in the relationship because of Sam’s inability to communicate and share feelings. By aligning with Sandy, I hoped to force Sam for the first time to confront his wife’s emotional needs. Sandy needed the support to strengthen her assertiveness so she could express the needs that had been repressed within her.
I demonstrated my awareness of clinical process and human communication by clarifying and interpreting the differences in the outlooks of these two people. Previously, Sam was unaware of Sandy’s discontentment in the relationship. Also, neither of them had examined the differences in their feelings concerning their mutual interests.
I also demonstrated my understanding of communication issues when I observed this couple’s non-verbal messages: Sam would become silent and turn away from Sandy when she was talking, while Sandy showed a lot of her inner feelings through her facial expressions. I then demonstrated my clinical self-awareness by pointing out these messages to the couple. In both cases, my intervention precipitated a clearer understanding of what their partner was trying to communicate.
I demonstrated my ability to keep the session focused on this couple’s deeper feelings and help them see more clearly their awareness of the specific differences and dissatisfactions in the relationship.
Case Excerpt 3
I asked, “Do you feel you show each other much empathy, such as if somebody is feeling upset or bad?” Sandy said, “Most of the time we don’t. I wish we did.” Sam sat silently, staring at the wall. I said to him, “What do you think about Sandy’s comment?” Sam said, “These questions feel very strange to me. I never felt much need for people being supportive of me. I just don’t want Sandy to be mad at me.” I said, “Do you think you know now what Sandy means about needing empathy?” Sam said, “No. I am having a hard time relating to that.” I turned and looked at Sandy, and observed her non-verbal communication when Sam said this. Her head was down, and she looked very sad. I asked, “Sandy, what were you thinking?” She said, “The more you focus these questions, the more depressed I feel. It becomes apparent to me that Sam and I have had very little in the way of relating to each other or showing much feeling. I realize more now why I have been feeling frustrated.” Again, Sam said nothing. I asked him what it was like to hear his wife saying those things. He looked directly at me and said, “It is depressing.” I asked if they could look at each other and express any thoughts or feelings about what had just been said. They turned to each other, but again there was silence. Then Sam said to Sandy, “This really scares me. I still want to try.” She stared at him and then said, “I want to try, too, but I don’t feel anything right now and I haven’t for quite a while. I am sorry if what I just said hurt you.” I intentionally sat quietly, because I felt that this couple, for the first time, was beginning to express and feel some of their pain and sadness about what had been happening in their relationship.
After a while, I said, “I know both of you are leaving this session feeling uncomfortable. But I hope that you don’t jump to any conclusions about this session because I think that we need to have much more information about what the problems are, and what to do about them before we come to any conclusions about what happened here today.”
At the end of the session when I intentionally sat quietly after the couple communicated their very painful feelings about the relationship, I demonstrated my understanding of another aspect of clinical process in therapy. Dr. Fleming pointed out that at critical points in the session, the therapist must learn to sit through the client’s discomfort to force them to experience the fullest amount of their feelings. This creates the potential for the greatest degree of change and growth. My natural tendency would be to protect the client from this pain and want them to leave the session feeling good. However, because of my awareness of my counter-transference potential, I was able to contain and deal with this feeling in an appropriate way.
I do agree with Framo, however, that most couples are very afraid to end even a bad marriage. When it is appropriate, I feel each session should end with the client feeling relieved and hopeful, and ready to continue to work on their relationship.
I also demonstrated in this session my use of a marital therapy strategy when I told Sam to turn and look at his wife, to affect more direct communication. I have found that it increases the feelings between persons when they make visual, physical, and verbal contact.
Case report summary
The study of human communication reinforced and heightened my ability to do clinical work with clients. As I worked with the couple in this case, I observed how important it was to watch the phrasing, speech patterns, tones, and the manner in which this couple subtly communicated with each other, as described by Bandler and Grindler.
Another important aspect of working with this couple was Perls’ idea of the importance of “I” messages. It highlighted a style of communication that prevents couples from blaming or just complaining about one another. Later, I was able to use this effectively with this couple.
Berne’s work describing human interaction (among adults, parents, and children) is helpful in looking at how a couple communicates. For example, the interactions of this couple at times had a parent-child position. Sandy would communicate to Sam with an irritated, scolding tone, at which time she would sound like a parent telling a child he was doing something wrong. Sam would complete the transaction by turning away like a child ignoring his mother.
Satir’s approach in teaching clients how to understand and communicate feelings was very useful in this case. The style and ability of this couple to communicate changed dramatically when Sam began to communicate his feelings and understand Sandy’s feelings. Satir’s comment about teaching a person to ask for what he needs applied to Sandy, because she had never been able to do this until she started therapy.
I found Jackson’s contribution (message received/message sent) to be a very helpful way to think about faulty communication. In the early part of this case, Sandy’s messages sent were never understood by Sam, because he had grown up with little or no practice in becoming an active listener or empathetic communicator, which are major aspects of communication.
Overall, the concepts from human communications were very helpful in rethinking the work on this case.
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