Value Systems and Psychopathology

in Family Therapy
Gerald H. Zuk

ABSTRACT: Two sets of values--the "continuity" and the "discontinu-

ity"--are readily apparent in family conflict. Pathogenic relating erupts
after an impasse between the sets of values. Husband-wife conflict,
parent-child conflict, and conflict between the family and neighbor-
hood or community are described in terms of conflict in value systems.
Family therapy is a method for influencing the value systems.
Each of the three role functions of the family therapist--the go-
between, the side-taker, and the celebrant--expresses both "con-
tinuity" and "discontinuity" values which are described. Depending on
his assessment of pathogenic relating and other features of family
dysfunction, the therapist selectively expresses values that serve to
disrupt and then repair destructive family interaction.
The process of engaging families in therapy is crucial because
many families, especially those that are poor and uneducated, do not
like to sit and talk about problems. Short-term therapy works best with
the majority of poor, uneducated families; it even works best with
middle-class families. Short-term therapy works mainly because it least
violates value expectations the majority of families have about therapy.

In the early days of family therapy--meaning in the early

1950s--when its major thrust was to investigate family dynamics
associated with schizophrenia, and to test its efficacy as a
therapy of schizophrenia, the problem of values in family
therapy and dynamics was considered of subsidiary importance

An invited presentation for the First International Congress of Family Therapy held in
Tel Aviv, Israel, in February, 1976. A brief version of this paper is scheduled for
Psychotherapy: Theory, Research and Practice, Vol. 15, No. 1, 1978, but due to an
extraordinary delay in publication of the above-named journal, the lengthier version
here may actually appear in print first. The possibility is mutually acknowledged by the
editors of both journals. Reprint requests should be addressed to Gerald H. Zuk, Dept. of
Family Psychiatry, Eastern Penna~ Psychiatric Institute, Henry Ave. at Abbottsford Rd.,
Philadelphia, Penna. 19129.
International Journal at Family Therapy 7(2) Summer 1979
0148-8384/79/1400-0133 $00.95 9 Human Sciences Press 133
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and given little consideration. The two major factions in family

therapy in the fifties, the analytically-oriented therapists and the
communicationists, hardly addressed the problem.

MAJOR ACHIEVEMENTS IN FAMILY THERAPY

From 1950 through the early 1960s

Of advances in this period, there are four that seem most
significant: (1) A confirmation of Harry Stack Sullivan's view that
it took longer to "learn" schizophrenia than infancy and early
childhood, but that adolescence and youngadulthood were also
important stages in causation, and that the family was a key
source of systematic reinforcement for the kind of learning
necessary to produce the illness. (2) The double-bind hypo-
thesis, conceived by the Palo Alto Group (Bateson et al., 1956),
although not the complete explanation of schizophrenia they
had hoped, nor effective as a treatment method, was the most
original, creative concept of the period in that it showed how
families systematically reinforced irrational modes of thinking in
members prone to schizophrenia. (3) While family therapy
proved neither more nor less effective as a treatment method
than other psychotherapies, it did produce some remarkable
instances of symptom reduction in schizophrenics--sometimes
in a remarkably brief period. (4) Family therapy experience
confirmed the notion that schizophrenia was an illness of
diverse origins which clearly ran different courses in individuals.
The intense focus of the 1950s on schizophrenia may itself
have contributed to adisinterest in the problem of values in
family therapy, for it is such a dramatic phenomenon that it tends
to mute others. In their work with families, the analytically-
oriented therapists maintained the traditional neutral stance
toward values, and the communicationists practically dupli-
cated their attitude. When values were mentioned, they seemed
to basically reflect the white, middle class family value system.
Only one of the early workers in the field (Midelfort, 1957)
suggested it was helpful if the therapist was familiar with the
ethnic and religious origins of the psychiatric patient and his
family; or even that he be a member of the same ethnic-religious
group.
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GERALD H. ZUK

From the mid-7960s through mid-7970s

With the advent of the community mental health move-
ment in the mid-1960s, family therapy underwent a radical
change. For the first time therapists began to see a wide range of
families presenting diverse problems. Many referrals were made
as "behavior problems" bearing little if any relation to accepted
psychiatric nosology. In my opinion the five major advances of
the period have been as follows: (1) A commitment to crisis-
oriented, short-term or brief family therapy as opposed to other
models, due mainly to the fact that this was the model that
families would accept. (2) A commitment to the problem of how
to engage families in therapy, due to the fact that so many were
lost during attempts to engage them. Once engagement "took,"
it appeared that various short- and long-term therapy models
could be successful. (3) A commitment to exploring the value
systems by which families operated, due to the growing con-
viction that the family value system was among the most
important determinants of whether a family would become
engaged in therapy. (4) A focus on values expressed by the
therapist and on values attributed by the family to the therapist,
such as might be related to their expectations about the therapy
or its outcome. Analytically-oriented therapists in the 1960s
were suggesting that beginners should undergo a personal
experience in family therapy or a study of their own families.
Although this never did gain much acceptance, in the 1970s it
became obvious that therapists had to be more sensitive to the
family values which might restrict or limit their readiness for
therapy. (5) A focus on the nuclear family rather than three or
more generations, particularly on the marital couple, due to the
difficulty of involving more than two generations in therapy and
the large increase in referrals presenting a discordant marriage. I
think it is also true that even in cases where children had been
identified as symptomatic, therapists increasingly came to focus
on the marital couple as the "source" of the symptoms.

FAMILY VALUE SYSTEMS

,Goal and Definition

The aim of this section is to present a system of values used
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by families. In the next section, "Technique in Family Therapy,"

there will be an attempt to relate values to family therapy
technique.
There are many definitions of the word value, but here it will
mean an attitude, belief or way of evaluating events that typifies a
person or group. The focus on value reflects my belief that it is a
central issue in any broadly-based theory of family therapy.

Conflict in Families
Elicitation of conflict often consumes a major portion of
family interviews, and rightly so because conflict provides rich
material for the therapist. The issues over which family members
quarrel probably number in the hundreds. Therapists listen to
arguments over family finances, child-rearing practices, relations
with extended family and friends, job commitment of the
husband versus his expected duties at home, and so on. These
are the "contents" of some of the manifold quarrels, but conflict
can also be viewed from the perspective of the "parties"
involved. In family therapy, because the nuclear family is
present in most instances, there are three main "parties": (1)
males versus females, especially husbands versus wives; (2) the
older versus younger generation, especially parents versus
children; and (3) the nuclear family versus other, usually larger
social units, such as the extended family, the neighborhood or
institutions.
In family interviews husbands and wives can and do accuse
each other of all sorts of misdeeds, bad intentions, or lies.
Sometimes this is done in an open manner, sometimes not.
Another male versus female conflict is that between brother and
sister. Conflict between parents and children is also common in
family interviews. It may be over the disarray of the child's
bedroom. Or it may be about the selection of the first "date" of
the adolescent, or the hour he or she is expected home from
dates. Still later it may be about the choice of careers. Gene-
rational conflict may also exist between parents and their
parents. It may, for example, arise when parents' parents remind
them of supposed duties or obligations to other family mem-
bers. Conflict between the nuclear family and other social units
is commonly observed in family interviews. In some instances
there is squabbling with neighbors because children have
trespassed property. A family receiving welfare payments may
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GERALD H. ZUK

be challenged to show why payments should be continued.

Parents may be upset with the school which sends home a poor
report card on a child. Or a child may be brought home by police
after being picked up on suspicion of delinquency.

Two Value Systems in Families

Observation in family interviews suggests that, with respect
to values expressed towards each other, the "parties" do not
enter into conflict in a completely random manner. For example,
in conflict between husbands and wives, wives are more likelyto
express certain values than their husbands. These I have referred
to elsewhere (Zuk, 1975) as "continuity" values. The values
expressed by husbands were designated "discontinuity" values.
Furthermore, I suggested that the "continuity-discontinuity"
polarity held with respect to values expressed in conflict be-
tween parents and their children, with children commonly
expressing the "continuity" values, parents the "discontinuity"
values. And in conflict between the nuclear family and other
social units, the nuclear family expressed "continuity" values
while charging other social units, such as the neighborhood, with
holding "discontinuity" values. When a wife had conflict with
her husband, she took the "continuity" position; but when there
was conflict between parents and children, she then joined her
husband in maintaining "discontinuity" values. So it was pos-
sible for a family member, depending on which "parties" were in
conflict, to switch sides from the "continuity" to "discontinuity"
position. To know specifically what the "continuity" and "dis-
continuity value systems are composed of, Table 1 is repro-
duced (from Zuk, 1975, p. 29).
There are four categories listed within the two value systems:
(1) the affective/attitudinal; (2) the moral/ethical; (3) the cog-
nitive/perceptual; and (4) tasks/goals. The affective/attitudinal
category distinguishes those affects, emotions or attitudes that
may be labeled empathic, sympathetic or "warm" from those
that my be labeled distant, reserved or "cool." The former are
"continuity", the latter "discontinuity". The moral/ethical cate-
gory distinguishes anticonformist, idealistic and egalitarian val-
ues ("continuity") from values expressed by the disciple of law,
order and codes, and pragmatic and elitist values ("discon-
tinuity"). The tasks/goals category distinguishes the values of
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TABLE 1. Categories of Contrasting Values Expressed in Family Interviews

Categories Values

"Continuity . . . . Discontinuity"

1. Affective/Attitudinal Empathic, Distant,

Sympathetic Reserved, "Cool"

2. Moral/Ethical Anticonformist, Disciple of Law & Codes,

Idealistic, Pragmatic, Elitist
Egalitarian

3. Cognitive/Conceptual Intuitive, Holistic Analytic, Systematic

4. Tasks/Goals N urtu ring, Achieving, Structuring

Caretaking

nurturingand caretaking ("continuity") from those expressed by

the desire for achievement and structure ("discontinuity").
As an example of how the table applies to family life, let us
consider the very common conflict over child-rearing practices.
When we hear arguments between husband and wife over the
raising of children, typically it is the wife who accuses the
husband of misunderstanding the situation due to his distance,
reserve and acting too "cool". She may simply accuse him of not
caring, of being uninvolved. The husband, on the other hand,
typically responds (retaliates may be the more appropriate
word) that his wife is the victim of her emotions when it comes
to the children: she is too sympathetic, too "warm." He says she
lacks proper perspective. This is an example of the "continuity-
discontinuity" division of values expressed along the affec-
tive/attitudinal axis. Of course, there are exceptions to the rule
(as in clinical work there are always exceptions), but the pattern
exists.
In a child-rearing conflict in which the parents and children
are at odds, more commonly the children accuse the parents of
holding "discontinuity" values, and the parents accuse the
children of holding "continuity" values. The argument, for
example, may be over the time the children are expected home
for dinner. The parents have set the time and the children
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GERALD H. ZUK

persistently are tardy and give weak excuses. When the issue is
confronted, the children typically charge the parents as too rule-
and-regulation oriented. The parents maintain that the children
are disobedient or rebellious and anticonformist. The conflict is
typically waged along the moral/ethical dimension of the "con-
tinuity-discontinuity" value system structure.
In child-rearing conflict in which the nuclear family and
other social units such as the neighborhood are engaged, more
commonly the nuclear family takes the "continuity" position,
the neighborhood the "discontinuity" position. An example is
the neighbor who complains to parents that their children are
making too much noise, or have damaged property. The parents
are inclined to defend their children by insisting that all children
are noisy or break things and that the neighbors should make
allowances. The neighbors reply that good parents discipline
their children for misbehavior, and that the attractiveness of the
neighborhood must be maintained. Here again is the "con-
tinuity-discontinuity" dispersion mainly expressed along the
ethical/moral dimension.
The nuclear family versus other social unit conflict can itself
be further broken down into conflict over race, ethnic origin,
religion, social class level, and even political association. For
example, in family interviews with blacks, it is not uncommon to
hear whites described as too achievement oriented, too imper-
sonal, too rational. On the other hand, with whites, blacks are
described as impulsive, lacking in orderliness. The whites are
usually assigned the "discontinuity" values, the blacks the
"continuity" values.
In interviews with families of southern European origin,
persons of northern European origin will be labeled too re-
served, too controlled, too orderly. Southerners will be des-
cribed by Northerners as impulsive, over-emotional. In inter-
views with middle class families, lower class families will be
described as impulsive, unorganized, over-emotional. Lower
class families will refer to the middle class as too rigid, over-
controlled, too orderlyand systematic. Gentiles will refer to Jews
as too achievement-oriented, too conscious of material well-
being; while Jews will criticize Gentiles for being wishy-washy,
hypocritical in their ideals and methods. Families whose politics
are conservative will describe those with liberal politics as wishy-
washy, prone to idealize; whereas liberal families will criticize
conservatives as too rational, too rigid. In these comparisons also
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there is a nonrandom assignment of values according to the

"continuity-discontinuity" system.
Two clinical examples may be useful here to highlight the
opposition of the t w o value systems in family conflict:

Case 1: I had been seeing the K family, even though the parents had
been divorced many years. Kenny, 1O, the youngest of six children, was
doing poorly in school and had been placed in a class for learning-
handicapped children. The bitterness and rancor of the parents were
immediately evident. Mr. K was especially harsh in his criticism of his
wife. She was careless, didn't know how to discipline the children, and
was impulsive. Mr. K prided himself on his methodical approach to
problems. He was a self-made man, even though at the time in a
dilemma concerning future employment, and he prided himself on his
efficiency and orderliness. He insisted his wife undermined his efforts
to help the children be better behaved and achieve more in school and
at jobs.
An important therapeutic step was, after a few interviews, to insist that
the recriminations stop during interviews. It was not easy to establish
this rule but after a few more meetings the parents responded to the
therapist's direction. Shortly thereafter, they reported improvements
in the conduct of the children. Kenny, the only child attending
meetings, was calmer and more helpful at home.
Clearly Mr. K was an exponent of"discontinuity" values, and attributed
"continuity" values to his wife. In their marriage they failed to resolve
their value orientations peacefully. The circumstances of their lives
added fuel to the kindling fire. Mr. K wanted desperately to succeed at
his job and deeply resented his wife's failure to use birth control. His
job required extensive travel, which facilitated his withdrawal from
wife and children, and he began to drink heavily while away from
home. Mrs. K became resentful of her husband's absences, his
drinking, and his failure to discipline the children.

Case 2- Ron and his wife contrast with the K family in that both were
professionally trained, there were no children, and they were younger
than Mr. and Mrs. K when first seen in therapy. I saw Ron and his wife
for several months before the breakup of their marriage of six years. He
was the only son of Jewish parents residing in a Canadian city; she was
from a German-Catholic family in a Midwest city. They met while Ron
was at a university where both obtained degrees.
About a year before I began to see them Ron persuaded his wife that,
since their sexual relationship seemed inadequate, perhaps sexual
experimentation with others might improve it. Far from being good for
the marriage, this arrangement seemed to doom it. Ron's wife decided
to leave him and seeka divorce, and she declined to continue in couple
therapy.
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GERALD H. ZUK

Ron was agitated by his wife's decision to leave him and asked me to
continue to see him alone, and I agreed. I saw him regularly for about
one year, then irregularly for another. During the period in which I saw
him alone, he changed jobs and the divorce became final. I asked him
to cooperate with me in two ways: (1) to find a job that offered him
responsibilities commensurate with his level of training and exper-
ience, and to stay with it for at least two years no matter what the
frustrations were; and (2) to form a serious relationship with a woman
with the intention to share his life on a permanent basis.
With the first task Ron more or less complied, but with the second he
did not. He formed numerous brief relationships with women during
the time I saw him. None seemed to him to match his ex-wife. He
mourned the end of that relationship,even as he recognized how he
had helped end it. I think Ron grew up a bit during the time I saw him. I
concentrated on trying to help him deal constructively with frustra-
tions at work and discouraged him from becoming over-manipulative
in his relationships with women.
Ron and his wife were a more "modern" couple than Mr. and Mrs. K;
that is, they were more geographically mobile, less bound by tradi-
tional family obligations, more socially sophisticated, and freer to
establish their own rules for their marriage. They had greater flexibility
in regard to the expression of"continuity" and "discontinuity" values. I
believe the failure of the marriage resulted from a failure to accept
limits to the flexibility.

The Power Concept in Relation to Values

In an interesting paper, Distler (1970) contends that there is
a revolution among youth due to a culture shift from what he
terms a patristic-instrumental culture to a more matristic-ex-
pressive culture. He refers to hippies as a prime example of a
youth group which has adopted values of their mothers. He cites
Adler to the effect that in the history of Western society there
have been shifts between the patristic-instrumental and matris-
tic-expressive. He also cites Keniston and Gutmann's formu-
lation that alienated, uncommitted young men were in effect
"living out" their mother's unresolved identity crisis.
In a brilliant paper written originally in German in 1932,
Fromm (1970) indicates the likelihood of the change from the
patriarchal to a matriarchal structure of society. Fromm cites the
theory of J.J. Bachofen, the German sociologist-philosopher,
who in 1861 first published " M o t h e r Right." According to
Bachofen, the matriarchal principle is that of life, unity and
peace. Through caring for her infant, the mother extends her
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INTERNATIONAL JOURNAL OF FAMILY THERAPY

love beyond herself to others with the aim of preserving and

beautifying the existence of others. While the matriarchal
principle is that of universality, the patriarchal principle is that of
restrictions. Along with Distler, Fromm notes that certain matri-
archal tendencies can be observed in radical youth, and he cites
other evidence of an increasing matriarchal trend in Western
society today. Referring to the fact that in history matriarchy and
patriarchy have frequently clashed, Fromm says that in other
instances they have formed a creative synthesis, as in the case of
the Catholic Church and Marx's concept of socialism. But when
they are opposed to each other, dire consequences for the
individual can result:
the matriarchal principle manifests itself in motherly over-
indulgence and infantilization of the child, preventing its full
maturity; fatherly authority becomes harsh denomination
(sic) and control, based on the child's fear and feelings of
guilt .... The purely matriarchal society stands in the way of
the full development of the individual, thus preventing
technical, rational, artistic progress. The purely patriarchal
society cares nothing for love and equality; it is only
concerned with man-made laws, the state, abstract prin-
ciples, obedience. (p. 83)

I would refer the reader to Table 1 at this point, because

there is more than a passing resemblance between the "con-
tinuity" value system and what Fromm and Bachofen described
for the matriarchal system, and between the "discontinuity"
value system and what they described for the patriarchal system.
Has there been a shift from the patriarchal to the matriarchal
in recent decades, as Fromm suggested? Parsons (1955) and his
colleagues suggest and provide evidence that the nuclear family
has emerged as the dominant family form in recent decades. I
have suggested (Zuk, 1971) that under the pressures of Ameri-
can society, the nuclear family is inevitably one in which the
mother assumes an increasingly central role with her children,
the father an increasingly peripheral role. The tendency of
children is to over-learn or over-identify with the values ex-
pressed by their mothers, with the result that they are poorly
adapted to the values dominant in society which are primarily
male values. I prefer the terms "continuity" and "discontinuity"
rather than matriarchal and patriarchal (or expressive and instru-
mental, following Parsons), because I believe they are more
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GERALD H. ZUK

inclusive, but my conclusion regarding the fate of children in

present-day society is the same as that of Fromm and the others.
Because they are so identified with the values of their mothers
("continuity" values), and because these values differ from
those held by their fathers ("discontinuity" values) children,
particularly males, are bound to have a difficult transition as they
make their way into a society still dominated by male ("dis-
continuity") values.
Thus I agree with Fromm and the others when they suggest
that Western society has shifted in the direction of the matri-
archal principle, but do not think this should be taken to mean
that Western, specifically American, society is matriarchal. On
the contrary, it is still overwhelmingly patriarchal (although I
would prefer to say that it overwhelmingly reflects "discon-
tinuity" values). Yet in that essential unit of society which is the
nuclear family, "continuity" values have become dominant.
Children and their mothers are allied against and antagonistic
toward fathers and society, and the result for the individual in
society reflects this condition of stress. The peculiar dilemma of
fathers is that they have been caught between what Alvin Toffler
has referred to as "future shock" and a further gradual weak~
ening of their position in the nuclear family as a result of
declining ties with the extended family. I think these factors are
interrelated: rapid technological advance has required greater
mobility on the part of the nuclear family, which has weakened
ties with extended family (which validated and confirmed the
importance of the father's role in the nuclear family), and the
result is a decline in the father's role.
Generally speaking, those who take the "continuity" posi-
tion in conflict situations tend to think of themselves and be
thought of as less powerful than those who take the "dis-
continuity" position. Less powerful can refer to physical or
numerical strength, or to material wealth. For instance, women
as wives tend to think of themselves as less powerful than men as
husbands. Children tend to think of themselves as less powerful
than parents. And the nuclear family believes itself to be less
powerful than other social units. Historically women, children
and the nuclear family have been less powerful when compared
to men, parents and other social units. In times past, the power
differential was significantly greater than it is today, and I would
surmise that the evolution of value systems in society has played
a prominent role in reducing the power differential. As men and
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women, parents and children, and the nuclear family and other
social units have related to each other over the centuries, have
struggled with one another and sought to resolve those strug-
gles, and as a result of powerful pressures brought to bear by
technological and other cultural innovations, the effect of new
values, in my opinion, has been to reduce the power differential
between the groups, although not totally erasing it.

Values and Psychiatric Nosology

In the previous section citations were made (Fromm was an
example) of deleterious effects on offspring of dominance of the
matriarchal principle in society, or the patriarchal principle.
Infantilization was given as one of the effects of matriarchal
dominance. Table 2 is a summary of the connections I visualize
between various psychiatric entities and the "continuity-dis-
continuity" familyvalue system structure. It is based on listening
extensively to what family members say about themselves and
others in family therapy interviews.
At the neurotic level, one will hear the family member who
engages in so-called antisocial behavior (various delinquencies
including drug use, heavy drinking, runaway behavior, sexual
promiscuity) describe himself or herself, or be described by
other family members, as having a hard time controlling emo-
tions, as being impulsive, perhaps even as too idealistic or
naive with respect to the motives of influential friends. I would
classify (and do so in Table 2) this description as consistent with

TABLE 2. Value Systems in Relation to Psychiatric Nosology

Psychiatric Disorder Values

"Continunity . . . . Discontinuity"

1. Neurotic Level Delinquent Behavior Psychosomatic

2. Characterologic Hysteric Obsessive-Compulsive

Level

3. Psychotic Level Catatonic or Paranoid

Hebephrenic
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GERALD H. ZUK

the "continuity" position. On the other hand, the member who

under stress and anxiety reacts with so-called psychosomatic
symptomatology (e.g., gastric, circulatory, respiratory or ortho-
pedic complaints with or without organic basis) is frequently
described as well-behaved, almost too"good," a perfectionist, a
person who "holds everything in" emotionally. These are judg-
ments that, according to my schema in Table 2, fall within the
"discontinuity" system.
At the characterologic level of psychiatric disorder, the
family member who responds to stress with an hysteric reaction
is frequently described by himself or other family members as
too emotional, as naive or immature, as either over- or under-
responsive to others. This is the person who can become over-
dependent, then suddenly seeks isolation from others. In Table
2, the individual falls within the "continuity" system. Then there
is the obsessive-compulsive who cannot tolerate disorder, dust
or dirt, and may create rituals to avoid them. The behavior of
such an individual is more in accord with the "discontinuity"
system.
At the psychotic level of psychiatric disorder, we find the
individual who reacts to stress radically--he or she falls into a
catatonic state or becomes somewhat hebephrenic. In family
interviews these individuals are often described as overemo-
tional or as naive and idealistic, as too easily influenced by
others, and so on. In other words, they are described in terms
that fit within the "continuity" system. Another radical response
to stress is the paranoid reaction. This individual has systema-
tized his suspicions about persons or events and sometimes
responds violently when his suspicions are triggered. In family
interviews these individuals may be described as ordinarily ones
who hide their emotions, are hard workers, neat, orderly,
somewhat perfectionistic, and shy of persons, especially stran-
gers. In Table 2, they fall within the "discontinuity" system.

TECHNIQUE IN FAMILY THERAPY

I have previously laid out (Zuk, 1971,1975) what seemed to

me the basic functions of the family therapist which, taken
together, constitute the whole of his role: (1) when he acts as go-
between; (2) when he acts as side-taker; and (3) when he acts as
celebrant. But I have not pointed to an interrelation of these role
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functions with the "continuity-discontinuity" value system

structure, and will do so here. I hope to show that within each of
the role functions the therapist responds basically in either of
two ways: either in accord with the "continuity" position, or the
"discontinuity" position. In carrying out his role, the therapist is
always expressing values of one sort or another, and I think it is
helpful if he recognizes that these values are essentially of the
two types considered at some length in this paper.
As go-between the therapist mediates or facilitates dis-
cussion with and within the family, or he sets limits and imposes
rules which are intended to regulate discussion. As indicated in
Table 3, when the therapist mediates or facilitates discussion, he
is espousing "continuity" values. When he sets limits and
imposes rules, he is espousing "discontinuity" values.
As side-taker, the therapist aligns himself with one party or
another in the family; he is, so to speak, for or against certain
family members in disputes that arise in interviews. If, for
example, he sides with a wife against her husband, or with a child
against parents, or with the nuclear family against another social
unit, he is espousing "continuity" values. If he sides in the

TABLE 3. Values in Relation to the Therapist's Role

Role Functions of Therapist Values

"Continuity . . . . DiscontiNuity"

1. Go-Between Mediator, Sets limits,

Facilitator Imposes Rules or
of Communication Regulations on Communi-
cation

2. Side-Taker Sides with Wife Sides with Husband

against Husband, against Wife, Parents
Children against against Children,
Parents, Nuclear Community against
Family against Nuclear Family
Community

3. Celebrant Espouses Mercy, Espouses Justice,

Compassion, For- Upholds Law, Codes,
giveness Regulations
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GERALD H. ZUK

opposite direction in the combinations mentioned above, then

he is espousing "discontinuity" values.
As celebrant, the therapist certifies family events or happen-
ings as either important or unimportant, relevant or irrelevant,
and may comment on the nature or meaning of the event or
happening for the family presently and in the future. When as
celebrant the therapist expresses compassion, or speaks on
behalf of mercy or forgiveness in the face of the event or
happening, and asks family members to do likewise, then he is
espousing "continuity" values. When, on the contrary, he ex-
presses moral indignation, is stern and insists that justice be
done in the face of the event or happening, then he is espousing
"discontinuity" values.

Short-term Therapy; The Engagement Process

In the past several years the trend in the field of family
therapy toward short-term technique has been one of the
notable events. The positive results of short-term work (Leven-
thai and Weinberger, 1975) are reasonably persuasive. Among
the reasons given for the good results, one of the most significant
is that the majority of families allow the therapist access for a
limited amount of time. Good results flow from the fact that the
therapist does not abuse the brief time limit established by the
majority of families. It is odd that many therapists who are
proponents of short-term methods appear quite oblivious to
this. Rather they seem entrapped in the old argument with the
advocates (usually psychoanalytically-oriented therapists) of
the long-term approach in psychotherapy, based on the view
that personality change was the major goal and that such change
obviously required an extensive period of time. Many short-term
advocates are preoccupied with proving, for example, how
useless insight is in producing change, thus fail to see that the
majority of families will simply not tolerate long-term contact
with a therapist.
In my view short-term methods work well, perhaps best, in
family therapy because they are consistent with the expecta-
tions of the majority of families. The majority does not want a
long-term contact, for such a prospect frightens most and is a
major precipitant of premature termination. In the past few
years I have concentrated on an aspect of therapy technique
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that seemed to me critical--the technique of engaging families

who are poorly motivated for therapy or whose motivation is
mixed. Quantitative reports by Sager et al. (1968), Shapiro and
Budman (1973) Solomon (1969) and Slipp etal. (1974) highlight
the need to find means to engage families of diverse origins.
Family values play a significant role in the effectiveness of
short-term methods because values affect the expectations of
families about therapy. Generally speaking, if therapy is ex-
pected to work--whether it be short-term or long-term--it
works. But values play an especially significant role in whether or
not families will become engaged in therapy. My experience
actually leads me to the following statement: once familes are
engaged, the outcome is likely to be successful regardless of
whether the succeeding method used is short-term or long-term.
I have come to the conclusion that establishing the engagement
is about half the battle. I am not astrict proponent of the short-
term method in family therapy, even though it is the most
appropriate method for the majority of cases. Therapists should
encourage families to continue so long as they are willing to deal
with issues affecting their lives, and so long as they are respon-
sive to the therapist's direction. In numerous cases, particularly
with lower class families, poor minority groups and families seen
at the point of crisis, symptomatic relief may be obtained during
the engagement itself (symptomatic relief during the engage-
ment also is not uncommon in well-motivated, white, middle
class families). But with the lower class, poor minority and crisis-
type families, once symptomatic relief has been obtained, there
is a tendency to quit therapy even when its continuation is
encouraged by the therapist. From the point of view of the
therapist, the therapy may be judged a failure; but from the
family's point of view it was successful in that it produced the
desired result in the desired time.
Studies are showing that change in brief therapy is fre-
quently of a relatively permanent nature. Not only does the
patient feel that help has been obtained, but relief and im-
provement are maintained over a significant period of time. Of
course, certain psychoanalytic workers have objected that even
though short-term methods appear effective, they are super-
ficial; and that in order to produce so-called dynamic change, the
long-term method is required. But a recent report by Malan et al.
(1975) from the Tavistock Clinic in London, casts doubt on this
line of reasoning. These workers, who are psychoanalytic in
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GERALD H. ZUK

orientation, reported on a group of eleven neurotic individuals

who appeared improved "psychodynamically" after only one or
two psychiatric interviews. These individuals, followed up over
periods of from two or more years, seemed substantially im-
proved in overall functioning, to have insight into factors respon-
sible for their improvement, and to have a sense that they were
more in control of their lives than they had been when they
sought help. Following an initial evaluation interview or two with
a psychiatrist (some of these were patients judged not accept-
able for or likely to be amenable to psychotherapy), the indi-
viduals felt relieved and were able to make use of friends for aid
and advice in a way they were unable to previously. At follow-up
they cited the initial interview or two as critical for producing an
immediate change upon which they were able to build over
time.
I have found that even a single interview ortwo with a family
can have a therapeutic effect that persists and develops with
time, despite the fact that the family leaves treatment for one
reason or another. The therapist may be disappointed with what
he considers a premature termination, but the family may be
grateful beyond words for the experience.

Family Bias Versus Therapist Bias

Any definition of the family must include the fact that,

because it is an agent that transmits values, it has prejudices and
biases. Prejudices and biases are values of a certain kind which
will be leveled against the therapist as they are toward any
outsider. In my experience as therapist and training supervisor,
the three major biases exhibited by families against therapist
are: (1) the therapist is female; (2) the therapist is young; and (3)
the therapist is black. (The presumption, of course, is that the
family is one of the majority in the United States: white, from a
part of the middle class, and that the parents are in their late
thirties or early forties.)
Today, fortunately, the majority of families do not possess
such deep-set prejudice that being female, young or black rules
out effective work as a therapist. In the great majority of cases,
such therapists can be effective, although a training supervisor
would be less than diligent to forget to advise the trainee of
possible adverse family reactions. In certain instances prejudice
is deep-set and, after a suitable period of exploration, the
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INTERNATIONAL JOURNAL OF FAMILY THERAPY

therapist would be well advised to refer the family elsewhere.

This is not a reflection on the therapist's skill, but simply an
acknowledgment that all families impose some limitations on
what may transpire in therapy, or even if therapy is to occur.
With black families the white therapist is at a disadvantage
and in certain one-parent families (with father absent) it may be
advantageous if the therapist is a middle-aged female or older.
Some young couples today will react poorly to an older male
therapist whom they regard as "not with it." These are cases in
which the advantage is to the female, young or black therapist.
The other side of the coin is that, as human beings who grew
up in families, therapists have biases and prejudices which may
interfere with effective work with families. In the case of female,
young or black therapists, I think there is a tendency to side with
"continuity" values against "discontinuity" values. Simply being
female, young or black tends to produce this type of allegiance.
Now when these therapists work with the garden variety type of
problem in American family life--namely, the coalition of moth-
er and children against father and/or community producing
stress that leads to symptoms in a family member--they are
somewhat at a disadvantage. This all too common problem in
families results in the erosion of "discontinuity" values repre-
sented by the father and community. If therapists begin therapy
allied too strongly with the "continuity" values, then they cannot
set right the imbalance between the one value system and the
other, and consequently their therapy will be less effective.
Training supervisors are responsible for spotting these special
allegiances that interfere with effective work. Obviously being
white, older and male does not protect the therapist from biases
which may also require correction.
The issue of therapist-family match along age, gender, racial
and religious lines (to mention only a few of the more obvious
relevant factors) is one on which there has been a major
deficiency of studies. The reason is probably that it is deemed
too "sensitive", and it is indeed my experience that it elicits
strong emotional reaction in trainees and supervisors when it is
raised. Still I believe there is no avoiding the issue in the long run
because it is a major contributor to the high loss-rate early in
family therapy.
 15t

GERALD H. ZUK

REFERENCES
Bateson, G., Jackson, D., Haley, J. & Weakland, J. Toward a theory of schizophrenia.
Behavioral Science, 1956, 1, 251-265.
Distler, L. The adolescent "hippie" and the emergence of a matristic culture. Psychiatry,
1970, 33, 362-371.
Fromm, E The crisis of psychoanalysis. New York: Holt, Rinehart, Winston, 1970.
Leventhal, T., & Weinberger, G. Evaluation of a large-scale brief therapy program for
children. American Journal of Orthopsychiatry, 1975, 45, 119-133.
Malan, D., Heath, E., Bascal, H. & Balfour, H. Psychodynamic changes in untreated
neurotic patients: II. apparently genuine improvements. Archives of General
Psychiatry, 1975, 32, 110-126.
Midelfort, C. The family in psychotherapy. New York: McGraw-Hill, 1957.
Parsons, T. The American family: Its relation to personality and social structure. In T.
Parsons & R. Bales (Eds.), Family, socialization and interaction process. Glencoe, II1.:
Free Press, 1955, 3-33.
Sager, C., Masters, Y., Bonall, R. & Normand, W. Selection and engagement of patients in
family therapy. American Journal of Orthopsychiatry, 1968, 38, 715-723.
Shapiro, R. & Budman, S. Defection, termination and continuation in family and
individual therapy. Family Process, 1973, 12, 55-67.
Slipp, S., Ellis, S. & Kressel, K. Factors associated with engagement in family therapy.
Family Process, 1974, 13, 413-427.
Solomon, M. Family Therapy dropouts: resistance to change. Canadian Psychiatric
Association Journal, 1969, 14, 21-29.
Zuk, G. Family therapy: a triadic-based approach. New York: Behavioral Publications,
1971.
Zuk, G. Process and practice in family therapy. Haverford, Pa.: Psychiatry and Behavior
Science Books, 1975.