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J Can Acad Child Adolesc Psychiatry. Feb 2006; 15(1): 40–41.
PMCID: PMC2277277

Family Therapy: An Intimate History

Reviewed by Philip Barker, MB BS FRCPC

Family Therapy: An Intimate History.
Hoffman Lynn New York, NY: W. W. Norton and Company. 2002. 294p. CA $51.00

It is a long time since I have reviewed a book as beautifully written as this. “Enter Melanie, with her bright spirit, dark tangled locks, impudent smile, and saucy answers”, writes Lynn Hoffman (who could surely have been a great novelist), as she starts to tell us about a family that altered her attitude to change (page 93). Again, she tells us that the times when Jay Haley praised her, “stood out for me like meteors in the night sky” (page 11). So Hoffman has a fine gift for words.

Lynn Hoffman came to family therapy by an unusual path. She was awarded a Summa Cum Laude in English literature at Harvard, which no doubt explains why this book is so well written. Subsequently she did some home editing work, specializing in psychologists who couldn’t write, until – in 1963 – she took a job editing Virginia Satir’s Conjoint Family Therapy. She also used to watch Satir working with families, from behind the one-way screen. This piqued her interest in family therapy. Conjoint Family Therapy was published by Don Jackson under the stamp of his publishing house, Science and Behavior Books, and for a time thereafter Hoffman worked as an editor for Jackson.

In 1969 we find Hoffman in New York. Having no formal qualifications in any mental health discipline, she enrolls in an M.S.W. course and in due course graduates. She subsequently worked with, associated with, or observed the work of many of the foremost family therapists of the last 30+ years, and clearly learned from all of them. The list includes, among others, Jay Haley, Harry Aponte, Peggy Papp, Olga Silverstein, Mara Selvini and the other members of the Milan group, Peggy Penn, Bradford Keeney, Harry Goolishian, Tom Andersen, Michael White and David Epston. She also has studied the work and writings of many others. Her studies have also extended to many from other disciplines, for example Michel Foucault, Jacques Derrida, Gregory Bateson and Umberto Maturana.

What we have here is an absorbing account of Hoffman’s life in family therapy or, as she puts it, her “journey from an instrumental, causal approach to family therapy to a collaborative, communal one” (page xi). It is also an – admittedly selective – account of the development of family therapy over the last four decades. I cannot imagine that anyone who has even a passing interest in the field will not find it fascinating, even though some may not identify fully with Hoffman’s perspectives, nor agree with all her opinions. As a bonus, the book is easy to read.

I have only one main caveat. Throughout the book, Hoffman seems to assume that each new insight she has, each new therapeutic approach she describes, is an advance on what has gone before. Chronologically it is, of course. But she does not address the question of whether it gets better results. I cannot criticize her for this. Family therapy must be among the most anecdotal of scientific endeavours – if indeed it has anything at all to do with science. Carrying out any sort of controlled trial comparing one family therapy approach with another presents difficulties which, I suspect, are virtually insurmountable. But change, when it happens, may be obvious (though Hoffman has reservations about therapy that aims for specific changes).

Over the years, Hoffman has moved beyond the earlier approaches, such as the structural therapy of Minuchin and his colleagues. But do we know whether Minuchin would have got better results than, for example Michael White, if working with similar families? I don’t think we do. What does seem clear is that we therapists tend to use approaches with which we are familiar, and which we believe to be more effective, at least in our hands, than other approaches, however questionable such beliefs may be.

Despite this reservation, I wholeheartedly recommend this book to anyone with an interest in how family therapy has developed over the last three or four decades. It is a worthy follow-up to the author’s Foundations of Family Therapy.


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