_____________________________________________________________________________________________________________

Fam Proc 17:231-238, 1978

BOOKS
Family Therapy: Full-Length Case Studies, PEGGY PAPP (Ed.), M.S.W., for The American Orthopsychiatric
Association. New York, Gardner Press, 1977, 210 pp. (cloth) $14.95.
Although most cultures and societies have maintained a variety of institutional arrangements designed to modify family
dysfunction, family psychotherapy per se emerged in the 1950s. Its roots are varied, with influences from social work,
psychiatry, psychology, sociology, religion, hypnosis, cybernetics, general systems theory, and a variety of other physical
and social science disciplines and professions. Today family therapy represents an "umbrella term" manifesting a host of
perspectives regarding human behavior. Included are multifarious methodological approaches and techniques designed to
facilitate change.
While most family treatment formats are network or milieu therapies, and even though areas under the family therapy
umbrella are becoming more formalized under the rubrics of Structural Family Therapy, Family Systems Therapy, Family
Interactional Psychotherapy, and so forth, "the state of affairs in family therapy... is [still] ambiguous." (1) Contributing to
this complexity are the problems inherent in the fundamental differences between the description of human behavior as
depicted in theoretical constucts and the translation of ideas into the practice, interchange, and artistry that is family
psychotherapy.
Peggy Papp has made a welcome contribution toward resolving these issues. In a well-constructed and well-edited
volume, she has brought together a collection of articles by prominent cliniciansFrank S. Pittman, John H. Weakland, C.
Christian Beels, Elizabeth A. Carter, Ian Alger, Harry J. Aponte, David V. Keith and Carl A. Whitaker, Agustus V. Napier,
Peggy Papp, James L. Framo, Marianne Walters, and Richard Fisch. Her goal, aptly stated and well accomplished, was to
allow these therapists a forum to present their unique and idiosyncratic approaches to selected cases. However, one should
bear in mind when reading the twelve full-length case studies that they may not be representative of the manner and
approach of a given therapist beyond the specific case presented. Included are discussions, observations, and
interventionstherapeutic and/or contratherapeutic-pertaining to the processes, problems, activities, successes, and
failures throughout the duration of treatment. Each article is readable, rich, and vivid, focusing upon the experiential, the
"experimental," and the human aspects of the family therapeutic encounter. Of particular interest is the opportunity afforded
the reader to contrast and compare case after case without the editor finding need for additional commentary to
introduction.
In examining the bibliographies accompanying most articles, I recalled Riskin's (2) emphasizing the tendency of
therapists and researchers to remain in their own backyard, a finding confirmed in the present volume; the range of
bibliographic materials addresses itself to the focus of the individual contributors. The editor and authors seem to have
begun to come to grips with the reality that a total or unified family theory is not the criterion for good therapy. A number of
the articles demonstrate internal divergencies in thinking, observation, and practice that seem to strengthen the treatment. It
is hoped that, as a result of reading this series of papers, the "myth" of the necessity of a supra-family theory will be
supplanted by the pragmatic desire for increased knowledge and empirical support.
Papp has brought us a fascinating and informative collection. Its application for student, teacher, or therapistadvanced,
intermediate, or beginneris as wide as the breadth and depth of its unique contributors.

REFERENCES
1. Ackerman, N. W., "The Growing Edge of Family Therapy," Fam. Proc., 10, 143-155, 1971.
2. Riskin, J. and Faunce, E. E., "An Evaluative Review of Family Interaction Research," Fam. Proc., 11, 365-456,
1972.
George S. Greenberg, D.S.W.
Family Therapy Institute of Greater New Orleans;
Department of Psychiatry
Louisiana State University Medical School

Psychoanalytic Family Therapy, by HELM STIERLIN, M.D., New York, Jason Aronson, 1977, 355 pp. $15.00.
Stierlin's book is not, as one might expect from the title, an organized treatise on how to reconcile the practice of family
therapy with the theoretical orientation of psychoanalysis. Rather, it turns out to be a collection of fifteen articles (a majority
of them first published during the seventies but some dating as far back as 1959) related to the two captioned subjects of
the titlesometimes jointly, sometimes separately, and sometimes in a rather peripheral manner. Whatever initial

1
_____________________________________________________________________________________________________________

disappointment there may be in this, however, is more than offset by the quality of the individual essays. Indeed, one
wonders why this work has remained somewhat of a "sleeper" in spite of being offered by two book clubs: is Stierlin, as a
European, known mainly to the aficionados of Family Process?
And this is clearly a European book in several noticeable respects. First of all, it displays an ancestry not just of
psychodynamic and psychotherapeutic formulations but of equally influential philosophical constructs. References to Freud
easily outnumber all others, except the author's own; but the most noticeable secondary base is a solid conglomerate of
Jaspers, Heidegger, Nietzsche, Kierkegaard and Hegel. Reconciling this with the more specifically technical data provides
a refreshing change of pace in a field whose literature often achieves professional status at the price of uninspired
one-dimensionality.
Stierlin also presupposes a degree of literacy (of the belles-lettres variety) reminiscent of Freud himself. His bestiary
comfortably houses Camus, Sartre, Dostoevski, Goethe, Schiller, Shakespeare and a host of others: this orientation is
underscored by the inclusion of the fourth essay, "Lyrical Creativity and Schizophrenic Psychosis in Friedrich Hlderlin's
Fate." It is hard to tell, in this astounding exegesis of the long neglected German poet, where psychology ends and literary
comment begins. Family therapy it is not (though one marvels at a letter to the poet from his mother, signed "Yours
faithfully, M. Gockin"), but does it really matter? Stierlin manages, in this brief 26-page essay, to fill the major gap in
Arieti's otherwise excellent book on Creativity (1), namely, the relationship between what we label "psychotic" and that
which we call "creative": where Arieti concentrated on their dissimilarities, Stierlin instead places the two (correctly, I
believe) on a continuum, summarizing:

...the creative effort is frequently so total and so exclusive that it thrives only at the expense of almost everything
else. Nietzsche once said that any great talent tends to turn into a vampire: it feeds on everythingon friends, on the
family, on the artist's physical and mental health. For this reason, the world in which creative persons move often
becomes a human disaster area. It is strewn with the wreckage of ruined and exploited lives and hopes. ...The
creative drive does not align itself with an ego that obeys a so-called reality principle but seems, rather, captive to
an unusually exacting and idiosyncratic superego which disregards what may seem most important for survival, as
well as most elementary in human decency. [p. 95]

Apart from this, the initial section of the book primarily concerns itself with the author's historical overview of
schizophrenia as a component of family therapy. From a systems point of view, the chapter entitled "The Adaptation to the
"Stronger" Person's Reality" is particularly significant, and the section ends with an elegant summarization of ego
psychology called "The Functions of Inner Objects."
In the middle section, Stierlin tackles the separation process as part of family dynamics; the most outstanding essay is
Chapter 12, "Roles and Missions in Family Theory and Therapy." The author here draws simultaneously on concepts of
Watzlawick et al. from Change (2) and of Ivan Boszor-menyi-Nagyin itself no mean feat! eventually subdividing what
most of us call "roles" into true roles and a new category called missions. The latter are defined as delegated roles in which
the recipient/victim acts out the expectations of the stronger persons in the system. Stierlin calls this operating mechanism,
psychological exploitation, referring to

...the (more or less hidden) bargain a delegate strikes with his delegator: while the delegate, by executing his
mission (or missions), finds vital meaning and a sense of importance, he also accedes to a dependency that often
limits his freedom, saps his initiative, and stunts his growth. Whether it is a good bargain depends on the mission. In
some cases, it may work out well for the delegate; ...it is different when his chief mission is to absorb his parent's
disowned badness or craziness. [p. 277]

The final section, consisting of three chapters, turns first to details of working with adolescents; an essay on
countertransference in such situations excels in its clarity and conciseness. It is followed by a collection of ideas "Toward a
Multigenerational Therapy," which draws much inspiration, again, from concepts developed by Nagy. Stierlin summarizes
his own recommended stance of involved impartiality as a therapist and clearly states that his particular family model
"...introduces a systems perspective, but also takes account of (past and present) individual actions, obligations, rights and
needs." Some systems purists may consider this as trying to eat one's cake and having it too, but if one accepts even part of
Murray Bowen's constructs as a metatheory, it is hard to find fault with Stierlin's suggested steps of demystification, belated
mourning, balancing of accounts, and reconciliation across generations. Besides explaining these concepts in detail, the
author calls attention to primary, often overlooked differences between families he calls "homeostatically deadlocked"
(enmeshed) and those in which an "expelling mode" prevails and a separate set of interventions has to be designed to
establish bonds of belonging before the separation process can be fruitfully completed. Stierlin's comment on his principal
case illustration is that "the family therapy, no less than an individual therapy or analysis, had to plow the same ground
again and again in order to break up entrenched homeostatic patterns" (p. 339).

2
_____________________________________________________________________________________________________________

Depending on theoretical orientation, you either agree with that or you don't. Obviously the devotees of brief therapy,
Gestalt, communication and other here-and-now-oriented family therapies fall into the latter category. Even they, however,
would do well to consider John Steidl's hypothesis that there may well be "different pathologies, different forms of
treatment, and different ways change takes place," and his recommendation that "clinicians develop a good working
knowledge of the variety of models in order to do justice to the variety of families we see." Stierlin's book provides a host of
challenging new ideas and practical suggestions for those who either believe in multigenerational family therapy as the
treatment of choice or at least consider it as one of the necessary models to be applied in some cases.

REFERENCES
1. Arieti, S., Creativity, New York, Basic Books, 1976.
2. Watzlawick, P., Weakland, J. and Fisch, R., Change, New York, Norton, 1974.
3. Steidi, J., "What's a Clinician to Do With So Many Approaches To Family Therapy?", The Family, 4, 64, 1977.
LOTHAR SALIN, M.A., M.F.C.
Kentfield, California.

Male Sexuality, by BERNIE ZILBERGELD, PH.D., Boston-Toronto, Little, Brown and Company, 1978, 334 pp. $12.50.
The sexual behavior of the chronic, undifferentiated, heterosexual male, a topic long neglected by writers in favor of the
more exotic epiphenomena of sex, may be coming into its own. Within weeks of one another, two books have appeared on
the subject. The first is Anthony Pietropinto's and Jacqueline Simenauer's Beyond the Male Myth, which reports the results
of questionnaires administered to over 4000 men; the second is Bernie Zilbergeld's Male Sexuality, a book of significant
importance and the subject of this review.
Unlike the Pietropinto-Simenauer book, Male Sexuality does not base its theses on statistical data. But what makes it an
exceptionally valuable book for both the professional and the general reader is its synthesis of intensive study of the major
elements of male socialization with insights drawn from the author's extensive clinical experience as Director of Men's
Programs of the Human Sexuality Program at the University of California School of Medicine in San Francisco.
Zilbergeld has done his homework with impressive thoroughness. His book distills and evaluates both the professional
and the relevant popular literature in order to construct a context for his own clinical data and conclusions. He continually
questions seldom questioned assumptions.
Written in a straightforward, unpretentious, often wryly humorous style, Zilbergeld's book speaks to the general public as
well as to the professional. Both will profit from reading through the book once for the sheer pleasure of it and again to
mark the passages that bear remembering.
The book begins with a discussion about what men (and women) learn about sex. The opening chapter introduces the
theme that runs throughout the book: that men learn rules and concepts that are destructive to their development as sexual
beings. This thesis is cogently illustrated and developed in a chapter titled "It's Two Feet Long, Hard as Steel, and Can Go
All Night: The Fantasy Model of Sex." In this chapter, the author quotes excerpts from the works of Harold Robbins (whom
he calls, "the most influential sex educator of our time," in the light of his sales in excess of 150 million) and from a wide
range of other best-selling authors, including D. H. Lawrence, Henry Miller, Norman Mailer, and James Baldwin, whose
hyperbolic descriptions of sexual activity have been read by millions of men and women. Sex therapists and researchers
who read these excerpts will recognize immediately the source of the overblown fantasies and ruinous expectations that
prevent men and women from accepting their own sexual patterns as adequate. Belief in this fantasy model keeps people,
and men in particular, forever striving to achieve that which never existed, cannot be attained, and would not be fun if it
could. What we learn from fiction and from the other major wellsprings of male sexual knowledgepornography and dirty
jokeskeeps us preoccupied with images of gigantic penises, instantly ravening females, volcanic orgasms, and all the
other bits of hyperbole that occur more in folklore than in bed. Zilbergeld argues that these influences, plus the
superstructure of male socialization, propagate myths about what males should feel and how they should behave that
constrain men from feeling and behaving in ways that would enable sex to be a congruent expression of individual needs
and preferences rather than one more occasion for the pursuit of success or the experience of failure.
Once having presented his central thesis, the author expands it in subsequent chapters. There are chapters dealing with
the male's discovery and assertion of his sexual needs and desires, with emphasis on discriminating sexual desire from other
needs; the physical side of sex: touching, masturbation, relaxation and sex; the uses of sex and sex problems (including an
analysis of the ways in which sexual dysfunction may be used as a defense against facing other problems of living); dealing
with partners; and female sexuality (based in part on the questionnaire responses of 400 women to questions about their
expectations of their male sexual partners). Additional chapters cover such topics as sex and aging; sex and medical
conditions; and measures to be taken to deal with problems regarding erection or ejaculation. The chapters that focus on

3
_____________________________________________________________________________________________________________

more satisfying sexual function or on the reversal of dysfunction contain brief exercises that can be tried by readers or
prescribed by therapists. These exercises have been clinically tested; however, like the responsible and careful clinician
that I know him to be, Zilbergeld emphasizes the limitations of self-help measures and clearly delineates the importance of
seeking professional help for persistent difficulties that do not yield promptly to self-treatment.
Throughout the book the author uses observations about simple phenomena, which all of us are aware of but have
overlooked, to make telling points about male sexuality. He avoids excursions into remote theoretical territory and fanciful
speculations to focus instead on data accessible to any astute observer of contemporary society. He never strains the
reader's credulity. Common sense pervades the book, acting as an effective antidote to the distortions that have warped our
view of male sexuality in the past.
This book can be of substantial value to therapists working with couples, in that it provides a framework for
understanding what the man brings to the sexual relationship, the common problems that beset it, and some approaches to
their resolution. It is a book that can be given to clients to readone that can be read profitably by any man or woman who
wants a clearer understanding of the human male as a sexual being.
JAY MANN, Ph.D.
Family Study Unit
VA Hospital
Palo Alto, California.

Family Therapy and Diagnosis, by GERALD H. ZUK, Ph.D., Fourth Avenue, New York, New York, Six audiotapes
produced by Psychotherapy Tape Library, 59, 1973, $50.00.
Family Therapy and Diagnosis strives to present an overview of the models and treatment approaches of Gerald Zuk, a
well-established figure in family therapy. Tape one points out Zuk's two primary aims for family therapy: enhanced
solidarity and greater individuality among members. He reviews crisis, short-term, middle-range, and long-term therapy
candidates, providing guideline criteria, approximate number of sessions, and a descriptive commentary. Tape two is
entitled "The Runaway Wife" and consists of a therapy interview, followed by the commentaries of two other family
therapists. Tape three deals with the author's definition of pathogenic relating. He sees three possible roles for the therapist
in dealing with pathogenic relating: the go-between, the side-taker, and the celebrant. Most are familiar with the concepts of
the first two roles but may not be as knowledgeable about the celebrant. From this position, the therapist is viewed as
celebrating change. The family members empower him to certify that something important has happened or is about to
happen. In this sense, he functions as a "quasi-priest," providing an arena for "confessions, or rites of passage." Tape five
expands this position considerably, while tapes four and six are family interviews with adolescent identified patients.
Clearly, one of the gaps in professional education centers around the availability of actual clinical interviews. Zuk is to be
commended for producing, not just one, but three separate interviews with his commentaries. On this basis alone, the tape
series has merit. The families are quite interesting, and Zuk shows himself to be a skillful therapist. The theoretical
sections, however, are sometimes uneven and lengthy. While this might be useful to a beginner trying to assimilate a great
deal of new material, the intermediate and advanced therapists would want a more succint approach. Beyond this, there are
two further considerations. First, insufficient evidence is presented to justify the conclusions reached about treatment
indications and characteristics of minority, black, and Jewish families. Second, and more important, Zuk presents an almost
grandfatherly type of role in his work. While he is obviously skilled and comfortable in this style, a number of his
interventions would be difficult for a younger or less worldly therapist to accomplish. Given these limitations, the tape
series is useful, especially for the individual beginning his exploration of family therapy.
CHRIS HATCHER, PH.D.
University of California
Langley Porter Institute
San Francisco

Family Structure and Effective Health Behavior: The Energized Family, by LOIS PRATT, Boston, Houghton Mifflin
Company, 1976, 230 pp. $7.75 (paper).
This book successfully closes the gap between two important systems whose relationship has as yet escaped a systematic
analysis. It encompasses a unique approach that broadens our understanding of family structure and the health care system.
The point of the book is that the family has a major responsibility for its members health but due to both dysfunctional
processes in its own functioning and that of the medical system its health activities are often ineffective. Lois Pratt both
theoretically and through a field study of families assesses various factors that enable the family unit to organize and
effectively carry out health care of it's members. Through interviews with different types of families, she has identified such
characteristics as freedom and responsiveness to the individual, active coping efforts, regular links with the community,
etc., as factors commonly found in families that demonstrate self-management capabilities in its health-care functions. The
author confronts the medical system as it exists today and explicates the ways in which this structure inhibits the family's

4
_____________________________________________________________________________________________________________

efficiency and efficacy at health maintenance. Through this thorough examination of health practices and the family, the
author points out practical ways in which the medical care system can be reorganized to make health care more constructive
for both systems. Subsumed under the name of the "Energized Family," the author has created an innovative and productive
model that is vital for people concerned with the family and health behavior.
CATHERINE M. SHISSLAK, PH.D.
Albuquerque, New Mexico

Who Will Raise The Children? (New Options for Fathers and Mothers), by JAMES A. LEVINE, Philadelphia and
New York, J. B. Lippincott Co., 1976, 192 pp. $1.95.
"I was raised by my mother and I don't see why other people shouldn't be raised by their mothers." So spoke a superior
court judge in determining legal custody in a couple's recent divorce case. And so indicate legal and moral attitudes of
American society in regard to men and child care. In Who Will Raise the Children? James Levine makes a successful
attempt to place this issue in historical perspective.
Ten years ago it was unheard of for men to become househusbands. There were no single adoptive fathers, and very few
men even sought custody of their children. The author presents a convincing case for men who have chosen to devote a
substantial part of their lives to the rearing of their children and soundly refutes the mores of society as to the innate
inability of men as caretakers. Options including part-time work and part-time child care for working parents are examined,
with several examples of those who are struggling to make it work for them, including their plights with institutions that
look with a skeptical eye at men that want to spend more time at home and less time on the job.
Also discussed are single adoptive fathers and the obvious stress they must enduree.g., attitudes regarding
homosexuality and the lack of drive a man must have to want to become a homemaker.
Certainly no one would refute the lack of status society bestows upon the homemaker. In 1974 the United States
Department of Labor's Dictionary of Occupational Titles rated homemaking equal to restroom attendant and parking lot
attendant. In a society that encourages men from day one to press for upward mobility through competition for power and
wealth, it's a small wonder that only a few disillusioned men have sought fulfillment through new roles as caretakers and
homemakers. Mr. Levine's own experience and sensitivity come shining through in a well-presented book on options to
men and their families.
KEN BRESLIN, M.A.
School of Professional Psychology
San Francisco, California

BOOKS IN BRIEF
Father's Influence on Children, by Marshall L. Hamilton, Chicago, Nelson-Hall, 1977171 pp. $9.95.
Marshall Hamilton presents a vast number of clinical studies in an effort to draw a picture, both historical and
contemporary, of the father's role in influencing his children, both in his absence and in his presence. What seems to be
lacking is the author's personal touch, despite his inclusion of examples of interaction with his own children, presented here
quite impersonally.
However, Mr. Hamilton does present the data in a way that is certainly not dry and at times highly fascinating, exploring
issues of dominance, absence, high and low expectations, and the father's influence on homosexuality. Of particular interest
to this reviewer were studies of the father's influence on famous people in history in relation to a chapter's presented
material, e.g., Lee Harvey Oswald (father absence); Adolf Hitler (undesirable effects); Indira Ghandi (positive
father-daughter relationships); and Winston Churchill (career choice). Included is a 25-page bibliography that is of value to
those interested in further research. Short summaries ending each section are of help to those readers, the reviewer
included, who tend to get overwhelmed by data.
KEN BRESLIN, M.A.

Fathering: Fact or Fable?, EDWARD V. STEIN (Ed.), Nashville, Abingdon, 1977, 181 pp. $6.95.
Edward Stein and several highly qualified men and women attempt to meet a growing need in American society to
redefine and reassess today's changing roles for the father. From excellently presented personal, psychological, and, at
times, theological points of view, these professionals examine the children of the absent father, the need of many men for
refathering, creative fathering, and problems and potentialities of changing sex roles. Two essays, in this reviewers'
opinion, are especially worth reading, Jungian perspectives on fathering and a highly poignant article on loss and grief in
fathering through death or separation. Included is a group of suggestions a father or potential father or caretaker can begin
considering in liberating himself from the Dagwood Bumstead syndrome.

KEN BRESLIN, M.A.

5
_____________________________________________________________________________________________________________

BOOKS RECEIVED
1. Arnold, Eugene L., Helping Parents Help Their Children. New York, Brunner/Mazel, 1978, 403 pp. $17.50.

2. Eshleman J. Ross, The FamilyAn Introduction. Boston, London, Allyn and Bacon, 1974, 692 pp.

3. Fanshel, David and Shinn, Eugene R., Children in Foster Care: A Longitudinal Investigation. New York, Columbia
University Press, 1978, 522 pp. $25.00.

4. Grollman, Earl A. and Sharon, Hya, Caring for Your Aged Parents. Boston, Beacon Press, 1978, 149 pp. $8.95.

5. Hazen, Barbara Shook, Two Homes to Live In: A Child's Eye View of Divorce. New York, Human Sciences Press,
1978, $6.95 (cloth).

6. Larossa, Ralph, Conflict and Power in Marriage: Expecting the First Child. Beverly Hills, Sage Publications, 1977,
176 pp. $14.00 (cloth), $6.95 (paper).

7. Lewis, Jerry M., M.D., To Be a Therapist. New York, Brunner/Mazel, Inc., 1978, 186 pp. $10.00 (cloth).

8. Nagi, Saad Z., Child Maltreatment in the United States. New York, Columbia University Press, 1977, 162 pp.
$8.00.

9. Napier, Augustus Y. and Whitaker, Carl A., The Family Crucible. New York, Harper & Row, 1978, 301 pp. $11.95.

10. Papp, Peggy (Ed.), Family Therapy: Full Length Case Studies. Gardner Press, Inc., distributed by Halstead Press,
1977, 210 pp. $14.95.

11. Petras, John W., The Social Meaning of Human Sexuality. Boston, London, Sidney, Toronto, Allyn and Bacon,
1973, 234 pp.

12. SINICK, DANIEL, Counseling Older PersonsCareers, Retirement, Dying. New York, Human Sciences Press,
1977, 112 pp.

13. Stevenson, Olive, Someone Else's Child. London, Routledge & Kegan Paul, 1965, 122 pp. $3.50.

14. Strayhorn, Joseph M., Jr., Talking It OutA Guide to Effective Communication. Champaign, Illinois, Research
Press, 1977, 175 pp. $4.95.

15. Ude-Pestel, Anneliese, BettyHistory and Art of a Child in Therapy. Palo Alto, California, Science and Behavior
Books, 1977, 204 pp. $7.95.

16. Winch, Robert F., Familial Organization: A Quest for Determinants. New York, The Free Press, 1977, 340 pp.
$13.95.

17. Wolberg, Lewis R. and Aronson, Marvin L., Group Therapy: 1977An Overview. New York, Stratton
Intercontinental Medical Book Corp., 1977, 298 pp.