(organ music)
- [Voiceover] This tape will illustrate one way
in which a systems-oriented therapist
might treat a family, one of whose members
displays psychotic symptomatology.
The tape is based on two consultations
that Doctor Salvador Minuchin had with a family
being treated by Margaret Meskill,
one of his students.
- Okay, so, this is a 45, mid-40's couple
in this tape, when they come in they'll be a family.
They have lots of symptoms, you know,
they haven't had sex in nine years,
she keeps going into hospitals and coming out again,
and he falls apart when she goes in and drinks.
And parenting issues, they have a lot of trouble
with their daughter.
- [Voiceover] What are her symptoms
when she goes through this?
- I'm not around, but according to what the couple says,
her symptoms or his?
- [Voiceover] Hers.
- Hers, umm, well this time she started slashing her arm.
That seems like that isn't something she always does,
she usually, she hears voices and starts yelling at people.
Acts crazy.
- [Voiceover] The way she is with you.
She looks crazy, she sounds crazy?
- She sounded a little off sometimes,
but she's very high-functioning
for a psychiatric client, you know?
She doesn't present that way, no she presents fine.
- [Voiceover] In making his first supervisory comments
on the case, Doctor Minuchin responded to a segment
of the taped session presented by the therapist
in which Hector was angrily complaining to Angela
about the negative effects her out-of-control behavior
was having on him and Danielle.
- This man had talked,
and he had done something nice there
saying listen, you symptoms are not psychiatric,
your symptoms are related at me.
He made the symptom very much interpersonal.
- [Voiceover] Doctor Minuchin likes Hector's
interpersonal framing of Angela's psychotic symptoms
because it is congruent with his own
systemic view of the family.
As a systems thinker, Doctor Minuchin sees
the family members as inextricably interconnected
with each other.
He also sees their symptoms as interconnected.
Because they are mesmerized by their symptoms,
the family members do not see the connections.
The task of therapy is to make the connections explicit.
As family members explore their connections with each other
they become empowered to activate alternative,
more satisfying patterns of connectedness.
The activation of these new patterns expands family members'
experience of themselves,
which in turn diminishes their experience
of being at the mercy of their symptoms.
- [Margaret] So we're in a regrouping place,
and I wondered what, you know,
maybe you want to start and say something about
what your thoughts are about having Danielle join us,
and what you want to get done.
- [Angela] Well I thought it was necessary for Danielle
to participate in the family therapy
because she's having such a hard time in school.
At the moment she's not in school.
I don't know what to do with her now.
I mean, in the past, Danielle and I used to butt heads
all the time, we were constantly fighting to the point where
the police had to come to the house.
- [Doctor Minuchin] That much?
- That much fighting, but that's stopped.
Danielle and I are getting along much better,
but I don't know what to do with her with school.
I can't get her in school, she's having too much trouble
in regular school.
The main problem is that her mind races so much
that she can't.
- Your mother says your mind races, where does it go?
- [Danielle] Nowhere, just can't concentrate.
- [Voiceover] The family's assertion of a focus
on Danielle's school problems provided Doctor Minuchin
with his first task of the session.
He must find a way to connect Danielle's problems
to the parents' symptoms.
A passing reference made by Angela to her hospitalizations
will provide Minuchin with the opportunity
to begin laying the foundations for the construction
of such a connection.
- So Danielle has gotten into the habit
of not being in school,
and that's why she has gotten so far behind.
- [Doctor Minuchin] And why is that?
How did that happen?
How is it that Danielle did not go to school,
and you did not know?
- [Angela] No, she would leave the house like she was going,
but she wasn't, and then she would come home
at 3:00, 3:30, like she was supposed to
at the end of the day.
Where she went during the day, I don't know.
- [Danielle] I was always home.
- [Hector] She was home because you were going
to the hospital. - [Angela] Yeah, I was going
- [Angela] to the hospital, so I was not home
during the day.
And if there were days that I did decide to stay home
she would leave, but there was one time
when I did catch her cutting.
And I caught her cutting again in high school.
- She would go to Grandma's house also,
because she had the key.
- [Doctor Minuchin] Why did you go to the hospital?
- Uh, hmm.
You seem a very well put together lady.
- Well I feel very well put together now,
I wasn't so put together before.
- [Doctor Minuchin] No?
- [Angela] No. - [Doctor Minuchin] How so?
- [Angela] I've been in and out of hospitals
since the age of 13, and a couple of state institutions.
- [Doctor Minuchin] Why?
- Well, as a child I was put in by my family.
I guess they couldn't handle me--
- [Doctor Minuchin] I'm surprised, you seem such
a bright and steady lady.
- Well, there are bright people in hospitals, too.
I've met a lot of bright people, you know,
it's just certain times things would happen to me.
- [Voiceover] Doctor Minuchin will now invite family members
to describe the events that lead up
to Angela's hospitalizations.
As you listen to the descriptions offered
by the various family members,
note the significant difference between Danielle's framing
of the events, and her parents' framing.
- When your mom goes to the state hospitals,
how does she look like to you?
- I don't know, I don't see her.
- [Doctor Minuchin] Huh?
- I don't see her.
- [Doctor Minuchin] But before,
I assume that when she goes to the hospital
it's because she's going through (muffled)
because how she looks.
Now I would guess that she went to the hospital,
is she different?
- Sometimes.
- [Doctor Minuchin] How different is she?
What does she look like when she is not feeling well?
- [Danielle] I don't know, she just gets cranky.
- She's what?
- [Danielle] Cranky.
- Crabby.
- [Danielle] When she goes to the hospital.
Do people go to the hospital 'cause they are cranky?
My goodness, I've been cranky.
- [Danielle] She doesn't look sick right before she goes.
- Huh?
- [Danielle] She doesn't look sick before she goes.
- She doesn't look sick?
So she looks all just angry?
- [Danielle] No, she just gets bitchy.
Turns into a bitch.
- Yeah, she looks bitchy, and she's short-tempered?
Help me to understand.
- I don't know.
- I'm confused, I see your mother here,
and she tells me some things that seem strange to me.
I feel you don't know how you behave
when you go, because if you come to me,
I'm a psychiatrist, and you're like that,
and you said you want to go to the hospital
I would've said--
- Well I'm not this way when I go into the hospital.
- So you must be different then?
- Yes.
- Can you tell me, or can you tell me,
or can you both tell me different ways,
what's happening all your life.
- [Hector] I usually know when she's gonna go to hospital,
'cause usually there's a shortness of temper,
her sleeping is off, she forgets,
she's terrible--
- [Angela] The voices, I hear voices.
- Yeah, she hears voices.
Normally she doesn't tell me, so I say, "You okay?
"Do you hear voices?"
And she'll say, "No, no."
And then if she's really hearing them
she'll be very irritable and she becomes very irritable
and defensive if she's hearing voices.
And then I start looking for the patterns.
And then that's how I know she should be going.
- [Doctor Minuchin] Does she look, honestly now,
does she looks to you as if she is crazy?
As if she's irrational?
Or just she is short of temper, cranky?
- It just looks like she's cranky.
- Do you have two mothers?
One that is nice, and understanding,
and one that is bitchy, and cranky, and irrational?
And you admit who is the irrational,
cranky and bitchy?
I'm asking, because I don't know.
Because when your mother is cranky and bitchy
she's going through pain.
Is she a pain for you when she gets like that?
- When she gets like that it's like,
it's like I really have already, I already know,
so I talk to her, I go, "Well, she's acting this way because
"she's already going through an episode."
- [Voiceover] While her parents portray
Angela's hospitalizations as brought on by phenomenon
that are crazy and beyond control,
Danielle insists on explanations that are normalizing,
and interpersonal.
Minuchin's observation of this,
as well as of Danielle's protective attitude
toward her mother leads him to the following reframe,
which connects Danielle's school problems
to her parents' problems.
- [Doctor Minuchin] Tell me something,
so you had seen, you say you all know that she gets,
paranoid schizophrenic, or borderline psychotic,
or whatever term they call it.
- [Margaret] Cranky, yeah.
- It is cranky?
- [Margaret] I think it's a good word.
- Yeah, and can she hear you when she's like that?
- [Margaret] With a fight.
With a lot of work.
- [Doctor Minuchin] You're a good fighter.
- Yes, we fight well. (Angela laughing)
- [Doctor Minuchin] Do you think that Danielle sometimes,
do you think that Danielle's fighting
could be useful?
- I think so.
- [Doctor Minuchin] Do you think that she knows
that she was painful to mother?
See, children do sometimes wonderful things,
but we stop knowing.
- Danielle was one of the reasons why
I started turning around,
and started trying to pull myself more together.
- She seems very protective of you.
- Yes.
- Would you be a nurse?
- A nurse?
- Yeah, do you think?
'Cause I think you are a nurse.
So why you want to know if you will be a nurse.
At this point you have only one patient.
That is your mom.
- [Angela] What do you mean by be a nurse?
- Well I think she is a nurse.
I think she could grow up to be a nurse.
She starts training in you,
and then maybe she will be trained on somebody else,
or do you sometimes are protective of your dad, also?
- I am.
- [Doctor Minuchin] Yeah.
So when do you feel protective toward him?
When your mom--
- When I think of how stupid he's been sometimes.
- How stupid he has been?
- Yeah.
- [Doctor Minuchin] In what way?
- In letting Mommy do all that stuff she did
right in front of him.
And just sitting here, I think that's stupid,
I wouldn't have done that.
- [Doctor Minuchin] You think he should have reacted--
- He needs to be harder in his reaction.
- [Doctor Minuchin] Do you think that you can help him
to become stronger, or harsher, or more reactive?
or more reactive?
Have you talked with him about that?
- I did when I used to scream and get mad,
and I would say he's such a jerk because he lets her
get to him, he stand right there and lets her.
And that's what I would yell at them.
It never did anything.
- [Doctor Minuchin] He's a good patient or not?
- Is he a good patient?
- [Doctor Minuchin] Yeah.
I think that you are an evolving psychotherapist,
and you will be a colleague,
that I am interested in.
As I work with her, I am a teacher,
or family therapist, you start early.
- Mmm, no.
- [Doctor Minuchin] No? Okay.
It's very nice, Danielle is a very nice person,
and a very protective person,
and she's had a hell of a difficult life.
Because she had a mom that was in and out of the hospital,
and a dad with his mystical that did not respond.
So she tried to help both of you.
And if you are busy,
trying to make your mother
a person,
and make your father a helper,
then I don't think that you can have
too much energy to study.
You have a full-time job as a nurse.
- [Voiceover] In portraying Danielle as her parents' nurse,
Doctor Minuchin has succeeded in connecting
Danielle's symptoms to her parents.
There remains the task of connecting the parents' symptoms
to each other.
Minuchin devotes the closing minutes
of the session to this task.
- [Doctor Minuchin] And besides, Misses Soriano,
the hospital calls you with some label,
what's the label that they gave you?
You're really supposed to stay out of it--
- The label, paranoid schizophrenic,
some kind of a behavioral-borderline thing.
I don't know.
- [Doctor Minuchin] Borderline,
these are significant things.
Paranoid schizophrenic and borderline--
- [Angela] Something else.
- And something else.
- Well border-psychotic, or something like that.
One psychiatrist said that, too, and I looked at her,
I said, "You gotta be..."
- What would you say
if you would need to,
if you would need to describe your wife to me
in two or three words, what would you say about her?
- I'm sorry, I lost that.
- If you wanted to describe your wife,
I cannot see , and you say, "She's seated here,
"and I hear her talking."
She's a bright lady, and she tells me things
that don't make sense, like how all her life
she has been in and out of hospital, and so forth.
I'm confused.
So can you tell me something, or tell so that
I will be less confused.
Describe to me how she is with you.
- How she is with me, as a...
- [Doctor Minuchin] As a person.
- As a person, she is--
- [Doctor Minuchin] As a wife.
- As a wife she's attentive, she's sensitive, you know,
she's a good listener, she's good to talk to,
she's intelligent, so it's not like you're talking
to a moron, so that's a blessing.
She's organized, she thinks straight.
I tend to be more like, "Well, let's see.'
I tend to be like more mystical,
now let's look at it from this angle.
I'm just more like well this is the way it is,
and she's more grounded.
- If you would need to describe your husband to me,
how would you describe, I mean,
what I heard was how many nice things
your husband says about you.
How would you describe him?
- Loving, hard-working, sensitive.
- [Doctor Minuchin] Do you think he contributes sometimes
to you going to the hospital?
- Not really, no.
- [Doctor Minuchin] You hedged then.
- Recently it has been his drinking,
but he's not drinking now.
- [Doctor Minuchin] One of the things that you're proving
can make him to look was his family.
See, this is a family of good people.
But some of the things that they do are not good.
But since this is a family of good people
that believe in love, and they believe in good things,
they don't know how they treat each other,
they don't know clearly.
Because the most important thing for them
is love and protection.
So I think that Misses Soriano
is sometimes triggered by her husband.
And then Mister Soriano is sometimes, you see,
I think in strange ways, I think that your drinking,
it's not because you're a drunkard,
but it has to do with stresses in the family.
And I think that when you go to crack,
or you go to heroin, or you go to the hospital,
you're escaping from your husband.
Now, I am strange guy, I think like that,
I have strange ways of thinking.
So, if you want to be helpful, and us talk,
you're willing to work with these people
in terms of what they do to each other.
You know?
And it will be difficult, because they don't know.
You see, he would,
Mister Soriano will drink to help you--
- Stop.
- [Doctor Minuchin] to know, and Danielle will help,
when Misses Soriano does something
that kicks him off, that he does not respond.
Danielle will know, but he will also know.
And I think that this is a very nice family.
I think the family is in a tough spot
because they are new.
He is dry, and she's out of the hospital.
I think that you don't know how to behave
in this spot in which you are now,
in which you have decided that you have
a place in this family,
and that you will not run away from the family.
And I don't think that you know how to relate
with a wife as if she's healthy.
So that when she becomes a pain in the ass.
- That's part of the beauty of solution.
- [Doctor Minuchin] You're sick,
but you're a pain in the ass, you know?
When you are a pain in the ass, he says, "You're crazy".
Instead of saying, "Hey, wait a moment, my dear.
"Stop that nonsense."
And then you feel that he's not doing his job.
You're in a new spot, okay?
- Okay.
- [Voiceover] By reframing Hector's drinking,
and Angela's hospitalizations as the means
by which they escape from each other
in order to avoid conflict and stress,
Minuchin has completed the therapeutic task
of constructing a frame that connects the family members
to each other.
The second consultation session occurred
three months after the first.
Angela's individual therapist participated
in this consultation, as well as
in the pre-session discussion.
- Angela was taking care of Hector,
who had an accident, you know?
I think people here know that he was in a car accident?
- [Doctor Minuchin] No, I did not.
- Okay, he was in a terrible car accident,
and then what happened was Angela started
taking care of him, which was a shift,
instead of him taking care of her,
and then she became overwhelmed by it
and went into the hospital.
- [Voiceover] Doctor Minuchin opened the second consultation
by chatting with the family members
about the affects of Hector's accident on the family's life.
- [Doctor Minuchin] You had the accident, and everything--
- Everything just kind of got, well, the accident
kind of intruded a bit.
It disrupted things, really made an impact more on my wife,
I think, than on me.
- [Doctor Minuchin] How so?
- Because she suppressed her feelings about what happened.
- Actually it was the first time I felt that
I had to be totally responsible,
and had no one to fall onto.
If things got difficult I could say,
"Well, Hector, I can't handle it.
"Do it for me."
This time there was no Hector to do it for me,
it was me doing it for myself.
I was being super-person, and I kept on going and going,
and just kept on doing what I had to do.
Taking care of Danielle, taking care of Hector.
For awhile, when Hector was very sick,
I took care of everything.
I was taking care of everything.
- [Doctor Minuchin] Are you good at that?
- I found that I was.
- [Doctor Minuchin] Angela, I have a problem.
And you would need to help.
The problem is, like last time,
that I cannot jive your competance
with your going to the hospital.
You see, you are a very competent lady.
I am impressed that you're intelligent,
and in areas of difficulty you can manage.
And so that and the hospital just don't jive.
- Let me put it this way.
I'm not used to being able to function, or--
- [Doctor Minuchin] But you are a bright lady.
- Just let me finish saying what I'm saying.
I've always been told, from a very young age, I can't.
And for a long time I believed them.
I do have problems with voices on and off
that really make it very difficult for me
to function at times.
The majority of the time I can function a lot better
than I thought I could.
At least I'm starting to see that in the past year or two.
At times I really can't do a damn thing.
I get so out of hand that I can't think straight.
Lots of times I can't hear what other people
are saying around me, because I'm hearing everything else.
- [Voiceover] Angela's narrative of competence
in the aftermath of Hector's accident,
and the incongruity between that competence
and her pattern of repeated hospitalization,
has led Doctor Minuchin to focus early in this session
on Angela's psychotic symptoms.
Minuchin has thus entered the family
differently during this session
than he did during the first,
through Angela rather than through Danielle.
Minuchin's goal for this session is the same one
he had for the first: namely to help family members
explore their interconnectedness.
However, since he has entered the family differently,
the process by which this goal's accomplished
will be a very different one.
Doctor Minuchin has entered the family
through the portal of Angela's voices.
At this point in the session,
the family frames these voices as belonging only to Angela.
To pursue his goal of highlighting interconnectedness,
Minuchin will have to spread the voices around,
so to speak.
Watch as he begins to do this.
- [Doctor Minuchin] Tell me something about your voices.
How many voices are there?
- Sometimes one, sometimes several,
sometimes it seems like the whole world's speaking to me
at once and I just want to scream.
- [Doctor Minuchin] Are the voices male or female?
- Both.
Mostly female.
- [Doctor Minuchin] Mostly female?
- Yeah.
- [Doctor Minuchin] What do they say?
- They tell me what kind of a person I am.
- [Doctor Minuchin] And what kind of person are you?
- I really don't want to get to what--
- [Doctor Minuchin] According to the voices.
You see, I think that these voices are important,
so I want to know.
- Yeah, but, it's something I don't really discuss so much
when I'm in front of my daughter.
It's something that I don't want to.
It's something I've never really done.
- [Doctor Minuchin] Let's find out if she knows
about your voices--
- [Angela] She knows. - [Danielle] I know
- [Danielle] about them, I'd like to know what they are.
I want to understand what voices are,
because if I hear voices, I would freak out.
- I think that it's important to understand voices
because I hear voices.
I think we all hear voices.
And some people hear voices
as significant thoughts,
and some people hear voices as if they come from other.
Some people hear voices as if they come from inside.
We all hear voices,
so not just your mom.
I hear voices, you hear voices,
even she hears voices. - [Margaret] I hear voices.
- [Doctor Minuchin] So the question is,
and we listen to our voices,
and the voices tell us things.
But your mom hears voices as if they come from others,
is that correct? - [Angela] Mm-hmm.
- [Doctor Minuchin] So she has the skill
or the disability of hearing these voices
that I hear as inner voices, as if they are outside voices.
You know, that's all, the voices tell her things
that she really knows, because you also have
the same content of your voices outside
in your feelings inside.
If your voices say to you, "You're shitty",
then it is because sometimes your inner thought
says "You're shitty".
- Well then I'm full of shit.
- [Doctor Minuchin] Huh?
- Then I'm full of shit. (laughing)
- [Doctor Minuchin] Yeah, you know, we all are like that.
So what are you saying all of the voices tell you?
- Well sometimes they tell me to do things to myself.
Sometimes I can not listen to them,
and sometimes I listen to them.
- [Doctor Minuchin] They are powerful.
- Yeah.
- [Doctor Minuchin] And when they said,
"Do things to yourself" is to hurt yourself?
- Yes.
- [Doctor Minuchin] Because you're worthless.
- Right.
- [Voiceover] Doctor Minuchin's normalizing assertion
that we all have voices has begun
to spread the voices around,
and to call into question Angela's sole ownership
of the voices.
While this intervention has increased Angela's willingness
to talk about the voices,
it is too global to serve as the foundation
for a detailed exploration of Hector
and Angela's interconnectedness.
Therefore, Minuchin must now find a way
to describe more idiosyncratically
how Hector participates in Angela's hearing of voices.
- And how can you
help these voices?
You see, voices can be tamed.
But they need help.
Now, are the voices,
does your wife ever hear your voices
when she is hearing voices, do you know?
- No, it's never-- - [Doctor Minuchin] Huh?
- [Hector] She's never, my voice is never,
my voice is never part of her voices.
- [Doctor Minuchin] Never part of her--
- [Danielle] Is my voice in--
- Well, the only way that it's part of her,
it's a positive influence, push the negative voices out
when they're telling her to do negative things,
she'll key in on what I've told her over the years,
'cause of the voices.
If they come--
- [Doctor Minuchin] Listen, do you hear his voices also?
No, no, his voice is, I think his voice is too soft.
I don't think his voice is strong enough, you know?
To fight your voices you need another voice
that is at least as strong.
And you speak so softly.
- [Danielle] Excuse me, I always say that to him.
- Do you think your mom hears your voices
when she's like that?
- [Danielle] No, I never know.
- [Doctor Minuchin] So you don't have any influence, huh?
Do you think your voice is there?
- I don't think so, is it?
- [Hector] Veronica?
- Actually, lately I've been hearing mine.
- [Doctor Minuchin] You have been hearing your voice?
- Yeah.
- [Doctor Minuchin] And is it as strong as the others?
- It's getting very loud.
- [Hector] What were you saying?
- Telling me to shut the fuck up. (laughing)
- [Doctor Minuchin] Do you think you will wake up?
- I think so, I think I'm winning.
- [Doctor Minuchin] Tell you something,
I don't think that you can do it alone.
I'm not saying their voices,
I think that unless your voice,
and your voice,
join in the choir of voices,
she cannot do it alone.
- But it's his job, mainly, to do that,
I mean, he's her husband.
- Lovely.
- He should, I mean. - [Doctor Minuchin] Lovely.
- Louder.
- You're absolutely right.
And so, he's not doing his job.
- [Hector] It's difficult to do a job,
actually, if you're not clued in
to the voices, it's like she tells me about the voices
long after the fact.
It's like closing the barn doors after the animals went out,
I mean, it's pointless, might as well leave the doors open.
- I don't think he means that way.
- Yeah, it's that old, you know.
- You just have to be a little bit stronger in character
around me, the things that you do around me.
Not be a voice while the voices are going on.
- [Danielle] That's what he does, I mean,
when they argue or whatever, he just sits there.
It seems like she's the king or something,
she does what she wants.
My daddy should be the one to be the man,
and be like, "No, you listen."
You know? I mean...
- [Hector] Well I've done that, haven't I?
- Hector has changed in the past couple months
where he has been, being more of that dominating voice
that I need.
- [Danielle] See, she needs a dominating man.
- Not just, no, no, not just that, no.
- [Doctor Minuchin] Do you want,
explain to her what you mean by dominant voice.
- His voice is--
- [Doctor Minuchin] Explain to her, because she needs it.
- His voice is becoming stronger,
he's becoming, "No, this can't be done this way",
or "This is the way we have to do it",
or "Maybe we should do it this way".
The way he's saying things now is a lot different
than it was, he's not being so passive.
He's being a lot stronger than he has been in the past.
To the point where sometimes I shut up
when he's going off, you know?
Something has changed since we've been
in the couples therapy.
He's been more thinking about what he feels,
and worries a little bit more about what he's feeling
than what I was feeling.
'Cause he's always worrying about all those people
before himself. - [Danielle] He prefers it.
- [Doctor Minuchin] The question is,
your wife had always thought
that she would break if she has stresses.
And you learn to accept that,
and you never, then--
- [Hector] From the beginning, yes.
- You're never for certain whether you could
break the balance.
And you learn to quiet your voice,
to make it so thin, and so thin,
where's the idea that it's what you need, talking.
- To release her stress that way,
I think I would take the stress,
and I would take her situation.
- No, I want to be an equal partner.
- This is the beginning,
and all the trouble that we went through
fed right into it.
- [Doctor Minuchin] It seems as if maybe both of you
have a threshold of stress after which
you escape in different ways.
You escape into the hospital,
and you escape into the drinks.
Possibility, or...
- Yeah, it would be, but I just get lost,
I just click and turn on video.
- [Doctor Minuchin] So when you,
when you escape, I think she begins to hear voices.
Your voices become stronger when he escapes.
Or when, you know, even in this situation,
your escape was not,
was not there for you,
you were really sick and unable.
But it is similar to all her escapes that are psychological.
- Yeah, there was nothing special,
I was not there.
- You weren't.
- [Doctor Minuchin] And there she goes--
- Frickin' crying.
- [Doctor Minuchin] She goes into crazy.
- Yeah, I understand.
- [Doctor Minuchin] So it's clear that when she,
when her voices become loud,
it is because you - [Hector] I'm upset.
- [Doctor Minuchin] you disappear.
- [Voiceover] As the session closes,
Angela no longer has sole ownership of her voices.
Hector's participation in Angela's hearing of voices
has been described, and in the process,
the interconnectedness of the spouses
has been reaffirmed.
Moreover, the way in which Doctor Minuchin
has described Hector and Angela's interconnectedness
has suggested an avenue of possible change
in the way they relate to each other.
More than a year after the second consultation,
Doctor Minuchin met with Hector and Angela
for a followup interview.
During this period, Angela had had only a single,
brief hospitalization, a radical departure
from the previous pattern.
During the period, Danielle had become pregnant,
and given birth to a baby boy.
At the time of the followup interview,
Danielle, the baby, and the baby's father
were living with Angela and Hector.
Angela began the interview by talking
about her newborn grandson.
- [Angela] My daughter and my grandson.
- [Margaret] Okay, this is what I've come to see.
- Sal's gotta see this, he's gotta see--
- [Doctor Minuchin] I am embarrassed,
'cause I have a granddaughter, and I don't have a picture.
- I don't have a picture - [Angela] That's too bad.
- [Hector] of my daughter, and Angela, that's all--
- That's the one for me.
This is gorgeous. - [Hector] Isn't he beautiful?
- And it's a nice offspring.
- [Angela] He looks like me.
He also has a cleft in his chin.
- [Hector] Everyone says he looks like her.
- [Angela] He has a cleft in his chin,
and you can't see it on the film there.
- [Margaret] Isn't that lovely.
- [Hector] You think he looks like her?
- [Angela] He is very big.
- How old is he?
- [Angela] He's six months - [Hector] Six months now
- [Angela] and two or three weeks.
- He does look like you.
- [Angela] Yeah.
- [Hector] And what's good is that we're making a good,
a real impression on the kid.
- [Angela] Also we've changed, I mean,
the house setting is so different.
But we take care of our stuff.
Danielle cooks for
what's his face. - [Hector] King Tut.
- [Angela] King Tut. - [Hector] What's his face.
- [Angela] And little Anthony and herself,
and they clean behind themselves.
The living room is sort of like neutral territory.
There's a television set there with a VCR,
but everybody has a set in their own room.
We're all in our own rooms.
We sometimes come out into the living room.
- [Hector] She finally heard me.
- What do you mean, "I finally heard you", what?
- [Hector] Well I told you this business
of cloistering yourself in the room and everything.
- [Angela] Well I'm coming out a little bit more, yeah.
- You see, you know, 'cause you were doing this.
You would lock yourself in the room,
and you'd impose this punishment on yourself
then you say it's them.
And it was never them, it was always you.
You want, and it was a good idea, give them room,
access to the living room.
But you got into this thing, "Look what they did to us".
No one did anything to you.
The house is yours.
- [Angela] I know, I know.
- I know, now you know.
- And I started to feel claustrophobic a couple weeks ago,
I said, "Screw this"--
- Go out in the living room.
- Come back out in the living room.
- [Doctor Minuchin] And you don't know because
I have not seen you for over a year,
and I noticed that Hector is very different
than he was a year ago.
- Uh-huh.
- [Doctor Minuchin] How did that happen?
- I don't know, it's a little bit of that Puerto Rican stuff
coming out of him, and he just started to put his foot down,
and I'm like, "Okay". (laughing)
- [Doctor Minuchin] But very, very different.
- Yeah, I learned to shut up at times.
- [Doctor Minuchin] Is that an improvement?
- [Angela] Yes.
- In what way?
Because, you know, I'm impressed with you.
- [Angela] It makes me feel protected and safe.
He's taken charge, he's being the man of the house,
he's not being the doctor taking care of a patient.
I am not a patient, I am his wife.
And I am trying to be his wife,
and do the things that I have to do.
- I think it was because we were going to Margaret,
and we were doing well.
- We used a lot of - [Hector] Margaret was good.
- [Angela] things she told us. - [Hector] But Margaret called
- [Hector] us and things she pointed out.
We talked about and--
- [Doctor Minuchin] Like what?
- That I was being Angela's doctor, or her father,
or her big brother, protecting her, and not being a husband,
so I was playing, I was not a husband anymore.
So this altered our relationship as husband and wife,
I became her caretaker, I protected her against her mother,
I would do this for her, I would do that for her
to keep her shielded from anybody or thing.
And that's what I've been doing for all these years,
and my life, per se, was put on hold.
And then I would put severe demands on myself,
and that's when the Nazi came in, when I had to go to work,
I had to do this, I had to do that,
and Margaret pointed this out to me.
- What could you use from Margaret, or do you use,
to change your relationship with Hector, for instance.
- [Angela] Well the idea that you kept on talking about
how he was taking care of me, and I wasn't being a wife,
in reality I wasn't being a woman,
that's what I was hearing.
And I just, Hector got sick and it was like
I had to, all of a sudden,
somebody had to take care of the family.
- [Doctor Minuchin] But what kept you together
was the fact that you were needed.
- Needed by the man I love.
- [Doctor Minuchin] Yeah, but that was something
that didn't keep you before.
So something very, very new happened
in your relationship.
I think that part of it was that you used to escape,
if I remember correctly, as soon as she began to be upset,
that upset you, and--
- I would just quietly retreat, you know.
Now, when she gets upset, I tell her,
"Look, I don't need this", I tell her with her friend,
"That's enough", and I just walk away.
And I tell her, you know, enough is enough.
- [Doctor Minuchin] Okay, but in order to do that,
you need to have the certainty that she will not--
- [Hector] Totally collapse.
- Yeah, how did--
- [Hector] Because I know she will not collapse,
because I no longer believe that she's nuts.
Pure and simple.
She's not crazy, she knows what she's doing,
she knows what's going on. - [Doctor Minuchin] How long
- [Doctor Minuchin] did it take you to get that realization?
How many years?
- A long time.
- [Voiceover] As they themselves described,
it was the systemic, therapeutic strategy of affirming
and exploring their interconnectedness
that had allowed Hector and Angela to discover
unsuspected resources in their relationship with each other.
And it was, in turn, the transformation
of their relationship that had empowered the couple
to break the pattern of repeated hospitalization
that had for so long oppressed the family.
Hector and Angela's upbeat tone
during the followup interview
gave simple and eloquent expression
to the victory that this family had won
over its legacy of multiple problems.
(organ music)