Family Therapy: A Cultural Perspective

When I lived in Japan I came to describe the pace as “furiously slow.”  Everyone seemed busy all the time, but no one appeared to be in a hurry.  There was a methodical process for everything.  A process that did not require a heroic effort from any one person, but that required, it seemed, approval and a small contribution from every single person in the entire country.  Everything from writing a proposal to deciding where to go for lunch required a massive, consensus-driven group process.

Think of ants moving a grasshopper.  Or a light-bulb joke.  Or family-systems therapy.

A prime example of this dynamic was the “ringisho.”  As a senior executive in a Japanese education company, I had to submit any expense over a certain amount for approval.  I did not submit the request to my supervisor, who happened to be the Chairman and CEO; I submitted it to a subordinate—the financial controller of my division.  From there, the physical slip of paper my request was printed on had to land on the desk of every single manager in the company, receive their bright red “hanko” stamp, and return to my office before the controller would issue a check.

There were sixty-something upper-level managers in my company and they were scattered throughout Tokyo, Kobe, Yokohama, Kyoto, and Osaka. If a single hanko was missing—whether because a colleague did not think my request was warranted or by some oversight—I was out of luck. If the slip got lost in someone’s in-box or blew off a desk into the trash, there was no way to trace it.  To me, an American accustomed to a large measure of autonomy, the ringisho was terrifying.

Now that I work with families, I frequently think back on my experiences in Japan.   Virtually every aspect of life in Japan is designed to honor the group over the individual, which of course is the exact opposite of how things typically work in the US.  It’s incredibly difficult for many of us in the west to submit to a group process, to entrust our fate to the whims of consensus, to surrender control.   Democracy we get.  Consensus we don’t.

This fear of losing control manifests often and early in family therapy; it generally shows up in the form of resistance.  What if I don’t agree with the group?  I’m used to being the boss.  I’m used to being invisible.  I’m used to being the joker.  I have my place and role and I know how to do it—I feel in control, at least, of myself in that role.  In short, I’m used to the way things are—homeostasis—even when “the way things are” is clearly not working.

This fear of being subsumed by the family system is so powerful that it can end the family therapy process before it even begins.  Sometimes this occurs through passive refusal—as when a family member or members simply won’t open up, refusing to submit their thoughts, feelings, and concerns to the group.  Other times, this resistance manifests when a key family decision maker such as mom or dad simply terminates therapy.

My own fear of being subsumed by group identity manifested frequently in Japan.  The first time I submitted a check request to the ringisho, for instance, filled me with real anxiety.   The request was for a last-minute, mission-critical business trip to the US to discuss a major strategic partnership with an American company.  In the US I would have just whipped out the company credit card, but here I had to humbly submit a check request to my colleagues for approval.  Tapping nervously on her desk, I asked my controller when I could expect a check and begin making travel plans.  “Once we receive all hanko,” she said with a small bow.  I panicked.

“We need to make an exception, the trip is next week.  I need the check immediately!”

“Sumimasen, Will Sensei,” she said, looking away, “no exception to ringisho.”

One day passed.  Two days passed.  Three days passed.  On the morning of the fourth day, just as I had given up on the trip and started working on my resume in a desperate attempt to regain control of my professional destiny, Yoko-san approached my desk with a check in her hand.  I scrambled to make travel plans and barely pulled off the trip. But I returned to Japan with a new strategic partnership.

It wasn’t until I returned from the US to smiles and bows and gifts that I understood one of the main advantages of the ringisho—everyone in the company had reviewed and explicitly chosen to support my effort.  We were aligned.  In the coming weeks I would learn that much had happened behind the scenes while I was overseas—phone calls, emails, gifts—to support my effort and grease the wheels for the new partnership.

This profound level of alignment was the real point of the ringisho.

Like the ringisho, family therapy can be a maddeningly slow, seemingly chaotic, frequently discouraging process—especially for clients who are used to a high level of control and efficiency in other areas of their lives. It requires distinctly un-American qualities such as humility, submissiveness, and interdependence.   But, much like the ringisho, the purpose of family therapy is to create a powerful level of systemic, internal alignment.  With that kind of alignment, stunning progress can occur.  Without that alignment, change is difficult to achieve and to sustain.  Since the family is the primary system we all participate in, misalignment can profoundly impede progress—for the struggling individual and for the entire family.

Whole-family involvement is the best way to support the sustainable healing and growth of any one family member principally because it generates alignment.  But it requires each family member to submit their intentions, hopes, and feelings to a group—in this case the family—for comment, approval, and assistance.  It requires not only that you do your part, but that you trust others to do theirs.   Any one member of the group can stand in your way and you can stand in theirs.   These elements can be scary and can lead to very normal, sometimes appropriate, but often counterproductive resistance—the feeling inside that says, “something’s wrong; I don’t want to share; I don’t have anything to share: this is dumb.”  But once resistance gives way to sharing, submitting to the process, and engaging yourself and your family in new ways, amazing things can happen.

Following are a few tips to consider as you enter the scary, but exciting realm of family therapy:

• If you feel “emotionally constipated,” “blank” or numb, suspicious, or otherwise hesitant to engage in family therapy sessions, articulate these dynamics as a starting point for sharing
• Engage in your own therapy outside of family therapy
• Articulate your goals for therapy and ask for input
• Listen actively to others as they speak—sometimes it’s easier to open up when your focus is on someone else
• Accept that a level of resistance is normal and appropriate—everyone has a different pace for sharing
• Breathe—slow, deep breathing can reduce anxiety and help you relax enough to feel and to express; yoga is a great way to practice this kind of breathing outside of the therapy setting
• Be willing to try new things—crack a joke, ask a question, stand on your head, shake it up!
• Try a different therapist—if you feel stuck for an extended period of time, it’s okay to try a different therapist; resistance is often a two-way dynamic

Family therapy can be scary, frustrating, and difficult.  But it also creates the most incredible opportunities for sustainable change.   When change occurs at a systemic level in a family system, it means that your growth is supported by an almost irresistible force.  Like the ringisho, it means, ultimately, that you’re not alone—and neither is your son or daughter or spouse or whoever in the family is really struggling the most.