The Adolescent in Family Therapy: Breaking the Cycle of Conflict and Control.

Although the emphasis in this book is on therapy with families in which there is at least one adolescent, it is really a wide-ranging account of the author’s approach to family therapy. After an introductory chapter, Micucci outlines his treatment approach in a chapter entitled ‘The Process of Change’. While he draws from several schools of family therapy, he appears primarily to be a structural therapist and a disciple, though not a slavish one, of Salvador Minuchin. This is not surprising since for nine years he was on the staff of the Philadelphia Child Guidance Clinic. Micucci’s emphasis is on dealing with the ‘symptomatic cycle’ – the continuing process whereby by the circular transactions in the family perpetuate, and often magnify, the symptoms in the ‘identified patient’. His ‘central thesis’ is that ‘symptoms in families evolve in a context of personal isolation, characterized by conditional acceptance and efforts to control one another’ (page 17). Chapter 3 outlines adolescent development, including various ways in which this may go awry. There is nothing particularly new here, but it provides a context for the remaining chapters. These cover, respectively, eating disorders; depression and suicide; violence, delinquency, and other problem behaviours; psychosis; underachievement and other school-related problems; problems of ‘leaving home’; and ‘multiproblem families’. In each chapter the authors offer us a theoretical perspective and practical suggestions for working with the various problems, together with, in most chapters, a case example. There is much clinical wisdom here. I found the chapter on ‘multiproblem families’ to be one of the most interesting. It describes an approach to helping families that live in extreme poverty and face serious social disadvantage; it may serve as an antidote to the despair therapists sometimes feel when faced with such families. I learned much from the author’s empathic, sensitive and dedicated approach to the treatment of Rosa, a poor immigrant from Puerto Rico who’s English was limited, and her family. Micucci refers to the classic book Families of the Slums (Minuchin et al., 1967), which no doubt inspired him in his approach to this family. There is an Epilogue, which isn’t about family therapy in the strict sense of the term, though of course any intervention in the family – even one involving just a single member – has its impact on the family system. It outlines the author’s 15 sessions with a teenage boy who refused to come to sessions with his family, was ‘against therapy’, and insisted he didn’t want to change. Engaging him in any sort of helpful relationship was clearly a huge challenge, but Micucci rose to it, and Steve attended regularly for 3 months. This is a wonderful illustration of how it can be possible to engage even the most reluctant of teenagers in therapeutic relationships. This book is not a comprehensive text on family therapy, or even on therapy with the families of adolescents. But it is a useful contribution to the family therapy literature. For six years, the author was Director of the Adolescent Unit at the Philadelphia Child Guidance Center and he is no doubt sharing with us, in this book, much of what he learned from the families treated there. Anyone who works with the families of adolescents is likely to learn something of value from this book. It is clearly written and easy to read.