Salvador Minuchin, the Scientist

Greetings my name is Charles Fishman.  This is a short blog on my friend, Dr. Salvador Minuchin, who died recently at age 96.  He was still working avidly, preparing for a family therapy presentation to thousands of people at the Erickson Foundation in Arizona.

I’ve been fortunate enough to know Sal for over 40 years.  He was a great therapist, a great inspiration, and a warm person.  To use the words of Maria Montalvo, ‘Sal made everyone feel like they mattered’.

One of the things that has not been focused on the lavish accolades for Salvador at his death is that he was also a brilliant scientist.

If you define a scientist as someone who discovers patterns in nature, Sal was indeed a scientist. The pattern he discovered was family structure, crucially important to the clinician.  Akin to a tissue biopsy in medicine, structure gives the therapist an immediate map of what is the problem and what should be done.

I asked Salvador many years ago how he came upon the idea of structure.  He said,

“I was influenced by medicine as I strived to describe family systems.  I was looking for something like the structure of an organ, like the architecture of the heart, something that had a perceivable organization."  Of course, the concept, he said, had been misinterpreted with a criticism that I was describing a static system. "My concept at the beginning was a concept that acknowledges that structures are ever changing.” He went on to say:

"I was always interested in context. In Israel one day, I was watching some children playing.  There were European, South American youngsters alongside Turkish children. I was struck by the differences in their cultural context which was vast yet there were similarities in their family interactional patterns."

Indeed, Sal’s consistent use of structure over the years is a defining characteristic of his work and the work of countless family therapists, myself included.

In the 60s, Minuchin moved to New York City.  There, Sal worked with Braulio Montalvo, Bernice Rosman and others at Wiltwyck School for Boys which was a reform school outside of New York City for kids, mostly from Harlem or South Bronx, very impoverished families.  There he developed structural family therapy and they published that work in his classic book, Families of the Slums.

At one point in a discussion, I asked Doctor Minuchin how he came across the innovative idea of working with families, innovative even today in many contexts.  Sal said, “I had a very smart secretary who would type my assessments. One day, she said, ‘You know what Dr Minuchin?  I typed the exact same assessment for this boy, a year ago.’”

Sal said, "Do you know what? We’ve got to do something different. Let’s bring in the families."

The Minuchins then moved to Philadelphia where Sal became a director of the Philadelphia Child Guidance Clinic.  Some of his most innovative work was his work with psychosomatic families, troubled families that had children with severe diabetes and anorexia nervosa.  There again, he examined the family interactional patterns within these systems.  He developed with his colleagues the model of the Psychosomatic Family system. 

One of the most innovative parts of the work to me was the family task both in Wiltwyck as well as in Philadelphia. There were unique postulated family interactional patterns that they compared against  asymptomatic families.  The video tapes of these family tasks were then scored by raters who didn’t know whether they were experimental or asymptomatic families, that is where the families had conduct disordered children or psychosomatic symptomatology.

One anecdote that I believe hasn’t been put in the literature: the doctors in the hospital referred a girl saying they could find no reason for this girl’s weight-loss. They said it must be on psychological terms. The researchers did a family task and they found that this girl’s family did not have the characteristic psychosomatic family patterns such as conflict avoidance, triangulation, overprotectiveness and rigidity. The team decided to go back to the doctors and say, “You had better look further.” Indeed, the doctors of the hospital looked further medically and found the girl had a pineal tumor.

In contemporary treatments, two of these researchers have continued well into the next generation, the Maudsley method for treating anorexia is the standard worldwide for treating juvenile anorexia nervosa. In terms of conduct disorder children, multi-systemic therapy and functional family therapy are considered to be based on Minuchin’s work and are utilized worldwide.

In closing, Sal often used the metaphor of his many voices, the many voices of his mentors, when he was working. His legacy today, in many ways, is that his voice is one of the voices, and a loud voice, of countless clinicians worldwide that have the gift, his gift, of this powerful lens, family structure. Innumerable families worldwide have benefited from Dr Minuchin, the scientist. On their behalf I take the liberty of saying, thank you, Sal Minuchin.

Image credit: New York Times - https://www.nytimes.com/2017/11/03/obituaries/salvador-minuchin-a-pioneer-of-family-therapy-dies-at-96.html