An American Take on the Manifesto

Mary Hotvedt, PhD

Let me paint a picture for you of the Assisi Conference last July 2023, which spawned the Manifesto: Imagine an auditorium with banked seats, a thousand enthusiastic family therapists waiting for a plenary to begin. People are chatting in many different languages. People are getting up to hug old friends and shake hands with new ones. Those who have just finished their cappuccinos rush in to find seats as the house lights dim. Dr. Maurizio Andolfi, the conference organizer, starts to speak …

Read The Assisi Manifesto

For three days we met in Assisi, in large and small groups, to share our commitment to our work and our thoughts about what was most seminal to our field. The opinions of the many present went into shaping the Manifesto as published in this issue. The official authors are trainers from many countries, degrees, and settings who have worked with Dr. Andolfi. We met in pairs and groups to synthesize thinking and provide research background.

This work about our fundamentals is being published in many countries and continents. AAMFT was a major sponsor of the Assisi conference and our President and CEO, as well as the JMFT new editor were in attendance. As co-chair of the conference and a former AAMFT President, their participation meant a great deal to me. It was a joining of the two halves of my life work: my professional identity as an AAMFT advocate and my practitioner/trainer soul.

Why a manifesto, and why now? Many of us sense that family therapy, while considered a viable treatment approach, has lost the punch and primacy it once had. We may have become encumbered by therapeutic bureaucracy and pressure to treat individuals or dyads as opposed to working with the rawness and chaos of whole families. We think it important to state the old and new fundamentals of working with families. We are especially concerned that the voice of the child is being lost. The Manifesto is not simply a statement of principles. It is a call to action; to practice what we know and believe.

Some history is relevant. Back in the start of the family therapy movement, AAMFT was the place where “the Founders”—the ones we now study in our textbooks—would hotly debate their approaches to working with families, couples, and children. They were a feisty and passionate group, sometimes in error but seldom in doubt. Any of us who were fortunate to see Minuchin, Satir, or Whitaker (to name just a very few) work with a family will remember the inspiration we felt.

Our own Foundation sponsored those important first research conferences.

At the same time, AAMFT was growing a profession, moving through MFT certification into licensure for our members in all the States and Provinces. This, too, was important work. MFTs, all of us, fought hard for professional recognition and the right to practice. Highly important to that struggle was a growing body of research, much based on developing manualized FT treatment approaches, that demonstrated our work was as or more effective in treating a wide variety of mental health problems. Our own Foundation sponsored those important first research conferences. We reached our goals of licensure and then achieved inclusion in VA, Medicaid, and, finally, Medicare plans. Another critical piece of our success has been the growth of COAMFTE-approved training programs, mostly placed within universities, educating new practitioners and supervisors in a wide range of therapeutic modalities which have grown out of early FT.

In 2007, a group of us was tasked by AAMFT to draft a 20-year strategic vision for the association, based on foreseeable trends. It was undertaken at a time when all professional organizations were seeing declines in membership. We envisioned an association open to like-minded systemic professionals from all mental health disciplines and a far more international AAMFT. The Board, over time, has acted on those ideas and added to them. This collective thinking plus modern organizational practices have revitalized AAMFT. The foreign summer institutes have been just one outgrowth. Our strong participation in Assisi meant to me that AAMFT has truly joined an international cadre of systemic practitioners.

So that leads us back to the Manifesto. For me, as an AAMFT member, there are five important takeaways from the Manifesto. Each point implies questions we can ask ourselves:

Our shared focus is rooted in the family, and the family in community. Each family brings us problems but also their resources with which to work. We elicit healing from within rather than impose it from ourselves. We honor the voices of the family, meeting children and adolescents especially in a meaningful way, knowing they have special expertise in their families.

This approach means that we may understand the medical model at the basis of the DSM and ICD codes, and we follow research on the brain, but we also operate from the social reality of the family, the individual within their context, rather than a person with a diagnosis. Question: Am I using all the voices in the family as much as I can? Am I listening to the young people in my work?

We have grown as practitioners beyond some of the mistakes of early family therapy and embrace research as well as experience in training new people in FT. Our models are inclusive of all cultures, family types, and individuals. We teach and practice from an inclusive position. Do I move out of my comfort zone to work with new kinds of families and sociocultural situations?
Training is an ongoing experience. It should not stop with fulfillment of a degree, a licensure requirement, or the 40 continuing education units. It is an in-depth experience in which we challenge ourselves to move through our perceived blocks in confronting the pain in families.

One way to do this ongoing work is to form a small group with other therapists, one in which each of us talks about our impasses, our family pieces, and we help each other make breakthroughs. I have seen such groups who have worked with Maurizio Andolfi, Sue Johnson, and David Schnarch work this way. How do I challenge myself to grow as a therapist or trainer? Am I willing to work more closely with my peers on my own impasses?

We need to use our experience and expertise for the greater social good. This is a call for all of us to be involved and concerned citizens on every level. We vote. We work for bills that can benefit our client families. We write letters to the editor. We work to oppose prejudice in our communities. We serve on boards and run for office. We speak up for what we see as the common good.

Some would say they fear doing these things because they may cross paths with a client or may be seen too much in the public eye by clients or employers. It may be as we mature, we have less of these fears but still are reticent, used to being in our consultation rooms rather than out in the public. How do I speak out or work for families and the community outside of my work?

My own takeaway, maybe the most inclusive, is that the manifesto calls us to be bold. Bold and feisty, like the Founders. Did Whitaker worry he was breaking confidentiality when he invited a whole extended family to discuss dad’s depression? Did Michael White worry about saying hello to a client in the supermarket? Did Satir worry she was busting a “no-touch” boundary when she sculpted a family? There are sensible rules, and when we treat all family members with normalcy and respect, we and they know what is ethical. Being a whole person with our clients means speaking to them in their language and not in “Therapese.” It means helping our students and trainees to be as real and normal as they can be when with a family, to face their fears of screwing up or being held back because some dynamic reminds them of their own dilemmas.

We cannot be human without others. It is in this context, that of the family and the community, that our work exists.

So, is the Manifesto just a hearkening back to the days of the Founders? I think it is a call to reawaken what we all know as what excited us to pursue MFT work. It goes beyond all the necessary professionalization of our field. It goes to the fundamental principle that none of us is an island. We cannot be human without others. It is in this context, that of the family and the community, that our work exists. AAMFT members have been great activists for our profession. Now let’s be greater activists for helping families with the special insights we have developed.

Mary E. Hotvedt, PhD, is an AAMFT Professional member holding the Clinical Fellow designation, an anthropologist, and an MFT. She served as President of AAMFT and has worked with Dr. Maurizio Andolfi for over 35 years. She is currently Chair of the Board of Regents for Western New Mexico University.

An American Take on the Manifesto

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