Interfaces: Toward a New Generation of SystemicModels in Family Research and Practice

CARLOSE.SLUZKIw

After reviewing Engel’s bio-psycho-social proposal and Kandel’s ‘‘principles for anintegration between mind and brain,’’ the author introduces a set of akin propositionsthat aim at integrating neurosciences, genetics, the mind, and the social world into asuccinct set of systemic formulations focusing on interlevel interfaces, with profoundimplications for the training, practice, and research in the field of family processes andtherapy.

Keywords: Systemic Models; Neuroscience; Genetics; Family Therapy

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There has been a recent upsurge of publications exalting a paradigm that reener-gized the world of psychosomatic medicine and enriched the field of family-

oriented health care: namely, the pioneering bio-psycho-social model proposed byGeorge Engel in 1977 (Engel, 1977, 1980; Frankel, Quill, & McDaniel, 2003; Rolland &Williams, 2005). The bio-psycho-social model entailed, at the time of its formulation, aqualitative step forward in the evolution of the integration of biological, psychological,and social variables beyond its predecessor, the ‘‘psychosomatic’’ lens, which implied,but generally did not include explicitly, micro- and macro-social variables.

The author of this article was immersed for many years in the complex interdis-ciplinary terrain of a systems-oriented, family-based, socially concerned psychother-apy and clinical psychiatry, including the development of community-orientedprograms and services, and teaching of students and colleagues with a variety ofprofessional backgrounds. In those varied contexts, he strived to retain a systemicview and a guiding bio-psycho-social model, frequently under the attack (or thetemptations) of the Sirens that sang the oh-so-comfortable reductionistic approachesof biomedicine. But models, even the most elegant, are the product of their times.

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This article was delivered at the festschrift conference in honor of Lyman C. Wynne M.D. Ph.D., Uni-

versity of Rochester School of Medicine and Dentistry, Rochester, New York, September 9 and 10, 2005, as

homage to the pioneering work and the humanistic spirit of that colleague and mentor, who has consistentlypushed the boundaries of our traditional paradigms toward a post-Cartesian, integrated vision of humans as

simultaneously (and indivisibly) biologic, psychological, and social beings.

wProfessor, Department of Global and Community Health, College of Health and Human Services, George

Mason University, Fairfax, VA, and clinical professor of psychiatry, George Washington University MedicalSchool, Washington, D.C. E-mail: csluzki@gmu.edu

Engel’s model was dated almost 30 years ago, and the many recent developments inthe biological and the social sciences may justify a respectful but critical revisitation ofthat paradigm and related models. This article aims to do so, and then to suggest somereformulations, with full awareness that the latter are built on the shoulders of giants.

ENGEL’S BIO-PSYCHO-SOCIAL APPROACH

Engel’s 1977 bio-psycho-social model, epitomized by his seminal Science paper, washailed as an alternative approach to the biomedical view and praised (Wynne, 2003)both as an attack on reductionism and a plea for a systemic view of practice. It con-sists, in ultimate analysis, of a detailed specification of the ecosystemic hierarchy andcontinuum lodged between the biosphere and the subatomic particles. At the sametime, the many examples that enriched Engel’s publications and countless others inits support have been centered in the mind-body interface.

Engel did not write for the converted. In fact, for those professionals already im-mersed in systemic models at the time of its publicationFamong them, many familytherapistsFEngel’s paradigm contained an already very familiar tune.1 Engel ac-knowledged explicitly the influence of the novel wave of systemic principles that waspermeating the so-called soft sciences (making them less soft) and the so-called hardsciences (making them less hard). Engel wrote for the medical profession in generaland, more specifically, for those professionals dealing with the body-mind interfaceand with medical education. For them and for many others for whom that model was afirst exposure to systemic thinking, the impact was, and still is, extremely substantial(e.g., Frankel et al., 2003).

Engel’s writings and those of his followers display a richly textured, multilayeredcomplexity whenever the model is applied to clinical examples. However, its formu-lation proper appears linear in its structure; it consists of a list of levels of systems,from biosphere to molecule, each inclusive of the previous one; and it lacks any explicitevolutionary (temporal) dimension.

KANDEL’S ‘‘FIVE PRINCIPLES FOR AN INTEGRATIONBETWEENBODYANDMIND’’

Many scientific breakthroughs and epistemic shifts took place in the lapse followingEngel’s original publication. Among those that merit highlighting was the flood ofneurosciences research fostered by the strong support of the National Institute ofMental Health (NIMH), made explicit by its designation of the 1990s as ‘‘the decade ofthe brain.’’ This trend led to an explosion of molecular, biochemical, neurophysiologic,and genetic and genomic research at the expense of a drastic reduction of support topsychosocial research projects.2

1 Von Bertalanffy’s writings on general systems (1950, 1968), Ashby’s contributions (1954), thelegendary Macy conferences starting in 1946, and Wiener’s (1961) own pioneering synthesis ofcybernetics had already produced a major impact on the behavioral sciences (see Buckley, 1968, andGrinker, 1967, for some early echoes). In good measure, this impact spearheaded the developmentof family therapy, directly through Bateson’s coworkers and followers at the Mental ResearchInstitute (e.g., Bateson’s 1972 collection of articles; Watzlawick, Beavin, & Jackson, 1967), but,equally important, indirectly through the tremendous influence of the systemic paradigm in mostof the other pioneers and subsequent generations in the field.

2 This reflected the current U.S. government’s political slant that consistently eschewed sociallyoriented programs.

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In 1998, perhaps as a reaction to the reductionstic trend of most of the NIMH’ssponsored projects and rhetoric, and acknowledging the need to integrate therevolutionary advances in genetics into a broader view, Eric Kandel, a neurophysi-ologist and psychiatrist recipient of the 2000 Nobel award in physiology, proposed‘‘five principles for an integration between mind and brain’’ (Kandel, 1998). Thisformulation reached a new generation of psychiatrists and, interestingly, of psycho-analysts, which somehow heralded those principles as providing the opportunity to‘‘rewrite metapsychology on a scientific foundation’’ (David Olds, cited by Kandel,1999 p. 64).3

Although apparently not explicitly inspired by Engel’s formulationFEngel is notlisted among Kandel’s referencesFby focusing on a few of the multiple interfaces ofthe overinclusive systemic series proposed by Engel, Kandel’s model enriched andrefined the formulation of interfaces and made explicit not only reciprocal influencesbut also a directionality in the processes that interconnect them.

The following is a set of principles proposed by Kandel (1998; parentheses aremine):

I. All mental processes, even the most complex psychological processes, derivefrom operations of the brain. (Does ‘‘derive’’ mean that mental processesare a product of operations of the brain? If affirmative, it subsumes psyche tosoma!)

II. Genes and their protein products are important determinants of both thepatterns of interconnections between neurons in the brain and the details oftheir functioning. (Needless to say, that does not exclude the many intra-uterine contextual factors that affect the evolution of the brainFfrom ma-ternal undernourishment, substance abuse, or disease [e.g., measles] toteratogenic medications or toxic substancesFnor does it exclude intercon-nections that develop or fail to develop later in life according to contextualfactors.)

III. Altered genes do not, by themselves, explain the variant of a given majormental illness. Social or developmental factors also contribute very impor-tantly. . . . Learning, including learning that results in dysfunctional behavior,produces alterations in gene expression. Thus all of ‘‘nurture’’ is ultimatelyexpressed as ‘‘nature.’’ (This statement qualifies the previous one. Could it besaid that, following the form of the first principle, major mental illnesses de-rive, at least in part, from social or developmental patterns?)

IV. Alterations in gene expression induced by learning give rise to changes inpatterns of neuronal connections. These changes not only contribute to thebiological basis of individuality but presumably are responsible for initiatingand maintaining abnormalities of behavior that are induced by social contin-gencies. (This proposition seems to qualify principle II.)

V. Insofar as psychotherapy or counseling is effective and produces long-termchanges in behaviors, it does so through learning by producing changes in geneexpression that alter the strength of synaptic connections, and structuralchanges that alter the anatomical pattern of interconnections between nerve

3 Kandel’s formulation attracted the attention of many researchers and practitioners rooted inpsychoanalysis because it successfully challenged a vision of that model as a closed cosmogony.

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cells of the brain. He then ties this to a quantitative evaluation of the outcomeof psychotherapy. (This principle appears to be a benign expansion of propo-sition III that acknowledges, this time constructively, the influence of socialfactors and learning.)

Applying the Ockham’s Razor principle of parsimony that calls us to simplifypropositions as long as their descriptive or explanatory power remains intact, Kan-del’s principles are weaved together, in my view, on the basis of three key tenets: (1)Mind is biologically based; (2) Genes determine the biological base; and (3) Experi-enceFincluding learning and psychotherapyFstructurally alters this genetic ex-pression.

Kandel’s principles add an evolutionary component, both Darwinian and in thesense of human development, but are clearly skewed toward the gene-body dyad,underplaying the reciprocal nature of the influences between the levels he specifies.4

AREFORMULATIONOF PROPOSITIONS: AN EMPHASIS ON INTERFACES

Since Kandel’s formulation, a major scientific event has taken place: namely, themonumental feat of mapping the whole sequence of the human genome, completed in2003 by an international consortiumFonly 8 years after the first outline for this lineof research. A wealth of research ensued, including large-scale studies of gene ex-pressionFwith extraordinary implications for evolutionary biologyFand specificstudies that determine the involvement of sequence in tumor formation, with enor-mous therapeutic potentials.5 Further, the evolutionary rules followed by proteins andcells for an adequate development of the nervous system, and the psychosocial expe-riences needed to alter the genetic expression appear to be becoming unveiled (Insel,2005). Our understanding of the complex and rich nuances of the gene-environmentinterface was expanded during the past decades by the pioneering research projectsled by the Wynne/Tienari team and by David Reiss and his associates (McGuire, Ne-

4 Following are two examples of reciprocity. (1) Caspi, McClay, Moffit, and Mill (2002), re-searching on why some children who are maltreated grow up to develop antisocial behaviorswhereas others do not, traced back a genetic susceptibility modulated by a functional polymor-phism in the gene encoding the neurotransmitter monoamine oxidase A (MAOA). Maltreatedchildren with a genotype that facilitates high levels of MAOA were less likely to develop antisocialproblems (Rhee & Waldman, 2002). (2) The research conducted by the Tienari/Wynne team, dis-cussed next, seems to indicate that the characteristics of the family interactive style will modulatethe expressiveness of genetic proclivities toward schizophrenia in ‘‘high-risk’’ adopted offspringraised by those families.

5 Genomics has also become a field filled with economic potentials, and hence mined by theprivate industry in developments parallel to pharmacology: attempts to exploit advances for eco-nomic reasons, patent wars, and promises of panaceas. To that should be added the ethicalquagmires entailed in the potential use of genetic markers for differential selection criteria bymanaged care, health insurance, mortgage-related insurance (this use is being considered in theUnited Kingdom, with considerable controversy, specifically for Huntington’s disease, to preventdefrauding of insurance companies; Morrison, 2005), and the distortion of genetic findings at theservice of racist politics. This presentation does not explore these perilsFthere is an increasinglyrich and eloquent literature on the subjectFbut only highlights the constructive potentials of theinterface between genomics and the psychosocial world. For a discussion of bioethics with specificreference to neuroscience and the double-edged sward of genetics, see World Health Organization(2002; especially chapters 6 and 7); Duster (2003); President’s Council on Bioethics (2003); and thespecial issue on neuroethics in the journal Cerebrum (Vol. 4, No. 4, 2004).

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iderhiser, Reiss, Hetherington, & Plomin, 1994; O’Connor, Neiderhiser, Reiss, He-therington, & Plomin, 1998; Pedersen et al., 1989; Plomin, Chipuer, & Neiderhiser,1994; Reiss, 2000; Reiss, Cederblad, et al., 2001; Reiss, Pedersen, et al., 2001; Rende,Plomin, Reiss, & Hetherington, 1993; Tienari et al., 1987; Tienari, Sorri, & Lahti,1985; Tienari et al., 1994, 2000, 2003, 2004), and by other researchers exploring theinterface between family processes and genetics.6 This line of research is consistentwith Bronfenbrenner and Ceci’s (1994) bioecological postulation that environmentalvariables, including parental styles, play an important role in determining whetherbiological factors lead to the development of psychiatric disorders.

These new insights justify a reformulation of both Engel’s and Kandel’s proposi-tions, enriching them with these new insights and expanding them toward a paradigmformulated to make explicit the systemic interfaces adjacent to the psychosocial field,where our area of specialty is lodged.

The first proposition of this new set is, I believe, simply a tight reformulation of thecore focus of Engel’s view:

I. Mental processes, the neurobiological stratum, and the social/relationalworld operate as a system, and as such reciprocally influence each other

One could question whether they ‘‘operate as a system’’ or they are a system, onemeaningless without the other. It should be noted that ‘‘the social/relational world’’ isinclusive of several systemically related layers: the family, the personal social net-work, the community, the socioeconomic environment, the ecological niche, and so on.And, in turn, ‘‘the neurobiological stratum’’ is inclusive of several subsumed layers,from organism to cellular components, all in turn systemically related.

In this formulation, ‘‘social/relational world’’ encompasses two distinct levels: the‘‘micro-social’’ level of the family and the immediate relational network, and the‘‘macro-social’’ level of the world in which the family is immersed, including socio-economic variables, mobility, cultural variables and practices, race and ethnicitycontexts, and other traits of social inclusion/exclusion that impact individual and fa-milial resources and resilience. The micro-social world of the family is, in fact, anintermediate structure, both exquisitely sensitive to shifts in the neurobiological andmental level of processes, and readily affecting them; it is also equally sensitive to

6 The Wynne-Tienari ‘‘high-risk adopted-away’’ project consisted of a longitudinal study of alarge sample of families who had adopted newborns whose biological mothers fit the DSM-III di-agnosis of schizophrenia (‘‘high-risk’’ sample, meaning that these offspring had 10 times the sta-tistical probability of developing severe psychopathology as compared with the average population)or whose biological mothers were free of psychopathology (the ‘‘low-risk’’ cohort). These familieswere followed over time, their interpersonal dynamics studied, and the mental health of theadopted offspring evaluated until early adulthood. Although the ‘‘high-risk’’ sample presentedmore psychopathology than the control sample, the correlation between family interactional de-viancy and offspring psychopathology was statistically meaningful in both cohorts. This showsbeyond doubt the impact of the family environment in buffering the expression of pathology (or, tostate it in reverse, to enhance resilience and creativity). In turn, Reiss and his coworkers focusedon understanding the complex ratio between genetic factors and family relations on the develop-ment of competence (as well as psychopathology) in children and adolescents, with emphasis ondifferences among siblings. Rather than exclusionary approaches, these lines of research have sheda bright light on how nature and nurture interact in human development. These projects arediscussed more in detail in presentations on the interaction between genomics and family deliveredby Sluzki at recent congresses (2005a, 2005b).

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traits and changes in the macro-social realm. At the same time, the family and per-sonal social networks tend to buffer changes in either level of processes.7

The second proposition specifies the nonstatic, evolving nature of that system,making explicit what, in Engel’s proposal, is implicit:

II. Mental processes, the neurobiological stratum, and the social/rela-tional world coevolve.

Coevolution entails both short- and long-term reciprocal changes. Long-term re-ciprocal changesFfrom the concomitant evolution of the cranial capacity (and brainsize and complexity) and the evidence of increasingly complex mental processes asrepresented by tasks and social transformations, to the way humans have changednature and the way that those changes change them in turnFhave been eloquentlyargued in the evolutionary (Darwinian and Neo-Darwinian) literature (e.g., amongmany, Barkow, Cosmides, & Tooby, 1992; Bronfenbrenner & Ceci, 1994; Dawkins,1996; Gazzaniga, 1992; Wright, 1994). Short-term reciprocal changesFthat is,changes within a life spanFalso include a broad range of literature, from Bowlby-influenced developmental psychology to evidences at all ages.8

The next three propositions simply specify in a more detailed manner the rela-tionships between levels, ‘‘fracturing’’ the sequence of their reciprocal loops intosegments.

III. Changes in the social world unavoidably impact both the psychicworld (the mental processes) and the somatic stratum, directly throughthe neuro-endocrine subsystem and indirectly through mental processes.

This proposition covers two assertions. One is that stability and change in the socialworldFcrucially, the family, but including the larger social environmentFimpact theemotional and cognitive processes of the individual, but that mind and body are aunity; hence, the body, far from being a distant realm, should be included in the as-sessment of the impact of any psychosocial event. The other is a reminder that thereare two intertwined but distinct overall alarm systems in the organism: a fast-movingone, the autonomous nervous system, and a slower one, the neuro-endocrine system.Each affects different target processes, each adaptive and crucial for survival, but eachtied to both somatic and mental symptoms when acute circumstances exceed theadaptive repertoire or when these systems are chronically activated.

IV. Changes in the neurobiological system unavoidably affect both themental processes and the immediate social world.

Within the complex loop that includes body, mind, and the social world, thisproposition accentuates that somatic well-being and somatic disorders affect not only

7 Sufficient and effective personal social networks, of which the family is a central component,protect the individual member from the raw impact of social changes. Further, quality socialnetworks buffer the impact of changes at any level and facilitate the reequilibration between levels(e.g., Berkman & Kawachi, 2000.)

8 This includes a study by Maguire and colleagues (2000). Maguire is a rather well-establishedresearcher made famous by this article; the picturesque nature of his sample showed that expe-rienced taxi drivers develop structural changes in the hippocampus.

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the body but also the cognitive and emotional world of those who suffer from them,and those in their meaningful social network.

V. Changes in the mental processes translate into changes both in thesomatic stratum and in the immediate social milieu.

This proposition, far from controversial, acknowledges the well-documented impactof cognitive and emotional states on the body (the basis, in fact, of psychosomaticmedicine, from Hans Selye’s General Adaptation Syndrome on) and on the relationalmilieu (in fact, this proposition, complementarily tied with the above-listed proposi-tion III, constitutes a basic assumption of couples and family therapy).

VI. All these processes are affected by, and affect, the genetically pro-grammed constraints (a characteristic inherent to all biological entities).

This proposition acknowledges the reciprocal interface with heredity, building onKandel’s statements and enriching them, as a reminder that this is one of the coreinfluences that characterize living systems.

VII. The set [social milieu ! mental processes ! neurobiologicalprocesses] is sensitive to changes facilitated by psychotherapy (a socialpractice that perturbates one or more of the set’s interfaces).

This proposition, a specification of the third one, is discontinuous from the others, asort of ‘‘insiders’ comment’’ to remind us, psychosocial operators, of the systemicnature of our professional purview and, ultimately, that by restraining our view toonly one layer, we may lose the view of the forest.

From Seven Propositions to Four BasicTenets

For the sake of parsimony, the above seven propositions may be reduced, in turn, tofour basic tenets: (1) Mental processes, the neurobiological stratum, and the social/relational milieu operate as a system or set, and as such reciprocally influence eachother; (2) This set coevolves; (3) This set of processes is affected by, and affect, thegenetic constraints of individuals; and (4) This set is sensitive to changes that mayoccur within each component, in their relational milieu, or in the natural9 or socialenvironment (including those changes facilitated by purposeful endeavors such aspsychotherapy).

These tenets convey the rich tension between what has been called ‘‘morphogen-esis’’ (the forces toward evolution and change) and its counterpart, ‘‘morphostasis’’(the restraints that anchor sameness); the two coexist as a characteristic of livingsystems. Adaptive coevolution is limited by the constraints of each component (i.e., itis ‘‘structure-determined’’; Maturana & Varela, 1980) and of the setting, and itschanges are facilitated by shifts in the ecology and by random mutations. That is,

9 Natural refers to cataclysmic environmental events such as earthquakes, volcanic eruptions,tsunamis, floods, tornadoes, typhoons, and droughts, including those that are the result of globalwarming, exploitation of resources, or poor agricultural practicesFthat is, regardless of the factthat some, if not many, of those events are the long-term result of human ignorance, greed, or plaindisregard.

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species-specific limitations are ruled in large part by the limitations inherent to thespecies genetic program. In turn, the genetic program evolves at its own paceFwithoccasional mutations that take place in a probably random fashion, mutations that inturn may persist or be wiped out according to their fit with the milieuFa basic evo-lutionary assumption. But both the natural and the social milieu also evolve at theirown paceFeither on their own or by purposeful or unintentional alternations gen-erated by the inhabiting speciesFcreating a slowly moving target, shifting the con-textual conditions for the fit.

Implications of These Formulations for the Field of FamilyTherapy

We social scientists have, understandably, a social sciences bias, or at least aprivileged focus for speculation and for action: We intervene at the level of the psy-chosocial world of people. Further, from the perspective of these formulations, humanproblems are problems of calibration of fit between levels of processes within the bi-opsychosocial realm, including the interface with the macro-environment withinwhich this more micro-system is immersed. As agents of change, our areas of actionmay be targeted at one or another level of the system (the body, and its subsystems;the mind in its complexity; the family and other small social systems; society in itsdifferent expressions) but unavoidably will also be located at the interface betweensystemic levels. Changes we may foster are ultimately changes toward perturbing(increasing deviation), dampening (reducing deviation), and/or calibrating or fitting(‘‘tuning in’’) interfaces. This view, I believe, challenges the arrogance of certitudebecause it destabilizes directionality and enhances a view of the world as an unstablesystem, away from equilibrium. From this perspective, the proposed formulations arenot only a challenge; they are a call to battle against the flood of reductionistic bio-medical views materialized as evidence-based biopractices (and their funding!), whilebeing careful not to throw the baby of the biological and genetic variables out with thebath water of our fervor in the confrontation. They are also a call of caution againstthe temptation of directional hypothesis (and the definition of victims and perpetra-tors) that plagues our models and practicesFsometimes for practical reasons, some-times for political reasons.

If we accept that the focus of the therapist should include the vast territory ofsubsystemic (or intersystemic) interstices, it follows that therapists should not only belearned about those subsystems and the process of fit and misfit between them, butalso, equally important, about keeping the interfaces as a central locus of their prac-tices, because these interfaces are the territory of a good part of the source of pain andsuffering, and of assessment and change. Therefore, training of future therapistsshould illuminate those interfaces, educating them about each component, the waythey influence each other, and their potential misfits, destabilizing any traditionalnarrative of dominance of one level of analysis over the others. It will also have to crossthe micro-macro demarcations in ways that do not halt at the individual or familylevel, but include a thorough view of reciprocity in more corporeal-material andmacro-social ways than perhaps thought so far.

In the specific case of the interface between genetics and the psychosocial world,one of the many clinical corollaries of Lyman C. Wynne and Pekka Tienari’s research,as well as that of David Reiss and collaborators, is that the individual’s genetic pro-gram is a proclivity, not a destiny, and the most challenging and core task of a family is

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one of calibrating the fit between the different personal styles and assets of the dif-ferent members of the group. To acknowledge both the existence and the malleabilityof the genetic potentials empowers families toward the recognition and even the cel-ebration of differences in styles and potentials in one another, especially in offspring.It also fosters efforts to calibrate each person’s own styleFto tune it up to the oth-ers’Fso as to maximize the positive components of interfaces and to minimize thenegative ones. This view may rob part of the doom-and-gloom that our culture instillsin our views of genetic proclivities. Although therapeutic narratives based on ‘‘origin’’or ‘‘cause’’ tend to instill hopelessness because they are past-oriented, fixed, and guilt-inducing, narratives based on ‘‘fit’’ are empowering because they increase agency.That is, narratives based on fit offer the possibility of doing something about theproblem, focusing on the reciprocity of styles and talentsFwe are each and all shapedby genetic proclivities!Fand on the task of calibrating that reciprocity, developingtolerance and agency.10

A question that may be pertinent refers to the nature of a teaching curriculum thatmay incorporate those tenets into the training of psychotherapists. It may be rea-sonable to assume that family therapists in training should become also informedabout (1) the workings of each of those systemic levelsFgenetics, neurobiology, psy-chosocial processes, and interpersonal dynamics; (2) the complex processes of fit andmisfit between levels, and (3) sensitivity to macro socio-epidemiological variables,including socioeconomics, working conditions, culture, education, socioeconomic sta-tus, race, ethnicity, and gender impact on well-being/resilience and stress/vulnera-bility. In turn, the supervisory processes should favor the inclusion of all thosevariables in the reasoning underlying the practice of therapists in training. One caneven foresee the development of a variety of therapeutic trends built on a differentbalance between these principles.

The same considerations should apply to research in family processes, includingresearch in therapy. Family-centered research may be, and frequently is, focused onvariables pertinent to that level and not to others. However, that approach assumesthat either other systemic levels are invariant, or their variations are irrelevant (i.e.,that family variables are robust and resistant to change even when other systemiclevels vary). That invariant attribute is being questioned by many of the researchprojects discussed above. It behooves us, therefore, to assure that whenever familyresearch is being conducted, variables at other systemic levelsFboth inclusive, suchas social network, sociocultural, and socioeconomic variables, and embedded, such asneurophysiologic variablesFbe traced. The latter, we should recognize, may be lesseasily accessible to many psychosocial researchers because of the procedural com-plexity of their assessment, or less accessible for practical or legal reasons.

With regard to practices, bridging the distance between the rather general nature ofthe propositions listed above and the practice of therapy may require a double process:to inductively develop practices derived from these formulations, or to deductivelyspell out what practitioners guided by those principles do in their daily work. Bothpathways open up a new field of clinical research. It defines our practices not only astherapeutic/corrective but also preventive. For instance, it includes in our professionalarea of responsibility the calibration between parental and offspring behaviors and

10The same logic may be applied to all the other interfaces. In fact, the focus on medicine was atthe core of Engel’s plea to think of diseases ‘‘of the body’’ as bio-psycho-social events.

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the modification of child-rearing behaviors of parents of children at risk, includingchildren with emotional/behavioral problems or with parents with psychiatric disor-ders (Johnson, Cohen, Chen, Kazen, & Brooks, 2006).

The traditional fronts of debate in our field, and perhaps even the basic assump-tions of the field and of other fields, are shifting as the reciprocity of biologically de-termined and socially produced variables is being reconsidered. But, as what may infact be an optimistic colophon, perhaps many of the propositions of this article arealready seeping into our field, appearing here and thereFif not yet as main tenets ofour models, at least in the theories of practice or ‘‘theories in action’’ (as Argyris &Schon, 1974, 1978, called them; also Schon, 1983), then as assumptions that de factoguide the daily practices of a growing number of therapists, evolving as our world(view) evolves.

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