CHAPTER 6
POSTMODERN/POSTSTRUCTURALIST
THERAPY
1
MARGARITA TARRAGONA
A new generation of therapies has been developing since the past quarter of the
twentieth century. The proponents of these approaches questioned many of the premises
that historically sustained psychotherapeutic practice, and they offered alternative ways
of conceptualizing and doing therapy. This movement is not represented by a single
school or model, but by the work of many theorists and practitioners who share some
philosophical and epistemological common ground.
These therapies are variously called
and The lack of
one unifying name can be confusing, but each term highlights an important aspect of each
approach: Discursive and conversational suggest that therapy is seen as a conversation
and as a linguistic process. Narrative refers to a strong interest in the way people create
meaning in their lives through stories or narrations of their experience. Social
constructionist emphasizes that knowledge, meaning, and identity are constructed
through interaction with others. Poststructuralist identifies therapists who don’t think of
human difficulties as manifestations of deep or underlying structures. Collaborative
describes the kind of relationship that these therapists hope to establish with their clients
and the process of therapy as a joint endeavor.
In this chapter, I have chosen the word because I believe, like Harlene
Anderson (1997, 2006b), that it offers a broad philosophical umbrella that encompasses
several different but connected schools of thought. The term is also
included because it is the tradition in which the creators of narrative therapy prefer to
locate their work.
This chapter discusses three schools or postmodern/poststructuralist therapies: (1)
solution-focused therapy (SFT), represented by the work of Steve De Shazer and Insoo
Kim Berg; (2) narrative therapy, created by Michael White and David Epston; and (3)
collaborative therapy, developed by Harry Goolishian and Harlene Anderson. This is not
an exhaustive list of postmodern/poststructuralist therapies. Anderson (2003b)
1
To appear in Lebow, J. (Ed.) Hoboken, NJ, John Wiley & Sons
postmodern, narrative, discursive,
conversational, poststructuralist, collaborative, social-constructionist.
postmodern
poststructuralist
21st Century Psychotherapies.
acknowledges the important contributions of Lynn Hoffman, Peggy Penn, and Tom
Andersen to the development of these approaches.
Collaborative therapy, SFT, and narrative therapy each have unique characteristics
and specific ways of working. There are important differences between them, but they’re
frequently grouped together because they share certain basic premises about language,
knowledge, interpersonal relationships, and identity (Anderson,2006, Paré & Tarragona,
2006).
An in-depth discussion of the postmodern critique is beyond the limits of this
chapter. This chapter only describes some of the postmodern ideas that have had the
greatest impact on psychotherapy and how they have been translated into therapeutic
practice. It presents a brief overlook of the basic premises of narrative therapy,
collaborative therapy, and SFT, as well as the main therapeutic practices of each of these
models.
The word is generally used to refer to at least three realms: (1) a
historical era, (2) a movement in the arts, and (3) a critical movement in academia,
particularly in social sciences and philosophy.
The term is used to refer to a cultural epoch or historical period
(Grenz, 1996; Sarup, 1993). It would roughly correspond with a time beginning in the
second half of the twentieth century to present day. Grenz (1996) describes the industrial
age, often identified as the , as a period centered on the production of goods
and symbolized by the factory, whereas postmodernity is characterized by the production
of information and can be represented by the computer.
Postmodernity is characterized by an unprecedented speed and ease in
transportation and communications that leads to an interconnection between places,
people, and cultures. We are exposed to many different descriptions of reality and
different truths, to countless models or possible ways of being. In his book,
Kenneth Gergen says, “New technologies make it possible to sustain relationships—
directly or indirectly—with an ever expanding range of other persons. In many respects
we are reaching what may be viewed as social saturation” (1990,p. 3). Gergen argues that
Postmodernism, Poststructuralism, and
Psychotherapy
postmodern
postmodernity
modern era
The Saturated
Self,
Postmodern Era
these technological developments and the social saturation that they create have a
profound impact on our understanding of the self.
Postmodernism has had an impact in the arts, including postmodern architecture,
theatre, literature, painting, performance, and so on. Discussing postmodern artistic
expressions in detail is beyond the scope of this chapter. Suffice to say that they are often
characterized by deliberate juxtapositions of materials and styles and by an eclectic
aesthetic, in contrast to the univalence and stylistic integrity characteristic on modern art.
Postmodern artists frequently challenge cannons and institutions and blur the line
between high art and popular culture (Grenz, 1996).
as an intellectual movement is the aspect of postmodernity that is
most relevant for this chapter. Harlene Anderson (1997) considers that it’s more
important to think about postmodernism as a critique than as a historical period and
emphasizes that postmodern refers to a philosophical movement that includes the ideas of
many thinkers, like Mihail Bakhtin, Jacques Derrida, Michel Foucault, Jean-Francois
Lyotard, Richard Rorty, and Ludwig Wittgenstein, among others. The postmodern
critique, a movement that began in academe in the 1970s, questioned the nature of
knowledge and or universal explanations. It was especially strong in the
social sciences where it questioned the possibility of being objective observers of reality,
particularly of the reality of human phenomena.
Several authors (Gergen, 1991, Grenz, 1996; Sarup, 1993; Shawver, 2005) suggest
that to understand the postmodern, it is useful to contrast it with the modern, which refers
to a worldview rooted in the Enlightment and prevalent in the Western world during most
of the twentieth century. The industrial revolution brought a different form of production
and one new invention after the other. During the twentieth century, radios, cars,
telephones, television, airplanes, spaceships, and computers were all invented. Medicine
advanced in giant leaps, improving the life expectancy and quality of life of millions in
developed nations. Science and technology were seen as an unlimited source of hope for
the future (Shawver, 2005). The promise of continuous progress is what Gergen (1991 )
describes as the “grand narrative of modernism”: the idea that we are on a journey of
ever-increasing improvement and achievement.
Gergen notes that the “social sciences” were developed in the twentieth century
with the ideal of finding the rules that can explain and predict human behavior.
Psychology was redefined as a science “and its participants adopted the methods, metatheories
and manners of the natural sciences” (1991, p. 30). One implication of this is the
Postmodern Art
Postmodern Critique
Postmodernism
meta-narratives
belief that people, like the world, can be known though observation and examination
because we can also get to know a “true and accessible” self (Gergen, 1991).
In sum, the modern perspective is grounded in a positivist epistemology that
supposes the existence of a reality independent from the observer that we can access
directly and know objectively. The modern ideal is that can be found through the
scientific method. Grenz says, “the modern mind assumes that knowledge is certain,
objective and good” (1996, p. 4). From this perspective, knowledge is seen as a reflection
or a mirror of reality, and language is thought of as representational—its function is to
give us a correct representation of the world (Anderson, 1997).
The term was used as early as the late nineteenth century and
occasionally in the 1930s (Grenz, 1996; Shawver, 2005), but it did not gain force or
acquire its current meaning until the 1970s. Jean Francois Lyotard (1984 ) provided a
popular definition in his book “Simplifying to the extreme, I
define postmodern as incredulity toward meta-narratives.”(p.xxiv) Meta-narratives are
generalized, universal theories or, as Shawver (2005, p. 75) explains, “the central
assumption that a person makes which is never itself questioned.”
According to Grenz (1996), postmodernism “marks the end of a single, universal
worldview. The postmodern ethos resists unified, all-encompassing and universally valid
explanations. It replaces these with a respect for difference and a celebration of the local
and particular at the expense of the universal” (p. 12).
As a philosophical movement, postmodernism has questioned the nature of
knowledge and has pointed out some of the limitations of positivist epistemology in the
study and understanding of human experience. The postmodern perspective is different
from the modern position in many ways. A postmodern view of knowledge proposes that
it is socially constructed through language. It supposes that we cannot have a direct
representation of the world, so we can only know it through our experience of it
(Anderson, 1997, 2006a ). Anderson (2006a ) makes clear in her description of “socially
constructed” knowledge that it refers to the or the that we give
to events and experiences, not to scientific knowledge or knowledge of the physical
world.
One perspective that informs the postmodern view is social constructionism, a
theory that proposes that we are always looking at the world through some kind of lens—
our theories, culture, historical moment, gender, and so on (Hoffman, 1990). Social
constructionists say that we live in a world of symbols, in a social reality that to us seems
natural and objective, but that is built jointly between many people (Truett Anderson,
1990).
Language is a central concept in the postmodern critique. One important idea is
that language constitutes reality. The words we use do not simply reflect or express what
we think or feel, but rather language configures our ideas and the meaning of our
experiences. Hoyt (1998) points out that we know and understand through our language
truth
postmodern
The Postmodern Condition:
social knowledge meaning
systems. Language is more than a means to transmit information because it shapes our
conscience and structures our reality. Harry Goolishian, one of the founders of
collaborative therapy, used to say, “I never know what I mean until I say it” (Anderson,
2005, p. 4).
Harlene Anderson (1997) characterizes postmodern thought this way:
Poststructuralism is a movement in philosophy, particularly in French philosophy.
Belsey defines it as “a theory or group of theories, concerning the relationship between
human beings, the world, and the practice of making and reproducing meanings” (Belsey,
2002, p. 5). Arising from literary theory, poststructuralism proposed that the meaning of a
text is not the text, inherent in what is written, but that meaning emerges or is produced
as the reader interacts with the text (Grenz, 1996; Sarup, 1993). The leading
poststructuralist thinkers are Derrida, Foucault, and Lacan (Sarup, 1993). A central
concept in poststructuralism is a method of closely reading a text that
allows us to see that no meaning is fixed. Grenz (1996) offers this explanation of
deconstruction: “If language really does construct meaning (as opposed to revealing an
objective meaning already present in the world), then the work of the scholar is to take
apart (“deconstruct”) this meaning constructing process” (p. 43).
The relationship between poststructuralism and postmodernism is not clear cut.
For example, Grenz (1996) talks about Foucault and Derrida as postmodern philosophers,
whereas Sarup (1993) mentions them as two leading poststructuralists. Harlene Anderson
(1997) says that even though postmodernism and poststructuralism are often blended,
they come from different intellectual traditions. Grenz (1991) says, “postmodern
philosophers applied the literary theories of the deconstructionists to the world as a
whole” (p. 6).
In the world of therapy, some authors find that is too broad a term
because it is used to refer to the arts, philosophy, and popular culture. Michel White
(2004) prefers to describe narrative therapy as poststructuralist. , as it
relates to psychotherapy, also has to do with questioning structuralist ideas, like the
notion that people’s difficulties are the “surface manifestations” of invisible, deep-seated
structures. Russell and Carey (2004) explain that structuralist concepts in psychology
“led many of us to believe that if we wanted to know ‘the truth’ about a person, we had to
Postmodern thought moves toward knowledge as a discursive practice,
toward a plurality of narratives that are more local, contextual, and fluid;
it moves toward a multiplicity of approaches to the analysis of subjects
such as knowledge, truth, language, history, self, and power. It emphasizes
the relational nature of knowledge and the generative nature of language.
(p. 36)
in
deconstruction,
postmodern
Poststructuralism
Poststructuralism
peel away the ‘layers’ of the self. Structuralism implied that ‘deep down’ somewhere we
could find the ‘inner self’ and therefore ‘the truth’ of the person’s identity”(p. 94).
Postmodern and poststructuralist therapists do not search for deep structures or a true self,
but they are interested in people’s stories as they choose to tell them.
Another aspect of postmodern thought that is relevant to therapy is the emergence
of the text analogy and the narrative metaphor as useful similes for human lives. White
and Epston (1989, pp. 15–16), influenced by the work of Ervin Goffman and Clifford
Geertz, state that we all use or analogies to make sense of our world. These are our
or the analogies we chose determine how we understand events
and the actions we take. If therapists work with analogies drawn from the physical
sciences, they may think of people and their relationships as complex mechanical and
hydraulic machines; their problems may be understood in terms of breakdown or damage,
and the solutions as repairs or corrections. If we draw analogies from biology, we may
see people and social organizations as “quasi-organisms,” understand their problems as
symptoms, and see solutions as cures.
White and Epston (1989) prefer use of a to guide their work as
therapists. From this perspective, problems can be construed as certain kinds of stories
and their solution can be found in the authoring of different, alternative stories.
The emphasizes the importance of stories or narratives in
people’s lives (Anderson, 1997; Bruner, 1990 ; Gergen, 1994; Polkinghorne, 1988; White
& Epston, 1989). Narrative psychology proposes that human beings organize life
experience as stories of events that have temporal sequences, developments, and
outcomes all fraught with meaning (Morgan, 2000).
Life narratives not only describe or reflect our lives, but they constitute them.
According to Bruner (1987 ), we become the narratives that we construct to tell our lives.
For Anderson, narrative is more than a metaphor about storytelling: “it is a reflexive, two
way discursive processes. It constructs our experiences and in turn it is used to
understand our experiences. Language is the vehicle of this process: we use it to
construct, to organize and to attribute meaning to our stories” (1997, p. 213).
Contemporary thinkers like K. Gergen (1994) and R. Rorty (1979) propose that
throughout our lives we are constantly revising our stories and that we modify the
meaning of events and relationships. Our personal narratives are fluid and they take place
in the context of our interpersonal relationships and our linguistic exchanges with other
people.
The self, according to Anderson “is an on-going autobiography; or, to be more
exact, it is a self-other multifaceted biography that we constantly pen and edit” (1997, p.
216).
Text Analogy and Narrative Metaphor
maps
interpretive frameworks,
text analogy
narrative metaphor
History of Postmodernism and
Psychotherapy
The postmodern critique has had a great impact in social sciences, psychology,
and psychotherapy. Some of its implications include (a) questioning of the therapist as an
objective observer of the patient/client, (b) awareness of the cultural or ideological biases
in our theories, (c) examination of the metaphors that guide our work, and (d) questioning
of the self as permanent and integrated. Anderson (2003b) says that postmodernism
invites us to reconsider many of the traditional premises about human nature, problems,
and therapeutic relationships.
Once again, it can be helpful to contrast modern and postmodern perspectives, this
time regarding therapeutic work. Therapists who work in a modern tradition position
themselves as objective observers of clients. Modernist psychotherapies are often
inspired by a medical model, and the therapeutic process is understood as analogous to a
doctor’s treatment of a patient. The therapist is supposed to have an expert knowledge
about human nature or about the clients’ difficulties (Anderson, 1997). This privileged
knowledge frequently translates into a marked hierarchical difference between client and
therapist, given that the therapist “knows more” than the patient, knows what is “really”
happening to the client, and probably has some ideas about how people and relationships
“should be” to be functional or healthy (Anderson, 1997). The starting point of modern
therapies is generally a psychological diagnosis that determines the goals of treatment
and the probable path that therapy will follow. The therapist may know what steps or
stages will be taken in the process and designs interventions or strategies to achieve the
goals of therapy. The therapist is often the one who determines when therapy should end.
In contrast, when therapists’ work is informed by postmodern ideas, it is likely
that they see clients as experts in their own lives and see themselves as experts in certain
kinds of conversational processes. Therapy starts with the definition that the client has of
their dilemma, problem, or situation. The clients define the goals of treatment and can
decide when it should end. Therapists try to reduce the hierarchical distance between
them and their clients and make an effort to be aware of their biases and to be transparent
or public about these. The therapeutic process is not seen as a cure or treatment, but as a
conversation in which meanings and alternatives are co-constructed by the client and the
counselor as they engage in a process of shared inquiry.
I am aware that I am creating an artificial duality or binary by contrasting modern
and postmodern therapies as two clearly distinct categories. This is just for didactic
purposes. There are probably no pure modern or postmodern therapies and many
therapists may see aspects of both perspectives in their work.
Common Characteristics of Postmodern
Therapies
The remainder of the chapter presents an overview of three postmodern therapies:
(1) SFT, (2) narrative therapy, and (3) collaborative therapy. These therapeutic
approaches are different, but they share some basic concepts and a philosophical position
about relationships with clients. Some of their commonalities include the following 11
categories.
Much of the theoretical grounding of these therapies is inspired by ideas that come
from disciplines outside psychology. They are based in the work of philosophers,
anthropologists, historians, linguists, and literary theorists. Among them are Gregory
Bateson, Peter Berger and Thomas Luckman, Clifford Geertz, Victor Turner, Ludwig
Wittgenstein, Hans-Georg Gadamer, Jacques Derrida, Paul Ricoeur, Michel Foucault,
Jean-Francois Lyotard, John Shotter, Walter Truett Anderson, and Richard Rorty. In
psychology, some of the authors whose ideas have been especially important for
postmodern therapies are Kenneth Gergen, L. S. Vigotsky, Jerome Bruner, and William
James, among others.
Collaborative therapy and SFT are identified as social-constructionist (Anderson,
1997; De Jong & Kim Berg, 2002 ). Michael White (2000) says that even though he
appreciates many of social constructionist ideas, he’d rather place narrative therapy in the
poststructuralist tradition. Narrative therapy, SFT, and collaborative therapy coincide in
that our experience of reality or the meaning that we give to our experiences is
constructed through our interactions with other people. The same event may be
experienced differently in different cultural, relational, or linguistic contexts.
Collaborative therapy, narrative therapy, and SFT originally emerged from the
world of family therapy, but they have developed through the years. They are currently
used to work with families, couples, and individuals of different ages who face all sorts
1. Transdisciplinary Inspiration
2. Social or Interpersonal View of Knowledge and
Identity
3. Attention to Context
of difficulties. These approaches can be seen as systemic in the broadest sense of the
word: thinking about people in context, be it the context of their culture, their interactions
with other persons in their close relationships, or the conversational systems in which
they participate.
The proponents of collaborative therapy, SFT, and narrative therapy share an
intense interest in language. Anderson (2006a ) says that language, spoken or unspoken,
is the main vehicle through which we give meaning to our world. These approaches
conceptualize therapy as a conversational process and believe that dialogue and
conversation generate meaning. They propose that the way in which we think and talk
about our problems may contribute to further sinking into them or being able to
contemplate new possibilities.
Practitioners of collaborative therapy, narrative therapy, and SFT see the
therapeutic process as a joint endeavor between clients and therapists. Therapy is not
something that is done somebody but something done someone. Anderson (1997)
stresses the difference between talking someone and talking someone. Clients and
therapist are partners in conversing, building solutions, or developing new stories and
identities.
A recurrent idea in the postmodern critique is that there are many voices or human
realities. Truett Anderson (1990) points out that people may have different opinions not
just about politics or religious beliefs but also about basic issues such as personal
identity. Narrative therapy, collaborative therapy, and SFT consider that a multiplicity of
perspectives or descriptions enhances the therapeutic process. Each one of these
approaches has developed unique ways of incorporating different points of view or voices
into therapy, primarily through the use of questions. Plurality or can also be
achieved by incorporating teams of more than one therapist in the session. This is
exemplified by work with reflecting teams (Andersen, 1990; Fernández, E., London, S.,
& Tarragona, 2002), “as if” teams (Anderson, n.d.), “external witnesses,” and
“definitional ceremonies” (White, 2000). These are formats in which clients get a chance
to hear the reactions of other therapists who have witnessed the therapeutic session either
behind a one-way mirror or in the same room.
4. Language as a Central Concept in Therapy
5. Therapy as a Partnership
6. Valuing Multiplicity of Perspectives or Voices
to with
to with
polyphony
7. Valuing Local Knowledge
8. Client as a Star
9. Being Public or Transparent
A very important aspect of postmodern and poststructuralist propositions has to do
with the questioning of explanations that are meant to be
applicable to all people. The work of the collaborative, narrative, or solution-focused
therapist is not based on (e.g., a personality theory), but is rather
centered on the client’s own ideas and the new ideas that are generated throughout the
therapeutic conversations. Inspired by the concept of discussed by
anthropologists (Geertz, 2000), therapists who work from these perspectives are more
interested in understanding clients’ lives from the clients’ point of view than from the
perspective of some theoretical presupposition. Therapists want to take advantage of
everything clients know about their lives—their problems, stories, possible solutions, and
goals. This leads the therapist to adopt a position of curiosity and promotes a relationship
of respect and collaboration.
Another convergence of collaborative therapy, SFT, and narrative therapy is that
clients are the stars of the therapeutic process. The client is seen as the expert in his or her
own life, and therapeutic work starts from the definition that the client has about his or
her situation. Similarly, it is the client who defines the goal of therapy and when it has
been reached. The therapist tries not to assume the role of an expert. Michael White
(2000) proposes that in narrative therapy the therapist has a “de-centered but influential”
position. Harlene Anderson says that in collaborative therapy, the therapist works from a
“not knowing” position (1997, 2005). Peter De Jong and Insoo Kim Berg (2002) have
also adopted the term to describe the attitude of solution-focused therapists
in their work. Not knowing does not mean that the therapist is ignorant or does not know
anything. Anderson (2005) explains that what it means is that the therapist approaches the
patient with curiosity and willingness to be informed by the client, trying to leave aside
preconceptions and to avoid arriving to conclusions too soon.
Narrative therapy, collaborative therapy, and SFT coincide in that therapists are
not considered objective observers of clients. All people, including therapists, understand
things from a certain perspective—they are standing in a certain place. Therapists must
do everything they can to be free of prejudice in their encounters with clients, but because
it is impossible not to have personal values, opinions, or preferences, the therapist must
be open about these when they are relevant for therapy. In narrative therapy, this is called
(Freedman & Combs, 1996; White, 2000), whereas in collaborative therapy
universalizing discourses,
meta-narratives
local knowledge
not knowing
transparency
it is referred to as about ideas and sharing internal dialogues with the clients
(Anderson, 1997, 2006c).
One feature of postmodern therapies that distinguishes them from traditional
therapies is the emphasis on what is in people’s lives and on what clients
consider important and valuable. Narrative therapists explore the clients’ purposes,
values, dreams, hopes, and commitments as well as the times they have influence over
the problem that troubles them (White, 2004). Therapists practicing SFT emphasize
solution building (De Jong & Kim Berg, 2002) and clients resources (O´Hanlon &
Wiener-Davis, 2003). In collaborative therapy, Harlene Anderson (2006a) says that her
conceptualization of language as fluid and potentially transforming allows her to have a
hopeful attitude in therapy “to appreciate that human beings are resilient, that each person
has contributions and potentials, and that each person values winds and strive toward
healthier successful lives and relationships” (p. 11).
Many postmodern and poststructuralist writers in psychology point out that the
language of psychotherapy has historically been a discourse of deficit and that therapy is
frequently seen as a technology to fix defective persons. These authors have also
expressed their concern for the negative effects that psychopathological diagnoses may
have on people (Anderson, 1997; Gergen,Hoffman & Anderson, 1995 ; Gergen, 1990;
White & Epston, 1989). The concerns about the excessive emphasis on deficit and
pathology in psychology are shared by contemporary researchers and therapists who do
not place themselves in a social constructionist or postmodern tradition (e.g., the
proponents of positive psychology; Peterson & Seligman, 2004; Seligman, 2002;
Seligman & Csikszentmihalyi, 2000). Anderson (2006a) mentions a similarity between
the hopefulness of postmodern therapies and positive psychology as more promising than
deficit-based psychology.
Another idea that has an important place in SFT, narrative therapy, and
collaborative therapy is that of (Anderson, 2003 , 2006a ; De Jong &
Kim Berg, 2002 ; White, 2004; White & Epston, 1989), which refers to being able to
make decisions and take action in your life. White and Epston (White, & Epston, 1989)
often use the metaphor of “being in the driver’s seat of one’s life.”
being public
working well
personal agency
10. Interest in What Works Well
11. Personal Agency
Duration of Therapy
Values That Guide Therapists’ Work
The length of treatment varies in postmodern therapies. They tend to be brief,
especially SFT. Collaborative and narrative therapy can also be short-term, but they’re
very flexible about this. Generally, the client decides when and if they want to see the
therapist again and who it might be useful to include in the next session (a spouse,
another family member, a friend). In some cases, narrative and collaborative therapy may
be long because clients may see the therapist sporadically over years if this is what they
wish.
Harlene Anderson (2003b) believes that collaborative therapy, SFT, and narrative
therapy share certain values including:
Working from a nonpathological perspective and avoiding blame or
classification of individuals or families.
Appreciating and respecting the reality and the individuality of each client.
Working with the narrative metaphor.
Being collaborative in the therapeutic processes.
Being public or transparent about biases and information.
Steven Friedman (1996) provides a good summary of postmodern therapies when
he says:
§
§
§
§
§
§
§
§
§
§
§
The Postmodern therapist:
Believes in a socially constructed reality.
Emphasizes the reflexive nature of the therapeutic relationship in
which client and therapist co-construct meanings through dialogue
and conversation.
Is empathic and respectful of the client’s predicaments and believes
in the capacity of therapeutic conversations to bring forth voices
and stories that have previously been suppressed, ignored or
dismissed.
Minimizes hierarchical distinctions and prefer a more egalitarian
offering of ideas.
Co-constructs the goals and negotiates the direction of therapy,
putting clients in the “driver’s seat” as experts in their own
predicaments and dilemmas.
Looks for and amplifies skills, strengths and resources and avoid
being “pathology detectives” and reifying rigid diagnostic
categories.
§
§
Avoids a vocabulary of deficit and dysfunction and tends to prefer
everyday language.
Is oriented toward the future and optimistic about change. ( pp. 450–
451)
how
We discovered that problems do not happen all the time; even the most
chronic problems have periods or times when the problem does not occur
or is less intense. By studying these times when problems is less severe or
even absent, we discovered that people do many positive things that they
are not fully aware of. By bringing these small successes to their
awareness, and helping them to repeat these successful things they do when
the problem is not there or less severe, their life becomes better and people
become more confident about themselves. (Brief Family Therapy Center,
n.d.).
Even though postmodern/poststructuralist therapies share values and some
theoretical grounding, they can be clearly differentiated in their practices and in
these ideas are implemented. Narrative, collaborative, and solution-focused work each
has its own flavor; their interviewing styles are different, and they focus on different
aspects of the therapeutic process. Each of these approaches is described separately in the
following sections.
Solution-focused therapy was developed by Steve DeShazer based on the work
done by the Mental Research Institute (MRI; Bateson, Watzlawick, Weakland, & Fisch)
group in Palo Alto, California, and the ideas of Milton Erickson toward the end of the
1970s. A common denominator between Bateson, the brief therapy team at MRI, and
Erickson’s contemporary hypnosis is their interest in communication, which DeShazer
shared. Insoo Kim Berg (DeShazer’s wife) is considered to be the cofounder of SFT.
DeShazer and Insoo Kim Berg founded the Brief Family Therapy Center in Milwaukee,
Wisconsin, in 1978 and spent over 30 years working with individuals, couples, and
families facing a broad range of difficulties (De Jong & Kim Berg, 2002).
One important feature of the development of SFT is that it has been an inductive
process of “observing individual interviews and simply paying attention to what was
most useful” (De Jong & Kim Berg, 2002, p. 11). Insoo Kim Berg (De Jong and Kim
Berg, 2002) comments that when they did this, they tried to set aside any preexisting
ideas about the client’s problems. This defocusing on problems became a central aspect
of their work. The team at the Brief Family Therapy Center realized that too much time
was devoted to talking about problems, and there was not enough discussion of was
helpful in terms of solutions. They shared:
Solution-Focused Therapy
De Shazer and Kim Berg realized that there is not necessarily a connection
between a problem and its solution when, in 1982, they worked with a family that listed
27 different problems. Because there were so many problems and they were not clearly
defined, DeShazer and his team could not devise an intervention. They just asked the
family to observe “what was happening in your life that you want to continue to have
happen.” The family returned reporting that things were much better. That began a shift
in therapeutic work from “problem solving” to “solution building” (De Jong & Kim Berg,
2002).
Other practitioners and authors who have developed variants of the solutionfocused
approach include Bill O’Hanlon, who has created possibility therapy (1997,
2003, 2005; O’Hanlon & Bertolino, 1998); Michelle Weiner Davis (1993, 1995, 2003);
Eve Lipchik (2002); Scott Miller, Barry Duncan, and Mark Hubble (Duncan & Miller,
2000; Hubble, Duncan, & Miller, 1999; Miller & Kim Berg, 1995); Jane Peller [AU: Add
dates.] and John Walter (Walter, J.L. & Peller, J.E.,1992, 2000).
Like all postmodern therapies, SFT understands clients’ difficulties as constructed
in language. This does not mean that the work is only about language without involving
action or behavior. De Shazer (1995) works on the assumption that clients’ problems
have to do with behaviors that are based on their worldview. However, the SFT model
places much more importance on the exploration of solutions than of problems.
Establishing the goals of therapy is one of the most important aspects of SFT. It is
crucial that these goals be established by the clients. Therapists have a number of ways to
help clients clarify their goals. These are discussed in detail in the following sections.
There is one general goal in SFT: to build solutions. There are no preestablished
therapeutic objectives defined by the therapist. Each client is different and the therapist
tries to empower him or her to build solutions that fit his or her unique experience and
situation.
There is no assessment in the traditional sense of finding out what is wrong or
arriving at a diagnosis. Psychometric or psychological are not used. There is, however, a
Theory of Psychotherapy in Solution-Focused
Therapy
Goals of Solution-Focused Therapy
Assessment in Solution-Focused Therapy
careful inquiry about what clients would like to see different in their lives and about
exceptions to problems.
There is no special assessment phase. The investigation about what changes clients
want to in their lives begins in the first session and can continue throughout the duration
of therapy.
When the therapist is inquiring about exceptions to the problem, the focus is
generally on the past and the present. When goals are being established, the focus of the
therapist’s questions is on the future. Working from a SFT approach may involve talking
about the history of the problem or not, but it always includes discussing the future or
how the client would like his or her life to be.
Solution-focused interviews can be conducted with individuals, couples, families,
or groups. When the therapist is finding out about exceptions and goals, he or she usually
asks questions about how other important people in the client’s life have noticed or would
notice improvement or change.
From the perspective of SFT, “the mission of the helping professions is to
empower clients to live more productive and satisfying lives” (De Jong & Kim Berg,
2002, p. 9). The notion of empowerment adopted by SFT is based on a
The practitioner is to discover, together with the clients, the personal
strengths and resources that the client may be able to bring to his or her situation. The
therapist supports the client’s solution building by asking them what they would like to
see change in their lives; by listening to the directions in which clients want to go and
inquiring about exceptions to problems (DeJong & Kim Berg, 2002).
Kim Berg has adopted the term coined by Harlene Anderson, to
describe the therapist’s position in SFT. She proposes that there are some skills for not
knowing that include listening, formulating open questions, getting details, echoing
clients’ words, summarizing, paraphrasing, complimenting, affirming clients’
perceptions, normalizing, focusing on the client, noticing hints of possibility, exploring
clients’ meanings, asking relationship questions, and amplifying solution talk (DeJong &
Kim Berg, 2002).
The solution-focused therapist is very actively involved in the conversation, which
is a joint exploration of goals, exceptions, and solutions. Believing that clients are experts
in their own life does not mean that the therapist takes on a passive role. Kim Berg
describes the therapist in SFT as “leading from one step behind,” by practicing the skills
that allow the client to provide information about his or her situation and him- or herself
(DeJong & Kim Berg, 2002).
Process of Solution-Focused Therapy
strengths
perspective.
not knowing,
Self-Disclosure in Solution-Focused Therapy
Therapeutic Relationships in Solution-Focused Therapy
Strategies and Interventions in Solution-Focused Therapy
Self-disclosure is not common in SFT. Insoo Kim Berg says that they “do not
recommend that you tell clients about your own experiences” (De Jong & Kim Berg,
2002, p. 32). The rationale for this is that the best place to look for solutions is in the
client’s experience and ideas. Kim Berg (2002) adds:
She disagrees with the argument that such sharing enhances rapport and believes
that it can impair clients’ ability to find their own solutions.Solution-focused therapy is
usually brief. De Jong and Kim Berg (2002) report the results of a study of SFT in which
77% of clients improved at the end of therapy with an average of just two sessions. In
another study of 275 cases, more than 80% attended less than four sessions and 26% just
went to one session. The mean number of sessions was 2.9.
In SFT, the term is not frequently used, but there is much
written about how to develop productive and respectful relationships with clients. Berg
and De Jong (2002) describe three different kinds of relationships that can develop
between clients and therapists: (1) a relationship in which the client and
the therapist together can identify a problem and a solution scenario to work toward; (2) a
relationship in which
therapist and client can identify a complaint or problem but cannot see a way for the
client to build a solution; or (3) a relationship in which therapist and client
cannot identify either a problem or a solution. De Jong and Berg discuss different ways in
which therapists can respond to these situations.
De Jong and Kim Berg (2002) clearly outline the steps or stages of SFT:
Explaining to the clients how the therapist works.
Describing the problem (emphasizing solutions and expectations).
Finding out and amplifying what the client wants (defining goals).
Exploring exceptions (asking the miracle question; using scales).
Formulating and offering feedback to the client.
Seeing, amplifying, and measuring clients’ progress.
Self disclosure is best understood to mean using your senses, critical
thinking capacities and thoughts as instruments in the solution building
process. It does not mean telling your clients that, for instance, you too
broke curfew as a teenager or you too were sexually abused. (p. 33)
therapeutic alliance
customer-type
complainant-type[AU: Pls. check spelling this is how they spell it]
visitor-type
§
§
§
§
§
§
Describing the problem: Emphasizing Solutions and Exceptions
Finding Out What the Client Wants: Defining Goals
Exploring Exceptions: Asking the Miracle Question
The most important goal of SFT is to build and implement solutions. Solutionfocused
therapists pay much more attention to exploring solutions than to inquiring about
problems. It is important to understand what afflicts the clients in order to better
understand what they want to be different in their life or what change they want to
achieve, but Kim Berg and De Jong (2002) state that in some cases it is possible to begin
therapy speaking directly about solutions, skipping the problem exploration stage. This is
not the norm, but it illustrates how, more than solving problems, SFT is about building
solutions.
When clients and therapist do speak about the problem and it is clearly defined,
they proceed to talking about exceptions to the problem. Exceptions are those occasions
in which the problem is not present or is less frequent or less intense (De Jong and Kim
Berg, 2002). The client is asked to identify these situations and is asked many questions
about everything that is different during these moments: where the client is, with whom,
what he or she is doing and thinking when things are better, even if these occasions are
few or far between.
To do a good job in SFT, it is fundamental to explore where the clients want to
arrive, what they would like to see in their lives instead of the problem that brings them
to therapy. Establishing clear goals is one of the most important aspects of this therapy.
Having a clear goal is very useful, among other things, because it allows us to measure
the progress that the client is making toward it. The goal should be established by the
client, and the therapist may help clarify it. It is especially important that the client
describes not just what he or she would like to stop happening, but what he or she would
like to see of the problem. An important way to help the clients establish goals is
through one of the most well-known tools of SFT: the miracle question.
This question basically invites clients to imagine what would be different if the
problem were solved. Kim Berg and De Jong (2002) emphasize the importance of asking
the miracle question correctly, calmly, and with a certain dose of drama. It should not be
used lightly or frequently, and it is good to prepare the clients for it by saying, for
example, “Do you have a good imagination? Because I’m going to ask you a question
that requires a lot of imagination . . .” or “I’m going to ask a strange question, I know it is
strange, but there are no good or bad answers just use your imagination . . .”
The miracle question is generally asked in this way, speaking calmly:
in place
Suppose that while you are sleeping tonight and the entire house is quiet, a
miracle happens. The miracle is that the problem which brought you here is
solved. However, because you are sleeping, you don’t know that the
miracle has happened. So, when you wake up tomorrow morning, what will
be different that will tell you that a miracle has happened and the problem
which brought you here is solved? (DeJong & Kim Berg, 2002, p. 85)
The therapist can continue asking questions: What is the first thing you would
notice? What else would you notice different? The miracle question is extremely useful
for several reasons: First, often when we have a problem, we don’t see alternatives.
Second, because the miracle question is hypothetical and it is not real, it allows a client to
give themselves the freedom to imagine a scenario free of the problem, without censoring
their ideas. Third, the answer to the miracle question contains the keys or the clues for the
solution of the problem and the goals of therapy. For example, a woman comes to therapy
because she feels apathetic and lacks energy. We ask the miracle question and invite her
to describe what she would notice the next morning that would be an indication that the
miracle has occurred. She answers that she would get out of bed fast. This apparently
trivial behavior could be a clue to part of the solution to the apathy: not staying in bed
and turning off the alarm clock every 10 minutes for 2 hours, but getting up as soon as
the alarm clock rang the first time. From there, we could continue talking about what she
could do to get up with the first ring of the alarm. Maybe she could experiment with
putting the alarm clock away from the bed so she would be forced to get up to turn it off.
Or she might ask a friend who is an early bird to call her when she gets up in the
morning.
It is important to mention that the answer to the miracle question is just the
starting point for conversations. We have to work carefully, asking many more
subsequent questions. Among these, questions about the relational system; for example,
Who would notice that you got up early? How would you know that this person noticed?
Will this person behave differently seeing that you are up?
Scales are other characteristic tools of SFT. These are subjective scales with which
clients can evaluate, among other things, the intensity of the problem; how hopeful they
are about things changing; how confident they feel that they will change; the progress
that has been made since the last session; at what point he or she will feel satisfied and
much more.
The therapist generally draws a vertical line on a piece of paper and writes the
number 1 the bottom and a number 10 at the top. Number 1 may represent the problem at
its maximum level and number 10 can be the absence of the problem. The therapist asks
the client to indicate where the problem is right now on the scale, to rate how it has been
at its worst, and to indicate at what point the client may start to feel that things are better,
or at what level the client would need to see the scale to feel that therapy is working.
Scales can be very useful because they establish a baseline and can become a
frequent point of reference throughout the sessions. For example, a client comes to
therapy because she feels uncomfortable in social situations. In the first session, she
establishes that on a scale of 1 (the worst) to 10 (the best) her social comfort is a 3. We
Exploring Exceptions: Using Scales
can ask what would need to happen so her level would be up to 4 (to think of a small
change). Again, the answer may contain interesting kernels of possible solutions. In the
second session, we ask the client how she would rate her current comfort and she says 4.
This would probably pique our curiosity about what happened that she went from 3 to 4:
Did she do something different? Did circumstances change? What would need to happen
in order for it to stay at level 4? Scales can be used in many different situations and they
can be adapted to for use with children (Kim Berg & Steiner, 2003).
In every session of SFT, the therapist gives the client some carefully formulated
feedback. If there’s a team of colleagues observing the session, the therapist may take a
break and meet with the team and come back later with a message from the team
members. Even if the therapist is working alone, it is common to leave the clients for a
few minutes to think and then give them feedback. Feedback in SFT has three
components: (1) a that recognizes something positive in the client, (2) a
that has to do with the clients goals, and (3) a or that generally has
to do with observing what is different when things are better or with doing more of what
has been working well (De Jong & Kim Berg, 2002).
Sometimes a solution-focused therapist may start a session asking “What has been
better since we last met?” This contributes to creating an expectation of change and to
establishing the tone of the sessions in which there is great interest in understanding and
using what the client is already doing to improve his or her situation and life.
Solution-focused therapy consistently adheres to the steps described above,
independent of the presenting problem. De Jong and Kim Berg (2002) argue that it is not
necessary to understand a problem to find a solution, and they have research data that
“suggest that solution building is consistently successful, regardless of the client’s
problems” (p. 282).
In SFT, there is no particular position on medication. If medications are seen as
part of the solution by the client, the therapist is interested in finding out how they are
helpful.
All postmodern therapies have distanced themselves from a medical analogy of
therapeutic practices. Therefore, the work is not understood as a cure, but as helping
clients access their resources and creativity to build solutions and have their life be closer
to what they would like it to be. The focus on building solutions is the main contributor to
this process.
Formulating and Offering Feedback
compliment
bridge task homework
View of Medication in Solution-Focused Therapy
Curative Factors in Solution-Focused Therapy
Culture and Gender in Solution-Focused Therapy
Adaptation of Solution-Focused Therapy to Specific Problem
Areas
Narrative Therapy
Solution-focused therapy, like all postmodern therapies, is not normative. This
makes it less likely that therapists will impose gender or cultural biases on their clients.
There is not much written about gender and culture in SFT writings.
Solution-focused therapy has been successfully used with children, in schools, in
protective services agencies, with people with drinking problems and other addictions,
with mandated clients, and with people in crisis, among other many others. Recently, the
solution-focused approach has been implemented in individual and group coaching.
(Brief Family Therapy Center, n.d.) and in business and education.
Among the postmodern therapies, SFT is the approach that has produced the most
empirical outcome research. De Jong and Kim Berg (2002) report the results of a study of
275 clients in which they measured intermediate and final outcomes. Their findings about
length of treatment were discussed earlier. The authors conclude that the outcomes of
SFT compare favorably with other approaches: intermediate outcome data showed that
74% of SFT clients who were studied improved between their first and their last session.
Seventy-seven percent reported improvement in their final outcome, whereas the
literature indicates that success rates of other therapies average 66%. De Jong and Kim
Berg (2002) note that these comparable or possibly superior results were achieved with
fewer sessions than other therapies reported in the literature (median number of SFT
sessions was 2, whereas the median number of sessions reported in the psychotherapy
research literature is 6). The authors write that there have been other studies of SFT and
that even if they do not yet establish its efficacy, there is increasing evidence to support
the effectiveness of this approach.
Narrative therapy was created by Michael White, an Australian social worker, and
David Epston, a Canadian born anthropologist living in New Zealand. They met in 1980
and started working together shortly thereafter.
Empirical Support of Solution-Focused Therapy
Looking back on the history of his work, Michael White (Denborough, 2001;
White, 1995) recalls that in the 1970s he was interested in the philosophy of science. In
the early 1980s, he was very interested in the work of Gregory Bateson, especially his
ideas on “restraint of redundancy,” a set of presuppositions that determine how we
respond to the world, which events we single out and give meaning to, and how we
transform events into descriptions that later become stories. White (Denborough, 2001;
White, 1995) says that later in the 1980s, the ideas of Michel Foucault caught his
attention and that was also the time when, with Cheryl White’s encouragement and
interest in feminism, he started to think more about the narrative metaphor. David Epston
(Denborough, 2001) recalls how after a frustrating stint in academics, he worked as an
anthropologist with Aboriginal Welfare and emerged from that experience determined to
make some contribution to people’s life. He went on to study community development
and social work. The anthropological perspective and the focus on community have been
important elements in the development of narrative therapy. Epston (1989) tells how
during the 1980s he “re-imagined” his work, transitioning from a strategic way of
working toward a “text/story” approach, under the influence of Kenneth Gergen, Rom
Harre, and Michael White.
White’s initial therapeutic work was done in a psychiatric hospital and with
families who had children dealing with encopresis, fears, and family troubles (White,
1989). Epston also had much experience working with families who had children and
teenagers with all sorts of difficulties from illness to perfectionism to drugs to school
troubles and night fears (Epston, 1989).
White and Epston (1989) believe that people face difficulties when they live with
“dominant stories” that are “problem saturated.” These dominant stories are restricting;
they do not include important parts of a person’s experience and may lead them to
negative conclusions about their identity. Freedman and Combs (2002) describe the basic
premise of narrative therapy this way:
White and Epston, influenced by the ideas of Michel Foucault, stress the
importance of examining “dominant discourses” and how power is exercised in society.
They propose that cultural discourses and power practices have an impact on the stories
Theory of Psychotherapy in Narrative Therapy
We believe that we all live our lives through stories—the stories we tell and
the stories others tell about us. Those stories carry the meaning of our
lives; they organize the way we experience our relationships, our identities,
and the possibilities our lives hold. We think that people’s experience of the
meaning of their lives and relationships changes through changes in their
life narratives. As their narratives change, what they do and what they
perceive change as well. (p. 38)
that people build about themselves and that it is important to deconstruct them. Morgan
defines in narrative therapy as the “taking apart” or careful revision of the
beliefs and practices in a culture that strengthen the problem and the dominant story
(Morgan, 2000).
Even though several authors talk about narrative therapy as a postmodern therapy,
Michael White locates this approach as poststructuralist. Narrative therapy contrasts with
most personality theories and schools of psychotherapy that are grounded in the
structuralist tradition. Structuralist descriptions of human experience are based on the
notion that there are underlying structures that we cannot see, but whose external or
superficial manifestations we can observe. White (2000) adopts a poststructuralist
position and proposes that in therapy it is not very useful to think in terms of deep versus
superficial. He would rather follow the metaphor suggested by Gilbert Ryle and Clifford
Geertz (Morgan, 2000) who talked about “thick descriptions” and “thin descriptions.” A
story is full of details, connects with other stories, and, above all, comes from the
people for whom this story is relevant. A story generally comes from outside
observers, not from the people who are living it, and it rarely has room for complexity
and the contradictions of lived experience. The thicker a description or story is, the more
possibilities it opens for the people who are living it.
The goals of therapy are defined by the client. Generally speaking, the goals of
narrative therapy are to accompany clients in a process of rewriting their lives, so that a
painful or problematic story does not determine how they define themselves, whereas the
development of other stories brings them closer to their preferred identities.
Narrative therapy is not a normative approach, so there is no assessment of the
client in terms of diagnosis or evaluation. There is, however, a very careful assessment of
the effects of problems on the client’s lives and the ways in which clients can influence
the problems. There is no assessment phase separate from therapy.
White (Denborough, 2001) comments that the narrative metaphor has encouraged
him to pay more attention to the temporal dimension of life. Narratives are constituted by
events that are linked over time. When therapists inquire about problems and later in the
process about they are interested in finding out about the past, present,
and future.
deconstruction
thick
thin
unique outcomes,
Goals of Narrative Therapy
Assessment Procedures in Narrative Therapy
Levels of Self/System
Process of Narrative Therapy
Self-Disclosure
Narrative therapists have a strong interest in community and society at large. One
of the goals of narrative therapy is to connect the client’s life with the lives of others.
Problems are not understood as purely individual matters and part of the conversation is
usually devoted to examining the role that communities, families, and society have in
maintaining or solving a problem. White and Epston, inspired by Foucault, are interested
in understanding the sociocultural system that creates and maintains certain dominant
discourses. In narrative therapy, they explore the effect of these discourses and practices
on the client’s life. For example, when a woman is living with anorexia, a narrative
therapist may explore with her the cultural messages about weight and beauty that she has
received; they would also be interested in the practices that derived from these
discourses, like the self-monitoring involved in weighing herself daily and writing down
the calorie count of every thing she eats. The therapist would then ask the client to
evaluate the effects of these ideas and practices on her life and to determine if she thinks
they have had an effect on her life; and if they have, whether these have they been
positive or negative.
As in all postmodern/poststructuralist therapies, the narrative therapist is very
actively engaged in the conversation with clients. The therapist participates mostly by
asking questions. Epston sees himself as doing research on problems and investigating
the relationships that people have with problems and the knowledge that they develop to
address them (Denborough, 2001). Because this investigation is done in conjunction with
the clients, David Epston describes himself as a coresearcher. He believes that
relationship of coresearchers allows both the client and the therapist to bring together
their purposes.
Michael White describes the position of the therapist in narrative therapy as “decentered
but influential.” It is because it privileges the experiences, concerns,
and agendas of the client (White, 2000); it is because the therapist’s questions
influence how the conversation goes.
Narrative therapists are interested in —situating their comments,
putting them in context, or explaining where they come from (White, 1997).
decentered
influential
transparency
Typical Length of Narrative Therapy
Therapeutic Relationships in Narrative Therapy
Strategies and Interventions in Narrative Therapy
There is no standard duration of therapy. Many narrative therapies are brief, but in
some cases clients can continue to see the therapist over many years (though usually not
at frequent intervals).
The term is not used in the narrative therapy literature, but the kinds of
relationships that narrative therapists aspire to have with their clients are very important
in this approach. Combs and Freedman (2002 [AU: Not in Refs, add there or delete
here.]) share some questions that they ask themselves as they try to cultivate “narratively
informed relationships” in their work:
Narrative therapists do not think in terms of interventions, rather they speak of
practices and therapy as seen as a joint exploration. Narrative therapy has a clear working
style that includes different practices or kinds of conversations between clients and
therapists, including externalizing conversations, identifying , and
thickening the plot by asking and questions.
Other examples, such as working with external witnesses, and the use of therapeutic
documents are detailed in the following sections.
One of the features that distinguishes narrative therapy is the way in which
problems are talked about. Problems are not seen as symptoms or manifestations of some
deficiency on the part of the client. Rather, problems are thought of as something separate
or external to the client that is affecting his or her life. If we say that someone is
depressive, it is a description of the person. If we say that a person is living with
alliance
Am I asking if and how the work is useful and tailoring it in line with
the response?
Whose voice is being privileged in this relationship? What is the
effect of that on the relationship and the work?
Is anyone showing signs of being closed down, not able to fully enter
into the work? If so, what power relation/discourses are
contributing to the closing down?
What are we doing to foster collaboration? Among whom? What is
the effect of this collaboration?
Is this relationship opening up or closing down the experience of
agency? (p. 264)
unique outcomes
landscape of action landscape of identity
,
§
§
§
§
§
Externalizing Conversations
depression, or struggling with depression, the depression is not defining the person.
Freedman and Combs (1996) emphasize that externalization is more important as an
attitude then as a technique. They point out, following Epston (1993), that the now
common view of problems as symptoms has only existed recently in historical terms and
that there are many different ways of thinking about human difficulties.
When therapists and clients talk about problems this way, they have
As people begin to talk about their problems as separate entities, they feel
an almost immediate difference. Clients frequently report that externalizing the problem
helps them put it in perspective, feel less guilty, and think that they can do something
about it.
Externalizing conversations include the following steps: (1) naming the problem,
(2) exploring the effects of the problem on the life of the person, and (3) deconstructing,
or putting the problem in context (Morgan, 2000).
In narrative therapy, the therapist asks the client to describe and name the
problem. It is very important to work with the exact words that the client uses, and we
can invite him or her to share images or metaphors that describe the problem. A boy that
does not want to go to school describes the problem as “nerves.” The therapist may ask
questions about what these “nerves” are like: “Are they big, small, smart, slow, kind,
funny . . . ?” We can ask the child to draw the “nerves,” talking about them as characters
in his life.
After obtaining a description of the problem that the client finds accurate and close
to his experience, the therapist inquires about the history of the problem. This is not done
to find its cause or origin, but to understand it better and to later explore alternative
stories. The therapist finds out, for example, that “the nerves” appeared at the beginning
of the new school year. The therapist proceeds to interview carefully the boy about the
effects of “the nerves” on the different areas of his life: What effect do the nerves have on
your relationship with your mother? (They make the mother worry.) What effect do the
nerves have on the relationship with your dad? (They make the father get angry and
irritable.) Do the nerves have an effect on your relationship with your siblings? (Not
really) Do the nerves have an effect on your relationship with your teacher? (They make
the teachers think that this kid has a lot of problems and it will be hard to teach him
anything in school.)
It is important to “slice thinly” and obtain detailed descriptions of the effects of the
problem so that we can later ask about the effects of the person on the life of the problem.
We can ask the child “Can you tell me about a time when the nerves almost took over but
you were able to stop them?”
externalizing
conversations.
Naming the Problem
Exploring the Effects of the Problem
Deconstructing or Putting the Problem in Context
Narrative therapists also explore the effects that dominant discourses and social
practices have on the life of the clients. If you’re working with a man has been violent
with his wife, one part of the conversation may revolve around social ideas about
masculinity, masculine privilege, and the notion that violence is something natural to men
or something that they cannot control (Jenkins, 1990). The therapist may ask the client if
these ideas have influenced his views on marriage or his relationships with women. The
therapist asks the clients to evaluate the effects of these ideas and practices in his life and
to take a stance about them.
The problem and its effects constitute what White and Epston call the
Once this has been explored in detail, the therapist starts to inquire about times or
events in the client’s life that contradict this dominant story. There are experiences that
could not have been predicted based on the dominant or problem-saturated story. The
therapist listens for evidence of other possible stories about the client’s identity in the
client’s account. White and Epston call these contradictions to the problematic story
. For example, a client says she does not have good self-esteem and that
she feels insecure. She has defined her problem as “insecurity,” and she wants to explore
with the therapist the effects of this on her life. The therapist might ask her to think about
moments or events in which insecurity had not affected her so much or perhaps had been
completely absent from her life, even for a short moment. The client may remember that
when she was in the third grade she organized a volleyball tournament in her school and
it had gone very well. Unique outcomes serve as the foundation to start building one or
several alternative stories. In our example, knowing that the client was able to behave
securely, even if it was many years ago, makes the therapist want to know more about
that because that event may be part of a different plot of this woman’s life. Once unique
outcomes are mentioned, it is very important to explore them carefully, to learn about
their history and particularly about the meaning that these events had to clients when they
occurred, what they meant for other important people in his or her life, and the meaning
that remembering the event has right now.
Narrative therapy is based on the idea that we give meaning to our experiences by
organizing them as stories or narrations. There are certain stories that become dominant
in our lives and if they are very limited, they may exclude important aspects of our
identity. Finding unique outcomes that contradict the dominant story is the first step
toward the construction of alternative stories or plots. Initially it is likely that the
dominant story is very strong or has a lot of weight. The person who feels insecure can
give us many examples of how, when, and where insecurity has affected her life, but she
may just remember one or two occasions when she felt secure and capable. These
occasions may be the basis for a new plot or a different version of this woman’s life, but
Identifying Unique Outcomes
Thickening the Plot
dominant
story.
unique outcomes
initially it may seem a very fragile story and it is necessary to strengthen this alternative
story.
Narrative therapy is described as a process that rewrites the stories that constitute
our identity. White (1995, 2004 [AU: Not in Refs, add there or delete here.]) calls
therapeutic conversations that are developed around two
types of questions: (1) questions about action or behavior and (2) questions about the
meaning of action and behavior. Once a unique outcome has been identified, a therapist
can ask many questions about what the client did to behave that way or to take that step
or how she prepared herself to act in that manner. These are all 1
questions (Russell & Carey, 2004; White & Epston, 1989). For example, a teenager who
habitually skips school reveals that last week he went to class every day. This is a unique
outcome. The therapist asks him what he did to be able to go to school 5 days in a row:
What exactly did you do to get to school? How did you prepare to do this? Did anyone
comment on your attendance? If you continue going to school this week, what do you
think will happen?
It is important to also find out about the meaning of unique outcomes, what White
and Epston (1989) call In our example, some of these type of
questions could be: What do you think it says about you that after so many absences you
decided to go to school? How do you think your teachers are seeing you? Does the
decision to go to class have anything to do with something that’s important for you? Is
going to class connected with your plans for the future?
Morgan (2000) describes four narrative practices that are helpful in strengthening
alternative stories: re-membering conversations, (2) use of therapeutic documents, (3)
accountability, and (4) working with external witnesses. These are discussed in the
following sections.
White (2004 ) has adopted this term originally coined by anthropologist Barbara
Myerhoff. It has to do with membership and with how lives are intertwined. Narrative
therapists use the metaphor that we each have our own “club” of life and that we can
choose the members of this club—the people that contribute to our seeing ourselves in a
certain way and to our being the way we prefer to be. Once unique outcomes have been
identified, the therapist can ask questions about other people in the client’s life who may
know about them, or inquire about anyone else who might be familiar with the client’s
dreams or values. In re-membering conversations, the therapist may interview the client
about a significant person in his or her life. Later the therapist can explore the influence
that the client may have had on the life of this other person. For example, if the boy who
skips class mentions a teacher who used to be kind to him, we could ask him: What did
this teacher do when she was kind to you? Why do you think she treated you that way?
What you think this teacher saw in you? How did she make you know this? What hopes
or wishes do you think this teacher had for you?
re-authoring conversations
landscape of action
landscape of identity.
(1)
Re-membering
Once these questions have been explored, we could also ask him: What impact do
you think you may have had in the life of your teacher? What do you think that the
relationship with you meant to her? The main idea in asking these questions is to
underline how identities constitute the context of interconnected lives and relationships.
White and Epston (1989) used (they still do, I think it should be in present tense) a
great variety of documents in therapy. These authors believe that most of the documents
that are written about clients (e.g., clinic records, psychological reports) contain negative
descriptions based on the language of deficit and pathology. White and Epston think that
these documents may contribute to strengthening the dominant, problem-saturated stories
that have negative effects on people’s identities. They propose that the therapist can offer
a counterbalance to these documents by writing that offer different
descriptions of clients.
In narrative therapy, the therapist can write certificates or diplomas as recognition
of the client’s accomplishments. The therapist can also write letters, verbatim notes of the
session, letters of recommendation, letters of prediction, statements of position, and
invitations, among many other types of documents (Tarragona, 2003; White & Epston,
1989). Generally, therapists write these documents, although sometimes they do it jointly
with clients. Whether they are letters, notes, or certificates, they have a commonality in
that they strengthen the alternative stories that emerge in therapy. There are many
excellent examples of the use of documents in narrative therapy in White and Epston
(1989), Freedman and Combs (1996), and Epston (1989).
Narrative therapy is often described as a political therapy White and Epston
(1989) and other authors like Waldgrave, C., Tamasese, K., Tuhaka, F., & Campbell, W.
(2003) are concerned with the risk that the therapist may impose dominant discourses on
their clients or reproduce within the therapeutic relationship unfair or oppressive
practices. To try to avoid this, they have designed ways of working that promote
accountability, an important concept in narrative therapy. Waldgrave and collaborators
define accountability as “ways of working that seek to give space to the marginalized,
that seek to create the possibility of meaningful, respectful dialogue across power
differentials” (Waldgrave et al., 2003 , p. 101). Their “Just Therapy” team in New
Zealand has developed ways of addressing gender and culture biases in their agency.
They have workers who are members of Maori and Pacific Island cultures, as well as
“ (Caucasian). In the agency, there are sections or caucuses defined by cultural
group that meet separately. The Maori and Pacific Islands groups are self-determining
and the group, even though it is also self-run, is accountable to the other two. If
members of a group with less power feel there is an injustice, they have the right to call
for meetings to have the issue addressed. This is necessary because “although all staff are
committed to develop concepts of equality, unintentional impositions are still likely to
Use of Therapeutic Documents
Accountability
counter-documents
.
Pakeha”
Pakeha
occur because of our cultural histories” (Waldgrave, C., Tamasese, K., Tuhaka, F., &
Campbell, W. ,2003 p. 99). This group has also worked and written about “culturally
appropriate therapy.”
This aspect of narrative therapy has to do with the importance of “telling and
retelling” stories to constitute identity. This work is similar in some ways to reflecting
teams (Andersen, 1990; Fernández et al., 2002; Friedman, 1995), but it has developed in
a different direction than narrative work. It is also inspired by the work of anthropologist
Barbara Myerhoff. White (1997, 2000) proposes that we implement practices that act as
to connect and strengthen client stories. In these definitional
ceremonies, the therapist interviews a client in front of a group of who
can be other therapists, family members, or friends of the client, but they are often people
who have had some experiences that are similar to what the client is going through.
First, the therapist interviews the client while the external witnesses listen silently.
After the interview, the client exchanges places with the team. He or she listens as the
therapist interviews the witnesses or they speak among themselves about what it meant
for them to listen to or witness this session. When they are done, the therapist interviews
the client again, this time about what it was like for him or her to listen to the witnesses.
Michael White (2007 )has designed a in which he describes in detail the steps of
definitional ceremonies in therapy.
The goal of this type of definitional ceremony is to connect people’s lives. Having
witnesses when telling a personal story can make it more meaningful. This is especially
important when talking about alternative stories that a person tries to expand in the
context of other dominant stories that are already well rooted and that have influenced his
or her identity in negative ways.
Narrative therapy is used in the same way for a variety of different problems.
Some therapists have integrated narrative practices with artistic and dramatic expression
in their work with children and adults (Dunne & Rand, 2003; Freeman, Epston, &
Lobovitz, 1997).
Narrative therapy is neither for nor against medication. The staff at the Dulwich
Center expands on this:
Working with External Witnesses
definitional ceremonies
external witnesses
map
Narrative therapy questions pathologising practices. It is associated with
not locating the problem in the person and instead locating the problems in
people’s lives in their broader social context. This does not mean however
that narrative therapy is opposed to the use of anti-psychotic medication in
any general way. In some circumstances medication can contribute
View of Medication in Narrative Therapy
enormously to people’s lives, whereas in other circumstances, it can be
used in ways that are primarily for the purposes of social control. In
circumstances where medication is involved, narrative therapists are
interested in exploring with people a range of questions to assist in
clarifying what is and what is not helpful in relation to the medication.
(n.d., http://www.dulwichcentre.com.au)
We think that people’s experience of the meaning of their lives and
relationships changes through changes in their life narratives. As their
narratives change, what they do and what they perceive change as well. We
facilitate this process by asking questions to highlight unstoried events, to
encourage meaning making around those events, and then to tie the
meaning to actions and contexts. (p. 38)
Curative Factors in Narrative Therapy
Culture and Gender in Narrative Therapy
Adaptation of Narrative Therapy to Specific Problem Areas and
Populations
Narrative therapists do not see their work as a cure. Freedman and Combs (2002
offer their explanation of change in narrative practice:
Narrative therapists have gone to great lengths to examine their possible biases or
prejudices (e.g., sexist, hetero-sexist, Eurocentric, racist, classist). There are many
narrative practices that are designed to promote accountability to clients and colleagues
who may be socially marginalized or live with the oppressing or silencing effects of
dominant cultural discourses. There is an impressive body of work that deals with issues
of culture and gender in narrative therapy. Just a sample would include Waldgrave,
Tamasese, Tuhaka, and Campbell (2003); Jenkins (1990); Denborough (2002); Dulwich
Center Publications (2001); Pease, (1997); and Madigan and Law (1998), among many
others.
Narrative therapy has been used in work with a wide range of people of all ages
who are living with many different difficulties: psychoses, anorexia/bulimia, sexual
abuse, violence in the family, troubles in school, problems with attention or learning,
chronic illness, loss and grief, imprisonment, migration, bullying, marital conflict, temper
tantrums, enuresis and encopresis, fears of monsters, and so on.
Empirical Support for Narrative Therapy
Narrative therapists see their work with clients as a form of research called
. The countless published case studies attest to the usefulness of narrative
therapy. However, there is very little systematic empirical data on the effectiveness of
this approach.
Harlene Anderson has chronicled the history and evolution of collaborative
therapy (Anderson, 2000, 2001, 2006a). This therapeutic approach originated in the
1970s in Galveston, Texas, with an interdisciplinary team led by Harry Goolishian at the
University of Texas Medical Branch. The team worked intensively with adolescents with
psychiatric problems, their families, and other professionals involved in their care. This
approach was called multiple impact therapy (MIT). The team members were concerned
because different family members presented different accounts or realities. They thought
that if a group of professionals saw them all, they could integrate the disparate
information and have a better picture of the problem. Three therapists and a consultant
would meet before seeing the clients to exchange information. Then the team members
met with the patient, the parents, and the relevant others while the consultant moved from
room to room. The therapists and clients met, in different permutations, over 2 or 3 days.
Anderson comments that MIT developed out of clinical experiences and can trace back to
this way of working many of the “threads” of what later became collaborative therapy.
She says they were at the edge of a “paradigmatic shift,” a move from an intrapsychic
view of human behavior to a contextual and interpersonal one that focused on the family.
During this time, the members of the Galveston group were very interested in the
work of the MRI group in Palo Alto, California, particularly on the importance that the
MRI team placed on language and their recommendation that therapists speak the clients’
language (see Chapter 10). Anderson tells how the Galveston team originally wanted to
understand the clients’ language to be able to design better therapeutic strategies, but they
realized that they got so involved in what the clients told them that they sometimes forgot
to plan an intervention. With time, they noticed that the conversation itself had an impact
on the clients. That was the beginning of a way of working that understands therapy as
conversational dialogue. With their focus now on language, Anderson, Goolishian, and
the rest of the Galveston group began to read hermeneutic theorists and philosophers who
challenged strongly held notions of knowledge, language, and reality.
coresearch
Collaborative Therapy
Theory of Psychotherapy in Collaborative Therapy
Harry Goolishian and Harlene Anderson (1988) offered psychotherapists a new
way to think about They proposed that human systems are “language and
meaning generating systems.” are constituted by the people who are
having conversations around a certain concern, or The membership in these
systems may be fluid or changing because it is not necessarily determined by social roles
or family bonds, it depends on who is talking with whom about an issue that’s important
for both parties. A therapist that works with this conception of systems frequently asks
clients if they have talked with other people about their concerns and how the
conversations impacted them.
From this perspective, the distinction between individual, couples, and family
therapy is not very relevant. Rather, it is important to ask the question formulated by Tom
Andersen (1991): “Who should be talking with whom, when, where, and about what?”
The therapist often asks clients who they think should be present in the following session.
If we’re seeing a couple in therapy and they talk a lot about their adolescent children, we
could ask them if they would like to invite them to the next meeting. Sometimes you can
include a friend, a relative, a teacher, or any person that the client considers important in
relationship to his or her situation. The way in which we conceptualize, tell, and discuss a
story has an impact on the possibilities for change or solutions that we may see. “There
are as many observations, descriptions, understandings and explanations of a problem,
including ideas about its cause, location and imagined solution (as well as the therapist’s
role vis a vis the problem), as there are persons communicating with themselves or others
about it” (Anderson, 1997, p. 74). An important aspect of collaborative therapy is to open
a space so that all of these perspectives may be expressed.
In a collaborative approach, difficulties are understood as
or unsuccessful dialogues that lead to a lack of self-agency (Anderson,
1997). The way a situation is talked about, conceptualized, and storied can make a person
think that they can or can’t do anything about it.
The goals of therapy are established by the client. They are usually clarified and
defined through the conversation with the therapist. Goals are not set in stone because
ideas and understandings may transform as therapy moves along. The therapist frequently
asks the client if they are talking about what they want to talk about and if things are
going in the direction they want to go.
On the therapist’s part, there are no preestablished goals for a client and no
particular content that the therapist believes should be addressed. The therapist does have
a goal in terms of process: to foster the development of a dialogical space and to help
systems.
Language systems
relevance.
conversational
breakdowns
Goals of Collaborative Therapy
create conversations in which all the participants feel they belong. What the therapist can
do to achieve this is discussed in the following sections.
None of these postmodern models has an assessment phase that precedes or is
separate from the therapeutic phase; it is part of the therapy process itself. Madsen (1999)
has pointed out that assessment is intervention. Even if the interviewer’s intent is just to
gather information, the conversation that takes place while doing this generates an
experience for the client. It may evoke memories, stir up feelings, or clarify ideas. So
assessment from a postmodern perspective is understood as an integral part of the
therapeutic process.
In collaborative therapy, assessment would take place while the therapist tries to
understand the client’s initial predicament. The client leads the conversation and can
highlight the past, present, or future.
Anderson says that in any conversation there are at least three dialogues going on:
the external one between the participants and the internal dialogues that each participant
has with him- or herself. Collaborative therapists often share their inner dialogue, “make
their invisible thoughts visible” (Anderson, 2006c , p. 50) so that they can share their
ideas, questions, or suggestions and the client has the opportunity to respond to them.
Putting the inner dialogue into words is called and it is a way to keep the
therapeutic dialogue going. The process of collaborative therapy is the process of
conversation and dialogue, the transformation that language and relationships can
generate for the people that engage in them.
There is no typical duration of therapy. The client decides, sometimes in each
session, when and if he or she would like come back. Some clients only go to a one-time
consultation, whereas others may stay for years (though this would be rare).
The term is not commonly used in the language of postmodern therapies,
but the relationship between therapist and clients is very important in all of them. Harlene
Anderson (2006c ) talks about the client and the therapist as being conversational
partners
Assessment in Collaborative Therapy
Process of Collaborative Therapy
Typical Length of Collaborative Therapy
Therapeutic Relationships in Collaborative Therapy
“being public”
alliance
:
The participants become conversational partners who engage in
collaborative relationships and in dialogical conversation with each other.
The notion of with cannot be over emphasized as it describes human beings
encountering and responding with each other as they reciprocally engage
in the social activity and community we call therapy. (p. 45)
local knowledge
Strategies and Interventions in Collaborative Therapy
Collaborative therapy does not have a series of specific techniques with certain
steps to follow. The work of a collaborative therapists does not include designing
strategies or intreventions. Rather, as Harlene Anderson (1997, 2003a, 2003b, 2006a,
2006c) emphasizes, collaborative work has to do more with a philosophy or position in
relation to the people who consult us. This philosophical stance is manifested in an
attitude that it communicates to another that he or she is worth listening to, that we see
him or her as a unique person, and that we do not classify him or her as members of a
certain group or as a certain kind of person. If a therapist believes this, he or she connects
authentically with the other person. Together, they can collaborate and build a
relationship. Another important aspect of collaborative therapy is that it is based on the
assumption that most people value and want to have a successful relationships and a good
life (Anderson, 2003a, 2003b, 2006a)
The collaborative approach is described by Anderson (2003b ) as a group of
interconnected concepts (e.g., conversational partnerships, therapy as research, the client
as an expert, assuming a “not knowing” position, uncertainty, being public as a therapist,
and therapy as part of everyday life) that are detailed in the following sections.
The collaborative therapist and his or her client become conversational partners
who establish a collaborative relationship and participate in dialogical conversations. To
achieve this, it is necessary for the therapist to focus on what the client has to say and to
be constantly listening, learning, and trying to understand the client from his or her
perspective and in his or her language (Anderson, 2003a, 2003b, 2006c).
The collaborative therapist has a strong interest in — what the
client knows about his or her own experience and situation. Together, therapist and client
generate knowledge through a joint investigation in which they explore the familiar and
cocreate the new. The client tells his story and by doing this in the context of coresearch
clarifies, amplifies, and transforms it (Anderson, 2003b ).
Conversational Partnerships
Therapy as Research
Client as an Expert
Assuming a “Not Knowing” Position
Uncertainty
Collaborative therapists consider clients as experts in their own lives. Anderson
(2003b, 2006a, 2006c ) says that the client is the therapist’s teacher. “The therapist
respects, honors, privileges and takes the client’s reality (i.e., words, beliefs and story)
seriously. This includes what story, or parts of it, clients choose to tell and the way they
prefer to tell it—how they choose to express their knowledge” (Anderson, 2006c , p. 46).
The therapist is not an expert on the client and his or her problems, resources, or
solutions. In a collaborative approach, the therapist’s expertise is “in establishing and
fostering an environment and condition that naturally invites collaborative relationships
and generative conversational processes” (Anderson, 2006c , p. 47).
The idea of the client as an expert or teacher is related to one of the most
controversial propositions of narrative therapy—the therapist works from a position of
Anderson (2005) explains that this does not mean that the therapist does not
know anything, that the therapist is a blank screen, or he or she does not offer opinions.
Not knowing, according to Anderson (2005), refers to:
Another aspect of not knowing has to do with uncertainty. We can never know a
priori where a conversation will lead us or where the session might end. This is because
language is generative. When clients and therapist talk together, ideas emerge that
probably neither of the parties had before their conversation. Anderson (2006a) says that
in the light of a postmodern view of language, we cannot think of causality in human
interactions. We cannot predict that if the therapist says or does a certain thing, then the
client will say or do another. One implication of this, for Anderson (n.d.), is that the
therapist approaches each session as a unique situation and this includes what the client
presents and the possible outcome of the therapy.
From a collaborative perspective, the therapist does not provoke a change in the
client, but they are both transformed throughout their interaction.2
Anderson (2006a)
prefers the term over because change in psychotherapeutic
culture often has the connotation of causality: one person changes or somebody goes
from one state to another. Transformation, Anderson says, alludes to the fluid movement
in our lives while it preserves a sense of continuity.
not knowing.
the attitude and belief that the therapist does not have access to privileged
information, can never fully understand another person; and always needs
to learn more about what has been said or not said . . . not-knowing means
the therapist is humble about what she or he knows. (p. 501)
transformation change,
Being Public as a Therapist
Therapy as Everyday Life
Anderson has described how we all constantly have external conversations (with
other people) and internal conversations (with ourselves). To as a therapist
refers to being willing to share our internal conversations instead of maintaining them
veiled or hidden. The therapist shares his or her ideas in order to participate fully in the
conversation, not to guide it or direct it. Putting the therapist’s ideas on the table may also
prevent him or her from being from the conversation because what is not said can
influence the way in which the therapist asks questions or contributes to the conversation
(Anderson, 2006c).
Finally, Anderson emphasizes that we are all parts of many conversational systems
and that therapy is but one of them. The way collaborative therapists talk in therapy is
very similar to the way they talk in everyday life; they use colloquial language not
professional or technical language. In the discussion of narrative therapy and SFT, there
are examples of the questions that are characteristic of each of these models, like
externalizing questions or the miracle question. When we speak about collaborative
therapy, it is very hard to give one example of a single question or a type of question
because, as Anderson explains (1997, n.d.), these are They are
very similar to the ones that take place in everyday conversations, whose answers will
require new questions and invite us to speak about what is familiar or known in different
ways and may open up possibilities. To give an example of collaborative therapy, it
would be necessary to present the transcription of a good part of the session, because
what is important is the dialogical process and how it can clarify ideas and generate
possibilities.
An important idea in postmodern therapies is that there are many perspectives and
different possible meanings for any event in life. These therapies value plurality and
complexity, and therapists frequently look for ways of including different ideas or voices
in their sessions. Collaborative therapists frequently work with reflecting teams in the
style of Tom Andersen (Andersen, 1990; Friedman, S., 1995). Harlene Anderson (n.d.)
has developed a variant of the reflecting team called the “as if team. The team members
listen to a session “as if” they were different people involved in the situation that the
clients are describing. (For example, one team member listens as the client’s mother,
another as the client’s husband, a third one as the client herself. The “cast of characters”
is decided by the client at the beginning of the session). At the end of the interview, the
members of the team share their reactions speaking in first person, as if they were these
people in the client’s story.
be public
conversational questions.
”
A Multiplicity of Perspectives
Adaptation to Specific Presenting Problems
View of Medication
Curative Factors of Collaborative Therapy
Culture and Gender in Collaborative Therapy
In collaborative therapy, each client and each session is viewed as unique. Every
relationship and every conversation is different. What is a constant across different
situations and problems is the therapist’s philosophical stance or position regarding the
clients.
There is no special view on medication in collaborative therapy. It can like any
other part of the clients’ life, something to be talked about if it is relevant for the people
involved in that situation
Anderson (2006a,2003a) states that the two most important factors that promote
transformation in therapy are collaborative relationships and dialogic conversations
Dialogue and relationship go hand in hand because certain conversations generate
certain relationships and vice versa (Anderson, 2006d ).
The collaborative approach is conceptualized around the process of conversations,
not their content, and does not have a preestablished agenda about what issues have to be
talked about in therapy. Culture and gender would be included in the conversation when
they are considered relevant by the participants (clients or therapists) in the context of
that conversation and that relationship. This does not mean that therapists do not see
gender or culture as important issues in life or that they don’t have a position about them,
but that what they know about these matters does not precede or define the conversation
they have with a client. A collaborative therapist tries to avoid seeing people as
representatives of category or kind of person and strives to establish a dialogic and
collaborative conversation with each person in his or her uniqueness and complexity.
There are many examples in the literature of collaborative work with people in
situations where gender and culture can be seen as an important component, including
:
Dialogical conversation is distinguished by shared inquiry. Shared inquiry
is the mutual process in which participants are in a fluid mode and is
characterized by people talking with each other as they seek understanding
and generate meanings; it is an in-there-together, two-way, give-and-take,
back-and-forth exchange. (Anderson, 2006a , p. 15)
any
women who have been battered (Levin, 2006), homeless women (Feinsilver, Murphy, &
Anderson, 2006), and eating disorders (Fernández, Cortés, & Tarragona, 2006), among
others.
Anderson proposes that research about therapy is an integral part of our everyday
work as therapists. With every client, she is interested in learning what is helpful or not,
and she has interviewed many people in different countries about their therapeutic
experiences (Anderson, 1997). She states that most evidence about the effectiveness of
collaborative therapy is anecdotal or mentioned in articles that include accounts of
clients’ experiences. There are also qualitative studies of the experiences of clients and
therapists (Gehart-Brooks & Lyle, 1999). An important quantitative study was conducted
by Jaakko Sekkula in Finland, showing the positive results of a dialogical approach over
a 5-year follow-up with psychiatric patients (Seikkula, J. (2002) ; Seikkula et al., 1995, ).
Anderson (2003b) posits that the history of the development of collaborative therapy, in
practice settings with challenging clients (e.g., chronic psychiatric patients, children’s
protective services, mandates clients on probation, and women’s shelters) also attests to
the effectiveness of the approach.
alegría de vivir
Empirical Support for Collaborative Therapy
Case Illustration: Zest for Life and an
Oriental City
Eduardo came to see me because he felt he had lost his “zest for life.” He
was a man in his mid-40’s who had migrated to Mexico with his wife and
young children about 15 years ago. He said that for the past few months he
had not slept well, felt apathetic and tired, and had digestive problems.
Hearing about the sleeplessness and low energy level, I asked him if he
thought he was depressed. He responded “maybe a little,” but for him what
best described his situation was that he did not feel the (zest
for life) he usually had. I asked him to tell me more about that zest for life
and he said that for many years he had enjoyed going to work every day,
had many friends, and felt happy most of the time. He had semi-retired a
couple of years ago and now did some independent traveling sales. Even
though he enjoyed traveling in the Mexican countryside to make his sales,
he did it alone most of the time and felt isolated. He thought his work was
not challenging for him and he was not satisfied with the amount of money
he was making.
Eduardo also told me that he felt he was facing his parents’ mortality, and
his own, for the first time. His father had passed away and his mother had
recently come to spend a few months with him and his family. Eduardo was
shocked to see how much his mother had aged since he had last seen her;
she seemed very frail and vulnerable. Seeing her this way “brought home”
some of the emotional costs of migration: feeling guilty about not being
there for her, wondering if he would be at her side when she died, feeling a
unspoken resentment from his sister who lived near their parents and
looked after them, and feeling he had missed irreplaceable everyday
moments with his extended family. Realizing that his parent was getting old
made him think that he was “next in line” and he was aging, too.
I asked Eduardo a solution-focused inspired question: “Say you decide to
keep meeting with me, we have several sessions, and at some point you feel
that the therapy has worked for you. When this therapy ends, how will you
be able to tell that it was useful, what would be different?” he immediately
said: “I will have recovered my !” “How would that look?”
I asked. “It is hard to explain, but it would be easy for me to know when it
happened. I would just feel it. I would have enthusiasm to go to work, I
would exercise again in the mornings; I would not think about getting old
all the time, and I would enjoy the present more, especially with my wife
whom I love so much. I would get up in the morning and drive my son to the
bus stop. I have not been doing that because I can´t sleep at night, so I
don´t get up early enough; it used to be our father-son ritual.” I asked him
if we had a zest-o-meter that went from 1 (very little or no zest for life) to
10 (a tremendous zest for life), where would he place his zest right now?
He said it was currently about 4 and he would feel happy if he could bring
it up to 8.
After hearing his general description of the situation, I said that I
understood there were several things going on: lack of sleep, low energy,
digestive problems, not finding much satisfaction in his current work, his
parents´ old age, thinking about his own aging, and an examination of what
migration meant for him and his family. It seemed that these were all very
important to him. I asked him where he thought would be the best place to
start the therapy: What was most urgent or in what area did he think it
might be easier to get things moving? Without hesitating, he said:
“Sleeping! I need to sleep more.” I said I thought that might be a good
place to start, too, because I had just read a research study that found that
sleeplessness cannot only be a sign of depression, but it can actually
trigger depression. I wanted to know more about what was keeping him
from sleeping. He quickly identified two factors: the most important one
was that he lived right next door to a club that was open all night and
alegría de vivir
blasted music full volume until dawn every day. We talked about what he
had tried to do about this, from wearing earplugs to sleeping in a different
room, to sealing the windows with tape. The music was too loud to muffle.
Even his dog was going crazy, he said. He had spoken with the managers of
the establishment to try to get them to turn the music down to no avail. The
neighbors had written countless letters to the city government, never
getting a response. He and his wife had considered moving but could not
afford it. He also said they were very attached to this home because he and
his wife had practically rebuilt it by hand and they had worked on it for
years.
The other factor Eduardo identified as an obstacle to sleeping was that he
had heartburn every night. I asked whether he had seen a doctor about this.
He said he had had this problem for years, but it was now exacerbated. I
told him I thought it would be important to have it checked because
heartburn can sometimes be a sign of more serious health issues (ulcers or
even heart attacks). I also asked if he had considered seeing a psychiatrist
who might prescribe a medication to help him sleep and offered to give him
the name of one that specializes in sleep disorders. Eduardo told me that he
did not like to take medications and that his main health care provider was
an alternative care practitioner who used Chinese herbal remedies. He said
he would see him first and if he found no relief in a few weeks, he would try
the psychiatrist. That was the plan at the end of the first session.
By our next meeting, he had already seen his complementary medicine
doctor who gave him a remedy that helped his heartburn somewhat. What
would really help him sleep happened about 3 weeks later: Unexpectedly,
the city government closed the bar next-door. This may seem superficial,
but it had a huge impact on his well-being. Eduardo immediately started to
sleep better and shortly after that, because he was beginning to feel more
rested, he took up exercising in the mornings again. This greatly improved
his mood. We talked about studies that show that aerobic exercise several
times a week has effects comparable to medication for mild and moderate
depression. Eduardo had always liked to exercise and told me how he had
designed and built his own home gym equipment made of household items
(like cans) and junk yard metal pieces.
There is a cartoon by Sidney]Harris in which a scientist is writing a very
complex formula on the blackboard. After many mathematical operations
and variables he writes, “Then a miracle occurs” and his colleague says,
“I think you shpuld be more explicit here in step two.” I thought of this with
Eduardo because a totally circumstantial factor like the end of the noise at
night was almost miraculous for him and triggered a series of positive
changes in his life. What happened also reminded me of the research
findings that show that the greatest portion of change in therapy is
accounted for by extra-therapeutic factors (Hubble et al., 1999).
In one of our sessions, Eduardo told me about his work in more detail. He
liked the fact that he was his own boss, but other than that he felt isolated
and bored. He did not feel he had any challenges in what he did. He said
the business was simple and “ran itself.” He spoke of his previous job with
nostalgia. It was a much more interesting, and he had very good
relationships with his coworkers, many of whom had become his friends.
He had had an active social life with them. He said he was now realizing
that when he stopped working there he had lost more than a job, he had lost
his social network, too.
Because Eduardo often spoke of his wish to regain his zest for life and how
little satisfaction he found in his current work, it made me think of an
exercise developed by career counselor Kate Wendleton (1999). It is called
the Seven Stories exercise and even though it is usually used for career
counseling, I thought it might be interesting to try it in therapy to explore
with Eduardo what had previously brought him joy in his life. For the
Seven Stories exercise, the person has to write a list of 21 experiences that
have brought him or her great satisfaction, regardless of what other people
thought. These can be recent or go back all the way to childhood, but they
have to be specific instances (e.g., just writing “sports” would be too
vague, but “playing defense in the final of the soccer tournament when I
was in 11th grade” would be a good entry for the list). The person then has
to choose 7 items out of the 21 items of the list, describe them in detail and
see what skills and abilities were manifested on those occasions. I asked
Eduardo if he would like to try the first part of the exercise. He agreed to
compile a list of 21 experiences that had brought him great satisfaction or
joy in his life and bring them to our next session.
When we met again, Eduardo pulled his list from his pocket as soon as he
sat down. I thought we would go through the 21 entries, and then choose
and discuss seven stories in more detail. We hardly got beyond the first
story. He had so much to say and it was so fascinating to me that we spent
almost an hour talking about it.
As the first item in his list, Eduardo had written, “building my Oriental
city.” That sounded intriguing. I asked him what that was and he told me
that when he was a little boy, he lived with his family in a small town that
had a tile factory where his father worked. They did not have much money
to buy toys, but he had fun collecting little pieces of tile that he found on the
ground near the factory and building things with them. When he was about
9 or 10, he decided he wanted to build an Oriental city, with pagodas,
temples, and modern buildings. He had never been to such a place, but had
seen some pictures in movies and in a book. Every day after school, he
would work on his city. “I would build and build and almost every night my
mother would call me for supper and I could not believe the afternoon had
already passed, I would lose track of time whenever I was working on my
project.” He devoted months to his miniature city. It grew and children
from the town would come to see it; later his parents let him take over the
living room in their home so the city of tiles could fit. Even adults would
come by to admire his creation.
This story piqued my curiosity, and I asked him many questions: How did
you fine the tiles? How did you decide how to use them? Who helped you?
What do you think the Oriental city said about you? What skills and
qualities do you think it reflected? “Creativity, ability to build things,
ingenuity, imagination,” he said. When asked how he felt about his work
and himself when he built it? He answered that he felt smart because his
sister always had better grades than him and he was not a very good
student, but this was something unique that he did very well. What did he
think the other kids thought about what he did? They thought it was “neat.”
What about his parent and other adults? His parents must have been
pleased[AU: Okay?ok], he thought, or maybe they felt proud because they
let him use valuable space in their small house to showcase his project. He
thought his father may have felt particularly good about it because he was
a very creative man. Some of these questions were “conversational
questions” to clarify and understand better what Eduardo was telling me
and others were narrative-inspired “landscape of action” questions and
“landscape of identity” questions that inquire about behaviors and events
as well as the meaning that these have for the person and for important
people in his or her life.
When I heard Eduardo’s account of spending whole afternoons building his
city and “losing track of time” until his mother called the family to dinner
every night, I could not help but think of the concept of “flow” used by
Mihaly Csikszentmihalyi (1997) to describe people’s optimal experiences. I
shared this thought with Eduardo and asked him if he would be interested
in hearing more about flow. He said he was, on a piece of paper I drew a
graph in which the horizontal axis represented skill level and the vertical
one, the degree of challenge of an activity. Csikszentmihalyi’s research has
found that flow experiences happen when people can use their skills in
activities that are challenging. If the challenge is too low for their skill
level, they feel bored; if it is too high for their abilities, people may feel
anxious or frustrated. Flow experiences often happen when we are totally
concentrated on a task that has clear goals and provides us with immediate
feedback. Research shows that having these kinds of experiences often,
living what Seligman calls an “involved life” (2002), can significantly
contribute to happiness. Eduardo seemed very interested and I happened to
have a copy of the book in my office, so I offered to loan it to
him and he took it home.
The following week Eduardo was very animated. He immediately started to
talk about Csikszentmihalyi’s book and how much he liked it. He said he
had finished it almost in one sitting and had already recommended it to a
friend. Eduardo said that the book had helped him realized he used to have
many flow experiences in the past, doing activities he no longer did. For
years, he and his best friend would get very old cars almost for free and fix
them up to sell them. It was really fun for Eduardo to figure out how to
repair them, to decide how to reupholster them, to paint them, accesorize
them, and so on. He said he was rarely having flow experiences in his life
nowadays and he wanted to have more. We talked about how he might
foster them if he could make boring tasks more challenging or develop new
skills. He said he might call his friend again to see if they could go look for
an old car to redo. He also wondered if he might be able to fix some of the
products he sold and offer repair services to his clients.
Eduardo mentioned that he had gone over his list of 21 examples of
satisfying experiences and realized that there was a pattern to them: Many
of the events that had made him feel very good had to do with building,
inventing, and repairing things. As a teenager, he would collect seemingly
useless bicycles and make them work again; he practically rebuilt the
house where he and his family lived now, and of course, his Oriental city
was the most vivid example of his love of building and his imagination.
Eduardo seemed sad when he reflected on how he would build many things
with his hands as a child, but then had stopped doing this when he was a
teenager and went to college. He was silent for a minute and then said that
he had not thought about it this way, but he might say he had built
something while he was at the university, too: a student group to help
underprivileged people. This was the beginning of a conversation about
what he defined as a commitment to social justice. We talked about the
story of this commitment, and he told me about how he could trace it back
to his grandparents, his parents, and the cultural atmosphere of the
university he had attended in his country. He said he realized that his
desire to work for social justice had been a very important part of his life,
but that when he had arrived in Mexico he had abandoned it. There were
two reasons for this. First, that he had to start from scratch and build a life
Finding Flow
for his family. He had no energy to focus on anyone else; there were
enough needs to be met right at home. Second, he felt that, as a foreigner, it
would not be right to do anything political, and he did not know any people
or organizations that worked with community development. Eduardo
thought that it might be time to start looking for ways to do some sort of
volunteer work.
Another issue that came up in our conversations was Eduardo’s sense of
isolation. He said that he and his car-repair friend had gotten too busy to
continue with their hobby and, as a result, they stopped seeing each other
regularly. We wondered whether they could start getting together again,
either to fix up something or just for coffee. Eduardo said he had not
realized how lonely he felt in his current work as a traveling salesman until
he spoke about it, and that he would like to have more contact with his
friends, most of whom were coworkers from his previous job. He realized
that his previous work and his car-repair hobby had “automatically”
provided him with a social network and that if he wanted to have one now,
he would need to actively pursue it. This was something he had never had
to do before. A couple of weeks later, he called a new acquaintance and
organized a barbeque with their two families in his home.
Eduardo was very happily married. He often referred to his wife in our
conversations and I was moved by how lovingly he talked about her. He felt
very lucky to have her and proud of how they had faced so many difficulties
together and had been able to build a new life for their family in Mexico. I
asked him if he would like to invite his wife to join us for some of the
sessions. He thought it would be a good idea, but her work schedule and
the times of our meetings were hard to coordinate. Still, Eduardo would
often comment that he had spoken with Rosa about things we had talked
about in our sessions. I asked him about those conversations with her and
she seemed very present even though she was not in the room with us.
After about 10 sessions, Eduardo said he was feeling much better. He could
sleep; he was exercising again; he was inviting his wife to go along on his
business travels more often; he was getting together with one of his old
friends and was keeping in touch with his sister and mother back home
more regularly. He felt that little by little, his zest for life was coming back,
that it was reaching 7 on the scale. We decided we could stop our sessions
for the time being, leaving the door open if he ever wanted to come back.
Building things, sleeping, being a father, being a son, having flow
experiences, migration, old cars, friendships, aging, mortality, work, noisy
neighbors, nostalgia—these were some of the threads of our conversations.
I cannot identify defining moments or specific interventions that brought
about change. For me, the work with Eduardo illustrates how conversation
and language can be transformational. I believe that our conversations
helped him articulate his ideas and feelings and reflect on them. He was
able to see things from different angles and to identify what was important
for him and what he did well. He imagined different possibilities and
started taking steps in the direction he wanted to go.
Harlene Anderson (2006c ,p.57)says that the main question in postmodern
therapies is “How can professionals invite the kinds of relationships and
conversations with their clients that allow all participants to access their
creativities and develop possibilities where none seemed to exist before?” I
think that Eduardo and I were able to develop such a relationship and have
those kinds of conversations. By taking a collaborative stance, I contributed
to creating a space for dialogue. Eduardo did his part by openly sharing
what he was going through and being very motivated to recover his zest for
life. I felt very comfortable with him and was able to share my inner
dialogues and bring my ideas to the conversation, trying to convey that he
could take them up or not, depending on whether they seemed relevant to
him. For example, I knew about Wendleton´s Seven Stories exercise and
thought that a list of stories about what had brought him satisfaction and
joy might be a good springboard to find out more about his “alegría de
vivir.” I told him what I was thinking and he agreed to explore this
together. The idea emerged from our conversation; I had not planned it
before and had never used the exercise with a client. Similarly, I have a
long-standing interest in Positive Psychology, but I had not thought of
bringing it into the conversation until he started to talk about losing track
of time when he was building his tile city. His description of his childhood
experiences was what made me think about research on flow and made me
want to tell him about it.
I think that Eduardo was able to access his creativity by remembering and
reconnecting with many experiences in his life in which he had built,
designed, and repaired things and times when he had come up with original
solutions to problems. He was also creative in the present, thinking about
ways to make his travels less boring, imagining possible ways to make his
work more challenging, and planning things he could do to rebuild
connections with important people in his life.
One of the most exciting things about therapy is the uniqueness and
unpredictability of each process, the wonder of embarking on a joint
exploration with our clients. In postmodern therapies,, you never know
where a conversation may lead. Neither Eduardo nor I could have
predicted the first time we met that the road to recover his zest for life
would go through an Oriental city.
landscape of action landscape of meaning identity
[Footnotes]
1
The terms and or were borrowed by White and Epston from
Jerome Bruner.
2
Even if the most important transformations in therapy are the clients’, both Harlene Anderson and Michael White
note that our conversations with people who consult with us also transport and transform us as therapists.
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New York: Basic Books. A “classic.” The basic text to understand the impact of postmodern
though on the field of psychotherapy. It is rich with theory and articulates the philosophical
position that characterizes collaborative therapy. The chapters on what clients accounts ofwhat
has been helpful and unhelpful for them in therapy, should be required reading for all therapists.
Anderson, H., & Gehart, D. (Eds.). (2006).
New York: Routledge. Anderson offers a clear and succinct theoretical
framework on postmodernism, followed by examples of the work of over 30 collaborative
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Annotated References
Conversation, language, and possibilities: A postmodern approach to therapy.
Collaborative therapy: Relationships and conversations that
make a difference.
Interviewing for solutions
learning exercises and case examples that teach the reader how to actually do Solution Focused
work.
Freedman, J., & Combs, G. (1996). New
York: Norton. A thorough overview of Narrative Therapy. It presents complex concepts and
innovative ideas in a clear, straight-forward way. Full of examples and written in a warm and
personal tone. The authors’ passion about their work is evident in every page and it is contagious
for the reader.
White, M. (2007). New York: Norton. The result of Michael White´s years
of work to systematize the “how´s” of narrative practices and to further elaborate their theoretical
underpinnings.
White, M. & Epston, D. (1989). Adelaide, Australia: Dulwich
Centre. The book that put White and Epston on the map in the therapeutic world. Even though
their ideas have evolved over the years, the book still offers a very good introduction to the
narrative metaphor in therapy and many case examples, particularly of the use of documents in
therapy.
Anderson, H., & Gehart, D. (Eds.). (2006).
New York: Routledge. A collection of practice oriented papers that illustrate
how collaborative therapy is used in a variety of settings, with different populations and across
different cultures.
Epston, D. (1989). Adelaide, Australia: Dulwich Centre. A collection of very moving
and enjoyable stories about of David Epston´s work with many different clients.
Freedman, J., & Combs, G. (2002). Adelaide,
Australia: Dulwich Centre. Contains accounts of narrative therapy with couples, individual
adults and children that clearly illustrate this approach.
Kim Berg, I., & Steiner, T. (2003). New York: Norton. A book that offers
very clear guidelines for doing Solution Focused Therapy with children. Full of touching and fun
examples, it demonstrates the usefulness of a solution building perspective with young clients.
White, M. (1989). Adelaide, Australia: Dulwich Centre. A sample of Michael White´s
early work, with many accounts of his work with clients of all ages who face many different
kinds of difficulties, from encopresis, to fears, bickering and isolated lifestyles.
Narrative therapy: Social construction of preferred realities.
Maps of narrative practice.
Literate means to therapeutic ends.
Collaborative therapy: Relationships and conversations that
make a difference.
Collected papers.
Narrative therapy with couples . . . and a whole lot more!
Children’s solution work.
Selected papers.
Key References for Case Studies
Web and Training Resources
Web Sites
Postmodern and Collaborative Therapies
Narrative Therapy
http://ww.harlene.org
Harlene Anderson’s web site with many articles on postmodern and
collaborative therapy.
http://www.talkhgi.com
Web site of the Houston Galveston Institute, where the collaborative approach
was developed and one of the most important training centers for Collaborative
Therapy in the world.
http://www.california.com/~rathbone/pmth.htm
Web site on postmodern therapies hosted by Dr. Lois Shawver. Contains many
interesting discussions about postmodern thought and therapy in the archives of
the postings of the Postmodern Therapies Listserve.
http://www.grupocamposeliseos.com
Web site on postmodern therapies in Spanish. Home of Grupo Campos Elíseos,
a training center for postmodern therapies in Mexico City.
http://www.dulwichcentre.com.au
Home of the Dulwich Centre in Adelaide, South Australia, where Michael
White works. Many articles and resources on Narrative Therapy as well as an
international directory of narrative therapists.
http://www.eftc.org
The Evanston Family Therapy Center. Jill Freedman and Gene Comb founded
this institute, which is one of the main training centers for Narrative Therapy in
North America.
http://www.planet-therapy.com
A narratively informed web site with resources for the general public and on
line training programs for therapists.
http://www.narrativeapproaches.com
David Epston’s web site. Articles, resources and information about training
opportunities in Narrative Therapy.
Solution-Focused Therapy
http://www.brief-therapy.org
Home of the Brief Family Therapy Center in Milwaukee, WI, founded by Steve
de Shazer and Insoo Kim Berg, creators of SFT. Many articles and workshop
materials and interviews, plus books, audiotapes and videos for sale.
http://www.brieftherapy.org.uk
Web site of the largest training organization for solution centered approaches in
Europe.