Article was found at the Harlene Anderson, PhD
website. Introduction Family therapy as we know it today
can be traced back to two main roots. One perspective—the etiology, insight, and
family patterns view of Nathan Ackerman—focused on the individual in the family
and viewed families as a collection of individuals. Coming from within the child
guidance movement and drawing from psychodynamic and social theories, Ackerman
was interested in family role relationships and their influence on the intrapsychic development and make-up of the individual
(Ackerman, 1958, 1966). The other perspective, the rhetorical communication and
interactional view, grew from the early works of
Donald Jackson and Gregory Bateson and their later
collaborative efforts with interdisciplinary colleagues at the Mental Research
Institute in California (Watzlawick & Weakland, 1977).
They reached out to the social sciences and the natural sciences to understand
families, early on developing a theory of communication and later focusing on
the role of language in the construction of reality. They conceptualized
families as cybernetic systems of interconnected individuals and questioned the
concept of psychological problems as illness. They viewed psychosis, for
instance, as an interpersonal relational problem rather than as an intrapsychic problem or a disease of the mind
(Bateson, 1972; Watzlawick & Weakland, 1977;
Watzlawick, Beaven, &
Jackson, 1967). [ETS1] The current therapies primarily based
in postmodern and social construction philosophies that have evolved over the
last twenty plus years represent a hybrid-like ideological shift that can be
traced back to the California rootstock and to developments in
philosophy and the social sciences.
Postmodern social construction premises influence a dialogical and relational perspective on understanding human behavior, including the dilemmas of everyday life and a therapist’s stance regarding these. Although there are significant variations among the postmodern social construction therapies, generally speaking, some common basic premises (although with slight variations and differences in emphasis) include:
Common ValuesTherapies based on these premises share common values (with slight variations and emphasis):
More so than others, the postmodern/social construction therapies have captured practitioners’ interest in learning about the effectiveness of their therapy in their everyday settings (Andersen, 1997a; Anderson, 1997b). [ETS5] This interest has created a number of studies that provide in-depth first-person descriptions of the lived experience of therapy processes and the nuances of its effectiveness, or lack of, from both therapists and clients’ perspectives. What is learned from the “insiders” can have relevancy to both current and future practices and yields a more thorough story of the nuances of therapy than can be captured in “outsider” qualitative research. Together these efforts join other family therapy approaches at the forefront of promoting multiple alternative research methodologies, particularly those categorized as qualitative such as single case studies, ethnographic interviews and narrative accounts (see Addison, Sandberg, Corby, Robila & Platt, 2002). [ETS6]
Comparing and contrasting can be helpful in learning. A reader, therefore, might want to do this as they read along. In doing so they might note these distinctions among the three approaches regarding power, client-therapist relationships, the therapist’s role, and the process of therapy.
Collaborative TherapyHistory and Background: A SearchThe Collaborative Approach evolved from the twenty-year mutual work of Harlene Anderson and Harry Goolishian and their colleagues and students, beginning in the early 1970s within the context of a medical school and later in what is now the Houston Galveston Institute. Its roots can be traced back to Goolishian’s participation in the early Multiple Impact Therapy (MIT) family therapy research project at the medical school (McGregor, Ritchie, Serrano, Schuster, McDanald & Goolishian, 1964). Quite innovative at the time, the theory used to describe and understand the MIT practice was limited by the psychodynamic, psychoanalytic, and developmental theories available at that time. Soon deciding that these theories could not provide adequate descriptions of their clients and their experiences of therapy, Goolishian and his colleagues began what became a continuous search for new theoretical tools. Now, the stage was set for the important reflexive process of the interaction of practice and theory. That is, new practices led to new theories that influenced the practices, which in turn began to require new theories, and so forth. This early interest was influenced by the voices of clients and therapists–their experiences, descriptions, and understandings of successful and unsuccessful therapy— and has remained an important thread throughout the development of the Collaborative Approach. Major Theoretical Constructs: Human Systems as Linguistic SystemsAs Anderson and Goolishian and their colleagues searched for new
descriptions and understandings, they went down a meandering path to revolutions
in the social, natural, and physical sciences, philosophy, and eventually to the
postmodern philosophical movement and the works of
Etiology of Clinical ProblemsA Collaborative therapist takes the
position that there is no such thing as an objective problem. Problems are a
form of co-evolved meaning that exists in ongoing communication among others and
self. Through our interpretations we attribute meaning to others, events,
actions, and ourselves. Problems cannot be separated from an observer’s
conceptualizations.
AssessmentTraditional notions of diagnosis and assessment are based on the idea of objective reality, commonality across problems, and linear cause and effect. Inherent in the notion of assessment is a determination of what is: A problem can be defined, its cause can be located, and it can be solved. From a collaborative perspective each observation, problem description, and understanding is unique to the people involved and their context. Problems are collaboratively explored and defined through conversation. Because conversation or dialogue is generative, a problem is never fixed; it shifts as its definitions, meanings, and shapes change over time through conversation. Clinical Change Mechanisms and Curative Factors: Collaborative Relationships and Dialogical ConversationsTherapy is a process or activity that involves collaborative relationships and dialogical conversations. It is a process of coexploring, clarifying, and expanding the familiar; therapy invites and forms the “unsaid:” the newness. Although newness in some form or another—stories, self-identities, etc—can be the result, the emphasis of therapy is on this process, not on content or product. Collaborative therapists strive to be aware of this essentialist trap. 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
(
Specific Interventions: A Philosophical StanceLike most other postmodern/social construction oriented therapies, Collaborative Therapy does not consider the therapist’s position or actions as techniques. Anderson and Goolishian (1988) distinguished their work as a philosophy of therapy rather than a theory or model. For them, philosophy involves questions and ongoing analysis about ordinary human life such as self-identity, relationships, mind, and knowledge. Their conceptualizations of knowledge and language inform a worldview or philosophical stance-a way of being in the world that does not separate professional and personal. The stance characterizes a way of thinking about, experiencing, being in relationship with, talking with, acting with, and responding with the people therapists meet in therapy. Several interrelated characteristics partly define the stance.
Client as
Expert. The collaborative therapist believes that the client is the
expert on his or her life and as such is the
therapist’s teacher (Anderson, 1997b; Anderson &Goolishian, 1992)
Mutual Transformation. The therapist is not an expert agent of change; that is, a therapist does not change another person. Rather the therapist’s expertise is in creating a space and facilitating a process for dialogical conversations and collaborative relationships. When involved in this kind of process, both client and therapist are shaped and reshaped—transformed--as they work together.Uncertainty. Being a collaborative therapist invites and entails uncertainty. When a therapist accompanies a client on a journey and walks alongside them, the newness (e.g. solutions, resolutions, and outcomes) develops from within the local conversation, is mutually created, and is uniquely tailored to the person or persons involved. How transformation occurs and what it looks like will vary from client to client, from therapist to therapist, and from situation to situation. Put simply, there is no way to know for sure the direction in which the story will unfold or the outcome of therapy when involved in a generative process of dialogical conversation and collaborative relationship.
Effectiveness of Approach: Who Decides?Collaborative
Therapy contrasts with therapy approaches in which professional knowledge
externally defines problems, solutions, outcomes, and success--creating
expert-nonexpert dichotomies. Collaborative therapists
believe that one must ask the client to determine whether therapy was useful,
and if so how. Although therapists' experiences and opinions are valued, every
effort is made to privilege clients' perceptions and evaluations of therapy and
to pay attention to what therapists can learn from them. Research, so to speak,
becomes part of everyday practice, with therapists and clients as co-researchers
during the process of therapy, as well as at its conclusion (Andersen, 1997; Anderson, 1997a). Findings are used during the
therapy process to make therapy more useful to the client and, of course,
influence the further evolution of ideas and practices (see
Andersen, 1997[ETS14] ).
Social workers Michael White at the Dulwich Centre in Adelaid, Australia and David Epston in Auckland, New Zealand became interested in each other’s work in the early 1980s. Combining Epston’s background in anthropology and his interest in storytelling and White’s interest in interpretive methods inspired by the writings of Gregory Bateson, they created what became known as narrative therapy (White & Epston, 1990; Epston & White, 1992[ETS20] ). Several factors affected the development of narrative therapy. Contextually, it is not surprising that narrative therapy emerged in these geographic and cultural contexts during a period when social and governmental attention and commitment in both countries were drawn to the oppression of their indigenous cultures and efforts of restitution. Given this backdrop, Epston and White were naturally attracted to the relevance of European poststructural theory, particularly Foucault’s position on constructed truths and the inseparability of power and knowledge. White’s wife, Cheryl White also influenced White and Epston’s interest in feminist theory and analysis of power. Over the years, other important leaders and extenders of the narrative therapy movement are Gene Combs and Jill Freedman (Freedman & Combs, 1996), Victoria Dickerson and Jeffrey Zimmerman (Zimmerman & Dickerson, 1996), Sallyann Roth (Roth & Epston, 1996), and Kathy Weingarten (1998) in the United States and Stephen Madigan (Madigan & Epston, 1995) [ETS21] in Canada. Major Theoretical Constructs: Narrative, Knowledge, and PowerNarrative therapy is based in a
narrative/story metaphor: people make sense of and give meaning to their lives
including the people and events in it through their narratives, the stories they
tell others and themselves and the stories they are told. That is, narratives or
stories about others and self shape experiences, and thus lives. People’s
narratives are their realities. We are born into the dominant narratives or
discourses of our unique cultures that are created by the culture’s power
brokers. These dominant discourses, or truths, influence local and personal
narratives, affect the words we use and the knowledge we have, and become
internalized truths. The lived experience of the person becomes lost or
subjugated to the dominant narratives. Narrative therapy views problems--their
formation and their resolution--from this dominant narrative perspective.
In the
development of narrative therapy, this perspective and agenda were strongly
influenced by the post-structuralism view of the French social philosopher
Michel Foucault (
Etiology of ProblemsFrom the narrative perspective, dominant cultural discourses and institutions influence the problem stories that people bring to therapy. Discourses of pathology and causality that exist within our broader social and psychotherapy cultures are large influences and are easily internalized, inviting problem-saturated stories. Problem stories effect people’s identities and generate blame and hopeless feelings. Problems persist because problem-saturated stories persist. Thoughts and experiences of others and self become the interpreting and validating lens that fix and perpetuate the problem story. In the words of Epston and White (1990) [ETS28] “. . . persons experience problems, for which they frequently seek therapy, when the narratives in which they are ’storying’ their experience, and/or in which they are having their experiences ’storied’ by others, do not sufficiently represent their lived experience, and that, in these circumstances, there will be significant aspects of their lived experience that contradict these dominant narratives” (p. 14).
AssessmentAssessment assumes that there is something—e.g., a structure, a pattern, a personality, or a relationship--to evaluate. And, usually embedded in that assumption is that the something is static. Traditionally, in psychotherapy, assessment tends to focus on determining the correct diagnosis, which in turn informs the treatment. Narrative therapists do not use standardized assessment instruments or focus on quantifiable diagnoses. Narrative therapists value the local or the native description of the problem. The person consulting the therapist is the best source of description of the problem and the best judge of what they want from therapy and the therapist, and whether the therapy is helpful. Assessment is not seen as a beginning phase of treatment that determines the goal and the strategies for reaching that goal. Rather, assessment, or learning about the problem, is part of the continuous process of telling and re-telling the story. Narrative therapists are interested in mapping the impact and effect of the problem on the individual and the family rather than in finding its cause. Because narrative therapists hold assumptions about limiting and oppressing dominant discourses, they would have ideas about which discourses these might be as they listen to the client’s narrative. So, part of the assessment would include determining the discourse in which the client’s problem is located and the restraints that it poses on the client’s life. Although, introducing the taken-for-granted or invisible discourse can be viewed as an intervention, it is also viewed as an opportunity to assess the client’s response and negotiate understanding. Clinical Change Mechanisms and Curative FactorsNarrative therapy
is based on the assumption that resolution requires a change in story or
narrative. Narrative therapists want to help people “re-author”
(
1986
Specific InterventionsThe preferred position for a narrative therapist is one that exemplifies a worldview of a “way of living that supports collaboration, social justice and local, situated, context-specific knowledge rather than normative thinking, diagnostic labeling, and generalized (non-contextualized) ’expert’ knowledge” (Freedman and Combs, 2000, p. 345)[ETS30] . This de-centered therapist position is critical to achieving the mission of narrative therapy, more so that seeming interventions and techniques.
Being transparent. One way of minimizing the power differential between clients and therapists, narrative therapists offer information about themselves and invite clients to ask them questions about the their experiences and beliefs. In the words of Freedman and Combs, “We try to be transparent about our own values, explaining enough about our situation and our life experience that people can understand us as people rather than experts or conduits for professional knowledge” (1996, p. 36).[ETS32]Reflecting. Using Tom Andersen’s notion of
reflecting process (Andersen, 1995)
[ETS33] a therapist gives
a therapy client, a therapy team, or any observers of the therapy the
opportunity to reflect on the conversation while the client and therapist
listen. The reflectors are thought of as one kind of community of concern
(discussed below).
Effectiveness of Approach Most of the dissemination
of information on the effectiveness and in support of Narrative Therapy is found
in anecdotal form at conferences, in books and journal articles, and the Dulwich Centre Newsletter. In keeping with the
narrative/story metaphor, narrative therapists invite present and former
clients, individuals and large groups, to tell their stories in writing and in
professional presentations. This allows the conference participants and readers
to hear the clients’ stories and therapy experiences directly from the source
rather than through therapists’ filters. It also acknowledges the major role of
clients in the therapy and the change.
History and BackgroundSteve de Shazer is widely acknowledged as the principal originator of
solution-focused therapy, although its development emerged from the collective
work of de Shazer, his professional partner and wife
Insoo Kim Berg, and his colleagues in Milwaukee,
Wisconsin in the late 1970s. Well-known others, primarily William O’Hanlan, Eve Lipchik, Michele
Weiner-Davis, and Jane Peller and John Walter, built
on the early foundations and practices of solution-focused therapy, especially
its focus on solutions and brevity, and developed their own unique versions and
names for it (O’Hanlon & Weiner-Davis, 1989;
Lipchick,
1993; Walter & Peller,
2000[ETS42] ). de Shazer was strongly influenced by his early work with the
Mental Research Institute (MRI) group in Palo Alto, California and their brief
problem-focused therapy.
Major Theoretical ConstructsSolution-focused therapy is
historically rooted in a tradition that started with the influence of Milton
Erikson, Gregory Bateson,
and the MRI associates; and giving credit to Berg, de Shazer supplemented the MRI influence with the premises of
Buddhism and Taoism (de Shazer, 1982). De Shazer and Berg basically flipped the problem-focused
approach that suggested more of the same ineffective solutions maintain the
problem to more of the same effective solutions solve the problem. They
continued the MRI group’s commitment to a pragmatic, deliberate intervention and
brief perspective, including the importance of what rather than why and the
importance of the present rather than history, and they added an emphasis on the
future. They referred to their early task and goal-directed practice as an ecosystemic approach to brief family therapy (de Shazer, 1982). Later de Shazer and
Berg wove philosopher Ludwig Wittgenstein’s notions of language and language
games into the background of these earlier influences (de Shazer, 1991). Language creates and is reality.
Therefore, a problem is a client’s reality: to change a problem, one must change
the reality by changing the language. In de Shazer’s
view, a shift from problem talk to solution talk is critical to this change.
Solution-talk takes the form of what de
Shazer
(1991[ETS43] ) refers to as
progressive narratives, ones that lead toward goals by allowing “clients to
elaborate on and ‘confirm’ their stories, expanding and developing exception and
change [problem] themes into solution themes”
(p.92-93).
Etiology of Clinical ProblemsProblems from a Solution-Focused perspective are related to language: the way that people talk about and attribute meaning to what they call problems. The talk about the events, circumstances, and people in clients’ lives defines a problem as a problem. In de Shazer’s words (1993)[ETS45] “There are no wet beds, no voices without people, no depressions. There is only talk about wet beds, talk about voices without people, talk about depression (p. 89). From this perspective, information about the problem such as its root and cause, its patterns, or its frequency are not important. To the contrary, as mentioned earlier, Solution-Focused therapists want to avoid talking about the problem. AssessmentAssessment is not a component of solution-focused therapy in the traditional sense. De Shazer challenges the relationship between problem and solution, making assessment of problems irrelevant. In his words, “The problem or complaint is not necessarily related to the solution” and “The solution is not necessarily related to the problem” (p. xiii, de Shazer 1991). [ETS46] Again, they hold a strong belief that neither therapists nor clients need to know the problem’s etiology or to even understand the problem. Looking for causes and grasping for meanings of problems are viewed as little more than problem-talk. And, problem-talk can perpetuate the clients’ obsession with and immersion in their problems, risk reifying problems, and obstruct the development of solutions. This is believed to the true for both the therapist and the client.
TechniquesEarly in the development of solution-focused therapy de Shazer used what he called “formula tasks” (de Shazer, 1985[ETS47] ) and later included specific kinds of questions to help move people from problem-talk to solution-talk, to discover and create solutions. With the tasks and questions, therapists aim for specific concrete behavioral information and instructions. The approach is manualized in the sense that all questions and tasks are based on the assumption that the solution to client’s problems already exist in their lives and are constructed to achieve the desired outcome: solutions. In spite of the manualization, early on solution-focused therapists believed in the value of cooperative relationships with clients. The most popular questions and tasks include:
“Suppose that one night there is a miracle and while you were sleeping the problem that brought you to therapy is solved: How would you know? What would be different? What will you notice different the next morning that will tell you that there has been a miracle? What will your spouse [for instance] notice? (de Shazer, 1991, p. 113)[ETS49]
These postmodern social construction therapies represent an ideological shift that has slowly evolved over the last two plus decades and do not represent a trend that will fade. A frequently asked question, however, is what are the limitations of these therapies? Most therapists would respond that there are not across the board limitations in respect to particular client populations, presenting problems, or cultures. To the contrary, most of these therapists report that the postmodern/social construction approaches permit them, more so than other approaches, to engage and work with a variety of populations and problems even if they have no or limited experience with the same. This freedom and competence seems to be associated with the collaborative aspect of doing something together and pooling resources, whether the therapist calls it that or not. It also seems to be associated with therapists’ ability to be creative when not constrained by diagnosing pathology and being the curing expert. Perhaps therapists limit themselves when they fall into these essentialist modes. The implications of this shift stretch far beyond family therapy to other therapies and to contexts outside the mental health discipline. Common among these therapies is their continuous evolution. The so-called originators and their colleagues and other thinkers and practitioners around the world continue to explore and extend the vast possibilities for therapy, education, research, organizational consultation, and medicine, as well as the complex social and cultural circumstances that challenge the earth we inhabit.
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[i] Other therapies that are sometimes placed under the postmodern umbrella are Constructivist Therapies. The distinction is that they draw from constructivist rather or more than social constructionist theory. These therapies are not discussed in this chapter; for comprehensive reviews see Neimeyer, 1993 and (is there more, please correct)
[ii] Anderson does not suggest that “nothing exists outside linguistic constructions. Whatever exists simply exists, irrespective of linguistic practices” (Gergen, 2001), Rather, the focus is on the meanings of these existences and the actions they inform, once we begin to describe, explain, and interpret them.
To be published in: G. Weeks, T. L. Sexton & M. Robbins (Eds.) Handbook of Family Therapy. New York: Brunner- Routledge [ETS1]These three refs do not appear on reference list [ETS2]Not on reference list [ETS3]No 1994 work on ref. list [ETS4]Not on ref list [ETS5]Since there are multiple Anderson references with different first names, please include first initial on Anderson refs. Also since there are two Anderson, H. references with 1997 dates please label the (a) and (b) so we know which reference. [ETS6]Missing in ref list [ETS7]Which ’97 ref? [ETS8]Missing from ref list [ETS9]Missing from ref list [ETS10]Missing from ref. list [ETS11]No ’86 Anderson on ref list also which ’97 ref? [ETS12]1997a or 1997b? Anderson, H. or Anderson, T.? [ETS13]there is no Anderson, T. 1991 on ref list [ETS14]Anderson, H. a or b, or Anderson, T.? [ETS15]Please check refs and make sure they match ref list. [ETS16]What is MC? Is this another author? [ETS17]Missing from ref list [ETS18]Please check vs. ref list, also check date for Anderson & Levin [ETS19]Missing from ref list [ETS20]Not on ref list [ETS21]not on ref list [ETS22]not on ref list [ETS23]not on ref list [ETS24]not on ref list [ETS25]not on ref list [ETS26]not on ref list [ETS27]not on ref list (Geertz?) [ETS28]not on ref list [ETS29]missing from ref list [ETS30]missing from ref list [ETS31]missing from ref list, check date vs. other Freedman and Combs entries [ETS32]missing from ref list [ETS33]missing from ref list [ETS34]not on ref list [ETS35]not on ref list [ETS36]not on ref list [ETS37]not on ref list [ETS38]not on ref list [ETS39]not on ref list [ETS40]not on ref list [ETS41]not on ref list [ETS42]not on ref list. Check date on Walter and Peller (ref list says 1992, is this an additional reference? [ETS43]Not on ref list [ETS44]Not on ref list [ETS45]Not on ref list [ETS46]Not on ref list [ETS47]Not on ref list [ETS48]Not on ref list [ETS49]Not on ref list [ETS50]2002 not on ref list [ETS51]not on ref list [ETS52]not cited in text [ETS53]not cited in text [ETS54]not cited in text [ETS55]not cited in text [ETS56]no (a) so don’t need a (b), check to be sure this is cited in text [ETS57]not cited in text [ETS58]not cited in text [ETS59]not cited in text [ETS60]not cited in text |