ISSUE 139 SEPTEMBER 2010 BACK

THERAPEUTIC PRACTICE

Opening space: Towards dialogue and discovery

Colin Sanders and Garth Thomson

1. Honouring wisdom of self and others

Let us recall here that psychotherapy in accordance with the root meaning of the words “psyche” and “therapy” means to serve the soul, not to treat it. “]ames Hillman

We are revising the final version of this introductory paper on Easter Monday, two days after the completion of the second international Narrative Ideas and Therapeutic Practice conference in Vancouver, B.C. This year’s conference was more exciting than last year–s, with well over 350 persons in attendance from all over North America, as well as a significant contingent from New Zealand and Australia. Three members of the “]ust Therapy” collective from New Zealand opened the four days of workshops, paper presentations, roundtable discussions and special interest groups. Kiwi Tamasese, Flora Tuhaka, and Charles Waldegrave brought greetings in Maori and Samoan to all the persons gathered for the conference, both speaking and singing these greetings. The remainder of the first day was taken up by a discussion of their work together in New Zealand, and in impressing upon the participants the extent of their engagement in and commitment to emancipatory and celebratory practices relevant to issues of belonging, the sacred, and liberation in the lives of persons affected by problems. It is worthwhile quoting what Kiwi Tamasese and Charles Waldegrave have written regarding the centrality of belonging, the sacred, and liberation in their work at the Family Centre in Lower Hutt (Wellington), New Zealand:

We are now centring this work around three primary concepts: belonging, sacredness and liberation. Belonging refers to the essence of identity, sacredness to the deep respect for the humanity of people’s stories and liberation to the freedom and wholeness people seek in therapy. We are interested in the interdependence of these concepts. For example, not all stories of belonging are liberating, and some experiences of liberation are neither sacred nor in harmony with one’s culture. (Waldegrave and Tamasese, 1993, p. 5)

These therapists believe strongly in a commitment to community activism and community development, and in ideas and principles related to social action and social justice (Waldegrave, 1990). We will expand further upon this commitment to challenging sociopolitical structures and the dominant ideas maintaining these structures in the pages to come, as this is, in our view, an integral part of the importance of so-called “narrative” approaches to counselling or therapy. Papers gathered in this issue will also challenge psychological frameworks that are oppressive of persons, frameworks that totalize and pathologize experience, rather than encourage, enrich, and expand upon preferred ways of being.

Several points made by Kiwi, Flora, and Charles at the conference this Easter week bring meaning to the papers gathered here. They spoke of how the social sciences, and the truth claims created and often imposed upon persons by the social sciences, represent merely one culturally prescribed and informed perspective on how to comprehend the world of experience. Their point was that other cultures possess other wisdoms, other knowledges, other ways of being that often do not make the distinctions that western, Enlightenment-influenced, thought structures propose (see Tapping, 1993, for a synopsis of the views of other cultures regarding different world-views and ways of being and knowing, including Maori, Samoan, and First Nations groups from Vancouver Island).

Their critique marks an important distinction between theoretical frameworks that pay attention to socioeconomic barriers or restraints in persons” lives, and theoretical frameworks that pay no attention to such restraints. A therapeutic practice that considers “problems” as arising from the interrelationship of factors originating in questions regarding gender, social class, cultural discourses, and socially prescribed ways of conducting one’s self will be a practice that encourages challenging dominant sociocultural norms. To not attend to the effects of these discourses within a person's life is to take a stance that encourages blame and the categorization of persons through diagnostic labels. The literature on this critique is now decades old, but the tendency to pathologize and totalize clients” experiences remains powerful in too many agencies, programs, and institutions (Deleuze and Guattari, 1983; Gilligan, 1982; Kristeva, 1980, 1985; Szasz, 1970, 1984, 1992; Tomm, 1990; White, 1991).

Certainly, in the last 30 years, the voices and stories of the colonized, marginalized, disenfranchised, and oppressed have become less and less silent. In North America, for example, the 1960s witnessed the civil rights movement of black persons and the emergence of challenges by various First Nations bands to the hegemony of power structures that were racist and unjust. As well, the voices of women emerged as gendered social constructs and prescribed ways of being began to be challenged (De Beauvoir, 1952; Friedan, 1963; and the discussion of “feminisms” in Flax, 1990). There has also emerged a plethora of other, “different,” voices and stories: lesbian and gay concerns and challenges to the politics of sexuality (–body politics–), schizophrenics, sole parents, and the voices of hitherto “silenced” children, youth, and women oppressed by male violence.

These days, we are living in a context where formerly disqualified, subjugated knowledges (Foucault, 1980) have arisen from amid the shadows, the corners, the ghettos, and the “back-wards” (Bateson, 1980) of institutions. The counselling profession has been challenged, on account of the questions being asked by the above-mentioned voices and the intimate stories of abuse associated with counselling practices and the theoretical ideas underpinning these practices. In the counselling profession, the “role” played by child care workers and family counsellors alike has been transformed. The expert knowledge (Foucault, 1980; White and Epston, 1990) of practitioners has been called into question, and along with this challenge has emerged an awareness that the practitioner does not possess some neutral, objective perspective regarding the child/ youth / family; in fact, the practitioner, whether child care counsellor or family counsellor, is an integral part of the context of change. This stance has been discussed in terms of a collaborative process that privileges all voices and stories within the conversation (Friedman, 1993; McNamee and Gergen, 1992).

Through such a collaborative process, the deep, heartfelt intimacy of a person's stories is honoured and respected, a sacred space is created in which new possibilities may be discovered and realized, and a new language may emerge within which a vocabulary comes into being, allowing for the suffering and pain to be articulated. Stories that have hitherto dominated a child or young person's life, or the life of the family, become externalizecl as tragic tales that have unduly influenced the pathways that lives have taken. Within this collaboration, threads of new stories and new pathways emerge concerning preferred ways of living and being, and it is in the emergence of such alternate stories (White and Epston, 1990) that hopefulness becomes awakened or rekindled “hope for a life lived without “the problem.”

2. Some theoretical shifts: Or, the train kept rollin”!

There must be some kind of way out of here, said the joker to the thief! (Bob Dylan) One of the more innovative and challenging of therapists working today is Brad Keeney. Keeney was a student of Gregory Bateson and, in some respects, has continued to expand upon aspects of Bateson's ideas, particularly as regards cybernetics (Bateson, 1972; Keeney, 1983). As an introduction to this issue of collected papers, we think it is useful to quote the following points from Keeney (1990):

Therapists are advised to be mindful of the following:

  1.  Cultivate a healthy irreverence for all teachings (including this one).

  2.  Do what you want with any therapeutic model, school, or orientation “utilize it, ignore it, kick it, invert it, reverse it, distort it, misunderstand it, play with it.

  3.  Be cautious when therapy doesn’t feel like play, never forgetting that play is serious work.

  4.  Experience psychotherapy as theatre: when it’s boring, change anything “the script, the actors, the director, the audience.

  5.  Theory is critical for evolving clinical work: with every new understanding, you become a different person “the person you previously were plus the new understanding. This new you cannot necessarily perform what worked for the previous you. This means you must learn to do something different. Doing something different leads to new experience which in turn can be subjected to understanding. (1990, pp. 5-6)

We cite this advice in its entirety because we think it advisable to never take ourselves too seriously in this work, and to never accept our own beliefs, and restraints associated with these beliefs, as representative of some therapeutic “truth” or “fact.” The adage “question authority” makes perfect sense in this postmodern world, a world that has been liberating professional helpers from expert positions for a couple of decades now. For example, in keeping with this spirit of transparency, we think that the ideas informing our understanding of the work we are doing are ideas that should always be shared with clients. These concepts and strategies, and these ways of seeing and comprehending the world of experience, are not, in any sense, trade secrets of the counselling profession. To share this thinking with clients, and to be informed by clients as to their beliefs and worldviews, is to be respectful and to honour those with whom we work. In our work with children and youth, it is crucial to remember the remarkable power we, as helping professionals, possess. Many of those persons with whom we work are vulnerable, and they are ever hopeful that, in their relations with us, we may assist them in separating from a life lived with problems.

In terms of ideas and beliefs we have regarding how we understand the world (epistemology), it is crucial that we remain aware that these ideas and beliefs exist within a context of restraints (Bateson, 1972; White and Epston, 1990), and that these ideas and beliefs regarding the world often impede us from allowing new information, or different information, into our comprehension. Bateson wrote of this in terms of “a difference which makes a difference” (1972, p. 453), suggesting that it was difference over time that indicated “change” (1972, p. 452). Bateson's thinking has informed both the solution-focused and narrative paths in the evolution of practices associated with child care and family counselling.

Milton Erickson's thinking and creative practices have also informed some of the thinking associated with papers presented in this issue. Of particular interest is Erickson's notion of “utilization,” the idea that counsellors and therapists need to attend to the words and worldview the client offers, listening for clues indicating successful resolution of past difficulties (Erickson, 1954; Cade and O–Hanlon, 1993). Erickson was also quite irreverent, especially of diagnostic categories and clinical theories that constrained professional helpers from comprehending the uniqueness of individual clients. Apparently, Erickson is credited with exclaiming, “Every time a new client comes through my door, I have to invent a new theory!” He is also infamous for his creative suggestions and advice to clients; clients for whom traditional psychoanalysis and psychiatric practices had not been useful in dissolving “problems” and problem identities.

As Heather Elliot (1994, and personal communication, April 1994) has pointed out, attention to language (and language systems) became an important and integral component in the further learning of many professional helpers throughout the 1980s. Especially important within this development, for the domain of therapy and counselling, were the ideas of Harlene Anderson and Harry Goolishian. Anderson and Goolishian suggested that “[a] therapeutic conversation is an open conversation in which the focus is in the direction evolving new understanding of the problems and issues at 7 hand” (1988, p. 383), and that a “[t]herapeutic conversation is not the process of finding solutions. No solution is found; the problem dis-s0lves” (1988, p. 383). In such a context the counsellor or therapist is “an architect of dialogue whose expertise is creating and maintaining a dialogical conversation” (p. 338).

Elliot (1994) has also pointed out the significance of White’s (White and Epston, 1990) ideas regarding how language is constitutive of reality. If some “realities” constituted by language are oppressive and abusive, these sociocultural discourses may be challenged. Narrative ideas in counselling or therapy are committed to naming the restraints or barriers existing within clients” lives and assisting the facilitation of new stories, stories of victory over problems, stories of liberation.

Anderson and Goolishian took the stance that diagnostic categories tended to totalize and pathologize a person's lived experience (1988, p. 386). In this they echoed Thomas Szasz” efforts to deconstruct psychiatric diagnoses and labels, a practice Szasz refers to as dehumanizing, in that “[t]he diagnostic label imparts a defective personal identity to the patient . . . The psychiatric nosologist thus not only describes his patient’s so-called illness, but also prescribes his future conduct” (1970, p. 203). In Szasz” opinion, diagnostic labels are equivalent to “semantic blackjacks” in their tendency to ensure that the client remain in the patient role. The postmodern anthropologist, Stephen Tyler, went further when he proposed that the American Psychiatric Association's Diagnostic and statistical manual of mental disorders (DSM) represented the “terrorist bludgeon of the psychiatrist” (Tyler, 1986, p. 139).

Relative to how we come to know the experience of those in counselling or therapy, Anderson and Goolishian make this point: “Our view holds that each observation, each problem description, each understanding, each treatment is unique to the communicating realities in which we participate. These realities are always in flux and never stay the same” (1988, p. 386). These authors suggested that counsellors and therapists listen for the “un-said” and the “not-yet-said” (1988; 1992). According to the authors, “Not-knowing requires that our understandings, explanations, and interpretations in therapy not be limited by prior experiences or theoretically formed truths, and knowledge” (1992, p. 28).

We have found this notion of therapeutic conversation intriguing. As in a painting by Picasso or Braque, or a composition by Stravinsky or the Grateful Dead, the idea of therapeutic conversation created the possibility of a contribution of multiple voices, multiple stories, in a context in which there was no “correct” or “true” perspective. Rather, as we discovered in practice, and as evidenced in several of the papers within this issue, with this proliferation of stories, each voice made a unique contribution toward problem dis-solution. This languaged exchange resulted in an engendering of curiosity and interest amongst participants, not apathy and disinterest. “I didn’t know that–; “l didn’t realize you thought that way–; “What you said surprised me” ; “I have never heard that story before–; all became familiar refrains in the conversation (Sanders, 1993, p. 7-8).

Anderson and Goolishian suggest that the stance they practice in counselling is one informed by hermeneutics, or the theory and practice of interpretation. They write that hermeneutics “is a philosophical stance that “maintains that understanding is always interpretive . . . that there is no privileged standpoint for understanding” “(1992, p. 28). For the purposes of this introduction to papers utilizing narrative ideas and therapeutic practices, this “interpretive” understanding of the meaning and significance of what clients have to say regarding their experience(s) brings us up to a brief discussion of Michael White and David Epston's thinking and the impact of their thought upon practice.

Pertaining to the so-called interpretative method in counselling, Michael White has made the following point:

In regard to family therapy “which has been our area of special interest “the interpretive method, rather than proposing that some underlying structure or dysfunction in the family determines the behaviour and inte action of family members, would propose that it is the meaning that family members attribute to events that determines their behaviour. Thus, for some considerable time I have been interested in how persons organize their lives around specific meanings and how, in so doing, they inadvertently contribute to the “survival” of, as well as the “career” of, the problem. (White and Epston, 1990, p. 3)

Over the past decade, White and Epston have made a major contribution to the counselling field, with their notion of externalizing problems, the documentation of individual knowledges and personal wisdom, and the ways in which this knowledge and wisdom can be celebrated and used against problems (Epston, 1989; Epston and White, 1990; White and Epston, 1990). A special acknowledgement is due to David Epston and Michael White, as this issue would not have evolved without their inspiration. Their work has demonstrated that the more you assist clients in carving out, dislodging, and exposing the history of “problems” in their life, the more you begin to hear about dreams, visions, hopes, desires, aspirations, and love within families living out lives prescribed by “problem-saturated” diagnostic labels and descriptions. David and Michael have also punctuated, for many of us, the significance of understanding that the reality we construct or co-construct in counselling will always have socially and culturally prescribed meaning. Perhaps more than any others in the domain of counselling today, these authors have pointed out that the act of engaging in therapy is a political act, an act that demands structures of accountability and ethics. Practitioners who utilize the narrative metaphor in their work think that counselling represents a collaborative act; in other words, counselling is something you do with others, it is not something you do to someone. Our experience of collaborating in this discovery with young persons and their families has strengthened our resolve in recognizing the courage of young persons and their families as they attempt to unravel their lives from “trouble’s influence” and the various dilemmas that sometimes create disturbance, suffering, and pain.

3. An inconclusive conclusion

I know cats can turn monsters into dust! (Blake Retter, aged 9)

In the papers gathered within this issue, we have attempted to present accounts and descriptions of both theoretical innovation and practical relevance and delight. We have also attempted to illustrate ways in which these practices are celebratory of the experience of clients” lives, as children, youth, and families separate from oppressive stories, and discover liberation.

It is the hope of all those associated with this special issue of the journal that some of the ideas and practices espoused here will be of assistance to those working in the child care domain. There is a tremendous amount of client wisdom and knowledge contained here, and our clients are our greatest teachers. The work we do is only as good as the listening we do in our conversations with clients. Through listening, we become informed as to the meaning of a client’s experience, and, in expressing interest and curiosity regarding their experience, assist in the creation of new meaning and purpose.

Any residential child care program (and many day / evening programs) provides perfect arrangements for joining children, youth, and families in concerted efforts to defeat “problems”! To various degrees, this is what we have all been involved with for years! However, we think some of these “new” ideas bring greater clarity and meaning to our work and collaboration with clients intent upon making change happen in their lives. Rather than practitioners thinking they need to be endlessly creative in their work, an innovative idea is to have children, youth, and families consult with one another regarding their growing expertise in defeating problems through new solutions. White and Epston have called this “consulting your consultants.” This type of wisdom and knowledge, arising from the experience of “those who know” (Kinman and Sanders, 1994), is invaluable. It is clear from the work David Epston is doing, in particular (personal communication, July 1994), that we have barely scratched the surface of possibilities for evoking this kind of wisdom and knowledge and documenting the information for others afflicted by dilemmas and troubles. His work with children and young adults in creating the Anti-Anorexia, Anti-Bulimia League in New Zealand has been instrumental in connecting hundreds of individuals to share stories regarding ways to combat the power of anorexia in their lives. Similar leagues exist elsewhere around the world, including one at St. Paul’s Hospital, Eating Disorder Clinic, in Vancouver (Stephen Madigan, personal communication, February 1994).

There is much more that we could say, but we would be merely adding to the inconclusiveness of this evolving narrative, and it is time to let the collected papers gathered in this issue speak with their own voice, and the voices of the clients whose experience and thinking inform the writing. Finally, we offer this issue as a gift of encouragement to those committed to fighting the power of “problems,” clients and colleagues alike!

Keep on trucking!

References

Anderson, H. and Goolishian, H. (1988). Human systems as linguistic systems. Family Process, 27. pp. 371-393.

Anderson, H. and Goolishian, H. (1992). The client is the expert: A not-knowing approach to therapy. In S. McNamee and K. Gergen (Eds.), Therapy as social construction (pp. 25-39). London: Sage.

Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine Books.

Bateson, G. (1980). Mind and nature: A necessary unity. New York: Bantam.

de Beauvoir, S. (1952). The second sex. New York: Vintage Books.

Cade, B. and; O–Han1on, W. (1993). A brief guide to brief therapy. New York: Norton.

Deleuze, G. and Guattari, F. (1983). Anti-Oedipus: Capitalism and schizophrenia. Minneapolis: University of Minneapolis Press.

Elliot, H. (1994). Decentering the self: Who is the subject in family therapy? Paper presented at the Second International Narrative Ideas and Therapeutic Practice Conference, Vancouver, BC.

Epston, D. (1989). Collected papers. Adelaide: Dulwich Centre Publications.

Epston, D. and White, M. (1990). Consulting your consultants: The documentation of alternative knowledge. Dulwich Centre Newsletter, 4.

Erickson, M.H. (1954). Special techniques of brief hypnotherapy. Journal of Clinical and Experimental Hypnosis, 2. pp. 109-129.

Flax, J. (1990). Thinking fragments: Psychoanalysis, feminism, and postmodernism in the contemporary west. Berkeley: University of California Press.

Foucault, M. (1980). Power/knowledge. New York: Pantheon Books.

Friedan, B. (1963). The feminine mystique. New York: Dell.

Friedman, S. (1993). The new language of change. New York: Guilford Press.

Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press.

Keeney, B. (1983). Aesthetics of change. New York: Guilford Press.

Keeney, B. (1990). Improvisational therapy. New York: Guilford Press.

Kinman, C. and Sanders, C. (1994). Deconstructing addiction mythologies. Abbotsford, BC: Fraser Valley Education and Therapy Services.

Kristeva, J. (1980). Desire in language. New York: Columbia University Press.

Kristeva, J. (1985). In H. Eisenstein and A. Jardine (Eds.), The future of difference. New Brunswick, NJ: Rutgers University Press.

McNamee, S. and Gergen, K. (1992). Therapy as social construction. London: Sage Publications.

Sanders, C. (1993, April). Narrative imagination in evoking a language of mind. Paper presented at the First International Narrative Ideas and Therapeutic Practice Conference, Vancouver, BC.

Szasz, T. (1970). Ideology and insanity. New York: Anchor.

Szasz, T. (1984). The therapeutic state: Psychiatry in the mirror of current events. Buffalo, NY: Prometheus Books.

Szasz, T. (1992). The United States v. drugs. In J.K. Zeig (Ed.), The evolution of psychotherapy: The second conference (pp. 300-312). New York: Brunner/ Mazel.

Tapping, C. (1993). Other wisdoms, other worlds: Colonisation and family therapy. Dulwich Centre Newsletter, 1-2.

Tomm, K. (1990). A critique of the DSM. Dulwich Centre Newsletter, 3, 5-8.

Tyler, S. (1986). Post-modern ethnography: From documents of the occult to occult document. In J. Clifford and G.E. Marcus (Eds.), Writing culture: The poetics and politics of ethnography. Berkeley: University of California Press.

Waldegrave, C. (1990). Social justice and family therapy. Dulwich Centre Newsletter, 1.

Waldegrave, C. and Tamasese, K. (1993). Some central ideas in the “just therapy” approach. Australian and New Zealand Journal of Family Therapy, 14, 1. pp. 1-8.

White, M. and Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.

White, M. Deconstruction and therapy. Dulwich Centre Newsletter, Winter, p.8-14.

 

This feature: Sanders, C. and Thomson, G. (1994). Opening space: Towards dialogue and discovery. Journal of Child and Youth care, 9, 2. pp.1-11.

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