Contents
Introduction 1
Critique against the therapist-scientist 1
Social constructionism 2
Constructing the theoretical context 2
Chapter 1 A reflexive stance for family therapy: Hoffman 2
The 5 sacred cows of modern psychology 2
The colonisation of mental health 3
A growing dis-ease 3
Associative forms 3
Chapter 2 The client is expert: a not knowing approach to therapy 4
Therapeutic conversation 4
Forms of Practice 4
Chapter 3 Therapeutic Process as the social construction of change: Laura Fruggeri 4
Chapter 4 Reflections on reflecting with families: Tom Anderson 5
Chapter 5 Postmodern thinking in a clinical practice: William Lax 6
Chapter 6 Constructing Therapeutic Possibility Gianfranco Cecchin 6
Chapter 7 A proposal for a re-authoring therapy: Roses revisioning of her life and a commentary 6
Part 3 Construction in Action 6
Chapter 8 Therapeutic Distinctions in an ongoing therapy 6
Chapter 9 Collaborative Solution oriented therapy of the after effects of sexual abuse 7
Chapter 10 Narrations of the self 7
Chapter 11 Beyond Narrative in the negotiation of therapeutic meaning 7
Therapeutic Narrative in the modernist context 7
Chapter 12 Reconstructing Identity: The communal construction of crisis 8
Introduction
Therapy to date has traded on the notion of the expert. Of
the detached scientist-therapist who corrects the faulty living of the client.
The faulty living of the client created through a lapse in rationality, a lapse
in their ideal knowing.
Critique against the therapist-scientist
1.
Family therapy: Individual pathology is an
outcome out of the family unit
2.
System therapy: Individual pathology is an
outcome out of larger systems, family, community, society etc.
3.
Mental health professionals are not
ideologically neutral, so can’t be objective
4.
Phenomenology: Understanding people in terms of pre-existing
pathology prevents an understanding on their own terms
5.
Constructivists: therapists and client create
meaning together so you can stand outside of this to look at the client as an
object
6.
Hermeneutics : therapy is heavily ideological
and can never be an objective science
Social constructionism
Shows there is no logical empiricism rather domains of discourse.
In other words there is no overall rationality Newtonian physics can be
translated into Quantum mechanics, psychology can’t be translated to physics.
Rationality exists within a narrative discourse. Rhetoric is a significant tool
for rationality. What can be said in the narrative discourse is a product of
language\text, which are in turn the by-product of human relationships.
Constructing the theoretical context
Chapter 1 A reflexive stance for family therapy:
Hoffman
The 5 sacred cows of modern psychology
Objective social research
This forms the basis of RCT’s and is the evidence of follow
the evidence. Diagnosis is strongly linked to the health industry, where US
health insurance only activates on the basis of a diagnosed problematic
biological process. However in DSM 3 self-defeating personality disorder was
used to describe women who couldn’t leave abusive relationships, likewise ego
dystonic homosexuality was used to describe people who were uncertain by their
sexuality.
However if these objects of objective research are so
changeable and if these historic examples are so laughable then surely the
basis of the objects of objective research is political not substantive in
creation.
The self
The objectivity of this is challenged in Gergen where the
objective self is seen as a product of modernity, but that given rationality is
heterogeneous, given that more contradiction in self is now allowed through
multiphrenia, then the unified, coherent objective self must fall. Without an
objective self again we lose the object for mental health study
Developmental psychology
This is challenged in Gergen 1982 Toward Transformation in
Social Knowledge, where he argues there are an infinity of development
possibilities that are enabled by the confluence of variables and that there is
no trans historical development mould. Others e.g. Gould argue that species
develop discontinuously and Gleick sees how chaos theory predicts some random
developments. Without a unified
development of the self again we lose the objective self.
Emotions
Rom hare 1986 argues against the intrinsic nature of
emotions, but rather their social construction. However emotions are not
universal, emotions cannot be measured, emotional understanding has changed
quite radically over the years, e.g. boredom, depression, melancholia. Likewise
it has come into folklore that suppressing your emotions is bad and is the
cause of emotional problems, thus when there is a collective emotional problem
then professional mourners are called in, e.g. psychologists, and if you don’t
purge in the right way, then you are likely to have strange and unpleasant
outcomes afterwards.
Levels
Human knowledge is described in layers like the Chinese box,
one layer within another layer. But what if the layers were not hierarchical
but rather existed on one level each influencing the other. What if the other layers were merely contexts
for each other, with reciprocal influence?
The colonisation of mental health
There’s an argument, Kearney, that the studies that form the
underpinning of mental health discourse study less civilised societies, or
indeed have a less affluent cohort, indeed have a cohort that would identify
with having mental health disorders.
As with Foucault who saw psychotherapy as similar to the
confessional where if you tell your deepest, darkest secret, usually sexual to
a priest then you will be absolved. A similar myth perpetuates with catharsis
and psychoanalysis. The other aspect of relation is wherever there is a deficit
model, you haven’t enough friends: ipt, your thinking is wrong: cbt, you aren’t
engaged enough: gestalt, then there is the sense of the colonial attitude of
you aren’t civilised enough and you need help from a professional to address
it.
A growing dis-ease
Family therapy used to be one way, purely observational and
then their therapist would get the family to do what they wanted either overtly
or covertly. An alternative approach to hierarchy can be edge and centre
relation.
Reflexive is turning back on itself. So to reduce the expert
role of family therapist then get the family to observer the therapists as they
discuss them.
The Galveston group set about a project of not knowing,
where they believed that it was narrative that constructed reality and
therefore change and that when they were in conversation with their clients it
was the conversation that would at some point deliver change and not them, or
their client.
To reduce the expertness, be tentative, ponderous, long gaps
of silence, this reduces your expertness.
Furman believe we assume our intervention and then go
looking for the ideas\hypothesis to support it, so CBT they are through not
acting/getting to learn that their beliefs are faulty.
Associative forms
Therapists can make one style of intervention, understanding
a unit to be intervened on and the intervention itself and then start to believe
that this is the place to intervene, rather than for this difficulty in this
context this made sense. To reduce this sense of having found the solution, the
tool to provide future solutions, the
way to do this is to have multiple narratives, so you can describe the same
situation using different metaphors, or different mediums, or differently
within the same medium.
Postmodernity prefers discourse to text, dialogue to
monologue.
Chapter 2 The client is expert: a not knowing
approach to therapy
Humans are not objects. An object is something that is
defined by a human and has meaning, in the way that it will be used and
interact with humans. Thus an object is defined by its purpose for and with
humans. A human cannot be an object to themselves, a human is a meaning
generator, an object is a meaning recipient.
If you don’t know what the answers to the clients problem is
then you can work together to establish a new narrative.
Therapeutic conversation
In dialogic mode change is a shared change of the narrative
of a problem To not know is not to have no expectations or assumptions, but
rather so you can be aware of them and put them to one side so that you can
listen to the client’s narrative, put it together with yours and establish a
new assumptions. Thus be aware of your stuff, listen with newness to your
clients, and synthesise the two.
Expert therapists will defend and enhance their narratives
at the expense of the clients.
Narratives permit or inhibit a personal perception of
freedom to act. If I don’t believe I can change something then I won’t try to.
An expert explains from their knowledge in an attempt to
analyse the problem on the basis of their prior knowledge and provide a
solution. A not knower tries to understand the client.
Garfunkel and Shotter argue that the only meaning that is
understood is within the vocabulary and rules that have been locally
established between people in a conversation.
Therapy as re-narrating a story to include what hasn’t been
said. The therapist looks to understand the client’s story and in the attempt
to understand the story either implicitly the client will state the unsaid or
explicitly the therapist will ask for what hasn’t been said.
Forms of Practice
Chapter 3 Therapeutic Process as the social
construction of change: Laura Fruggeri
·
Role of observer effects the observed
Bateson 1972
·
The hermeneutic circle with a client,
is that on my assumptions I understand you on the basis of yours, that alters
mine…
·
Psychotherapy was built on the medical
model
·
Knowledge is an on-going
self-referential construction
·
No one can do anything to anybody (i.e.
knowledge is self-referential Bateson 1972) which leads to a non-instructive
interaction between client and therapist
·
if we construct reality then the
medical model must fall, there is no pathology to identify the correct
treatment for
·
The client responds to the therapist
according to the meaning they attribute to them
·
A therapeutic tool is only useful when
the client recognises it as such
·
Therapist sees client through their
map, the client will accept these maps only if they attribute meaning to them.
·
Client and therapist construct the
space where meaning is created between them
·
Ask the client how they see the
situation, how they construct things
·
Therapy is the process of redefining
social realities, we co-construct in therapy we don’t discover and fix. The
client constructs their alternative reality which doesn’t have their difficulty
in it, that’s a solution.
·
Through creating a different reality
from the one the client experiences elsewhere then this can trigger a process
of change
·
Clients change when they create
different worlds, when they take different perspectives. Taking of different
perspectives is entirely down to them.
·
To work in a constructivist way then
be aware and explicit of the assumptions and biases you have in constructing
the phenomena, the client also brings their assumptions and point of view which
provides the shared area where you construct meaning.
·
Change can happen through the
therapist taking a different way of observing that the client can buy into
Chapter 4 Reflections on reflecting with
families: Tom Anderson
·
If you know what to do it limits you,
if you know what not to do again it extends your possibilities
·
Life is mediated by what I put my
attention on and what language I have to experience what I put my attention on
·
Research discovers theories which are
actually those that support and are what the research assumes
·
Best research would be to work on
intuition and the describe what was useful afterwards.
·
The reflecting team, where family
would observe team discussion helped move the private professional, sometime
disrespectful language to a public language
·
We need disturbances to keep us alive
and make us able to change in correspondence to the ever shifting world around
us, but if the disturbance is too great then we can’t integrate it, indeed we
would disintegrate if we did integrate it
·
Clients generally say they don’t know
what to do: Bateson 1972 to those who do not know what to do then they need
something different but not too different=> The elementary unit of
information is a difference that makes a difference
·
If you offer your ideas tentatively
then this gives the client the space to disagree or not to listen, which gives
them autonomy
·
Clients often think there is one right
and many wrong ways to understand a situation and respond to it, it can be
liberating to find there are many ways to describe the situation
·
Objective knowledge is seen as that
which can explain and predict, either knowledge was right or wrong.
·
Postmodernity introduces
o Myth in addition to truth
o Figurative in addition to literal
o Metaphor in addition to Concrete
o Imagination in addition to reason
o Rhetoric in addition to logic
o Narrative in addition to argument
·
Picking up on nuances of words can
help shift descriptions, understandings and perspectives
·
Metaphor is the basis of knowledge as
we use knowledge from the known and apply it to the unknown
·
The search for new understanding, new
behaviour, basis itself on new use of language, new use of metaphor
·
Talking is a search for meaning
Chapter
5 Postmodern thinking in a clinical practice: William Lax
The idea with narrative therapy is to co-construct a
narrative with your client where the problem doesn’t exist.
Questions that produce tension with the existing narrative
can promote new ideas to be integrated into a new narrative.
If a conversation is too similar to an existing narrative or
too different it is unlikely to succeed.
Chapter 6 Constructing Therapeutic Possibility
Gianfranco Cecchin
To think in terms of TA and games theory assumes
interactions are competitive, tactical and strategic. Humans in systems are not
there to outsmart each other but are there to make sense of the situation.
The value of a hypothesis is its ability to create tension
with the existing narrative such that it can create a new one.
Chapter 7 A proposal for a re-authoring therapy:
Roses revisioning of her life and a commentary
No notes
Part 3 Construction in Action
Chapter 8 Therapeutic Distinctions in an ongoing
therapy
Range of anger
1.
Lashing out at anything
2.
Physically attacking the perceived source of the
frustration
3.
Directing the anger towards physical objects
rather than people
4.
Attacking verbally rather than physically
5.
Expressing anger in sarcastic statements or in
ones fantasy
6.
Imagining angry actions but not acting on them
7.
Anticipating frustrating situations and
preparing appropriately
8.
Accepting injustices and inequities in life that
cannot be changed
Chapter 9 Collaborative Solution oriented therapy
of the after effects of sexual abuse
Assessment is an intervention as you co create the problem. As you define the problem it can be
empowering or not, it can make the client an expert on their problem or have a
sense of agency. You need to create a
problem that is solvable. Sometimes the problem deems that the client has a
pathological problem that they are broken in some way. Therapist’s job is to
create the context where a client can use their own resources to solve their
problems. You need a goal for treatment that is shared between you and client
or you can meet resistance. To come to therapy someone is a complaining about a
problem that is deemed appropriate for therapy, therapy finishes when this
isn’t the case.
To suffer pain affects you, it can increase your sensitivity
and empathy, it can change your values that no one should have to experience
pain like this.
Chapter 10 Narrations of the self
Puppetry used for psychotherapy performance, the puppet acts
as intermediary between performer and viewer, if the puppet gets it wrong, it’s
not the performer.
Stopped at page 157 not getting anything out from reading this
Chapter 11 Beyond Narrative in the negotiation of
therapeutic meaning
Client has a narrative story that contains their problem.
Types of response
1.
Advisory
a.
Therapist accepts their story as true and then
looks to make things better within the story
i.
This can be effective for short term but given
the antecedents could happen again, this won’t prevent future problem nor deal
with long term problems
Therapeutic Narrative in the modernist context
Things have essences, this enables us to make predictions
about them, which enables us to gain mastery over them, which means we can put them
to our use. Objective knowledge has value subjective knowledge or report less
so. Hence why behaviourism is of interest where we can all observe something,
it can be objective.
Modernist psychotherapy therefore has
1.
Cause of pathology
2.
Location of this cause within client or relationships
3.
Means to diagnose pathology
4.
Means to eliminate pathology
The clients story is flimsy subjective and disease ridden,
the therapists is objective and scientific and if we replace the former with
the latter then the problem goes away. The client’s story is not seen as the
truth, but as something that needs to be corrected. Thus what happens is the
problem story gets replaced with the success story, and the continuing story of
the strong helping out the weak continues. Thus the client turns out with the therapist’s
view of the good world, so rationally appraising things, or being emotionally
expressive or whatever it is.
Discourses claim truth but rather what they do is to define
evidence, prove things against this evidence, and then predict things using
their proof of evidence that it worked. Although science does stop people
dying.
The other options is that client and therapist co-author a
new narrative for the client which is more helpful.
The Postmodern take is that we have narrative utility. The
narrative is socially constructed through language games that dictate the
meaning we ascribe to words, how we act for these words to be true, and how we
respond to them. Narrative story is shared with another and its effect will depend
on the context of the other and your relationship. Therefore in therapy you can
generate a new narrative but how will this play out in relationships in your
world?
Response in the world is best done contextually and in
relationship. If you move from I’m a failure to I’m a success, this is outside
relationship and context and to act on one is as bad as to act on the other.
Postmodern therapy then looks to generate contextually
useful meaning. This can lead to a number of views of the self, but the post
modern turn is to not identify with any of them individually. Postmodernity
puts the relationship above the individual, this is where meaning comes from,
this is where life lives.
There are finite games where the aim is to win, by
maximizing rule governed behaviour.
There are infinite games where the aim is to play and the
rules change as you play.
Chapter 12 Reconstructing Identity: The communal
construction of crisis
In crisis people invoke boundary descriptions, I was lost, I
had no centre, I wasn’t myself, I’m flawed. There is the sense that the self
suffers something externally. This being the case the solution proposed is how
can the individual get the strength to change these external circumstances.
Another way of describing this is to say given a person’s identity that crisis
is inevitable, so I am flawed in some way which is why I’m in crisis. Whichever
explanation crisis is deemed to be something the individual has.
Families are demarcated by boundaries, and too tight or too
diffuse inter-generational boundaries leads to trouble. To create a boundary
you define a centre and an edge and it is assumed that to be in the centre is
better, e.g. central administration, to centre oneself etc. One thing is only
understood in terms of its relation to something else.
In crisis identity and the centre is questioned. The typical
response to crisis is to try to find a route back to the centre or to move
beyond the border into another domain.
To be in crisis is to be held in crisis by other people not
just yourself. To be in crisis is also
to be defined as inappropriate within a certain domain. Therapy is a practice
rooted in modernist theories of the individual.
How can PM understand crisis?
See how within a discourse\relationship\community the central is defined to understand the
outlying.
Circular questioning allows perspectives to be brought out
that aren’t fact, what would X think of your anger?
