Harlene Anderson: Selected Writings

Becoming a Postmodern Collaborative Therapist
A Clinical and Theoretical Journey (Draft)
Part I

Harlene Anderson

Houston Galveston Institute
Taos Institute

ABSTRACT

The development of practice and theory are a reflexive process. Here, I share my journey toward a collaborative practice and a postmodern theory. My narrative of transformation begins with a glimpse into the traditions from which my journey began and pauses where I find myself at this time. My narrative is offered in two parts: Part I describes the shift in practice that evolved out of my clinical experiences. Part II will describe the shifts in theoretical biases and my current philosophical stance.

             I have created an account my journey toward my current practices--a postmodern collaborative approach. My account includes the tradition that I stepped into, the shifts that occurred in my clinical experiences overtime and the theoretical premises that surfaced along the way. I trace the distinguishing features that emanated from these, and most important among these features the postmodern notions of language and knowledge. As you will learn, I did not awake one day and decide to be a postmodern therapist. Rather, my becoming has been an evolving process, a process that continues, and in which practice and theory are reflexive and assume a delicate balance. What follows might be thought of as one history, a narrative of shifts in my own practices and thoughts that occurred within dialogues with clients, colleagues and students. It might be thought of as a narrative of transformation.

            This narrative, as does all narratives, occurs with a context that I think of as my knowledge system. The system has ebbed and flowed with inspiring and challenging colleagues, clients and students whom I have met around the world. Many of these people have been associated with the Houston Galveston Institute (HGI) at one time or another. (Since many of the ideas and practices developed within HGI, those readers interested in learning more about this knowledge system are referred to Anderson, 1997 and Anderson, Goolishian, Pulliam and Winderman, 1986.) Thus, in this narrative because I believe that all creations are communal, and to acknowledge the presence of Harry Goolishian in these creations, I shift between I and we.

Stepping into a Tradition: Multiple Impact Therapy

            I was introduced to family therapy in 1970 when I joined the Children and Youth Project in the Pediatric Department at the University of Texas Medical Branch in Galveston, Texas. Shortly after arriving I heard of Harry Goolishian, a psychologist in the Psychiatry Department who was doing something-called family therapy. Because Harry and family therapy were mentioned with such enthusiasm and reverence, I wanted to meet him and know about his work, not-knowing at the time how my curiosity would influence my professional future. So, I attended a family therapy seminar where I immediately caught Harry and his colleagues’ enthusiasm for family therapy. In retrospect, I had found something that I had been searching for even though at that time I was not aware of my search. Later, I also realized that I had stepped into the middle of one of the pioneering efforts in family therapy—Multiple Impact Therapy (MIT). I want to provide a brief overview of MIT because in my version of the history of my current work, I trace some of its threads back to MIT

MIT was a short-term family-centered therapy approach conceived by Harry Goolishian and his colleagues. It was a collaborative collegial effort where a multidisciplinary team worked intensely with a family and relevant others over a two-day period. Usually a team of three with a fourth colleague acting as a consultant to the therapists met before the family arrived to review available information and to share hypotheses with each other. The consultant was key in all team meetings facilitating team members’ exchange of impressions and information, and members’ analysis of their interactions with family members and with each other. The team then met with the family members and relevant others (usually community professionals who had been working with the then-called identified patient) to begin exploring definitions of the problem, including, ideas about etiology, previous treatment and expectations. This meeting (or conference as they called it) usually lasted two hours and was followed by a team member each meeting with a subsystem—parental, sibling and community professionals. The consultant rotated through the subsystem conferences, and as necessary, shared with each the focus of the others’ conversations. The two days were composed of various meetings with varying membership. Each conference’s membership was determined on a conversation by conversation basis. For instance, two therapists might meet with one family member or one therapist with the father and son; and, two meetings might overlap.

Theoretically and pragmatically MIT aimed to help a family grow as it confronted the crisis of its adolescent member by capitalizing on the rapidity of change possible in the adolescent years. MIT focused on creating a family self-rehabilitating process, and included other significant members of the extended family and relevant community professional and nonprofessionals in the therapy. An important premise was "If the family itself can become a partner in therapy, more energies are released for the task at hand" (MacGregor et al., p. viii). An important focus was the relationship among the team members. This focus was influenced by the research in the area of communications theory by Don D. Jackson and his colleagues in Palo Alto as they sought to understand and reduce interprofessional communication problem[s]. MIT was described by Robert Sutherland, the then director of the Hogg Foundation as "fresh and hopeful," having "far-reaching implications for the training of therapists" and having "many implications for [a] new social theory" (MaCGregor et al., pps. Viii-ix).

            I have often thought that MIT was an approach ahead of its time. That is, as I reflect on its key characteristics, I could be describing a contemporary theory and practice.

• The team valued the importance of the individual and their relational systems.
• Team represented a concept broader than numbers of therapists in a therapy room or behind a mirror.
• The team believed that human creativity and ingenuity were boundless.
• The team’s role was to mobilize the resources of the family and community members rather than to be the resource expert.
• The team believed in the importance of self-reflection and self-change, and in learning together with the family.
• The team valued a multiplicity and diversity of voices.
• The team believed that it was important to understand a different point of view rather than dismiss or judge it.
• The team valued each other openly probing and analyzing team members’ views in front of the family.
• The team valued live training and supervision with trainees working along side professionals and equally participating.

            Like other early pioneering family therapies MIT developed out of clinical experiences and familiar psychotherapy theories and practices inability to meet the demands faced by clinicians in their everyday practices. And, also like other early efforts, the theoretical explanations about behavior and therapy came later as clinicians searched to describe, understand and explain their work. Of course, although early MIT team members were talking about multiple realities, multiple relationships and so forth, they did not have the theoretical vocabulary for descriptions. And, although I can trace some threads of a postmodern collaborative back to MIT, the associated notions of language and knowledge were not part of the then theory and practice.

            The MIT approach, however, was part of an emerging paradigmatic shift on the edges of the field of psychotherapy. The shift represented a move from viewing human behavior as intrapsychic phenomena, to seeing it in the context of interpersonal relationships, namely the family. Family therapists adopted various systems theories as their explanatory metaphors. The family became the relational system that was the chief subject of inquiry and explanation for an individual’s problem. And, of course, this shift not only influenced psychotherapy theory but also the professional education of therapists.

            MIT gained recognition nationally and internationally and granted what had become known informally as the Galveston group a reputation for continually challenging tradition and being on the edge. When I met the then Galveston group the MIT format had continued as a practice with initial referrals and as a consultation with treatment failures. It had developed into an everyday family therapy practice in which teams of therapists met with families and significant others on an ongoing basis. And, it remained a mainstay for training therapists.

Intertwined with the MIT and everyday family therapy practice was an interest in learning, using and teaching the various family therapy theories that were developing around the States. We were particularly drawn to the theories and practices of those following and expanding the legacy of Jackson at the Mental Research Institute (MRI) and their radical move away from the traditional therapy methods that focused on "teaching the client the therapist's language" toward the therapist learning the client’s language. Historically, this interest in learning and speaking the client’s language (metaphorically and literally) proved pivotal in the shifts that occurred in our clinical experiences and the subsequent use of new theoretical metaphors.

An Interest in Language: Shifting From Hierarchical Strategy to Collaborative Inquiry

             We purposely set about on a new endeavor: to learn a client's everyday ordinary language, including their values, worldviews and beliefs as well as their words and phrases. We wanted to converse within their language and use it strategically. We believed that their language could provide clues for developing and situating our therapist ideas—problem definitions, treatment goals, strategies and interventions. We could then, for instance, use their language rhetorically as a strategic tool of therapy, as an editing tool to influence a client's story and as technique to invite cooperation toward change. We could use their language to revise faulty beliefs or to correct futile attempts at solutions. Of course, to adapt like chameleons to a client’s language required us to also pay careful attention to our own language.

            We believed if we were successful in our new endeavor that therapy would be more successful. That is, a client would be more amenable to a therapist’s diagnosis and interventions, and resistance would be less likely to occur. Overtime, however, as we continued on this path several interrelated experiences combined to create a significant turning point in the way that we thought about, talked with and acted with our clients.

            We became genuinely immersed in and inquisitive about what our clients said. We spontaneously became more focused on maintaining coherence within a client's experience and committed to being informed by their story. That is, we less and less tried to make sense of our clients’ stories, making them fit our therapists’ maps. Rather, we were absorbed with trying to understand the sense they made of things and their maps. Consequently, in this effort to learn and understand more about what they said—i.e., their stories and views of their dilemmas--our questions began to be informed by what was just said or what we later described as coming from within the local conversation rather than being informed from outside by preknowledge.

            We learned an individual’s not a family’s language. We noticed that, rather than learning a family's language, we were learning the particular language of each family member. The family did not have a language nor did a family have a belief or a reality. Rather its individual members did. And, each member's language was distinctive.

For instance, each had their own description of the problem and its solution, as well as their own description of the family and therapy. There was no such thing, therefore, as a problem, a solution, or even a family for that matter. Rather there were at least as many descriptions of these as there were system members. We were fascinated by these differences in language, including the differences in descriptions, explanations and meanings attributed to the same event or person. We had a sense that somehow these differences were valuable and held possibilities; therefore, we no longer wanted to negotiate, blur or strive for consensus (i.e., seek inga problem definition or an imagined solution). We wanted to maintain the richness of differences.

            We listened differently. Our intense interest in each person and in each version of the story found us talking to each person one at a time in a concentrated manner. We discovered that while we were talking intensely with one person that the others seemed to listen in a way that we had not experienced before. They listened attentively and undefensively, seeming eager to hear more of what the other was saying, being less apt to interrupt, correct or negate the other. We understood this as twofold. First, we conveyed in our words and actions that we were sincerely interested in, respected, gave ample time and tried to understand what each person said. Thus, the teller did not have to work so hard to try to get us to understand or convince us of their version of the story. Second, the familiar story was being told and heard differently than before. The content was the same but somehow the pieces were assembled differently; they newly fit together in a way that people had an altered sense of their experiences and each other. We did not purposefully try to influence their stories, their sensemaking. New ways of understanding their life struggles and relationships, for them and for us, seemed a natural consequence of this new way of talking and listening.

            We learned and spoke the client’s everyday ordinary not our professional language. When we talked about our clients outside the therapy room we identified them by their self-descriptions and shared their self-told stories as they had narrated them to us. For instance, in hospital staffings or school consultations we described our clients and told their stories in their words and phrases. In doing this we found that we were using clients’ everyday ordinary language rather than our professional language.

            Telling our clients’ stories as they had told them to us captured the uniqueness of each client, making them and their situation come alive. Students often commented that clients no longer seemed like look-alike classifications (known visions produced by professional descriptions, explanations and diagnoses) that overlooked their humanness. The sameness that dominated from professional language receded and the specialness of each client emerged. Consequently, this different way of talking about and thinking about our clients in their ordinary language not only made clients more human but brought forward the therapist as human, leaving the therapist as technician behind.

            We suspended our preknowledge and focused on the client’s knowledge. As our interest in and value of the client’s story grew, so did our interest in their knowledge and expertise on themselves and their lives. Our own knowledge and content expertise continued to be less important. We found ourselves spontaneously and openly suspending our preknowledge—our sensemaking maps, biases and opinions about such things as how families ought to be, how narratives ought to be constructed and what were more useful narratives. By suspend I mean we were able to leave our preknowledges hanging in the forefront for us and others to be aware of, observe, reflect on, doubt, challenge and change. The more we suspended our own knowing the more room there was for a client's voice to be heard and for their expertise to come to the forefront.

            We moved from a one-way inquiry toward a mutual inquiry. As we immersed ourselves in learning our client’s language and meanings in the manner that was developing, we realized that we and our clients were spontaneously becoming engaged with each other in a mutual or shared inquiry. We were engaged in a partnered process of coexploring the problem and codeveloping the possibilities. Therapy became a two-way conversational give-and-take process, an exchange and a discussion and a criss-crossing of ideas, opinions and questions. Consequently the stoiy telling process itself ,became more important that the story’s content or details. We began to focus on the conversational process of therapy and how we could create a space for and facilitate the process.

            Our need for interventions dissolved. As we learned about a client’s language and meanings, we spontaneously began to abandon our expertise on how people ought to be and how they ought to live their lives. We found, for instance, that we did not need to use this expertise to create in-session or end-of-session interventions. When we examined what we thought were individually tailored therapist-designed interventions, we discovered that they were not interventions at all in the usual sense. That is, although we thought we were doing "interventions," we were not. The ideas and actions—the new possibilities--emerged from the local therapy conversations inside the therapy room and were not brought in by us as an outside expert. And, because the client participated in the conception and construction of the newness generated through conversaton, the newness was more coherent with, logical for and unique to the family and its members. Consequently, our therapy began to look more like everyday ordinary conversations, sometimes described by others expecting interventions or content expertise as parsimonious, unexciting and even doing nothing.

            We entertained uncertainty. All of these experiences combined to leave us in a constant state of uncertainty. We began to appreciate and value this sense of unpredictability, which in a strange way provided feelings of freedom and comfort. We had the freedom of "not-knowing," of not having to know. Not-knowing liberated us, for instance, from needing to know how clients ought to live their lives, the right question to ask or the best narrative. We did not need to be content or outcome experts. We did not need to be narrative editors or use language as an editing tool. We were comfortable that our knowledge was not superior to our client’s knowledge. In turn, our not-knowing position allowed an expanded capacity for imagination and creativity. Not-knowing became a pivotal concept and would mark a significant distinction between our and others’ ideas about therapy. I will address the concept of not-knowing more in Part II.

            We were more aware of the reflexive nature of our practicing and teaching. We were influenced by our students’ voices—their remarks, questions and critiques. Their voices forced new ways of thinking about, describing and explaining our work. Students often commented on the positive way we spoke about our clients. They described our manner and attitude as respectful and humble. They were amazed at our excitement about each client and clinical situation. They were astonished that we in fact seemed to like those clients whom others might deem socially detestable. They were surprised by how many of our mandated referrals not only came to the first session but continued. They were puzzled that our therapy looked like "just having a conversation." In an effort to describe our approach to therapy, a student once wondered, "If I were observing and did not know who the therapist was, I wonder if I could identify them?"

             We were going public and hierarchies were dissolving. These combined clinical experiences and our conversations with others about our experiences influenced our teamwork and teaching. For the most part family therapy teams are organized in a hierarchical and dualistic manner. The team members behind the mirror are attributed a meta-position where they are thought to able to observe more correctly and quickly--as if they are "real knowers." The mirror is thought to give the members protection from being swooped up in the family's dysfunction, faulty reality or emotional field. The team members talk privately and come to a synthesis of their multiple voices—their hypotheses, suggestions, questions or opinions--and funnel what they believe to be the most fruitful consensus conclusion to the therapist and the family. What is taken back to the client is preselected by a team and therapist and looses the richness of the multiplicity of views. Whether a therapist is involved in the discussion or not, the therapist is often merely an implicit or explicit voice of the team, a carrier of their meta-view that will influence subsequent actions and thoughts in the therapy room.

            We began to realize how much of the richness of diversity was lost when we preselected what clients should hear when clients began to be inquisitive about the teams’ messages. In some instances clients demanded to meet the team "face-to-face" and hear what each of them had to say. Sometimes, clients stood up, facing the mirror, pointing their fingers and talking to the team behind it. Baffled and thinking perhaps we needed to more clearly deliver the teams’ words, we experimented by writing every thought, question and suggestion so that a therapist could take these into the therapy room. This not only proved timely and cumbersome, but often the client still wanted to talk with the team. So, we sent the team into the therapy room so that each member could offer their ideas in person and then return to the other side of the mirror. The clients still had questions. So, we next encouraged the client and therapist to talk with each other about what they heard the team say. We were surprised with what each person was most occupied by or ignored and what each liked or disliked. We were fascinated by the conversations they had, how together the client members with each other and with the therapist puzzled over the team’s offerings and we were impressed with what they collectively did with what they heard.

            The therapist was no longer an agent of the team who hid behind the mirror and no longer had privileged access to the team’s thoughts. Neither the team nor the therapist chose what could be heard. The therapist could now genuinely and spontaneously puzzle with the family about what they all heard together. This led to a growing sense of openness and unity between the team, therapist and family. Family members and the therapist felt free to ask a team member for clarification or to disagree with them. This began to make all thoughts more public and to collapse the artificial professionally imposed boundaries between team members, therapist and family.

            We placed multiple therapists in the room. In learning situations, we preferred two-person student therapy teams. We encouraged both students to be in the therapy room because we found that if one were in the room and the other behind the mirror, often the student behind the mirror felt, or at least acted if, they knew more. The student in the therapy room often felt awkward, as if they should have known or discounted, as if their thoughts were not as important as those were behind the mirror.

            We encouraged the students to talk with each other, share their ideas with each other, question each other and disagree with each other openly in front of the client. If they had conversations (i.e., with each other, with a supervisor and a referring person) about the family outside of their presence they were to offer a summary of their conversations to the family when they next met with them. This part of our history is compatible with Tom Andersen and his colleagues' development of the innovative reflecting team concept and practice (Andersen, 1987). Both approaches place an importance on respecting the integrity of the other, making room for multiple voices and encouraging therapists to share thoughts publicly.

            These early, and subsequent, shifts in our clinical experiences not only influenced the way that we began to prefer to practice but also compelled us to search for more suitable metaphors to describe, explain and understand these experiences. We purposely explored and sometimes serendipitously bumped into theories of biology, physics, anthropology and philosophy. These included the notions of chaos theory, randomness, and evolutionary systems, structure determinism and autopoiesis, constructivist theory, language theories, narrative theories, postmodern feminist perspectives, hermeneutics and social construction theories. In Part II I will discuss how these notions influenced how we came to describe, explain and understand our clinical experiences. I will discuss which of these theories and related premises remain in the forefront and the implications of our new views of the notions of language and knowledge changed and gained prominence.

References

Anderson, H. (1997). Conversation, Language and Possibilities: A Postmodern Approach to Therapy. New York: Basic Books.

Anderson, H., Goolishian, H., Pulliam, G. & Winderman, L. (1986). The Galveston Family Institute: A personal and historical perspective. In D. Efron (Ed.).Journeys: Expansions of the Strategic-Systemic Therapies. (pp. 97-124). New York: Bruner/Mazel.

MacGregor, R., Ritchie, A.M., Serrano, A.C., Schuster, F.P., McDanald, E.C. & Goolishian, H.A. (1964). Multiple Impact Therapy with Families. New York: McGraw-Hill.

 

 

If you have questions or would like to talk with me, email: harleneanderson@earthlink.net