A POSTMODERN COLLABORATIVE APPROACH TO THERAPY:

BROADENING THE POSSIBILITIES OF CLIENTS AND THERAPISTS

 

Harlene Anderson, Ph.D.

Houston Galveston Institute • Taos Institute

 

 

What Has Influenced My Ideas and Work

Over the years my work has been influenced by therapy conversations and conversations about therapy that I have taken part in with clients, colleagues, and students. In particular, I have had a sustained interest in clients’ experiences of therapy: What are their descriptions of successful and unsuccessful therapy and what do they identify as the characteristics of successful and unsuccessful client-therapist relationships? This question is always in the background:

 

"How can therapists create the kinds of conversations and relationships with

their clients that allow all participants to access their creativities and develop possibilities where none seemed to exist before?"

 

The primary contexts of my practices include the Houston Galveston Institute and the clinical and training programs that I consult with abroad. The Institute is a non-profit clinical, teaching, consultation, and research center where we work mostly with public agency clients who are often mandated to therapy and our students include master level, doctoral level, and postdoctoral interns.

 

As the world around us quickly changes--shrinking, becoming enormously more complex and uncertain--and our societies and cultures are becoming more intertwined. Many familiar explanatory concepts seem no longer helpful in accounting for and addressing the complexities of these changes and the impact they have on human beings and our everyday lives. What I have learned from clients has led me to question some familiar concepts such as: universal truths, knowledge and knower as independent, language as representative, and the meaning is in the word. Such concepts risk placing human behavior into frameworks of understanding that seduce therapists into hierarchical expert-nonexpert structures, into discourses of pathology and dysfunction, and into a world of the known and certainty.

 

The Postmodern Challenge

A search for new ways to describe and understand clients’ successful experiences of therapy and therapists led me down a meandering path and to the place where I have now paused: a postmodern collaborative approach to therapy, education, research, and organizational consultation. Postmodernism (referring to the philosophical movement rather than the artistic movement) offers a broad challenge to the culture, traditions, and practices of the helping professions. It invites us to examine and reimagine our traditions and the practices that flow from them, including: how problems are conceptualized, client-therapist relationships, the process of therapy, and therapists’ expertise.

 

Broadly speaking, postmodern refers to a family of concepts that critically challenges the relevance of universal or meta-narratives, including a self-critique of postmodernism itself. The central challenge, according to psychologist Kenneth Gergen (2001), focuses on the assumptions of the centrality of individual knowledge, an objective knowable world, and language as the carrier of truth. Although the postmodern family has many diverse branches, there is a common consistent trait that I find appealing: the concept that knowledge and language are relational and generative.

 

Knowledge (what we think we know or might know) is linguistically constructed, its development and transformation is a communal process, and the knower and knowledge are interdependent. Knowledge, therefore is not static or out there waiting to be discovered; rather, it is fluid and created. Authoritative discourses from this perspective give way to knowledge constructed on the local level that has practical relevance for the participants involved.

 

From a hermeneutic philosophical perspective understanding is an interpretative process that is influenced by language, history, and pre-understandings. We are always in the process of trying to understand and searching for meaning, the search itself creates meaning. Language in this perspective is the vehicle through which we try to understand and create knowledge about our world and ourselves.

 

Language (spoken and unspoken communication or expression) is the primary vehicle through which we construct and make sense of our world. As philosopher Richard Rorty suggests, language does not mirror what is; for instance, it is not an outward description of an internal process and does not describe accurately what actually happened. Rather, language allows a description of what happened and an attribution of meaning to what happened. It gains it’s meaning and its value through its use: the meaning of a word is in its use. Language thus limits and shapes our thoughts and our expressions.

 

What is created in and through language (realities such as knowledge, truth, and meaning) is multi-authored among a community of persons. That is, the reality that we attribute to the events, experiences, and people in our lives does not exist in the thing itself; rather, it is a socially constructed attribution that is created within a particular culture and is shaped and reshaped in language. What is created, therefore, is only one of multiple perspectives (realities such as narratives or possibilities. Language, therefore, is fluid and creative.

 

Like Gergen, I do not suggest, nothing exists outside linguistic constructions; whatever exists simply exists, irrespective of linguistic practices (Gergen, 2001). Rather I focus on the meanings of these existences and the actions they inform, once we begin to describe, explain, and interpret them.

Transformation (e.g. new knowledge, expertise, identities, and futures) therefore, is inherent in the inventive and creative aspects of language. This transformative nature of language invites a view of human beings as resilient; it invites an appreciation of each person’s contributions and potentials. This invitation is similar to psychologist Mikhail Csikszentmihali’s emphasis on positive psychology as more promising than deficit-based psychology.

 

Human Systems as Linguistic Systems

Combined, the above perspectives have influenced my notion of human beings as systems in language or language systems. They are meaning-making systems. Therapy becomes one kind of language or meaning-making system.

 

Philosophical Stance: A Way of Being

I think of my approach to therapy as a philosophy of therapy rather than a theory or model. Philosophy focuses on questions about ordinary life: self-identity, relationships, mind, and knowledge. It involves ongoing analysis, inquiry, and reflection.

 

The postmodern conceptualizations of knowledge and language inform what I call a philosophical stance. This refers to a way of being: a way of thinking about, experiencing, being in relationship with, talking with, acting with, and responding with the people we meet in therapy. Consistent with this view, the philosophical stance becomes a philosophy of life—a worldview that does not separate professional and personal.

 

Characteristics of the Philosophical Stance

 

The philosophical stance has several interrelated characteristics. The stance represents a belief-an attitude, a posture, a tone—that communicates to the other that they are a unique human being, not a category of people, and that they are recognized and have something to say worthy of hearing. If a therapist holds this belief, it becomes an authentic and natural way of connecting, collaborating, and constructing with others, not a technique. Combined these characteristics invite the opportunity for a therapy that is more participatory and collaborative and less hierarchical and dualistic. And importantly, though the stance may have common identifiable expressions, it is unique to each therapist and human system, the circumstances, and what is required.

 

Conversational Partners. The collaborative therapist and client become conversational partners as they engage in dialogical conversations and collaborative relationships. Dialogical conversation and collaborative relationship refer to a two-way process: a back-and-forth, give-and-take, in-there together activity and connection where people talk with each other rather than to each other. Inviting this kind of partnership requires that the client’s story take center stage. It requires that the therapist constantly learn—listening and trying to understand the client from their perspective and in the client’s language.

 

In my experience, this therapist learning position acts to spontaneously engage the client as a co-learner or what I refer to as a mutual or shared inquiry as they co-explore the familiar and co-develop the new. In this inquiry, the client’s story is told in a way that clarifies, expands, and shifts it. The newness is created is co-constructed from within the conversation in contrast to the newness being imported from outside of it. In this kind of conversation and relationship all members have a sense of belonging. And, in my experience, this sense of belonging invites participation and shared responsibility. Dialogical conversations and collaborative relationships go hand in hand. Think about it:  the kinds of relationships we have form and inform—enhance and limit--the kinds of conversations we have and vice versa.

 

Client as Expert. The collaborative therapist considers the client as the expert on his or her life and as the therapist’s teacher. The therapist respects and honors the client’s story and takes seriously what the client has to say and how they choose to say it.  This includes the many ways that the client may express their knowledge.  For instance, the therapist does not have expectations that a story should unfold in chronological order or at a certain pace. The therapist does not expect certain answers and does not judge whether an answer is direct or indirect, or right or wrong. Inherent in this approach is an appreciative belief in the good and the positive--which most human beings value, want, and strive toward healthy successful relationships and qualities of life.

 

Often a therapist is working with more than one person whether that person is a member of the client’s personal or professional system. The therapist appreciates, respects, and values all of the voices and their realities. Multiple voices and their multiple realities become the richness of differences with infinite possibilities inherent in them.

 

Not-Knowing The collaborative therapist is a not-knowing therapist. Not-knowing refers to the way that the therapist thinks about their knowledge and expertise. The therapist does not believe they have superior knowledge or a monopoly on the truth. They bring and offer what they know or think they might, but always hold it and present it in a tentative manner. That is, the therapist offers his or her voice, including previous knowledge, questions, comments, opinions, and suggestions as simply food for thought and dialogue. The therapist remains willing and able to have their knowledge (including professional and personal values and biases) ignored, questioned, and changed.

 

Not-knowing can be misunderstood as a therapist knowing nothing, pretending ignorance, or forgetting what they have learned. No. It simply refers to how a therapist positions oneself with their knowledge, including the timing and the intent with which that knowledge is introduced.

 

Being Public. Therapists often learn to operate from invisible private thoughts—professionally or personally and theoretically or experientially informed—such as diagnoses, judgments or hypotheses about the client that influence how they listen and hear and guide their questions. From a collaborative stance, the therapist is open and makes their invisible thoughts visible. For instance, if a therapist has an idea or an opinion it is shared with the client, offered for food for thought and dialogue. It is not a matter of whether a therapist can or cannot say or ask about anything, but rather the manner, attitude, and timing in which they do so. Keeping therapists’ thoughts public minimizes the risk of therapist and therapist-client monologue—being occupied by one idea about a person or situation. Monologue can subsequently lead to a therapist’s participating in, creating or maintaining what are often thought of as internal characteristics of clients such as ‘resistance’ and ‘denial.’

 

Mutual Transformation. The therapist is not considered 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 along side 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 when involved in a dialogical conversation and collaborative relationship.

 

Everyday Ordinary Life. Therapy from a postmodern collaborative perspective becomes less hierarchical and less dualistic. It resembles more the everyday ordinary conversations and relationships that most people prefer. This does not mean chitchat, without agenda, or a friendship. Therapy conversations and relationships occur within a particular context and have an agenda: a client wants help and a therapist wants to help. Clients and problems are not categorized as challenging or difficult. Each client is simply thought to present with a dilemma of everyday ordinary life.

 

Challenges and Implications:

 

If a therapist assumes such a philosophical stance, they will naturally and spontaneously act and talk in ways that create a space for and invite conversations and relationships where clients and therapists connect, collaborate, and construct with each other. Because the philosophical stance becomes a natural and spontaneous way of being as a therapist, theory is not put into practice and there are no therapist techniques and skills, as we know them as is commonly the case with most therapies.  Instead, the characteristics are the “guidelines.”

 

A postmodern collaborative approach contrasts with therapy approaches in which professional knowledge externally defines problems, solutions, and preferred outcomes--creating expert-nonexpert dichotomies. The strength of the approach is in the relationships and conversations that are created between the client and the therapist and in the possibilities inherent in these. Inherently, therapy becomes less hierarchical and dualistic, less technical and instrumental, and more an insider rather than an outsider endeavor.

 

Clients report a sense of ownership, belonging, and shared responsibility. Therapists report a newfound sense of appreciation for their clients, a renewed sense of enthusiasm, and an increased sense of competency and hopefulness for their work. They also report a reduction in burnout.

 

 

RECENT PROJECTS AND AREAS OF INQUIRY

 

I translate my postmodern collaborative biases to all of my practices and have found that possibilities are broadened for both client and therapist. My longtime interest in the client’s voice and what we can learn from them continues in my present areas of inquiry which include:

 

Handmaidens to Power. I interviewed women who are executive/administrative assistants to corporate leaders to learn about their professional and personal histories, their roles and responsibilities in the organization, and how they think they contribute to their executives’ and their organization’s success. I invited them to identity their knowledge and skills, how these are used or underutilized. I was also interested in how they described their relationships with their bosses and what they identified as the characteristics of successful relationships?

 

The Voices of Homeless Women with a History of Substance Abuse. I wanted to learn from the women about their unique experiences regarding their problems and prior treatment, what they identified as the characteristics of successful treatment, and what they identified as their competencies. I wanted to invite their voices and expertises to help provide personalized, individually tailored counseling. I created, along with colleagues Judy Elmquist, Debbie Feinsilver, and Eileen Murphy, a collaborative clinical research project in which we facilitated women accessing their own voices, interviewing and talking with each other, and producing their collective “advice to therapists.”

 

Maximizing the Effectiveness of Therapists and Clients in the Juvenile Justice System: Seeking the Potential. I was puzzled as I met two kinds of therapists who worked with the juvenile justice population: burned-out therapists who talked pejoratively about their work and their clients and therapists who talked positively and with energy about their clients and their work. Along with colleagues, I created a research forum in which we could learn from an agency therapy staff and their administrators, community colleagues, and clients what contributes to therapist competence and effective outcomes in this challenging population.

 

 

REFERENCES

Andersen, T. (2004) A COLLABORATION, of some called psychotherapy: Bonds filled of expressions, and expressions filled of meaning. Paper presented at the Common Grounds Conference, Hameenllinna, Finland, June 10, 2004.

 

Anderson, H. (2003) Social construction therapies. In G. Weeks, T. L. Sexton & M. Robbins (Eds.) Handbook of Family Therapy. New York: Brunner-Routledge.

 

Anderson, H. (2001) Postmodern collaborative and person-centered therapies: What would Carl Rogers say? Journal of Family Therapy. 23:339-360.

 

Anderson, H. (2001) Becoming a postmodern collaborative therapist: A clinical and theoretical journey, Part II. Journal of the Texas Association for Marriage and Family Therapy. 6(1):4-22.

 

Anderson, H. (2000) Becoming a postmodern collaborative therapist: A clinical and theoretical journey, Part I. Journal of the Texas Association for Marriage and Family Therapy. 5(1):5-12.

 

Anderson, H. (2000) Supervision as a collaborative learning community. Supervision Bulletin. Fall 2000. Washington, D.C.: American Association for Marriage and Family Therapy.

 

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

 

Anderson, H. (1997) What we can learn when we listen to and hear clients’ stories. Voices: The Art and Science of Psychotherapy. 33(1):4-8.

 

Anderson, H. & Goolishian, H.A. (1988) Human systems as linguistic systems:  Evolving ideas about the implications for theory and practice. Family Process 27:371-393.

 

Boyd, G. (1996) The Art of Agape Listening. Sugarland, TX: The Agape Press.

 

Gergen, K.G. (1999) An Invitation to Social Construction. Newbury Park, CA: Sage Publications.

 

Rorty, R. (1979) Philosophy and the Mirror of Nature. Princeton, NJ: Princeton University Press.

 

Seikkula, J. & Olsen, M. (2003) The open dialogue approach to acute psychosis: Its poetics and micropolitics. Family Process 42:403-418.

 

Seligman, M.P. & Csikszentmihalyi, M. (2000). Positive psychology. American Psychologist, 55(5),:5-14.

 

Shotter, J. (1993) Conversational Realities: Constructing Life through Language. Newbury, CA: Sage Publications.