Harlene Anderson: Selected Writings

POSTMODERN SOCIAL CONSTRUCTION THERAPIES (Draft)

Harlene Anderson, Ph.D.
Houston Galveston Institute and Taos Institute

 Introduction

Family therapy as we know it today can be traced back to two main roots. One perspective—the etiology, insight, and family patterns view of Nathan Ackerman—focused on the individual in the family and viewed families as a collection of individuals. Coming from within the child guidance movement and drawing from psychodynamic and social theories, Ackerman was interested in family role relationships and their influence on the intrapsychic development and make-up of the individual (Ackerman, 1958, 1966). The other perspective, the rhetorical communication and interactional view, grew from the early works of Donald Jackson and Gregory Bateson and their later collaborative efforts with interdisciplinary colleagues at the Mental Research Institute in California (Watzlawick & Weakland, 1977). They reached out to the social sciences and the natural sciences to understand families, early on developing a theory of communication and later focusing on the role of language in the construction of reality. They conceptualized families as cybernetic systems of interconnected individuals and questioned the concept of psychological problems as illness. They viewed psychosis, for instance, as an interpersonal relational problem rather than as an intrapsychic problem or a disease of the mind (Bateson, 1972; Watzlawick & Weakland, 1977; Watzlawick, Beaven, & Jackson, 1967). [ETS1] The current therapies primarily based in postmodern and social construction philosophies that have evolved over the last twenty plus years represent a hybrid-like ideological shift that can be traced back to the California rootstock and to developments in philosophy and the social sciences.

During these years the world around us was fast changing, shrinking, becoming enormously more complex and uncertain and was impacting human beings and our everyday lives. Familiar concepts such as universal truths, knowledge and knower as independent, language as representative, and the meaning is in the word no longer seemed helpful in accounting for and dealing with the changes and complexities and their associated impact. The familiar systems concepts, whether first- or second-order, did not help either. Such concepts risked placing human behavior into frameworks of understanding that seduced therapists into hierarchical expert-nonexpert structures, into discourses of pathology and dysfunction, and into a world of the known and certain. Among developments in philosophy and the natural and social sciences, postmodernism and social constructionism have emerged as more fitting, offering alternative ways to think of people and their problems and therapists’ relationship to both.

Broadly speaking, postmodern refers to a family of concepts that critically challenge the certainty of objective truths, the relevance of universal or meta-narratives, and language as representative of the truth (Lyotard, 1984; Kvale, 1992[ETS2] ). Postmodernism is not a meta-narrative, but rather one among numerous others. Inherent in postmodernism is a self-critique of postmodernism itself; that is, it invites and demands continued analysis of its premises and their applications. Social construction, a particular postmodern theory, places emphasis on truth, reality, and knowledge as socially embedded and the role that language plays in the creation of these products. According to the foremost proponent of social constructionism, social psychologist Kenneth Gergen (1982, 1985, 1994[ETS3] , 1999), it is “...principally concerned with explicating the processes by which people come to describe, explain, or otherwise account for the world (including themselves) in which they live ” (1985, p. 266).

Language emerged as the meaningful and useful metaphor, especially its role in the creation of knowledge, the power of discourse and transformation, and its role in human systems and interaction. This ideological and epistemological shift holds significant implications and challenges for therapists’ thoughts, actions, and interpretations of others. It offers a broad challenge to the culture, traditions, and practices of the helping professions. It invites reexamination and reimagination of psychotherapy traditions and the practices that flow from them, including: how problems are conceptualized, client-therapist relationships, the process of therapy, and therapists’ expertise. For varying reasons, a focus away from the family as the limited target of treatment is inherent in this shift. Instead, the postmodern/social construction ideology-informed approaches are not limited to families but are applicable to individuals, couples, families and groups. In the words of family therapist historian Lynn Hoffman (2002), [ETS4] the shift changed the definition of what needs to be changed: The target has moved from the unit to the situation. Problems are not believed to reside within the person, the family, or the larger system. Instead, problems are considered as linguistic constructions, with various punctuations such as the local dialogical context and process of people’s everyday lives and the subjugating and oppressing influence of dominant universal narratives. Thus, the aim of the therapist has changed: to set a context and facilitate a process for change, rather than to change a person or group of people.

Common Premises

Postmodern social construction premises influence a dialogical and relational perspective on understanding human behavior, including the dilemmas of everyday life and a therapist’s stance regarding these. Although there are significant variations among the postmodern social construction therapies, generally speaking, some common basic premises (although with slight variations and differences in emphasis) include:

1. The notion of objective discoverable knowledge and universal absolute truths is viewed skeptically.
2. The world, our truths, is not out there waiting to be discovered.
3. Knowledge and social realities are linguistically and communally constructed; reality, therefore is a multiverse.
4. Language is the vehicle through which people know and attribute meaning to their world, including realities about the people, events, and experiences of their lives. Neither problems nor solutions exist within a person or a family; they take shape and have meaning within a relational and dialogical context.
5. The goal of therapy is to create a relational and dialogical context for transformation.
6. Transformation--outcomes and solutions--is inherent and emerges in dialogue.
7. Transformation is unique to the client and the participants in the therapy conversation and therefore cannot be predetermined ahead of time.
8. The person and self, including development and human agency, are viewed as interdependent, communal, and dialogic entities and processes rather than as isolated autonomous interior ones.
9. People have multiple identities and their Identities are shaped and reshaped in social interaction.

Common Values

Therapies based on these premises share common values (with slight variations and emphasis):

1. Taking a non-pathological, non-judgmental view.
2. Appreciating, respecting and utilizing the client’s reality and uniqueness.
3. Using story and narrative metaphors.
4. Being collaborative in structure and process.
5. Avoiding labeling and blaming classifications of individuals and families, or their behaviors.
6. Being more “public” or “transparent” with information and biases.

More so than others, the postmodern/social construction therapies have captured practitioners’ interest in learning about the effectiveness of their therapy in their everyday settings (Andersen, 1997a; Anderson, 1997b). [ETS5] This interest has created a number of studies that provide in-depth first-person descriptions of the lived experience of therapy processes and the nuances of its effectiveness, or lack of, from both therapists and clients’ perspectives. What is learned from the “insiders” can have relevancy to both current and future practices and yields a more thorough story of the nuances of therapy than can be captured in “outsider” qualitative research. Together these efforts join other family therapy approaches at the forefront of promoting multiple alternative research methodologies, particularly those categorized as qualitative such as single case studies, ethnographic interviews and narrative accounts (see Addison, Sandberg, Corby, Robila & Platt, 2002). [ETS6] 

A growing number of therapists place their practice under a postmodern/social construction umbrella or are heavily influenced by it. The author chose to discuss three therapies in this chapter: the collaborative approach of Harlene Anderson and Harry Goolishian (Anderson & Goolishian, 1988, 1992; Anderson, 1997a)[ETS7] , the narrative approach of David Epston and Michael White (White & Epston, 1990; White, 1995), [ETS8] and the solution-focused approach of Insoo Berg and Steve DeShazer (de Shazer, 1985, 1988, 1991; Berg & de Shazer, 1993). [ETS9] This choice was made because these three therapies are often the core therapies that are typically found in graduate and postgraduate family therapy courses with titles such as postmodern/social construction, advanced systems, and narrative therapies. Other significant contributors to the emergence of postmodern social construction practices included in these courses who must be acknowledged are Tom Andersen in Norway, and Lynn Hoffman and Peggy Penn in the United States (Andersen, 1987, 1991; Hoffman 1981, 1998, 2002; Penn, 1985, 2001; Penn & Frankfurt, 1994[ETS10] , and Jaakko Seikkula in Finland 1993, 2002). Although each of the above approaches is historically or currently influenced by the postmodern social construction perspectives to various extents, they are not necessarily limited to these influences and their originators might make different theoretical and practice applications punctuations than this author.[i]

Some Distinctions

            Comparing and contrasting can be helpful in learning. A reader, therefore, might want to do this as they read along. In doing so they might note these distinctions among the three approaches regarding power, client-therapist relationships, the therapist’s role, and the process of therapy.

1. Collaborative and Narrative therapies place importance on power. Similarly, they value client-therapist relationships and systems that are more egalitarian and less hierarchical; they are careful to be respectively, public and transparent about their views and biases. Dissimilarly, Narrative Therapy holds an agenda to liberate people from constraining or oppressive dominant narratives; Collaborative therapists pay attention to these narratives when the client thinks it is important; and Solution-Focused therapists do not find the issue relevant.
2. Collaborative and Narrative therapies place emphasis on the client-therapist relationship, although perhaps a different emphasis; Solution-Focused therapies do not accent the relationship.
3. Therapists’ expertise can be thought of as along a continuum in terms of importance and intent. Collaborative therapists espouse that the clients are the experts on their lives and the therapist is in a not-knowing position regarding it. Narrative therapists are experts in helping clients achieve preferred stories and living them, and Solution-Focused therapists use their expertise in strategies toward goals.
4. Collaborative therapists favor a process of mutual inquiry and are not invested in a content outcome; they view themselves as walking along side their client toward an unknown destination of new meaning and action. Narrative therapists favor a process that leads to preferred stories and people being able to live these; their role is like a narrative editor. Solution-Focused therapists overtly steer clients toward solution-talk and a specified behavioral goal.
5. Observers might notice a Narrative or Solution-Focused therapist systematically, for instance, ask questions and make comments as if moving the conversation in a particular direction; whereas, a Collaborative therapist might be described as wandering here and there.

Collaborative Therapy

History and Background: A Search

            The Collaborative Approach evolved from the twenty-year mutual work of Harlene Anderson and Harry Goolishian and their colleagues and students, beginning in the early 1970s within the context of a medical school and later in what is now the Houston Galveston Institute. Its roots can be traced back to Goolishian’s participation in the early Multiple Impact Therapy (MIT) family therapy research project at the medical school (McGregor, Ritchie, Serrano, Schuster, McDanald & Goolishian, 1964). Quite innovative at the time, the theory used to describe and understand the MIT practice was limited by the psychodynamic, psychoanalytic, and developmental theories available at that time. Soon deciding that these theories could not provide adequate descriptions of their clients and their experiences of therapy, Goolishian and his colleagues began what became a continuous search for new theoretical tools. Now, the stage was set for the important reflexive process of the interaction of practice and theory. That is, new practices led to new theories that influenced the practices, which in turn began to require new theories, and so forth. This early interest was influenced by the voices of clients and therapists–their experiences, descriptions, and understandings of successful and unsuccessful therapy— and has remained an important thread throughout the development of the Collaborative Approach.

Major Theoretical Constructs: Human Systems as Linguistic Systems

As Anderson and Goolishian and their colleagues searched for new descriptions and understandings, they went down a meandering path to revolutions in the social, natural, and physical sciences, philosophy, and eventually to the postmodern philosophical movement and the works of thinkers such as (Bakhtin, 1981; Bruner, 1986, 1990; Geertz, 1983; Gergen, 1985; Lyotard, 1984; Rorty, 1979; Schon, 1984; Shotter, 1993; Vygotsky, L.S., 1986; and Wittgenstein, 1953 who focused on the relational and generative nature of knowledge and language.. Anderson and Goolishian found contemporary hermeneutics and social constructionism primarily relevant: the concepts of a socially constructed world of truths and knowledge, language as the vehicle and product of human interchange, understanding as an interpretive process, and language as generative. These concepts took their interests in language, which had been inspired by the work of Bateson and his colleagues at the Mental Research Institute in Palo Alto, California, away from learning clients’ language toward using it in a strategic sense and away from systems theories and in a different direction.

Specifically, knowledge--what we think we know or might know--is linguistically constructed. Furthermore, its development and transformation is a communal process, and the knower and knowledge are interdependent. Knowledge, therefore, is neither static nor discoverable; 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. Language in this perspective—spoken and unspoken communication or expression—is the primary vehicle through which we construct and make sense of our world and ourselves. As philosopher Richard Rorty (1979) 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 it. Language gains its meaning and its value through its use. Thus, it limits and shapes thoughts and experiences and expressions of them. 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).[ii]  Language, therefore, is fluid and creative.

Combined, these perspectives influenced Anderson and Goolishian to move away from the familiar, general, and second-order cybernetic systems notions on which family therapy had been based to the notion of human beings as systems in language or language systems (Anderson & Goolishian, 1988). Human systems are meaning-making systems. Therapy becomes one kind of language or meaning-making system. Originally, Anderson and Goolishian referred to their work as a Collaborative Language Systems Approach and more recently Anderson has simplified it to Collaborative Therapy (Anderson, 2001a; Anderson 2001, b; Anderson, 2000).

Etiology of Clinical Problems

A Collaborative therapist takes the position that there is no such thing as an objective problem. Problems are a form of co-evolved meaning that exists in ongoing communication among others and self. Through our interpretations we attribute meaning to others, events, actions, and ourselves. Problems cannot be separated from an observer’s conceptualizations.

Problems are considered part of everyday living; they are not considered the product of pathological individuals or dysfunctional families. What is problematic to one person or family may not be problematic to another: “Each problem is conceived as a unique set of events or experiences that has meaning only in the context of the social exchange in which it happened” (Anderson 1997a, p.74). Problems can be perpetuated and escalated through conversational breakdowns, a failure to maintain generative conversations (Anderson, 1986, 1997a).[ETS11] 

Assessment

            Traditional notions of diagnosis and assessment are based on the idea of objective reality, commonality across problems, and linear cause and effect. Inherent in the notion of assessment is a determination of what is: A problem can be defined, its cause can be located, and it can be solved. From a collaborative perspective each observation, problem description, and understanding is unique to the people involved and their context. Problems are collaboratively explored and defined through conversation. Because conversation or dialogue is generative, a problem is never fixed; it shifts as its definitions, meanings, and shapes change over time through conversation.

            Although collaborative therapists seldom find traditional notions of diagnosis and assessment useful, they acknowledge that they and their clients live and work in systems in which these are important. This is simply a challenge for therapists to respect, be in conversation with, and navigate multiple realities. In other words, it is a challenge to be true to one’s beliefs and act accordingly whatever the situation or context.

Clinical Change Mechanisms and Curative Factors: Collaborative Relationships and Dialogical Conversations

Therapy is a process or activity that involves collaborative relationships and dialogical conversations. It is a process of coexploring, clarifying, and expanding the familiar; therapy invites and forms the “unsaid:” the newness. Although newness in some form or another—stories, self-identities, etc—can be the result, the emphasis of therapy is on this process, not on content or product. Collaborative therapists strive to be aware of this essentialist trap.

            Dialogical conversation is distinguished by shared inquiry. Shared inquiry is the mutual process in which participants are in a fluid mode and is characterized by people talking with each other as they seek understanding and generate meanings; it is an in-there-together, two-way, give-and-take, back-and-forth exchange (Anderson Anderson & Goolishian, 1988; Anderson, 1997[ETS12] , 1997a). Dialogical conversation begins with the therapist as a learner whose interest and curiosity about the client naturally invites the client into shared inquiry. This shift and the interpretive process of shared inquiry are transformational processes.

Language is the primary vehicle for therapy. Transformation (e.g. new knowledge, meanings, expertise, identities, agency, actions, and futures) is inherent in the inventive and creative aspects of language, and therefore, dialogue: “In dialogue, new meaning is under constant evolution and no ‘problem’ will exist forever. In time all problems will dissolve” (Anderson & Goolishian, 1988 p. 379). This transformative nature of language invites a view of human beings as resilient, and it invites an appreciation of each person’s contributions and potentials.

Specific Interventions: A Philosophical Stance

Like most other postmodern/social construction oriented therapies, Collaborative Therapy does not consider the therapist’s position or actions as techniques. Anderson and Goolishian (1988) distinguished their work as a philosophy of therapy rather than a theory or model. For them, philosophy involves questions and ongoing analysis about ordinary human life such as self-identity, relationships, mind, and knowledge. Their conceptualizations of knowledge and language inform a worldview or philosophical stance-a way of being in the world that does not separate professional and personal. The stance characterizes a way of thinking about, experiencing, being in relationship with, talking with, acting with, and responding with the people therapists meet in therapy. Several interrelated characteristics partly define the stance.

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 the shared inquiry process in which 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 the client’s perspective.

This therapist learning position acts to spontaneously engage the client as a co-learner or what collaborative therapists 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 it clarifies, expands, and shifts. Whatever newness created is co-constructed from within the conversation in contrast to being imported from outside of it. In this kind of conversation and relationship all members have a sense of belonging. Collaborative therapists report that this sense of belonging invites participation and shared responsibility (AndersonAnderson, 1997a). Dialogical conversations and collaborative relationships go hand in hand: the kinds of relationships people have with each other form and inform the kinds of conversations they have and vice versa.

Client as Expert. The collaborative therapist believes that the client is the expert on his or her life and as such is the therapist’s teacher (Anderson, 1997b; Anderson &Goolishian, 1992)teacher. The therapist respects and honors the client’s story, listens to hear what is important for the client, and takes seriously what the client says and how they say it. This includes any and all knowledge; for instance, whether dominant cultural discourse or popular folklore informs the client’s descriptions and interpretations, and it includes the many ways that the client may express his or her knowledge. For instance, the therapist does not hold expectations that a story should unfold in a 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, right or wrong. Tom Andersen (1991) [ETS13] suggests just how challenging it is to respect the client’s expertise, “...what I myself found important, but extremely difficult, to do was to try to listen to what clients say instead of making up meaning about what they say. Just listen to what they say” (p. 321). Inherent in this approach is an appreciative belief that most human beings value, want, and strive towards healthy successful relationships and qualities of life.

Collaborative therapists often work with members of clients’ personal or professional systems. The therapist appreciates, respects, and values each voice and their reality and strives to understand the multiple and unique understandings from each member’s perspectives: the richness of these differences are found to hold infinite possibilities.

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

Not-knowing can be misunderstood as a therapist knowing nothing, pretending ignorance, or forgetting what they have learned. Instead, it simply refers to how therapists position themselves with their knowledge, including the timing and the intent with which knowledge is introduced.

Being Public. Therapists often learn to operate from invisible private thoughts—whether professionally, personally, theoretically, or experientially informed. Such therapist thoughts include diagnoses, judgments, or hypotheses about the client that influence how they listen and hear and that form and guide their questions. From a collaborative stance, therapists are open and make their invisible thoughts visible. They do not operate or try to guide the therapy from private thoughts. For instance, if a therapist has an idea or opinion it is shared with the client, again offered as food for thought and dialogue. Important are the manner, attitude, and timing in which therapists offer opinions, not whether they can or cannot share them. 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 external descriptions of clients such as ‘resistance’ and ‘denial.’

Mutual Transformation. The therapist is not an expert agent of change; that is, a therapist does not change another person. Rather the therapist’s expertise is in creating a space and facilitating a process for dialogical conversations and collaborative relationships. When involved in this kind of process, both client and therapist are shaped and reshaped—transformed--as they work together.

Uncertainty. Being a collaborative therapist invites and entails uncertainty. When a therapist accompanies a client on a journey and walks alongside them, the newness (e.g. solutions, resolutions, and outcomes) develops from within the local conversation, is mutually created, and is uniquely tailored to the person or persons involved. How transformation occurs and what it looks like will vary from client to client, from therapist to therapist, and from situation to situation. Put simply, there is no way to know for sure the direction in which the story will unfold or the outcome of therapy when involved in a generative process of dialogical conversation and collaborative relationship.

Everyday Ordinary Life. Therapy from a collaborative perspective becomes less hierarchical and dualistic. It resembles 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: simply, a client wants help and a therapist wants to help. Clients and problems are not categorized as challenging or difficult. Collaborative therapists believe that each client presents a dilemma of everyday ordinary life.

If a therapist assumes the described 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, there are no therapist techniques and skills as we know them. The stance is unique for each therapist and for each client and situation they encounter.

Effectiveness of Approach: Who Decides?

Collaborative Therapy contrasts with therapy approaches in which professional knowledge externally defines problems, solutions, outcomes, and success--creating expert-nonexpert dichotomies. Collaborative therapists believe that one must ask the client to determine whether therapy was useful, and if so how. Although therapists' experiences and opinions are valued, every effort is made to privilege clients' perceptions and evaluations of therapy and to pay attention to what therapists can learn from them. Research, so to speak, becomes part of everyday practice, with therapists and clients as co-researchers during the process of therapy, as well as at its conclusion (Andersen, 1997; Anderson, 1997a). Findings are used during the therapy process to make therapy more useful to the client and, of course, influence the further evolution of ideas and practices (see Andersen, 1997[ETS14] ).

The strengths of the approach are in the relationships and conversations that are created between the client and the therapist and in their inherent possibilities. Consequently, therapy becomes less hierarchical and dualistic, less technical and instrumental, and more of an insider rather than an outsider endeavor. Clients report a sense of ownership, belonging, and shared responsibility. Therapists report an increased sense of appreciation for their clients, sense of enthusiasm, and sense of competency, creativity, flexibility, and hopefulness for their work. They also report a reduction in burnout.

Most evidence of the effectiveness of Collaborative Therapy is anecdotal: client and therapist stories about their experiences of therapy and the usefulness of the approach for them are included, for instance, in articles on child abuse and other types of domestic violence, eating disorders, and substance abuse, war trauma (Anderson, 1997a; Anderson & Levin, 1998; Anderson, Burney & Levin, 1999; Anderson & Creson, 2002); Chang, 1999;  London, Ruiz, Gargollo & MC, 1998; St. George & Wulff, 1999 ; Swim, Helms, Plotkin & Bettye, 1998)[ETS15] . As in Narrative Therapy it is not unusual for therapists to invite clients to participate in writing and professional presentations  (London, Ruiz, Gargollo & MC[ETS16] , 1998; Swim, Helms, Plotkin & Bettye, 1998[ETS17] ). Qualitative research includes studies of the effectiveness of Collaborative Therapy and analysis of whether therapists’ behaviors and attitudes were consistent with their therapy philosophy (Gehart-Brooks & Lyle, 1999; Swint, 1995), and the application of the ideas in supervision and education (St. George, 1994).

The history of its development also supports its effectiveness. The collaborative approach evolved in practice settings with a variety of challenging clients. These include chronic treatment failures and patients in outpatient and inpatient psychiatric settings and later with public agency clients such as children’s protective services, women’s shelters, and adult and juvenile probation who were often mandated for therapy and from various cultures (Anderson, 1991; Anderson & Goolishian, 1986, 1991; Anderson & Levin, 1998 ; Levin, Reese, Raser, Niles, 1986). [ETS18] Finnish psychologist Jaakko Sekkula and his colleagues have aptly demonstrated effectiveness of a dialogue approach through a research project with a five-year follow-up with psychotic patients and their families (Seikkula, 1993; Seikkula, Aaltonen, Alakare, Haarakangas, Keranen & Sutela, 1995). [ETS19] 

Often asked questions about the effectiveness of the collaborative approach include: (1) “What are its limits?;” and (2) “It sounds so cognitive, how does it work with people who are not so verbal or bright or who are psychotic?” When limits are experienced, the therapist creates the limits, not the client or the kind or severity of their problem. Therapist-created limits are usually associated with slipping out of a collaborative mode. When clients are approached from a collaborative perspective, they talk, they are forth coming, and they are active in addressing their problem.

Narrative Therapy

 

History and Background: Joint Efforts

Social workers Michael White at the Dulwich Centre in Adelaid, Australia and David Epston in Auckland, New Zealand became interested in each other’s work in the early 1980s. Combining Epston’s background in anthropology and his interest in storytelling and White’s interest in interpretive methods inspired by the writings of Gregory Bateson, they created what became known as narrative therapy (White & Epston, 1990; Epston & White, 1992[ETS20] ). Several factors affected the development of narrative therapy. Contextually, it is not surprising that narrative therapy emerged in these geographic and cultural contexts during a period when social and governmental attention and commitment in both countries were drawn to the oppression of their indigenous cultures and efforts of restitution. Given this backdrop, Epston and White were naturally attracted to the relevance of European poststructural theory, particularly Foucault’s position on constructed truths and the inseparability of power and knowledge. White’s wife, Cheryl White also influenced White and Epston’s interest in feminist theory and analysis of power. Over the years, other important leaders and extenders of the narrative therapy movement are Gene Combs and Jill Freedman (Freedman & Combs, 1996), Victoria Dickerson and Jeffrey Zimmerman (Zimmerman & Dickerson, 1996), Sallyann Roth (Roth & Epston, 1996), and Kathy Weingarten (1998) in the United States and Stephen Madigan (Madigan & Epston, 1995) [ETS21] in Canada.

Major Theoretical Constructs: Narrative, Knowledge, and Power

Narrative therapy is based in a narrative/story metaphor: people make sense of and give meaning to their lives including the people and events in it through their narratives, the stories they tell others and themselves and the stories they are told. That is, narratives or stories about others and self shape experiences, and thus lives. People’s narratives are their realities. We are born into the dominant narratives or discourses of our unique cultures that are created by the culture’s power brokers. These dominant discourses, or truths, influence local and personal narratives, affect the words we use and the knowledge we have, and become internalized truths. The lived experience of the person becomes lost or subjugated to the dominant narratives. Narrative therapy views problems--their formation and their resolution--from this dominant narrative perspective.

Based on this cultural discourse problem formation perspective, narrative therapy carries a political and social agenda: to help people deconstruct and liberate themselves from their culture dominated problem stories and to construct stories about themselves that give more possibilities to their lives. This applies to therapists as well as clients. Therapists are also subject to being captives of cultural privileged truths and imposing them on their clients. To avoid this risk, narrative therapists examine the influence of larger cultural discourses on their own narratives, preferred truths, and actions, and they openly disclose, or are transparent about, their beliefs and biases about problems, therapy, and so forth.

In the development of narrative therapy, this perspective and agenda were strongly influenced by the post-structuralism view of the French social philosopher Michel Foucault (1965, 19725, 1984)[ETS22] , more so than by a postmodern perspective. Foucault’s life work was committed to calling attention to and challenging the taken-for-granted and often invisible but pervasively influential social, political and cultural institutional structures and practices in which people live. Foucault, persuaded by his studies of institutions such as justice-penal systems and medical-psychiatric systems, believed that the dominant discourses of these institutions gave power and influence to some people, usually to those deemed to have expert knowledge, and objectified, marginalized, or victimized others. This consciousness-raising became a guiding principle for narrative therapy in relation to the goal of therapy, the process of therapy, and the position of the therapist. Narrative therapy’s commitment to social justice and questioning of power influences outside and inside the therapy room drew many therapists who shared this commitment to it.

The works of French literary deconstructionist Jacques Derrida (197892), [ETS23] North American anthropologist Clifford Geertz Geertz (19873) and psychologist Jerome Bruner (1986) [ETS24] have also influenced the narrative approach. Derrida’s work focuses on meaning and its relation to the texts. For Derrida, a text has no one true meaning. The reader, through reading and interpreting a text, creates a text and its meaning. It is a linguistic trap to assume that a certain text exists or that one can search for and find it. Narrative therapists have also adopted Derrida’s concept of deconstruction: “the critical analysis of texts . . . how a text is given meaning by its author or producers” (Smith, Harre, Langenhove, 1995, p. 52[ETS25] ). For Epston and White the text analogy “advances the idea that the stories or narratives that persons live through determine their interaction and organization, and that the evolution of lives and relationships occurs through the performance of such stories or narratives” (White & Epston, 1990, p. 12). [ETS26] Geertz introduced the concept of “context analysis:” an interpretive process of looking into the meaning of talk and action in their social and cultural contexts. The analysis gives a local “native” (1983) [ETS27] understanding, or a fuller understanding that Geertz referred to as ‘thick description” (1973). Through these local understandings access is gained to the human lived experience rather than to normative objective descriptions, labels and classifications. A common thread through the works of Foucault, Derrida, and Geertz is a strong plea to the human sciences to be aware of and not participate in the entrapping danger of normalization to subjugate and control. Narrative therapists borrowed from Burner’s narrative theory, including his ideas about the structure of stories, how people understand and give meaning to their experiences through them, and how they create realities for the writer (teller) and the reader (listener).

Combined, these conceptual works influenced the designation narrative therapy: the way that our narratives, our stories about others and ourselves shape our experiences, and thus our lives. They are our realities. And, they influence the mission of a narrative therapist: to help people deconstruct the stories that guide their lives, emancipate themselves from limiting or oppressive stories, and live their preferred stories. The influence of these conceptual works on the premises and promises of narrative therapy are apparent in the following sections.

Etiology of Problems

From the narrative perspective, dominant cultural discourses and institutions influence the problem stories that people bring to therapy. Discourses of pathology and causality that exist within our broader social and psychotherapy cultures are large influences and are easily internalized, inviting problem-saturated stories. Problem stories effect people’s identities and generate blame and hopeless feelings. Problems persist because problem-saturated stories persist. Thoughts and experiences of others and self become the interpreting and validating lens that fix and perpetuate the problem story. In the words of Epston and White (1990) [ETS28] “. . . persons experience problems, for which they frequently seek therapy, when the narratives in which they are ’storying’ their experience, and/or in which they are having their experiences ’storied’ by others, do not sufficiently represent their lived experience, and that, in these circumstances, there will be significant aspects of their lived experience that contradict these dominant narratives” (p. 14).

A problem is not inside a person, couple or family; it is not found within family structures or interaction patterns. Instead, problems are viewed as external to each person, limiting or oppressing them and other members of their system. People, therefore, are not blamed for problems.

Assessment

Assessment assumes that there is something—e.g., a structure, a pattern, a personality, or a relationship--to evaluate. And, usually embedded in that assumption is that the something is static. Traditionally, in psychotherapy, assessment tends to focus on determining the correct diagnosis, which in turn informs the treatment. Narrative therapists do not use standardized assessment instruments or focus on quantifiable diagnoses. Narrative therapists value the local or the native description of the problem. The person consulting the therapist is the best source of description of the problem and the best judge of what they want from therapy and the therapist, and whether the therapy is helpful. Assessment is not seen as a beginning phase of treatment that determines the goal and the strategies for reaching that goal. Rather, assessment, or learning about the problem, is part of the continuous process of telling and re-telling the story. Narrative therapists are interested in mapping the impact and effect of the problem on the individual and the family rather than in finding its cause.

Because narrative therapists hold assumptions about limiting and oppressing dominant discourses, they would have ideas about which discourses these might be as they listen to the client’s narrative. So, part of the assessment would include determining the discourse in which the client’s problem is located and the restraints that it poses on the client’s life. Although, introducing the taken-for-granted or invisible discourse can be viewed as an intervention, it is also viewed as an opportunity to assess the client’s response and negotiate understanding.

Clinical Change Mechanisms and Curative Factors

Narrative therapy is based on the assumption that resolution requires a change in story or narrative. Narrative therapists want to help people “re-author” ( 19866) [ETS29] their lives and relationships and to form new identities that liberate them from limiting and oppressing narratives. Re-authoring involves re-envisioning both the past and the future. It also requires making the invisible constraining problem-supporting discourses visible and helping people “confront the discourses that oppress or limit people as they pursue their preferred directions in life” (Freedman & Combs, 2000). The new or alternative story is sometimes called a preferred outcome. The new story becomes the vehicle for a new self-identity.

The focus is not on the more usual techniques and goals of therapy such as improving communication among family members or encouraging people to express their feelings. Instead, the primary therapist activity is deconstructing the problem story and its supporting assumptions and on externalizing the problem. Critical to change is the therapist’s attitude of respectful confidence in the client and tenacious hope.

Specific Interventions

The preferred position for a narrative therapist is one that exemplifies a worldview of a “way of living that supports collaboration, social justice and local, situated, context-specific knowledge rather than normative thinking, diagnostic labeling, and generalized (non-contextualized) ’expert’ knowledge” (Freedman and Combs, 2000, p. 345)[ETS30] . This de-centered therapist position is critical to achieving the mission of narrative therapy, more so that seeming interventions and techniques.

Whether narrative therapists describe their work in the language of technique and intervention varies. For example, some speak of “practices” (Freedman & Combs, 2002, p. 350). [ETS31] Narrative therapists take several identifiable actions, regardless of what they call them, to help them achieve their mission to deconstruct the problem story, liberate people from it, and construct a preferred story. Questions lead this agenda; that is, narrative therapists ask questions to influence the emergence of preferred outcomes.

Deconstructing. A therapist asks questions to deconstruct the problem story—detail it, explore its context—and to reveal the dominant social, cultural and political practices that have helped create and maintain the problem. Some therapists refer to the deconstructing process as unpacking.

Externalizing. A therapist asks questions and makes comments that emphasize the problem as an outside influence on the person rather than as a characteristic or defect inside them or their actions. Externalizing separates the person from the problem and disrupts the idea that problems originate within people. To aid in this separation and to help people renegotiate their relationship with the problem and exercise control over it, the problem is often given a name or personified. Externalizing the problem challenges not only the location of the problem, but also the idea of it as fixed and as a totalizing entity.

Thickening stories. A therapist asks questions that help create fuller descriptions and understandings of the lived experience of the client and that invite new preferred life narratives. Deconstructing, unpacking, and externalizing are part of the thickening process.

Realizing unique outcomes and creating preferred outcomes. Critical aspects of creating external definitions of problems are what narrative therapists call realizing unique outcomes and creating preferred outcomes. A therapist asks questions that help elicit unique outcomes--instances or “sparkling events” that contradict or open the way for an alternate or preferred story. They identify, highlight, and reinforce these unique outcomes, inviting and supporting the client to have power over the problem and his or her life. In addition to focusing on past and present unique outcomes, a narrative therapist focuses on future unique and unexpected outcomes. Therapists ask questions, using their knowledge of the problem story and their imagination to help the clients construct a preferred or more useful story.

Being transparent. One way of minimizing the power differential between clients and therapists, narrative therapists offer information about themselves and invite clients to ask them questions about the their experiences and beliefs. In the words of Freedman and Combs, “We try to be transparent about our own values, explaining enough about our situation and our life experience that people can understand us as people rather than experts or conduits for professional knowledge” (1996, p. 36).[ETS32] 

Reflecting. Using Tom Andersen’s notion of reflecting process (Andersen, 1995) [ETS33] a therapist gives a therapy client, a therapy team, or any observers of the therapy the opportunity to reflect on the conversation while the client and therapist listen. The reflectors are thought of as one kind of community of concern (discussed below).

Writing letters. A therapist or team writes letters as another way of participating in a client’s story, externalizing the problem, and creating unique outcomes. Letters are most often written and mailed to a client after a therapy session or at the end of a course of therapy. Letters are used to show therapists’ recognition of the client’s situation and to help support and sustain change during the course of therapy or at its end. A client will then have the letter to read and re-read long after therapy has concluded. Letters may take any creative form and their content may vary, all depending on the clients and their circumstances and what the therapist hopes to accomplish. Numerous examples of a variety of letters can be found in White and Epston’s book[ETS34] , Narrative Means to Therapeutic Ends (1990, pp. 84-187).

Two other techniques, creating communities of concern and designing definitional ceremonies, serve as important aids to acknowledging, solidifying, and sustaining the new story. They create another way of telling and retelling the story or what Wolfgang Iser (1978)[ETS35]  calls a “performance of meaning.” They also invite a sense of ownership for the client and a sense of joint responsibility for all participants.

Creating communities of concern. A therapist invites the client to bring into the conversation, literally or figuratively, the voices of significant people in their lives to help counter the influence of the broader culture’s restrictive narratives and to support and maintain new narratives and preferred outcomes. These voices are utilized throughout the therapy and at its conclusion. A therapist can also encourage and help the client to bring together or join groups of people with the same kind of problem. Examples include Anti-Anorexia/Anti-Bulimic Leagues (Madigan & Epston, 1995) [ETS36] and Internet websites (Weingarten, 2000).

Designing definitional ceremonies. To focus on the change, to witness it, to celebrate it, and to sustain it, narrative therapists borrowed from anthropologist Barbara Meyerhoff’s (1986) [ETS37] practice of definitional ceremonies. Therapists invite clients to create a ceremony or ritual in which significant people in their lives can witness the change, thus highlighting it. The event can take any form or shape that acknowledges the accomplishment such as a certificate, a declaration, an imagined public announcement, a song, and so forth. The options are limitless and only depend on the creativity of the participants.

Effectiveness of Approach

            Most of the dissemination of information on the effectiveness and in support of Narrative Therapy is found in anecdotal form at conferences, in books and journal articles, and the Dulwich Centre Newsletter. In keeping with the narrative/story metaphor, narrative therapists invite present and former clients, individuals and large groups, to tell their stories in writing and in professional presentations. This allows the conference participants and readers to hear the clients’ stories and therapy experiences directly from the source rather than through therapists’ filters. It also acknowledges the major role of clients in the therapy and the change.

The approach has demonstrated success in various contexts and with different presenting problems: Application in schools is partly demonstrated in a special section on “Narrative Work in Schools” in the Journal of Systemic Therapies (Zimmerman, 2001[ETS38] ) including success with bullying (Beaudoin, 2001); dealing with the effects of terroism  (Shalif, Y, & Leibler, M., 2002;  [ETS39] and the use of teacher’s knowledge to revive commitment and success in teaching (Kecskemeti & Epston, 2001[ETS40] ). Application with custody evaluation has demonstrated a favorable outcome of a narrative-collaborative process in which all parties (clients and evaluators) felt more respected and heard and less traumatized and blamed. Furthermore, its application and effectiveness in home-based therapy has been demonstrated (Madison, 1999). [ETS41] The success of Narrative Therapy is also discussed in Freedman and Combs (2000) and Smith and Nylund (1997).

Solution-focused Therapy

History and Background

Steve de Shazer is widely acknowledged as the principal originator of solution-focused therapy, although its development emerged from the collective work of de Shazer, his professional partner and wife Insoo Kim Berg, and his colleagues in Milwaukee, Wisconsin in the late 1970s. Well-known others, primarily William O’Hanlan, Eve Lipchik, Michele Weiner-Davis, and Jane Peller and John Walter, built on the early foundations and practices of solution-focused therapy, especially its focus on solutions and brevity, and developed their own unique versions and names for it (O’Hanlon & Weiner-Davis, 1989; Lipchick, 1993; Walter & Peller, 2000[ETS42] ). de Shazer was strongly influenced by his early work with the Mental Research Institute (MRI) group in Palo Alto, California and their brief problem-focused therapy.

De Shazer and Berg may not place solution-focused therapy under a postmodern social construction umbrella, for there are distinct differences between solution-focused and collaborative and narrative therapies. All three, however, share the centrality of language and its relationship to reality; and de Shazer and Berg also use the narrative metaphor to refer to the ways people talk about and construct their lives. Like the MRI group, they promote the simplicity of their theory and practice; however, solution-focused therapy does have a solid theoretical base.

Major Theoretical Constructs

Solution-focused therapy is historically rooted in a tradition that started with the influence of Milton Erikson, Gregory Bateson, and the MRI associates; and giving credit to Berg, de Shazer supplemented the MRI influence with the premises of Buddhism and Taoism (de Shazer, 1982). De Shazer and Berg basically flipped the problem-focused approach that suggested more of the same ineffective solutions maintain the problem to more of the same effective solutions solve the problem. They continued the MRI group’s commitment to a pragmatic, deliberate intervention and brief perspective, including the importance of what rather than why and the importance of the present rather than history, and they added an emphasis on the future. They referred to their early task and goal-directed practice as an ecosystemic approach to brief family therapy (de Shazer, 1982). Later de Shazer and Berg wove philosopher Ludwig Wittgenstein’s notions of language and language games into the background of these earlier influences (de Shazer, 1991). Language creates and is reality. Therefore, a problem is a client’s reality: to change a problem, one must change the reality by changing the language. In de Shazer’s view, a shift from problem talk to solution talk is critical to this change. Solution-talk takes the form of what de Shazer (1991[ETS43] ) refers to as progressive narratives, ones that lead toward goals by allowing “clients to elaborate on and ‘confirm’ their stories, expanding and developing exception and change [problem] themes into solution themes” (p.92-93).

Solution-focused therapy is a nonpathologizing, positive, and future oriented approach. Therapists focus on the positive aspects and potential of clients, as well as on empowering them. Solution-focused therapy revolves around the question, “How do we construct solutions?” (Walter & Peller, 1992). The major premise is that information about problems is not necessary; for change, all that is necessary is solution or goal talk (Walter & Peller, 1992). Central assumptions that guide the therapist’s thinking and activity include change and cooperation as inevitable, everyone has the resources to change, and clients succeed when their goals drive therapy (Selekman, 2002).00, p. 2-4). [ETS44] Maintaining the early systems notions that a change in one relationship or part of the system will effect change in others and that a small change can lead to a large change, solution-focused therapists believe it is only necessary to work with the complainant and to have modest goals. They are, however, flexible depending on the requests of the referring person(s) or other customer or complainant. Early on solution-focused therapists placed clients in one of three categories to designate their commitment and level of desire to change: visitors, complaintants, and customers. Interestingly, when clients do not cooperate they interpret this as helping the therapist find a better way to help them.

A later influence for de Shazer was the work of Austrian philosopher, Ludwig Wittgenstein (Miller & de Shazer, 1998). Drawing on Wittgenstein’s notion of language games and his and other philosophers’ notion that realities and meanings are created in language, de Shazer speaks of the construction and action of problem-talk and solution-talk as language games. Solution-focused therapists prefer to play the solution-talk game with its focus on solution consequences.

Etiology of Clinical Problems

Problems from a Solution-Focused perspective are related to language: the way that people talk about and attribute meaning to what they call problems. The talk about the events, circumstances, and people in clients’ lives defines a problem as a problem. In de Shazer’s words (1993)[ETS45]  “There are no wet beds, no voices without people, no depressions. There is only talk about wet beds, talk about voices without people, talk about depression (p. 89). From this perspective, information about the problem such as its root and cause, its patterns, or its frequency are not important. To the contrary, as mentioned earlier, Solution-Focused therapists want to avoid talking about the problem.

Assessment

            Assessment is not a component of solution-focused therapy in the traditional sense. De Shazer challenges the relationship between problem and solution, making assessment of problems irrelevant. In his words, “The problem or complaint is not necessarily related to the solution” and “The solution is not necessarily related to the problem” (p. xiii, de Shazer 1991). [ETS46] Again, they hold a strong belief that neither therapists nor clients need to know the problem’s etiology or to even understand the problem. Looking for causes and grasping for meanings of problems are viewed as little more than problem-talk. And, problem-talk can perpetuate the clients’ obsession with and immersion in their problems, risk reifying problems, and obstruct the development of solutions. This is believed to the true for both the therapist and the client.

Solution-focused therapists do want to know or assess the client’s goal. They also want to know the exceptions to the problem, for these exceptions hold the seeds for solutions. Although historically they have maintained a strategic stance, some now strive for a collaborative construction of goals and solutions.

Techniques

            Early in the development of solution-focused therapy de Shazer used what he called “formula tasks” (de Shazer, 1985[ETS47] ) and later included specific kinds of questions to help move people from problem-talk to solution-talk, to discover and create solutions. With the tasks and questions, therapists aim for specific concrete behavioral information and instructions. The approach is manualized in the sense that all questions and tasks are based on the assumption that the solution to client’s problems already exist in their lives and are constructed to achieve the desired outcome: solutions. In spite of the manualization, early on solution-focused therapists believed in the value of cooperative relationships with clients. The most popular questions and tasks include:

Exception questions. Establishing exceptions to the problem is intended and believed to be an important part of orienting people toward solutions. Exception questions search for, identity, and confirm times in the past and present when the problem was not as problematic. This is a way of deconstructing the problem without searching for causes and understandings of it and constructing the solution. Another way to consider this process is to think of the therapist as helping to deconstruct an unsatisfactory reality, and when the problem is no longer a problem, the therapist constructs a satisfactory one.

Miracle questions. Miracle questions are “hypothetical solution questions” (Walter & Peller, 1993, p. 75-85[ETS48] ). They help people set goals by coaching them to imagine what their life would be like if the problem were solved. As with other solution-focused questions, the intent is to focus on the solution and defocus on the problem. The miracle question is typically worded,

“Suppose that one night there is a miracle and while you were sleeping the problem that brought you to therapy is solved: How would you know? What would be different? What will you notice different the next morning that will tell you that there has been a miracle? What will your spouse [for instance] notice? (de Shazer, 1991, p. 113)[ETS49] 

Scaling questions. Scaling questions are used by solution-focused therapists much like they are used by other therapists; that is, to help clients be more specific and concrete and be able to quantify and measure problems and successes. They can note how and where the client perceives him or herself and give the therapist clues for questions that can reinforce improvement as well as suggest the possibility of or nudge extenuation of the improvement. For instance, a therapist might ask questions such as: “On a scale from one to ten with one being the lowest, where would you place your depression when you first came in?; Where are you now? How did you move from a 1 to a 3? What would it take to move from a 3 to a five?”

Coping questions. DeShazer and Berg also use what they call coping questions. These are questions to help clients who fail to see any exceptions or forward movement. Such a question might be, “I’m curious to know why you’re doing as well as you are?” Again, striving for any kind of difference.

Creative misunderstanding. De Shazer suggests that therapist misunderstanding is more likely to occur than understanding, so use misunderstanding to the therapist’s advantage (de Shazer, 1991). For example, what might be typically thought of as resistance is viewed as information or a message that the therapist has misunderstood the client or erred in their interpretation. This provides the therapist the opportunity to learn more from the client and get back on the solution track.

Effectiveness of Approach:

Like Collaborative Therapy and Narrative Therapy, the effectiveness of Solution-Focused Therapy is mostly found in anecdotal and specific case reports. Solution-focused therapists have been prolific writers and conference presenters. Berg and Dolan (2001) offer a collection of success stories by clients and therapists on a variety of presenting problems. Miller, Hubble, & Duncan (1996) offer a review of relevant outcome research and reports of numerous applications of solution-focused therapy in action. Its usefulness has been demonstrated with specific populations and presenting problems such as alcohol abuse (Berg & Miller, 1992), child abuse (Berg & Kelly, 2000), groups (Metcalf, 1998; Sharry, 1999), adolescents (Seagram, 1977, Selekman,  2002[ETS50] ), the elderly (Dahl, Bathel & Carreon, 2000), marital therapy (Gale & Newfield, 1992[ETS51] ), schools (Osenton & Chang, 1999), and client-perspective. Qualitative research supporting its effectiveness is reported by Miller (1996) and Gingerich & Eisengart (2000).

Future Developments and Directions of Postmodern/Social Construction Therapies

These postmodern social construction therapies represent an ideological shift that has slowly evolved over the last two plus decades and do not represent a trend that will fade. A frequently asked question, however, is what are the limitations of these therapies? Most therapists would respond that there are not across the board limitations in respect to particular client populations, presenting problems, or cultures. To the contrary, most of these therapists report that the postmodern/social construction approaches permit them, more so than other approaches, to engage and work with a variety of populations and problems even if they have no or limited experience with the same. This freedom and competence seems to be associated with the collaborative aspect of doing something together and pooling resources, whether the therapist calls it that or not. It also seems to be associated with therapists’ ability to be creative when not constrained by diagnosing pathology and being the curing expert. Perhaps therapists limit themselves when they fall into these essentialist modes.

The implications of this shift stretch far beyond family therapy to other therapies and to contexts outside the mental health discipline. Common among these therapies is their continuous evolution. The so-called originators and their colleagues and other thinkers and practitioners around the world continue to explore and extend the vast possibilities for therapy, education, research, organizational consultation, and medicine, as well as the complex social and cultural circumstances that challenge the earth we inhabit.

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