Collaborative Therapy 2016

Hello and welcome! I'm Dr. Diane Gehart and in this talk I'm going to talk about

collaborative

therapy

, a postmodern approach, and the related approach of reflective teams. This lecture is designed to accompany my textbooks: Mastery of Competencies in Family Therapy, Theory and Treatment Planning in Counseling and Psycho

therapy

, as well as Theory and Treatment Planning in Family Therapy. All of these are available through Cengage.com. So let's start talking about

collaborative

therapy. So collaborative therapy is an approach that is often difficult to handle at first because there aren't many really concrete techniques. It relies heavily on therapists' ability to embody social constructionist ways of knowing and ways of being, ways of being in a relationship.

So it's much more of a philosophy and a process that is facilitated than, you know, kind of cookbook text type techniques. So the process they're trying to create is this two-way dialogic conversation. And what does that mean exactly? It is when the therapist and the client participate in a process in which both parties are able to share their internal dialogues but at the same time really assimilate and reflect, in a very non-defensive way, the perspective of the other person, or in a way non-judgmental is probably a better way to say it: understanding other people. And since there is this multiple and two-way exchange - or if there are more people there could be a three-, four-, five-, six-way exchange - all of these ideas and perspectives can coexist in the room without the therapist privileging one or the other.

There is a very transformational process that occurs where new meanings and new understandings emerge naturally from this process. And what I think is powerful in this process is that whatever understanding about the problem arises with the new understandings, it makes a lot of sense to the client because it is based on the client's understanding and worldview to begin with. And so it feels very natural, almost effortless, for customers to adopt these new perspectives. And that's contrasted with an approach, like more traditional cognitive-behavioral approaches, where the therapist comes in and offers the client this other way of looking at things that's based on science and research, but not necessarily vision. internal world and in the client's vision. the way the client makes sense of things.

And there really is more: in that type of approach or even in a systemic family therapy approach, there is a reframing that the therapist offers that they try to adapt to the client's worldview. But in many ways, this is a much more subtle process and much more organic, and it arises much more organically from the client's perspective. And so when new perspectives and ideas emerge, they make perfect sense to the client, and I think that's one of the real strengths of this particular approach. It is very much a particular type of process. There is no specific technique or cookbook recipe that you are going to use in collaborative therapy, but it is largely a matter of the therapist embodying this approach.

So it's not one where you're going to read the book and you're going to role play and everything is going to... yeah, you're not going to understand it like that. Or you can even say something like this: I feel like the therapist almost needs to be trained in an environment, a complete environment where people think, live, work, relate and talk in this way where it starts to really make sense. And so in another key area here, the concept here, is that the therapist is trying to promote the client's sense of agency. So the therapist does not necessarily control the developing meanings or interpretations of life, but rather puts those things out there, doing so in such a way and through a process in which the client develops a sense of agency. , where many clients arrive feeling very helpless in their situation.

And so, one of the main results of this dialogic co-creation of bidirectional meaning is that the client regains the sense of agency of being the main actor in his own life. So, the juice: significant contributions to the field. So you'll hear a lot within the field: many, many therapists claim to be collaborative in a more generic way. But when postmodern collaborative therapists talk about being collaborative, one of the key concepts that emerges from this approach is the idea of ​​what they call “not knowing” or “knowing with.” And I know collaborative therapists get made fun of a lot and made fun of for not knowing or, I don't know, criticized. "You know people pay you to know, how can you not know?

How does that help you?" And the idea of ​​not knowing doesn't mean that the therapist forgets everything he learned in graduate school or studied for the licensing exam. It's really more about not assuming and avoiding prior knowledge. And it's a strange, kind of trap that we have as therapists: you know, we get master's degrees and doctorates to do what we do, which involves mastering a lot of knowledge. But also as knowledge is mastered, and there is some research to support this, the more experienced a therapist is, the more they assume and there is a lot more that they overlook and sometimes they actually overlook a lot more. important things because they assume they know everything.

So when you hear a client come in, let's say there's a first-year therapist and a client comes in describing symptoms that may be consistent with...let's even say something so generic is major depression, okay? A new therapist will usually be much more curious about what's going on with the client, how he experiences his depression because he's still trying to figure it out, maybe he can distinguish between certain types of anxiety, versus depression, versus bipolar. . Whereas a more experienced doctor will probably hear a couple of symptoms and just assume that he knows, that he's seen so many people with this profile.

But it is very possible that things will be lost. For example, I recently had a case where she was 14 when I met her: textbook symptoms, bipolar. However, one thing that was interesting to me was that there was a lot of content, but her parents were absolutely determined not to take any medication. So I worked with her, we met for a year and a half and stabilized her off medication until it was one summer before junior year. And she was an honors student, she practiced theater, music and she just did it, she performed great, but between 6 and 8 weeks into her junior year, she suddenly was so depressed that she couldn't get out of bed. .

She got so bad that her parents agreed and we sent her to a psychiatrist. It's like she, of course, she was bipolar, a textbook case, she was given the bipolar medications and she couldn't take them because of the side effects in two to four weeks. But she, too, had no relief from her symptoms. She then agreed to give him the antidepressants, but she said, "You know she might have a manic episode if we do this," but at the time she was on disability leave from school because she was so unwell. So her parents agreed and she was prescribed that medication and four weeks later she still had no relief from her symptoms.

I'm like, Oh my God, you know what? This is really strange, and it's also very strange that she still doesn't have any content about this, like debilitating depression, and I sent her... I asked her mother, you know? Have you ever been to that functional medicine doctor? Functional medicine is a newer branch of medicine that is very wellness oriented, where they draw a lot of blood to see if your organs are working properly and they also tend to do a lot of allergy testing. She hadn't done it. Then they went and took her away. I guess, long story short, it turned out that she had a gluten intolerance and a congenital liver defect in which her body did not absorb vitamins.

She was then prescribed 22 different supplements and these are vitamins, so she had omega three and she had to take B injections. In two weeks, all the classic textbook bipolar symptoms disappeared and she has now been stable for six or eight months. . So again, it's funny and it's... I remember talking to the psychiatrist and saying, "She's, oh, this is just textbook bipolar, I've seen it a million times, it's there, she'll respond, she'll just respond." takes a while to respond." So you have to be curious, be open and avoid assumptions. It's a discipline, it's actually very difficult to do because when we listen to the stories of the people we love, we naturally fill in the blanks with our own reality, our own beliefs and our own experience.

Once you become a therapist, now that you have the experience, the more experienced you become, you get thousands of other stories to fill out someone's story and it takes a lot of discipline, especially the more you practice not making assumptions, being tentative, be continually curious. So when you hear that someone has lost their mother, you don't want to fill in all your assumptions about what that was like for you. It could be like "What do you imagine it will be like for you?", "What is most meaningful about losing your mother?", "That brings you the most sadness." Someone says they are depressed: "How are you?", "What is your depression like?", "How are you in the morning?", "What kinds of things do you think about?", "What things do you do?" .

So it's as if no depression, no anxiety, no marital conflict, no response to an affair is the same for anyone. And then you're intensely curious because you know that this person has totally unique meanings of what the affair might have meant to them, a totally unique experience of anxiety or depression or whatever. There is very much a recognition of how meaning is created, especially around our problems. It's completely unique and you just want to really understand that unique client versus the unique meanings he's giving and avoid assuming and putting your own meanings on his situation. Rumored: people and their stories.

So most of what is considered collaborative therapy was developed by Harlene Anderson and Harry Goolishian, who established the Houston/Galveston Institute in Texas. They first developed their ideas by working systemically, but as they worked with families with multiple problems in a psychiatric unit, I think that started in Galveston, they began to listen differently and were influenced by these new postmodern ideas that emerged and evolved. This approach. Tom Andersen, note there is a spelling difference and Tom and Harlene are not related, but they were actually best friends in many ways. Tom is from Norway and came to develop these ideas by visiting the Milan team that he was practicing in a very traditional systemic way.

Where, what they actually did in those days is the team was in one room behind a one-way mirror and the family and the session driver or therapist were in another. And they actually turned the lights on and off, so in Milan they would do it: the team would see it, then the driver therapists would leave and go back to the room. So when Tom went to install this in Norway, he had the idea to start a family: change the lights in the two rooms. So the family could hear what the team was really saying. That's how the practice evolved and we'll talk more about that later.

But he worked very closely with Harlene and Harry, taking postmodern ideas, specifically social constructionist ideas, and putting them into practice. Lynn Hoffman, who actually started out as an editor for Virginia Satir, who also studied with Minuchin and Jay Haley and wrote for both of them, at least for Haley, I think. She also ended up working with the Milan team and from her connection with the Milan team she also ended up working with Harlene, Harry and Tom Andersen, it kind of evolved into a collaborative social constructionist way of approaching meaning. Similarly, Peggy Penn, who was at the Ackerman Institute and was also very involved with the Milan team, evolved into a more collaborative way.

And I suppose that Gianfranco Cecchin, one of the founders of the Milan team, also in his later years practiced much more in this type of collaborative therapy. Jaakko Seikkula will talk more about him. He has developed an approach called open dialogue in Finland that is used to work with clients having psychiatric episodes and has seen phenomenal results. In fact, probably one of the most effective treatments yet for schizophrenia psychosis and most of the work is associated with the Houston/Galveston Institute. The Big Picture: Treatment Overview. So in a sense, the overview of the treatment, the treatment process, is very, very simple.

In collaborative therapy, it's basically about having a two-way dialogue and that's it. There aren't necessarily stages of change or anything complex like that. So, as long as there is a two-way dialogue and exchange, therapists trust that new meanings will evolve that will help the client resolve the problem in whatever way is necessary. Sometimes a resolution is "oh, the client sees it differently", maybe you are no longer personalizing an attack from your partner or such.Maybe you see it, and you say, "Oh, these new meanings allow me to take this kind of new action." .” So that's the essence.

The main thing that you're not doing... um, I think about the very simple and very wise words of Harry Goolishian when he said, "You know, it's a lot easier for me to tell you what not to do in therapy than it is to tell you what to do." and it is more important not to do these things than to do them exactly a certain way.” So what you don't want to happen is to have the dialogue break down into dueling monologues, so to speak, so each person tries to convince the other of their perspective. Obviously, when couples and families come in that's where communication usually breaks down, they have dueling monologues: "but it should be this way, not that way", "we should do this and not that", "you should do this and no." that." So the first thing you wouldn't want to happen, and I think this is true in many approaches, is for the therapist to tell the client that "you have to do this," while the clients are trying to convince the therapist of something else.

So the other way to think about this when this happens is that a monologue creates a therapeutic impasse and that the conversation no longer generates useful meanings or understandings. So the therapists' main job, the main job is just to make sure that. people, and one of them, it's not the word that I know that any collaborative person could use, but maybe it's helpful when you're trying to understand this for the first time. You don't want anyone to get defensive because that's what a. monologue: "my truth is reality" Because when someone gets really stuck and tries to convince another person of their position, they are not taking in any new information, and if they are not taking in new information, nothing is going to change.

Even if you are “right” and have a ton of research backing you up, nothing is going to change. And then the therapist doesn't get into this “well, I'm right, I have more experience, more knowledge or more research behind what I'm saying and I'm just going to convince the client how to do it.” him." If you've ever tried to do this with a client or another human being, usually someone in your family or a friend, it rarely works. And that's why the therapist's job is simply to maintain that two-way communication and exploration of ideas. and, if that fails, it's the therapists' job to go back and open that two-way dialogue.

So now let's talk a little more about the specific elements of the therapeutic relationship in collaborative therapy. In many ways, a big part of this approach is the relationship. therapeutic. And the main aspect of this approach is the philosophical stance, the belief that we, human beings, construct meaning through relationships and dialogue. Those are basically the social constructionist assumptions. as conversation partners creating a type of dialogue, a kind of two-way, meaning-making dialogic conversation that will produce new insights, there is a sense of witnessing and exploring the client's perspective, concerns, and possibilities together, there is a sense. of being with the other person.

Um, and there really is an art of curiosity and not knowing and you'll hear these terms thrown around a lot, and it sounds like initially you know what they mean, but it's a very specific type of postmodern curiosity, and this ability to really put aside all our assumptions and meanings that we have. As I said before, doing this is a very intense discipline and the more you practice it, the more you realize how much we do it automatically and, in a way, this is what culture is. Culture is a bunch of assumptions we all share and we fill in the blanks so we can coordinate meaning, we can coordinate our actions, we can't run over each other at intersections.

And that natural default socialized living skill, it's a social skill to fill in some of these blanks, you have to undo that when you work from this approach. So when someone says they're depressed, you want to do it, to a collaborative therapist, when a client comes in and says I'm depressed, that pretty much means nothing to a collaborative therapist. It's like “when and how you experience it, what is it like for you?” So you're really curious about the real nuances and specificities of that particular customer's experience. And so it's the ability to not know, but of course there will be times when the therapist will bring in their own experience and I often think of it as, okay, I have this huge shelf of knowledge, professional knowledge. in my head and so on, but it's on the shelf when I talk to a client.

First I want to start by understanding life within your reality, and how you make sense of things, how you interpret them, what you think, what is important, what is not important, and how you put the pieces of your life together. And while they're talking, I could turn to my bookshelf and say, "Hey, you know what? You know, there's someone, you know, there's a therapist who thinks this, what do you think about that?" or "oh, what do you think?" There was a study that found this to be the case for certain people, does that match your reality?

Would any of this professional information be useful to you? "Oh, yeah, well, let's keep reading," "Oh, no, let's put it back on the shelf." I don't care if, you know, I'm not; There comes a point where we no longer stick to it. know. For example, I love and believe a lot in mindfulness. I think it's an amazing approach and very useful for a lot of people, but I'm realistic: it's not for most people. And so, while the research may be phenomenal on how mindfulness could help my client, I might say, "hey, is there ever this practice called mindfulness and these are some of the basics of the research and the types, Is there any interest for me?" you?

Or something like that and they might say "there's no way in the world I'm ever going to sit down and watch this or breathe for two minutes a day" and I'm like "okay, that's great, let's move on." something else”, and that's where it is: the client has the experience in their world and I have my own professional knowledge and experience, but my true expertise is creating a conversation that changes meaning for clients and opens new possibilities. These are: Collaborative therapists really try to use everyday language and avoid jargon and introducing jargon to clients. They prefer: If the client says "I feel sad" instead of depressed, then that is what we will call "feeling sad." And the other idea here too is that there is an internal and external conversation and that both the client and the therapist have internal dialogues as well as the external dialogue that we are hearing, what is happening between us.

And obviously the more people, the more dialogues. But you make space for all of them, you honor and give time for that internal dialogue, and you also attend to your own internal dialogue because it can give you a lot of important information. And so, even if whatever the therapist's internal dialogue is, it's also something that the therapist is monitoring. There are times when you will say out loud what it is and we will talk more about being public. And there are times when you use that information simply to facilitate the conversation in some way. We will talk a little about the conceptualization of cases in collaborative therapy.

So case conceptualization is largely built around the postmodern social constructionist worldview. The previous way that Harlene and Harry made the transition from systemic to postmodern ideas, they talked about the system of “problem organization” and “problem dissolution”, it's not so much a term they use today, but it is something interesting and I think I think it's worth mentioning. Because instead of talking about the family system they began to talk about the problem organization system. That is not so, so the question is who is talking about the problem? And they are the ones who need to be in therapy or participate in the therapeutic conversation because they are the ones who help shape the meaning of the problem, and all those different perspectives can often help us co-construct new understandings that help us move forward. in a useful way.

So whether it's the teacher, the grandparents, the friend or whatever, they are part of the organizing system of the problem, whoever is talking about the problem. The problem solving system means, it refers to, that the problem, the problem solving system is - with the therapy system systems it dissolves - I'm having trouble with that word right now. Um, when there is no longer any problem to be defined. So you know that therapy is done when no one sees the problem anymore, that's how they described it. Very focused on social constructionist understanding. And so, for case conceptualization, it's not necessarily about getting a single definition of the problem; in fact, you almost want to avoid that.

The collaborative therapist greatly desires multiple conflicting definitions, points of view, and perspectives on the problem. Without prejudice or privilege for anyone and simply letting them float in the room, each with their own space. What happens is that, with the dissonance there, people start with a no - since there are no dueling monologues, which one is right, we allow everyone to sit there - it's almost as if the ideas just seep in and bounce around. room. And because no one (for lack of a better term, this is not a postmodern term, but I think my students often find it useful) no one feels defensive, so they're taking in all of these ideas, eventually it starts to help them. reshape and reunderstand your own position.

And a good way to think about this process is that even if, for example, you don't change a person's perspective, because all these ideas were floating around the room, the story that they're telling themselves about what the problem is and what is. It hasn't moved. And that is significant. It's that change in their view of the world, their definition of what they tell themselves, the stories they tell themselves what the problem is, will change the possibilities they see about how to solve things. So what is really being evaluated first is, I think, the internal logic or the glue that makes up the client's world, or their hopes, their dreams, their understanding of the problems, that from possible solutions, what the symptoms are.

You want to get a very, very detailed understanding of the logic that is maintained, that makes the client's world make sense. Now let's talk briefly about how to approach change and setting goals in collaborative therapy. In terms of goal setting in collaborative therapy, the overall goal is to create a sense of agency within the client. What this means is that we want the client to feel that they can make decisions in their own life, make changes and create the life they want. They can affect her life and direct her where they want to go. And there is that feeling of being competent and being able to take meaningful action in their lives.

Harlene often talks about this sense of transformation, so it's not that we change people so much, but there is some of the old that remains and we transform it, reshape it, add more nuances or layers to it instead of getting rid of the problem. , solve it and have something new. And then there is this, more of a sense of transformation, and of change rather than changing or fixing what's there. And it's really more about creating new possibilities for meaning and relationship. Then, once the client feels that he knows how to affect, create her life and move it in the direction he wants, the therapy can end.

And in most cases, unless it's a client, unless a therapist's internal dialogue says “no, no, you know, I don't think you're ready to discharge,” but in most cases , once they have that feeling of “I can affect the change I want to have in my life,” then it's like you've achieved the ultimate goal. But any specific objective is always co-constructed, identified in collaboration with clients, and captured in the client's everyday language to define what that objective is. For example, “I want to be able to share my emotions more with my partner” or whatever. So let's talk a little more about the events or interventions.

And certainly, intervention is not a term a collaborative therapist would use; rather they see it as ways to promote change and ways to promote more effective dialogic conversations. So in many ways, the main intervention, so to speak, is what you would call “conversation questions.” And these are questions that arise naturally within dialogue rather than professional theory. So while there are many similarities between narrative therapy and collaborative therapy, I think one of the most striking differences is that collaboration; I mean, narrative therapists have many predefined sets of questions to help the therapist change meaning. But in collaborative therapy it happens that there are, but there are none.

I think there are almost none because the idea is that the questions arise within the conversation. So when the client begins to describe her world through these conversation questions that come up, in which nothing is assumed, when the client says "my husband had an affair," thatcould be the statement and you want to, you don't, you don't want to fill in any of those blanks. You want to be really curious about it, so, “What are they?” What was your response like when you found out that he had that affair?” You don't assume that the person was devastated, he might be angry, he might be sad, he might be everything, so you don't fill in those blanks for whatever the problem might be.

And then you keep hearing how they interpret the meaning. For example, if there was an affair and the woman is devastated, she says, "Oh my God, I don't believe it, I can't believe it, he must not really love me." And then you would do this very gently, you know? and maybe not in the first session, but the question later is: “so your husband had an affair and I'm curious how his decision to do what he did makes you feel like he never loved you, or that you're not worthy.” of being loved, or that you did something wrong, where does that idea come from?

And if so, of course, you need to develop the right relationship, and then she can do that too, then you get this kind of mutual bewilderment that will get to where she's like, well, she's in his world" of course he No". love me” or it is “of course you know something must not be good enough.” and "of course, it's just this line", but where did you get that idea? Because it's actually an interpretation. And then you become very curious with them and ask them these questions that arise from the conversation. And if you don't assume anything, you're looking for the logic of the interpretation and even if it's a very standard interpretation like "It hurts me that my husband had an affair," that's socially the normal interpretation of such an interpretation. answer.

So even if it is standard within our culture, where do you understand it, what meaning do you give it, and where did you get that idea? And you start to explore them and, while you are looking for the source of these ideas, many times clients are not even fully aware of it. That is where the new meaning begins to be generated. Perhaps one of the most useful ideas in all of psychotherapy is the idea of ​​appropriately unusual comments. This really comes from the thoughtful teamwork of Tom Andersens. He identified three types of comments. One is comments that are "too common," so this is where you may be reflecting or summarizing what a client is saying, but there isn't really any added meaning.

The other, there's another type of comment that is "too unusual," and it comes too much from a therapist's perspective and the client isn't able to integrate it, or I think can digest whatever the idea is, and it may just be too strange. You may be creating a monologue, or your therapist's idea of ​​what should happen or how it should be defined is turning the client off. But if it's too unusual, that's also a problem, which is why this Goldilocks principle of "appropriately unusual" is preferable. So what you want is feedback that's similar enough to the client's worldview that you can digest it, make sense of it, work with it, but different enough that you can create new meaning.

There needs to be appropriately unusual comments that allow the client to generate new meanings. Whether they are habitual or too unusual, neither can be used by the client to generate new meanings. I think this is very important, no matter what approach you work from. I often think about teenagers; Initially, for most teenagers, anything that is too different from their reality and coming from an adult is too unusual. But it's funny and what I love about teenagers is that once they realize that you're not one of them, one of "those adults," and that they can actually talk to you and that you will listen to them and be curious, and understand their worldview, then you can say almost anything.

But yeah, what's appropriate and what's too usual, too unusual really depends on the client, your relationship, and the level of trust and rapport between the two of you. So how far, how different to be, it really depends. One of the things I think about when I work with clients is the pause, which is when you ask a client a question like "where does the idea of ​​him having an affair mean that you're not good enough, or?" You did something wrong, where did that idea come from?”, you understand what I call, the pause where they say: “eh, I don't even know where that idea came from, why, why do I think that?” So they had this pause and often they hold on, then they start saying "what I don't know" and instead of letting them get away with it, they don't, getting away with it is the wrong term, so they don't know!

This is perfect, so now we are gaining new meaning and them understanding where their ideas come from. So with “I don't know” we left some time to pause, explore it and become more curious about where it could have come from and what's your best guess as to where it could have come from. Think it came from your family, or from social networks, or from the media in general. You just become very curious and then they often join you in that curiosity. There is this process that I alluded to a couple of times and that is already called “mutual confusion.” This is where you start by asking customers and then they answer the questions because they know the answer, and you keep going and going and there comes a point where everything starts to change, where the customers have to think about it too. , they're not quite sure where they got that idea from, or made that assumption, or what you know they become...

Then you shift into this process of mutual bewilderment and this is a very two-way process of meaning-making. And so you're testing, tossing around new ideas, um, and you're very curious. And this requires a lot of rapport and trust on the part of the clients, where they know that you are presenting ideas and we are just exploring, we are trying to understand, we are trying. For example, in an interview I did recently, I mean a session I had recently, we went from exploring the mother's understanding of why her daughter is dating this "loser" and her perspective to blaming herself and then we looked at its intergenerational patterns, I looked at a lot of different things.

And so, none of what, I didn't say "ah, clearly, it's three generations replicating the same pattern," I didn't get stuck on that, you know, I didn't get stuck on the substance use problems that were nice. On the periphery here, we continue to explore all the different possibilities that might make sense. It was a very two-way exploration of what's going on. That's where the new happens, that's where the co-creation of meaning happens, that's where clients begin to understand themselves differently so they can make different decisions and choices in their life. So another important idea that comes out of collaborative therapy is the idea of ​​“being public.” This is where the therapist shares his inner dialogue.

This is usually only done when the therapist's internal dialogue is so intense that it makes the relationship difficult. Like in the extreme examples, you know, people sometimes say, well, if a client believes in domestic violence, there are times when he should be able to hit his partner or his child or whatever. You have to do it, does the therapist ever talk? Do they just sit there and be quiet and of course not? Collaborative therapists still follow the rules, the legal mandates of what therapists must do. And obviously, if there's something going on that seems very ethically wrong to the therapist, it could be mentioned, like someone who advocates violence, either doesn't want to be questioned, or doesn't want to look at that or explore that. .

Therefore, the therapist does not privilege his perspective, but rather presents it on par, usually with clients, unless there are important legal and ethical mandates and they must be addressed as you know. Sometimes it is simply used as a reflection of how the client might see something that is happening in her life that could hopefully be helpful if the attention is helpful for the client to generate new meanings. Therefore, you will typically do this large public only when you have significant differences, perhaps in values, goals or purposes, but even more importantly when communicating with external third parties.

And in fact, most public agencies now embrace this part of collaborative therapy and require clients to sign off on treatment plans and so on. The idea here is that if you're going to have a conversation with a professional about your client, whatever you say to that person, you should be able to tell the client instead of having these kinds of therapeutic secrets going back and forth. . A therapist. So if it's a report and you say, "I don't think this mother is ready to get our kids back," she'll talk to the client about that and maybe not let you be caught off guard when she goes to court. . .

Talk about it, be very clear about: "this is what the social worker says you should do, I will do everything I can to help you achieve those goals, but I will not lie or cheat for you and I will write a letter." Then you write the letter, you let them know what's going on, you're open about it, and you don't have these kinds of secret conversations just out of respect. That's why Peggy Penn, in particular, is known for using writing and writing. letter writing to access multiple voices. You can ask clients, and on this side, again we are talking about collaborative therapy, one of the main things is that there are multiple contradictory voices in the room, and therefore, often You can do this by writing letters or writing various forms.

Therefore, clients could be asked to write a letter to themselves from various aspects of their newly emerging self, their future self, and their past self. I do this a lot. type of work with people who have suffered child abuse, writing to that child in the past who has been abused or even to the wise older woman or man who is writing to that person now, or to the child in the past, these various letters begin to create new meaning. You can also ask them to write letters to each other from significant others who are alive in the past or future.

Um, again, this can be healing after a loss or after abuse. Ah, so letters addressed to and from significant others living or dead from a voice or perspective that was formally kept private to them in their lives. Also, letters or journals in which they speak from different parts of themselves that are not normally expressed or that are new parts of themselves that are emerging in therapy and that they can explore with these different parts. And obviously there is infinite possibility. Again, this is done when customers are interested and it seems to make sense to them; can be very powerful.

And obviously, if clients are not interested, the therapist will not try to convince them to do it. Now let's talk about reflective equipment. Reflective equipment emerged from Tom Andersen's work with the Milan team. As I think I mentioned, Tom had gone to Milan to study, and the setup, physically in those days, was that the family would be in a room, there was a one-way mirror, the team would be behind it, physically behind the one-way mirror and they would they would do: the therapist would go out, talk to the team, and come back. Well, if you've ever worked behind a one-way mirror, you know there's an opportunity to turn on the lights on what would have been the customer side where the equipment is and turn off the lights where the family is and whatever you really can. do it the other way around.

So Tom Andersen, who was very affected by social constructionist ideas when they first emerged, had the idea of ​​just changing the lights. And so the team reflective practices began and the idea was to have these team conversations in front of clients. One of the things - if you've ever done this, practiced it or seen it in action, you know that one of the things it really does is help the therapists involved, the team, the observer (could be a supervisor involved) , to be very aware and respectful of how they describe the family. And he makes you... when you do this he makes you very aware of how they could understand how we speak.

And you know, whether you do it or not, no one ever does this, very few people do it on a regular basis, but I think one of the most important things that comes from training with reflective equipment is learning to be respectful in the way in which you talk about clients. I think we have a very deep ethical obligation and that is why it is important. I mean, there are times in this job where we can push a little bit and go a little bit silly, but it's important that fundamentally we have a deep, deep respect for clients and I think that's one of the things that Tom Andersen , your work, really stands out to me in this way.

So this reflection process evolved over the years and the form it most often takes is that, especially when you work in a collaborative way like Harlene or Tom Aandersen did, is that you want to develop diverse schools of thought. conversation. And so, it's not that the team comes to a consensus as they would in traditional systemic Family Therapy,where you may want to come up with a hypothesis that we will all work from. This is almost the opposite idea that we are simply presenting different perspectives. One of the easiest ways to do this is to describe how each person makes sense of the situation because it is usually a little different.

We're not necessarily trying to force the pieces to fit together perfectly. You're trying to create some dissonance, like appropriately unusual comments, which creates some dissonance, allows the client to create new meanings, allows the meanings to change for the client and that's why you're trying to avoid this kind of common agreement. . Obviously, you should also be very careful to avoid evaluating or judging customers. Although you will definitely see people complimenting clients, I think even then you should be more careful with praise and praise than you think because when a therapist praises a particular course of action, perspective, or way of looking at things , in a way it closes off other possibilities.

That's why I think it's very important when we give praise, to do it from within the client's value system, because otherwise, even if you are very polite and kind, the clients may like it, but you are still imposing the views and the values ​​from therapist to client. So the idea here is just to offer these reflections and make sure they are owned by the person speaking because you never know when you're accidentally offending someone. We try to be as thoughtful as possible, but because we have all found meaning from different life experiences, different behaviors and actions, what may be very polite to one person may be very offensive to another.

And it's important with reflective teams because you don't have a lot of context and often you don't have as much information to be tentative and cautious about how you put ideas forward. So Tom Andersen has some basic guidelines for working as a reflective team and the first is to only use them with the client's permission. It is never something that should be forced down a client's throat. Although I find that if the therapist is capable, he is enthusiastic, he is hopeful, and he trusts the process that clients typically go through. And this is true whether it's Gestalt reflective chairs where you're talking to an empty chair or reflective equipment.

One interesting thing Tom does is give clients permission to listen or not listen. It's okay to disconnect if he chooses to do so. He recommends that therapists comment only on what is seen and heard and not what is observed, and this goes against much of the training of traditional therapists. But Tom really believed in client privacy and he felt that if a client is trying to hold back tears, don't push him, you know, if he's trying to hold back tears, respect him. Why do we bother them? And if they don't want to show us those tears.

So there was a deep respect for the customers, some would say to a fault, but it was a deep respect and I think it's hard to be too respectful. It certainly gives you pause and something to reflect on when you try, when clients seem to be trying to hide something, whether or not we have the right to proceed just because we are therapists. As I mentioned, speaking from a very questioning, speculative and tentative perspective is very, very important. And physically separate the team from the family. Nowadays, the team often just sits in a corner of the room.

Otherwise, you can have two different physical spaces, it's another way to do it. You can also have a video camera, in modern times we have more video cameras in the family, and the equipment comes only for the reflection part, the five to ten minute reflection part, and then they leave for the rest of the session. All roads are good. And again, hearing what is appropriately unusual, or how something can be created, meanings that are appropriately unusual. And another way to start sessions is to start by asking “how would you like to use this session today?” It is a question that is asked by the family, that is, the therapist at the beginning of any session, but particularly one that the team is there so that the team also has an idea of ​​what the family or client expects.

So you will also hear about the “as if” reflection process. This was mostly developed, I think, by Harlene, so at least I've gotten to know it. And this is a supervision technique, in which the therapist, or the supervisor, has all the members of the supervision group listen from a particular point of view in the system. So they listen to you as if you were the mother, the father, the child, the social worker, the teacher, the best friend, whatever. Then each member listens as if they were one of these people and then speaks in the first person from this perspective.

Many times, someone will speak as if they were the therapist, and the therapist will usually not participate, but rather observe the reflection process. This is really great for staffing cases, especially complex cases, or cases that don't respond well to treatment, or if a therapist is feeling stuck, it can really help you better understand where everyone is coming from. It's actually a very emotionally intense process when you do it normally. Now, briefly about the highlights and elements of the research and evidence base for collaborative therapy and reflective teams. So, as you may or may not expect, there is definitely more qualitative research than quantitative research on collaborative therapy and reflective teams.

And so most of the focus is on the clients' lived experience of therapy and its effect on their lives and, again, this is very consistent with his social constructionist philosophy. In fact, there has been more research done on narrative therapy, most of it coming from Australia, where it is widely used. And the push to use any approach today in public mental health requires further research and that is where most of the quantitative research related to postmodern therapies will be found. Interestingly, there is a lot of neurological and interpersonal neurobiology research that actually supports, not directly the results of these approaches, but it does largely support the premise of these approaches.

One is that neurologically and psychologically, our brains think narratively, we think in stories. And that is mainly the social constructionist metaphor. I guess they use text too. But this idea of ​​history and storytelling of a person's identity, that's where identity comes from, and that's how the brain actually processes information. We put everything into story timelines, and trauma is actually when that process is interrupted, so it's a very important process for the human brain to make sense of lived experience. Another interesting corollary is the idea of ​​bottom-up processing versus top-down processing. And this refers to the different layers of the prefrontal cortex.

So the higher levels are largely about where you take your current categories for the universe, and the world, and the experience, and you, process downwards, and just label the information that comes in. That's called top-down processing, where you label what comes in. We have to do this. Our brain - we would go crazy if we had to treat everything consciously - would be "as if it had never experienced it before", it would not be able to get out of bed and have a cup of tea. the morning. Where bottom-up processing is actually very close to what mindfulness is, where you're taking in information as if you were seeing it for the first time, as if you were re-experiencing it and allowing it to be recategorized, that is. a very simple way of saying it.

And this bottom-up processing is very useful in many ways, but it is also very useful when a person feels stuck, because it brings new ideas. Often this derogatory conversation is like "my husband is lazy, my son doesn't respect me, my boss is an idiot." Whatever it is, you know these stories, no matter what the other person does, you have these stories and it's very difficult, and the research is very clear, it's very difficult for us to change those labels that we give to other people in our lives. . And so this bottom-up processing allows us to reorganize, change those categories, smooth them out so that we can process what comes in in a new way.

Finally, I want to conclude by simply describing the use of these approaches, collaborative and reflective teams, with diverse populations. Collaborative therapy has been widely used in Europe, Latin America and Asia. Interestingly, it's probably used less in the United States because it's a very philosophical approach and the United States tends to be a fairly pragmatic culture. But one of the things that really makes it useful for working interculturally and internationally is the concept of not knowing, that is, not assuming. And the whole process, the whole basic process, is trying to understand from the client's lived perspective and understanding the logic and values ​​that cause the client to make sense of the world the way she does.

It is a very respectful approach to the client's values, it does not judge them as good or bad, rational or not, it is a very gentle process where we explore it; We do that, we go through that process, the client joins in, becoming curious and bewildering, a mutual bewilderment, a mutual exploration. And then the client gives its meaning, it is actually, let's say, reinterpreted, through the client's own process. The therapist does not offer new interpretations or new ways of seeing things, it is the process that does so. And there's just this incredible emphasis on respecting the client's worldview in a way that few other approaches do.

There have been particular studies and interest in collaborative use with intercultural couples. When you think about intercultural couples, in most cases you will have two different genders, two different cultures, two different personalities, two families from different backgrounds, and that's a lot, that's a lot to integrate and try it all out. There will be many differences and core values ​​that can often be different. And it's hard enough when you have a couple from the same culture trying to make it work, but when you add that extra layer of cross-cultural differences, there's so much more there and this process of mutual exploration, curiosity, being open, being respectful, that whole process. that the therapist provides can also be used by a couple between them.

And again also, working with same-sex couples or couples with alternative sexual identities or gender identities, helping clients make sense of these differences, explore them in a very respectful way, and be able to allow their meaning-making to lead. You know it's a very respectful approach where making the client feel respected and not judged is key and that can be a real problem for clients with diversity. So this approach is one of the most ideal, along with narrative therapy, one of the few that really puts the concept of culture and diversity at the center of the practice. So I'll leave you here with some online resources for collaborative therapy and reflection teams.

I hope you found this introduction helpful and I wish you the best as you continue to explore the theories of family therapy.