The Dialogical Therapist

Dialogue in Systemic Practice

Paolo Bertrando

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429920462
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

In this book, the author describes the dialogic therapist as someone whose therapy is guided by the use of systemic hypotheses, helping the readers understand how the ideas and techniques can take their place among the vast array of ideas in the systemic field.

CHAPTER ONE
Understanding and influencing

A client arrives in my office. A family, maybe, or an individual, or a couple: this is not so important. Let us assume, for the sake of clarity, that it is a couple, a heterosexual couple, with both partners in their mid-thirties. A dialogue—necessarily—takes place: I listen, I ask questions, I get answers, I make statements; I am asked questions, too. This is the stuff therapy is made of, and it never seems to change: it could have been the same twenty years ago, except for the clothes, perhaps, or some mannerisms in speech. But therapy does, in fact, change; and it has changed a great deal in recent years. Sometimes we are very aware of the fact, extremely conscious of such changes; at other times the changes are not so conspicuous for us to notice. For me, the last few years have been among the most challenging, in terms of the mutation in my (our) everyday practice.

I will leave my couple to rest for some time. I will not introduce their problems, nor my own problems in dealing with them. Before going into the centre of action, we need to set the stage: it is necessary to enter a historical perspective.

Epigenesis

The history of family therapies is discontinuous. New approaches have constantly been emerging, while older ones have faded into the background. Each time, the supporters of the new models have invoked the name of Thomas Kuhn, speaking of a "paradigm shift".¹ This may be due to reasons other than theoretical, such as the need for any new model to be different from others, in what Frame) (1996) has called "the battle of brand names". For example, the first strategic and systemic therapists came from a psychoanalytic background but were almost compelled to deny this, in order to maintain the novelty and dignity of their own model. Nevertheless, they still tended to use—albeit implicitly—most psychoanalytic practices, which they knew well. In a similar fashion, some therapists later substituted systemic models for strategic and structural, and postmodern and narrative for systemic, in a constant pursuit of novelty (see Bertrando & Toffanetti, 2000).

We may or may not like the idea of substitution: I simply consider it impossible. Luigi Boscolo and I (Boscolo & Bertrando, 1996) proposed the concept of "untold" to refer precisely to those theories and life experiences that any therapist encounters, which become a part of her way of doing therapy and go on working within her, whether consciously or not.² A therapist of some experience reveals, in practice, much more than is prescribed or allowed by the theory. This hidden area constitutes the untold: any therapist works by integrating, more or less consciously, the various experiences and theories she has been touched by in the past. Theoretical purism, then, becomes but a myth: anyone working in our field undergoes innumerable influences throughout their personal and professional lives. To free ourselves from the paradoxes of the untold, Boscolo and I theorized an epigenetic model for the therapist:³

Rather than such progress "by leaps and bounds", we prefer an epigenetic evolution, in which every change in theory or practice connects up with those experiences that have proven themselves useful. This manner of theorizing is not a simple linear process of accumulating new ideas over time, but rather (in harmony with our systemic-cybernetic view) a system of concepts and of experiences recursively connected and in continual evolution. ... In our work we find inspiration in the meaningful voices to which we have been exposed during our professional career. In accordance with our epigenetic view, we integrate within our more recent version of the systemic model the theories learned in the past, and all the meaningful "voices" (professional or simply human) that inspire us in our daily practice and life. [Boscolo & Bertrando, 1996, pp. 35-39]

If this epigenesis is not acknowledged, the therapist thinks she is a "purist" in her approach, but in fact the bases of the epigenesis sink in the untold. An example concerns the work of the original Milan Team: the team members considered themselves "systemic purists", but when a fellow family therapist, who had remained faithful to the psychoanalytic tradition, saw them at work in the Milan Centre circa 1975, he was seeing four psychoanalysts working with lots of analytic ideas, but without speaking them aloud.

Now, what can be said of persons can also be said of theories—which are, after all, created by persons. I believe that, as the therapist may develop herself through epigenetic evolution, so the theories themselves may evolve in the same manner. As Reisman (1991) points out, any historical period in clinical psychology has concepts that are taken for granted and emphasize certain issues. In the 1950s, psychoanalysis was obvious, and it was the systemic view that made a difference; forty years later, within the field of family therapy,⁴ systems had become obvious and were replaced by stories, conversation, or solutions—and many more substitutions had happened in the intervening years. But each discarded theory or model left something of itself in the new ones. In an epigenetic perspective, what comes last contains, in a way, what has come before, is influenced and shaped by it, and, in turn, gives a new shape to it. Any change takes place in continuity, and nothing is forgotten, just transformed.

If we follow this version of the evolution of systemic therapy we may find more continuity than is usually acknowledged; and we may find, at the same time, that new theories are built over old ones, in a process dictated not only by theoretical choices, but also by cultural and material conditions. Family therapy has been influenced by the wider cultural climate, by the requests and economic conditions of health and social services, and by the changing demands of clients.⁵ At the same time, many aspects of older theories remained hidden, embodied in the practice of therapists.

To explain what I mean, I will go back for a moment to some members of the original Milan Group whom I had the opportunity to know well personally. One may wonder why they obtained wonderful results with the paradoxical method, results other professionals were not able to attain. I believe this was due to their psychoanalytic background, which, when uniquely combined with the ideas of first-order cybernetics, produced a very effective mix (Boscolo, personal communication). The emphasis on the therapeutic relationship and on neutrality in systemic therapy came from Milan (see Selvini Palazzoli, Boscolo, Cecchin, & Prata, 1980a); and the Milan Group, in turn, emphasized those concepts and the consequent praxis because it had been central in their years of practice as psychoanalysts. Milan-style therapists of the next generation were, in turn, influenced by Luigi Boscolo and Gianfranco Cecchin's workshops rather than by articles or books (see Stratton & Seligman, 1997). They learned not only from what the Milan Associates told, but also from what remained untold.

At the same time, though, what sinks into the untold becomes more and more difficult to convey to colleagues. If one only reads about any therapeutic approach, the best one can do is to try to put abstract ideas into practice. Those who try to learn a practice by readings books are frequently misled. Lannamann (1998) gives an example of a Milan-style discussion where all team members forgot to anchor their refraining of the situation to the emotional experiences of their clients and began a totally self-absorbed team discussion, ending up with a disastrous final statement. Now, an expert Milan-style therapist would never forget the concrete life experiences and the emotional tones of the clients' situation and would have calibrated herself to these; but such a sensibility is difficult to convey and teach purely through writing, where ideological infatuation becomes easier—as was probably the case with Lannamann's team.

I think there is a sort of recursive relationship between theory and practice. Theories shape part of the therapist's practice (most of all, leading us to consider a certain situation as a "problem", or an "illness", or a "subjugated knowledge");⁶ and practice, in turn, shapes theory (especially the way of dancing with clients to explore problems, illnesses, and so on).

This means that what is embodied in a therapeutic conversation is more important than the theory held by the therapist. In psychoanalysis, the embodied practice is transmitted chiefly through personal and didactic analysis: future analysts learn the implicit tenets of the technique through the experience of their own analysis. In family therapy the widely used public demonstrations, role playing, and videotapes are among the most important media for the transmission of the practice. At the same time, on the part of the therapist, the embodiment is made up—not only, but also—of the theories to which she has been exposed. Thus, at the individual therapist's level, the epigenesis of therapist and the epigenesis of theories come to confluence of a sort.

Dell (1989) remembers mat early systemic-cybernetic therapeutic theories encompassed an implicit knowledge of individual psychology; the same, in my view, applies to contemporary postmodern therapies, which embody an implicit knowledge of systemic interactions. Postmodern narrative therapies have been built on systemic therapies, keeping some implicit assumptions of the latter but without speaking them aloud. In other words, I believe postmodern therapists work under powerful influences from their own theories, but, at the same time, they are also influenced by internalized theories and praxes they do not explicitly profess. I would like to render such implicit assumptions more explicit. To this purpose, I want now to deal with the complex relationship between postmodern perspective and systemic-cybernetic theories as used by therapists with a systemic background. My aim is to throw a slanting, oblique light on this complex relationship between systems and postmodernism—a sort of meta-postmodern vision.

Understanding

According to Michel Foucault, genealogy is a way of tracking the historical development of ideas and practices trying to start not from a (hypothetical and metahistorical) origin but, rather, from contemporary preoccupations, and going backward in time to find the discontinuities from which they emerged and their (possible) development, complex and erratic though it may be:

History is the concrete body of a development, with its moments of intensity its lapses, its extended periods of feverish agitation, its fainting spells. . . . Genealogy does not pretend to go back in time to restore an unbroken continuity that operates beyond the dispersion of forgotten things; ... on the contrary, to follow the complex course of descent is to maintain passing events in their proper dispersion; it is to identify the accidents, the minute deviations—or conversely the complete reversals— the errors, the false appraisals, and the faulty calculations that gave birth to those things that continue to exist and have value for us. [Foucault, 1971a, pp. 86-87]

I would like to do something similar in relation to the possible ways of conceiving, theorizing, and practising therapy. Among the nearly endless possibilities for dividing and ordering clinical approaches, I chose—arbitrarily, but not entirely so—to discriminate between what I call the pathway of understanding and the pathway of influencing. Those two pathways run next to each other through all the vicissitudes of systemic therapy, sometimes coming close to each other, sometimes seeing each other from a distance. To give a preliminary definition, I refer to one of the sharpest and clearest authors within the field, Jay Haley:

What is the cause of change? There are two extremes. Some therapists believe that change occurs only through insight and self understanding and so they explore with clients hypotheses about their nature. In contrast, other therapists believe that change is caused by a shift in a person's behaviour and social situation and insight is irrelevant. [Haley, 1986, p. 106]

When Haley wrote these lines, he obviously had in mind his lifelong adversary: psychoanalysis. After all, in creating, with psychoanalysis, the original source of all modern psychotherapy, Sigmund Freud had defined a kind of wisdom: if you understand (yourself, your inner process), then you change. Of course, the first and foremost example of an understanding attitude in therapy is psychoanalytic interpretation, aimed at bringing unconscious content to consciousness, overcoming resistance. In traditional Freudian psychoanalysis the accent is on the patient's production of meaning: the patient speaks, the analyst listens and interprets. In this process, understanding is twofold: interpretation makes the patient aware of some of his unconscious processes and, at the same time, furthers the analyst's knowledge of the human mind. Psychoanalysis is both cure and science. As Freud himself confided to Wilhelm Fliess in one of his innumerable letters:

I am plagued by two ambitions: to see how the theory of mental functioning takes shape if quantitative considerations, a sort of economics of nerve-force, are introduced into it; and secondly, to extract from psychopathology what may be of benefit for normal psychology. . . . I get great Satisfaction from the work on neuroses in my practice. Nearly everything is confirmed daily, new pieces are added, and it is a fine thing to feel certain that the core of the matter is within one's grasp. [Freud, letter to FliesS, 25 May 1885: in Ehrenwald, 1991, p. 287]

Freud probably took this attitude from his own academic past: he had, after all, been an experimental neurologist. Thus the ambiguous position of psychoanalysis—partly the art of healing, partly a science of the mind—was established and was taken for granted for years. All psychotherapies have inherited something from it.

Gregory Bateson, who was so different from Freud, did share with him at least one feature: originally, he had had nothing to do with psychotherapy. When he approached psychiatry, working with Jurgen Ruesch in the late 1940s, he did it from an anthropologist's point of view: he set out to study the customs and the world view of what he called "the tribe of psychiatrists" (Lipset, 1980). And, even earlier, when he had first proposed some therapeutic ideas in his book Naven, he was thinking along similar lines. Bateson was interested in understanding how people functioned rather than in changing them.

In Freudian analysis . . . there is an emphasis upon the diachronic view of the individual, and to a very great extent the cure depends upon inducing the patient to see his life in these terms. . . . But it should also be possible to make the patient see his reactions to those around him in synchronic terms. [Bateson, 1935, p. 181; italics added]

Bateson shared with Freud a faith in a scientific kind of understanding, which Should lead a person to become a sort of researcher of himself.⁷ What changes here is the locus of understanding: not the hidden depths of the person, or the forgotten past, but, rather, his patterns of interaction with the others. The first systemic group established in Palo Alto, California, appropriated such a stance through Bateson, who had been its founder. It was natural for him to use, for this new kind of understanding, the conceptual tools he had collaborated in developing—those of cybernetics.

Cybernetics had been created in the late 1940s, at the Macy Conferences (Heims, 1991) organized in New York by the Macy Foundation between 1946 and 1951. The Conferences were occasions of meeting and discussion for a composite group of neurophysiologists, mathematicians, logicians, engineers, physiologists, anthropologists, psychoanalysts, and psychologists. Together with Margaret Mead and Warner McCulloch, Bateson had been one of their leaders.

Cybernetics was born in a well-defined time and place: the immediate postwar period in the United States. At that time, the United States had reached the zenith of its political and economic power in the world, while its establishment was starting to fear the communist menace. It was an era of growth, confused and sometimes fearful, but—at least on the surface—filled with optimism and social dynamism. The American supremacy was largely due to a scientific and technological primacy: it is not a surprise, therefore, that the founders of cybernetics would call themselves scientists, nor that most of them, independently from their specific field of inquiry, would show a great optimism about the possibility of developing technologies for the amelioration of society. This could not happen, though, through political means: politics was suspected of radicalism and pro-communism (Senator Joseph McCarthy would come to the fore in a short while); the idea was to ameliorate society by ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• SERIES EDITORS' FOREWORD
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• Introduction
• 1 Understanding and influencing
• 2 Text and context
• 3 Practices and theories
• 4 Hypotheses and dialogues
• 5 Therapists and clients
• 6 Frames and relationships
• 7 Dialogues and systems
• 8 Statements and questions
• 9 Presence and absence
• 10 Selves and technologies
• Postscript
• REFERENCES
• INDEX