Multiple Voices

Narrative in Systemic Family Psychotherapy

John Byng-Hall, Renos K. Papadopoulos, John Byng-Hall, Renos K. Papadopoulos

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781855759954
• eBook ISBN:
  9780429916397
• Topic: Psychology
• Subtopic: Education in Psychology
• Index: Psychology

Part of the Tavistock Clinic Series, this book focuses on narrative and stories in Family Systems Therapy - particularly on how stories develop within the domain of a therapist's own theoretical, clinical and professional contexts. The aim is to allow the reader to understand the uses of stories in family therapy.This book offers a comprehensive overview of issues related to narrative which appear in a family therapy setting. Originally embarking on a joint project to share clinical experience, members of the Family Systems Group at the Tavistock Clinic discovered that what was common in their work was their emphasis on narrative. This discovery led in time to the development of a shared discourse about their diverse approaches to narrative which are carefully reflected in the contributions in this volume. Part One sets out the context of narrative with contributions on bilingualism and the family's experience of therapy, ending with a thought provoking critique of narrative. Part Two concentrates on applications of these ideas, providing analysis of multiple narratives in illness and loss, gender and language, neonatal care, adoption, divorce and refugee families.

Part One
Narrative

Construing the Context

1
The Other Side of the Story

Listening for the Client’s Experience of Therapy

David Campbell

Introduction

I have been a family researcher all of my life. As the second and last child born into my family I arrived to discover (or should I say invent) a ready-made family of mother, father and older brother, and I suppose I have been trying to make sense of how to ‘fit in’ ever since.

In many families the youngest child slots into a favoured role, but in my case, I was more interested in growing up and joining the others. I soon became interested in power and inequality and the struggle to get more power for myself without revealing my wish to destroy all my competitors. As I look back now on my childhood preoccupation with sports and teams, I see it as an opportunity to gain power in ways that are reasonably acceptable. I have always supported the ‘underdog’ to win a sporting competition because I can deeply identify with the struggle to overcome the odds.

As a family therapist, my most significant journey has been the one from structural family therapy to the Milan approach. Following training events with Minuchin, Aponte and Walters in the 1970s, I could see how effective these therapists were with troubled families; but they were also people holding and utilising considerable power; and, although I tried to master these new techniques, I couldn’t help feeling this therapeutic style, unfortunately, just wasn’t me. With the arrival of the Milan approach in the early 1980s with its emphasis on neutrality and an open, circular style of questioning, I felt this style allowed me to become powerful in more subtle ways which I was used to. Perhaps it allowed me to be powerful without openly demonstrating the exercise of power. And in the meantime, I feel I have now been able to develop a style which integrates different models and techniques because I am more interested, and more comfortable, exploring expressions of power and powerlessness in myself as well as the family as a basis of much of my work with families.

What does all this have to do with my approach to family research? The underlying assumption in my research is that the key to unlocking family problems lies within the stories families tell us, but families in therapy are ‘underdogs’, and as therapists in positions of power, we may not be able to hear the vital elements in the stories which lead to therapeutic change. The research is an attempt to give the ‘underdogs’ a stronger voice and ultimately encourage therapists to re-examine the way they listen and negotiate the use of power in the process of therapy.

This chapter is based on three years’ work of a research team whose broad aim has been to understand the experience which families have when they take part in family therapy. The team has had a shifting membership during this time.¹ I have been the constant member of the team, and while my ideas have been influenced by discussions in the team, and I will refer to the projects of team members, I am presenting, here, my own thoughts which are based on my own interviews with families.²

Why this area of interest? Following the exciting and creative injection of family therapy techniques into the field from the early 1980s (see Hoffman, 1982; Penn 1983; Campbell et al. 1983 and Tomm, 1984, amongst many), I have more recently looked beyond the techniques of family therapy to the fundamental therapeutic process and specifically the developing relationship between therapist and clients (see Flaskas and Perlesz, 1996). I spend much of my time as a ‘live’ supervisor, and on the dark side of the one-way mirror there is plenty of time to think. I am more interested, today, to observe the way the therapist creates what I will call the ‘therapeutic context’ with families, and I frequently ask myself, what is the therapist doing (or not) to allow the family to trust enough to join the therapist in creating a therapeutic context?

There is more to this process than being a genuine and empathie person. 1 am interested in the process by which therapists become aware of the ongoing development of the therapeutic context and adjust their behaviour as a result. As a supervisor I aim to help therapists monitor the ongoing relationship between themselves and their clients. When I observe sessions I ask myself such questions as: Does the relationship, at this moment seem sufficiently therapeutic, i.e. is everyone in the room (both clients and therapists) safe and able to trust, yet also willing to be challenged to see things differently and to tolerate new feelings? Will therapists allow themselves to learn from clients and vice versa?

To develop greater awareness in this area therapists need to be more aware of clients’ experiences of the therapeutic process. 1 am aware of often being absorbed by my own mental efforts to make some meaning out of what clients are saying. This self-absorption can then become a barrier between me and the clients, and I cease to be aware of the evolving relationship between me and them.

Perhaps more than anything, this chapter is about my attempt to think less about my own ideas and more about the client’s. This is obviously a personal pursuit of my own, but I also find when therapists can do this the therapeutic context is established more quickly and it is maintained more assiduously throughout therapy. In the context of this book, this chapter is about the way therapists and clients create a narrative about their therapy together and how both clients and therapists can become more aware of this process.

My Position as a Researcher

The traditional position of the researcher is to observe families and then categorise these observations. However, in the era of social construction we are challenged to take greater responsibility for what we observe; for the social discourses which influence how we observe; and for the process of consensual agreement which verifies our observations. Valuable discussions of the way social constructionism can be integrated with research methodology will be found in Burr, 1995; Burman and Parker, 1993; Hollway, 1989; and Steier, 1991. I will present my experience interviewing several families by clarifying my reasons for pursuing a particular method, the way I was affected by the feedback, and the reasons for changing to a new method.

I am interested in the problem of who is commenting on what families say? Are they to be taken at their word, or is it the place of a researcher to interpret what is said and give it a new meaning. And if this is deemed a helpful process, who is this researcher anyway? What are his or her credentials for doing this and how will he or she account for his or her own biases in making their interpretations?

I find that, as a struggling therapist, I would welcome some generalised research findings which I could apply to my own therapy, but I know they are also potential traps, for while research can unearth such ‘truths’, we still must be careful that the generalisation of such truths does not stop us from thinking, and from observing the evolving therapeutic relationship. This chapter, then, has more to do with my attempts to raise my own awareness, by using a research methodology to understand more about the obstacles I encounter in listening to clients’ experiences. I will share the problems designing this type of research project and I will share my own personal learning as a result of the project.

Starting Out

I began the project by looking at the literature to learn what was known about families’ experience. Reimers and Treacher, (1995) have produced a helpful guide into this area; nevertheless it is very difficult to summarise studies which have used different designs to contact diverse samples of users of family therapy. But there is some convergence of findings in studies trying to understand the consumer’s experience. For example, one consistent finding (Woodward, 1978; Crane et al., 1986) is that many families feel therapy is not being carried out to their needs and expectations. Kuehl (1990) found users felt their direct questions were not met by therapists, and a frequent finding amongst many researchers is that family members want direct advice about what to do to ease their problems.

Levels of satisfaction with therapy vary from 50 to 85 per cent depending on which study is consulted. One major study by Piercy et al. (1986) stands out as the most positive. In addition to overall satisfaction, this team discovered high rates of satisfaction with technical aspects such as the team behind the screen, interruptions, video and phone-ins.

But the literature is replete with negative reactions to therapy which therapists must take seriously. For example, Richards (1995) set out to study the responses of working-class families to family therapy. Of 21 families interviewed in person, 19 were dissatisfied with therapy they had received. The major theme emerging from the data was the families sense on incomprehension. They did not understand what the workers were getting at, or felt the workers did not understand what their problems and needs were, or sometimes both. The purpose of the session did not seem to be understood by clients who consequently felt angry, frustrated or disorientated. The researchers also interviewed the workers in each case and found they were under no illusions about the outcomes of their work with the families, but they seemed to be unaware of how ‘thoroughly disenchanted some of the clients were about their experience’.

This study suggests therapists may not be paying sufficient attention to whether their approach fits with their clients, and Richards concludes that differences of fit may be more pronounced with working-class families whose language and expectation of therapy are different from those of the therapist. I am not aware of any studies which look at therapy done with therapist and family each coming from a different culture, but I think we could all learn about the problem of fit by studying such a group of cases. Richard’s views are echoed by Howe (1989) in Britain who studied 21 family therapy cases and concluded that systemic family therapy failed to understand the individual’s subjective experiences, and fails to allow a genuine dialogue to take place between therapists and users. He felt therapists disempowered family members, but were themselves empowered by technique and theory and language which created a barrier for their clients. Howe’s is one of several studies which report families found therapists ‘robotic’ and ‘dehumanising’ in some cases. Marshal et al. in 1989 set out to measure the degree satisfaction with Milan-style therapy found nearly half of the families contacted disliked the therapy they received. The strongest criticisms were reserved for the team behind the screen and long intervals between sessions.

Home-Grown Findings

I now want to discuss briefly some of the findings which have emerged from our team before turning to the wider field. Rutherford found in child protection cases that the overwhelming fear that children would be taken from their families made it difficult to create a good working relationship with professionals. A central paradox for these families is: If people admit they need help with their children, will this be construed as evidence of inadequacy, which means they are one step nearer to having their children removed? Families came to the NSPCC Centre feeling blamed for being bad parents and expecting to be judged by the workers as to whether or not they were good enough. The intensity of this experience led to polarised feelings: either they were good or they were bad. Rutherford observed that this polarisation characterised their feelings about the workers, as if they were saying, ‘It’s not us, so it must be you.’

She concluded that there is a tendency for all child protection issues to be seen in terms of only one side of the question. For example, users views are either ignored completely as biased or inconsistent, or they are accepted at face value without sufficient attention to the context. In the press, workers are either gullible stooges or child snatchers. Parents are either abusers or victims. One of her conclusions is that the agency must address both sides of these issues and acknowledge the many layers of meaning which underlie the communication between the clients and workers in this field.

Richardson used a grounded theory approach to analyse the transcripts from her family interviews. In relation to the question, ‘What was helpful about therapy?’, five themes emerged consistently: 1) being able to talk to someone about their problem; 2) being able to express their feelings; 3) coming to terms with a problem or illness; 4) new realisations about the problem; and 5) changing their views of relationships. The first three of these would seem to be universal benefits of any type of ‘talking cure’, but the last two seem to confirm the benefits of a family therapy approach which places some emphasis on a kind of systemic understanding, and the significance of family relationships in maintaining family based problems.

Of the eight families she interviewed, two said family therapy was not helpful. All were asked to create a picture by describing the ingredients for a therapist who would be helpful for them, and again five themes emerged: 1) (most helpful) shows an interest in the family; 2) provides a focus for discussion; 3) asks everyone to speak; 4) asks questions about the past and future, and 5) asks surprising questions. We were surprised that the families responded with such specific ideas about what is helpful in therapy, not only in terms of the general atmosphere, but in terms of the therapist’s technique. This may be the result of these families taking part in a type of therapy which emphasises certain techniques. The initial reading of this data suggests family members did respond in a particular way to the Milan approach, but Richardson will be looking further into this data for other possible explanations.

Going Solo

My own research has become a two-phase project with two different methodologies. Within the framework of the researcher as a participant observer who is continuously modifying his or her view in response to feedback, the great challenge for research is not the creation of a research question but the continuous reformulation of the question as one’s learning advances. In the first phase I chose to interview families in their homes using a semi-structured interview schedule 3–6 months following the termination of therapy.

I made a deliberate distinction between outcome and follow-up studies whose aim was to reflect back upon the outcome of therapy. Instead I aimed to explore:

• a) what therapy experiences families wished to talk about;
• b) how they expressed themselves on these topics; and
• c) what questions seemed most helpful in stimulating these discussions.

I have not found any other studies which were framed in this way. Early on I found this unnerving because I could not find any guidelines from more experienced researchers, but this has also encouraged me to consider my own experiences more carefully and to look to the clients for any guidance I may need.

There is always a selection problem in studies such as these, because the families who elect to be interviewed are generally well-disposed to therapy. (Certainly the converse is true. I have se...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgements
• Foreword
• Contributors
• Introduction
• Part One Narrative: Construing the Context
• Part Two Narrative: Applications
• Index