Becoming Miracle Workers

Language and Learning in Brief Therapy

Gale Miller

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780202305707
• eBook ISBN: 9781351328302
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Brief therapy is a postmodern treatment mode that treats problems as social constructions, encouraging those seeking treatment to replace personal troubles (negative stories) with new problem-solving skills (positive stories). The significant differences discussed in this book do not involve sociologists and brief therapists. The differences are between brief therapists, on the one hand, and practitioners of psychotherapy and family therapy on the other. One indicator of these is brief therapists' describing the people who seek their services as clients. The terminology may be contrasted with the language of patients used by many other therapists. At the very least, this difference suggests how brief therapy departs from therapy approaches that are based on the medical model.

Becoming Miracle Workers takes the reader inside "Northland Clinic," one of the most innovative and important centers of brief therapy in the world. Based on twelve years of research, Miller's book discusses how brief therapy has evolved into its present, postmodern form. He describes the details of brief therapist-client interactions, and the behind-the-scenes discussions among brief therapists about their clients' problems. This readable account of the workings of brief therapy invites readers to sit in on brief therapy sessions, provides them with new understandings of personal troubles as social constructions, and shows how brief therapists help their clients develop new, untroubled, life stories.

CHAPTER 1

OPENING MOVES

I grew up on a farm in southern Iowa during the 1950s and 1960s. My childhood and teen years were quite unremarkable. I attended the local public schools where I proved to be a lazy and mediocre—but not always uninterested—student. While I participated in several school sports from grammar school through high school, I still successfully managed to avoid distinguishing myself at any of them. I occupied the last chair in the coronet section of the band for over two years. Eventually I noticed that even the beginners were outperforming me, and decided that musical achievement was not in my future. Not only was I not elected to an office in student government, my name was never raised as a possibility. And I used not a minute of my eighteen years on the farm to develop an appreciation for the beauty and joys of the bucolic life.

None of this is to say, however, that I was inept at, or uninterested in, everything. Indeed, I was highly skilled at getting in trouble with adults, particularly with my family, teachers, and those who defined themselves as protectors of the local morality. These and other adults in my life regularly complained about me and expressed their worries about how I might turn out, even though few of my offenses were serious. Only a minority of my adventures would have justified arrest or expulsion from school had I been caught. The words that might have been used to characterize me during this time are underachiever, disobedient, incorrigible, disruptive, know-it-all, undependable, and smart ass. These were the sorts of words that the superintendent of my high school used to describe me during a private meeting on my graduation night. He seemed happy to see me gone.

Now, from my perspective, all of this was much ado about very little. My troublemaking was not malicious, and might even be described as a side effect of my other—quite sensible—activities. My troubles usually emerged from having fun with my friends (several of whom were also adept at upsetting adults), misunderstandings with others, standing up for my rights, youthful curiosity and experimentation, and simply trying to deal with the circumstances of life. Nor was I a full-time troublemaker. While I sometimes went through extended periods of being continuously in trouble, I also experienced stretches of trouble-free life. Most of the time, however, my troublemaking involved isolated and episodic events. I would make a teacher mad one week, upset a family member the next, irritate a church official, police officer, or merchant two weeks later, and so on.

I tell you this story because, when I think back on this period in my life, I am struck by what is absent from the story. Despite my chronic troublemaking, I was never referred to a psychologist, social worker, psychiatrist, or other therapist for counseling. I only remember this possibility being discussed a few times. Of course, who knows what was said in my absence? It seems that while I was a problem to the adults in my life, they treated me as their problem. They reacted by warning me, scolding me, threatening me, giving me “one last chance,” and punishing me. They also conveyed to me the lessons that they had learned from their—more mature—life experiences, described my inevitable descent into serious criminal activity if I did not change my ways, praised me when I acted like a “good boy,” and initiated projects intended to get me interested in positive activities. Their problem literally went away when I left home to start a new life on my own.

It is unlikely that I would be treated similarly today. The period since my childhood has seen the professionalization of counseling and the spread of therapy services throughout American and many other societies. Even small, relatively isolated schools—like the ones that I attended—provide counseling services today. Further, courts routinely refer offenders to therapists, and members of the clergy make similar referrals, if they do not offer their own counseling services to their congregations. Families often voluntarily enter therapy in order to better understand and deal with children and teenagers who act as I did. Or parents might call one of the many counselors who dispense advice via television and the radio.

But this does not exhaust the choices to be made in referring children and others to counseling today. There is also the matter of what kind of therapy should be used. Corsini and Welding (1989), for example, include fifteen different kinds of psychotherapy in their overview of the field, and Lynn and Garske (1985) discuss twelve psychotherapy models and methods. These listings are a bit deceiving, however, since some of the categories include more than one type of therapy. This is also true of family therapy, which Goldenberg and Goldenberg (1991) subdivide into ten categories and which Hansen and L’Abate (1982) discuss as thirteen types. And there are therapies that do not easily fit into any psychotherapy and family therapy categories, such as narrative therapy (White and Epston 1990; Freedman and Combs 1996).

The ready availability of diverse therapy services today also suggests how public attitudes about counseling have changed since my early troublemaking days. Issues that were once likely to be treated as private matters—to be handled discretely by families, the police, and school officials—are now more likely to be treated as conditions requiring the intervention of experts, including therapists (Gubrium and Holstein 1995a, 1995b). We now seek therapists’ services in dealing with a wide range of personal troubles, including some that we acknowledge are less serious than others. I was recently reminded of this circumstance when I was asked, during a seminar about therapy, “So, who is your therapist?” Such a question would have been strange—maybe even offensive—in my youth, but it is quite appropriate today. After all, why wouldn’t I have a therapist?

I must also admit that there are times when I wonder what would have happened to me had I been referred to a therapist. My wonderment is not about whether my behavior would have changed; who can know about that? My interest, instead, is in how my behavior and I would have been defined by the therapist, and the treatment strategies that the therapist would have used to change my behavior. We further consider these issues in the next section, where I describe three scenarios of what might have happened to me had I been referred for counseling.

Three Counseling Possibilities

One possible source of counseling for me would have been psychoanalysis. This would have involved several—maybe many—meetings with a therapist who would assume that my troublesome behavior was a symptom of a more basic problem or disorder. That is, my behavior would have been treated as a sign of poor mental health and inadequate maturation. It might also have been classified much as other “diseases” are classified by medical professionals. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (1994) lists several potential categories for classifying my behavior, I suspect that it would have been diagnosed as evidence of Oppositional Defiant Disorder. According to the DSM,

Negativistic and defiant behaviors are expressed by persistent stubbornness, resistance to directions, and unwillingness to compromise, give in, or negotiate with adults or peers. Defiance may also include deliberate or persistent testing of limits, usually by ignoring orders, arguing, and failing to accept blame for misdeeds. Hostility can be directed at adults or peers and is shown by deliberately annoying others or by verbal aggression. … Manifestations of the disorder are almost invariably present in the home setting, but may not be evident at school or in the community. Symptoms of the disorder are typically more evident in interactions with adults or peers whom the individual knows well, and thus may not be apparent during clinical examination. Usually individuals with this disorder do not regard themselves as oppositional or defiant, but justify their behavior as a response to unreasonable demands or circumstances. (1994:91-92)

Does that sound familiar? But diagnosing my behavior as symptomatic of Oppositional Defiant Disorder is not as simple as it might seem at first glance. This category could have only been applied to my situation if my psychoanalyst also determined that my defiant behavior was more severe than that of other people of my age, and that it had resulted in “significant impairment in social, academic, or occupational functioning” (ibid., 91). If, in my psychoanalyst’s judgment, these conditions did not apply, then he or she might have considered a different psychiatric category and diagnosis. It is also possible that my psychoanalyst might have concluded that my defiant behavior was not sufficiently severe to warrant professional treatment, even if it was upsetting to others.

Had treatment been offered, a major goal of my psychoanalyst would have involved uncovering and exposing the hidden, underlying realities associated with my troublesome behavior. This would have likely included discussions about my early childhood experiences, and their significance for understanding my psychosexual development and the intrapsychic processes that lie behind my troublesome behavior. Indeed, virtually any past experience might have been considered in these discussions since psychoanalysts assume that all behavior is meaningful and potentially relevant to therapy. The therapy might also have included analysis of my dreams, and activities designed to “work through” my resistance to change. Much of the working through would have focused on my conscious and unconscious fantasies, which, from a psychoanalytic perspective, are defensive compensations for past conflicts and deprivations. Getting better would have required that I put these fantasies behind me.

If successful, my discussions with the psychoanalyst would have resulted in insight into my life, self, and troubles. I could use this new self-knowledge to take greater control over my life and to liberate myself from past—inappropriate—behaviors and choices. The behaviors would no longer be necessary since their causes would have been discovered and treated. Put differently, psychoanalytically created insight would make it possible for me to become a new person, one who is less disordered and therefore enjoys increased mental health.

A second source of counseling for me could have been behavioral therapy. While my behavioral therapist might have classified my “maladaptive” behavior within a professional category, she would have oriented to me and my troubles differently than my psychoanalyst. One of the most important differences would have been the behavioral therapist’s primary focus on my present behavior. She would have shown little interest in the conflicts and deprivations of my early life, or in discovering unconscious resistances and processes. Nor would this therapist have cared about helping me develop insight and self-knowledge so that I might make better choices about my life. For a behavioral therapist, my problem would have been behavioral and learned. She would have assumed that I acted as I did because aspects of my environment reinforced the behaviors that others found to be disturbing. Indeed, my behavioral therapist might have said that, since my critics were part of my behavioral environment, it was likely that they unwittingly contributed to my ongoing troublesomeness.

Based on these assumptions, my behavioral therapist would have initiated a treatment program designed to eliminate my maladaptive behavior, and to reinforce desired behaviors. A simplistic description of the program would emphasize how my therapist rewarded (positively reinforced) me for acting in preferred ways, and perhaps punished (aversively responded to) me for continuing to make trouble. In actual practice, I think my therapist would have selected a more sophisticated response than this, although it would still have been based on these basic behavioralist assumptions and principles.

One possible response is contingency contracting. That is, my therapist and I might have developed an agreement that specified which of my behaviors should be increased and which should be reduced. The contract would have also described when and how I was to be rewarded for positive behavior and punished for negative behavior. The rewards might have included the chance to stay up late at night, use the car, or stay all night at a friend’s house. Aversive treatment would have probably involved temporarily taking away something that I valued and/or being isolated from others for a time. The contract would have also included agreements about who could reward and punish my behavior, and perhaps even included a plan for eventually making me the primary dispenser of rewards and punishments. Behavioral therapists define the latter circumstance as self-control.

Behavioral therapists use these and related strategies to “teach” their clients new behaviors. Learning, for these therapists, consists of conditioned responses to environmental stimuli. They are not interested in transforming the personalities of their clients or expanding the clients’ free will. These are unrealistic and unattainable goals for behavioral therapists because they define human behavior as driven by environmental factors, not our personalities or free will. Successful behavioral therapy might have made me happier, but only because I would have learned behaviors that fit better with the world in which I lived. My “adaptive” behavior would be no less responsive to environmental rewards and punishments than my previous “maladaptive” behavior.

Finally, the adults in my young life might have arranged for me to talk to an existential therapist. The focus of these meetings would have been on the unique ways in which I interpreted aspects of my life, and how the interpretations were related to the everyday decisions that I made. This focus reflects two major assumptions of existential therapists. They assume that we are all limited by social, biological, physical, and other “objective facts” that exist in the world “out there,” and that each person’s experiences with these facts is different because we all interpret the world in our own ways. Everyone’s life and personality are, from this point of view, unique.

My existential therapist might have gone on to explain to me that my personality is a blend of facts over which I have limited control and imagined possibilities that are under my control. Our lives consist of what now exists, and what might be in the future. Much of my existential therapy would have been concerned with the development of greater awareness of the facts and possibilities of my life, and how they were shaped by my everyday decisions, particularly decisions that I made with little or no existential reflection. My therapist might have further explained that mature people, or “authentic beings,” make decisions that realistically accept the facts of life, but that also enhance the future possibilities of their lives. The best decisions, he would have said, involve choosing change over repeating the past.

No doubt, the most surprising aspect of my existential therapy experience would have been the day that my therapist told me that my troublemaking behavior was not a sign of personal strength and independence, but an expression of conformism. This approach to troubles treats them as part of a passive orientation that overemphasizes people’s powerlessness in dealing with the facts of their lives, and ignores the possibilities for building different future lives. My existential therapist might have further characterized my troublesome behavior as immature, inauthentic, or as part of my existential sickness. Whatever the terminology chosen, he would most certainly have assumed that the solution to my problems required that I overcome my passive orientation by taking responsibility for my life by choosing to change.

Among the likely techniques used by my existential therapist to get me to take responsibility would have been confrontation. He would have intentionally made me uncomfortable and even angry in order to get me to think about the choices that I had been making. He would have shown no interest in my theorizing about traumatic childhood experiences or how others unintentionally rewarded my troublesome ways, but would have insisted on talking about my present behaviors and decisions. It is also possible that my existential therapist would have asked me to focus. This technique involves turning one’s attention to a bodily state (such as fear, anxiety, or anger), trying to fully experience it, and then finding the word that best captures the feelings involved. Existential therapists use this technique to help their clients develop the skills needed to imagine new life possibilities.

If successful I would have emerged from existential therapy with a new—mature or authentic—orientation to life, one that stressed the opportunities available to me for shaping myself and my world. I would be a new person living in a new world of possibilities that I could choose and for which I would be responsible, even if those choices sometimes proved troublesome to others.

Focus of the Study

My point in constructing these scenarios of counseling possibilities is to illustrate how all therapies inevitably involve more than treatment techniques designed to remedy people’s troubles. They also include assumptions and theories about people’s troubles and troubled people, as well as vocabularies for describing people and their troubles. Indeed, these aspects of therapy are quite interconnected since therapy treatments only make sense in the context of the theories, assumptions, and vocabularies associated with them. These differences are perhaps most obvious in my imagined therapists’ orientations to the causes of my behavior. My psychoanalyst would have looked for these causes in my unconscious, my behavioral therapist in my social environment, and my existential therapist would have focused on my orientation to my present and future life.

Put differently, these issues involve the relationship between language and meaning, on the one hand, and therapeutic practice on the other. Therapy is a meaning-creating process involving language and social interaction. Whatever their approaches, experienced successful therapists are adept at meaning creation, and at using language in interacting with their clients. My interest in language use and meaning in therapy is both academic and practical. I am interested in the artful ways in which therapists and clients use language to create therapeutic meanings and in their practical consequences for therapists and clients. My interest in the artfulness of therapy emphasizes therapists’ and clients’ interactional and interpretive skills. While often taken for granted by therapists, clients, and others, these skills are vital aspects of all therapy relationships and interventions. Therapists and clients collaboratively construct meanings in their mutual interactions, and the meanings have practical implications for how clients’ problems are defined and remedied.

These interests define the general focus of this study and my approach to therapy. The approach draws from aspects of sociology that stress how our knowledge of the world, and actions within it, are shaped by language and social interaction. My approach also involves qualitative research in therapy settings. As a qualitative researcher, I observe what others do, ask them to explain their actions, and sometimes tape record their interactions. My job, as I see it, is not to critique the people who grant me the opportunity to observe them as they go about their everyday lives. They—not I—are the experts on the professional significance of their activities, including whether they are doing them properly. My contribution involves describing, and sociologically analyzing, what I see and hear.

I apply and elaborate on my approach to therapy in the rest of this book by analyzing the philosophy and practice of brief therapy, a unique approach to personal troubles that does not easily fit into conventional psychotherapy and family therapy categories. As the name suggests, brief therapy is designed to remedy clients’ ...

Table of contents

• Cover Page
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• 1 Opening Moves
• Part I Contexts of Brief Therapy
• Part II Workings of Brief Therapy
• Part III Implications of Brief Therapy
• References
• Index