Family Therapy

A Constructive Framework

Roger Lowe

`I liked this book. Though I am not a family therapist, like most mental health nurses I try to bear in mind the family relationships of individuals I am working with. This is an enlightening text which not only offer a framework with which we can better understand the severe psychopathologies seen in forensic work, but also gives examples of how it may be used therapeutically? - Mental Health Practice

`I think this is an important book that crystallises complex theory into a user-friendly model, using case material and discussions from the therapeutic community. A must have for counsellors working with families, this will form part of the recommended reading on the Family Counselling course? - Barbara McKay, Relate Head of Training, Relate News

`The book provides a good overview of a number of recent approaches to working with families as well as how the author thinks about them? - Stephen Bray, Nurturing Potential

`Roger Lowe achieves the almost impossible task of bringing together various theories, techniques and case examples in clear and accessible ways. Readers of all disciplines, from front-line hard-pressed practitioners to students on therapy and social work courses, will be grateful for the simple and, above all, useful way he tackles the burning questions that arise in working with the family group. Highly recommended!? - Harvey Ratner, Brief Therapy Practice, London

Family Therapy introduces practitioners to the principles of using a constructive and collaborative approach with families. The approach builds on a strengths-based philosophy and focuses on enhancing family resilience and competence in a way that is both time-efficient and comprehensive. It brings together skills from contemporary models such as solution-focused, narrative and conversational therapies and adapts them to the specific challenges of working with family relationships. It is the first book to systematically integrate these influential approaches and apply them to family work.

Setting out a clear framework for practice, Roger Lowe describes the key tasks for the therapist as:

· hosting meetings

· negotiating concerns, and

· evoking family members? personal and relationship resources.

The framework is designed to be clear but flexible, and to allow practitioners to adapt it to their own situational needs. For example, it suggests ways for practitioners to selectively ?borrow? from other therapeutic models while retaining a constructive orientation. It also explores ways in which therapists can use their ?inner? conversation during a session as a tool to overcome obstacles to the therapeutic process. Although there is a common belief that the approach is only suited to brief interventions, the author also describes ways of working constructively over a longer period of time.

Throughout the book, case studies are included to show how the constructive framework is used in practice and to highlight a range of challenging situations that may be encountered during family therapy.

Roger Lowe?s book provides a refreshingly different approach to working with families, which chimes with the growing interest in constructive approaches. It is written for trainees and for practitioners who are interested in developing their skills in this collaborative and optimistic approach.

1	Travelling Light

Maybe family therapy practice can best be compared with making a voyage through some unknown country, on a strange continent. … The travellers face a lot of uncertainty and insecurity, because on this journey unexpected things are bound to happen. Just like these travellers, the therapist does not have a lot of tools to fulfil the therapeutic mission. (Rober, 2002: 477)

If one can trust nothing, then the best way to start travelling is to travel light.… (Curt, 1994: 211)

Foundations of a constructive framework

To set the scene for this book, I will begin with a travel analogy.

Imagine that you are about to embark on an open-ended professional journey that will involve you in many different contexts and applications of family therapy. You don’t know how long you will be away or where your adventures as a family therapist might take you. You cannot predict whom you will encounter, what kinds of relationships you will be working with, or what kinds of issues will be presented. You cannot rely on regular consultation with colleagues, and may have to practise alone for considerable periods. If you could pack only a handful of key, durable and adaptable concepts and skills to sustain you on this journey and fulfil the therapeutic mission, what would you take? What would you select in order to have a solid, reliable and robust framework at your disposal? What would be the therapist’s equivalent of a Swiss army knife?

This book represents my attempt to address these questions, and to offer a constructive framework for family therapy that may serve your needs on this imaginary journey. The theme of travelling light underlies the approach:

My guess is that we need to travel light and avoid carrying excess baggage in the form of assumptions that draw us into the whirlpool of hypothesis generation and structural analysis. By freeing ourselves of these assumptions, we increase our readiness to listen to the client’s story and to generate with the client new meanings and new understandings that will lead out of a problem-saturated world and into a world in which competence and a sense of personal agency become the dominant discourses. (Friedman, 1993: 252)

The preference for travelling light reflects two complementary themes in constructive therapies: affirmation of human resourcefulness and possibilities, combined with scepticism about many of the claims and uses of professional knowledge. Reflecting on these themes, it is easy to agree with the spirit of Friedman’s suggestion that we discard excess theoretical baggage and free ourselves to listen more generously and appreciatively. But putting this into practice poses some inevitable questions. How much can we afford to discard, and what exactly are we going to take instead? Where do we draw the line between travelling light and being ill-equipped? We can consider a number of questions:

• How do constructive therapists conceptualize family therapy? How do they understand their ‘therapeutic mission’? How is this different from other approaches?
• Given the complexity and variety of family relationships, how can we work in ways that are simple and sustainable, simple but not simplistic?
• How can we select from the confusing variety of concepts and skills that are found in the constructive therapy literature? Which will travel best?
• What about other therapeutic traditions? How much extra knowledge do we need, and where should we look for it?
• Can we utilize knowledge from other traditions while maintaining a constructive orientation?
• How can we work in ways that are theoretically consistent but encourage flexibility and improvisation?

In other words, how can we ensure that we travel light, but journey well?

The travelling light metaphor helps to define both the challenge and the structure of the book. Each chapter corresponds to one item of essential ‘luggage’, one important component of a constructive framework. This opening chapter provides the foundation by setting out some theoretical contours for our framework. It focuses on some of the ‘realities’ we will select for the journey, our preferred understandings of constructive therapy, family therapy and therapeutic processes.

Let us take the analogy between travel and therapy a little further. Inexperienced travellers carry too much luggage. They imagine every conceivable eventuality that might occur on their trip and try to pack something to cover it. The unused baggage weighs them down and restricts manoeuvrability. Similarly, inexperienced therapists carry too much in the way of complicated and competing theories and skills. Lacking the discernment that comes with practice, and acting from a sincere desire to help, they often try to do too much too quickly, confusing themselves as much as their clients. With more experience, both travellers and therapists learn to travel light – to separate luggage from baggage – and to put their trust in their most useful, durable and versatile pieces of ‘equipment’. The art of travelling light involves learning to do a lot with a little.

Where to begin: families or therapy?

Should a book on family therapy begin with a discussion about families or a discussion about therapy? This is not an idle question, but a moot point that will help to clarify some important priorities. If the book began with a discussion about families, this would have the effect of prioritizing knowledge about families. The implication would be that our approach must be derived specifically from a theoretical understanding of families, and that working with families is fundamentally different from working with individuals or couples. On the other hand, if the book began with a discussion of a therapy framework, this would suggest that the main knowledge base we are working from consists of some generic therapeutic principles that can be adapted to the context of family work (and supplemented, where necessary, with additional specialized knowledge). Knowledge about the therapeutic orientation would be prioritized over knowledge about families.

Constructive therapists favour the second option. Their particular theoretical starting point is not an understanding of how problems occur in families but an understanding of how change occurs in therapy, regardless of whether you are working with individuals, couples or families (or, for that matter, with groups or organizations). Therefore, it makes sense to focus first on what is common about constructive therapy across all modalities. Then we can consider what is different about working with families, and what additional forms of knowledge may be needed in developing a framework for constructive family therapy.

A constructive orientation

I have borrowed the umbrella term ‘constructive’ from two main sources. In the therapy field, Michael Hoyt (1994, 1996, 1998) has used this term to cover a range of contemporary approaches including solution-oriented, solution-focused, possibility, narrative, postmodern, co-operative, competency-based and constructivist therapies. Acknowledging their theoretical differences, Hoyt suggests that in practice they share several important features:

… a respectful partnership between therapist and client, an emphasis on strengths and resources, and a hopeful eye toward the future.
Each, in its own way, is constructive therapy, the building of solutions, with language or ‘conversation’… being the map if not the territory. (1994: 2)

Hoyt emphasizes two other characteristics:

Constructive therapies are approaches that begin with the recognition that humans are meaning-makers who construct, not simply uncover, their psychological realities. … [W]e are actively building a worldview that influences our actions. (1998: 1)

Further, in relation to practice he suggests that constructive therapists are especially interested in ‘the enhancement of choice through respectful collaboration and the fuller utilization of clients’ competencies and resources’ (Hoyt, 1998: 1).

Friedman (cited in Hoyt, 1998: 3) has summarized some distinguishing features of constructive therapy practice. These are presented in Box 1.1.

Box 1.1 Characteristics of constructive therapy practice

The constructive therapist:

• Believes in a socially constructed reality.
• Emphasizes the reflexive nature of therapeutic relationships in which the client and therapist co-construct meanings in dialogue or conversation.
• Moves away from hierarchical distinctions toward a more egalitarian offering of ideas and respect for differences.
• Maintains empathy and respect for the client’s predicament and a belief in the power of therapeutic conversation to liberate suppressed, ignored, or previously unacknowledged voices or stories.
• Co-constructs goals and negotiates direction in therapy, placing the client in the driver’s seat, as an expert on his or her own predicament and dilemmas.
• Searches for and amplifies client competencies, strengths, and resources and avoids being a detective of pathology or reifying rigid diagnostic distinctions.
• Avoids a vocabulary of deficit and dysfunction, replacing the jargon of pathology (and distance) with the language of the everyday.
• Is oriented toward the future and optimistic about change.
• Is sensitive to the methods and processes used in the therapeutic conversation.

Friedman (cited in Hoyt, 1998: 3)

Parton and O’Byrne (2000) have also used the term in their development of ‘constructive social work’. They juxtapose two important senses of ‘constructive’: a theoretical sense relating to the influence of constructionist ideas, and the everyday sense of contributing in a positive, co-operative and practical manner. Building on these uses, I will identify a constructive therapy framework as one that combines two aspects: a theoretical stance informed by constructionist ideas, and a practice stance that is optimistic, collaborative and competency-based. Before going further, it is important to note that these two aspects are not intrinsically linked. It is perfectly possible to identify with collaborative and competency-based practice without embracing a constructionist framework. For example, it is not unusual for therapists to adopt some of the methods of solution-focused or narrative therapies but to ‘relocate’ them within humanistic, cognitive-behavioural or systemic frameworks. It is also possible to base many aspects of collaborative and competency-based practice on the findings of contemporary research into common factors of change (Hubble, Duncan and Miller, 1999). A pragmatic approach might suggest that broad meta-frameworks such as constructionism are of little interest to practitioners who should be encouraged to learn a wide range of methods and to do whatever works for their clients.

My suggestion, however, is that if we wish to travel light, and to do a lot with a little, it is fundamentally important that we have some consistent principles to guide our actions. We will need to be able to think quickly and clearly in response to unexpected, difficult and novel situations, and to reflect on our practice in productive ways. At the very least, we need to have an understanding of the connection between means and ends, between what we are doing and why we are doing it. A broadly based constructionist perspective provides one consistent way of integrating many of the contemporary competency-based practices. This does not mean that we cannot draw upon other traditions, or that we must jettison all of our prior learning. However, by linking constructionist ideas to constructive practice we can establish a preferred philosophy and orientation for our framework.

Constructionist themes and constructive practice

Rather than discussing constructionism¹ in general I will focus specifically on particular themes that have been influential in the therapy field. Gergen (1999) has identified four characteristics of constructionist-based therapies: a focus on meaning, therapy as co-construction, a focus on relationship, and value sensitivity. I will build the discussion around these interrelated themes and then link them to more specific practice principles. At a broader level, these themes highlight the paradigm shift from a realist perspective to a constructionist perspective. As Shotter (1993) suggests, the tension between realist and constructionist positions relates to the different emphasis they place on ‘finding’ and ‘making’ – between an assumption that realities are found and an assumption that realities are made. In making these particular connections, it is important to acknowledge the inevitable influence of personal choice and preference. This is my (current) way of making sense of a complex, contentious and always changing field.

A focus on meaning

This theme reflects a shift in emphasis from the analysis of structures and essences to the process of social meaning-making. Problem-oriented therapies have been traditionally concerned with finding the root cause or the essential nature of the problem. The emphasis is on getting to the ‘facts’ of the case, based on the assumption that the language used to describe it objectively maps what is ‘really there’.

Constructionists, however, assert that language is a form of action that works to make the world rather than to map it. The terms that we use to understand our world do not correspond directly to what is ‘really there’ but are derived within particular cultural traditions of understanding, and inevitably involve forms of reification: the confusion of words with things. For example, within the realist tradition of therapeutic discourse, we might take for granted that words like ‘self’, ‘personality’ or ‘family system’ refer to actually existing entities. From a constructionist perspective, however, these familiar terms do not refer to entities but are, themselves, ‘inventities’ (O’Hanlon and Wilk, 1987). Recognition that such terms are social and linguistic constructions rather than actually existing entities, essences or structures leads us to examine the way they are used in specific situations and the meanings and consequences that follow. Constructionists take the view that, for any given situation, there are ‘multiple realities’ in the sense of multiple potential descriptions and explanations. Meaning is not derived directly from ‘the facts’ of the case but is negotiated through social processes.

If we view meaning as being created in the social interactions that occur between people, and as being context-dependent and constantly changing, this suggests a new therapeutic emphasis based on the ongoing negotiation and storying of experience (Walter and Peller, 2000). This involves a shift away from the language of observation, assessment and intervention to a language of conversation, narrative and consultation. The central metaphor is one of therapy as both conversational resource and resourceful conversation, rather than a form of treatment or psycho-education.

Practice principles

• Human experience is inherently ambiguous and negotiable. People are ‘multi-storied’ and ‘multi-voiced’. However, particular stories and voices inevitably highlight some experiences and obscure others. Constructive therapists choose to highlight experiences of personal agency, hope and resourcefulness in the belief that as we describe the present and past, we simultaneously fashion the future.
• Therapy can be viewed as an ongoing process of negotiating narratives with clients (O’Connell, 1998). Certain types of narratives are more likely to motivate and support clients through difficult circumstances. These are ‘narratives about competence, skills and qualities which the client can utilize’ (ibid.: 16).
• By contrast, certain kinds of narratives are unlikely to be helpful, and tend to constrain time-effective work. Bertolino and O’Hanlon (2002) define four major kinds of problematic stories:
  1. Stories of blame. These occur where individuals are labelled, pathologized or blamed as being the ‘cause’ of the problem, or as having bad intentions or personality traits. Example: A wife says, ‘Our marriage is under stress be...

Table of contents

• Cover Page
• Title
• Copyright
• Dedication
• Book
• Contents
• Acknowledgements
• Introduction
• 1 Travelling Light
• 2 Hosting Family Members
• 3 Negotiating Concerns and Requests
• 4 Clarifying ‘Who Wants What?’
• 5 Evoking Possibilities
• 6 Working Constructively over Time
• 7 Using Inner Conversation
• 8 Borrowing from Other Frameworks
• 9 Responding to Challenges
• Final Reflections
• References
• Index