Art-Making and its Interface With Dissociative Identity Disorder: No Words That Didn’t fit

Studies point to promising developments in expressive arts therapy work with clients who experience dissociation as one of a constellation of symptoms of trauma. Individuals diagnosed with Dissociative Identity Disorder, however, may be hesitant to engage with long-term therapy and its relationship. This article presents the case of one such individual, a participant in a narrative phenomenological study who was able to develop her own visual art-making practice. Reflections on this practice revealed that it offered a safe place for her to explore the voice of her “parts” hitherto silenced. Her narrative has implications for professionals working in the expressive and talking therapies.     

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

Narrative Sexual Identity Therapy

Sexual identity therapy is an alternative to the two polarized positions of sexual reorientation therapy and gay-integrative therapy for clients who present with sexual identity concerns. This alternative model focuses on sexual identity—the private and public acts of identifying and communicating one's sexual preferences—and how the decision to do so is informed by dominant stories about what sexual attractions mean to a client. As one expression of sexual identity therapy, this paper presents narrative sexual identity therapy, an approach that utilizes a narrative therapeutic approach and techniques to facilitate exploration of dominant narratives and counter-narratives that speak to sexual identity with the goal of achieving a synthesis that reflects felt congruence of clients' beliefs/values and behavior/identity.     

Towards a new philosophy of education: Extending the conversational metaphor for thinking

Recently, feminists like Jane Roland-Martin, Elizabeth Young-Bruehl, and others have advocated a conversational metaphor for thinking and rationality, and our image of the rational person. Elizabeth Young-Bruehl refers to thinking as a “constant interconnecting of representations of experiences and an extension of how we hear ourselves and others. There are numerous disadvantages to thinking about thinking as a conversation.We think there are difficulties in accepting the current formulation of the conversational metaphor without question. First, there is danger that we will lose important dialectical connections like that between the self and society. Second, the conversational metaphor alone cannot fully express the way conversations are constructed. We will want to take up the notion of narrative as a metaphor for thinking advocated by Susan Bordo, Alasdair MacIntyre, Jerome Bruner, and others, including Mary Belenky and her colleagues.Eventually, we want to champion narrative and the dramatic narrative of culture as a metaphor for thinking that involves such expressions as sights, insights, silences, as well as sounds, moments of mood and poetic moments. The dramatic narrative provides the structural possibilities needed to criticize certain kinds of conversations, in order to talk about the relations of public and private, self and society and most importantly, about the drama of our lives within and without.The dramatic narrative for thinking helps dispel the dangerous dualisms of mind and body that not even conversation or narration alone can banish, and allows us to frame questions about education that do not require us to separate mind from body. The dramatic narrative metaphor for thinking lets us show who we are, act out what we think, and reconstruct rationality to reflect what many women, and some men, do.     

Towards a new philosophy of education: Extending the conversational metaphor for thinking

Recently, feminists like Jane Roland-Martin, Elizabeth Young-Bruehl, and others have advocated a conversational metaphor for thinking and rationality, and our image of the rational person. Elizabeth Young-Bruehl refers to thinking as a constant interconnecting of representations of experiences and an extension of how we hear ourselves and others. There are numerous disadvantages to thinking about thinking as a conversation.We think there are difficulties in accepting the current formulation of the conversational metaphor without question. First, there is danger that we will lose important dialectical connections like that between the self and society. Second, the conversational metaphor alone cannot fully express the way conversations are constructed. We will want to take up the notion of narrative as a metaphor for thinking advocated by Susan Bordo, Alasdair MacIntyre, Jerome Bruner, and others, including Mary Belenky and her colleagues.Eventually, we want to champion narrative and the dramatic narrative of culture as a metaphor for thinking that involves such expressions as sights, insights, silences, as well as sounds, moments of mood and poetic moments. The dramatic narrative provides the structural possibilities needed to criticize certain kinds of conversations, in order to talk about the relations of public and private, self and society and most importantly, about the drama of our lives within and without.The dramatic narrative for thinking helps dispel the dangerous dualisms of mind and body that not even conversation or narration alone can banish, and allows us to frame questions about education that do not require us to separate mind from body. The dramatic narrative metaphor for thinking lets us show who we are, act out what we think, and reconstruct rationality to reflect what many women, and some men, do.     

Family Therapy with Couples and Individuals with Parkinson’s Disease

Family therapists are increasingly called upon to work with individuals and families with medical issues, but often do not have sufficient background on the issue to be most helpful. The purpose of this paper is to help family therapists understand Parkinson’s Disease (PD) and its impact on the individual and his or her family. PD is the second most prevalent neurodegenerative disorder in the United States, following Alzheimer’s disease (Hirtz et al., Neurology 68:326–337, 2007). According to the Parkinson’s Disease Foundation, approximately 60,000 individuals are diagnosed with PD every year, and approximately one million Americans are currently living with PD. In this paper, we provide an overview of PD based on research and the second author’s many years of providing services for individuals with PD, as well as offer specific recommendations for providing family therapy using narrative, solution-focused and emotionally focused therapy based on the first author’s work as a family therapist with individuals, groups, and couples dealing with PD.     

A Poetics of Psychological Explanation

Intentional, 'commonsense,' or 'folk' psychology is, as Jerry Fodor has remarked, ubiquitous. Explanations of what we say and do in terms of our reasons for acting are the stock in trade of intentional psychology. But there is a question whether explanations in terms of reasons are properly explanatory. Donald Davidson and Daniel Dennett, to name two, have defended intentional psychology and its reason-explanations. Still, many philosophers – including Fodor, Davidson and Dennett – fail to pay due attention to the narrative basis of such agent-centered accounts of action. In this paper, I argue that psychological explanation is an agent-centered, narrative-based interpretive practice. To make my case, I present a poetics of psychological explanation: seven elements which collectively describe what makes psychological explanations work. Narrative form allows us to represent the temporal arc of agents' actions – as well as the temporal arc of their reasoning about their actions, both prospective and retrospective. It allows us to negotiate between the canonical and the exceptional in human experience, and thus to account for actions that strike us as puzzling or unusual – whether the puzzle originates in our suboptimal understanding or the agent's suboptimal reasoning. And it allows us to juxtapose different perspectives on any action. Such juxtapositioning gives us a mechanism for coming to see how an action that strikes us as misguided might have been construed by the agent as reasonable given her understanding of her circumstances. After establishing the seven elements of the poetics, I address the objection that narrative-based accounts of intentional action are not properly explanatory.     

Arguments from Aesthetic Merit to Fictional Content

Often, part of the fictional content of a narrative is not stated explicitly. Interpreters are frequently concerned with establishing this content. In doing so, they sometimes argue that, fictionally, something is the case because under that interpretation, the aesthetic merit of the work would be greater than under an alternative interpretation. The move from what would be of greater aesthetic merit to what is (fictionally) the case raises questions regarding the argumentative force of such arguments: How exactly do the premises of arguments from aesthetic merit to fictional content (for short: Afams) establish their conclusions? This paper spells out four ways to reconstruct the argumentative structure of Afams: In Section ii , we analyze two possibilities to establish Afams as deductive arguments; Section iii is concerned with a reconstruction based on a constructivist picture of literature and literary interpretation; and in Section iv, we look at a nondeductive reconstruction of Afams in accordance with an intentionalist framework. While we conclude that all four reconstructions can account for the argumentative force of Afams, the ultimate acceptability of each reconstruction rests on the readers’ commitment to background assumptions concerning the theory of interpretation.     

Family therapy and the politics of evidence

This article situates family therapy in the politics of evidence-based practice. While there is a wealth of outcome research showing that family therapy works, it remains on the margin of mainstream therapy and mental health practice. Until recently it has been difficult to satisfy 'gold standards' of randomized control research which require manualization and controlled replication by independent investigators. This is because systemic family therapy is language-based, client-directed and focused on relational process rather than step-by-step operational techniques.
As a consequence family therapy is an empirically supported treatment unable to join the evidence-based club. The politics here concerns what is 'evidence', who defines it and the limitations of a scientist-practitioner model. Therapy is art and science and its research needs to be grounded in real-life clinical practice. Common factors such as personal hope and resourcefulness and the therapeutic relationship contribute more to change than technique or model.
While arguing for a wider definition of science and evidence it is politic to seek evidence-based status for family therapy. Family therapy is a best practice approach for all therapists where systemic wisdom helps to decide what to do with whom when . A systemic-practitioner model is informed by quantitative and qualitative research and holds modern and postmodern perspectives in tension, a stance I call paramodern . Family therapy is both scientific and systemic; it is a science of context, narrative and relationship.     

(My) spirituality in medical education

During these times of the situated, contingent text, it is not unusual for an author to disclose her biases and other sources of potential partiality as a researcher or theorist. That is, an author often discloses her race, class origins, or sexual orientation at the onset, announcing particularities that enable readers to adjust their reading to the subjectivities inherent to knowledge production. One glaring omission to these announcements, especially in medicine, has to do with the spiritual domain. This essay, written as a personal narrative, provides one example of how one's spirituality is connected to what and how one chooses to teach, even in the medical academy. Acknowledging those beliefs and considering how our spirituality (along with our other subjectivities that are known to us) may influence our work is an important process in developing a more reflective practice.     

'This is our life': strong evaluation in psychotherapy narrative

This paper examines the relevance of both client and counsellor conceptions of the ‘good life’ in relation to a narrative analysis of the first session of a case of successful client-centred therapy.In this opening session, the client embeds her ‘problem’ story within contrasting cultural narratives of what it means to live a good life. The therapist discourse also consistently draws upon a therapeutic meta-narrative that conveys an implicit story of how to live life well. This material is discussed from the perspective of the concept of ‘strong evaluation’ offered by the philosopher CharlesTaylor.Implications for research and practice are discussed.     

On the significance of Hannah Arendt's the human condition for sociology

Arendt's book is an analysis of the vita activa, which comprises the three human activities of labor, work, and action. Her presentation involves a critique of modern and current conceptions of them and of many other social phenomena, and an emphasis on distinctions customarily neglected. The interpretation of her book, disregarding the many factual statements it contains, proceeds in a theoretical vein, analyzing her major conceptions, and then turns practical, asking what we as social scientists who listen to her must do (focusing on “behavior” and “action”, “values”, the means‐end scheme, and man's historicity and dualism). The paper concludes with a brief explication of areas of research seen to emerge out of Arendt's work.     

Reauthoring One's Own Life in the Face of Being HIV+: Promoting Healthier Narratives with Metacognitive Interpersonal Therapy

We describe here a narrative-based psychotherapy for a woman in her 40s who had been HIV+ since the age of 21 and who suffered from posttraumatic symptoms related to having received the diagnosis. She had also suffered from self-stigma and had lost the capacity to envision a future filled with hope. Treating individuals with HIV who face posttraumatic symptoms and stigma can be challenging for the clinician. A narrative approach to therapy can be helpful for these persons, in order to overcome symptoms, build a more benevolent self-image, feel accepted by society, and promote posttraumatic growth. Current evidence indicates that such an approach is mostly lacking. We describe how we applied metacognitive interpersonal therapy—an approach rooted in narrative constructivism. By using this treatment, the patient could overcome posttraumatic symptoms, participate in social activities after years of avoidance and isolation, and recover her sense of being a person able to make plans for the future with strength and dignity. Discussion includes ideas of how to generalize some of the mechanisms that have likely been effective in this therapy to other individuals with HIV.     

The mirroring function of the child analyst

This paper follows the progress of four years of twice-weekly psychoanalytic psychotherapy with a borderline girl aged 4 at the start of treatment. It describes how her early experience with her mother, who was ill, and her subsequent removal from her mother and placement with a foster-family led to her having severe difficulties in relating to others. Using the work of Ekstein as a framework, it follows the changes in the child’s behaviour in the therapy from acting out to playing with toys to role playing to the apparent development of her capacity to phantasize. It focuses on what the dolls’ house represented for her and how it came to be a transitional space where the inner world of the child could be represented. The play in and around the dolls’ house is described to show how she moved from playing on the outside of the dolls’ house to playing in part of the inside to using the whole house and how this seemed to parallel the development of her relationship with her therapist. Furthermore, it presents the views of a number of commentators on the use of the dolls’ house and what it represents for children in therapy and in our culture in general.     

Exploring the Use of an Integrative and Ecological Framework When Treating Children with Trauma

ABSTRACT

Children’s clinical symptoms can often only be understood within their individual and family contexts. However, contemporary research has pointed to the importance of also working with children’s social identities and macrosystem environment when attempting to understand and treat clinical problems. The case of a 10-year-old Dominican-American girl who presented with a significant trauma history, oppositional behavior, and difficulties interacting with her peers is examined using a developmental ecological framework. Attachment theory, cognitive behavioral therapy, narrative therapy, and multicultural family systems therapy, with a focus on trauma responses, are integrated when exploring the case. Additionally, the benefits of exploring the influence of social identities (race, ethnicity, immigration status/perceived immigration status, and class) are explored via an approach that focus on transformation and healing from oppressive systems by integrating sociopolitical realities in therapy.     

Gracious Play: Discipline,Insight, and the Common Good

The article is a theological reflection on the vocation of university teaching that describes the heart of the matter of what faculty do in the classroom. The author draws on personal narrative, social‐psychological analyses of how insight occurs and contexts for insights are constructed, and sociological accounts of shifts that have altered significantly the context of university teaching and learning at the cusp of the millennium to make her case. She argues that the vocation of university teaching involves creating spaces of gracious play that are potentially transformative for students and faculty. Creating such spaces, however, draws faculty into an asceticism that can be understood as a spiritual path. The article is a revision of the author's 1999 St. Elizabeth Seton Lecture at the College of Mount St. Joseph, Cincinnati, Ohio.     

A Narrative Model of Recovery

Abstract

In this paper I defend the suggestion that narratively understanding her experience of rape can help a survivor in her recovery from the harm that she has suffered. Susan Brison defends a similar suggestion, but, I argue, does not get all of the possible mileage out of narrative understanding because she does not explore what she takes to be the necessary features of a successful narrative itself. I hope to supplement her, primarily relational, account with a richer understanding of narratives themselves, as it is only, I argue, through coming to understand the essential characteristics of a narrative that we are able to grasp the particular explanatory force of narratives and, thereby, all of the potential benefits of narratively understanding her experience for a rape survivor.