Social Construction and Materiality: The Limits of Indeterminacy in Therapeutic Settings

By drawing parallels between the courtroom testimony of a Christian Science practitioner and an intersession conversation between systemic family therapists, I critique the abstract idealism of language-centered social constructionism. I argue that social constructionist inquiry that highlights the indeterminacy of meaning without a corresponding emphasis on the responsive embodied practices of family members glosses over the material conditions shaping the politics of interaction. The implications of this problem are discussed as they relate to the setting of family therapy, where social construction theory is often used to guide practical interventions.     

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.     

ISLAM AND SCIENCE: THE PHILOSOPHICAL GROUNDS FOR A GENUINE DEBATE

What does it take for Islam and science to engage in a genuine conversation with each other? This essay is an attempt to answer this question by clarifying the conditions which make having such a conversation possible and plausible. I will first distinguish between three notions of conversation: the trivial conversation (which requires sharing a common language and the meaning of its ordinary expressions), superficial conversation (in which although the language is shared, the communicators fail to share the meaning of their theoretical terms), and genuine conversation (which implies sharing the language and the meaning of ordinary as well as theoretical terms). I will then argue that our real concern with regard to the exchange between Islam and science is to be to specify the conditions under which their proponents can engage in a genuine conversation with each other and that such a conversation to take place essentially requires sharing a common ontology. Following Quine, I will argue that Muslims, like the followers of any religion, would have no other choice but to work from within science. Doing so, however, would not prevent Muslims from having a genuine conversation with the proponents of other worldviews because when the shared ontology fails to offer any potentially testable answer to our remaining questions about the world, the Islamic viewpoint can appear as a genuine alternative among other underdetermined ones, deciding between which would be a matter of pragmatic criteria.     

Occasioned Semantics: A Systematic Approach to Meaning in Talk

This paper puts forward an argument for a systematic, technical approach to formulation in verbal interaction. I see this as a kind of expansion of Sacks’ membership categorization analysis, and as something that is not offered (at least not in a fully developed form) by sequential analysis, the currently dominant form of conversation analysis. In particular, I suggest a technique for the study of “occasioned semantics,” that is, the study of structures of meaningful expressions in actual occasions of conversation. I propose that meaning and rhetoric be approached through consideration of various dimensions or operations or properties, including, but not limited to, contrast and co-categorization, generalization and specification, scaling, and marking. As illustration, I consider a variety of cases, focused on generalization and specification. The paper can be seen as a return to some classical concerns with meaning, as illuminated by more recent insights into indexicality, social action, and interaction in recorded talk.     

Language and meaning in RET

The same verbal labels can have different semantic meaning. RET often assigns idiosyncratic meaning to commonplace words and misunderstandings between therapists and clients may result. In this article the issue of language and meaning in RET is discussed with special reference to feeling words, rational and irrational concepts, and the language of change. Some therapeutic strategies are suggested to help therapists develop shared meaning frameworks with their clients.     

Client-therapist intimacy: responses of psychotherapy clients to a consumer-oriented brochure

Psychotherapy clients read two consumer-oriented brochures: a general brochure on psychology and a brochure on the topic of client-therapist intimacy. Half of the participants read the general brochure first and the brochure on client-therapist intimacy second, and half the participants did the reverse. Participants reported favorable reactions to the brochures, indicating they thought both should be made available to psychotherapy clients; that neither were too long, too sensitive, or too difficult to read; and that the brochures should be made available early during the therapeutic process. After reading the client-therapist intimacy brochure, participants also showed some changes in Likert-type scores measuring attitudes regarding intimate contact between clients and therapists. Although participants were more negative about issues of sexual misconduct after reading the client-therapist intimacy brochure, they did not indicate a decrease in trust of therapists, nor did they indicate a greater likelihood of filing a false complaint. We concluded that therapists' reservations about presenting clients with factual information regarding therapist sexual exploitation of clients are not empirically founded.     

Client-Therapist Intimacy: Responses of Psychotherapy Clients to a Consumer-Oriented Brochure

Psychotherapy clients read two consumer-oriented brochures: a general brochure on psychology and a brochure on the topic of client-therapist intimacy. Half of the participants read the general brochure first and the brochure on client-therapist intimacy second, and half the participants did the reverse. Participants reported favorable reactions to the brochures, indicating they thought both should be made available to psychotherapy clients; that neither were too long, too sensitive, or too difficult to read; and that the brochures should be made available early during the therapeutic process. After reading the client-therapist intimacy brochure, participants also showed some changes in Likert-type scores measuring attitudes regarding intimate contact between clients and therapists. Although participants were more negative about issues of sexual misconduct after reading the client-therapist intimacy brochure, they did not indicate a decrease in trust of therapists, nor did they indicate a greater likelihood of filing a false complaint. We concluded that therapists' reservations about presenting clients with factual information regarding therapist sexual exploitation of clients are not empirically founded.     

Vivid RET II: Disputing methods

Summary In this article, I have outlined a variety of ways in which therapists can make the disputing process more vivid and memorable for clients. I have underlined that tailoring interventions to fit clients' idiosyncracies is most important and have suggested ways of doing this. The point was made that what might work for one client may very well not work for another. In conclusion, I would encourage therapists to adopt an experimental attitude toward their interventions and to continually monitor the effect of them by requesting feedback from clients as Beck et. al. (1979) advocate. This would help therapists to construct, for each client, a profile of the types of disputing tactics that are effective and the types that prove ineffective.     

Transparency and self-disclosure in family therapy: dangers and possibilities

Therapy is a paid intimate relationship that thrusts clients and therapists into navigating personal and professional boundaries. When, where, why, and how is it appropriate and ethical for family therapists to be transparent, and when is it damaging? Theorists take varied stances from Haley's position of tight boundaries around therapist disclosure—whether in treatment or training—to the narrative viewpoint that therapists should be transparent about models of therapy, personal values, and life experiences that inform their practice and beliefs. However, these positions are not research based, and theorists who support disclosure offer few guidelines other than general statements. This article examines the history of ideas about disclosure in six major family therapy models, and the dangers and possibilities of transparency. It looks at the research on self‐disclosure in individual therapy and whether and how it could apply to family therapy. Guidelines are proposed that take into account the multiple social identities of therapists and clients, and issues of safety and transparency.     

Some Hypotheses about Hesitations and their Nonverbal Expression in Family Therapy Practice

When people seek therapy they have stories to tell. In the course of the therapeutic conversation the clients continually make selections about what they want to tell, and what they want to keep silent. In this article the author focuses on the border zone between the said and the not-yet-said, and proposes three hypotheses about the client's hesitations about speaking in the family therapy session. In these hypotheses 'hesitation' is used as a metaphor to give meaning to some nonverbal utterances of clients in such a way that space is opened up in a respectful way for as-yet untold stories. I suggest that it is fruitful to think of certain nonverbal utterances of the clients as hesitations to proceed with the conversation, and to use these nonverbal utterances, in the line of Tom Andersen's thinking (1995), as a starting point for a respectful dialogue with the family about the good reasons they might have not to speak. Not only can this open up space for as-yet unspoken stories, it can also help the therapist to establish a collaborative therapeutic relationship with the family. These ideas are illustrated with several case studies.     

Ontological and epistemological reflexivity: A core skill for therapists

This paper argues that a core skill needed to be an effective therapist is to have developed an awareness of one's own ontological and epistemological positions in relation to one's work as a therapist. In the same way that researchers need to develop reflexive awareness of their assumptions about what there is to know (ontology) and how they can come to know about it (epistemology), therapists need to be aware of their fundamental assumptions about human beings and the world they live in (ontology), as well as their beliefs about how best to develop an understanding of their clients and the meaning(s) of their experiences (epistemology). Regardless of which therapeutic model is adopted, the language used to talk about (and in) therapy, the kinds of questions asked of clients and the comments/interpretations offered, all presuppose and reinforce particular versions of human being and experiencing, which are themselves not usually questioned or challenged during the course of therapy. It is essential that therapists are aware of their own fundamental assumptions about what it means to be human and that they recognise their ontological and epistemological positions as positions that they are taking (rather than perceiving them to be self‐evident truths). This is important for two reasons: (a) if clients do not share the therapist's assumptions, the therapeutic work cannot proceed and be effective; and (b) without such an awareness, therapists are at risk of unwittingly imposing their own model of the person upon the client which raises ethical issues.     

Therapists’ experiences with internal representations of clients

Fourteen therapists were interviewed via telephone regarding their experience of “carrying around” their clients with them between sessions (i.e. internal representations, or IRs, of clients), a phenomenon about which little empirically based knowledge exists. Data were analyzed using consensual qualitative research. Findings indicated that overall, therapists have IRs infrequently, most often have IRs of clients struggling with severe or challenging presenting problems, and do receive some training about IRs. When describing a specific IR experience, therapists typically noted a strong therapy relationship, and stated that the IRs typically had specific triggers. The IRs generally consisted of feelings about the client, and typically consisted of thoughts about the client or the felt presence of the client. The IRs generally yielded positive effects, typically both personally and professionally, and were typically discussed with supervisors/consultants. Implications for research, training, and practice are presented.     

Grief Therapy and the Reconstruction of Meaning: From Principles to Practice

Viewed from a constructivist perspective, grieving is a process of reconstructing a world of meaning that has been challenged by loss. Although most people successfully navigate bereavement and retain or return to pre-loss levels of functioning, a significant proportion struggle with protracted grief, and are unable to find meaning in the wake of an unsought transition. For these individuals, constructivist therapists have a number of strategies at their disposal that foster meaning making and help clients reestablish a coherent self-narrative that integrates the loss, while also permitting their life story to move forward along new lines. After reviewing theory and evidence that scaffolds this constructivist conceptualization, this article draws on excerpts of therapy with two bereaved clients to illustrate how narrative retelling, therapeutic writing, a focus on metaphorical language, and the use of visualization can all be viable strategies in helping individuals reconstruct meaning in the wake of bereavement.     

Three Aspects of the Therapeutic Conversation in Couples Therapy

Abstract

Feminist scholars have revealed the importance of examining the influence of gender on the therapeutic process. Gender differences in the treatment of clients may reveal inequitable or traditionally Stereotypie treatment of clients by therapists. This study examined gender differences in three conversational strategies widely used by therapists: expressions of empathy or understanding, compliments or praise, and challenges or requests for change. Fourteen tapes of live therapy sessions conducted by “master” therapists were examined using an exploratory, qualitative methodology based on Conversation Analysis. Results of this exploration revealed that therapists who are not self identified as “feminist challenged female clients more than male clients, and complimented male clients more than female clients. Feminist therapists challenged male clients more than female clients, and complimented female clients more than male clients. Feminist therapists used more challenges designed to facilitate non-stereo-typic gender behavior in both male and female clients. Only male therapists used disrespectful challenges of female clients, and were more often disrespectful to female clients than to male clients. Implications for the therapist-client relationship and the feminist critique are provided.     

Addressing power in couples therapy: Integrating socio-emotional relationship therapy and emotionally focused therapy

Romantic relationships are more satisfying and fulfilling when power is balanced relatively equally between partners (Leonhardt et al., Journal of Family Psychology, 34, 2020, and 1). Yet, few couples therapy models explicitly outline how to confront relational power issues (Knudson-Martin & Huenergardt, 2015, Socio-emotional relationship therapy: Bridging emotion, societal context, and couple interaction, Springer). Emotionally Focused Therapy (EFT; Johnson, 2020, The practice of emotionally focused couple therapy, Routledge) is a well-established, evidence-based therapy modality that many therapists use with couple clients, yet despite its effectiveness, it does not provide direction for explicitly addressing and treating power differentials in couple relationships. In this paper, we explore the integration of EFT with Socio-emotional Relationship Therapy (SERT), a model overlay that acknowledges the impact of social discourse on enactments of power in intimate couple relationships. We first address the importance of understanding power in couple relationships, addressing power in couples therapy, and provide a brief overview of SERT and EFT. We then introduce an integration of the models intended to help therapists balance power, increase connection, and secure attachment bonds between romantic partners.     

Working with Families from the Indian Sub-Continent: An Indo-German Experience*

Whereas most Western European therapists and clients consider emotional distance and abstinence as desirable and conducive in the therapeutic process, this may not always be the case with clients from India. Cultural components such as the contrast between linear and cyclic world-views and the traditional view of the psychologist as an advisor in India present a challenge to professionals with a Western background. Some factors such as the situation of women in society and seemingly too close familiy ties can mean that a Western therapist fails to promote the changes an Indian client is desiring for his or her family. However, besides cultural awareness and caution, one of the most helpful tools in work across cultures is curiosity in its most positive sense and the readiness to be surprised by ones’ clients.I would like to thank all my Indian colleagues who supported and advised me in my work in India.     

Exploring Levinas: the ethical self in family therapy

From a systemic perspective, people are relational beings located in wider systems of interaction, conversation and meaning. As for social constructionists, the self is positioned and storied through language and dialogue. Yet is the self no more than the multiple conversations and relations it enters into? Systemic therapists informed by psychoanalytic thinking describe a reflective self, responsive to inner conversation about emotional experience ( Flaskas, 2005 ). Those working in mental health services contend with the biological and ‘cognitive‐mindful’ self. Perhaps the self can be defined in many ways or languages as a deconstructive both/and. In this paper the systemic, relational or dialogic self in family therapy is discussed from the perspective of the ethical philosophy of Emmanuel Levinas. For Levinas ethical intersubjectivity is what makes subjectivity and thinking possible. The self is respons‐ibility to other or, as Derrida (1999) says, ‘consciousness is hospitality’ (p. 48). Yet for both Derrida and Levinas the relational self is also a separate and unique self. The ethical self is discussed in relation to family therapy practice.     

Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority

Family and couples therapy in the main concentrates on heterosexual clients, and has thus been described as limited in its outlook, or discriminatory. It is argued that family and couples therapy is at present not offered to gay and lesbian clients because of an absence of appropriate referrals, the inability of therapists to recognize the sexual orientation of their clients, a belief that skills held by therapists are not appropriate for this client group, or because of the homophobia of the therapist. It is suggested that family and couples therapy should be more readily available for gay and lesbian clients, and a number of different issues which these families might face are discussed. This includes problems associated with the gay adolescent and the gay or lesbian parent, as well as the gay or lesbian couple. It is concluded that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist.