The Discursive Performance of Change Process in Systemic and Constructionist Therapies: A Systematic Meta‐Synthesis Review of In‐Session Therapy Discourse

Despite the emphasis of systemic and constructionist approaches on discourse and interaction, to date there has been no comprehensive overview of how change process is performed within in‐session therapeutic dialogue. In this paper, we present a qualitative meta‐synthesis of 35 articles reporting systemic and constructionist therapy process data from naturally occurring therapeutic dialogue. The studies were selected following the screening against eligibility criteria of a total sample of 2,977 studies identified through a systematic search of PsycINFO and MEDLINE databases. Thematic analysis of the 35 studies’ findings identified four main themes depicting change process performance: (a) shifting to a relational perspective, (b) shifting to non‐pathologizing therapeutic dialogue, (c) moving‐forward dialogue, and (d) the dialogic interplay of power. Findings highlight the interactional and discursive matrix within which systemic and constructionist change process occurs. Findings illuminate the value of qualitative research studies sampling naturally occurring therapeutic discourse in bringing this matrix forth, particularly when utilizing discursive methodologies like conversation or discourse analysis.     

The presence of the third party: systemic therapy and transference analysis

While today many therapists try to integrate different therapeutic models, it does not seem easy to define the specific clinical features of each model. In this article, the practice of systemic individual therapy is compared to the psychoanalytic practice of transference analysis. The relevant distinction is found in the different use of third parties within the therapeutic frame. In systemic therapy, the third party is 'presentified' within the therapeutic dialogue, which becomes centred on external relationships, while in transference analysis the third party is subsumed to the therapeutic (transferential) relationship, which is considered the core of therapy. The practical consequences of those two different 'technologies of the self' are discussed.     

Subgroup conflicts? Try the psychodramatic "double triad method"

The present article suggests the application of a psychodramatic action method for tackling subgroup conflicts in which the direct dialogue between representatives of two opposing subgroups is prepared step by step through an indirect dialogue strategy within two triads, a strategy known as the Double Triad Method (DTM). In order to achieve integration in the group as a whole, it is important that all the members of both subgroups participate actively during the entire process. The first part of the article briefly explores the theoretical background, with a special emphasis on the Phenomenological-Dialectical Personality Model (Phe-Di PModel). In the second part, the DTM procedure is systematically described through its five action stages, each accompanied with 1) a spatial representation of the consecutive actions, 2) some illustrative statements for each stage, and 3) a theoretical interpretation of the dialectically involved personality dimensions in both protagonists. The article concludes with a discussion and suggestions for more extensive applications of the DTM method, including the question of its relationships to Agazarian's functional subgrouping, psychodrama, and sociodrama.     

Treating family relational trauma: a recursive process using a decision dialogue

This article describes a therapeutic process that combines individual and family sessions to maximize therapeutic opportunities to bring forward, understand, validate, and empower children's experience as equal participants in family therapy. The aim is to strengthen relational bonds within the family. Drawing from earlier work with families where incest had occurred, the authors present a recursive process that utilizes a "decision dialogue" to link individual and family sessions. Clinical examples are provided.     

Systemische Therapien bei Menschen mit psychotischen Verhaltens- und Erlebnisweisen

Systemic therapy for persons who have been diagnosed as having schizophrenic or schizoaffective psychosis has been practiced since the 1950s, not everywhere and routinely but in many psychiatric hospitals and outpatient clinics with a strong psychosocial orientation. Evidence of the effectiveness is well documented in randomized controlled studies. This article describes three systemic approaches in which the authors are actively involved: (1) systemic constructivist family therapy developed in Heidelberg for outpatient contexts, (2) need-adapted treatment and open dialogue developed in northern Europe that has gained access to psychiatric clinics through regional training within integrated care projects and (3) the concept of systemic therapeutic methods of acute psychiatric treatment (SYMPA) a systemic family-oriented inpatient treatment.     

My Psychoanalytic Journey

In this article I describe the evolution of my psychoanalytic thought and my current perspective of psychoanalysis, after almost a half century of professional practice. For the most part, three ideas have guided this evolution: (1) considering the patient’s mind as the major source of knowledge; (2) my firm belief that the patient–analyst dialogue, taken from the Gadamerian point of view, is the best way to have access to the patient’s mind and also to that of the analyst himself; and (3) the notion that the mind constitutes an open, dynamic, and nonlinear system in constant interaction with the environment that surrounds it. In my writings, I have tried to show that the therapeutic action in the psychoanalytic process is formed by the therapist–patient interaction. I also propose that psychoanalysis must endeavor to be a social therapy, even as it treats individuals, and go beyond what is purely instinctual so as to emphasize what is particular to human beings and sets us apart from the other animal species.     

Intersubjectivity and the Many Faces of Forgiveness: Commentary on Paper by Stephen Wangh

Stephen Wangh's insightful article, “Revenge and Forgiveness in Laramie, Wyoming” invites a psychoanalytic contribution to interdisciplinary dialogue on violence, revenge, and forgiveness. This author suggests that one strength of Wangh's perspective is his attention to the interplay of systemic and intrapsychic dynamics, which offers a needed corrective to dominant individualistic perspective in psychological and clinical literatures on forgiveness. He notes that Wangh does not clarify a particular definition of forgiveness or an approach to interdisciplinary dialogue. This commentary outlines a linguistic approach to the definition of forgiveness by drawing on three semantic domains of meaning (forensic, therapeutic, and redemptive or sacred). The author suggests some areas of rapprochement between the construct of forgiveness and psychoanalytical theory across each of these semantic domains and briefly illustrates the role of hermeneutics in interdisciplinary dialogue.     

Dialogue and power: a critical analysis of power in dialogical therapy

This article explores the relationship between dialogue and power in the practice of dialogue-oriented, "not-knowing" forms of therapy. It is argued that power of a dynamic and reversible kind infuses much ordinary social dialogue, and that the joint processes of power and resistance work together to render an interaction dialogical. In contrast, in dialogical therapy, overt exercises of power threaten the interaction's dialogical status, and power is deferred and denied by the therapist through not-knowing practices. A case study of Harlene Anderson's (1997) is used to illustrate that it is precisely power's presence that informs the practices of not knowing and uncertainty that characterize dialogical therapies. It is suggested that the not-knowing therapist withholds aspects of his or her voice as a condition for dialogicity. Instead, special speaking arrangements are required, in which the therapist's not-knowing is continuously communicated to the client, for the therapeutic conversation to remain dialogical. Without these speaking arrangements, I argue that therapy moves toward monologue. Therapists inherit powerful speaking positions from the institutional and sociocultural context, and the rejection of power within therapy serves only to conceal this aspect of power, which nevertheless pervades the therapeutic relationship. Finally, it is suggested that power is a "common factor"--shared by all therapies--and that our status as "inheritors" of power needs to be included in our understanding of the therapeutic process. This expanded view of therapy requires the re-theorization of dialogue, such that it includes, rather than excludes, considerations of power.     

Therapist in Distress: Team-Supervision of Social Workers and Family Therapists Who Work and Live Under Political Uncertainty

This article describes and analyzes a 2-year supervision process with social workers and family therapists who live and work under conditions of uncertainty on the West Bank. The systemic orientation used in this specific approach to supervision emphasizes the double role of the therapist: one as part of the therapeutic system, and the second as a member of the same community that is living in political uncertainty. The analysis revealed that a long-term supervision process, in which the supervisor encouraged a containing context, was meaningful to the group. As a result of this secure atmosphere, the group was ready to talk about painful issues like loss as the result of war and terrorist attacks, loss as a result of immigration, and loss of ideals. Furthermore, the members of the group were ready to confront the possibility of relocation and their role in such a situation. The techniques used in the process, such as narrative and metaphors, were implemented by the members in their daily professional interventions. The flexibility between working on regular professional issues and issues related to stress and uncertainty seemed useful to the supervision, as well as the political dialogue that was created between the supervisor and the group.     

The infant with a depressed mother: destruction and creation

From the hypothesis that vitality and creativity in the individual depend on the quality of the dialogue between the ego and the unconcious, the author seeks to show from observations of infant-parent interactions how this dialogue develops. The notion of the experience of the self helps us to describe the way in which mother and baby act upon each other like living mirrors, each reflecting for the other an image of the self. Maternal care, as long as it is disengaged from the sexual excitation, both erotic and aggressive, with which it is charged for each of the partners in the interaction, allows the self to be projected on to the infant's body; the ego–self dialogue then develops its roots in the bodily experience of the infant as it interacts with the world. Post-natal depression, which is frequent, affecting 15–20% of births, is a cause of major distortion in the establishment of the ego–self dialogue. An account of a clinical observation helps us to understand the process as it occurs     

The Narrative/Collaborative Process in Couples Therapy:

A narrative approach to couples therapy provides a glance at the emerging postmodern dialogue. This article discusses changes in the therapeutic relationship, content, and process, emphasizing a feminist perspective. The client/therapist relationship is viewed as a collaborative process by which hierarchical distinctions are decreased. Externalization, deconstruction, and re-authoring are described and demonstrated through a clinical vignette. Our own evolving story as couples therapists is also presented.     

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.     

Promiscuity in the practice of family therapy

Family therapy has continually confronted choices between polarized positions, each one taken up with zeal because it solved an old dilemma but eventually encountering its own limitations. In this article I suggest that we have evolved to a point where, instead of deciding which is better, we can focus on how to use theories, models and techniques as fluid and flexible resources for action in the therapeutic conversation. Doing so focuses our attention on how we can move in and out of various positions, including those that simplify issues and those that embrace complexity. In addition, our attention is drawn to the ways in which we can make choices between following a model as opposed to engaging in spontaneous dialogue. This promiscuous stance can help trainers and therapists answer questions concerning how we make decisions in therapy. Such promiscuity also positions us to confront our images and expectations of what it means to be a professional.     

Reading Hannah Arendt as a Biblical Thinker

This article presents an interpretation of the role that religious concepts play in Hannah Arendt’s political thought. While Arendt is typically regarded as a secular thinker, I argue that she turns to resources found in biblical traditions of thought when she finds Greek and Roman traditions to be lacking in vital respects. The concepts that she associates most strongly with the Bible—natality, forgiveness, and plurality―are necessary to her vision of a political community that is genuinely pluralistic and which understands the nature and implications of human action. By examining the role that biblical concepts play in Arendt’s thought, this article explores the possibility of setting her work in dialogue with a range of Jewish and Christian traditions. Placing Arendt in such a dialogue also opens up the question of what it means to be a "biblical thinker."     

INTEGRATING INTERIORITY IN COMMUNITY DEVELOPMENT

This article explores Integral community development; an approach that integrates material needs (such as economic growth, resource management, and decision-making structures) and interior needs (such as cultural, spiritual, and psychological wellness). Including “interiority” in development is unique to conventional and alternative development practices, and analysis suggests it is necessary for sustainability. Integral community development works in three domains of action/application, dialogue/process, and self-growth/reflection, and recognizes the importance of changes in worldviews. Using this approach in a case study in El Salvador, research outcomes showed increased collaboration and self-reflection, where economic objectives merged with equality and environmental concerns.     

Emotional dances: therapeutic dialogues as embodied systems

The mind/body dualism, although scarcely relevant in clinical practice, remains unsolved theoretically. The pragmatic wisdom of the founders of family therapy, which implied that bodies and minds in therapy were one, has been easily forgotten. Such a situation had practical results, leading to naive solutions, both on the materialistic and idealistic sides, represented by biological psychiatry on the one side, and by most postmodern therapies on the other. This article proposes to consider the role of emotions in therapeutic dialogue to solve this dilemma within the field of systemic therapy.     

Examining process constructs of narrative career counselling: an exploratory case study

The present article examines how the five process constructs of reflection, connectedness, meaning making, learning and agency are operationalised in a constructivist approach to career counselling, specifically a storytelling approach. This article reports on an exploratory case study of a Black South African female university student. The case study provides examples of how a career counsellor enacts these constructs and facilitates their development in a client, as well as examples of how they are evident in client dialogue and action. Insight into the process of a storytelling approach to narrative career counselling is demonstrated, from which tentative suggestions are made about how to facilitate the process constructs of reflection, connectedness, meaning making, learning and agency.     

Relationships as dialogues

This article discusses five interrelated conceptions of dialogue in the works of Russian scholar Mikhail Bakhtin that ground relational dialectics theory: (a) dialogue as constitutive process, (b) dialogue as dialectical flux, (c) dialogue as aesthetic moment, (d) dialogue as utterance, and (e) dialogue as critical sensibility. The author's recent research in relational dialectics is discussed, as are directions for future research. Relational dialectics is positioned as a sensitizing theory different from systems theory and other dialectically oriented approaches.     

解读“反胜为败”的现象：一个“Choking”过程理论

运动员关键时刻以先赢后输的形式丢掉冠军的现象越来越多地发生在现代竞技体育比赛中。心理学上称之为压力下的“Choking”,并定义为压力条件下一种习惯的运动执行过程发生衰变的现象。对于“Choking”的研究开始于八十年代初中期,迄今为止,主要有干扰假说和自动执行假说解释其发生机制。但由于现有的假说过于简单,理论的研究一直不能为实践防治“Choking”提供可行的措施。本文基于笔者多年来的研究积累,就这一空缺,提出并讨论了一个“Choking”过程理论。该理论把“Choking”作为一个过程来讨论,包括引起因素、认知过程、应付过程和运动过程。根据过程理论,本文讨论了“Choking”发生机制。在此基础上,提供了防止“Choking”发生的具体可行性措施。     

Voices of Dialogue and Directivity in Family Therapy With Refugees: Evolving Ideas About Dialogical Refugee Care

In this article, we reflect on our evolving ideas regarding a dialogical approach to refugee care. Broadening the predominant phased trauma care model and its engaging of directive expertise in symptom reduction, meaning making, and rebuilding connectedness, these developing dialogical notions involve the negotiation of silencing and disclosure, meaning and absurdity, hope and hopelessness in a therapeutic dialogue that accepts its encounter of cultural and social difference. In locating therapeutic practice within these divergent approaches, we argue an orientation on collaborative dialogue may operate together with notions from the phased trauma care model as heuristic background in engaging a polyphonic understanding of coping with individual and family sequelae of forced displacement. This locating of therapeutic practice, as informed by each perspective, invites us to remain present to fragments of therapeutic positioning that resonate power imbalance or appropriation in a therapeutic encounter imbued with a social context that silences refugees’ suffering. In a clinical case analysis, we further explore these relational complexities of negotiating directive expertise and collaborative dialogue in the therapeutic encounter with refugee clients.