The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation

In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.     

Healing elements of therapeutic conversation: dialogue as an embodiment of love

From our Bakhtinian perspective, understanding requires an active process of talking and listening. Dialogue is a precondition for positive change in any form of therapy. Using the perspectives of dialogism and neurobiological development, we analyze the basic elements of dialogue, seeking to understand why dialogue becomes a healing experience in a network meeting. From the perspective of therapist as dialogical partner, we examine actions that support dialogue in conversation, shared emotional experience, creation of community, and creation of new shared language. We describe how feelings of love, manifesting powerful mutual emotional attunement in the conversation, signal moments of therapeutic change.     

Micro‐analysis of a therapist‐generated metaphor referring to the position of a parentified child in the family

The purpose of this exploratory study is to develop a deeper understanding of the way in which the metaphorical language of therapists evolves in dialogue with a client over the course of a therapeutic session. We first briefly report on a study in which we categorized the metaphors used by therapists in twelve therapy sessions with a role‐played client. Then we focus on an intensive micro‐analysis of one particular metaphor that was introduced in the session by one particular therapist in the categorization study: the metaphor of a fireman in the family. Our analysis allowed us a detailed look at some of the ways in which metaphorical language opens dialogical space in the session to talk about the position of parentification of the client and about the price she has to pay for this position in terms of preoccupying worries and loneliness. Furthermore our analysis revealed the delicate dialogical nature of the therapeutic process in which, in talk, the therapist takes the client's experiencing into account all the time.     

Therapeutic moments are the key: foster children give clues to their past experience of infant trauma and neglect

Foster parents often despair over the lack of information about the past experience of the children in their care, particularly with children who have experienced infant trauma and neglect. In the context of family therapy these unknowns pose both a challenge and an opportunity. The author proposes that foster children gives clues to their past experiences in therapeutic moments, which the therapist may recognize as a result of her own inner conversation. In conjunction with a sound theoretical knowledge of infant trauma and neglect, these moments have the capacity to open a dialogue in the relationships between therapist, child and foster family. This dialogical process offers an opportunity for the child's past experience of infant trauma and neglect to be expressed in silence, and the foster parent's present experience to be heard in stillness, opening for them a way to go on beyond the family therapy sessions.     

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.     

Utilizing artistry in a therapeutic relationship

Abstract

In many humanistic approaches, therapeutic change involves utilizing the relationship between the client and therapist as a tool for personal growth. Like any relationship, the therapeutic relationship is one that is co‐created between those engaged in it, namely, the client and the therapist. Utilizing this co‐created relationship requires a sense of artistry on the part of the therapist. A therapist must be willing to engage in this meaningful relationship with the client. A therapist must also be aware of the personal values that he or she brings into therapy, and how they influence the therapeutic relationship. Finally, a therapist must acknowledge the power that the therapist and the client possess in the relationship, and understand how that power can be used to validate and invalidate the therapist's and the client's personal meanings. These aspects of therapeutic artistry are discussed and the use of therapeutic artistry in Eron and Lund's (1996) narrative solutions approach is presented.     

On patients’ unique self-knowledge

Abstract

Patients contribute to analytic endeavors through a knowledge of their own unique ways of organizing their experience, of building an intersubjective space with significant others, of the type of life that they consider worth living, and primarily of their specific passions and yearnings. The more that therapists allow the patients’ unique self-knowledge to influence their therapeutic perceptions and decisions, the further they will advance patients’ status as co-experts working together with the therapist to create and formulate new, richer knowledge. In the present article, it is suggested that one of the main reasons why patients’ self-knowledge is excluded from the therapeutic dialogue is that the persuasive power of the therapists’ rich and deep knowledge challenges the patients’ self-authority. Through an illustrative vignette, therapists are recommended to use a metacommunication intervention to restore the balance that has been undermined between the therapist’s authority and the patient’s self-authority.     

Therapist attentiveness and negative capability in dialogical family meetings for psychosis

Jaakko Seikkula (2008) has pointed towards the importance of practitioners working in the present moment in dialogical therapy. Extrapolating from Seikkula's work, this article considers the significance of the qualities of therapist attentiveness, generosity and negative capability in dialogical family meetings for psychosis. It is proposed that these qualities are of particular importance when family meetings occur in crisis situations, as when under pressure practitioners can easily be drawn into prematurely interventionist stances that may unintentionally promote chronicity for the person experiencing psychosis. The value of co‐working arrangements in enabling practitioners to maintain attentiveness and negative capability in this work is also considered.     

Ways to Bolster Resilience in Traumatized Clients: Implications for Psychotherapists

This study aims to further theoretical and clinical discussions regarding the therapy of psychosis from a dialogical perspective and to contribute to the contemporary research literature that works toward developing methods for studying the dialogical processes in therapy. Three videotaped sessions of a therapy with a heterosexual couple, in which both partners had psychotic experiences, were analyzed using the Dialogical Investigations of Happenings of Change, a method developed with an aim to capture the dialogical qualities of multiactor conversations. The analysis illustrated shifts in the dialogical characteristics of the conversation through the sessions and associated shifts in the clients’ positioning, toward increased agency, as well as enrichment of the narratives regarding their difficulties. The gradual development toward more dialogical conversations, evidenced mainly in increased sharing of dominance and therapist responsiveness and participation, seemed to facilitate the joint construction of new words and meanings, the expression of strong feelings, the narration of difficult experiences, and increased agency. The findings support the view that a client's sense of agency, which can be particularly impoverished in psychosis, can be reconstructed in the context of dialogue, in which clients have a central place in telling their story.     

The real as illusion: deconstructing power in family therapy

This paper examines the current issue of power and intervention in family therapy from the perspective of Jacques Derrida's philosophy. In a deconstructive reading which presents power as both real and socially constructed, it negotiates the border between such dualities as knowing/ not-knowing, intervention/non-intervention, and power/non-power. The paper tracks Goolishian and Anderson's approach to therapy as deconstructive in practice, but not in theory, and discusses a double view of power in relation to both Bateson and Foucault. It suggests that power is both endemic to the context of family therapy and an illusion of epistemology. The paper concludes with a discussion of the wider question of ethics in relation to technology.     

Hypotheses are dialogues: sharing hypotheses with clients

The use of systemic hypotheses in therapy has been criticized on the ground that it promotes the expert position of the therapist and tends to underplay the role of the client in the therapeutic process. In this article, we propose to view the systemic hypothesis as a collaborative action, involving the dialogue between therapists and clients. This interactive hypothesis is created by the very interaction of all participants in the therapeutic dialogue, and as such it may be considered a dialogue in itself. The article articulates a way of hypothesizing that is consistent with both systemic and dialogic premises, and presents some examples of the process in action.     

Editors' introduction

Among the challenges posed by postmodernity are significant questions concerning the proper role and even the ultimate legitimacy of traditional theories and practices of argument. This introduction positions the essays that follow against the intellectual landscape of postmodern thought.Without dialogue our views and experiences would be locked within a narrow range. We discover our own limits only when our views are contested in a dialogical encounter. The dialogical partner decenters us from our own egocentricity and opens us to experiences which not only contest our own, but also expand our horizons. This process is prior to any reflective self-reference of the individual to itself.- Joseph Pilotta (1989, p. 113)     

Relational Drawings in Couple Therapy

In couple therapy sessions, partners often get into long and drawn-out discussions, heavy with pain, resentment, and blame. It is vital for the therapist to avoid becoming entangled in these escalating interactions. In this article, as one way of avoiding these interactions, a protocol is proposed of using relational drawings in couple therapy for opening space for new stories. This approach is strongly rooted in extensive therapeutic experience, as well as in dialogical ideas. Not the content of the partners' imagery is central, but rather the dialogical exchange about the drawings. In particular, the focus of the therapist is on the partners' interactions, their hesitations and their surprises. Working in this way opens space for the partners to reflect on what they experience as crucial in their bond. The protocol is illustrated with two detailed case examples.     

Jungian dialogism and the problem of depth

Notions of dialogical inquiry and of the dialogical self have become increasingly influential in contemporary psychology in response to the limitations of the traditional view of monologically encapsulated and radically disengaged consciousness. Conceptions of self and inquiry as intrinsically embedded in and constituted by our shared life with others seem to do better justice to the richly interconnected character of contemporary life. At the same time, our highly interconnected global world has also tended to foster a flattening of cultural and inter‐cultural horizons that undermines dialogical engagement in any deeply meaningful sense. What is needed is to enrich current conceptions of dialogue with an understanding of experiential and cultural depth. This paper seeks an understanding of the depth dimensions of dialogue through an engagement of dialogical self theory with Jungian dialogical thought. Critical to this engagement is to appreciate the expressive potential of Jungian dialogism beyond Jung's theoretical claims about dialogue.     

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.     

Dominance and Dialogue in Couple Therapy for Psychological Intimate Partner Violence

Although there is controversy concerning indications for conjoint therapy in Intimate Partner Violence (IPV), both research and practice have come to recognize that it has some important benefits. This study analyzes issues of dominance and dialogue in a conjoint therapy for psychological IPV within a naturalistic setting, in which the spouses sought couple therapy on a voluntary basis. The method used to analyze the therapy was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the male client showed more quantitative dominance, whereas semantic dominance was more present in the female client, and therapists used more interactional dominance. Results on dialogue analysis showed that dialogical dialogue might help to construct a new-shared meaning of the issue of violence. In the Discussion section some research and clinical implications of the results are derived.     

Creating “Maneuvering Room”: A Grounded Theory of Language and Influence in Marriage and Family Therapy

Influence in psychotherapy has been described as a characteristic of the therapist, a characteristic of the therapeutic relationship, and a negotiated process. This study combines grounded theory and task analysis to explore language patterns in facilitating change in family therapy. Thirty-one episodes of therapy were analyzed, resulting in the emergent concept of creating maneuvering room. Therapists introduce uncertainty into clients beliefs about problems then offer new ways of defining problems by speaking from three dimensions: therapist as expert or non-expert, therapist as participant or observer, or family members experiences as similar or different. The findings of this study support a possible common factor in family therapy.     

Quelques réflexions sur l’incidence des valeurs éthiques sur le choix technique des interventions psychothérapeutiques

If we consider the evolution in the patterns of psychopathology during the 20th century, we discover the evolution of ethical values implicit in the theory and their implications as far as our technical choices are concerned. The therapeutic relationship is asymmetrical, not only because of different role positions but also because of an inherent power differential. The therapist is consciously recognized as occupying a superior role because of his or her professional status and at the unconscious level, too, through transfer and projection of different fantasies. Being in charge of the therapeutic process carries with it the professional responsibility for handling this asymmetry. The therapist's theoretical and technical decisions in this regard reflect his or her ideology about power and how it should be used to establish the therapeutic alliance.