Case Formulation in Poststructural Narrative Therapy

This article offers a formulation structure for poststructural narrative therapy. As a self-declared constitutionalist approach, narrative therapy has neglected the issue of formulation, perhaps out of concern that it might lead to an essentialist and seemingly objective account of the person. However, provided care is taken around these dangers, there are advantages to formulation: It can provide much needed theoretical discipline in our thought, encourage us to reflect on how persons become trapped in problem-saturated identities and situations, and permit previously unforeseen intervention strategies. This article offers a simple structure for the development of a narrative therapeutic formulation, presented in four parts: subject positions, discourses, normalizing judgments, and disqualified knowledges. An example of a case is used to illustrate.     

Using proton magnetic resonance imaging and spectroscopy to understand brain "activation"

Upon stimulation, areas of the brain associated with specific cognitive processing tasks may undergo observable physiological changes, and measures of such changes have been used to create brain maps for visualization of stimulated areas in task-related brain "activation" studies. These perturbations usually continue throughout the period of the stimulating event, and then subside when the event is terminated. In this communication, we consider the nature and meaning of these task-related brain activations. Since stimulation usually results in an increase in the frequency of neuron depolarizations or "spikes", an energy expensive activity that requires ATP for restoration of ionic gradients, additional energy supplies must be rapidly deployed to the stimulated areas or rates of re-polarization could be decreased, and refractory periods between spikes increased. As a result, maximum spiking rates may be decreased and some frequency-encoded information lost. The energy available to brain cells to re-synthesize ATP from ADP is a function of levels of glucose and oxygen in blood, and their availability to stimulated neurons is a function of the rate at which focal blood supplies can be increased (hyperemia). In this review we explore how neurons transmit meaningful encoded information; how the integrity of that information is dependent on a continuous supply of energy, and how proton magnetic imaging and spectroscopy may aid in understanding the process. Finally, evidence is presented that the neuropeptide, N-acetylaspartylglutamate, is a neuronal astrocyte-vascular feedback signal that regulates activation induced focal hyperemic responses.     

Rhetorical processes in therapy: the bias for self–containment

This paper argues that therapy tends to reproduce a particular version of personhood, identified by Sampson's notion of the self–contained indi–vidual. The self–contained individual is a contemporary Western construction, which requires a denial of the interactive processes that permit its appearance and idealization. Focusing on constructionist therapies, it is argued that therapists use rhetorical strategies to more or less systematically argue for self–containment as a preferred way of being. These rhetorical manoeuvres render different aspects of self–containment plausible, practicable and 'real', while alternative versions of the self and behaviour are discursively minimized, becoming less plausible in the process. An analysis of two family therapy sessions is then used to illustrate these processes. It is suggested that therapy may reproduce Western ideals about being human.     

Sorry is the Hardest Word to Say: The Role of Self-Control in Apologizing

Apologizing is an effective strategy for reconciling relationships after transgressions. However, transgressors often resist or refuse to apologize. The current research investigated the role of self-control in apologizing. In Study 1, self-control was associated with participants’ proclivity to apologize and apologetic and nonapologetic behavior. In Studies 2 and 3, self-control was manipulated to test the causal relationship. Both studies found participants with high self-control were more apologetic and less nonapologetic and were more likely to use apologetic statements in e-mails to their victims. Overall, these studies suggest that transgressors with high self-control are more apologetic than those with low self-control.     

Storying Unstoried Experience in Therapeutic Practice

Sometimes life events resist storying. Although their conversion into narrative form is often recommended as a therapeutic strategy, particularly in the case of trauma, this can be a difficult and complex process. Sometimes emerging stories are associated more with therapist than client knowledges, and therefore may not be experientially resonant, and some clients’ narrative habits may predispose to problem-saturated stories and negative identity conclusions. This article uses a case study to explore the notion of unstoried experience, and the ways in which it can inhibit a sense of personal agency. I propose a constitutive witnessing practice, conceived as a constructive and generative rather than objective-observational practice, as a vehicle for the cultivation of ethically infused, but client-led storying activity.     

Therapy and the aesthetics of the self

Post-structuralists argue that personal identity is a function of societal power dynamics. This becomes especially problematic for persons recruited into problem-saturated identities. In this paper, inspired by Foucault's call for us to ‘create ourselves as a work of art’ (p. 262), I explore the therapeutic value of an aesthetic approach to identity. Instead of orienting to the client as one to be known and understood, we might envisage his or her life as an open-ended, never quite finalised oeuvre. Identity is therefore conceptualised not as something one ‘is’, but as a creative performance. A therapeutic case is presented to highlight some of the possibilities and challenges associated with such an approach.     

Relationships between quality of life,spiritual well-being,and psychological adjustment styles for people living with leukaemia: An exploratory study

This paper reports on the relationships between quality of life, spiritual well-being, and psychological adjustment styles for people living with leukaemia. Participants were 40 adults (26 women and 14 men) aged between 22 and 80 years living with acute or chronic leukaemia in Western Australia. Participants completed three scales measuring spiritual well-being (FACIT-Sp-12-C Version 4; Cella, 1997 Cella, D. 1997. “Functional Assessment of Chronic Illness Therapy (FACIT) Manual, Version 4”. In Chicago: Center on Outcomes Research and Education CORE, Evanston, Chicago: Northwestern Healthcare and Northwestern University.  [Google Scholar]), psychological adjustment styles (MAC; Watson, Greer, & Bliss, 1989 Watson, M, Greer, S and Bliss, JM. 1989. Mental Adjustment to Cancer (MAC) Scale: User's manual, London: CRC Psychological Medicine Research Group The Royal Marsden Hospital.  [Google Scholar]), and quality of life (FACIT-G; Cella, 1997 Cella, D. 1997. “Functional Assessment of Chronic Illness Therapy (FACIT) Manual, Version 4”. In Chicago: Center on Outcomes Research and Education CORE, Evanston, Chicago: Northwestern Healthcare and Northwestern University.  [Google Scholar]). No differences were found between the men and women participants, with the exception of the anxious preoccupation adjustment style. Significant positive correlations were found between spiritual well-being and quality of life (r?=?0.72, p?=?<0.01), and between fighting spirit and both spiritual well-being (r?=?0.55, p?<?0.01) and quality of life (r?=?0.67, p?<?0.01). Spiritual well-being and quality of life were both significantly negatively correlated with hopelessness/helplessness, fatalism, and anxious preoccupation, suggesting that people who are able to find meaning in their illness are more likely to utilize functional psychological adjustment styles. A stepwise multiple regression revealed that spiritual well-being was most strongly associated with quality of life for people living with leukaemia, followed by a fighting spirit; together, these accounted for 61% of the variance in quality of life scores. Thus, having a reason for living, making life more productive, finding comfort in faith or spiritual beliefs, being determined to control the environment, and feeling a sense of meaning, peace, harmony, purpose, and comfortable in oneself are factors that contribute to a better quality of life among patients with leukaemia. Strengths, limitations, and implications of the findings are discussed.     

II Sensory feedback influences on keytapping motor tasks

Subjects were trained to tap a key continuously at a specific rate, and with a specific amount of pressure (regularity task). Performance of this task was studied under conditions of: (a) decreased auditory feedback (masking noise through earphones), (b) decreased visual feedback (tapping hand screened from view), (c) vibration (vibrators applied to forearm in order to “mask” proprioceptive feedback), (d) digital block of tapping finger, and (e) combination of all four conditions. Significant changes in rate and intensity of tapping resulted under conditions of decreased auditory feedback, vibration, and the combined condition.

In the second part of the study, the effects of different delayed sensory events on keytapping were examined. The five conditions of delayed sensory feedback were: (a) delayed auditory feedback, (b) delayed visual feedback, (c) delayed tactile feedback, (d) the first three delayed sensory events presented simultaneously, and (e) condition (d) repeated with digital block of the tapping finger.

The conditions of delayed sensory feedback did not markedly alter performance of the regularity task. The same conditions of delayed sensory feedback did, however, produce highly significant changes in the performance of a more complex pattern task. All of these delay conditions produced parallel changes in the pattern task, namely increased intensity and decreased rate of tapping. The fact that the pattern task is more disturbed by delayed sensory feedback than the regularity task suggests that temporal complexity of the task is one determinant of the degree to which it will be disturbed by a delay in sensory feedback.     

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.