COLLABORATIVE THERAPY:
Houston Galveston Institute
“How can our therapy practice have relevance for people’s everyday lives in our fast changing world, what is this relevance, and who determines it?” is a persistent question for collaborative therapists and a question that I think all therapists should be asking. Why?
We live in such a fast-changing world that is characterized by global and local shift--social, cultural, political, and economic transformations as well as the influence of the internet and media on the decentralization of information, knowledge, and expertise. Equally important, there is an international spotlight on democracy, social justice, and human rights; the importance of the people’s voice, singular or plural; and the need for collaboration. People around the world increasingly want input into what affects their lives; they have lost faith in rigid institutions and practices in which being treated as numbers and categories ignores their humanity or worse yet, violently violates it. They demand systems and services that are more flexible and respectful. These shifts, the unavoidable complexities inherent in them, and the effects they have on our individual and communal lives and on our world press therapists to reassess how we understand the world around us, our clients, and our roles as therapists. Collaborative therapy is a response that shares common ground with a growing international community of practitioners and clinical scholars including Tom Andersen, Vivien Burr, John Cromby, Kenneth Gergen, Mary Gergen, Lynn Hoffman,
Though Collaborative Therapy and other approaches sometimes referred to as dialogical therapy, conversational therapy, open dialogue, and reflecting process therapy are often seen as new approaches to therapy, the assumptions about knowledge and language that they draw from have been present within philosophical discourses since the eighteenth century beginning with the historian Giambattista Vico’s notion that the observer is part of the description. Other seminal authors in this philosophical movement include Mikhail Bakhtin, Jacques Derrida, Hans George Gadamer Jean Francois Lyotard, Richard Rorty, Lev Vygotsky, and Ludwig Wittgenstein, to mention a few. In psychology, similar assumptions were introduced with George Kelley’s personal construct theory and other constructivists who disclaim a tangible, external reality. This direction in family therapy was strongly influenced by Gregory Bateson and his
Collaborative Therapy as presented in this article has evolved over time with its roots tracing back to the 1950’s Multiple Impact Therapy project in
“Your attitude towards your life will be different
according to which understanding you have.”
I do not use a single definition of postmodern, instead I refer to a set of abstract assumptions that I think of as a “postmodern tapestry.” These assumptions—the threads of tapestry--challenge our inherited traditions of knowledge and language, and provide a contemporary alternative. The central challenge is to reexamine these traditions of knowledge as fundamental and definitive, the top-down nature of knowledge systems, language as descriptive and representational, and the stability of meaning. Following, I discuss seven assumptions of a postmodern tapestry.
1. Maintaining skepticism
Postmodernism asserts the importance of holding a critical and questioning attitude about knowledge as somehow fundamental and definitive. This includes knowledge of inherited and established dominant discourses, meta-narratives, universal truths, or rules. We are born, live, and are educated within knowledge traditions that we mostly take for granted. A postmodern perspective suggests that unwittingly buying into and reproducing institutionalized knowledge can lead to forms of practice that risk being out of sync with our contemporary societies and possibly alien to humanity as well. This is not to suggest that we abandon our inherited knowledge or discourses (i.e., psychological theories, a priori criteria), or that these can be discarded for that matter. Any and all knowledge can be useful. Nor is it suggested that postmodernism is a meta-knowledge narrative. The invitation is simply to question any discourse’s claim to truth, including the postmodern discourse itself. And, hopefully, to minimize the risk that we carry our knowledge errors forward.
2. Eluding generalization
The probability that dominant discourses, meta-narratives, and universal truths can be generalized and applied across all peoples, cultures, situations, or problems is suspect. Thinking in terms of ahead-of-time knowledge (i.e., theoretical scripts, predetermined rules) can create categories, types, and classes (i.e., people, problems, solutions) that inhibit our ability to learn about the uniqueness and novelty of each person or group of people. Instead, we might learn about the distinctiveness of others and their lives directly from them and see the familiar or what we take for granted in an unfamiliar or fresh way. We are accustomed to viewing, wittingly or unwittingly, many people and the events of their lives encountered in therapy as familiar rather than exceptional. Familiarity tempts us to fill in the gaps and proceed based on our pre-assumptions about what is in these gaps; this knowing can put us at risk of depersonalizing the client and preventing us from learning about their specialness—limiting our and the client’s possibilities.
3. Knowledge as an interactive social process
Embedded as it is in culture, history, and language, knowledge is a product of social discourse. The creation of knowledge (i.e., theories, ideas, truths, beliefs, or how to) is an interactive interpretive process in which all parties contribute to its creation, sustainability, and change. Knowledge is not fundamental or definitive; it is not fixed or discovered. Instead, it is fluid and changeable. So, instructive interaction is not possible; knowledge cannot literally be transmitted from the head of one person to another. Knowledge transforms as we share it with each other, in our interactions with each other, and in the dynamics of the relationship be that a relationship with an author on the pages of a book or with a teacher at the head of a classroom.
4. Privileging local knowledge
Local knowledge–the knowledge, expertise, truths, values, conventions, narratives, etc.--that is created within a community of persons (i.e., family, classroom, board room) who have first-hand knowledge (i.e. unique meanings and understandings from personal experience) of themselves and their situation is important. Since knowledge is formulated within a community it will have more relevance, be more pragmatic, and be more sustainable. Local knowledge, of course, always develops against the background of dominant discourses, meta-narratives, and universal truths and is influenced by these conditions. This cannot be, nor is it suggested that it should be, avoided.
5. Language as a creative social process
Language in its broadest sense--any means by which we try to communicate, articulate, or express with ourselves and with others--is the medium through which we create knowledge. Language, like knowledge, is viewed as active and creative rather than as static and representational. Words for instance are not meaning-mirrors; they gain meaning as we use them and in the way that we use them. This includes a number of things such as context, why we use them, and how we use them such as our tone, our glances, and our gestures. Language and words are relational. As Bakhtin (1984) suggests, “No utterance in general can be attributed to the speaker exclusively; it is the product of the interaction of the interlocutors, and broadly speaking, the product of the whole complex social situation in which it has occurred” (p. 30). He further suggests that we do not own our words:
The word in language is half someone else’s. The word becomes “one’s own” only when the speaker populates it with his own intention. . . the word does not exist in a neutral and impersonal language . . . but it exists in other people’s mouths, in other people’s contexts (1984, p. 293-4).
Knowledge and language are relational and generative, and therefore intrinsically transforming. Transformation—whether in the form of a shift, modification, difference, movement, clarity, etc.--is inherent in the fluid and creative aspects of knowledge and language. That is, when engaged in the use of language and in the creation of knowledge one is involved in a living activity—dialogue with oneself or another—and cannot remain unchanged.
7. Postmodern is only one of many narratives
The postmodern tapestry and its assumptions are considered as one of many narratives. Postmodernism is not a meta-narrataive or –perspective as self-critique is inherit in and essential to postmodernism itself. This does not suggest, therefore, that postmodernism is an oppositional perspective that calls for the abandonment of our inherited knowledge or any discourse, or that these can be discarded for that matter. Postmodern assumptions simply offer a different language or set of assumptions, or as Wittgenstein suggests, a different language game (Amscombe & Amscombe, 2001).
Implications for Clinical Practice
“All understanding is dialogical.”
Bahktin
The question is “How does this different language or language game influence the way that I think about the goal of therapy and its process, including the client’s role and my role?”
First, they inform what I call a philosophical stance: a way of being. And second, particular kinds of relationships and conversations naturally develop from this philosophical stance.
The philosophical stance is the heart and spirit of the collaborative approach: a way of being. It is a posture, an attitude, and a tone that communicates to another the special importance that they hold for me, that they are a unique human being and not a category of people, and that they are recognized, appreciated, and that their voices are worthy of hearing. This stance invites and encourages the other to participate on a more equitable basis. It reflects a way of being with people, including ways of thinking with, talking with, acting with, and responding with them. The significant word here is with: a “withness” process of orienting and re-orienting oneself to the other person (Hoffman, 2007; Shotter, 2004, 2005). Hoffman (2007) refers to this kind of relationship “withness” as “one that is as communal and collective as it is intimate, withness that requires us to “… jump, like
With this belief connecting, collaborating, and constructing with others become authentic and natural performances, not techniques. I call these performances collaborative relationships and dialogical conversations, and although I address them separately below, they are intrinsically interrelated. The philosophical stance becomes an expression of a value, a belief, and a worldview that does not separate professional from personal. Before elaborating on the philosophical stance, I will briefly discuss collaborative relationship and dialogical conversation.
Collaborative Relationship and Dialogical Conversation
Collaborative relationship refers to the way in which we orient ourselves to be, act, and respond “with” another person so the other joins a therapeutic shared engagement and joint action that I call a shared inquiry (I discuss shared inquiry in the next section). Shotter (1984) suggests that all living beings exist in joint action--in the meeting and interacting with one another in mutually responsive ways. That is, we are relational beings who mutually influence and are mutually influenced by each other. As relational beings our “selves” cannot be separated from the relationship systems which we are, have been, and will be a part of. As well, though we are always speaking an ambiguous and different language than the other, as Bahktin (1981) suggests, our speaking and our language always includes others’ intentions and meanings.
Here I want to highlight “respond.” We are always responding: there is no such thing as a “no response” or “lack of response.” There is simply one kind of response which as with any response, the “receiver” interprets and decides whether this action is hearable or visible or not. Our responses to the other are critical to the development and quality of the relationship. They create the framework, the parameter, and the opportunity for the relationship. Collaborative Therapists value partnerships characterized by joint action or social activity in which each member develops a sense of participation, belonging, and co-ownership. With these come a sense of commitment and shared responsibility. The therapist is the catalyst for this partnership and its process. I am talking about the therapist’s response to the client, yet, of course, responding is an interactive two-way process.
Dialogical conversation refers to talk in which participants engage “with” each other (out loud) and “with” themselves (silently)—in words, signs, symbols, gestures, etc.—in a mutual or shared inquiry: jointly responding (i.e., commenting, examining, questioning, wondering, reflecting, nodding, gazing, etc.) as they talk about the issues at hand.
Drawing on Bakhtin’s (1984) definition, dialogue is a form of verbal interaction; it is communication between people that takes place in the form of an exchange of utterances. Dialogue, however, is not limited to spoken words; it also includes the silent way (inner talk and physical expressions) in which we talk with ourselves and others.
Dialogue involves a process of trying to understand the other person from their perspective not ours. Dialogical understanding is not a search for facts or details but an orientation. It is an (inter)active process not a passive one that requires participation through responding to connect and learn about the other from them, rather than to pre-know and understand them and their words from a theory. In relation to therapy, dialogue is invited through the process of the therapist’s learning about the other, especially about their uniqueness and noticing the not-yet-noticed. Through the process of trying to understand, local understandings develop from within the conversation. Dialogue is an always becoming, never-ending, and immeasurable process. As Bakhtin (1981) said, dialogue is the condition for the emergence of new meaning and other newness.
I assume that when people have a space and process for collaborative relationships and dialogic conversations, they begin to talk with themselves, each other, and others in a new way. Through these conversations newness develops and can express itself in an infinite variety of forms such as enhanced self-agency and freeing self-identities, different ways to understand themselves, their life events and the people in their lives as well as new options to respond to the challenges and dilemmas of the circumstances and situations in their lives.
I ask, “How can practitioners invite and facilitate the condition and the metaphorical space for dialogue?” I return to the philosophical stance.
The Philosophical Stance: