During a video-tape review session in Clinical Skills seminar, I interrupted the discussion by seeking clarification for the difference between two interventive techniques "positive connotation" and "reframing". That question had been troubling me since the earlier part of my course. Answers had been given before in other seminars but each time I was left even more confused. Felt really relieved when this time round the explanations were made once again and I got it!
What I wanted to write about here is not so much the content of this discussion but the process I went through in gaining "enlightenment". I realise whenever I ask a question in a seminar, the answer to my question and the interactive experience of talking about it would always be my key learning. Overtime I grew to appreciate this and understand why my clinical supervisor in Singapore and my placement supervisor now always start a supervision with by asking what questions I have and how I want to make use of the session.
This also leads me to think of a contrast though – systemic therapists tend to focus a lot on questioning, just like Karl Tomm opined that circular questions at the beginning of a therapeutic process are meant more for therapists to understand the problems and the contexts of the problems (Tomm, 1989); if this is the case, would therapists “gain” more than the families initially? Would it be more helpful for families to ask more questions in session over time so that they will surpass therapists’ learning about themselves? I suppose this is what Tomm proposed asking more “reflexive questions” overtime for families to trigger more thoughts about their problems and the contexts. Our tutor also agreed and added that overtime there should be a responsibility shift from therapist to families, and from tutors to trainees.
A further reflection of my reflection above made me think that it would be too constraining to assume that families will only gain from asking questions in a session. For me personally, there have been simple words, phrases and comments made by people in my life, be it a therapist or a friend, that made such great impacts that even today, I could still remember vividly! Of course, whether the words are helpful or not is another question altogether.
There could also be many other aspects of a therapy that have an impact too, for example, holding on to a sense of hope (for change) or just purely the experience of listening to what one would not hear outside of a therapy session because family rules and boundary forbid.
On a separate note, our tutor also highlighted there had been research in couples relationships that found that people pay attention to body language (55%), next the tone (38%) and lastly words (7%). This resonates with what most systemic therapists' emphasie on processes (all three components) rather than just content (words). Yet at the same time, I wonder if social constructionist approaches in systemic therapy could have lost important cues of change if the main emphasis is just on language, i.e. words? This is also Minuchin’s critique (1999). Found it fascinating that he described therapy as more of a drama than a story, the former encapsulates the story and the actors, whereas the latter just the story itself. I could however, see this in another perspective, in which social constructionist approaches focus not just on words, but the meaning behind the words and how they are constructed by the metaphorical and physical structures of the family and the society. Also, some people gain more from reading a book, while others from watching a film. One size cannot fit all! If so, could a systemic psychotherapist who only adopt one model, one approach, be it say Narrative, Milan or Structural, be genuinely systemic?
Interesting point about the focus on "words" by social constructionists. I think there might be misunderstandings here, or at least narrative practitioners do not just focus on words. The concept of narrative itself is rather ancient. It captures symbols, images, metaphors, and persons. And presents itself in many forms such as books, comics, movies, cartoons, toys, pets, etc.
ReplyDeleteWell, that was my interpretation of what Minuchin wrote in his "Mastering Family Therapy" as his critique and his way to differentiate, using his words, "interventionist" and "restrained therapy". The book was first published in 1996, so social constructionist approaches might have expanded a lot more thereafter, or it could be more of a political debate and defense of respective models.
ReplyDeleteJust read Goldenberg and Goldenberg's 6th edition of Family Therapy, An Overview about a heated debate between Minuchin and Satir in 1974 which resulted in Satir departing from the mainstream family therapy scene.
We could see this as power struggles within the therapeutic field but perhaps a different way to look at it is such debates and differences pushes for changes and models keep up-to-date with contextual issues and applicability.