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The Therapeutic Relationship in Systemic Therapy

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Brings the issue of the therapeutic relationship in family systems therapy into focus, by examing the relationships between the client family as a system, and the use of self in therapy.

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Chapter 1. Leaving well alone: a systemic perspective on the therapeutic relationship

ePub

Tom Paterson

INTRODUCTION

In recent years there has been widespread contention that systemic therapists have under-theorized the therapist-family relationship—especially in its emotional aspects. This lack is often attributed to what Smith, Osman, and Goding (1990) call the “dominance of ‘male stream’ thought in family therapy” (p. 143). This dominance, they argue, has led to a privileging of reason over emotion and objectivity over subjectivity, which has remained unshaken by the emergence of second-order cybernetic theory. Interest has also been shown in the idea of exploring the relevance and possible value of psychoanalytic ideas for filling what is seen as a theoretical vacuum surrounding the therapeutic relationship in family therapy (cf. Flaskas, 1989, 1993, 1994).

I agree that the therapeutic relationship has been ignored for misguided reasons1, and I also think that psychoanalytic ideas are valuable for some of the things family therapists do. In this chapter, I begin with the simple point, which appears to have been overlooked, that systemic therapists play a more marginal role in the natural groups they join, whereas the one-to-one psychoanalytic therapist-client relationship demands more intense involvement. Thus it is appropriate for the former to focus more on the process in the natural group and for the latter to analyse the therapist-client relationship in depth.

 

Chapter 2. Understanding the therapeutic relationship: using psychoanalytic ideas in the systemic context

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Cartnel Flaskas

INTRODUCTION

This book has taken as its departure point the impoverishment of the current systemic understandings of the therapeutic relationship. I am not interested so much in developing any further critique of this absence in systemic therapy. Rather, I am looking toward ideas which may extend our understandings of the therapeutic relationship and, specifically, I want to explore some ideas from the psychoanalytic therapies that have this potential.

Systemic therapy has had an ambivalent relationship with the psychoanalytic therapies, and in many ways it has had an oppositional relationship. Though there are probably complex historical and political issues involved in this opposition, nonetheless, at a more straightforward level, it is easy to appreciate why the intra-psychic focus of analytic work has not sat comfortably with the interpersonal and relational focus of the systemic therapies.

This is not to say, of course, that there have been no intersections drawn between analytic ideas and the project of systemic therapy. The earlier collections by Helm Stierlin (1977) and John Pearce and Leonard Friedman (1980) stand out here, as do the integrative projects of Ivan Boszormenyi-Nagy and Geraldine Spark (1973) and Michael Nichols (1987). From quite a different angle, Deborah Luepnitz has juxtaposed object relations therapy as meeting some of the shortcomings of a systemic frame (1988). There has been another body of work (particularly from Britain) that has emphasized the complementarity of these therapy frames (see, e.g., Byng-Hall, 1986, 1988; Campion & Fry, 1985; Crowther, 1988 ). In the Australian context, a number of recent discussions have raised the renewal of interest in analytic ideas (e.g. Gibney, 1991; Quadrio, 1986a, 1986b; Smith, Osman, & Goding, 1990) and I have also tracked around this area in different ways (Flaskas, 1989,1992,1993,1994).

 

Chapter 3. Empathy and the therapeutic relationship in systemic-oriented therapies: a historical and clinical overview

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Edwin Harari

INTRODUCTION

“there are between heaven and earth things … which demand not to be developed or explained but understood”

J. G. Droysen—Outline of the Principles of History [cited in Burger, 1978, p. 8]

From Antigone to Princess Diana, from Cain and Abel to the Kennedys of Massachusetts, family relationships have been an inexhaustible source of fascination for people. That family relationships could be a force for happiness or misfortune in a person’s life, whose effects could be transmitted across the generations, was widely appreciated, and variously attributed to the workings of Divine Will, Fate, History, Blood, Race, and Nation. Implicit in the account of such influences was the idea that they were beyond people’s capacity to change.

The Enlightenment of the eighteenth century challenged this view. Inspired by the success of science to explain, control and change the natural world, the thinkers of the Enlightenment (and the social and political revolutions they encouraged) sought to explain Human Nature and the social order in human terms. This quest could not begin until two fundamental questions were answered:

 

Chapter 4. Embedded and embodied in the therapeutic relationship: understanding the therapist's use of self systemically

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Vivien Hardham

INTRODUCTION

Our “use of self is… the only tool available to (us)” (Real, 1990, p. 255 ). Every beginning therapist is painfully and humbly aware of the meaning in practice of this statement. Our selves are what we use to do therapy. The beginning systemic therapist may also note that to help us in our practice we have literature that describes techniques or styles of therapy, theory that implies certain approaches, or vague statements about the existential or intuitive aspects of therapy. Yet somehow, none of this directly helps us understand how we use ourselves as feeling and thinking people within dynamic action-packed therapeutic relationships.

This chapter presents a stage in the development of my thinking about the use of self of the therapist. It is addressed to therapists who identify their theory of practice as systemic, and it was inspired by a personally felt need arising from my wish not to have to “step outside” my theory of practice in order to understand how I do therapy. The essay is strongly shaped by two allegiances that I should own from the outset. Firstly, I wished to be consistent with systemic (ecological/second-order cybernetic) understandings of therapy, and so I am trying to focus on the therapist and the therapist’s use of self, while still seeing the therapist as inextricably and recursively a part of a dynamic relationship /system. Secondly, I wished to do this in a way that meant that I did not compromise a commitment to the broader issues of power, and to the ethics that are consistent with feminist and culturally sensitive practice.

 

Chapter 5. To embrace paradox (once more, with feeling): a commentary on narrative/conversational therapies and the therapeutic relationship

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Paul Gibney

THE GROUNDWORK

Family therapy has undergone a major shift in theoretical emphasis in the last twenty years. In the 1970s, family therapists spread themselves between the technical and theoretical certitudes of the strategic and structural schools of family therapy. In the late 1970s to mid-1980s, therapists embraced systemic therapy with its stylized practice format, its rigorous questioning, and its complex theorizing. The late 1980s to the mid-1990s have been increasingly characterized by a move towards narrative/conversational models of therapy. These latest models de-emphasize the power of the therapist and speak of the co-construction of meaning, a collaborative approach, the shedding of power, and the challenging of dominant paradigms. There is an accompanying sense of having attempted to address the arrogant certainties of yesteryear with a more tentative, more politically correct stance of today.

The epistemology debates of the early 1980s invited therapists to reconsider how they thought, knew, and decided about families; once they did that, with any amount of earnestness, the possibility of constructivism became available and the promise of certainty seemed to recede forever.

 

Discussion paper I You cannot not relate

ePub

Bebe Speed

INTRODUCTION

As the Editors of this volume indicate, the therapeutic relationship within systemic approaches has been little theorized about or discussed, at least in the public domain. But because it hasn’t been much written about doesn’t mean it hasn’t existed. By definition, every time a therapist sees a client, a relationship comes into being—”you cannot not relate”. But somehow this medium in which our practice is embedded has been taken for granted, and little commented upon, and its potential significance as a crucial part of our encounter with clients has therefore been underplayed. This volume makes a substantial and innovative contribution to placing the topic of the therapeutic relationship within the formal discourse of the systemic therapies.

THE RELATIONSHIP IN THERAPY OR THE THERAPEUTIC RELATIONSHIP?

The Editors have chosen a nicely ambiguous phrase in their title for the book. “The therapeutic relationship” can be taken to mean the relationship which comes into being between clients and therapist as the vehicle carrying the content of therapy, or it can imply that the relationship between clients and therapist may in itself be therapeutic—that the quality of the relationship itself may be change-enhancing or, at the very least, may affect the content of the work for better or worse.

 

Chapter 6. The therapeutic moment: a double-sided drama

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Peter Cantwell and Brian Stagoll

It was inevitable that in the consulting room there would be two dramas played out, and one of them was going to occur in the unconscious of the therapist.

(Kahn, 1991, p. 118)

Anew voice being heard more frequently in the systemic world stresses the therapeutic relationship. Emphasis on the therapeutic relationship is not new in systemic thinking (a fact sometimes overlooked by writers in the systemic tradition—Skynner, 1987), but it is now receiving more attention. This is a reflection of the rising influence of feminist-informed therapy and the elaboration of social constructionist thinking (Cantwell & Holmes, 1994). Earlier family/systemic therapies originating from work with highly dysfunctional and stuck systems needed to be preoccupied with strategies for shifting rigid structures and behaviour patterns. In its time, this pioneering work was a significant addition to psychotherapeutic thinking. Now, with systemic approaches more fully established, systemic therapists can turn to paying more attention to the therapeutic relationship itself.

 

Chapter 7. A systemic therapy unravelled: in through the out door

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Amaryll Perlesz, Mark Furlong, and the “D” family

INTRODUCTION

How could one ever write about a therapy in a way that comprehensively reflected the therapeutic relationship, involved the family in those reflections in a truly collaborative manner, did not treat the therapy and the family as “a case”, explored the co-therapy relationship, and was honest enough to describe the vicissitudes in the complex set of relationships between therapists and family over a period of more than eighteen months? These were some of the issues that we, the therapists, pondered over as we once again contemplated this project, drinking Guinness on one of those winter Melbourne days that silently, without notice, turn into night. The glass of Guinness was not as creamy and as rich as we would have liked, just as we knew that an account of a therapy can never “accurately” reflect the experience of the participants. The map cannot be the territory. Only 5,000 words, two therapists, five family members, eighteen months of therapy, twenty-three sessions, and a paper to be written within three months.

 

Chapter 8. From both sides now: the therapeutic relationship from the viewpoint of therapist and client

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Catherine Sanders

INTRODUCTION

Systemic therapy has been responsible for the production of thousands of words and has absorbed the time and energy of theoreticians and practitioners the world over. Yet despite the more recent rhetoric of conversation and goals of equality and respect, the bulk of this material has reflected the practitioner’s understanding and experience of the therapeutic process. As Conran and Love (1993, p. 2) reflect:

it is not typical for therapists to ask clients for their opinions about therapy. Most therapists… have listened to other therapists for their opinions about therapy.

When considering the nature of the relationship between client and therapist, this balance seems particularly inappropriate. By definition, systemic therapists view the relationship as shaped and guided by circular and reciprocal processes, which influence both the person asking the questions and the person answering the questions. It seems ironic, therefore, that there has been so little description of the client’s experience of this reciprocal process of therapy.

 

Chapter 9. Cross-purposes: relationship patterns in public welfare

ePub

Mark Furlong

INTRODUCTION

One hallmark of systemic theory, particularly second-order systemic theory, is its attention to the contextual relationships within which “personal” relationships occur. This attention has made it possible to move from the narrower lens of simply considering intra-familial relationships, to the wider lenses of considering the family in the context of the family-therapist relationship, the family-therapist system in the context of the network of “helping relationships” in which the therapy may be taking place, the structuring of relationships within the social domains of (for example) the health and welfare fields, and the dominant cultural ideas that govern how family relationships and, indeed, the activity of “therapy” are able to be constructed and enacted.

This chapter chooses to use these wider lenses in locating the patterns of difficulties that commonly emerge in public welfare practice. Rather than focusing on the therapist /family relationship per se, the focus is on the wider context, which is the venue for therapist/ family relationships in this arena. In this way, public welfare practice becomes a “case study” for mapping a particular set of contextual relationships for the therapist/family system.

 

Chapter 10. Personal relationships in systemic supervision

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Banu Moloney and Lawrie Moloney

INTRODUCTION

In this chapter, we consider systemic supervision and the importance of an understanding of the personal nature of the experience for both supervisor and supervisee. The chapter begins with a general discussion of the interpersonal nature of supervision and then moves to a description of four cases of supervision. These descriptions invoke the issues of the personal involvement of the therapist and supervisor in meeting the clients’ situations, and raise the accompanying issues of emotions, parallel process, transference, trust and respect, self-awareness, and self-disclosure. The cases become the springboard for a wider discussion of the personal in systemic therapy and of concepts that have been used to describe systemic patterns and personal interaction.

THE INTERPERSONAL NATURE OF SUPERVISION

Most definitions of supervision emphasize its interpersonal nature. Hess (1980), for example, defines supervision as:

a quintessential interpersonal interaction with the general goal that one person, the supervisor meets with another person, the supervisee in an effort to make the latter more effective in helping people, [p. 25]

 

Discussion paper II. Changing systemic constructions of therapeutic relationships

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Elsa Jones

Two factors, in particular, have allowed systemic therapists to pay attention to the therapeutic relationship. The first relates to changes in systemic theory. As Carmel Flaskas and Amaryll Perlesz point out in their Introduction, taking a second-order cybernetic stance, and incorporating feminist and social constructionist ideas, has obliged us to think about the presence and influence of the self of the therapist—and the relationships between therapists and clients—as significant elements in the process of therapeutic change. Secondly, as systemic therapy has become better established it has become possible to acknowledge the potential contribution of psychoanalytic thinking; the denial of its relevance which characterized the (largely psychoanalytically trained) family therapy pioneers can be replaced not only by the much-trumpeted “re-discovery of the individual”, but by attention to the inner worlds of therapists and clients.

As someone working in Britain, it is stimulating to note the similarity in the evolution of thinking about practice between our work here and that of our colleagues in Australia. However, while many—or some—of us may be doing things differently, it is also true, as regards therapy in general (Flaskas and Perlesz, Introduction) and supervision in particular (Maloney and Maloney, Chapter 10), that not enough is being written on it. This wide-ranging collection will therefore prove a stimulus to the practice and the writing of other systemic practitioners. Certain themes recur in all the papers in Part II; I discuss these below, with reference also to my own ideas and those of other European authors.

 

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