Assignments over for a while

Felt a long time coming but finally all deadlines are complete. Feeling good and happy! Been very exhausted and had little time to add to this blog. Will look to continue once I return to my studies.

Post 15: Minuchin & Narrative - an interesting read

Expert taken from 'Where's the Family in Narrative Therapy' Journal of Marital and Family Therapy

Volume 24, Issue 4, pages 397–403, October 1998.

"Practitioners share a penchant for a therapy of questions, on the assumption that questions are more respectful of the patient’s own framework than are comments, interpretations, or prescriptions. The social concern for liberating people from the dominant discourses that marginalize them leads these therapists to minimize therapists’ statements of expertise - to taking a stance of “not knowing.” Paralleling the social constructionist acceptance of diversity and multiculturalism, their interventions are oriented toward increasing diversity in the internalized voices of the patients. Unfortunately, in my view, that focus decreases attention to the patterns of interaction presently being played out by family members. "

Minuchins view here is fundamentally that contemporary approaches are missing the interactions between family members. The title of the article leads me to question more about how family interactions are indeed considered in todays therapeutic culture.

As a framework, deconstructing beliefs and cultural constraints etc is a sound approach - yet in my view, practically more applicable in a quiet, reflexive, patient manner and not in a volatile risk covert home or clinic based situation.

Minuchin & Structural therapy weighs in with lots of ideas that 'reality' does not exist and instead clients should be walked to alternative patterns of thinking & behaving - nothing new in our contemporary approaches then.

My view is it is the job of the therapist to judge what is required. It seem heretic to apply just a hermeneutic approach to all clients. A therapist working with a client 'taking with out consent' or 'joyriding' on a weekly basis may find themselves judging that a family need re-balancing before being curious about what holds them to their beliefs.

Perhaps "first order" CHANGE has been lost as the second order and third order APPROACHES come in to play. Many will have been tempted to offer solutions based on their 'common sense' (..or considering family of origin, aspects of self, inner dialogue etc etc), yet careful not to direct their 'power' on to others. Having worked in services that value first order changes, I can vouch for richer conversations about experiences rather than fear of experiences,

Having just read part of a CMM article, I like the following piece.

"Practical theories are intended to inform patterns of practice that make life better and are judged according to the pragmatic criterion of utility as opposed to an epistemic criterion of truth "

Barge, K. Articulating CMM as Practical Theory. Human Systems: The Journal of Systemic Consultation & Management.Volume No 15, issue X, 2044

Contemporary approaches....or perhaps the students, practitioners and trainees of..... have seemed to move in to this 'not knowing' position which in itself seems to hint at a criterion of truth....."I cannot assume....I must seem curious...I do not understand their experience" for instance. Following the above musing by Barge, I am more comfortable than ever to work in a systemic way and use some counter cultural approaches to guide my work, whilst reflexively using my work to inform my approaches - surely one of the most important tenants of systemic practice.

 

Post 14: CMM basics

Having to start an assignment on CMM and read the Cronen and Pearce handbook on using CMM, along with an article by Bruss on using CMM to understand more on Obesity (Mozhdeh B. Bruss, Joseph R. Morris, Linda L. Dannison, Mark P. Orbe, Jackie A. Quitugua & Rosa T. Palacios (2005): Food, Culture, and Family: Exploring the Coordinated Management of Meaning Regarding Childhood Obesity, Health Communication, 18:2, 155-175).

So far I find it reasonable user friendly so far. In my place of work I am taught to observe a) The context of conversations b) the process within the room c) Content & language of the conversation. The order of these may vary as they come in to focus but by enlarge, I am focussed on context & process.

CMM seems to take suggest this approach to communication and encourages clinicians to observe the context of the conversation and messages there within. Hopefully many a Supervision on detailed analysis of my work (conversations context, process and language) has prepared me for the task of understanding CMM.

The next challenge seems to be how is this applied? Is it an over arching broadbrush in which I operate? Do I share the theory with clients to help loosen their constructed contraints? Are there interventions within CMM to be used. Does it apply strictly to social constructionist theories or in more interventive approaches (MST, Family Functioning ala Tom Sexton?).

CMM seems to have cross overs to understanding the Domain theory of parenting (Discipline, Attachment, Exploratory, Safety).

More to come on all this....

post 13. Assignment finished. Circularity

Having written a 10 minute transcript (always takes much longer than you think), analysing it and placing it within a systemic orientation, it is now finished.


My broad take on circularity was exposed as I read in increasing detail the philosophical view of circularity. My usual style of 'circular questioning' succeeded in having family members comment on other relationships or action, but has not had the deeper understanding of a circular process. My aims are now to take this forward with gusto! I intend to sit back and have that circular posture, that there are moments of information that a therapist can spot and re-feedback in to the therapist/family system. These 'blips' as I refer them as, are moments of offerings the family give a therapist ("I think my son punches my daughter because....." and moments of offerings from a therapist to a family (" who would be able to make a best guess to why you punch your sister?". It is far more skill full than I have given it credit for. Having transcribed 10 minutes and spent up to 20 hours analysing it, I formed very creative questions....something I worry about as I need to do it almost immediately preceding a 'blip' within session.


The Milan team made a quick shift to social constructionism, something I was not familiar with. Particularly Cecchin (Cecchin, G. (1992). Constructing therapeutic possibilities. In Therapy as social construction(ed. S. McNamee, Gergen, K.J.), pp. 86-95. Sage: London). This chapter is well worth a read and I want to give it more time myself rather than taking key bits for the purpose of my assignment. Briefly, Cecchin described how the movement in to co-constructing different perspectives gradually occurred. Their adherence to systems theory and strategic interventions disappeared as they placed emphasis on content and communication.


Currently my knowledge of CMM is poor, but I guess the Cecchin paper is alluding to the higher levels of communication that occur in families. More to come on that...!


Another assignment down. Maybe a short weekend break then best keep on top of this work.

Post 12: Circularity - revisited

Thinking I'm hilarious by using 'revisited' like the Milan team. Anyway - a long day of catching up on the concept of circularity for the purpose of an essay. Far more in-depth as a concept that a technique as I came to realise.

Karl Tomm papers (Interventive Interviewing, Fam Proc 27:1-15, 1988) , looked at how the concept can be functional within session.

After reading these, I looked over Burnham AMT which has a similar statement - ie orientate yourself to a posture/intention. It's a really useful way to begin viewing your questions in the hope to refine, improve as, as Tomm says, the process becomes natural to the therapist.

As my confusion over collaborative approach continues I again ask, how does this fit in to collaborative work (less so Burnham, more so Tomm)?

Enough for tonight 1pm-8pm is a long days studying.

Post 11: Where's the technique in Collaborative

Firstly - It's been a while since I have written on here. The demands from the course has upped and increasingly I find myself preparing and analysing sessions, revising, re-reading, re-familiarising myself with literature, preparing presentations and completing research assignments. Time and space for sleeping eating and seeing people outside of the MSc and work is limited - time to blog is therefore much shorter!



Currently I have to analyse a ten-minute segment of video, transcript it, and focus upon techniques I have used within session. From my shift away from agency level interventions (using say, structural techniques), it has become necessary for me to use different approaches that cause to step blindly in to a session, and at this stage, still unclear what 'techniques' I have used. My past three sessions have been under the paradigm of collaborative but for the purpose of the assignment I have no idea what techniques I have used! Sure, I have formed my questions based upon the feedback of the family, and remained un-assuming (not knowing) and excluding any narrative techniques (social constructionist re hermeneutics) I may have added to a session I cannot write 2500 on collaborative techniques, even though my session was (based on supervisor feedback) a session with major collaborative intent!

Post 10 - Content vs Process

Structural, Strategic, Systemic (Milan) - all have similarities according to Heather Hayes (Re-Introduction to Family Therapy Clarification of The Schools) A.N.Z. Fam Ther 1991, Vol 12 No 1, pp 27-43.
All 'school's have similarities in how they view the emergence of a 'problem'. They see the problem emergence as synonymous with a transitional period in family life. They also see inflexibility, rigidity, old beliefs as informing a family's attempted solutions to problems, focus on present not the future, change rules/beliefs, use language to help change beliefs and pattern of interactions (e.g. relabelling or reframing), therapist adopts views of family, but with another alternative view.

Most interesting for me is that Heather Hayes suggests process is emphasised above content. This is certainly my current stance. In a service that encourage process shifts, I may be finding the observation of language (as per my current understanding of Collaborative) difficult to tap in to. 

Am I then still a first order therapist? What needs to change for me to become more contemporary (second/third order)?

Firstly, I am excited at having noticed where I stand. I have alluded to hesitance to 'jump' over the many years in which FT tried to find it's feet and automatically become contemporary. Hoffman, beautifully describes her own path to being contemporary and how over time she rejected/built upon, traditional approaches to then help her own 'aha!' moments, and transition herself in to a new way of thinking.
Secondly, I have no idea if that will come for me! I am staunchly an interventionist, however I do enjoy exploring the language and beliefs of clients. Partly I am genuinely interested (nosey?) in peoples history, and partly introducing more exploration of language in to my practice. I've yet to offer an direct intervention nor be intentionally strategic.

Ok, a long way to go I know, but I'm eager to become that 'great' therapist that colleagues refer difficult cases to!