If anybody says he(sic) can think about quantum physics without getting giddy, that only shows that he has not understood the first thing about them.
That opinion, from the father of twentieth century fundamental physics, demonstrates how an exploration of uncertainty lies at the heart of contemporary empirical science. In the systemic literature, the history of disputes and contested discourses has been largely around Modernism. Its critics argued that it offered spurious precision and false dawns, with certainties that risked deluding and disappointing. Worse still, any deeper understanding of human relationships might be obscured, echoing Niels Bohr’s view almost a hundred years ago.
Minuchin’s pioneering work in family therapy, informed by past involvement in assisting deprived and marginalised families, became unfairly tarred by post-modern therapists. Descriptive adjectives like “enmeshed” and his account of structural techniques were seized upon as examples of ‘certainty’ where a dominating discourse subordinated deeper engagement with families and the unique qualities each has.
Integrated Family Therapy’s para-modern position holds on to the usefulness of what can be recruited from past years of systemic family therapy literature such as the patterns and relational factors within families described by Structural family therapists, but equally holds on to the constructed aspects of family life in a social context. From this position, family assessment is approached with an open mind, bringing genuine curiosity to meeting the family. Anyone who has seen Minuchin joining a family will have witnessed genuine curiosity in abundance.
Neither uncertainty nor curiosity require fixed theoretical positions on the initial meeting with a family, and are closely allied. Family members may not expect the therapist to privilege the family’s ideas above their own expertise, but should discover that it is possible and that power is distributed rather than hierarchically imposed.
Curiosity and Safe Uncertainty
By introducing the term ‘safe uncertainty’ and advocating its place in systemic work with families, Barry Mason emphasised the importance of openness and retaining an awareness of the very provisional nature of human ideas, which are socially constructed rather than containing absolute ‘truths’. Mason’s publication was part of a tide in systemic literature of colonising claims about how best to approach an understanding of families in difficulty, but unlike some of these competing claims, his paper adopts a measured position, standing back from the fray, and it remains influential.
The principle of safe uncertainty applies throughout a therapeutic contact and is vital to the first encounter between a family and therapist. Without uncertainty being permissible, curiosity closes down, making any subsequent deep understanding of a family’s difficulty unlikely. However, ‘unsafe’ uncertainty is equally unhelpful. That is because uncertainty that feels unsafe induces anxiety, disorganisation, and disruption, the stress of which usually prompts a return to closed-down position-taking, with conclusions of spurious precision.
Power and confirmatory bias: questions about power, and who holds it, were ushered into systemic practice by feminist writers such as Lyn Hoffman, an early post-modern therapist, generalising to how power is exercised and the effects of being a member of a marginalised group with little power. Some therapists now write about how masculinity is under siege too, but whatever the validity of such concepts, and however persuaded a therapist is, Integrated Family Therapy considers the concepts as relevant but not absolute truths. They should be set to one side on meeting a family: not out of the door but not used as a starting point. This stance differs from that suggested by the recently published summary of one author’s systemic work:
“My starting point for working therapeutically with men is the conviction that the traditional patriarchal masculinity is a product of the socially sanctioned, systematic, emotional and often physical abuse of male children … [I] endeavour to find the means to interrupt this vicious cycle, and to engage men in a different kind of narrative about themselves and their masculinity.”
One must be wary of predetermined convictions about social constructs in just the same way as being wary of ignoring societal influences on meaning.
Integrated Family Therapy invites caution when embarking on a therapeutic journey with a family: none of the most commonly occurring or most frequently cited issues in the systemic literature may turn out to be salient to that particular family during therapy. How the family think of themselves is vitally important, and as they re-story their lives during family sessions their therapist may be taken in quite unexpected directions. The unexpected may emerge at any stage during therapy: for example, family-valued outcomes which had not occurred to the therapist and which might challenge their ideas of what would constitute a good outcome for this family.
Safe uncertainty and task-setting: The increasing appreciation of a family’s own ideas and stories is reflected by the diminishing frequency of therapist initiated task-setting in systemic work. The first edition of Integrated Family Therapy contained an extensive account of task-setting, and tasks remain integral to several models of psychological therapy, notably CBT. Task-setting is still cited in the systemic literature and even reported in accounts of narrative therapy. The absence of a separate section on task-setting on this website reflects our own practice of infrequent task-setting, for the two reasons set out below:
- vague task-setting is not usually useful and any certain therapist opinion on what might be useful could prove unsafe, either disrupting the family and our therapeutic engagement with them, or be of unexpectedly little significance
- from a belief that the most effective ‘behavioural activation’ (a term introduced from the CBT literature) arises from a family’s changed view of themselves. For example, our experience is that once space has been provided to explore and understand any behaviour or style of communication which alters during a consultation, the newly altered becomes the most effective foundation for how family members subsequently relate.
The stance sought is one that optimises safety but opens up uncertainty within therapeutic processes, and in turn widens the potential for change. The stance might shift in appearance according to the therapeutic encounter and the influencing theoretical model at any given time but fundamentally holds on to safe uncertainty as an organising concept.
Families’ experience of therapist uncertainty: this is best understood using Mason’s dimensional grid, which represents four expressions of uncertainty.
As therapists, and depending on the context and complexity of our work with families, we might opt for one position over another but not always in the best interests of therapeutic change.
Safe Certainty: offering safe certainty when we ourselves feel unsafe within our organisational contexts, providing a tangible sense of security in the approach to family complexity (e.g. to over-focusing on the evidence-base of how we might meet with families), at the cost of limiting creativity and genuinely (emotionally) engaging with them.)
Unsafe certainty: from an equally rigid therapeutic position, risks to the family are left unresolved – this might include families involving domestic violence or where child protection concerns are present.
Unsafe uncertainty: as we described earlier, this constitutes the highest risk position for a family and for therapy, because the lack of structure and organisation of therapy and the unresolved risk factors for the family leave all involved in highly anxious positions.
Safe Uncertainty: this summarises an optimal therapeutic stance, where structure around therapeutic intervention is present but not at the cost of stifling creativity, as illustrated below.
Therapeutic conversations with Mandy and David: as these progressed the therapist sensed that David appeared to be filled with dread when he sensed that he might be asked a question. Asking Mandy what David might be concerned about, she described David as being ‘sensitive’, always worried that he will be criticised, blamed or in trouble for the problems the two of them were facing.
Providing a structure for the therapeutic process lessened some of the tension David experienced. The therapist contracted with David to understand what has been happening but also to be interested in other parts of his life that were not so constrained by the problems.
It was agreed that if the therapist noticed that David could be feeling blamed at any point, they would pause and think again in a different way so that David could share his thoughts. This structure to the sessions settled David enough to enable him to participate, while still engaging Mandy enough to believe she would also be heard. The sessions became safe enough for David as well as for Mandy but did not constrain the spontaneity within the therapeutic process by introducing too much certainty.