Constructing meaning is integral to contemporary family therapy. Interest in meaning-making has been part of family therapy’s history from the earliest schools, thereafter diverging through different techniques and positions. Tracing back from Virginia Satir and then through techniques such as positively connoting intentions within families and reframing problems using a shift in language and emphasis, constructing meaning is not new.
Integrated Family Therapy incorporates the long-established idea of constructing meaning as essential, alongside other important positions within assessment and intervention. Separated into two closely connected yet philosophically different forms of constructing meaning, the approach first recognises Social Constructionism in how meaning is developed, maintained and changed within families, and then moves to constructivism for a different perspective.
Social Constructionism and Narrative Therapy
Constructed meaning may be enabling, alter over usage, and can also become problematic “when (families) internalize conversations that restrain them to a narrow description of self”. Although on this occasion Lassie may not agree, “stories (may be) experienced as oppressive because they limit the perception of available choices.” Adams-Wescott and Colleagues (1993; cited in Freedman and Combs, 1996).
The concept of social constructionism presupposes that social structures, containing inherent imbalances of power, are formed and maintained through the medium of language. Narrative therapy is the organized therapeutic model that draws on this concept. It was championed by the late Michael White and by David Epston; the Dulwich Centre is the leading presence for contemporary practice.
Narratives or stories are linguistic means of communication between individuals, communities and cultures. Our ‘lived experiences’ are related as stories. Encompassed in published stories, from fiction (as in Peter Pan, the brothers Grimm, or the children’s books of Roald Dahl), traditional story-telling (e.g. ancient myths – rooted in religion and tribal memory), and 19th century travellers’ tales, through to individual family stories and myths: we imagine our futures, anticipate our dreams and relay the horrors of life. Stories are powerful representations of our values, thinking styles and aspirations (or the absence of them).
The McMaster approach provides such a story. It was developed from a community-based naturalistic study of families in Montreal during the 1960’s, but was put together later in Hamilton, Ontario, where Nat Epstein was working with others to establish a new medical school. All medical-teaching was to be problem-based learning, and the family therapy model that developed there reflected this: distancing itself from psychodynamic thinking, it was problem-focused, and based on the types of rational principles articulated by Thomas Paine and the Scottish Enlightenment (i.e. unsentimental, democratic, empirical, enquiring, distancing itself from received wisdom and traditional established powers). However, trying to escape a story often becomes another story, because systemic family therapy is inextricably linked to lived experience past, present and future. The 1985 text Integrated Family Therapy was simply how its two authors, after working at McMaster, chose to re-story the development of the model after their return to the UK.
History and Philosophy of Social Constructionist Narrative Therapy
Narrative therapy has its roots in sociological thinking, from Foucault in particular, where society does not exist as a fixed entity. It is perceived through “interpretive frameworks”. Social structures (such as the beliefs and values upon which society has developed and continues to function, and the elements that create these structures) are borne out of the repetition and re-enactment of dominant themes and objectives. Individuals become socialised into beliefs and behaviours; repetition of these establish social norms, social controls regulate deviations allowing the dominant narrative of a culture to continue.
Understanding the power and influence held by dominant social and family narratives, narrative therapy considers that no therapeutic encounter can be truly objective. Therapists are inevitably caught up in narratives, including those of their own workplace as well as of prevailing political systems. Nonetheless, narrative therapy considers that local knowledge can in turn influence larger discourses, without which of course therapy would be futile.
Re-authoring lived experience: it starts from the position that all individuals and families have a wide repertoire of lived-experience, which is only selectively recalled. As personal experience is described or aspects of life lived is reflected upon, dominant themes become established that permeate lived-experience; over a lifetime these become a dominant narrative that is repeated and replayed. Simultaneously, exceptions to a dominant story that challenge the ‘script’ used to author our lives are actively filtered out.
Such re-authoring, over a family history or an individual’s lifetime, recreate and re-enact the dominant themes so they become entrenched behavioural and emotional responses, narrowing recognition of exceptions or unique outcomes. In short, lived-experience will always have been deeper and broader than what we describe in discourse; all family members will have knowledge of a wider range of experience than that which has been storied. Narrative therapy seeks to explore this, undoing the binding influence of dominant narratives as illustrated below.
David, aged 12, sat rigidly in his chair as his mum, Mandy, described how he would come into her bedroom at night, too anxious to sleep in his own bed. The therapist was acutely aware of the overwhelming shame that this tall, well-groomed young man was feeling while this problem was relayed. Implicit through the description of the problem was the notion held by Mandy and shared by David that he was incapable of facing fears of any kind and that David needed Mandy to fight his battles for him.
Such dominant narratives severely narrow the possible range of ways a family takes to resolve their problems, thus highly relevant to the problem-focused approach we describe.
A further reason to integrate social constructionism in our systemic model arises from the way dominant narratives may also prevent other more ‘distant’ influences on lived-experience emerging into conscious or storied awareness. For example, experience before verbal language had developed, and the dissociative barriers that protect individuals from processing unbearable experiences; arising from episodic or longer-term adversity and trauma.
Adams-Wescott, J., Dafforn, T., & Sterne, P. (1993). Escaping victim life stories and co-creating personal life story. In S. Gilligan & R. Price (Eds.), Therapeutic Conversations. (pp. 258-276). New York: Norton.
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White, M. (2002). Externalising Conversations Exercise [Online]: www.dulwichcentre.com.au/michael-white-workshop-notes.pdf
White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. London: W.W. Norton.
Constructivism is the concept that describes how individuals and families make meaning out of social encounters that are shaped through language. The meaning of experience is shaped by social encounters, the language used within these encounters, by the social context in which encounters occur and the language used in discussing social encounters after the event. This differs from social constructionism in emphasis, where constructivist approaches to systemic family therapy focus on the way individuals and families internalise and then hold on to meaning and how this can be re-shaped through therapeutic conversation.
Brief, strategic and latterly solution-focused therapy has evolved from constructivism. Key components to early family therapy models can also be seen with constructivism as a major influence. Reframing and positively connoting family struggles can be linked back to Bateson’s early research into brief intervention using a positive focus, suggesting change can be brought about for families by future-thinking in as effective a way as by problem-resolution.
Integrated Family Therapy celebrates the way in which contemporary practice now recognises the importance of incorporating discussion of family strengths and resilience in therapeutic conversations, promoted in the last two decades by Froma Walsh. In addition, Tom Sexton’s revival of reframing as a core aspect of Functional Family Therapy draws on constructivist use of language to actively notice the positive intentions of family members when caught in problem-maintaining feedback loops of behaviour and language.
Mandy sat looking in despair as she relayed the conflict David had been engaging in with one of his teachers. She described feeling helpless, generalising his behavioural problems into being a behavioural problem in school. Meanwhile David looked discouraged, his face hidden by the hoodie he was pulling further down over his forehead.
The therapist faced a dilemma at this point. Acknowledge the distress and pain? Deconstruct the incident with the teacher? Consider whether David might be projecting expectations of male adults onto his relationship with his teacher? Use circular questions to widen out consideration of other family members’ perspectives on education, or relations with teachers, or expectations of David?
Considering David’s age and concerned about his engagement with the therapeutic process at this moment in time, the therapist decided to draw on social constructivist influences to bring new meaning-making within the family. Checking out how many of the teachers David related positively to, David peered out of his hoodie and tentatively talked about his ‘Techie’ teacher, who had helped him develop an idea of how to make a ‘cartie’ using scraps of wood and some old buggy wheels. Mandy rolled her eyes at David as they shared a cautious smile about the ‘cartie’ and spoke of David’s hours of work on it one Saturday, before proudly riding it down the road. David, prompted by the therapist, identified a hope that his interest might become a vocation in the future.
The therapist asked Mandy what she thought worked well in David’s relationship with the ‘Techie’ teacher. She identified that David knew he took an interest in his learning and that David responded to this with compliance, respect and even enthusiasm. Using a reframe, the therapist tentatively suggested that might David have been working hard to show the teacher, with whom he got into regular verbal conflict, just how much he wanted to be noticed and encouraged by him. The therapist used a language shift within the reframe to express how David’s best efforts at this had been viewed by his teacher as disrespect and that this had caused problems in misunderstandings, as David became more and more disappointed and discouraged. Noticing David shrugging his shoulders but with his face clearly seen now within his hood, the therapist asked David what it would be like for his teacher if he could see how David showed his enthusiasm and interest with his ‘Techie’ teacher. David thought his other teacher would like this and might help him a bit more when he got stuck.
Mandy looked a little impatient as this aspect of the conversation developed, wishing to remind the therapist of the numerous phone calls she had received from the school in complaint about David’s behaviour. The therapist again faced the dilemma about what direction to choose regarding her next question. Should she give space to Mandy’s struggle, risking David retreating back into his hoodie? Should she continue with the constructivist conversation? Reflecting-in-action, the therapist decided to move her attention to Mandy but retain the constructivist influence in the therapeutic conversation. She asked Mandy what it would be like for her if David brought the respect he showed his ‘Techie’ teacher to his interactions with his other teacher. Mandy stopped for a short pause, with the therapist wondering whether she would engage with this question. Looking less tense than a few moments before, she described (and was clearly, briefly, feeling) the relief and freedom she would gain from constantly waiting for a complaining phone call.
The therapist then asked how that might change what happens between her and David when he came home from school. Mandy thought that she would be calmer and might not interrogate him as she was currently and frequently doing. The therapist asked Mandy how this might feel for David. Mandy thought he would probably be more relaxed after the school day ended and the evening began as he wouldn’t be expecting his mum to ‘give him a row’. Asking Mandy again how David being more relaxed might impact on his emotional state by bedtime, Mandy thought he might be less tense than he is currently if she and David had had a calmer evening.
Drawing on strengths already held within David and within the family, i.e. David’s capacity to relate well to a teacher, Mandy’s capacity to reflect, social constructivist influences led the family to envisage a different reality from the one they were currently living. Using reframing as a technique, the therapist helped the family bring different and more positive meaning to a volatile experience, which took the emotional charge away from the constructed memory of the experience for David and for Mandy.
This did not require the therapist to ignore other theoretical influences and possibilities. Instead a social constructivist stance provided an opportunity for a glimpse into a different reality for the family. This created a marginal shift in perspective for them and brought a loosening of the grip of the current feedback loop in which the family had become trapped.
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