“And what have we done to contribute to this mess?” Not necessarily Laurel and Hardy’s “another fine mess” but a call from Duncan Tennant, Systemic Psychotherapist, to consider each interaction between families and ourselves and take responsibility for the impact, both direct and indirect, that our thoughts, words and behaviour bring.
How might we use ourselves in therapeutic conversations so that we can avoid the pitfalls of strong emotional reactions to families and consequently finding ourselves floundering after an impromptu reaction that we would have preferred not to have made? Possibly not “mess” but certainly pitfalls that can hinder therapeutic engagement. Use of Self in family therapy serves not just to avoid a “fine mess” though but also how we might helpfully use ourselves within the therapeutic process to enhance the experience of families.
Self-talk before and after acting: Peter Rober provides us with a systemic model for ‘inner conversations’ that draws on our in-the-room in-the-moment experiencing selves within therapy and then helps us use our emotional reactions and associations to guide how we might respond in our professional role.
For example, thinking through which aspects of pacing, of theory, of scientific knowledge or legal position might be most relevant at any given time within the micro-interactions of a therapeutic conversation. Creating mental pauses to allow ourselves to notice our experiencing self, we can reflect-in-action on responses already made within a therapeutic conversation and then later reflect-on-action, in supervision or with a colleague, once a therapeutic conversation has concluded.
Rober calls his model the Dialogical Process, which is circular: we join a therapeutic conversation; our thoughts and associations influence how we respond to a family; in turn family members will respond to us, influenced by their experiencing selves within moment-to-moment interactions. This then impacts on our next experience of thoughts and associations within an interaction and so the cycle continues.
So responsibility to notice and be mindful of our emotional experiences at any point within a therapeutic process is an important use of self. It also requires therapists to be aware of, and come to resolution of, aspects of our personal history prone to react without thinking. These may be lurking out of cortical-awareness, provoked into expression by arousal of limbic system-based memories.
In conversation with Mandy and Dave, the therapist was aware of feelings of mild discomfort in relation to David, a young adolescent, sleeping in his mum’s bedroom. The therapist felt the level of embarrassment within David, bordering on humiliation, as his mum described her concerns about this. The therapist, recognising her own discomfort within, recalled using an in-session mental pause, a memory about her own struggle for independence as a young woman. She recalled how hard she used to work to present an independent persona to the outside world when, in fact, as a young teen, she was struggling with separation from her own very unwell mother.
Using this emotional experience to guide her pacing of the therapeutic conversation, the therapist was cautious not to push for details too quickly. Rather, she slowed the pace of information-sharing until David felt more certain that the therapist only wished to understand what prevents him sleeping in his own bedroom, rather than wishing to humiliate him.
Using Rober’s Dialogical Process to guide the pacing of the session, the therapist was able to stay in touch with David’s sensitive emotions at this crucial stage of the therapeutic engagement process, without losing touch with the overarching themes of the session and without negating the concerns of David’s mother.
Rober’s Dialogical model for using the self of the therapist within or following a therapeutic conversation facilitates the recognition of the therapist as an emotional, experiencing being without negating the important and often differing professional roles we hold, according to our work context and organisational tasks. When we can hold both our experiencing and professional selves in mind simultaneously within a therapeutic conversation. We are then less likely to get into a “fine mess” through impulsively, insensitively and possibly inappropriately reacting to content shared directly by a family using language or indirectly through projections, transference and through activation of mirror neurons.
Not only that, holding this experiencing process together with our professional knowledge adds a rich dimension to the space between ourselves and family members that could otherwise be lost to professional responsibility, theory and to technique.
Further Deconstruction of Use of Self in Practice
A further practice example is provided in the case of the 11-year-old young man with ADHD described elsewhere, in which during heated family conversation, self-talk during otherwise invisible pauses allowed the therapists to attend to and understand what was happening in the room. This took the therapists into considering various explanatory models, finally alighting upon the domain of discourse analysis (understanding the confusing arguments between him and his parents as an example of subjugated and dominant discourses), and its heat arising from anxiety and fear, which was best understood using psychodynamic thinking.
This simple example also illustrates two important capacities that facilitate self-reflection:
- an ability to ‘think under fire’ i.e. to keep thinking even as there is a lot going on that commands attention
- a wide knowledge of the main psychological models currently described in the literature, not only able to draw upon it at times of need but also to hold in mind any words/beliefs/glances, etc., that had seemed of significance in the light of any of these models.
The earlier example of David and his parents illustrated a third capacity:
- sufficient self-knowledge and experience to trust oneself, to be open to and comfortable with uncertainty, not lacking personal authority, and able to be both direct in communication and to nuance how and what is said in order to get a fit with the people involved.
These capacities are particularly challenged when a therapist feels uncomfortable, as it is then always important to reflect upon the source of this i.e. whether it arises from the unique encounter with a particular family, or represents (or accentuated by) something that the therapist has personally not dealt with sufficiently as an individual themselves.
Historical Influence on Use of Self in Family Therapy
This stance is very different to that of the early pioneers of family therapy, who wrote as observer and whose detailed observations of how to achieve change did not include themselves. For example, Auerswald’s ‘non-blaming ecological detectives’ became perturbed by ‘stuck’ families, striving to maintain their curiosity about the ‘resistance’ of these families to whatever well-meaning interventions the family therapist/s had tried.
That position was reflected too in the early work of the Milan group, who guarded against any breach in the therapist’s neutrality by rigorously following a protocol involving hypothesising and circular questioning. Postmodernism changed all that, arguing that therapist neutrality was impossible, that instead what was required was a high level of self-awareness on the part of the therapist.
Use of Self in Integrated Family Therapy Now
Integrated Family Therapy moves away from neutrality to emphasise the importance of Use of Self within the therapeutic relationship. This becomes an integral feature of the model throughout all stages of assessment, formulation and intervention.