Constructivist Models Ch 7

Miracle question

"Suppose one night, while you were asleep, there was a miracle and this problem was solved, how would you know? What would be different?"

The central thesis of the narrative method is that...

"the person is not the problem; the problem is the problem."

Unique Outcomes

*Instances in which the client did not experience the problem* for which he/she seeks therapy. These experiences to the problem (Sparkling Events) are highlighted in the therapy to contract a problem-saturated outlook.

Who was one of the leading proponents of *Social Construction Theory*?

*Lynn Hoffman* She outlined several ways that this idea led to radical new views of therapy and human research. -the observer cannot be separated from the thing observed. -the "self" is socially constructed. -there are no standards for normal development. -emotions are determined according to context. -communication has no underlying, consensual meaning, but is subjective. -therapists participate in the construction of reality with their clients and are not experts.

Exception question

*Recall the times when they did not have the problem in a circumstance where they normally would*, or when they had the problem and solved it. May need to find potential exceptions, "why is the situation not worse?"

Basic approach of collaborative language systems

- A person's reality is socially constructed and maintained through dialogue, which emerges as narrative reality. - Each session is viewed as unique and the therapist comes with no preconceived notion of how things should be. - A "not knowing" position is taken - Belief that all knowledge arises from social dialogue.

Initially, White was influenced by

- Bateson's work on information processing, he rejected the mechanistic principles of cybernetics. -The cultural narratives, in Foucault's view. -And by David Epston, his collaborator in Auckland, New Zealand, who focused on the individual narratives that people construct.

What are some criticisms of the solution-focused approach?

- Because Therapy is solely focused on the future and in positive solutions some clients may feel invalidated. Client's attention may not be able to be directed toward solutions until they feel heard.

Goals of treatment in solution-focused therapy

- Help clients *shift from talking about problems to talking about solutions* - Identify resources - Build on successful past solutions to problems. - Highlight the exceptions to the problems and design interventions to help amplify non-problematic patterns. - Over time the exceptions become the norm. *Treatment is limited to finding solutions to a current, specified problem*, and treatment ends when the problem has been satisfactorily resolved.

How is narrative therapy a constructivist model?

- Narrative is based on the constructivist belief that there is no absolute reality;*reality is constantly being constructed* even during therapy. - Avoids diagnoses and labels - Problems are external to a person - Problems are view within the social and political context.

Assessment and Treatment CLS

- Therapist is not an expert - T. assumes a Not Knowing Position - Goal of therapy is the dissolution of the problem system as a result of the evolution of new meaning through the narratives and stories created in the therapeutic conversation and dialogue. - Therapist don't use diagnoses, give directives, or make hypotheses. They may offer tentative opinions or ideas, but try to focus on the solutions they might discover together through their conversations. - The therapist is not separate from the problem system, and the problem system changes week to week depending on who is in the conversation and current focus of therapy. - The therapist asks conversational questions and is an active, responsive listener. - *Problems are not solved or cured in this model, they are dissolved*, and then the system that was organized around it also dissolves.

Narrative approach to assessment

- Therapist respects client's perspective and tries not to impose their own cultural biases, and talk about their assumptions with clients. -Treatment begins with gaining an understanding of, and appreciation for, the problem-saturated story. Hear the client's history. -Therapist shows understanding (to establish trust) and listens for competencies.

Family therapy Reflecting Team - T. Andersen

-An alternative, less hierarchical model in which the team members do not assume the role of experts, and do not discuss the family in private. They observe the therapy, and then the family is asked if they would like to hear the comments of the team. The team comes out and has a conversation, including the family. Family members discuss their reactions to the team's conversations as the team listens. -The family is engaged in external conversations (with the interviewing therapist) and internal conversations (as they listen to the reflecting team). -Therapists strive to ask questions that are moderately unusual in order to facilitate both kinds of conversations.

Main proponents of solution-focused therapy

-Brief treatment, oriented toward future. -Adhere to minimal intervention, collaborative with clients. -Do not emphasize underlying pathology or family history. -*Focus attention away from the problem* presented, and help clients identify and repeat behaviors they did when the problem did not exist. -Solutions develop out of amplifying a pattern or behavior that already works while de-emphasizing the problem of its cause. -Believe that clients have the ability to solve their own problems with slight shifts in behavior or perspective.

Reconstructing and Reinforcing a New Narrative

-Client and therapist look for ignored elements that contradict the problem saturated story, paying special attention to competencies that have been unstoried. -The therapist helps broaden and strengthen the view by including the past ("Who in your past would not be surprised to learn that you were able to resist the forces of Anorexia on those occasions?") and the future ("What do you think your marriage will be like now that you don't let Rejection make your decisions?"). -The therapist asks landscape-of-meaning questions to help clients consider a new, more heroic view of themselves, ("What do you think it says about you as a person that you were able to feel loved by your wife, even when she was late getting home from shopping?"). -Clients reflect on their growing ability to overcome the effects of the problem, reinforcing the more competent definition of self. -Therapist helps the client or family build the needed support network. He might suggest contacting people from the client's past who would confirm the subjugated narrative and to find new people to support their changes.

Constructivism model

-Constructivism is not a passive model. -Constructivist therapy supports collaborative inquiry. -Proponents of the models appreciate the significance of each person's invented reality (the constructions); the importance of language (symbols of the construction); and the tradition-bound nature of human judgment and evaluation. -The therapist may sometimes take direct, explicit action but must acknowledge responsibility for the outcome. -Constructivists are also aware of the changing motivations of people as they interact with their universe.

Social constructivists...

-Do not adhere to norms of development -They defer to clients' views of how they wish to lead their lives. -Norms are often seen as the product of such socially repressive forces as sexism, racism, and classism. - Therapy is not done in the clients but something they do with them. -The therapy and its outcome are jointly constructed. - Cultural assumptions, even those of the therapist, are talked about in therapy so that the therapist does not impose their belief on the client. - Reject the systems view of families. - Focus their attention in language and meaning.

What are some narrative therapy interventions?

-Externalizing the problem. -Deconstructing the dominant narrative. -Mapping the influence of the problem. -Finding the subjugated story by uncovering unique outcomes and sparkling events. -As treatment progresses, clients reflect on their growing ability to overcome the effects of the problem.

Solution-focused therapy interventions:

-First session task. -Miracle question. -Exception question. -Scaling questions. -Therapist may ask family to predict when exceptions to the problem will occur, either in their own behavior or the behavior of other family members.

Collaborations of David Epston

-He developed a set of questions to elucidate the stories of client's lives. -He also recognized that to maintain the gains made in therapy, clients need an environment that supports those gains. -He developed leagues, bringing together clients who were working on similar problems. -He also created a letter-writing technique that reinforced and extended the therapeutic work.

T. Andersen: The Reflecting Team

-He rejected the observing team approaches of the Milan group and strategic therapists, and the expert position taken by therapists who pathologize families. -He sees the family as a stuck system that is unable to solve its own problems. -He thinks people engage in two conversations: an external one as they share their ideas, and an internal one as they talk to themselves while they listen to others.

Hoffman's model

-Hoffman would avoid the term "therapy" in favor of calling the work "a hopeful discourse." -To the extent that it can, the model is non-judgmental, non-ethnocentric, and non-pejorative. -The work is not control oriented or hierarchical. -It does not instruct or influence, and it respects many views since its proponents assume no one knows the truth about objectivity or reality.

Externalizing the problem:

-Involves conceptually and linguistically separating the person from the problem -Identify and externalize the problem, and then personify the problem as an unwelcome invader. -Unite the family against a common enemy.

The narrative Therapist

-Is interested in the narrative stories people have constructed about themselves. -The *therapist chooses language that does not communicate blame*. -Works to help them create a new narrative, which focus on their preferred ways of relating to themselves and to the larger culture. -Narrative therapists do not adhere to specific notions about what constitutes normal development. -They avoid categorization and labeling of problems with psychological or systemic diagnoses. -They strive to be aware of the larger social and political pressures that influence them and their clients. -Narrative therapists *are not so much interested in solving problems as they are in helping people rewrite their lives successfully*. -To practice this model, the therapist must embrace the fundamental idea that people are not their problems.

Do narrative therapists use reframes?

-No, they don't see them as valuable unless the client has a broader, more competent narrative that allows them to believe it.

How does de Shazer go even further that the general constructivist belief that language creates reality?

-Nothing exists outside of language. There are no wet beds, etc. there is only TALK about wet beds. -Talk in conceptualized as the method of therapy, and is highly influenced by the therapist's own language. The therapist needs to be able to convey hope and understanding.

Describe deconstructing the dominant narrative and mapping the influence of the problem:

-Once the problem is externalized and personified, it's influence can be explored. -therapists explore the influence of socio-cultural norms. such as expectations for men, women, or African-Americans, and externalize and personify them.

Postmodernism thinking

-Postmodernism => Reality is only mental construction. -Social construction theory posits that meaning emerges from the interactions between people. -Family therapists became interested in semiotics, hermeneutics, narrative, and linguistics. -Expert knowledge is rejected due to it being a product of one's lens (dominant cultural influences and ideologies).

Lynne Hoffman

-She began her career with a systemic view of families in which problems were conceptualized as something in the system that was malfunctioning, in need of "repair" by the "expert" therapist. -But Hoffman soon *objected to the therapist-as-expert view*, and began to question objectivist ideas of reality. -Her thinking underwent a major change as she was influenced primarily by the social constructivists von Foerster, Maturana, and von Glasersfeld and their notions of second-order cybernetics and by the Milan therapists' team approach

Collaborative Language Systems - Theory

-Since knowledge is socially constructed, also are problems and their solutions. -*A problem is something that somebody is worried about and wants to change*. -The problem develops a "problem-determined system", made up of everyone who wishes to talk about the problem. -Similarly Hoffman suggests, "problems are stories that people have agreed to tell themselves".

Solution-focused theory of normal development and dysfunction

-Solution-focused therapists do not adhere to a normative model of development. -There is no single right way to live one's life and no need to analyze abstract structures, hierarchies, conflicts, or sequences of behavior. -Difficulties of living occur when clients engage in problem-focused thinking rather than capitalizing on their competencies to solve problems. - *The therapist is primarily interested in the client's or family's goals and in the ways they talk about themselves and their problems.*

"Talk" is conceptualized as the method of therapy

-The therapy is strongly influenced by the therapist's own language. -solution-focused therapists also consider the therapist-client relationship, particularly the therapist's ability to convey hope and understanding, as significant as the actual discussions.

Tomm's reflexive questions

-Tomm constructs his questions, *not just to gather information, but to induce change in the system* as well. -Questions can help families find new meaning and new ways of behaving. -He designs reflexive questions to inspire families not only to reflect on the meaning of their current perspectives, but also to consider new options.

Goal of treatment

-Whether with individuals or families, is to deconstruct the problem-saturated stories. -and dominant cultural discourses -to co-author new, more helpful stories.

3 categories SFT use to describe the client/therapist relationship

1. *Visitor*: No specific problem is brought to therapy, and client is not committed to participating in treatment. Therapist gives compliments (genuine), has solution-focused conversation, and hopes the relationship will move therapy forward. 2. *Complainant*: Client brings specific problem, but is unwilling to focus on a solution. Therapist does the same as above, and also asks the client to observe when exceptions to the problem occur. 3. *Customer*: Client brings problem and a willingness to work toward resolution. Therapist is able to move toward amplifying behaviors that move the client toward their goals.

Tomm classifies eight types of reflexive questions

1. Future-oriented questions - to stimulate new options for the future; 2. Observer-perspective questions - to stimulate self-observations; 3. Unexpected counterchange questions - to alter the context in which the problem behavior is viewed, to open up choices not yet considered; 4. Embedded suggestion questions - to allow the therapist to point to new possibilities; 5. Normative-comparison questions - to normalize the circumstance by comparing to other people in similar circumstances; 6. Distinction-clarifying questions - to separate the components of a problem; 7. Questions introducing hypotheses - to offer tentative hypotheses about the meaning of the problem behavior; 8. Process-interrupting questions - to create a sudden shift in the therapeutic session.

What are the five family therapy models influenced by social constructivist thought?

1. Solution-focused therapy. 2. Narrative therapy. 3. Anderson and Goolishian's Collaborative Language Systems. 4. Inventive Questioning. 5. Reflecting Team.

How do narrative therapists encourage support for the new narratives?

1. Suggest *contacting people from client's past* who would confirm the subjugated narrative and to find new people that will support the change. 2. Clients create *therapeutic certificates*, announcing their victory over the problem. 3. Therapists write *therapeutic letters*, used to extend the therapy. The therapist document the client's competences with respect to overcoming the problem and acknowledges sparkling events. 4. *Leagues* to support the new narratives.

Hoffman outlines the general philosophical and therapeutic stance of family therapies influenced by a constructivist approach in 9 points:

1. There is no belief in an objective reality. Problems exist "only in the realm of meaning,". 2.There is a shift in focus from behaviors to ideas. 3. The problem creates a "system." 4. There is no such thing as a "God's eye view." no "outside place" from which to view the family 5. The therapist sides with everyone. 6. There is a relative absence of hierarchy. 7. There is much less focus on issues of power and control. 8. The concept of position (hierarchical position) the therapist is in a horizontal position, 9. There is a tendency to inhibit intentionality. Change cannot be controlled with techniques or artistry.

What are unique outcomes or sparkling events?

Another way to talk about times *when the person or family resisted the effects of the problem*, which are often ignored due to not fitting with the dominant narrative. The therapist highlight these events without trivializing the difficulties the family has faced.

Preference Questions:

Ascertaining if the unique outcome is preferred. "Do you think reacting this way was better or worse?"

Story Development Questions:

Broadening the story from the unique outcomes. "Who will notice your new way of handling these situations?"

Deconstructionist theories

Challenged the idea of expert knowledge and argued that scientific knowledge is the product of one's perspective. Thus, all perspectives are the product of the dominant cultural influences and ideologies.

Scaling questions

Clients are asked to rate on a scale of zero to ten, how they are currently feeling compared to an earlier time.

Therapeutic certificates

Clients create them, announcing their victory over the problem which they show to others and review when they feel the effect of the problem reasserting itself. As a concrete reminder of client's personal successes

The role of language

Constructivist theorists posit that, "language creates reality," thus, what people say powerfully influences how they view reality.

Meaning Questions:

Developing a more positive view of self. "What does this new reaction say about you?"

Deconstruction Questions:

Externalizing the problem. "What does Depression try to tell you to do?"

In SFT treatment is limited to...

Finding solutions to a current specified problem.

The second session

Focuses on the question "*So what happened that you want to continue to have happen?*". The therapist can then reinforce the expectation that worthwhile things did, or could, happen. A clear understanding of the difference between the problem and the exceptions can emerge from the discussion. -The goal is to develop new concepts, modify others, and formulate a better description of the solution.

Collaborative language systems founders

Harlene Anderson and Harry Goolishian. This model continues to be shaped by a variety of theorists and practitioners, among them are Lynne Hoffman. What ties this group together is their emphasis on the idea that *all knowledge arises from social dialogue*.

Basis of collaborative language systems:

Hermeneutics and social construction theory. Humans create meaning through language.

What are the goals of treatment in narrative therapy?

In general, treatment proceeds from gaining an understanding of, and appreciation for, the problem-saturated story. -The process of rewriting the story and co-constructing the self-concept begins with *externalizing the problem*; thereby, separating the person from the problem. -The therapist and client then *look more closely at the client's experiences for ignored elements that contradict the problem-saturated story*, paying particular attention to competencies. - Through their conversations, they continue re-writing the story, resulting in the client's growing sense of him/herself as a more heroic, competent person. - Finally, they find ways of supporting the new story.

During what decade did the field of family therapy begin to shift from a modernist philosophical basis?

In the 1980s.

de Shazer & Berg: *Solution-Focused Therapy*

In the late 1970s, a group of clinicians in Milwaukee, Wisconsin, chiefly Steve de Shazer and Insoo Berg, formed the Brief Family Therapy Center (BFTC). *They were influenced by the brief treatment model at MRI* in Palo Alto where de Shazer had worked.

Landscape of action questions

Involve inquiries into events and actions. Once a unique outcome has been articulated then the following sorts of landscape of action questions might be asked: • Can you tell me a bit about what happened there? • Where were you? • Who was around? • What were the steps that you took to get yourself ready to do what you did? • What do you think was the turning-point that led to you being able to do what you did? • Was this event unusual or have there been times when you've done this sort of thing before? • Have there been other occasions when you have managed to do this?

Therapy in CLS

Is a linguistic process of co-creating stories in which members of the problem system discover new possibilities.

Formula first session task

Is given at the end of the first session as follows: Between now and the next time we meet, I want you to observe, what happens in your life that you want to continue to happen. -The goal of this intervention is to redefine the client's situation as one in which the therapist believes something worthwhile is happening, will happen, or is expected to happen.

Collaborative Language Systems

Language and conversation are the central ingredients of the collaborative language approach. -Collaborative language approach assumes that *a person's reality is socially constructed and maintained through dialogue*, which emerges as a narrative reality. Given this view, each session is seen as unique and the therapist comes to the session with no preconceived notion of how things should be. This is referred to as a not knowing position.

*Narrative Therapy* was developed by

Michael White at the Dulwich Centre in Adelaide, Australia.

Modernist thinking

Modernism => reality can be uncovered through objective scientific observation and measurement. -Individuals and families, like machines, operate based on implicit laws that can be discovered. -Goal in family therapy was to look beneath behaviors and sequences to find the universal principals (hierarchies and triangles) that guided operation. -Intrapsychic pathology was discounted by the systems approach. -Family dysfunction was broadly conceptualized as a malfunctioning system. -Therapist was seen as the expert that could diagnose and repair dysfunctional systems.-

What are landscape-of-meaning questions?

Questions to help the clients consider a new, more heroic view of themselves. Therapist begins to bring in the past and the future as the client begins to broaden their view of themselves and include the competencies that have been unstoried (ex. "Who in your past would be surprised" and "What will your marriage be like now?")

Questions to Extend the Story into the Future:

Reinforcing positive changes. "What will your life be like now that _______ doesn't have the upper hand?"

Subjugated Story

Stories about the client that are obscured by the dominant story. Some subjugated stories are helpful and others are not. Narrative therapist help clients construct a new, more helpful story, which includes unstoried competencies.

What is the self in Narrative T.?

The narrative model suggests that the self is not a stable entity, but rather, is a constitutionalist self, plastic and *continuously deconstructed and reconstructed through interactions*. The sense of self derives from whatever fits into the dominant narrative.

Narrative therapy development and dysfunction

The narrative stories that people hold exert a powerful influence over their lives and their relationships. -Some narrative stories are more helpful than others and problems arise out of unhelpful stories. -people are not viewed as dysfunctional in this model, but rather under the influence of problem-saturated stories. -People select data from their experiences that confirms their story and ignore data that does not. -People can internalize the dominant culture norms and judge themselves according to it.

Mapping the Influence of the Problem

The therapist inquires about how the problem has affected the lives of the client and significant others.

Solution-focused approach to assessment

Therapists help clients articulate attainable goals and *identify exceptions to when the problem occurs*. Solutions "involve determining what 'works' so that the client can do more of it" .

Therapeutic letters

Therapists write therapeutic letters, a procedure created by Epston, used to extend the therapy, in which the therapist documents the client's competencies with respect to overcoming the problem and acknowledges the sparkling events.

Sparkling Events

Those events that exemplify the client's preferred outcome rather than his/her problem-saturated stories.

First session task

To begin to identify strengths, clients are asked to *observe their lives between the first and second session* and notice what they would like to continue to have happen. Then follow up with "So what happened that you want to continue to have happen?"

Opening Space Questions:

Uncovering unique outcomes. "Has there been a time when _____didn't happen, even though you expected it to?"

Fixed linguistic statement

Usually families bring into treatment, a statement about the problem as though it were a permanent fact, which leads to hopelessness about the situation. -*Response of the therapist is to highlight exceptions, which are usually undervalued by the family*.

Karl Tomm

Was influenced by the Milan group, and the system concept of second-order cybernetics. Tomm added the concept of strategizing to hypothesizing, circularity, and neutrality.

History Taking and Establishing a Collaborative Relationship

Whether working with individuals or families, the therapist is interested in hearing the client's history so that he/she gains an appreciation of how the client or family members view themselves and their problems (their narrative story). -look for events that offer alternative narratives. -Conveying an understanding of what difficulties the client has experienced also helps establish a relationship of trust. -As the therapist listens to the story, he/she pays attention to areas of competency. -Therapists establish a collaborative atmosphere. -Clients are invited to ask questions about the therapist, look at the therapy notes, or take collaborative case notes. -Narrative therapists ask question after question to elucidate the effect of the problem.

Solution-focused therapists

Work collaboratively with clients to negotiate achievable goals, and therapy is oriented toward the future, not the past or even the present. They assume that clients have the ability to solve their own problems with only slight shifts in how they behave or the way they view problems