Collaborative Therapy

Collaborative Therapy

John Stafford

Brandman University

Abstract

Postmodern therapy gave rise to new and innovative theories and approaches to working with clients experiencing a variety of problems. A vital aspect of the postmodern movement is the divergence from traditional methods of how the therapist and client interact sessions. Collaborative therapy is one example of how the postmodern movement has taken an innovative approach to using a conversational technique that allows both the client and therapist to work together in a collaborative process without the traditional diagnosis and hierarchical methods.

Keywords:  Postmodern Therapy, Collaborative Therapy, Psychology, Family Therapy, Individual Therapy, Couples Therapy

Collaborative Therapy

Postmodern therapies are considered a new generation of psychotherapy that started development in the latter part of the twentieth century and spawned from the belief that alternative methods to psychotherapeutic practices could challenge historically sustained premises of existing therapeutic process[s] (Lebow, 2008). The practitioners and theorists of this movement chose not to focus on a single model but instead introduced numerous theories including, collaborative, discursive, conversational, narrative,  and social-constructionist, to name a few (Lebow, 2008). Collaborative therapy, which this paper focuses on, is an approach designed to create a process where the therapist and client establish a collaborative, shared experience where both parties explore the client’s story and learn as that story progresses. To do this, the postmodern approaches needed to create a paradigm shift from some of the traditional practices like providing a diagnosis, the therapist and client not being viewed as equals, and adding an emphasis that the therapist must learn the client’s language (Bardin, 2018).

The views of postmodern therapy approaches assert that the client is the expert on his or her own life story and truths. There is also a belief that individuals communicate and share knowledge and experiences through forms of attitude, language, the tone of voice, bodily expressions, and even the words chosen during conversation (Anderson, & Gehart, 2006). The construction of language, both spoken and unspoken, is a representation of how the individual interprets and constructs his or her world and expresses or communicates those experiences to others. According to Anderson & Gehart (2006) “Knowledge is not an individual activity or passive process: knowledge cannot be sent to or received by another (p.9). What this means is that what people create through the use of language is a multifaceted collaboration of events and experiences curated through a social construct that is fluid and always changing (Anderson & Gerhart, 2006).

Collaboration serves as a primary practice of different therapeutic approaches for working with clients (Sutherland, & Strong, 2011). People are not passive transmitters or receivers of information, nor does the individual process information in an identical manner as another. Even if two people with the same upbringing, career path, and social environment who experience the same event, they will both have a different truth (Hansen, 2006). The reason individuals interpret similar experiences differently is due to variations, both major and minor, are their respective social constructs and ability to construct and understand the world around them (Hansen, 2006; Anderson, & Gehart, 2006). Because of this, social constructionists view therapeutic collaboration as a process involving mutual coordination, sharing, and the construction of meaning (Sutherland, & Strong, 2011). Language, as referenced above is not simply the language one uses in the cultural construct. Instead, it is a primary method that people use when constructing and making sense of their world and truth. Language gains meaning and value because of its meaning or roots when used to transmit information about one's life experiences (Bardin, 2018).

Additionally, when we look at the therapeutic process, notable differences emerge. In traditional or commonly used therapeutic approaches like Cognitive Behavioral, Dialectical, Solution-Focused, or Acceptance and Commitment therapies, the therapist is notably in control of the therapeutic session. Barring the most crucial aspect that of creating the therapeutic alliance, the therapist takes the role of inquisitor asking questions, providing a diagnosis, and helping the client explore his or her presenting problem before developing a treatment plan designed to improve the client’s ability to come to their conclusions and resolutions. In contrast, the collaborative approach might appear as if the client and therapist are engaged in a casual conversation. But a closer look reveals that the therapist acts as a guest in the client’s story and aims at focusing on the uniqueness of the client as an individual, ignoring similarities, and centers of the client's unique experience[s] by asking pertinent questions and talking about things within the client’s context (Bardin, 2018).

Effective counseling has a general purpose of enhancing the well-being of an individual client, a couple, or a family unit. No matter the theoretical perspective used, the general process includes forging a solid therapeutic alliance in which the client[s] are free to express their problems [story] in a safe environment where they feel the receiving party [the therapist] is genuinely attuned, attentive, and empathetic. In collaborative therapy, the therapist and client engage in a conversational approach to articulate and align with one another on shared goals (Horvath & Symonds, 1991: Hubble, Miller, & Duncan, 1999). Adherently, this conversational process is not without particular difficulties. Cultural differences introduce variations in verbal and non-verbal language, and generational or gender differences may complicate the conversational method. The therapist needs to consider and compensate for any perceived complications that make the collaborative process more difficult for the client by learning the client’s preferred way of verbal and non-verbal language and helping construct the conversational direction.

Collaborative Family Therapy

Family therapy introduces additional complexities into a therapeutic situation because the therapist is not focusing on a single person. He or she is balancing the individual personalities and difficulties that impact the entire family unit. Hoffman (2003) eloquently states “An autonomous system is any composite unity formed of elements that may or may not themselves be autopoietic” (p.18). Similar to a computer network, if a single node within the network fails to operate to specification, the remaining nodes become taxed with the additional workload to keep the network functioning. If multiple nodes experience system malfunctions, the network becomes bottlenecked, data transmission slows or becomes corrupted, and data gets lost in confusion. The failure results in what is called a network-wide failure. Families operate on the same premise. For the family to function effectively, all family members need to communicate and work together. The commonality is open lines of communication and shared operational structure or goals. However, humans cannot alter those shared regularities at whim because the autonomy of social and biological systems cannot be erased and reformatted as in a computer network (Hoffman, 2003). A primary difference is that a failed node can easily be replaced without disrupting the computer network, whereas a family member cannot. If a family member gets dysfunctional or removed the family structure changes entirely, and damage to the family is imminent. However, similar to the computer network, the loss or alterations may only be temporary if proper maintenance is initiated. Similarly, in both cases, the restoration of communication becomes the primary emphasis.

Collaborative family therapy approaches family dysfunction from a communicative perspective. It views the family structure from a systemic framework that focuses on human determination and reciprocality that impacts human behaviors. At the core of this perspective is how the family communicates with each member and as a whole unit (Tuerk, McCart, & Henggeler, 2012). Families experiencing difficulties usually prolong the issues by trying, generally without success, to deal with the underlying problems on their own. Problem children might sometimes get labeled as going through a phase or are just bad seeds that should be sent to boarding schools or to live with relatives. Problems within the marital dyad can result from issues ranging from financial matters to infidelity, or even just a feeling that the spark in the relationship has died. The common thread in many of these issues is the lack of active collaboration within the family. In the nuclear family, many of these issues got ignored because the family presentation was an essential aspect of societal expectation. In modern society, technology has added additional complications to familial communication because the art of talking face-to-face is slowly becoming obsolete. Collaborative therapists aim, in some ways, to reintroduce family members by helping them share their own stories and truths (Tuerk, McCart, & Henggeler, 2012). The therapist is a guest in the family story that can walk with the family and each family member as they collaborate on the issues, thoughts, and feelings that impact the individuals and the family as a whole. By doing this, the family members learn valuable collaborative skills that enable them to understand one another from a different perspective.

The Family in Trouble

The vignette presents a family in severe distress and dysfunction. Juliet is troubled by her past abusive marriage that resulted in addiction issues and the loss of custody of her child. She is overcompensating for these haunting experiences by overindulging her two children. Romeo is troubled by the fact that Juliette is overindulging the children and feels neglected. He is frustrated and hurt by what he perceives as Juliet favoring the children over him and views divorce as the only way to resolve the issue. Both parents have an unhealthy desire to be central in the children’s lives, and the possibility of divorce will lead to a bitter custody battle for the children. The marital issues have overflowed into the entire family dynamic. The daughter, Elizabeth has become withdrawn from the family, and her grades in school are negatively affected. Of more significant concern is the son, Ceasar who has grown angry at his parents and has made threats of harm towards others as a way of getting his parents attention. Current attempts at couples therapy appear to produce little to no resolution in the presenting issues.

Conceptualization

There are severe failures in the family resulting from the lack of communication skills and understanding where each family member is emotionally and mentally. Juliet is experiencing difficulties coping with the loss of her first child, her addiction, and abandonment issues. Romeo is feeling ignored and irrelevant in Juliet’s life in comparison to the children. He feels abandoned in his own home and believes that the love between them has died, or possibly never existed. The children think they are the subjects of a tug-of-war between the parents and suffer the adverse effects of the hostility and turmoil the parents believe they have been successfully hiding from them. Elizabeth, most likely the timider of the two children resorts to alienating herself from the issues and has lost the ability or desire to focus on her scholastic activities. Caesar, naturally the stronger of the two has taken a path of being angry at the situation and is lashing out at his parents and, more concerning appears to start harboring dangerous thoughts towards others. Although it is difficult to tell if his threats are real or just a ploy to get his back at his parents, the severity of his threats requires immediate action.

How it Came to Be

A common denominator in this family’s problems is the lack of proper communication and the ongoing individual stories that keep the issues active. It is apparent that neither of the parents is collaborating with or hearing each other's truths behind their feelings and actions. In turn, the children mostly left to interpret the uncomfortable and tumultuous atmosphere in the household are left to make their assumptions, thereby creating their realities. At the forefront of all of the issues are the issues Juliet holds from her past and how they influence her relationship with the children and Romeo. Additionally, Romeo’s inability to put Juliet’s past into context and work with Juliet to find a happy middle-ground are compounding the problems and ultimately affecting the children and their ability to be active participants in a harmonious family unit.

Can it be Fixed

It is too early to say the problems will resolve, nor would I assume that the family will remain together. The outcome will result from how the family, in particular, the parents, decide what direction is best for them at the end of therapy. Either way, there are stories to be told and heard from each family member that becomes a journey of exploration, learning, and understanding. The ride starts by helping the family understand that they are not talking with one another, but instead of one another. When people talk to one another, the meaning lost, emotions miscommunicated, needs are unspoken, stories left unrevealed. If Romeo and Juliet learn how to speak with one another, to hear each other's stories, and understand the language, each other is using to communicate, their ability to work together as a couple improves. Harmony improves as the family begins to understand the language, both verbal and non-verbal, that each person is expressing. Their stories start to unfold and realign to bring the family together.

However, there is another side to how the problems may cease to exist. IN learning to talk with and hear one another. To understand each other’s stories and language, the potential of realizing there is no ability to reestablish the family as it once was. Separation or divorce could be the eminent solution. In this case, the family, using what they have learned, will start to spin new stories and collaborate to find a suitable and amicable dissolution of the current family structure and provide a positive experience for the couple and the children. In either outcome, the family has a tremendous task ahead of them.

Family Goals

The first goal is to establish effective communication strategies that allow each member of the family to collaborate on restoring homeostasis to the family unit. We start by exploring communication and a collaborative effort that creates acceptance through the use of language, learning to understand the differences in individual perceptions, evaluating the strengths and weaknesses of each member, and what each member needs from the family unit to feel accepted, loved, and understood.

The second goal would be to enhance the first goal by learning how each family member’s reality differs based on their perceptions of the situation and how their language is either hampering or helping the condition exist. Learning how to collaboratively communicate how each member of the family perceives issues and how it affects their individual feelings is a primary consideration. Initially, the family members will exhibit apprehension to express their opinions, but being able to explore those apprehensions in session will enable them to gain comfort in communicating them at home. If open discussion appears too difficult, possibly asking each member to journal their thoughts to share in session could be a starting point.

The third goal is to remove blame, guilt, and anger. The family needs to learn that there is no singular truth involved and that each family member holds a different perception of reality. A family is a socially constructed unit impacted by numerous factors. Similar to a planet being hit by a meteor shower, every single impact leaves a distinct mark. To paraphrase Hansen (2006), singular truths are not revealed by the passive or disinterested investigation of a phenomenon, but are in-fact, discovered by attentive observation with the observers providing meaning.

The Therapist Role

As mentioned earlier in this paper, the postmodern theory asserts that the client is the ultimate expert of his or her own life. Understanding this allows the therapist to take the role of a guest in the client’s journey or story as they collaborate to seek new meanings and creating an environment for change. Because the therapist is a guest in the story, he or she should take the not knowing position. The not knowing stance places the therapist as a blank slate that is open, and willing to learn the nuances of the client and their story. As the story starts, the therapist and client begin to discover one another’s internal voice, or language and build a rapport of understanding and communication. The therapist should also employ the technique of circular questioning and reframing as he or she walks the path of the client’s story to reveal hidden nuances and meanings behind the client’s perceptions of his or her truth.

Conclusion

The conclusion to this story is not one of simplicity. Some complexities affect every aspect of the family’s existence. Each member has individual perceptions of truth and reality that once explored, reveal a family in severe dysfunction. Also, there is no reliable method of predicting how the family’s story will unfold. The therapist must rely on his or her ability to join the family in a journey of exploration and learning through collaboration, and understanding individual perceptions. Teaching the family how to interpret the language each member uses, how they perceive events and issues, and how to collaborate with one another to openly express their feelings and thoughts, instead of talking at one another, will give the family a substantial advantage in either resolving their issues, or finding an amicable way of dissolution. Collaborative therapy provides these unique tools in a method that differs from conventional treatments that view the client as sick, or that focuses on a single presenting problem. Collaborative therapy teaches the skills of honestly expressing and hearing every aspect of what another person is relaying because it shows people that there is no absolute truth and that everyone’s story is a learned journey.

 References

Anderson, H., & Gehart, D. R. (2006). Collaborative therapy in action: Bridging the gap between theory and practice. London: Routledge.

Bardin, G. (2018, October 31). Postmodern Therapy. Lecture presented at PSYU 556 in Brandman University, Palm Desert.

Hansen, J. T. (2006). Counseling Theories Within a Postmodernist Epistemology: New Roles for Theories in Counseling Practice. Journal of Counseling & Development,84(3), 291-297. doi:10.1002/j.1556-6678.2006.tb00408.x

Hoffman, L. (2003). Exchanging voices: A collaborative approach to family therapy. London: Karnac.

Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology,38(2), 139-149. doi:10.1037//0022-0167.38.2.139

Hubble, M., Duncan, B., & Miller, S. (1999). The Heart and Soul of Change. American Psychology Association.

Lebow, J. L. (2008). Twenty-first century psychotherapies: Contemporary approaches to theory and practice. Hoboken, NJ: Wiley.

Sutherland, O., & Strong, T. (2010). Therapeutic collaboration: A conversation analysis of constructionist therapy. Journal of Family Therapy,33(3), 256-278. doi:10.1111/j.1467-6427.2010.00500.x

Tuerk, E. H., Mccart, M. R., & Henggeler, S. W. (2012). Collaboration in Family Therapy. Journal of Clinical Psychology,68(2), 168-178. doi:10.1002/jclp.21833

.