Theorizing about power: intersecting the ideas of Foucault with the "problem" of power in family therapy

Power, position and social relations: Is the espoused absence of hierarchy in Open Dialogue naïve?

Open Dialogue practitioners aim to reduce social hierarchies by not privileging any one voice in social network conversations, and thus creating space for a polyphony of voices. This sits in contrast to the traditional privileging of those voices credited with more knowledge or power because of social position or professional expertise. Using qualitative interviews, the aim of this current study was to explore Open Dialogue practitioners' descriptions of challenges in implementing Open Dialogue at a women's health clinic in Australia. Findings revealed how attempts to rhetorically flatten hierarchies among practitioners created challenges and a lack of clarity regarding roles and responsibilities. As the practitioners tried to adjust to new ways of working, they reverted to taking up engrained positions and power aligned with more conventional social and professional roles for leading therapy and decision-making. The findings raise questions about equity-oriented ways of working, such as Open Dialogue, where intentions of creating a flattened hierarchy may allow power structures and their effects to be minimised or ignored, rather than actively acknowledged and addressed. Further research is needed to consider the implications that shifting power relations might have on the roles and responsibilities of practitioners in the move to equity-oriented services.

The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage

The global COVID-19 pandemic challenged the world-how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person-centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID-19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic.

Whose Expertise Counts? Women Survivors' Experiences With Psychologists

Many women who experience intimate partner violence seek the expertise of psychologists to support their healing. However, there is a gap in the research about what women want from their psychologists. We interviewed 20 women survivors who had seen psychologists. Using reflexive thematic analysis, we constructed three themes: see all of me, see me for my expertise, and don't impose an agenda on me. We found that often psychologists acted as experts imposing their own agendas, rather than supporting survivors to make their own decisions. We discuss this in relation to the link between knowledge and power through dominant social science discourses and explore how resistance to this dominant discourse was taken up by many women.

From Therapeutic Power to Resistance?

Four ideas are used to conceptually link local therapeutic practices with macro sociocultural arrangements, and to question the feasibility of therapeutically derived resistances against them: power as a productive force; the power–knowledge integration; the power–resistance relationship; and power in context. Narrative therapy is presented as an example of a ‘therapy of resistance’, which at a micro level challenges the therapist–client power relation and privileges clients’ local knowledges, and hence, at a macro level, promotes resistance against dominant discourses and practices. However, at least two fundamental problems face therapies advocating resistance. At a macro level, they are vulnerable to neutralization when they engage in broader power relations. And at a micro level, they cannot escape the institutionalized therapist–client power imbalance, which renders ethically problematic the use of the therapeutic encounter to promote resistance. Strategies for addressing these problems are discussed.

Responsive persistence part I: therapist influence in postmodern practice

Feminist and social constructionist developments in family therapy highlighted the importance of attending to therapist-client power relations and incorporating clients' understandings and preferences as a part of therapy. Significantly, less attention has been given to how postmodern therapists do use their power and influence. This is an important topic because it is therapists who have the major responsibility for guiding the interaction with clients and persisting in this so that change is facilitated. Therapist persistence in various forms and across dimensions of therapy process is examined to expand understanding of therapist influence in postmodern and collaborative work. An analysis of responsive persistence in a session with Karl Tomm as the therapist is presented to illustrate this conceptual framing.

Exposing operations of power in supervisory relationships

Through a poststructural lens, we examine how power may show itself in relationships between supervisees and supervisors, producing both helpful and harmful effects. Drawing from our own experiences, as well as conversations with other members of our supervisory group, we demonstrate how privileged discourses around professional status, gender, and race may bring about difficulties including a sense of doubt, worry, inadequacy, and a fear of speaking up. We also illustrate how these difficulties can be addressed in a manner that may lessen their influence, while increasing supervisees' sense of agency.

Hidden points of view in cross-cultural psychotherapy and ethnography

This article examines the challenges posed by cross-cultural psychotherapy in a creolized world, and the way this intersects with issues faced by the ethnographer. It proposes 'the relational subject,' implicit in systemic psychotherapy and social anthropology, as a framework for an understanding of communication. In cross-cultural psychotherapy, this assumption is central to non-discriminatory and equitable treatment. Drawing on Bateson's ethnographic work, the article connects 'the relational subject' to what Bateson, following Whitehead, called 'the fallacy of misplaced concreteness' and later referred to as 'context.' The article examines the choices of 'context' first in ethnography and systemic psychotherapy and then in Bateson's own analysis of the Naven ritual. It is suggested that cross-cultural psychotherapy is psychotherapy in which the therapist keeps in mind, both her own and her client's contexts. This means an assessment of process (performative aspects) as well as content (semiotic aspects) and attention to 'moments' rather than longer sequences in the therapy.

Hierarchical relationship development: parents and children

Child growth and development occur in hierarchical relationships. In our attempt to work more collaboratively, family therapists have neglected to work toward developing theory that guides our work in such hierarchical relationships. This article describes a method for understanding child and relational growth. It builds on Wynne's (1984) epigenetic model of relational systems by integrating his model of family development with Bateson's (1958) concepts of complementarity and symmetry. Wynne's model defines a process for understanding the stages of relationship development, and Bateson articulates the process of change within a relationship. Utilizing principles from both theorists, this paper proposes that parent-child complementary relationships mature through Wynne's developmental stages via symmetrical struggles, and that these symmetrical struggles are necessary ingredients in the development of the relationships as well as of the individuals within those relationships.

Reading against the lines: resisting foreclosure in therapy discourse

In this article, it is noted that poststructural ideas can be useful tools in fostering reflexivity and creativity for clinicians. By examining the process of meaning construction, clinicians can detach from repetitive interpretations of therapy discourse that lead to conversational closure. Four strategies for guiding a reading of family therapy interaction are presented: incitement to discourse, deconstruction, normativity, and the cultural grid of intelligibility. These strategies are used to describe examples of marital therapy discourse. By learning to read therapy as discourse, clinicians may critically examine how meaning is constructed and use that awareness to foster therapeutic conversations.

Family bereavement and cultural diversity: a social developmental perspective

This article offers an integrative, interdisciplinary model of bereavement as a family developmental process that unfolds in cultural context. A critique of cultural assumptions highlights the culture-bound nature of prevailing North American practices, which view grief as an isolated individual experience and emphasize detachment from the dead as a way to promote recovery. Death and grief precipitate two kinds of family change, both guided by culture yet uniquely experienced and interpreted by individual families: 1) recreating the family without a key family member, but capable of coping with both existing and new tasks; and 2) incorporating the death into an ongoing but irrevocably altered family life-cycle developmental process. In supporting family change after a death, family therapists need to collaborate with grieving families in examining the goodness of fit between their unique circumstances and the bereavement expectations of their community and culture. Four case examples are presented, two of which will apply this social developmental model to emphasize transformations of attachment to the deceased--rather than detachment--that will support the ongoing family development of grieving families.

Asthma, power, and the therapeutic conversation

Previous research has indicated that family therapy may be of use when a child has chronic, uncontrolled asthma. The significant power relations were considered to be those between the child and the parents. In this article, I examine the wider contextual relations that the family encounters when asthma is a problem, and suggest that these relations are unable to be understood without more thoroughly theorizing power. Because of power relations, the meanings of therapeutic encounters for families and health care professionals may not be consensual. The effect may be to hamper adequate asthma management. I suggest that when Foucault's work is examined alongside that of Hoffman, and Anderson and Goolishian, then the processes that distort these understandings are more readily understood. These ideas are illustrated with examples from a research project.