Creating a participant text: writing, multiple voices, narrative multiplicity

Creative writing in recovery from severe mental illness

There is evidence that creative writing forms an important part of the recovery experience of people affected by severe mental illness. In this paper, we consider theoretical models that explain how creative writing might contribute to recovery, and we discuss the potential for creative writing in psychosocial rehabilitation. We argue that the rehabilitation benefits of creative writing might be optimized through focus on process and technique in writing, rather than content, and that consequently, the involvement of professional writers might be important. We describe a pilot workshop that deployed these principles and was well-received by participants. Finally, we make recommendations regarding the role of creative writing in psychosocial rehabilitation for people recovering from severe mental illness and suggest that the development of an evidence base regarding the effectiveness of creative writing is a priority.

Collaborative relationships and dialogic conversations: ideas for a relationally responsive practice

The author presents a set of philosophical assumptions that provide a different language for thinking about and responding to the persistent questions: "How can our therapy practices have relevance for people's everyday lives in our fast changing world, what is this relevance, and who determines it?" "Why do some shapes of relationships and forms of talk engage while others alienate? Why do some invite possibilities and ways forward not imagined before and others imprison us?" The author then translates the assumptions to inform a therapist's philosophical stance: a way of being. Next, she discusses the distinguishing features of the stance and how it facilitates collaborative relationships and dialogic conversations that offer fertile means to creative ends for therapists and their clients.

Exploring the meaning of trauma in the South African Police Service: A systems psychodynamic perspective

Orientation: This study explores individual stories of trauma and their dissonance with the official, dominant discourse on trauma in the South African Police Service (SAPS) from a systems psychodynamic perspective.Research purpose: The purpose of the research was, firstly, to explore how trauma experienced by South African Police Service members is constructed or ‘talked about’ and made sense of. Questions and issues that are considered relevant to the primary purpose are: which aspects of the working environment do members consider to be the most stressful, traumatic and difficult to cope with, and what is the effect of the change and transition processes on members’ working experiences?Motivation for the study: The authors set out to explore the role of systems psychodynamics in the experience of trauma and stress in the SAPS.Research design, approach and method: Through this qualitative, explorative, social phenomenological study, contributing circumstances and processes are included as additional discourses in an attempt to deepen understanding. The epistemology viewpoint of the study is found in the social constructionism and the data comprise 15 essays by members of the SAPS, all of which have been analysed from the perspective of systems psychodynamics.Main findings: Although the effect of trauma on police officers can never be negated, the way in which they deal with trauma seems to be different from what was initially believed. Further, their experience of stress is not solely the result of traumatic experiences but rather the result of traumatic experiences and systems psychodynamics operating within their organisation – which includes both organisational stressors or dynamics and transformation dynamics.Practical/managerial implications: The history of psychological trauma indicates that constructions of traumatic stress are strongly related to cultural, social and political circumstances. Current psychoanalytic thinking emphasises the meaning of the real occurrence, which causes trauma by changing the person’s experience of the self in relation to self-objects. Practical implications are the loss of the supportive subculture of the police, the loss of masculinity, as well as the loss of the power to be competent and meaningful. Furthermore, feelings of being overwhelmed, powerless and helpless generate anxiety and may have a significant impact on officers’ self-esteem and impede their feelings of omnipotence and invulnerability, which are necessary to cope in the policing environment.Contribution/value-add: The current study found various traumatic and systemspsychodynamic factors and processes to be anxiety-provoking as a result of exposure to trauma. Without a supportive social group the anxiety becomes uncontained and unmanageable.

Red balloon: approaching dreams as self-narratives

In this article, dreams are seen as stories within a self-narrative. Dream stories, like all other stories, are told in an effort to make sense of experiences. Here, dream content is linked to current concerns, some aspects of which are not given voice in waking. Dreams depict restricting themes but also openings in self-narratives. Several examples are provided of how dreams can be linked to early, middle, and late therapy phases associated with recognizing, challenging, revising, and maintaining a revising stance. It is further suggested that dream stories can be used to trace, facilitate, and evaluate the process of reconstructing self-narratives. Finally, a number of therapeutic interventions are briefly presented to facilitate the work of narrative-informed family therapists working with individuals, families, and groups.

The interacting-reflecting training exercise: addressing the therapist's inner conversation in family therapy training

In recent years several authors have made a beginning in describing therapeutic conversations from a dialogical perspective. Training and supervision, however, have not yet been addressed from a dialogical perspective. In this article, an experiential training exercise is described that is focused on the basic dialogical skills of the trainee: respectful inquiry and constructive reflecting. Rather than teaching and instructing, this training exercise is aimed at staging a dialogue. The trainees are invited to take part in this dialogue, as they are encouraged to experiment with new positions and new ways of encountering others, and as their different voices tell of their experiences, of the things they have learned, and of the new perspectives that have opened up for them. Leaning on ideas about the therapist's inner conversation (Rober, 1999, 2005b) and stressing the importance of polyphony, dialogism, and tolerance for uncertainty, the training exercise described in this article is consistent with a dialogical and postmodernist frame, as described by Seikkula and Olson (2003).

Narrative and collaborative practices in work with families that are homeless

This article reports on the use of narrative therapy ideas and practices in working with families that are homeless in a shelter-based, multiple-family discussion group program called Fresh Start for Families. It begins with a review of the challenges facing homeless families. It then briefly describes the collaborative methods used to develop the program. It then describes a range of practices and activities that provide opportunities for families to be witnessed in telling their stories of challenge and coping, to help and be helped by other families experiencing similar challenges, to reconnect and strengthen a positive sense of family identity while externalizing the constraining, stigmatizing descriptions associated with homelessness, and to envision and take steps towards their preferred futures.

Externalizing problems through art and writing: experiences of process and helpfulness

Externalization of problems as a component of narrative therapy has been well defined by such authors as Epston and White, and Freedman and Combs. This study reflects the voices and experiences of 17 participants who engaged in an innovative externalization exercise combining sculpture and journaling over a period of 4 weeks. In an attempt to better understand the experience of the participants, the principal investigator also engaged in the exercise. Findings indicated that the intervention helped participants express emotions, increased their awareness of personal resources and agency, helped separate problems from self decreased symptoms and problem behaviors, and fostered a sense of empowerment. This study reveals the potential usefulness of physically externalizing problems and interacting with them deliberately over time. Such interventions may be useful components of narrative therapy or augmentations to brief therapy. They may help reach populations who have limited access to therapy services or who are reluctant to present for therapy.

Talking about violence: a microanalysis of narrative processes in a family therapy session

In this article, we look at the development in family therapy of narratives about domestic violence. We report on microanalyses of a family therapy session, using narrative research methods, including some conversation analytic tools. The main questions posed in this investigation were: How does storytelling of a highly charged and delicate topic like domestic violence develop in the session?; how do the different actors in the therapy room contribute to telling such stories?; how do actors try to put forward domestic violence as a conversational topic? and how do different actors react to these attempts? Our research illustrates how the recounting of stories of violence seems to go hand in hand with modes of interaction that discourage the telling of these stories. In the back-and-forth process between voices of hesitation and voices of reassurance, the participants weigh the level of safety in the session. In as far as the voices of hesitation can be reassured of the safety, it becomes gradually possible to talk about delicate, problematic experiences, such as violence in the family.

The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation

In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.

Healing elements of therapeutic conversation: dialogue as an embodiment of love

From our Bakhtinian perspective, understanding requires an active process of talking and listening. Dialogue is a precondition for positive change in any form of therapy. Using the perspectives of dialogism and neurobiological development, we analyze the basic elements of dialogue, seeking to understand why dialogue becomes a healing experience in a network meeting. From the perspective of therapist as dialogical partner, we examine actions that support dialogue in conversation, shared emotional experience, creation of community, and creation of new shared language. We describe how feelings of love, manifesting powerful mutual emotional attunement in the conversation, signal moments of therapeutic change.

Family therapy as a dialogue of living persons: a perspective inspired by Bakhtin, Voloshinov, and Shotter

There are not a lot of conceptual tools that can help a family therapy teacher to talk and teach about the importance of the therapeutic relationship in family therapy practice. The idea that family therapy can be conceived as a dialogue might offer a fresh and promising perspective. Mainly inspired by the work of Bakhtin, Voloshinov, and Shotter, the author considers if the concept of dialogue can help us to talk about something that is there all the time in our family therapeutic practices, although sometimes unnoticed, and that is hard to talk about because we lack the necessary conceptual tools. When we choose to conceptualize family therapy as dialogue, the focus of the therapist is not primarily on data collection, information processing or problem analysis. The therapist is not primarily concerned with knowing, or with not-knowing. Instead, the focus is on the idea that first and foremost therapy is a meeting of living persons, searching to find ways to share life together for a while. Clinical vignettes that feature children's drawings in family therapy are used as illustrations.

A twice-told tale: a phenomenological inquiry into clients' perceptions of therapy

Typically, what we understand about therapy and the families we work with comes from the therapist's observations. This inquiry evolved out of the empirical data that indicate the dramatic importance of the client's perceptions to achieving a successful outcome. The research was guided by the understanding that it is vitally important for therapists and therapy researchers to listen to clients and to examine our practices and theoretical approaches in the light of the client's experience of them. This study is a phenomenological inquiry into the client's experience of therapy.

Testimonial psychotherapy for adolescent refugees: a case series

Adolescent refugees are a traumatized, vulnerable group of arrivals to America who lack experience with or interest in psychiatric care. Testimonial psychotherapy's unique focus on transcribing personal, traumatic events for the altruistic purpose of education and advocacy make it an acceptable interaction by which to bridge the cultural gap that prevents young refugees from seeking psychiatric care. The theoretical basis for testimony is discussed. Testimonial psychotherapy has been used with adult refugees, but not with adolescents. This article describes the testimonial process with three Sudanese adolescents (the so-called 'Lost Boys'), which appeared feasible and safe. An efficacy study is underway.

Sociopolitical activist or conversational partner? Distinguishing the position of the therapist in narrative and collaborative therapies

In this article, we explore the similarities and differences of two contemporary family therapy approaches: narrative and collaborative therapies. These therapies are contrasted by describing positioning of the narrative practitioner as sociopolitical activist and the collaborative practitioner as conversational partner. The article begins with a brief overview of the two therapies. Subsequently, we outline their epistemological genealogies and the practice similarities that arise from the theoretical assumptions underpinning these therapies. The remainder of the article addresses the theoretical and therapeutic differences in narrative and collaborative approaches reflected in the positioning of therapist as either sociopolitical activist or conversational partner. While narrative and collaborative approaches share more similarities than differences in relation to their emphasis on the constitutive characteristics of language, focus on sociorelational contexts, and critique of singular objective truths, prominence is given to the starker contrasts in narrative and collaborative understandings of politics, power, dialogue, and discourse. It is proposed that by outlining some provocative contrasts between narrative and collaborative approaches, new conversations and generative practices will emerge in the therapy room.

Dialogue and power: a critical analysis of power in dialogical therapy

This article explores the relationship between dialogue and power in the practice of dialogue-oriented, "not-knowing" forms of therapy. It is argued that power of a dynamic and reversible kind infuses much ordinary social dialogue, and that the joint processes of power and resistance work together to render an interaction dialogical. In contrast, in dialogical therapy, overt exercises of power threaten the interaction's dialogical status, and power is deferred and denied by the therapist through not-knowing practices. A case study of Harlene Anderson's (1997) is used to illustrate that it is precisely power's presence that informs the practices of not knowing and uncertainty that characterize dialogical therapies. It is suggested that the not-knowing therapist withholds aspects of his or her voice as a condition for dialogicity. Instead, special speaking arrangements are required, in which the therapist's not-knowing is continuously communicated to the client, for the therapeutic conversation to remain dialogical. Without these speaking arrangements, I argue that therapy moves toward monologue. Therapists inherit powerful speaking positions from the institutional and sociocultural context, and the rejection of power within therapy serves only to conceal this aspect of power, which nevertheless pervades the therapeutic relationship. Finally, it is suggested that power is a "common factor"--shared by all therapies--and that our status as "inheritors" of power needs to be included in our understanding of the therapeutic process. This expanded view of therapy requires the re-theorization of dialogue, such that it includes, rather than excludes, considerations of power.

Multiple realities in a study of medical consultations

A study of doctor-patient communication offers convincing arguments for using multiple methods of data collection incorporating both meanings and practices. Multiple realities emerged clearly that would have remained invisible had only one data source been used. Two case studies illustrate how four factors interact to produce different versions of reality: setting, participants, time, and forms of data recording. The author discusses the apparent markedly different realities of doctors and patients, and the researcher's role in synthesizing these multiple accounts. Only by using multiple methods can attention be paid to the central tensions, the gaps and white spaces, and the discrepancies and misunderstandings that are so important in understanding human interaction. However, this approach is labor- and time-intensive, and requires skilled, experienced researchers.

Open dialogues with good and poor outcomes for psychotic crises: examples from families with violence

In Open Dialogue the first treatment meeting occurs within 24 hr after contact and includes the social network of the patient. The aim is to generate dialogue to construct words for the experiences embodied in the patient's psychotic symptoms. All issues are analyzed and planned with everyone present. A dialogical sequence analysis was conducted comparing good and poor outcomes of first-episode psychotic patients. In good outcomes, the clients had both interactional and semantic dominance, and the dialogue took place in a symbolic language and in a dialogical form. Already at the first meeting, in the good outcome cases, the team responded to the client's words in a dialogical way, but in the case with the poor outcome, the patient's reflections on his own acts were not heard.

The self-characterization as a narrative tool: applications in therapy with individuals and families

In this article, I argue that the use of Kelly's self-characterization can aid story telling in therapy. It describes the use of the tool's original instructions, and of two other versions (the ideal self in 5 years time and the family characterization sketch), with individuals and families. In contrast to Kelly's practice, clients' written self-descriptions are not stripped to uncover cognitive schemata, but are treated as whole narratives. The texts are collaboratively analyzed, by looking at both their form and content. The cases presented illustrate ways in which these narratives can be read to help therapists recognize a person's/family's language "codes" and transgenerational family themes. "Warded off areas of feeling" are opened up, and differentiation from dominant family voices is facilitated. The whole technique process reveals the great importance people place on negotiating, editing, and finally presenting a narrative that portrays the way the self and the family are experienced at that particular time (see Endnotes).

Approaching the locked dialogues of the body. Communicating symptoms through illness diaries

OBJECTIVE

To describe and analyse communication following the use of an illness diary method in consultations with patients suffering from longstanding illness without clinical findings.

DESIGN

Action research in own practice with qualitative formative evaluation of material provided by the use of the diary method. Analysis followed a procedure modified from phenomenologically-based methodology.

SETTING

The practice of the main author.

SUBJECTS

36 consultations with 16 patients where the illness diary method was applied.

RESULT

Communication following illness diary utilisation could be summarised as: 1) illness diaries as medical documentation, 2) making access to the insight of the patient, 3) exploring internal dialogues and locked voices, and 4) adding meaning to a spoken message through writing (creative distance). By changing the frames of conversation through illness diary utilisation towards one or more of these four levels of communication, the patient may become a more equal consultation partner.

CONCLUSION

Illness diaries can provide clinically relevant information and may emphasise the patient's input and significance in medical dialogues on longstanding symptoms without clinical findings.

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.

Rape flashbacks: constructing a new narrative

This article offers an approach to the dissolution of rape flashbacks when the usual treatment of talk and group support doesn't work. The client, with her family, constructs a new rape scenario to replace her abusive story. In the new story, the client introduces a chosen protective figure into the flashback, which has the effect of interrupting the old scenario so that it cannot take place in the same way again. This approach relies on the client finding a new or freed voice in the treatment conversations in order to tell her story differently. The new, repopulated story eventually has the effect of altering her memory and renewing her life direction and belief in herself.

The small and the ordinary: the daily practice of a postmodern narrative therapy

In this article, I contrast assumptions of a modernist worldview and a postmodern worldview as they relate to clinical practice. Two exercises are described that help therapists develop insight into and practice with the kind of thinking that is consistent with a postmodern narrative clinical practice. Particular attention is paid to the ways that even the small and the ordinary--single words, single gestures, minor asides, trivial actions--can provide opportunities for generating new meanings. Five concepts that I routinely use in my professional and personal life and that are consistent with a postmodern narrative practice--discourse, externalizing the internalized discourse, exceptions, power as the means to produce a consensus, and characteristics of narrative--are illustrated.

Social construction and materiality: the limits of indeterminacy in therapeutic settings

By drawing parallels between the courtroom testimony of a Christian Science practitioner and an intersession conversation between systemic family therapists, I critique the abstract idealism of language-centered social constructionism. I argue that social constructionist inquiry that highlights the indeterminacy of meaning without a corresponding emphasis on the responsive embodied practices of family members glosses over the material conditions shaping the politics of interaction. The implications of this problem are discussed as they relate to the setting of family therapy, where social construction theory is often used to guide practical interventions.

New gateways to dialogue in general practice. Development of an illness diary to expand communication

OBJECTIVE

To present the development of a clinical communicative method based on illness diaries.

DESIGN

Action research with qualitative evaluation of experiences leading to the clinical method.

SETTING

The practice of one of the authors.

PATIENTS

16 patients with long-standing illness without clinical findings.

MAIN OUTCOME MEASURES

Description of the illness diary method grounded in patients' and doctor's experiences.

RESULTS

The illness diary method includes the following approach: The patient presents his symptoms and the doctor may suggest the use of an illness diary. Together, they shape the format of the diary and identify items to be included. The patient uses the diary for home notes between consultations. The notes constitute the frame for a fresh dialogue about the complaints in the next consultation. The method has gradually been elaborated according to utilization experiences on an interactional level, leading to a more specific presentation of the method and how it can be used.

CONCLUSION

An illness diary and the subsequent doctor-patient interaction can be a feasible tool to expand the gateways to dialogue in general practice.

Hearing metaphor: an approach to working with family-generated metaphor

This article presents a step-by-step approach to working with family-generated metaphor in family therapy. Although the use of therapist-generated "therapeutic metaphors" has been widely advocated and practiced for many years now, less attention has been paid to the metaphors used by family members. We argue that the family's metaphors are a neglected linguistic resource in family therapy. Highlighting and validating these metaphors produces a therapeutic conversation in which the voices of family members are heard more clearly by the therapist, and the families' own imaginative energies are engaged in defining and pursuing the goals of therapy. Several case examples illustrate the use of this approach with children of various ages.

The politics of gender in family therapy

This article provides an overview of the political implications of various approaches to gender within the clinical literature. It emphasizes the process of therapy within the social context of gender relations and identifies the political consequences of various clinical responses. Issues surrounding the appropriate role and stance of therapists relative to gender are identified, ethical issues such as neutrality and client welfare are re-examined, and suggestions for practice are addressed.

Narrative child family therapy

In this article, child family therapy is presented as a hermeneutic activity shaped by an interest in the evolving narrative. Over brief, analytic play interviews, the therapist documents a child's narrative understanding of the presenting family problem. This allows psychological meaning to be jointly constructed in therapeutic conversation with the child and family. The idea of play as narrative integrates child psychotherapy into recent social constructionist thinking in family therapy. The article also discusses how narrative therapists can use prior theory and training.