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 By
David Pocock,
Principal Family Therapist
Child and Family Consultation Service, Marlborough House,
Princess Margaret Hospital, Okus Road, Swindon, UK. SN1 4JU
dpocock@poey.demon.co.uk
http://www.poey.demon.co.uk/
Biographical details of David Pocock
Responses to this article from Sylvia Crocker, Ph.D., Maya Brand, and Rodger Bufford, Ph.D
 Two cars collide head on. No-one is killed but both drivers are stunned and confused by the impact. A passer-by, late on the scene, recognises the driver of one of the cars as his brother. Although he has not witnessed the accident, he invents an account which he tells to the police officer who arrives soon afterwards. This account blames the other driver for speeding and exonerates his brother.
How can we know what happened? Does "what happened" only exist in the accounts of the two men who were drivers? If the accounts are different, could one be more true? If we consider the accounts both to be stories, is there any difference between the stories of the drivers and the story of the brother? How might we define that difference? Has anything real happened beyond the stories of the protagonists? If so, how would we come to know that reality? Am I now telling a made up story or a story of something I experienced? How would you be able to know?
I assume that all psychotherapies have to consider the philosophical questions of how we think we know anything. If the gestalt of the patient [FOOTNOTE 1] can only be perceived within the gestalt of the therapist, then all that the therapist can say about the gestalt of the other is that which the therapist has created. What is the relationship between this creation in the mind of the therapist and the real patient?
In this article I will sketch some of the shifts in the way that family therapy has struggled with these issues of knowing or, in the parlance of philosophy, questions of epistemology. I will suggest that our field has found it difficult to resist a tendency to split along a fault line offered by some apparent dichotomies: depth vs surface, objectivity vs subjectivity, and modernism vs postmodernism. I will outline both an eclectic epistemology that attempts to occupy some middle ground and some considerations for practice that may be drawn from this. I hope these considerations may be of interest to Gestalt therapists, either by supporting existing Gestalt views - via an unfamiliar theoretical route - or by supplying some provoking differences to those views which may lead to further dialogue. (For an overview of family therapy see, for example, Goldenberg and Goldenberg, 1996.)
A history
The first serious consideration of epistemology in family therapy began with Gregory Bateson. Bateson (1972) once began a speech to a conference of mental health professionals by asking all those in the audience who thought they could see him to raise their hands. After an understandably nervous start there was a reasonable showing of hands at which Bateson remarked "I guess insanity loves company". For Bateson, reality (including himself) was not there to be seen, touched or captured in any direct way; each member of the audience had created him as a picture image out of masses of pieces of information. The best the observer can do, according to this view, is to construct mental images or maps by drawing out distinctions from the real world - which Bateson refers to as "territory". For any observation of this territory there are, according to his theory of "constructivism" potentially endless characteristics that can be drawn forth as data to mentally assemble our maps. [FOOTNOTE 2] In our search for meaning we invent patterns and categories to structure our experience. Information from the external world enters these maps via the perception of difference: a chair is only a chair when it can be perceived as different from all that which is not-chair which surrounds it. Differences require the presence of an observer to make distinctions - when a human takes a dog for a walk, their respective maps of the experience will vary to the extent of their separate capacities to draw forth distinctions from their environment. (See Singer, 1995 for a longer summary.)
The first popular models of family therapy to incorporate cybernetics - Structural, Strategic and early Milan - only went part way with Bateson's constructivism. In retrospect (Flaskas, 1997), it is possible to see that, for these early models, although family members were considered to be living in a world of constructions, their therapists seemed to have implicitly retained for themselves a more objective vision. The latter - often charismatic men or, subsequently, powerful teams - somehow knew, without much assistance from the family members, which hierarchical arrangement needed to be re-ordered, which boundary needed to be clarified, which cross-generational coalition needed realignment and which paradoxical communications needed to be countered. Indeed some family therapists who claimed a Batesonian influence saw their families at least as clearly as Bateson's hand raisers. For many family therapists this period of our history is considered to be one of authoritarianism and these models of practice - at least in pure form - are almost extinct and little grieved for.
In the 1980s several waves of critique fell upon this established paradigm. Feminism (e.g. Goldner, 1985) focused on the way patriarchy in families, not only went unchallenged in these models, but could be reinforced by the emphasis on the strong leadership and readiness for combat which they required. Those sensitive to cultural diversity (e.g. McGoldrick, 1988) pointed out the strong eurocentric bias implicit in theoretical issues of differentiation, autonomy and hierarchy. Most influential of all was, perhaps, the work of Hoffman (1985) who popularised a new constructivism - one which took seriously that a constructivist epistemology was not just for families, but for therapists too. The system was no longer seen as a field that the therapist could conveniently step back from and zap with some therapeutic magic bullet. Instead the therapist was a participant-observer occupying no comfortable outside position. The system observed included the observer and a statement about the system was always, therefore, a creation of that observer. This paradigm shift was widely perceived as more ethical; processes of change took place not through the controlling interventions of the therapist but via co-evolution of new meanings between therapist and family. Therapists not only lost confidence that they knew what was best for families, they sometimes seemed not to be able to know anything at all, even tentatively. Since, in a family therapy session, an observation made by anyone present was nothing more or less than their construction, all meanings were equally valid. Not only had the confident belief in therapist leadership gone out of the window but therapist knowledge was now seriously problematic.
Curiously, this phase proved to be short lived. Constructivist theory reached the point in which the individual seemed enclosed in some rigid casing (although individuals could be "structurally coupled" to others through language) shielded largely from an environment which only made its presence felt through its capacity to bump the individual (Maturana, Varela). By 1990 constructivism was being rapidly replaced by social constructionism (e.g. Gergen) which seemed to have greater aesthetic appeal to family therapists (e.g. Hoffman, 1990) who much preferred an image of individuals in conversation rather than withdrawn into the near solipsism of constructivism. Social constructionism sees reality as that which people construct together through language. Families invent that which they hold to be true in constant dialogue, both with each other, and with the wider cultural systems of meaning that our world offers us. The role of the therapist is then to co-construct with system members a new - hopefully more helpful - version of reality. Some social constructionists accepted that therapists would inevitably have their own theories about what was going on in the system, but these were considered as unavoidable biases. Since reality was only that which was constructed in dialogue, there was no other basis for choosing between these biases than, perhaps, social acceptability. Bateson's territory and, indeed, any other notion of external reality seemed to be quietly dropped as a reference point.
Social constructionism prepared the ground for the latest wave of critique; one which seems to have completed the paradigm shift away from any notion of the therapist holding an objective or outside view of the family system. The last seven years has seen the incorporation into family therapy of the postmodern philosophy of Foucault, Derrida and Lyotard or, at least some versions of their views. (For a sympathetic introduction to postmodern thinking in psychotherapy see Shawver, 1997 and this list of her brief notes on aspects of postmodern thinking.) Foucault, Lyotard and Derrida each, in a different way, call into question the legitimacy of our preoccupation - from the Eighteenth Century Enlightenment onwards - with developing rational, objective views of our world. Lyotard (1979) defines "postmodern" as a position of incredulity towards the big ideas - or metanarratives - of science, Marxism, humanism etc. (We need not take "incredulity" to mean dismissal - as some family therapists seem to do - but as scepticism to the claims of universality made by these major systems of thought.) In questioning our awestruck commitment towards these big ideas, Lyotard helps us to reconsider the legitimacy of small narratives in which the terms for discussion are locally defined. Derrida, in his work on the analysis of texts, challenges the notion of correct interpretations by discovering other legitimate readings cast into the shadows or - deferred - by the attention demanded by the "correct" reading. (Later we will see that we do not have to take Derrida to mean that all readings of a text - or clinical situation - are equally valid.)
A major translator of postmodern thought into family therapy has been Michael White (e.g. 1991) - currently, perhaps, the most influential voice in our field. White's narrative therapy picks up Foucault's view that individuals internalise the social attitudes (discourses) that powerfully define who people are and how they should live their lives. In working with anorexia, for example, White would wish to notice with the client or client family the powerful discourse that requires people (especially women) to be thin in order to be acceptable. He helps clients to resist succumbing to these dominant stories and, instead, to regain authorship of their lives by developing their own prefered self-narratives. (However, in taking the power of culture seriously, we need not overlook - as some narrative and constructionist therapists seem to - that self-narratives are also generated in intense personal relationships and modified through testing against the constraints of external reality.)
One further distinction worth drawing in contemporary family therapy is between those who assume that there may be deeper issues to be explored which underlie surface presentations of the presenting clinical problem (structuralism) and those who assume that what constitutes a problem is the system of those connected through language who agree to describe a particular situation as problematic ("post-structuralism" or postpositivism [FOOTNOTE 3]). The "poststructuralist" group (solution focused therapy, narrative therapy, and collaborative language systems therapy) have, in practice, tended to be more schismatic than other groupings in family therapy, establishing separate journals, conferences and teaching institutions. It is by no means clear whether family therapy can avoid splitting along this hairline fracture at some future point. Smaller groupings are not undesirable in any field of endeavour and the notion of local knowledges in family therapy is in line with the general drift of this article. My concern though, is that these changes are partly driven by an over-reaction to the apparent authoritarianism of the early models - especially in their use of theories as blueprints for living. There is a new tendency to turn away from notions of any reality outside of our constructions, to abandon clinical theory (as hopelessly structuralist) and such a polarisation of structural and post-structural positions that they become straw men. This seems to me no basis for a helpful division.
The version of history I have provided concerns only the mainstream in family therapy. There are other lesser known epistemologies which - borrowing from postmodernism - we may call subjugated narratives. My website includes a commented reading list of papers from authors who feel that questions of knowing in family therapy still require further debate. I identify with the concerns of this group and in a series of papers and articles (Pocock, 1995a, 1995b, 1996, 1997a) I have sought to articulate a position which explores a middle ground between knowing and not-knowing, depth and surface, modernism and postmodernism; between the dangers of certainty of one hand and relativism on the other.
Towards a reconciling of epistemologies
Having roughly sketched out both my view of the historical trends in family therapy and my position within it, I now wish to develop my ideas on what might constitute a more adequate epistemology. However before doing so, we need to pay more attention to the way the term "reality" is used in these debates. Many apparently unresolvable arguments become stuck because the protagonists use the same terms in quite different ways but without recognising that difference. Wittgenstein helps us to notice that language does not just point to things and does not provide us with reliable, non-negotiable meanings. What we mean by "reality" depends on the local context of meaning (or language game) in which the term is being used. We must work harder to tie down these contexts before we can have some genuine dialogue. When "reality" is being spoken of we may not know whether the term is being used by an objective realist to denote the idea of a world beyond constructions that can come to be known independently of any knower; or by a naive realist who just looks at the world and sees (like the hand raisers in Bateson's audience); or by a critical realist who believes that we can come to know reality better, but only through elaborating a constructed position; or by a social constructionist who considers reality only to be our mutually constructed views; or by a Foulcaldian who might see a reference to reality as an attempt by one person to persuade another to accept their expert viewpoint. (For some wonderful illustrations of the kind of epistemological trench warfare that can develop when terms are not defined see Edward Friedlander's Why I Am Not a Postmodernist.)
Let me try to tie down two definitions of reality: constructed reality and external reality. When we say we know something, or when we say that something is true we are always operating, I suggest, in the domain of constructed reality. Either on our own or with others we have created a view (or story) of our world. All knowledge - including scientific knowledge - is constructed. However, before you are tempted to reach for the standard counter-arguments of solipsism or relativism, let me quickly add the suggestion that external reality is ever present as context to this process of construction or story-making. How can this be?
Consider a man who every night, after work, walks home through a dark forest. In his head he has a rough map of the path; each time his internal map (or construction - since he has had to make it, or borrow it from others through language) does not fit and he strays off the path, he walks into a tree. He experiences this external reality not objectively, but as context to his map; one that acts as a painful constraint. He will, no doubt, re-adjust this map on the basis of its failure at that point and, after several nights (and numerous bruises) he may eventually be able to get home without accident. However, the man will know nothing objectively about the trees (they are just painful points of failure on his map) let alone the forest. External reality is that which always lies beyond our constructed reality. Any statement about our world always falls short of this external reality because language has inherent limitations for capturing external reality.
Let us flesh this out with another example. If you attempt to describe a chair, you will always end up with other kinds of description which you will never get beyond, no matter how hard you try. However, unless there is something externally real beyond the description "chair", you will fall to the ground if you try to sit on one. A convention of the best chairmakers will never manufacture a chair that they tell anyone about without also constructing a reality, and a three day conference of eminent social constructionists will never create any meaning chairish enough to be reliably sat upon. All truth is in the domain of construction. But all that construction is attempting to describe is in the domain of external reality. External reality may be precisely defined as that which language and description attempts to reach but falls short of.
The metaphor of "map" can draw our attention to the relationship between our constructed reality and external reality but it can also restrict our thinking by leaving out the power of constructions to define, not just our world (the trees and forest), but who we feel ourselves to be within that world. We should place alongside "map" another metaphor which is meeting widespread acceptance in psychotherapy - that of "story". "Story" encourages a view of a dynamically shifting sense of self in the world. We may hold many versions of ourselves negotiated, both in self-other relationships, and in the context of the big cultural stories (such as those which carry societal blueprints for gender). In this metaphor, some narratives of the self may become relatively unavailable for re-editing (which some call a core self) while other narratives will shift, depending on the context in which we do the telling.
Constructed reality is frequently political since, by defining who we are, it can so readily shape the power relationships between individuals and groups. When we hear the word "nagging" used by either partner in a heterosexual couple relationship, we may begin to suspect that the legitimacy of the woman's voice has been restricted by the patriarchal colonising of the bit of external reality that others might describe as "complaining" or "challenging". For many (pre-Zimbabwe) white Southern Rhodesians, their collective body of truth included the key premise that blacks had smaller brains than whites. External reality as context was, of course, present throughout the period of this discourse. Science, if consulted, might have constrained this prejudice but, naturally, external reality in this case would have had negative value to the white status quo so its use as constraint was implicitly proscribed.
It may be argued that we should put ourselves in the hands in science since it seems to be the most reliable and just arbiter of competing constructions about external reality. Science does have some special methods of controlled walking into trees which can yield tremendous results when the forest is not too tangled. Research into attachment and expressed emotion has for example, been of great interest to many family therapists. But it should be remembered that the products of science are, like all knowledge, constructionist. As Popper, Kuhn and Feyerabend point out, even with its brilliant controlled methods of stumbling in the dark, the choice of scientific knowledge still depends on social shifts of paradigm, on social acceptance of the newly constructed maps by a scientific community, and of a willingness to hold onto socially sanctioned theory even when criteria for falsification are available. And, when it comes to a dense tangled thicket such as the human mind, the price of scientific theory is, all too frequently, reductionism which inherently provides us with a misleading fit for psychological constructs. For therapists to depend on science alone, the cost of "validity" would be the loss of complexity. If we can avoid the naive belief in scientific objectivity then we may cautiously welcome careful science as an opportunity to test our clinical ideas against the constraints of external reality. But we also need to guard against theories becoming restricted to simple, sterile sketches of the human condition; ones that suit the political ends of the community which legitimises them.
What I am saying in this article is that an adequate epistemology should include both the notion that what we know is always a constructed or storied reality and the notion that external reality is always present as context and, in some circumstances can act as a constraint to our stories. Note how this eclectic combination refuses to split easily into the usual dichotomies of idealism vs empiricism, narrative vs science and modernism vs postmodernism. Indeed, on closer inspection it is not so far from what some postmodernists are already talking about. Derrida, for example opposes the popular misconception (inside family therapy too) that deconstruction means that all interpretations of a text (or, indeed a clinical situation) are equally valid. Instead he explains that "one cannot refer to this real except in an interpretative experience" (Derrida, 1972) and that text may become more understandable within context which "does not exclude the world, reality history." (Derrida, 1972) He is also irritated by relativist readings of his work - "Every week I receive critical commentaries and studies on deconstruction which operate on the assumption that what they call 'post-structuralism' amounts to saying that there is nothing beyond language, that we are submerged in words - and other stupidities of that sort." (Kearney, 1984 p.123)
And for Lyotard, postmodernism does not insist that reality exists only in language (as many family therapists believe) but as something unpresentable and beyond language. "Finally it must be clear that it is our business not to supply reality but invent allusions to the conceivable which cannot be presented." (Lyotard, 1979 p81)
A role for clinical theory?
Let me illustrate the polarities inside family therapy in order to bring their difference into focus and, against which, the synthesis I am suggesting can stand out more clearly.
A structuralist such as Salvador Minuchin can look at a family with an anorexic member and "see" the same family he has seen 100 times before. His "seeing" puts out of awareness issues other than enmeshment, cross-generational coalition, conflict avoidance and over-protection (Minuchin et al, 1978). His theory of deep structures embedded in the family system contains both the blueprint for therapy and its goal. His strong leadership of the family system would be required for the problem to be solved.
"Post-structuralists" such as Anderson and Goolishian (1988) in meeting the same family would assume that "anorexia" was a problem of collective definition within the system of those "in language" about it. They would hold no theory of underlying causes (or, at least, attempt to avoid influencing the family with these theories) and instead, see their role as that of "master conversational artist", exploring and helping system members to expand on the narrative coherence of their constructions. Anorexia would not be solved but "anorexia" might be "dis-solved" as a construction that determined how the identified patient and the family should live their lives.
Notice how in both these scenarios the use of clinical theory is linked to expert power. Minuchin unashamedly embraces this power since he has constructed his experience and research as informing him that this power will be clinically effective and therefore ethically justified. Anderson and Goolishian scrupulously avoid the power to impose their own expert definitions [FOOTNOTE 4]. Since, in their model there is nothing beyond the surface play of language, an introduction of ideas from clinical theory - no matter how cautiously done - is merely an authoritarian attempt to get the system members to see things their way and is, therefore, unethical.
In my own work, or at least in my thinking about my work, I have moved away from the notion of a scientist-practitioner who can come to know objectively, through exploration, the world of the client and act upon it from above. But I am not satisfied with the notion that meaning can be created only through processes of unconstrained mutual construction. "Co-evolution" and "co-construction" seem insufficient as descriptions and I prefer the more user friendly terms of "understanding" and "feeling understood" (Pocock, 1997a). I now frame the process of therapy as a search in the area of the not-yet-known and the simultaneous construction of new meaning together with the client or family to make sense of this journey from the familiar to the unfamiliar.
Elsewhere (Pocock, 1996, 1997a) I have suggested that clinical theory can be used consistently with what I am describing here as an adequate epistemology. The reality of any clinical situation is one of almost infinite complexity; there is insufficient paper in the world for even one case example. As the novelist Salman Rushdie says - "every story is an act of censorship" - each telling requires inclusion and exclusion (Rushdie, 1985 - quoted in Parry, 1991). The therapist, in "hearing" the stories of the patient draws out particular distinctions, is attentive at some places, tunes out at others, has her own thoughts at others, is intensely curious, moved or bored. These reactions depend on that which the therapist brings to the encounter with the other or others. Each way of picturing the encounter depends on the constructions, or - using Hoffman's (1990) metaphor - the set of lenses used by the therapist at each moment. (Note how this metaphor suggests that the external reality is not observed in an undistorted way as, for example, through a plain sheet of glass).
We may also think of constructions as filters which allow in certain information, which we call "facts", and exclude others. All clinical theories are both lenses and filters but so too are all other experiences of the therapist, stored prior to that clinical moment. [FOOTNOTE 5] We can only avoid the myth of the objective knower and take responsibility for our "seeing" and "hearing" by attempting to understand how what we see or hear at that moment depends on this particular arrangement of lenses and filters. The personal therapy required of many psychotherapies (but not yet family therapy) is helpful in creating this sense of self-reflexivity but so too is an attitude of uncertainty to all our knowing.
For clinical theory to be used in a non-authoritarian way it needs to be held irreverently, reflexively and with a loose grip. Since each theory represents the best attempt (from its own particular standpoint) to make sense, in general terms, of an externally real but never certain world, then there are few grounds for excluding any theory other than the psychotherapeutic version of religious intolerance. This eclectic epistemology requires no effort to integrate theory. As each theory is both what can be "seen" and the position from which it "sees" then any grand metatheory which tries to create a unified position is doomed. Instead, lenses may be thought of as overlapping each other, creating richer ways of thinking. In my work, I regularly draw on the large loose collections of theories from both family therapy and psychoanalysis. But this epistemology places no restriction on theories from any source and allows visits to other therapy cultures. So far, I know little about Gestalt therapy but I suspect that many Gestalt ideas could be used in family therapy within this framework of knowing.
From big stories to local understandings
On the path taken by this article: from the historical struggles in family therapy with questions of knowing; through the outlines of an adequate epistemology that attempts to reduce schismogenic pressures in our field; and through the pluralist use of clinical theory, we reach the point of needing to consider how clients can make use of the big theoretical stories (or metanarratives) rather than be crushed under their weight. We need to consider how theory can be made fluid enough to be of value within the small and specific contexts that make up the flux of therapeutic work.
Postmodernism may give us some kind of assistance to the modernist project of helping others. The therapist and family may form a small temporary institution for dialogue; a language game in which the rules for understanding can be locally and subtlely defined. The therapist may use clinical theories but without credulity or reverence to offer up some new ideas into the work/play space of this therapeutic moment. This cautious and plastic use of theory may allow some ideas to find their way into a fresh collaborative mix; a new little narrative which may slowly emerge, coaxed on by its meaningfulness to the family members. But ever present to this making-sense-together is the context of that which is really going on- the nameless, unconstructed external reality.
A nine year old boy living with his mother and stepfather and two elder sisters was referred following a period in which he had begun to fall behind in his school work, had become rather socially isolated, anxious about attending school and aggressive towards his mother when she insisted. The step-father was polite but seemed to have attended the session rather reluctantly. The mother's vivacity seemed to help keep things fairly light in the session and she and the other children openly teased her husband about his 4 marriages. He had three children from two of the marriages, with whom he had lost contact, since he felt it would be better for them if he made a clean break.
There was much exploration of the child's social relationships and potential reasons for difficulties, such as the recent move of a friend to another school. The family acknowledged some special closeness between the boy and his mother but his relationship with his birth father seemed uneventful. Contact had become irregular, but this appeared to create no particular difficulties for the child. About half-way through the session I noticed that I had begun to feel depressed. Later I thought I could identify that this feeling had started when the boy and his mother had been discussing his father. There was, for that time, a stillness about the boy and some fading of his warm smile. His mother seemed extra bright - chivying him along during this part of their narrative and the step-father had remained quiet.
Two months previously I had re-read an old paper by Skynner (1979). I was interested in how he used his sensitivity, in working as a group analyst, to allow himself to experience the feelings disowned by the family. Since that reading I had begun to monitor my feelings more in family therapy sessions and to think about their relevance to the issues under discussion. Later in the work with the boy and his family, I shared this emotional reaction with them by wondering aloud whether there were more difficult feelings about the boy's father than we currently knew. Over time it became possible, from collaboration with them, to tell a new clinical story about their difficulties: the boy had begun to feel that he was not important to his father who now had a new child; the mother partly sensed this, but hadn't wanted to acknowledge it openly with her son since she hated his father and was happy for him to fade out of their lives; the step-father was envious of the mother's close relationship with her son; the mother feared the son retaining longings for his natural father since, in allowing his memory to be openly acknowledged in the family, it might de-stabilise the relationship between her and her husband (he had, after all, left 3 other families); these fears of the mother had meant that, despite the closeness to her son, there was no emotional holding of his complex feelings about his father; the boy had defended against his anger with his father by a growing sense of his own unlovability which others picked up at school; and in the absence of a holding of his painful feelings he needed to stay close to his main attachment figure.
This has all the hallmarks of a classic written-up case example - there was even a thank-you card sent some months afterwards to say that things were going well. But note that this account is a clinical story. It is honest (in the sense that it is not a deliberate lie) but it is full of post-hoc rationalisations and still speculative connections. I have left out enormous amounts of information and entirely failed to convey the messy stumbling uncertainty of therapy. (I was not even the therapist but a member of a Reflecting Team (Andersen, 1987) [FOOTNOTE 6] and a supervisor of the therapist.) I have included only a small portion of my constructions about this family but cannot include either the enormous amount that remains unconstructed or the different ways in which it might be constructed. I might tell the story differently next time; the accounts of the other team members and of each family member would be likely to vary considerably from this one; and, as reader, you may have created your own version. Finally, I have no firm idea whether our work had any influence on the reported change - only that the mother and son said that it did.
I have written this at length to create a more complex context than usual for examining only that small sequence in which the big general story of Skynner created the possibility of receiving something new from the family which, through reverie, could be given back into the work/play space of the session for further consideration. In that moment the issue of the boy's feelings about his father could be temporarily rescued from the shadows of the dominant narrative which held that the relationship was unproblematic. Depending on our theoretical loyalties we may call this a bringing into consciousness or - to a more postmodern mind - a deconstruction of the dominant story. A more complex, painful but ultimately, perhaps, more enabling version lay partly obscured in the not-considered-in-the-moment (or what Derrida calls différance.) The boy and his mother seemed to be able to invest that idea with some value and in that short period of locally determined understanding some new possibilities for change opened up.
This is the description of the therapeutic process that I wish to reach - the progression through time of a series of these small local understandings in which some neglected issues can be re-appraised or - as Shawver (1983) puts it - "transvalued" in the light of new premises. We may assume that there were causes for this child's behaviour - but ones of such staggering interwoven and dynamic complexity that the word "cause" itself needs to be treated with great caution, in case it seduces us back into the familiar modernist trap of blinding us to the partiality and incompleteness of our understanding - suggesting, instead, that we can truly come to know. The totality of that which is really going on in this family, as with all others, remains firmly out of reach to any of us. The best we can hope for is that these local understandings and transvaluations can allow family members some pragmatic negotiation of its constraints.
In summary the thesis of an expert exploration of the objective reality of the client or family and the antithesis of an unconstrained process of mutual creation of reality are both rejected. Instead, I believe that something transforming may happen for the patient or family only through the synthesis of collaborative exploration and social creation of meaning within the never-fully-known context of the externally real.
Footnotes
1. Since the terms "patient", "client" and "family" are all in different ways unsuitable, but hard to avoid in writing, I will use them interchangeably. (Return to text)
2. Bateson might have chosen a less ambiguous term than "map". As a metaphor it may cast a spell that he did not intend: namely, that our constructions can be assembled into an miniature but accurate replica of key features of the external world. Constructivism is written against this naive reflection-correspondence theory of knowledge. (Return to text)
3. I have placed inverted commas around "poststructuralism" to denote some doubt about whether contemporary family approaches which see no reality outside of language may be referred to as poststructural. See Derrida's comment on this below. (Return to text)
4. Although it may be argued, that a therapist who brings an assumption to a clinical encounter that anorexia is a problem in language only is, from a postmodern point of view, acting very powerfully indeed. (Return to text)
5. Notice how, in this article, when constructed reality becomes something we wish to describe, we can only allude to that, too, through metaphor and that each shift between metaphors - "maps", "constructions", "stories", "lenses" and "filters" brings forth some distinctions while simultaneously allowing others to be temporarily lost to our attention. (Return to text)
6. In this model of teamwork, the team members are brought into the family session in order to have a reflective conversation about what they have felt to be significant in the session to that point. The family listen to this conversation and are then invited to comment on the reflections. (Return to text)
Acknowledgements
My thanks to Padraig Quinn and Lois Shawver for their generous help with this article.
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