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Chapter: Essentials of Psychiatry: Family Therapy

Postmodern Family Therapies

Innovations introduced by postmodern therapies including nar-rative, solution-focused, collaborative language systems and feminist family therapies.

Postmodern Family Therapies


Innovations introduced by postmodern therapies including nar-rative, solution-focused, collaborative language systems and feminist family therapies (Andersen, 1987; Anderson, 1997; de Shazer, 1985; Epston, 1989; Epston and White, 1992; Freedman and Combs, 1995; Griffith and Griffith, 1994; Madsen, 1999; O’Hanlon and Weiner-Davis, 1989; Penn, 2001; Tomm, 1987; Weiner-Davis, 1992; Weingarten, 1995; White, 1989, 1995, 2000) have opened new ways for families to solve problems by valuing and learning from their own experiences, histories, traditions, values and identities, instead of seeking answers from mental health experts. The postmodern therapies have sought to em-power families by helping them to develop reflective processes for exercising choice, to build supportive communities with other families, and to clarify undesirable ways in which cultural influ-ences have limited appreciation and utilization of the family’s own practical wisdom. In these ways, the postmodern family therapies have rendered family therapy more usable for those whose lives vary from the stereotypic American two-parent, middle-class, nuclear families, traditionally the largest consum-ers of private-practice family therapy.


The postmodern therapies have made contributions that have broadly influenced the clinical practice of family therapy through:

       the art of crafting interview questions for fostering reflection and creative problem-solving;


·              clinical methods that help patients and families to identify and use skills, competencies, and resources from their everyday lived-experiences;


·              clinical methods that counter adverse influences of culture in generating and maintaining problems that families face.


What to Think About


Each person makes sense out of his or her life experiences by attributing meaning to them. This meaning is shaped by a canon of personal narratives as they are told and retold to self and to others. Among the most important of these narratives are those of identity about who one is as a person and as a family. There are certain dominant narratives in a person’s life that, more than others, organize one’s perceptions, cognitions and actions. How a family member views oneself and the other family members is shaped by the limits of the language – the metaphors, stories and beliefs – he or she employs.


Impasses occur in family relationships, and problems emerge when


·              one or more family members lack either the needed emotional vocabulary or the needed narrative skills to make one’s per-sonal experience understandable to others;


·              the available narratives preclude ways of relating other than conflictual ones;


·              specific words hold very different meanings for different fam-ily members due to different personal narratives connected to the language (e.g., “loyalty,” “trust,” “safety”);


·              family members have become positioned relationally such that they cannot hear, tell and/or expand their stories in conversa-tion, i.e., they have become confused by or habituated to the conflict such that they have stopped listening


Therapy provides a context where narratives that limit and constrain relationships can be identified. The power ofconstraining narratives can be attenuated through careful interviewing that renders visible the specific historical, cultural, or political contexts from which they emerged and the hidden interpretive assumptions upon which they rest. Alternatively, more useful narratives often lie unnoticed within forgotten ex-periences the partners have had with one another, but are now outside their recollection.


What to Look For


·              Listen for the exact words and precise manner in which people use language. The focus of therapy is the language itself and the limits of its possibilities, not what this language is inter-preted to mean.


·              Metaphors, phrases and prominent or repetitive words in the family members’ specific uses of language are noted as “doors to be knocked upon” by asking specific questions about stories of lived-experience that have given them meaning.


·              “Unique outcomes” or “exceptions” when problems might have been expected to occur, but did not.


What to Do


Narrative approach to therapy consists of two phases:


§   First Phases: A first priority is creation of a therapeutic relationship within which important first-person narra-tives can be safely told, heard and changed. In particular, the therapist carefully watches for nonverbal signs that the dialogue is opening up or closing down, such as family members’ breathing, posture, and flow and tone of speech. Creating a relationship and a conversation favorable for the telling of important personal stories is the priority, not gath-ering data.


§   Second Phase: As important first-person narratives relevant to the problem are told, the therapist asks carefully designed questions that facilitate:


i)             retrieval of other forgotten, or unnoticed, narratives that might enhance solving the problem of the therapy, in con-trast to the dominant narrative;


ii)          cocreation of an alternative narrative to a form that holds more possibilities for resolving the problem of the therapy;


·              The therapist utilizes such questions as circular, reflexive, unique outcome, or relative influence questions (Tomm, 1987; White, 1989).


·              A solution-focused therapist may assign couple-partners the task of studying segments of time when the problem is “not” occurring, looking for “exceptions…” Examples of solution-focused questions include:


i)              “Between now and the next time we meet, I would like you to observe – so that you can describe to us next time – what happens between both of you that you do value, would NOT want to change, and would like to see continue to happen in the future”.


ii)          The Miracle Question (de Shazer, 1985): “Suppose that one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different? How would your partner know without your even saying a word about it?” [The therapist then negotiates with the partner(s) what part of this new reality the partner(s)  would be willing to implement the next day, as if the mira-cle had occurred.]


iii)        (Weiner-Davis, 1992) “If the problems between you and your partner got resolved all of a sudden, what would you do with the time and energy you have been spending on fixing or worrying about the marriage? Describe what you would do instead”.


iv)        (Weiner-Davis, 1992) “What might be one or two small things that you can do this week that will take you one step closer to your goal?”


v)          (Weiner-Davis, 1992) “What, if anything, might present a challenge to your taking these steps this week, and how will you meet the challenge?”


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