UNIT 4

The Collaborative Language-Based Models of Family Therapy: When Less

Is More

 This unit includes reflexive family therapy (both languaging and reflecting
models), solution-oriented family therapy, and narrative family therapy.
Together, these models of family therapy are the collaborative language-
based models of family therapy.
 They are also sometimes called postmodern or social constructionist
models, because they agreed that cultural realities develop through
conversation, and different individuals and cultural groups may perceive
reality very differently.

HISTORY AND BASIC ASSUMPTIONS

The Galveston Connection

 Collaborative language-based model is from school of MRI therapy, with its

focus on nonpathologizing and multiple realities. This models share a
common connection to the Galveston Family Institute also known as the
Houston Galveston Institute.
 The Galveston Family Institute founded by Harry Goolishian, a young
psychology student completing his internship at the University of Texas at
Galveston Medical School clinic came across a man seeking treatment of his
nagging, domineering wife.
 Goolishian saw this man individually and felt very sympathetic toward him,
one of his friends was seeing the client’s wife. In those days, it was very
confidential to see the husband and wife together, and compare notes of the
two therapists.
 Once his friend went on vacation, so happened to meet his friend’s client. He
was surprised to find that he liked her just as much as he liked his own
client, and that she had other ways of describing their marital problems that
made sense.
 Goolishian began to meet both husband and wife. He had to do this
secretly, because if his supervisor had known he was doing this he would
have been fired from his internship.
 At first, Goolishian wanted to find out which person was “right,” the
husband or the wife; after a while, he formulated the idea of multiple
realities.
 Goolishian participated in a research project called the Multiple Impact
Therapy Project experimented with each member of a troubled family for
an intensive individual session. Each therapist met with the other therapists,
and all the therapists and all the family members met together called multiple
realities.
 Goolishian with Harlene Anderson, Paul Dell, and George Pulliam, founded
the Galveston Family Institute. Dell left the institute, Pulliam and
Anderson remained. After Goolishian’s death in 1991, Anderson became
director and renamed as Houston Galveston Institute because most of its
office locations were in Houston rather than Galveston.
 The Galveston Family Institute (GFI) one of the training centers for family
therapy, trained many people and became a stopping-off place for family
therapists. GFI group developed collaborative language systems or
languaging. They see the process in psychotherapy as a dialogical one,
believing that problems naturally dissipate through conversation or in
responsive dialogue. The task of the therapist, then, becomes to
1. maintain a not-knowing stance (do not be the “expert” on the
client’s problem; let the client tell you what it is really like);
2. embrace the client’s reality (believe and trust in what the client
says, even when it does not initially seem to make sense);
3. ask conversational questions (keep the dialogue going); and
4. listen responsively (provide plenty of affirmation and
encouragement so that the client feels heard and understood. GFI
therapists also talk about this as honoring the client’s story)

 Closely related to the GFI model of family therapy, is the work of Tom
Andersen formal reflecting team to his work with families. The reflecting
team involves a team of therapists observing behind a one-way mirror while
a therapist works with a family in the therapy room.
 Andersen’s innovation was to share the team discussions with the family.
The therapist confines to conversational questions and lets the family talk,
while the observing therapists hold their comments until they can be shared
with the family. At a specified time, midway through the session, the team
behind the mirror changes places with the therapist and family. Then the
 therapist and family watch the team that has been observing as they
comment freely on what they have noticed, careful only to keep their
comments affirming and nonpathologizing.
 The family and therapist then change again to their original positions, and
the therapist invites the family to comment on what was useful to them about
the discussion and what ideas they might like to pursue. This format is seen
as less invasive and more consistent with the not-knowing stance, while still
allowing the therapeutic team to introduce some new ideas to the family.
 In this way, those ideas do not come directly from the therapist, and the
family is free to pick and choose the ideas that appeal to them.
 Hoffman emphasized self disclosure, for increased openness on the part of
the therapist. Hoffman coined the term reflexive therapy to describe
Andersen’s reflecting team work, and the work of the GFI in particular.
Reflexive here means the use of the formal reflecting team, also includes
informal in-session reflections among therapists and between therapist and
client, the use of self-disclosure, and the commitment to affirming,
accepting, nonpathologizing dialogue.

Review and Summary

Galveston Family Institute developed a model of family therapy that

emphasizes dissipating problems through dialogue. Influenced by the work of
the Galveston Family Institute, Tom Andersen in Norway and Lynn Hoffman in
Massachusetts have added additional reflecting components to their practices.
The work is collectively known as the reflexive model of family therapy.

Related Models: Solution-Focused and Narrative Therapies

Two other models of family therapy also emphasize collaboration and

nonpathologizing. These are the solution-focused and narrative models of
family therapy.

Solution-Focused Therapy

 Solution-focused therapy. Together with his wife Insoo Kim Berg at the
Brief Family Therapy Center in Milwaukee, Wisconsin, de Shazer came
up with the term solution-focused therapy.
 In this therapy, the therapist begins by embracing the client’s reality about
the problem, then starts to shift that reality to its hidden opposite, the
absence of the problem. In other words, if a client complains that he and his
 wife frequently quarrel, the solution-focused therapist will draw the client’s
attention to the times the two do not quarrel and what is different about those
times and will discuss.
 In hypnotherapy, the client’s attention is shifted to where the hypnotherapist
wants it to go. This is why the solution-focused model borrows more from
hypnotherapy than from the original MRI model.
 Other important solution focused therapists are Yvonne Dolan and Eve
Lipchik, who expanded the model to traumatic abuse and domestic violence
respectively, and Scott Miller, who with Insoo Kim Berg expanded the
model to alcohol abuse.
 O’Hanlon called this model as possibility therapy instead of solution-
oriented therapy, to avoid confusion. He also shifts the client’s attention
away from the problem to the absence of the problem, but in addition he
widens the conversation to include social, political, and cultural forces.
 For example, if a client came in complaining about his quarrels with his
wife, O’Hanlon would shift the conversation to the times the husband and
wife do not quarrel, but would also possibly raise the issue of what in the
client’s cultural background led him to think that quarreling was always
negative or was not supposed to happen in marriage.
 Michele Weiner-Davis is a well known solution-oriented therapist
encouraging the client to focus on the positives about his/her marriage, even
when the client does not want to talk about those positive at first.
 Ben Furman and Tapani Ahola, in contrast, take a less directive but still
solution-oriented approach, blending solution talk and elements of reflexive
family therapy in their native Finland.

Review and summary.

Solution-focused and solution-oriented or possibility therapy redirects the

client’s attention away from the presenting problem toward the absence of
that problem. They do this by techniques from hypnotherapy. They share with
the MRI and reflexive models an emphasis on collaboration,
nonpathologizing, and change through dialogue, but they are more directive in
their solution focus.

Case Examples. When a mother sought treatment from Ben Furman and Tapani
Ahola, mentioning that she did not always feel competent to set limits with her
four year-old, they asked her to visualize the times when she did feel competent
and give that experience a name. In contrast, when Harlene Anderson consulted
with a client who was also feeling guilty about being a bad mother, she would
have found this approach too directive. She instead commiserated with the
client and mused aloud about the difficulty of figuring children out. However,
she limited herself to this kind of curious stance and reflection, and avoided
giving the client any direct suggestions. She expected that the problem would
eventually dissipate through dialogue.

Narrative Therapy

 In this therapy they concentrated on the recent past, and present in memory
to allow for therapists, especially those of European descent, to embrace
their client’s reality without discussing the larger political issues, especially
when the client is of Aborigine or Maori descent.
 They preferred to concentrate on hearing the client’s story and moved away
from giving directives,.
 Stephen Madigan and Heather Elliott, formed the Yaletown Family
Therapy Centre in Canada after their graduation. Narrative therapy spoke
strongly to Madigan in part because of his father’s background as a labor
union organizer. Elliott draws on her interest in feminism to encourage
clients to explore less oppressive gender-related life stories for themselves.
 Narrative therapists use deconstructing questions and unique outcomes to
broaden the conversation into social, political, and cultural areas. They also
use externalizing to further guard against pathologizing.

Review and Summary.

Similar to reflexive therapy and solution-focused/ possibility therapy, the

narrative therapy model emphasizes nonpathologizing, embracing the client’s
reality, and change through conversation. Narrative therapists’ emphasis on the
importance of the client’s voice, however, leads them to avoid explicit
directives. They may shift the conversation to the absence of the problem, as do
solution-focused therapists, but they do so in a particular way. They differ from
reflexive therapists in that they will introduce into the conversation issues of
gender, politics, and culture, even if the client does not bring up these issues or
seem to want to pursue them.

Case examples. Anderson and Furman and Ahola (1994) both cases involved
clients who were concerned that they might not be competent mothers. You
may wonder why it seems that many clients are mothers who feel guilty;
narrative therapists would explicitly address that commonality. When
Zimmerman and Dickerson saw such a client, they explicitly commented on
how often mothers get blamed for their children’s behavior in Western culture,
and cautioned the client: “A lot of parents get sucked into the notion that they’re
to blame for this. I don’t know if you’ve tortured yourself with this. I hope not. I
run into that a lot”, thus broadening the conversation to consider maternal guilt
as a cultural theme.

CONSTRAINTS AND LIMITATIONS

Because there is no one correct reality, none of these models can be considered
the one correct model of therapy.

Social Control Issues

 Therapists become agents of social control. For example, a parent convinced

to discipline his/her child by beating the child with a belt poses a difficulty
for the collaborative language-based therapist. This difficulty is typically
raised in one or more of three ways.
1. First, an outside agency may be invoked. For example, if child welfare
authorities are involved, the client may be reminded that such discipline
techniques are not legal and invited to consider alternatives, with the goal
of ending child welfare’s involvement in the client’s life.
2. Second, particularly if no outside agency is presently involved, the
therapist may need to make what Lynn Hoffman calls a citizen’s protest.
In other words, the client may be told that, as a person and a citizen the
therapist cannot approve of this behavior and must indeed report it if
legally mandated to do so.
3. Third, the therapist may use deconstructing and curious questions to lead
the client to question the behavior on his or her own. For eg., Harry
Goolishian used to ask client, “Leaving aside for the moment whether or
not it was legal, was the method of discipline you were using, working?
Did you feel that your child was really listening to you?” In Goolishian’s
experience, this question was always answered with a resounding “No, it
wasn’t. My child doesn’t listen,” which then opened up other avenues of
conversation.

Strongly Held Therapist Values and Beliefs

 Therapists working in these collaborative language-based models have their
own beliefs and convictions. It is neither necessary nor desirable to abandon
these beliefs but it is difficult to listen openly to clients whose worldview
differs from their own.
 It is necessary, that listening nonjudgmentally can be a healing experience
for therapist and client alike. When faced with a client whose particular ideas
are abhorrent, a therapist should try to understand:
o how does it happen that this worldview makes sense to the client?
o Where would the client have gotten such ideas?
o Are there times the client thinks in other ways?
 As Tom Andersen notes, the therapist should not be the dominant voice in
the room, but neither should the therapist feel silenced as a person, any more
than the client should. All voices should be valued in the therapy room.

NORMAL FAMILY DEVELOPMENT

Some reflexive family therapists go to give the notion of development: Hoffman

states for a predetermined developmental path within any human group or for
any human individual, dangerously downplays both individuality and the role of
chaos. However, more narrative family therapists have offered rite-of-passage
suggestions for life passages common within a particular culture, embracing the
client’s perceived transitions. However, concept of “norms” and “stages” for the
collaborative language-based therapist must be tempered with a respect for the
client’s perceptions and for multiple interpretations.

PATHOLOGY AND BEHAVIOR DISORDERS

 John Weakland: a helluva lot more respectful than knowing better than the
client what ails them, which I think is the most basic comparison. And that’s
what the whole damn other psychiatric and psychotherapeutic scheme is
based on.”
 Harlene Anderson: “To my way of thinking, a problem does not have a
cause that needs to be discovered; it does not need to be diagnosed, labeled,
fixed, resolved, or solved... the traditional diagnostic processes and
categories are of little use.”
 Ben Furman and Tapani Ahola: “The term depression can be used to refer to
the condition known in psychiatry as major depression, but there are many
alternatives, such as down in the dumps or feeling blue. It is possible to
develop even more inventive names, such as doing one’s life inventory,
 hatching, or latent joy . . . perhaps we should start by giving this problem a
nice optimistic name.”
 Jeffrey Zimmerman and Victoria Dickerson: “[Therapists and clients] have
been subjected to normalizing judgments, and evaluated as objects . . .
furthermore, anorexia (and other psychiatric diagnoses) seems to reflect
many of the techniques of power that are in evidence when one group
dominates another: techniques of isolation, evaluation (through surveillance
and comparison), and promotion of a lack of entitlement to one’s own
experience.”

A dislike and distrust of conventional psychiatric diagnosis is found across the

collaborative language-based models. Yet given their emphasis on
collaboration, these therapists are often also not comfortable giving up the
possibility of collaborating with physicians and other mental health
professionals who do use diagnosis. Also, as Lynn Hoffman sagely points out,
even reflexive family therapists need to get paid and diagnosis is a requirement
of insurance companies. The resulting uneasy accommodations are a frequent
topic of discussion among collaborative language-based family therapists.

TECHNIQUES

The following techniques are common to all the collaborative language based
models.

1. Maintaining a curious stance: It may seem strange to think of curiosity as a

technique, but the ability to keep an open mind and convey genuine interest in
what the client has to say is central to keeping a collaborative conversation
going. A good therapist working in this model, when confronted with a
comment or a behavior he or she does not understand, will continue asking
questions until understanding is achieved. This is sometimes referred to as the
not-knowing position, meaning that the therapist does not act as if he or she
knows more than the client, but as if what the client has to say is truly
fascinating and the therapist’s best source of information. This is consistent with
a nonpathologizing approach, which downplays diagnosis and therapist
evaluations of the client.

2. Conveying respect for the client’s own resources: Equally central to these
models is the ability to convey that the therapist and client are a team, working
together to meet the client’s goals. Even in the more directive models, the client
should experience therapy as a partnership, not as receiving instruction from an
authority figure. The therapist conveys respect for the client’s goals, and for the
client’s ability to solve problems, and uses the client’s language whenever
possible.

3. Asking engaging questions: To keep the collaborative conversation going,

the therapist must ask interesting questions that “invite a client into shared
inquiry”. These questions should come from a genuinely curious, not-knowing
perspective. These questions should also utilize the client’s language.

4. Affirming and conveying hope: A long string of questions with no

comments can begin to seem like an interrogation, not at all what the
collaborative therapist wants to convey. To guard against this, to build hope for
change, and to create a healing therapeutic space for conversation, the
collaborative therapist is generous with what Lynn Hoffman calls the “three
A’s”: affirmation, affiliation, and appreciation. The therapist avoids blame and
negativity, and frequently points out examples of the client’s progress, hard
work, and/or courage in struggling with life difficulties. When it is possible to
interpret a client’s action in several different ways, the collaborative therapist
will choose to interpret the action in the most positive way. For example,
Furman and Ahola, consulting with a teenage boy whose parents disapprove of
his friends, suggest that the boy is trying to help his more delinquent buddies,
rather than that he is descending to their level.

In addition to these basic skills common to all the collaborative models, some
techniques are specific to each of the models.

1 .Reflexive therapists reflect. That is, they constantly wonder about their
own thinking, as well as the client’s, and they share their thoughts and reactions
with the client on an ongoing basis (being careful to stay consistent with an
affirming context).

2. Solution-focused therapists look for exceptions. That is, they direct their
own attention and the client’s attention to the times when the client is not
experiencing the problem. Their way of being affirming includes conveying
great optimism about these exceptions. To this end, solution-focused therapists
typically ask the miracle question—“What if you woke up one morning and
the problem was gone?”—to get the focus on the positive as quickly as possible.
They may also use scaling questions, asking the client to rate the intensity of
the problem from one to ten, in order to track even small progress from session
to session, and so expand upon it.
 4. Narrative therapists ask deconstructing questions. That is, they ask
questions designed to draw the client’s attention to larger social and cultural
issues. In addition, narrative therapists externalize, meaning that they are careful
to talk about the problem as a thing apart from the person of the client. For
example, a client diagnosed with anorexia would be asked how the anorexia
was terrorizing him or her to underline the point that the diagnosis is not the
client, but rather an annoying (or terrorizing) outsider. Narrative therapists also
look for exceptions, which they call unique outcomes. The difference is that the
narrative therapist prefers unique outcomes that are exceptions to larger social
and cultural patterns also, while the solution-focused therapist is content with
any identified exception. For example, a wife may notice that she and her
husband light less about housework when she calmly but firmly asserts her
belief that housework should be shared, but that they also fight less when she
gives up and hires outside cleaning help. Either exception will work for the
solution-focused therapist, but the narrative therapist would typically prefer the
first of these two exceptions.

In summary, it is worth stressing that all of these auxiliary techniques rely on

the central techniques of respect for the client's own resources, affirming, and
conveying hope, as well as the conversational skills of maintaining curiosity and
asking engaging questions. Research suggests that these central techniques,
“low tech” as they may seem, are actually the most effective interventions of
all.

RELEVANT RESEARCH

Research on these collaborative models falls into four general areas:

1. Case studies: individual case is viewed as its own research project and
compared with both reflexive and narrative family therapists, focus on
moment-to-moment one the client desires, and the client’s individual
story. This led to a rich library of case histories and videotapes.
2. Ongoing outcome surveys: clients are periodically surveyed to
determine their satisfaction with services. Clients are generally asked if
their problem has gone away or lessened, and if they were pleased with
the services received.
3. Controlled outcome studies: Considered the most valuable evidence for
efficacy by most funding sources, these have been in short supply for the
collaborative language-based models and are somewhat at variance with
 the premises of the models. However, the outcome focus of solution-
focused therapy makes it the most likely candidate for study using this
method, and the recent intense interest in solution-focused therapy has
indeed resulted in a small but significant number of traditional double-
blind experimental research studies in which solution-focused approaches
were compared with a control group or with another form of treatment,
and the outcome was evaluated not by the client but by the researcher,
using preestablished criteria. Fifteen of these studies were reviewed by
Gingerich and Eisengart. Of the fifteen research studies, one did not
clearly report posttreatment results for either group; thirteen reported
positive outcomes for the group receiving solution-focused therapy; and
only one did not report positive results. The study without positive
outcomes used high school guidance counselors given only very minimal
training in solution-focused therapy who may thus have been less than
clear on the techniques to be used. Of the thirteen studies that did report
positive outcomes, eleven permitted a comparison between solution-
focused and other models of family therapy. In seven of these eleven
studies, solution-focused therapy resulted in either more positive results
or equally positive results in less time than the comparison method. Thus,
solution-focused therapy has received recent empirical support.
4. Research across all models, which at present provides indirect support
for collaborative language-based models. The trio of Scott Miller, Barry
Duncan, and Mark Hubble have taken a leading role in the family therapy
field in systematically investigating factors in successful therapy
outcome. The three factors they (and other outcome researchers such as
Lambert and Bergin identify as most significant are
• extratherapeutic factors—the client’s own resources;
• relationship with the therapist—the client feels validated and affirmed
in the therapy context; and
• expectancy—the degree of hope generated by the therapy process.
• The technique of the therapist is also a factor, but a far less significant
one. This finding fits nicely with the beliefs of collaborative therapists,
who have long stressed respect for the client’s own resources,
affirmation, and conveying hope.
5. Client-directed outcome research: Most recently, Barry Duncan and
colleagues have begun a large-scale outcome research project, utilizing
both quantitative and qualitative measures, which uses clients as
coinvestigators, thus combining all four of the previously noted research
areas. Early results have been promising, as clients are able to identify
salient factors in their own progress and fold this back into their therapy.
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