Collaborative Therapy –Transformations Through Creative Processes

By, Luuk L. Westerhof, M.Sc




Abstract

Collaborative Therapy as a Postmodern approach has become a broad movement in the therapeutic landscape. Postmodernism has contributed to different ways in which people approach philosophy, litterature, and therapy. This article addresses how the therapist, from a postmodern collaborative stance can become expedient for -and with the client in creating transformation through creative process.


Keywords: Collaborative, Therapy, Transformation, Change, Postmodern, Modern, Truth, Realty, Expert



Some differences between the Modern and Postmodern approach in Therapy

Postmodernism is a critique of modernism, referring to a philosophical movement that embraces and includes the ideas of great thinkers, like Bakhtin, Lyotard, Derrida, Rorty, Foucault, Wittgenstein, and many others. Unlike the modernist approach, in which a person’s ideas and theories builds on one another, postmodernism gives a general critique of the underlying concepts, categories, and assumptions that constitute our ways of thinking about the world. Postmodernism as a critique questions the nature of knowledge and meta-narratives: universal explanations. Postmodernism is strongly represented in social science where it questions concepts, like reality, and the notion of the therapist as an objective observer of reality and truth (Anderson, 1997). The ideals of truth and self-have been the foundation of western culture for centuries (Anderson, 1990).

Harlene Anderson (Anderson, 1997) describes postmodernism as an invitation to reconsider many of the traditional premises about human nature, problems, and therapeutic relationships.

From a modern perspective the therapist position himself as an objective observer of his client(s). Psychotherapy from a modernist tradition is thus in high degree inspired by the medical model: a deficiency and deficit approach, and the therapeutic process as assumed to be analogous to a doctor’s treatment of a patient. From this stance it is expected of the therapist that he possesses expert knowledge concerning human nature and about the difficulties a client’ is striving with (Anderson, 1997).

The modern expert position brings with it privileged knowledge wrapped in expert language which often translates into hierarchical differences between therapist and client. The assumption is that the therapist “knows more” than the client knows about himself. Too, the therapist knows what is “really” going on in the clients life, and “knows” how people and relationships really “should be” to be functional or healthy (Anderson, 1997).

Therapy within a modern paradigm context often starts with psychological diagnosis that decides the goals of treatment. Too, the therapist decides which measures and what route is most fit to obtain problem-resolve. This means that the therapist knows what steps to take, what stages a client must undergo in the therapeutic process, and too, that he designs strategies that aim at obtaining goals. From a modern approach one expects of the therapist that he knows when therapy is mature for termination.

From a postmodern approach, the client is the one that informs the therapist on how he wants therapy to be, and in what direction therapy should go: the client is the expert of his own life! (H. Anderson & D. R. Gehart, 2007; H. Anderson, Jensen, & ProQuest (Firm). 2007). From a postmodern perspective, therapy is a collaborative endeavor. The client defines the goals of treatment something that is contrary to the modern approach in which the professional defines the goals. The postmodern collaborative context invites the client to define his goals for the therapeutic process, too he decides whenever he wants to pause or end the therapeutic process. The postmodern approach is thus more a collaborative process rooted in the “soil of equality.” The soil of equality (my personal definition) must be at the basis of all collaborative discourse and talk to downsize hierarchical distance between therapist and client. Too, it contributes to transparency as a prerequisite for exposing biases. Therapy is thus not some sort of cure or evidence-based treatment, but a collaborative co-creative conversational process -a joined venture- through which meanings and alternatives appear because of therapist and client cooperation. A postmodern collaborative therapeutic process is thus an endeavor of shared inquiry.


Collaborative Therapy: Routes towards Transformation

Collaborative therapy originated through the work of Harlene Anderson and the late Harold Goolishian in Galveston, Texas (H. Anderson, 2001). Collaborative therapy is among other things concerned with how to create expedient conversations in which the client feels he belongs. Anderson postulates that in any conversation there are at least three dialogues going on: the external one, between the participants, and the internal dialogues that each participant has with himself (H. Anderson & D. R. Gehart, 2007). In collaborative therapy self-disclosure is an important part of the process as a means of sharing inner dialogues: “make invisible thoughts visible” (Anderson, 1997; H. Anderson & D. R. Gehart, 2007; H. Anderson & Jensen, 2007). This approach opens the opportunity for the therapist and the client to share ideas, questions, or suggestions. Too, it opens possibilities to respond to them. When the client is putting his inner dialogue into words, he then “becomes public” and through “being public” the collaborative dialogue keeps its momentum. From this perspective one can appreciate collaborative therapy as a dialogical process, a conversation, language, and a transformative activity.

The endeavor of the collaborative therapist in becoming expedient for the client lies among other things in his ability to share his inner dialogue (H. Anderson & D. R. Gehart, 2007, p. 50) with the client, something that makes his invisible thoughts visible and allows him to share his ideas, suggestions etc., and the client has the freedom to respond. Putting the inner dialogue into language is becoming and “being-public” and helps the therapeutic collaborative dialogue to stay in motion. When the therapist and the client are in conversation and dialogue, they are in a collaborative process that can lead to the acquiring of transformation obtained through language and relationship. The acquiring of transformative power can easily become obstructed when either client og therapist puts a duration-limit on the collaborative process. Therefore, let the client decide if he wants to come back for a new session. After my experience, there are clients that only seek the help from a therapist one-time, thus needing one-single consultation, while other clients come for a longer duration of time.

In collaborative therapy there is no such thing as an assessment phase that precedes or is separate from the therapeutic process; rather assessment is a part of the collaborative process itself. Collaborative therapy is to be understood as a non-directive approach and has no assessment phase: assessment as juxtaposed with intervention. The accumulation of information with instrumental intent, will affect the collaborative dialogue and process, too, it will affect the clients inter-subjective experience of the collaborative process as well. When a therapist attempts to acquire information that the client is not ready to share with him, it than may lead to evoking unwanted memories, stirred up feelings, but too it may contribute to clarification. Key is at any time to show respect for where the client is at, emotionally and mentally, and what he is prepared to share and talk about (Andersen, 1990; Andersen & Seikkula, 2005).

The late Norwegian psychiatrist Tom Andersen (Andersen, 1990) was very clear on this topic: Don’t talk about the unspeakable! Instead of assessment being a phase preceding the therapeutic process, assessment is an integral part of the collaborative therapeutic process.


Partners in Conversation

In collaborative therapy all participants become partners in conversation, engaged in collaborative relationships and become partakers in dialogical conversations (H. Anderson & D. R. Gehart, 2007). The collaborative therapeutic process is thus reciprocal in nature. John Shotter (Shotter, 2008, 2010, 2011) talks about “witness-thinking,” which is to be understood as a form of reflective interaction that involves coming into living contact with an other’s living being, with their utterances, their bodily expressions, their words, their works” (H. Anderson & Gehart, 2007: 45).

Collaborative therapy is thus about creating space for the client’s voice to be heard. A space serving as a meaning emergent property of “coordinated action” (Gergen, 2015, p. 145). It is when the client can vent his voice that the construction of meaning can take place within a collaborative process that can assume expedient outcomes for the client.

Meaning is thus not a fixed property but rather an emergent reflecting the dialogical quality between client and therapist (Shotter, 1993). Since the construction process of meaning is unpredictable, to respect space and time are inevitable features to adhere to for both client and therapist. Within collaborative therapy, no timeframe is set as to how many sessions a client needs: allow the client to decide for himself - some come back for multiple conversations while others will not.

I suggest that the therapist often reflects upon the question: Who is steering the process? Being in Collaborative conversations requires craft in navigating – who is steering the boat? To be curios on the question ‘do I as a therapist really know what is best for the client? – as a metaphor for steering. I think that reflecting over a question like this will prevent one from chocking the creative collaborative process, something that easily happens when space for expressions and creativity become to narrow or eroded from the process substituted by ideas like, I know which way to go, narrowing space and expressive freedom.


Collaborative conversations – A different Protocol

Continuously we must remind ourselves that collaborative conversations are a different protocol, it is larger and more encompassing than the more instrumental approaches: a collaborative approach contributes to fundamental identity shifts that are taken place in the collaborative therapist and client. In the early “prehistoric” days of mental health services and treatment one drilled holes in the skulls of people for the sole purpose of casting out evil spirits something that revealed a severe power issue: “who defines that someone else has a mental deficiency?” i.e., who sits with the upper hand? And just as the healers of that time who believed to have enough expert knowledge to cure a person, todays modern therapists still are the assumed expert on people’s problems.

Maintaining and expanding dialogical space has to do with letting the client have enough input in the therapeutic process, and then especially in the realm of where and what direction he wants the collaborative process to go. Dialogical space will be jeopardized when unspoken hierarchal issues stays unaddressed.

Within many therapeutic encounters, the therapist assumes a “guru” status who directs the therapeutic process. This practically means that when a therapist prefers cognitive therapy, then that is what the client assumingly gets. And like with all therapeutic approaches, sometimes it works sometimes it does not.

Maintaining the collaborative “spirit” and the dialogical space is about an emerging meta-approach to therapy that the client leads, not the therapist, to unprecedented degree. Maintaining a dialogical space is thus depended on an egalitarian relationship between the collaborative therapist and his client. Sometimes this means that a therapist must reevaluate his identity as a prerequisite for the obtaining of an egalitarian relationship. For some this engenders change in professional identity, from being the expert in the room to be a highly valuated co-worker – a co-constructor of meaningful outcomes.


Change versus Transformation

In therapy we often talk about change as the goal for our togetherness. Yet there are pivotal distinctions between change and transformation. Distinctions that capsulate different implications in a collaborative process. For instance, talking about change needs some familiarity with the current situation. The past serves as a fundamental reference point, and actions referring to alter what already happened. Change can be small and incremental, yet it is something that is constant monitoring and performs maintenance. Change is thus assessing the past, comparing it to the present and deciding the ideal future state from the current state. Successful measurement of change is how much better the future state is from the current state. Change is about applying external influences to change actions to achieve desired outcomes.

Transformation at the other hand is an assertion that someone’s actions today create his future tomorrow. The future as being free from constraints of the past. Within the frame of transformation, a person designs future and ways to bring it about. This means that within the concept of transformation there is no describing the future by referencing the past as being worse, better etc. Transformation is a fundamental interior upheaval of your beliefs of why you perform certain actions. Contrary to change, transformation does not need external influence to maintain, and due to its fundamental nature, transformation is esteemed as more permanent.


Truth and Self

The postmodern critique of self is amongst others related to theories of “truth.” The postmodern stance promotes the thought that it is impossible to grasp or obtain pristine truth about self, nature etc. Attempting to find some essential truth is therefore a misguided goal (Rorty, 1999). When absolute truth is rejected so is an authentic true self. The postmodern paradigm hold the idea that multiple selves are socially constructed in the context of relationships and language (Anderson, 1997; H. Anderson & D. R. Gehart, 2007; Gergen, 1991). In conjuncture with this concept, it is impossible to say that there is one specific “right” route towards transformation. Creating expedient routes for transformation can be thought of as “moves” from universe to multivers: from singularity to multiplicity. It is when we are socially engaged in collaborative togetherness and conversation that possibilities for transformation can emerge. Truth and self-oscillate where ever social interaction and exchange of language takes it.

What often stands in the way for transformation is the adherence to the idea of transformation being some sort fixed singular structure, as this too is the problem with the construction of selves and truth (McNamee & Gergen, 1999, 2013). Selves and truths are continually constructed in the contexts of social activity, dialogue, and relationship. Thus, a client behaves differently in different settings and contexts because the relational and dialogical contexts create different selves. This means that the client, as any other human being, has many relational constructed selves. To create transformation needs having multiple selves adaptive (Gergen, 1995).

The therapist is a peer facilitator in a joint-venture of constructing meaning and transformation. This means that the client must trust his relationship with the therapist and vice versa: trust as a prerequisite for meaning and transformation. The client and the therapist must trust that the relationship between them withstands critique whenever they feel that the process is not going the way they think the process should go, without being afraid that this will derail their collaborative meaning making process. Feedback than, can be appreciated as an asset for shifts towards new and more desired directions. Amongst other things, what matters in collaborative conversation and process is getting better: creating, together, meaning and transformation as a prerequisite for expedient transformations. Reaching meaningful transformation, sometimes needs “courage” to go in directions the therapist and client know nothing about without having to fear that their trusted ways of working and moving together gets dismantled.




The Collaborative Relationship

Within collaborative language the idea of alliance is not widely used. Harlene Anderson (H. Anderson & D. Gehart, 2007) describes the relationship between therapist and client as being conversational partners. The collaborative therapeutic process considers the client as an expert over his own live. Harlene Anderson coined the idea that the client is the therapist’s teacher (Anderson, 1997; H. Anderson & D. Gehart, 2007). This idea entails that the therapist respects, honors, and privileges, at any time, the client’s reality (i.e., story, words and beliefs). This implies too, that the therapist honors what story, or parts of it, the client choose to talk about (Andersen, 1990; H. Anderson & D. Gehart, 2007, p. 46). Key in reaching transformation and more desired therapeutic outcomes is the acknowledgement of the client as being the expert over his own life, resources, problems, or solutions. The expertise of the therapist is rooted in his ability to establish and fostering an environment and conditions that, in a natural way, allures the client into a collaborative relationship and generative conversational processes (H. Anderson & D. Gehart, 2007, p. 47).

Within the collaborative relationship communication is applied as a way of orienting and navigating in an ever-changing-and-complex world (Shotter, 2014). The therapist and client coordinate and adjust their language and activities in correspondence to each other. Being in a collaborative reciprocal relationship needs being sensitive to one another’s needs and feelings. This too entails that the therapist must accept that he does not have direct access to his client feelings, thoughts, story etc., and vise-versa, but that responses are responses to the responses of the other, meaning that nothing can be taken for granted.

Therefore, within a collaborative relationship, collaborative partners invite one another to conversation wherein they can reveal their intentions, feelings, etc. We cannot predict one another’s response, that again depends on how we respond to one another’s invitations (Shotter, 2014). Bakhtin describes this process as follows:

“(…)the speaker talks with an expectation of a response, agreement, sympathy, objection, execution, and so forth…” (Bakhtin, Holquist, & Emerson, 1986).

The late John Shotter writes: “Words are not simply about a circumstance, but arouse anticipations as to how next one might relate oneself to it, thus to move around with it.” (Shotter, 2014, p. 102). This means that we affect one another, in one way or the other, when we are communicating, this means too, when we do not respond on the other one’s invitation’s (ibid).


Being in a collaborative relationship entails Assuming a “Not-knowing” position

The client as being the expert, or a teacher is related to what has been a controversial proposition of narrative therapy: the therapist maneuvers’ himself and works from a position of not-knowing (H. Anderson & D. R. Gehart, 2007, pp. 187-188). Many misunderstand this concept, thinking that the therapist fools the client by asserting that he does not know anything. Yet this is a misconception: the not-knowing position does not mean that the therapist does not know anything, that the therapist is like a ‘tabula-rasa’ – a blank screen. Anderson (2005) refers to not-knowing as:


the attitude and belief that the therapist does not have access to privileged information, can never fully understand another person; and always needs to learn more about what has been said or not said…not-knowing means the therapist is humble about what she or he knows. (p. 501)


Taking a not-knowing position invites to explorative endeavors in whatever the client presents as being his situation and reason for coming to therapy in a curios fashion, encouraging a process of “mutual puzzling” (Anderson, 1997). A not-knowing position will help the therapist in not understanding too fast, something that will eliminate curiosity (Cecchin, Lane, Ray, & Wendel A.. 1994; Hoffman, Cecchin, & ProQuest (Firm). 2003). Instead, the therapist allows ideas to appear through dialogue. From this vantage point one can appreciate that there are no certainties, instead, all still is open to new perspectives, concepts, meanings, etc.


Uncertainty

Uncertainty and not knowing are like a hand in a clough. It is impossible to know a priori where a conversation or process will lead and where it may end. This is due to the generative nature of language. We do not know what we think before we talk, thus, unknown ideas emerge within the context of collaborative ‘talks’ (H. Anderson & D. R. Gehart, 2007). This means too, that we cannot think of causality in human interactions, due to the postmodern view of language.

There is no room for predictions within collaborative conversations meaning that the therapist cannot predict what the client will say and vice versa. Within the context of collaborative conversations to obtain desired therapeutic outcomes and transformation, the therapist approaches the conversation as a unique setting and situation, and this includes what the client brings into the conversation.

In contrast to the more strategic approaches, from a collaborative vantage point, the therapist does not intend to provoke any change throughout his interaction with the client. One of the reasons why transformation is preferred over change is because change in psychotherapeutic tradition and culture has the connotation of causality: one goes from one state to another (H. Anderson & D. R. Gehart, 2007). Harlene Anderson says; transformation alludes to the fluid movement in our lives while it preserves a sense of continuity (ibid).



Crucial factors in promoting transformation in collaborative therapy

The former leaves us with the question; “What are the most crucial factors that promote transformation in therapy?” Harlene Anderson (2006a) states that the two most crucial factors are collaborative relationships and dialogical conversations:


Shared inquiry distinguishes dialogical conversation. Shared inquiry is the mutual process in which participants are in a fluid mode and is characterized by people talking with each other as they seek understanding and generate meanings; it is an in-there-together, two-way, give-and-take, back-and-forth exchange. (Anderson, 2006a, p. 15).

Dialogue and relationship are a pair, they are mutual dependent on each other because conversations generate relationships and vice versa (Anderson, 2006d). The collaborative approach revolves around the process of conversations, not their content. Collaborative conversation holds no preestablished agenda on what must be talked about in therapy. Instead, topics appear in conversation. The collaborative therapist avoids considering the client as a representative of any category, instead he seeks ways in which he can set up a unique relationship through collaborative dialogue with the client.

Anderson (2006c, p. 57) says that the main question in postmodern therapy is “How can professionals invite the kinds of relationships and conversations with their clients that allow all participants to access their creativities and develop possibilities where none seemed to exist before?”


Truths are created, they are not discovered

In contrast to the modern paradigm in which people are esteemed as being capable of discovering objective truths about reality, the postmodern paradigm is saturated by the idea that people create truths, they do not discover them (Anderson, 1997; H. Anderson & D. R. Gehart, 2007; H. Anderson et al., 2007). Postmodernism can thus be understood as a philosophical approach that critiques and rejects, traditional, modernist assumptions about truth and self (Anderson, 1990). Traditional counseling is traditionally founded on modernist assumptions (Hansen, 2002).

Replacing modernist assumptions with postmodern ones has direct implications for collaborative therapeutic process. One of these implications is the modernist view on truth as being discovered while the postmodern collaborative approach emphasizes on creating truth together (Anderson, 1997; H. Anderson & D. R. Gehart, 2007; Gergen, Schrader, & Gergen, 2009). Within the modernist paradigm the therapist will think that he has discovered that a client is irrational in his thinking about e.g., relationships and that this is the true cause of the client’s struggle with fear of abandonment. After that the modernist therapist has revealed this truth, he will start the process of helping the client to reframe his cognitions that ignites and fuel the fear. The postmodern approach, however, reject the notion that there is some truth about the client to be discovered. Within the postmodern paradigm the emphasis is more placed on how we, together, can create new and helpful perspectives. Solution-focused therapy, for example, aids the client in constructing new solutions for their problems (De Shazer, 1985). Likewise, narrative therapy advocate constructions of new explanatory narratives that facilitate the client’s healing and betterment (White & Epston, 1990). From a postmodern perspective, the emphasizes is placed on the creation of meaningful and helpful structures, and not on the discovering of static psychological truths, something that is the case in modernism. The postmodern focus is more on what works rather than on what is supposedly true.


Dialogue – a human construction not correspondent with reality

Peggy Penn (Penn, 2009) describes therapy as an activity of connected voices. Its crucial, how we “put words on” our experiences, feelings, thoughts etc. Our language in dialogue is not just concerned with how things appear in this world, in the way they express themselves, dialogue serves not just as a representation-reference, but too as relational responsive (Shotter & Shotter, 2008). When client and therapist are active involved in dialogue, they are present and active with expectation as to what is about to happen, because of their dialogical togetherness. Thus, their dialogues are not just future-oriented, but too relational-oriented (Bachtin & Holquist, 2000).

The oscillation of activity between the therapist and client in dialogical process evokes “differences” in self and the other. The back-and-forth-activity of e.g., words, thoughts, feelings, stories are meant to evoke changes in one another’s inner-dialogue. These changes appear in dialogical activity: when therapist and client are “together-with”, “talking-together”, “feeling-together” and so on. In sharing narratives, therapist and client contribute to the expansion of the dialogical process, helping it to assume and develop creative transformative momentum and strength. When we take part in dialogue, “words spoken are half yours and half mine” in that every word is oriented towards an answer, where it is affected by the answer given. The client and therapist, borrow, use, expand, and combine each other’s language helping one another to form their own discourse (Penn, 2009, pp. 51-52).

Dialogue is a human construction not correspondent with reality; reality is created in dialogue between therapist and client, a process where voices are melting and merging together. Dialogue thus, is a powerful reciprocal creative process where client and therapist reflect on each other’s words. In addition to reflecting on one another’s words they may add their personal ideas – thus making them personal (Andersen, 1990). Dialogue is not necessarily meant as a means for reaching agreement - being in agreement can serve as a pause for utter reflection on what therapist and client are agreeing on (Weingarten, 1998). It may prove to be expedient to pause and reflect whenever one feels that the other is holding-back his thoughts and feelings.

The stories the therapist and client share with one another serve as a basis for development. A development that reveals new possibilities through narration and dialogue, and where meaning and new understanding is created in collaborative interaction and communication wherein the utilizing of one another’s stories can become a meaningful and expedient transformative process. Thus, new possibilities emerge through the telling of stories.

Collaborative therapy is thus a nondirective approach that preserves the genuineness and realness as essential prerequisites for therapeutic growth towards transformation (Rogers, 1990). Partaking in collaborative therapy as a road to transformation means that the various aspects that are coming up, are not separately: they are not discrete events, rather they mingle and shade in one another. Through words and actions, the client develops ownership to the collaborative process - it is his to use, take responsibility, seizing the opportunity as a prerequisite to be himself: the person he feels himself to be comfortable with at any time.

When the client takes responsibility for bringing himself, he too, then, accepts the responsibility for working upon whatever he is striving with. The client signifies that he needs help when coming to therapy, the therapist, however, must emphasize the fact that he hasn’t the answers to the client’s challenges -and/or problems, but that the collaborative process between them possess transformational potential.

Spontaneity emerges an important feature in collaborative dialogue: the free expression of feelings, ambivalence and so on regarding what the client experiences as being his problem -and/or challenge in life (Anderson; 1997; H. Anderson & D. R. Gehart, 2007; & Rogers, 1990). The spontaneous client-therapist interaction as a precondition for freeing creativity in dialogue. Spontaneity in dialogue is thus not something static, but rather creates a context which is fluid and dynamic, so that the dynamic interaction creates a salient context for the client and therapist to perceive, detect, process and respond. This is extremely relevant because as the range of participatory activity increases, so does the opportunity to create new meaningful understandings.

Spontaneous collaborative interaction solicits collaboration between client and therapist establishing and reinforcing a dynamic relationship which is social in nature, and brings with it interactional benefits through collective interactions, e.g., the sharing of ideas and views in real time. From this vantage point, social and verbal interaction in the collaborative dialogue become important resources for the creation and construction of generative thoughts and ideas as a prerequisite for transformation. Thus, when client and therapist are joined together in collaborative dialogical activity they too enjoy the rewards of a joined and shared outcome.




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