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Making the Expert Disappear – Collaborative Conversations as the Author of Change

Luuk L. Westerhof, MSc Master’s in health Promotion. Licensed clinical specialist in family therapy. Licensed Social worker. Licensed Supervisor. Supervisor at VID (Vitenskapelig Institute Diakonhjemmet, Oslo) for Master grads students i Family Therapy.Certified Addiction Counselor. Certified International Master Instructor. Certified International Family Specialist. Certified International Drug and Alcohol Interventionist. Lecturer and Public speaker. Svenn Erik Knutsen, Cand.polit. Cand.polit. psychology pedagogy and sociology. Family therapist. Worked for the Norwegian BUP (Child guidance clinic). Worked as a lecturer and supervisor at HIO – College in Østfold, Norway. Licensed Supervisor, Lecturer and Public speaker. Abstract Working together with people in therapy is an intricate meticulous collaborative process, and its outcome depends highly on how the client feels he can relate to the therapist: the therapeutic relationship, the therapist’s attitude, and the language emerging and applied between them. In the collaborative therapeutic processes there is no place for an expert or unilateral power or inequality. All meaning as the basis for change and knowledge in collaborative co-creative therapy is arrived at socially and languishingly, and changes are reached at through renewable moments of interaction. From this stance, more appropriate and expedient narratives and changes, surfacespontaneously during the conversation. This perspective represents a non-expert therapist position since changes occur spontaneously and not always planned. The collaborative conversation as a social activity of being together, walking-together, talking-together, co-creating-together, based on equality between therapist and client is thus more likely, the author of more appropriate and desirable outcomes. Keywords: expert, equality, inequality, collaborative, conversation, power.

Some Uncomfortable Thoughts Towards the “Now” How a therapist ought to approach and treat his clients is a theme that has been extensively discussed in both, literature and media. This is thus indeed an important issue to dwell on, since clients are entitled to, descend treatment. Being together in helpful ways raises the question; “How do we, as professionals chose to be together with our clients in ways helpful to them?” (Wifstad, 1994). This ought to be a pivotal question when working with clients in diverse contexts wherein we are assumed to be of help for the client. From this perspective it also will be expedient to look at some parts of the social - and psychiatric help system. James Davies (Davies, 2014) mentioned that psychiatry is an increasing specialty, which operates with an increase of diagnosis based on insufficient scientific evidence. In addition to the increased use of diagnosis, GP’s, and psychiatrist are requisitioning large amounts of pill’s to their clients/patients even though their therapeutic effect is very disputable (Davies, 2014, p. 16; Gøtzsche, Smith, & Rennie; Kinderman, 2014; Kinderman, Tai, British Psychological Society. Working Group on Psychological, & Well, 2009; B. Whitaker, 2002; Robert Whitaker, 2010; R. Whitaker & Cosgrove, 2015). The question arises:

Has the biomedical model which includes psychiatry become so domineering that other alternative approaches are silenced?” In his book Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform” (R. Whitaker& Cosgrove, 2015) Whitaker askes the question“Why do people suffer more if medicines have become better and better?” In his book “Deadly medicines and organized crime : how big pharma has corrupted healthcare” Peter Gøtzsche (Gøtzsche et al.) refers to Allen Frances (chair of the DSM-IV taskforce) who in his book “Saving Normal” (Frances, 2013) askes the question,“if there stillare normal peoplearound, since normalis losing all purchase?”, and that there is a diagnostic inflation which occurs as a public health and public policy dilemma that urgently needs solving (p.112). James Davies (Davies, 2014) is concerned with the question ‘why is psychiatry doing more harm than good?’ This is a valid question and should kindle our curiosity yet doing so seems to be associated with discomfort for many. Is it maybe therefore, that many professionals avoid self- examination on how they are meeting - and are together with people in the therapeutic context? Will this reluctance to self-examination have implications for the therapeutic process? Literature informs us that it has, and that the direction of a therapeutic process, in high degree, is determined by, and depended on, how the professional is choosing to position himself. The position of the professional will contribute to how and where the problem is placed. The position will also influence the professional’s attitude in relation to diagnosis, manual-based-approaches and how that contributes to the pathologizing of an individual. Our understanding is, that within the biomedical model, the professional as the expert assesses whatallegedly is wrong with a person.

Too, the professional expert, determines how, and by what approach(es) and technique(s), intervention should be executed. Intervention(s) based on measures that the expert qualifies as best suited for “reparation” of that which is qualified as dysfunctional.

I.e., here the expert is the one making the unilateral decision as to what is “right” or “wrong” evidence-based knowledge. Our culture is conditioned for this kind of thinking and approach. In the 1950tieswe were introduced to systems-theory1 where they found it more expedient to place the problem within the family as a system, and that the different proponents of the system interacted with one another:change in one part of the systemleads to, and perturbed otherparts of the system (Minuchin, 1965, 1982; Minuchin, Auerswald, King, & Rabinowitz, 1964; Minuchin & Montalvo, 1967). In the field of family therapy, we were introduced to the structural-model by Salvador Minuchin, while the strategic-model (Minuchin, 1982; Minuchin, Chamberlain, & Graubard, 1967; Minuchin & Fishman, 1979; Minuchin &Montalvo, 1967) wasintroduced by Jay Haley (Erickson & Haley, 1985a, 1985b, 1985c; Haley, 1973, 1976, 1980, 1984, 1986; Haley & Hoffman, 1968). These two approaches are considered as “strategic techniques.” In addition to the strategic and structural approaches, the Milano-model (Boscolo, 1987) emerged from the systems-model. Both the biomedical - and systems-model operate from an instrumental therapeutic position -the expert- and intervene differently into client’s life. In the last 30-years, new forms of therapy have emerged, and hopefully, with new possibilities for more expedient therapeutic outcomes? These new forms for therapy developed alternative ways in terminology and implementation to different approaches (H. Anderson & D. Gehart, 2007). In literature these new forms for doing therapy are featured as the philosophical postmodern paradigm (Anderson, 1997; H. Anderson, 2002; H. Anderson& D. R. Gehart, 2007;Davis & Gergen,1985; K. J. Gergen,1991, 1994b, 2015; K. J. Gergen & Davis, 1985; K. K. J. Gergen & ProQuest(Firm). 2001).

The postmodern paradigm is a critique on what was former, the modern paradigm, which is connected to and associated with, natural-science, positivism, the expert-paradigm, diagnosis, placing the problem within the person, and instrumental thinking and approach. The postmodern paradigm represents the opposite, uncertainty, we develop within the space between us in language,dialogue and relationship (Anderson, 1997; H. Anderson & D. R. Gehart, 2007; Harlene Anderson & Jensen, 2007b; Bayer, Shotter, & ProQuest (Firm). 1998; Campbell, Shotter, & ProQuest (Firm). 2000; K. J. Gergen, 2000, 2015; K. J. Gergen & Gergen, 2008; K. J. Gergen, Schrader, & Gergen, 2009; K. K. J. Gergen & ProQuest (Firm). 2001; McNamee & Gergen, 1999; Shotter & Shotter, 2008). From a postmodern perspective we don’t represent reality but co-create in dialogue and language a consented reality. Thus, reality is created and recreated when people exchange ideas, thoughts, feelings i.e., while they are conversing together in dialogue. The modern paradigm represents a “universe” approach, while the postmodern paradigm represents a “multivers” approach. This is why Anderson (Anderson, 1997) features the postmodern paradigm as a umbrella which fathoms theoretical, philosophical, and scientific positions that have a lot in common.

All knowledge is socially constructed. I.e., it is questionable how exact knowledge and scientific objectivity is generated. One of the pivotal issueswithin the postmodern paradigm is the question as to how dowe construct our narratives; how do we understand and interpret what is perceived as deviant behavior, and, how, can we work with processes of transformation in ways more congruent with the postmodern paradigm? The way we chose to understand the challenges in life, will affect the ways in which we are together with people, i.e. inviting people to more attractive and humane processes, rather than the approaches that esteem people as a diagnosis that must be treated by an expert. From the Expert Position Towards Equality in Collaborative Conversations When people approach a therapist for help they often assume that this professional is the expert and solution to their problems due to his knowledge and experience. Many therapists assume the role of an expert in power of their alleged knowledge and professional experience.

Too, it may be considered an epistemological2 error to assume an expert3 position in therapy. Assuming a unilateral expert position is infecting and permeating the professional - client system with a unilateral position of poweraccompanied by assertions on what is false and truth, andwhat is the “right” way to go.

Assuming an expert position will easily disturb the therapeutic process since it repeals the experience of equality which is a concept among other things, in philosophy, sociology, and psychology, based upon the notions of equal treatment, equal access to resources, and similar concepts. In practicing collaborative therapy, the professional should develop the desire to abandon the expert position.

“The expert knows more and more about less and less until he knows everything about nothing.” – Mahatma Gandhi Adam Galinsky at Northwestern University studied the relationship between power and the ability to perceive people’s perspective. He divided the participants into two groups, each group was asked to do something different before the experiment. One group performed exercises that made them feel powerful. The other group partook in activities that emphasized their lack of power. When they brought them into the experiment they realized that those who got a sense of power became less able to perceive someone else’s point of view. The conclusion of the study was that there is an inverse relationship between how much power peoplefeel and how open they are to see other’s perspective. Feelingpowerful can backfirebecause it distortsthe messages and signals that client’s send you, and that you need to pay attention to when attempting to understand them (Galinsky, Magee, Inesi, & Gruenfeld, 2006).

The value of equality is of major importance in collaborative therapy. Equality contributes to a sense of agency4 (H. Anderson & D. R. Gehart, 2007; Hauge & Mittelmark, 2003; Jensen & Anderson, 2008; McNamee & Gergen, 2013). For instance, many mental health advocates have pushed for equal treatment of people diagnosed with mental conditions, and this includes participation in treatment decisions as well as an end to discrimination against those with mental health conditions (Green, 2015; Green & Tones, 2011).

A professional assumingan expert positionis often biasedin such a way that it will have negative directive consequences for the therapeutic relationship and its outcomes. Thus, the therapeutic process will not become much more than a mirror, reflecting the professional’s values, orientations, and attitudes. The therapist’s perception of the problemwill domineer the relationship between the professional and the person seeking for help.

At a clinic where I (Luuk) worked, one colleague once said in a staff meeting “clients have to understand that we are the experts.”To me this sounded like this colleaguewas biased in the sense that she strongly adhered to one specific intervention model thereby excluding and pushing to the background, other alternative approaches (Andersen, 1990). Not being insistently and unceasingly curios is something Cecchin (1992) warned us against (Cecchin, Lane, Ray, Keeney, & ProQuest (Firm). 1992). Cecchin stated that we never should “fall” in love with our hypothesis etc., since that causes us to lose our curiosity as a prerequisite for the ability to get our eyes on the “undreamed” possibilities, but that we often don’t register due to a lack of curiosity (Hertz,2013). The lack of curiosity easily promotes prejudice. Curiosity is a pivotal prerequisite in the meaning-making process. Meaning-making as a social endeavor (Lock & Strong, 2010, 2012), a interpersonal linguistic activity, and a prerequisite for voluntary change (Bruner, 1990; K. J. Gergen, 1982, 1997, 2001a, 2009a, 2009b, 2015; K. J. Gergen & Davis, 1985; Therapy as social construction, 1996).