Exploring the practical potential of discursive research in family therapy

Olga Smoliak, Shari Couture, Joaquin Caete Silva, Marnie Rogers-de Jong, Ines Sametband, and Andrea LaMarre

Introduction

Talking is central to psychotherapy; psychotherapy itself has been described as a “talking cure” dating back to Freud (Marx, Benecke, and Gumz, 2017). While researchers and therapists have pointed out that talking is not the only aspect of therapy that contributes to therapeutic processes and outcomes (e.g., Benecke, Peham, and Banninger-Huber, 2005; Tschacher, Rees, and Ramseyer, 2014), talking remains the primary way of “doing” therapy (Marx et al., 2017). In family therapy, especially, talking can provide the route through which families’ concerns, experiences, and relationships are articulated, made sense of, and transformed. While there are frameworks delineating how talk therapy works (e.g., Marx et ah, 2017), there is room to explore the communicative and interactional aspects of how therapeutic change comes about - that is, how change is produced through talking and interacting.

Discursive approaches (e.g., discourse analysis, conversation analysis, critical discourse analysis) can help clarify the taken for granted means through which clients and therapists use language to accomplish therapeutic goals. Beyond a focus on the content of language, which is shared across most approaches to therapy, discursive approaches direct one’s attention to the process of therapists and clients talking together, that is, to how-’ language is put to use and what gets accomplished through such use. The focus is on how questions are asked and responded to and how' therapists join clients to manage professional agendas (e.g., for clients to shift aw'ay from mutual blaming to seeing their problems as rooted in their relational dynamics). Many therapists see language as either irrelevant to their w'ork or as a medium of communication peripheral to the “real work” of therapy, w'hich is presumed to transpire within clients or in their relational dynamics. Discursive approaches advance a different view of therapeutic change as transpiring through language use. Therapy talk is seen as producing alternative psychological or relational realities, not merely communicating or reflecting therapeutic processes occurring outside and beyond language use.

In this chapter, we will use the terms “discursive approaches,” “discursive inquiry,” and “discursive analysis” interchangeably. In our use of each term, we intend to offer a discussion of the merit of their common focus: the process conversational participants negotiate as they accomplish the work of therapy. Discursive inquiry entered family therapy in the 1980s (e.g., Gale, 1991: Gale and Newfield, 1992) and has experienced steady growth, evidenced by a proliferation of book chapters, methodological reviews, published studies, and special issues devoted to discursive work (e.g., O'Reilly et al., 2018; Tseliou, 2013; Tseliou and Borsca, 2018). Our overall aim in this chapter is to propose that discursive inquiry offers relevant and valuable knowledge to practitioners. Specifically, we discuss and illustrate how discursive inquiry can be useful to family therapists in addressing common practical dilemmas they may encounter in their work with families. We offer a brief description of discursive research methods and a selective review of how they can be applied to study family therapy.

Context and literature review

Discursive approaches share the premise that clients’ psychological and relational “reality” is not given, singular, or stable but created through social practices and interactions. Within the broad umbrella of discursive approaches to research, there are varied and multiple orientations to “discourse”; each strand has distinct aims, premises, and procedures. Conversation analysis (CA) is used to investigate how social interaction is organized in turn-by-turn linguistic sequences (e.g., Schegloff, 2007; Sidnell and Stivers, 2013). It lends itself to “micro” analysis of language that could, for example, highlight how asking a question in a certain way opens up or closes down what can be said in response. Maynard’s (1991) work offers a specific example of this. He used CA to illustrate how medical practitioners tend to deliver a medical diagnosis in an indirect way. This research showed how practitioners elicited clients’ perspectives on their concerns and then fit their diagnoses within clients’ descriptions and explanations. Maynard argued that this way of sequencing the delivery of a diagnosis helps bridge the gap between the doctor’s and the client’s views and increase the likelihood that the diagnosis is accepted by the client.

Discourse analysis (DA) and discursive psychology (DP) tend to focus on how language is used in real-life situations. DP scholars investigate how people practically manage and use psychological concepts (e.g., emotion, memory, agency, intent) and to what social, interactional aims (e.g., blaming, convincing, refusing) (e.g., Edwards and Potter, 1992; Potter, 2012). An example of a DP study is Edwards’ (1999) analysis of couple counselling. For

Edwards, emotion words are not the mirror image of inner emotional states but are rhetorical devices used by speakers. The same emotion word can be mobilized to accomplish different social actions in interaction. Edwards showed how one partner, Connie, described her partner Jimmy’s emotions of anger and jealousy as inherent aspects of Jimmy’s identity (i.e., he is a jealous and aggressive person). Jimmy, in contrast, described his anger not as a personality predisposition but as a sensible response to Connie’s recurrent provocations - her ongoing flirting with other men. The study highlights that DP offers a discursive antidote to conventional psychological conceptions of emotions as invariable internal states.

In contrast to micro-oriented approaches that amplify what happens at the level of concrete speaking turns, critical discourse analysis (CDA) takes a broader view, examining links between power and language. CDA's focus is on how societal power relations are established, reproduced, and/or resisted in and through talk and text (e.g., Wodak and Meyer, 2015). Sutherland et al.’s (2016) analysis of couple therapy offers an example of a CDA study. The researchers showed how partners in intimate relationships described their partner roles and obligations with reference to broader (normative or dominant) cultural prescriptions concerning gender and sexuality (e.g., there are only two genders, men should do X and women should do Y, men's sexual desire is privileged). They also highlighted how therapists can reinforce (and challenge) normative gender and sexuality through their responses to partners’ descriptions.

Each of these approaches offers insight into the nuances of language and its use in therapy. In order to argue and illustrate the relevance and value of discursive research for practitioners, we focus here on three practical questions or dilemmas family therapists commonly face when working with families. These are:

  • 1. How to help families move beyond “conversational impasses” where family members seem to be stuck speaking from different or incommensurable ways of understanding their situation.
  • 2. How to challenge or augment views presented as singular or ultimately correct (without being heard as blaming or critical).
  • 3. How to advance professional knowledge collaboratively or in ways that do not negate or disregard clients’ familiar understandings and preferences.

We offer conversational strategies that may help therapists to address these questions and dilemmas. We present extracts from various discursive studies, which in our view, help demonstrate the value of attending to discourse in formulating solutions to the aforementioned dilemmas. To select extracts, we reviewed existing discursive studies of psychotherapy to identify moments of interaction that can, in our view, capture the dilemmas we list above. Most examples we present come from initial sessions of family therapy, which are often concerned with “problem formulation,” or therapy participants co-developing and negotiating descriptions and understandings of concerns that bring families to therapy (e.g., what is “wrong” and who is responsible). Issues of blame and accountability, therefore, seem central in these initial therapeutic encounters and feature throughout our discussion.

For the purposes of illuminating specific discursive “strategies” or practices that will help therapists in their work, we focus on micro-oriented approaches to discourse analysis, namely CA and DA. However, it is important to note that CDA studies can provide key insights for therapists, particularly into the lives of clients living in a world that constructs them as problematic (think, for instance, of racist, sexist, ableist, and other “isms” that limit people’s possibilities for flourishing). Thus, while it is beyond the scope of our chapter to speak in depth to CDA studies, we draw the reader’s attention to studies of therapy that unpack sexist (e.g., Sutherland et al., 2016; Sutherland et al., 2017), neoliberalist (e.g., LaMarre et al., 2019), and biomedical discourses (e.g., Gaete et al., 2017; Sutherland et al., 2016).

Research conclusions Addressing conversational impasses

Family therapists often encounter different or even opposite accounts of family difficulties. Commonly, different members in a family position one family member (e.g., a child or one partner) as the source of problems or as someone to blame. Family members may expect therapists to join and validate their specific versions of “what is wrong” and “who is at fault.” However, the therapist’s role is to be “neutral,” or not to take sides (or better, to take all sides; Anderson, 1997). Thus, family therapists have the delicate task of balancing all views within the family, while inviting families to move beyond blame and individually focused explanations.

At times, family members can get stuck in a conversational “impasse” when each member is overly invested in their way of understanding a topic. Family therapists are often aware of how a particular view may contribute to the “impasse” by inviting defensiveness in another family member or other unintended relational consequences. Finding a compromise, or a mutually agreed-upon way of understanding and addressing an issue, may not be easy. Arguably, it is difficult to move forward beyond an impasse unless all views are “put on the table” and treated as valid and legitimate. Several strategies can be identified in the discursive literature for moving beyond these impasses. We will delineate selected strategies below. They include using questions, obliqueness, orchestrated talk, and humour.

 
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