Implications for therapy research

It has been argued that therapy needs to be guided by the available scientific evidence of effective practice (Yates, 2013). Evidence-based practice in psychotherapy has become equated with an attempt to develop a list of empirically supported therapies for specific mental disorders (Chambless and Ollendick, 2000). Some have argued that this dichotomous understanding of effective therapies (either supported or unsupported) is overly restrictive and simplistic, and that evidence-based practice is greater than a list of empirically supported therapies (Westen and Bradley, 2005). Narrow conceptualizations of evidence not only exclude potentially efficacious therapeutic approaches that do not easily lend themselves to more conventional methods of inquiry but may also contribute to a gap between science and practice by privileging artificial and highly controlled over real- life practice settings (Berg, 2019).

By examining therapy naturalistically as it unfolds in real-world settings, discursive research offers practice-based evidence, or evidence that is close to “actual” practice (Barkham and Mellor-Clark, 2000). It provides a distinct, conversational kind of evidence of helpful (and less helpful) ways of working with clients (Strong et al., 2008; Helps, this volume). Because discursive research examines in-session conversational evidence it can help clarify how therapists can practice in responsive ways, or ways informed by emerging responses from clients. Discursive methods of inquiry are not meant to replace more conventional ways of studying therapy but to complement them (Tseliou, 2018). Arguably, no single method can answer all possible questions about therapy.

Discursive methods are especially well-suited for the study of family therapy concerned with relationships among family members and between family members and therapists (Tseliou, 2018). Discursive scholars attend to both the broader context of meaning-making in family therapy and the immediate interactional context. Each therapy participant’s contribution to an interaction is seen as shaped by and shaping the actions and responses of their co-participants (Heritage, 1984). Within family therapy, discursive methods align particularly well with the concerns and premises of social constructionist therapies (e.g., narrative, solution-focused, collaborative), which are focused on meaning co-construction in therapy and on how power dynamics in a society shape and constrain clients’ self-definitions, experiences, and relationships. Thus, practicing family therapists can learn from this kind of evidence, and we make some suggestions for practice in Box 3.1.

Box 3.1 Practical tips

Practical tips for improving communication

  • • Reading or conducting discursive studies can help practitioners identify discursive practices involved in the actual “doing” of therapy (e.g., asking and responding to specific kinds of questions). Therapists can attempt to apply this discursive knowledge in their own work with clients and observe the immediate interactional effects of their communicative efforts.
  • • When thinking about “discourse” and its analysis, remember that discourse can involve micro-level attention to language (e.g., turns of phrase, the way questions are asked, turn-taking, etc.) and broader-level constructions (e.g., discourses or commonly relied upon ways of describing people or things)
  • • Some questions for therapists to consider:

о How do family members respond to each other? о What may be signs that their responses to each other are limiting rather than facilitating their conversation? о What assumptions about family members and relational dynamics seem to be at play in the interaction and how are they interactionally produced and advanced? о How do family members respond to my initiatives in our conversation?

о How can I notice times when what 1 offer does not seem to “fit” for clients, and collaboratively generate and renegotiate descriptions so they are more mutually agreeable? о What do family members’ responses tell me about a conversation’s direction? Is this direction coherent with the client’s expressed or displayed agendas and preferences?

Reflections: Implications for therapy practice

“In order to find the real artichoke, we divested it of its leaves.” (Wittgenstein, 1953, aphorism 164)

Learning about and conducting discursive research has shaped our work as therapists in significant ways. Wittgenstein’s aphorism inspires us in adopting a critical stance towards more conventional approaches to the study of therapy, which too often treat communication as an “add-on” to the real work of therapy - very much like how we may illusorily aim to find the real artichoke by taking away all its leaves. Most therapy researchers envision therapeutic phenomena (e.g., change, distress, relationships, self) as existing beyond and outside of language. Therapists’ and clients’ language (e.g., post-therapy reports, in-session interactions) are implicitly treated as a window into the heart of therapy. In contrast, as discursive scholars, once we came to see therapy as communication, it seemed relevant to focus on it analytically. Discursive therapy research treats language not as a resource to “get at” processes and outcomes of therapy but as a topic in its own right (Zimmerman and Pollner, 1970). Conventional systemic and psychological notions seemed much less mysterious when approached as conversational accomplishments of therapists and clients (Sutherland et al., 2013). For us, notions like therapeutic “impasses” can be seen as conversational stuck- nesses such as the patterns of blaming-defending that we showcased in this chapter. And therapists may unwittingly be recruited into participating within them - or critically and artfully resist such invitations by engaging in alternative, more “therapeutic” conversational practices. Through a discursive lens, such practices become observable and learnable.

From this view, we have transformed the question of “What’s the problem in this family?” into the following inquiries: “How are particular understandings or versions of the problem produced, what are the potential implications on clients (and broader professional practice and society) of advancing these versions, and which alternative understandings are we disregarding?” Discursive inquiry helped us become better sensitized to important aspects of our interactions with clients (Madill, 2015: Tseliou, 2018) and develop discursive awareness and resourcefulness (Strong, 2016). Through reading and conducting discursive studies, we were able to “step back from communications in order to see what is constructed in and from them” (Strong, 2016, p. 481).

Early in our development as therapists, we noticed that our textbooks and courses often emphasized what therapists were supposed to say or do. It seemed as though if we talked in some particular way (e.g., “That must have been tough”), clients would inevitably understand that we were performing certain actions, such as showing empathy or validating their experiences. We soon realized that therapy interactions do not necessarily go as expected; our conversations with families were dynamic and sometimes unpredictable.

Conducting discursive research provided us with a useful framework to look closely at the details of our interactions, including how clients responded to our intended interventions with minute verbal and non-verbal cues. We learned to slow down and check in with clients when their responses informed us that we may have missed something important. Discursive research methods have also helped us look closely at the dominant cultural ideas informing clients’ (and our) lives, attend to broader structures of oppression, and invite families to move beyond gender, racial, and other stereotypes (McDowell et ah, 2018; McGoldrick and Hardy, 2019). We feel better equipped to recognize times when we may be using our position as family therapists to “impose” our own ideas rather than collaborate with clients to create and negotiate understandings that are mutually agreeable. As such, adopting this framework has enabled us to take a more critical, reflexive stance on our practice, with greater awareness of how power can be enacted and challenged in therapy conversations (Guilfoyle, 2003).

From the family therapy literature, we learned that it is important for us to remain neutral and not side with selected family members. We were less clear about how to implement a neutral stance. Discursive inquiry offered possible conversational means of maintaining a neutral stance. We learned, for example, that speaking in generalities (e.g., “Some people find that ... Often this is what happens ...”) may be a way to challenge certain views or introduce alternative views without leaving clients feeling blamed or criticized. We also learned that rather than responding to clients ourselves (e.g., challenging, disagreeing, offering alternatives), we could ask others in the family to respond to them and build on their responses or introduce alternative views.

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