CYBERNETICS & HUMAN KNOWING

A Journal of Second Order Cybernetics & Cyber-Semiotics

Volume 5, No.1 1998

Review of Harlene Anderson: The Therapy of Dialogical Possibility

New York, Basic Books, 1997, $38,00 USA. ISBN 0-465-03805-0, Harbound. 308 Pages - References and Index included

By Mariaelena Bartesaghi

What would it mean for psychotherapy to be conversation?

The provocative implication that therapy, as it now stands, is not conversational-though the author insists it could be-is the focus of Harlene Anderson's most recent book. Anderson has been a conversational partner of her clients, students and colleagues at the Galveston Family Therapy Institute (which she co-founded with the late Harold Goolishian) for twenty-some years, and the critical significance of this question is revealed in the way she chooses to begin her own answer to it.

The book opens with an account of failed the-rapy, in the form of a letter written to the author by a Swedish family prior to their consultation. In the narrative of the family's painful, lengthy search for a professional who would actually "listen" to their daughters suffering from anorexia, someone who would not operate under the a-priori supposition that they knew more or knew best, Anderson hears a sincere appeal. The rest of the book is a response to this appeal, and the beauty of Anderson's answer is that she offers her response as a whole person, primarily as a human being, and, secondarily as a theoretician and practicing professional in the field of psychotherapy. Indeed, the author strives to re-articulate the impasse engendered in the dichotomy between the two halves of this whole as a linguistic issue, one of "technique taking precedence over person."

Anderson contends that it is the use of medical, specialized language that leads both therapist and client to occupy conversational positions which close off, rather than open the door to a mutual exchange. In contrast, she allows the pages of her book to become a space for opening up the conversation on therapy, and adopts conversation as the very metaphor for the endeavor. This accomplishes three important things. First, she reveals the institution of therapy-and this includes the brand of family therapy that evolved from systems theory and (first-order) cybernetics-as a vestige of the modernist tradition. Second, adopting the questioning, tentative stance offered by postmodernism, she offers an alternative to modernist tenets of therapy as a medical endeavor, whereby a professional is called upon to "fix" a problem by imposing a solution from a third-person perspective of being outside the immediate conversation. This stance, which Anderson presents in her own collage of hermeneutics, narrative theory and social constructionism, can best be described in terms of a drive to open up the certainty of monologic thought on the matter of "problems" in therapy to the alternative-a space where problems are not "held" by the client and "solved" by the therapist but dis-solved in reciprocal and open interaction between the two. Third, she offers a glimpse of a dialogical construction of human beings as beings in conversation, where the conversational metaphor entails reciprocity, accountability and possibility.

What struck this particular reader is that the author accomplishes all this in a way that speaks not only of her integrity but as something else she exudes, which I can only describe as grace: her tone is never polemic, her suggestions never dogmatic, her first-person narration never affected. She intersperses theory with bits of session conversations, if not entire sessions, and a significant portion of the book is dedicated to insights offered by her clients. Unlike anything I have read before, Anderson's postmodernism is not theory but lived experience. She includes excerpts from fiction, and tidbits of herself as a person-how she perceives herself, and how others perceive her (recounting her exhaustion after a trip, her frankly emotional response to a client's story, and the experience of being described as a "boredom-making machine" at a conference). Anderson clearly offers an invitation to her readers, to read her book as they please, according to what they wish to get out of it.

For a postmodern thinker to offer a negative appraisal of modernism is of course nothing new. However, for a therapist such as the author to do so is a bold move that involves questioning the very essence of the overarching therapeutic model-be it that of traditional psychoanalysis, the wide array of behavioral or cognitive schools of individual therapy, or for that matter family systems therapy, which grew out of a desire to broaden the focus from the individual to communication processes between individuals. Anderson's contention is that what needs to be addressed is the very essence of therapy as a therapist-led endeavor, yielding therapist-determined possibilities. Hence, she challenges the mechanistic metaphor that informs the entire enterprise: namely, the entailments of a therapeutic metaphor that constructs clients as observable/knowable machines with a deficiency or problem in their mechanism; a specialized deficiency-based scientific language for the accurate description of a behavioral and emotional reality, which exists as a tangible referent of its linguistic construction; and, most importantly as far as the author is concerned, a privileged knower trained in the process of inquiry-extracting the right information-into the machine, the end result of which should optimally bring (read: if the therapist is competent and skillful) localization of the problem and provision of a solution or fix.

The mechanistic metaphor described above can only be afforded by a modernist idea of language, which, in the words of Richard Rorty, serves as a "mirror of nature." If language is considered as a mirror, then the essence of such constructs as "mind" and "self" will be fixed in words of pure denotation, and given a tangible existence outside of the language itself. This language, which is the monologic voice of scientific theory, cannot be meant for conversation-a first on second-person endeavor that requires participants to be within it-but only for observation and classification, and closure of conversation by an outside observer/knower.

In the mental health field, this practice of observation and classification (or, as Anderson proposes we should conceive of it, the closing off of all possibilities for alternative interpretations) starts before the session proper with the clinical chart. The chart immediately enables-or rather, constrains-the therapist entering the session to be primed for gathering linguistic cues that will provide explanations, in the forms of symptoms, for the disturbances listed on the chart. In turn, this narrowing of possibilities will lead to the formulation of a diagnosis and-in the best of all possible worlds-therapeutic interventions, which will affect change in the form of a cure that restores optimal operation by pointing to the source of trouble in the patient-machine. Anderson convincingly argues that this process is a perfect circular system for the reification of expert knowledge. In actuality, it produces knowledge that she describes as "the delusion of understanding or the security of methodology."

Anderson includes the first-order cybernetic view of Batesonian-inspired therapy in this model, which-by conceptualizing families as closed systems resisting change-did no more than move the focus of pathology from the individual to the family. This places the group of therapists known as "the team" in the position of hierarchically superior observers, behind the traditional one-way mirror, seeing but not seen, privileged and unaccountable. The language of this brand of therapy centers on the therapist-client conflict: clients are seen as opponents to the therapist who must, in effect, beat them. Families are said to "resist" change, and display "attrition" to the therapist's "strategic" "interventions." Ironically, if change does not happen, it is the therapist's skill that is at issue, rather than a breakdown inherent in the therapist-client relationship.

This is a juncture of the book where Anderson does not mince her words. In a virtual response to critics of the postmodern as an apolitical, anything-goes theoretical attitude she writes that:

the dominant voice, the culturally designated political voice, usually speaks and decides for marginal populations-gender, economic, ethnic, political and racial minorities-whether therapy is indicated and, if so, which therapy and toward what purpose. Sometimes unwittingly, sometimes knowingly, therapists subjugate or sacrifice a client to the influences of this broader context, which is primarily patriarchal, authoritarian and hierarchical.

True to her theoretical stance, Anderson proposes no "cure" or solution for this, but an alternative way to do therapy as a "mutual endeavor toward possibility." This is presented through a metaphor which resounds as a leitmotif of her work: space. What she means by space is indeed the crucial feature of the Anderson and Goolishian therapeutic approach, presented in the many articles they published as a team prior to this volume. Space entails the withholding of the therapist's pre-conceived specialized knowledge in order to allow for a collaborative conversation with clients in which new meanings are free to emerge. It is therefore the space for a dialogical conversation.

Anderson draws upon the idea of dialogue first introduced by linguistic philosopher Mikhail Bakhtin in his analysis of Dostojevsky's fiction, and elaborated by social constructionist thinking on the potentialities of a conversational construction of human interaction. While monologue is the master narrative of modernism and the voice of the therapist's authority to silence client voices, dialogue involves an idea of reciprocity and equal accountability of participants, and of the interaction between them as a generative process of self-and-other enrichment through openness, reflexivity and collaboration. It is at its core a deeply ethical and moral vision.

While Anderson embraces the dialogical vision, she also stops short of its inherent potential for self-invalidation. That is, if dialogue were to become a normative condition, its very tenets would be sabotaged. As a dialogic thinker, she intuitively resists the notions of "problems" or the closed intelligibility offered by diagnostic descriptions. As a conversational therapist, she does not veto her clients' choice to adopt the very language of deficiency she wishes to undo.

In Chapters 6 and 7 Anderson details her task as a therapist-participant in conversations with her clients by describing the therapeutic stance of "not knowing." What the therapist should not know, and indeed should prevent herself from knowing is anything that cannot be created by therapist and client from within the conversation. Because Anderson, as the therapist, is "inside, and not outside, the process (she) is trying to create" all that she is required to know is how to keep the conversation going. Conversation in this sense is an elaboration of Shotter's idea of "joint action"-a languaging that proceeds moment to moment, of which the ultimate outcome is unknown and always open to be affected by participants.

Anderson describes the not knowing stance as one of freedom. Once the therapist is liberated from the constraints of having to control the conversation, the space is opened for creativity, trust, and problems to be dis-solved by alternative venues of self-narration. The "self" of the client is a narrative that emerges in collaborative conversation with the therapist, and with it the possibility for reconfiguration if so desired. If change should happen, it will involve a change for both parties as contributors to the dialogical narrative. What is also advocated here is an abandonment of medical language in favor of word choices that do not privilege third-person or meta observation. What replaces it is an I-Thou relationship which is only possible if the therapist is to be a true conversational partner. In dialogical space there is no need for agreement, for that too may endanger dialogue, no absolute claim of understanding the other, but rather humility, ambiguity and what she aptly refers to as "courage for uncertainty." As I see it, it is the courage to reformulate the entire set of expectations of what therapy is all about.

On this note, if there is something that I feel is perhaps lacking in Anderson's account, it is something that I have encountered almost without fail in my brief forays as a participant-observer of the therapy process. Clients dislike uncertainty as much as therapists. They come to the therapeutic encounter wanting answers. Although they do not wish to be condescended to, they often rate the ability of their therapist in terms of his or her ability to pinpoint the reason for the problem that brought them to therapy in the first place. Perhaps Anderson might have given more space than a brief paragraph to the matter of the difficulty of embracing uncertainty by those whose life is already ridden with it. Had she done so, I feel that her attack on traditional therapy's upholding of social- including economic and educational-inequalities would have been bolstered by examples of the ability of dialogic therapy to address them.

CYBERNETICS & HUMAN KNOWING

Contents:

Review of Harlene Anderson: The Therapy of Dialogical Possibility