The Narratives Which Connect…

Paradigm Cases about how Private and Personal Background, Parallel Connections and Moral Values Influence Clinical Practice

Paradigm cases are meant to teach us something that is more general than the content of the single case. They are cases that show lines of interpretation that sometimes are invisible or hidden from ordinary perspective. In this paradigm case Adam (3) shows us how he developed his abilities as a mediator as a young boy and illustrates how this competence is useful in his current work as a therapist.

It is Part A (p. 87), “Family background, private lives” and category 3, “The participants’ explicit values that influence therapeutic work” that are connected to “Parallel connections”. These are parallel connections concerning how private and personal background influences clinical practice, including dynamics that show how personal and moral values influence therapeutic work.

Table 19. Relations between GT categories and parallel connections formatting a paradigm case.

Mediation in therapy

When Adam (3) grew up he was the middle child and only boy of three siblings. When I ask Adam (3) what his background and his upbringing have meant for him as a context for becoming a therapist, he points out two areas. He says: ”I believe some of it is connected to the family situation I’ve grown up in…sort of (to) the role I had there. Then some of it is connected to things that I’ve actually just read” (6, 15). The period he refers to is when he was between 14 and 17 years of age and when I ask what he has read, he points as mentioned earlier to his reading of fiction during his adolescence.

When he starts talking about his background in his family of origin, the picture of his function as a mediator soon emerges. His personal history contains an important sequence where, for a long period, his family of origin was in a kind of a fight with the rest of the family. Actually he cannot say what it was all about, but he is sure ”…it was a situation where there was a frustrating break between our family and my parents, there on the one side and the rest of the family” (6, 37). He also clearly remembers his own role in it.

He had the function as mediator between his family of origin and the rest of the family for periods of time during his growing up. This function gave him a particular position and a special status in his family. He says: ”I had a role where I got a bit like a middleman or mediator sort of also between…also between us children and the adults” (6, 31). To elaborate what this involved he says:

”For periods of time there was little conflict at home like between my parents and then…then I probably had a sort of dampening effect on them, or what can I say one, one who…brought…things further or…in a way one who kept the conversation going, I think. Kept sort of the connection going. Both sort of inside the family and like outside to the extended family, relatives and the like, grandparents and that” (6, 33).

In the video of his first session, he meets with a man who is in the middle of a “frustrating break-up” from his wife. They have been married for 15 years and have two children aged 11 and 14 years old. He has fallen in love with a new woman and he has moved away from home to a new apartment where he lives alone. He is not sure what to do and he is afraid to end up in the situation of having a broken heart in ten years’ time. When he asks Adam (3) about his experience with breaking up like this, the mediator in him seems to appear when he answers: “I have experience with both those who have regretted it and those who feel it has been a good thing” (15, 23).

The client shows a lot of doubt about what to do and he is very concerned about his children and about their growing up with divorced parents. Adam (3) follows up and shows a particular interest in this aspect, returning to the children’s situation repeatedly. Adam (3) underlines the situation when he says: ”It is hard to choose in stressful situations. It isn’t for nothing that one practices what one will do in stressful situations” (15, 53). Through the entire session, Adam (3) goes slowly and introduces different questions and topics for the client to investigate. Along with his obliging attitude and kind manner, he guides the client into several important questions without suggesting any answers.

When I, in the next interview, ask him if it was his mediating skills I saw on the video he says:

”Yes, yes, mmm, I believe I’m more concerned with sort of taking in his story then and taking…maybe taking in his experience around it and in that maybe think…also be a bit sort of what should I say, small steps or maybe not to bring in too big, what should I say, contrasts into the conversation. If that has to do with being a mediator, yes, that is maybe the case. Because a mediator, some of that is about maintaining a position, then…also maintaining a position in relation to him. In order to preserve the contact and then certainly I’m relatively careful with introducing sort of the big, big leaps…” (7, 42).

When I ask him what he thinks about giving advice when a client like this asks for it he says that he never would offer any advice when clients are struggling with existential questions like this (7, 58). He could perhaps give advice if the client asked what to do to keep the contact with his children or how he should handle his wife, but never about whether or not it is right to leave or stay in the marriage.

Comment

In the Norwegian educational tradition, we have a long history of making a distinction between the place where knowledge is applied and the place where knowledge is picked up. The distance between university on one side and working life on the other are growing. The kind of knowledge we can only acquire through practical work has little or no space in the academy today. This has moved us towards a narrow definition of knowledge. At the same time this process has led to a rise in the status many educational programmes and professions.

Practical knowledge may here be seen as the kind of knowledge that has lost priority or that has never established its own domain. Michael Polanyi named this personal knowledge, and he called for the search for an epistemology of personal knowledge (Polanyi, 1958). Jeff Faris argues that: “The relationship between the personal epistemology embodied in therapists’ practice and the discourses of espoused theory about therapy seems central to this process” (Faris, 2002, p 92). He claims that it is important to examine this relationship rather than allow it to “silently” influence practice.

The researcher’s personal reflections:

When I was a young man, I used much of my time to listen to my friends’ problems and troubles with girlfriends and boyfriends and family and the meaning with life and... I did not say much about myself. I was much more interested in listening to my friends’ stories than telling stories by myself. May some of the foundations for a family therapist be found in her or his own personal and family history? In the memo after the first interview with Adam (3), I consider his ability to mediate as a part of his personal history. Adam (3) agrees that he has ability as a mediator and that it is a strong element in his clinical practice. Adam (3) tells that he developed this ability during his youth, when his family went through a period of internal conflicts. For me it seems obvious that this ability represent an advantage for him as a family therapist. When I watched his video, this ability as mediator came forward even though it was a single client with him in the therapy room. On the other hand, when one has developed a certain speciality, this may also represent some difficulties and hindering. It might represent an avoidance of alternative approaches when a useful approach is developed. However, I do not have any empirical data to support this possibility when it comes to Adam (3).