The Narratives Which Connect…

Appendix 7. Construction of a category

Construction of category “Personal and moral values and personal experience influence therapeutic work”.

Text	Categories	Research category
My father has been married and divorced three times and I am a child of his first, his second marriage. He has a daughter from his first marriage, she is (9) years older than me, and then he has a son from his third marriage. I am in the second, and it was my mother’s first marriage and there was a great deal of age difference between them, my mother was 2(0) and he was 1(5) years older in (Middle-East) and my mother took me back to Norway when I was (3)…and they were divorced. Ehhh and then my mother met another man when I was 5 and they married when I was 10, and he had a daughter from an earlier marriage where he had scarcely lived together with her. And then they had a child together ehh and then they had a “project” to bring about a good family. I then took his name and from that time on it was just us, and I was very proud about many things and I was very proud that I was an (Middle East) citizen and that I had a father in (Middle-East). So we have, in a way, two parallel histories, he tells his colleagues on his job a great deal about me being his daughter and I tell people he is my stepfather. We moved to (Tromsø) when I was 1(5) because he had started taking courses at a medical school. I have always felt, or early on in life, that I was a person who where unthankful because I didn’t accept his love the way he wished. And I wanted nothing to do with their new “project” because I saw it as something that would fail. For example, my sister, half-sister, who was born when I was 1(6); she was 8 before knew that I was her half-sister and that (Ann), her father’s daughter from an earlier marriage wasn’t her cousin, but was her sister, because they were attempting to protect her. And I am very much opposed to that, because I have, she is one of theirs; if a person becomes over…tell if one time you were knocked off your perch and you were overly engaged. I don’t think I would be professional because I would be in a setting, I was at (Åsgård) working in the family unit…. E.: It was at the family unit where there was a therapist who went out in…we have both therapists and co-therapists in the unit…. It was a somewhat new therapist who was a social worker who has the head therapist, and there was a nurse. They had been there with an experienced nurse but she went on leave for childbirth, so I almost got the family in my lap. And that was a family with a mother and father and two small girls, one who was 5 – 7, yes 5. Yes, 5 and 7. Perhaps one was 6, she had not begun to go to school by any means. 4 and 6, or 4 – and 6 years in age. And they had…and the father was depressed and had many anxiety problems and things of that nature. Then, in one of the appointments he disclosed…something that caused him to be so very depressed and so anxious because he had two children where were, yes, around 13 and 15 years old. And they came...there…on a visit and it had functioned so poorly when they came and he felt they wanted to have nothing to do with him. And then it came forth that they were introduced as cousins to his new daughters. P.: Um hum, this is parallel, yes.. E.: Then I saw red, real red. Yes. We attempted to speak about all of this and I attempted to ask questions, as did their therapist, but we couldn’t make any headway. I then had a discussion with their therapist asking that I be permitted in one way to give the force I had and that she would remain neutral and provide them a little support. I thought this was somewhat clever. So I came to an appointed time and said what I thought of all of this and that I had lived in such a situation and how that…how it feels to visit one’s father only to hear that it is…shall pretend that he is an uncle during the entire weekend or throughout Christmas. That, that…then one does not have any desire to visit and that which I could... And they were very disturbed and went forth and back with each other, and then they decided to tell all of this to the daughters. And then it is the nurse who is at the house. Ehhh so I arrived the morning after and was met by a chalky white man who said he never wanted to see me again and that I had ruined his whole family. He was enraged.	Divorced One daughter from first marriage Mothers first marriage Back to Norway Divorced Married again Daughter from earlier marriage New child Good family Proud He is father She is stepdaughter She felt unthankful Nothing to do with new project Half sister 8 before she knew Not cousin They would protect her I am opposed to that Tell! Therapist and co-therapist A new therapist Got the family in lap Two small girls Depressed and anxious father Two children from former marriage Introduces as cousins to new daughter Saw red Speak about it Asked to be permitted to tell Told what she meant Told about own experience How it feels to pretend Decide to tell to daughters Ruined the whole family	You should tell children the truth Personal values appear Personal experience influence therapeutic work Personal and moral values influence therapeutic work

Appendix 8. Map of GT categories

GT categories with sub and sub sub-categories

Appendix 9. Further research on parallel connections

In the following presentation of my research, we will briefly get an overview of these ten areas with their forty sub categories. Then we will look closer into four different cases connected to four of these areas. I have chosen four examples that can stand as paradigm cases and represent different situations and contexts where these parallel connections give meaning to the clinical practice.

1. Difficult relationships and divorce

It is a huge literature on for example couples therapy, unhappy relationship and sexual problems. From time to time, these kinds of problems also affect family therapists (Hårtveit and Jensen 2004; Jensen 1994; Caillé 1992). Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Unhappy relationship
  
• 
  Divorcing a spouse or breaking up an intimate relationship
  
• 
  Adultery
  
• 
  Sexual problems in relationship.
  

2. Difficulties with children

The whole field of family therapy in many ways emerged from clinical work with families with troubled children, (Don Jackson, Jay Haley, Virginia Satir, Salvador Minuchin, Mara Palazzoli Selvini and John Byng-Hall among others). Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Children’s psychiatric disorders
  
• 
  Children’s somatic disease
  
• 
  Children’s social problems
  
• 
  School problems
  

3. Drug and alcohol abuse

The family perspectives have influenced and shaped the understanding and treatment of alcohol and drug abuse (Stanton and Todd 1982). Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  A child with abuse problems
  
• 
  A spouse with abuse problems
  
• 
  A family member (a parent or sibling) with abuse problems
  
• 
  The therapists own drug or alcohol abuse
  
• 
  Friends with abuse problems
  

4. Violence

Violence has in many ways been a difficult topic in the field of family therapy. Although the relational perspective is highly relevant when it comes to violence, it was not much focused on these aspects of family life in the first decades of the family therapy movement. Family therapists have also been criticised for not being sufficiently aware of and sensitive to this topic when it occurs in therapy. Especially the feminist criticism has been important and has made a difference when it comes to clinical practice (Cooper and Vetere 2005). Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Physical and/or psychological battering
  
• 
  Incest
  
• 
  Experience from rape and other sex related violence
  

5. Eating disorders

Although eating disorders usually are seen as a psychiatric disorder I chose to treat it separately because this is a fast growing disorder and an important topic in the development of family therapy (Hårtveit and Jensen 2004; Jensen 1994). Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Therapists own eating disorder
  
• 
  Child’s eating disorder
  
• 
  Family member’s eating disorder
  
• 
  Friend’s eating disorder
  

6. Psychiatric disorders

Some could claim that the article “Towards a theory of schizophrenia,” from 1956, by the Bateson-group formed a starting point for the relational oriented family therapy field. In the first years of the development in the field traditional psychiatric disorders were very much the centre of attention in the field (Hårtveit and Jensen 2004; Jensen 1994). It is enough to mention Jay Haley, the Milan-group, Salvador Minuchin and Carl Whitaker. Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Therapist’s own disorder
  
• 
  Family member’s disorder
  
• 
  Friend’s disorder
  

7. Somatic disease and death

Somatic disease and the loss of a spouse or partner, parents, children, siblings and friends will influence a therapist’s mind in significant ways. In our western society, the probability for a woman to be a widow is four times higher than for a man losing his wife. Fredda Herz Brown claims that the degree of disruption to the family system is affected by several factors. The most significant factors are (Carter and McGoldrick 1989, p. 458):

1. 
   The social and ethnic context of death
   
2. 
   The history of previous losses
   
3. 
   The timing of death in the life cycle
   
4. 
   The nature of death or serious illness
   
5. 
   The position and function of the person in the family system
   
6. 
   The openness of the family system
   

Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  A spouse with disease or dying
  
• 
  A child with disease or dying
  
• 
  A family member with disease or dying
  
• 
  A friend with disease or dying
  

8. Problems connected to work life, economy or studies

In family life cycle theory, career issues are mostly connected to the launching of the single young adult. The question of career is also a topic connected to lower-income families (Carter and McGoldrick 1989). Problems connected to work life, economy and studies may however affect family life at any time in the life cycle. Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Therapists’ own problems
  
• 
  Spouse’s problems
  
• 
  Children’s problems
  
• 
  Problems in the rest of the family
  
• 
  Friend’s problems
  
• 
  Problems connected to different local family cultures
  

9. Sexual preferences

It is a part of the political discourse today to make marriage neutral from sex. From 1993, gay and lesbians in Norway could enter into an official partnership. Although our view of gay, lesbian and other variation connected to sexual orientation has changed the last thirty years it is still an important and not very much persuade area for many family therapy students and therapists in Norway. Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Lesbian/gay therapist
  
• 
  Transsexual therapist
  
• 
  When the therapist is a fetishist
  

10. Cultural expectations

The sociocultural context of the family is often overlooked when it comes to understand for example divorce (Stern Peck and Manocherian 1989, p. 335). The cultural questions are personal and often hidden topics in a therapist’s life and probably in need of being lifted forward in a more profound way than today. Some central areas where the therapeutic process could be affected because of the therapist’s parallel experience in own life could be:

• 
  Family from different cultures
  
• 
  Different values
  
• 
  Religious views
  
• 
  Political views
  

These 10 main topics and 40 subtopics emerged from my research interview material and from my experience as a family therapist and from my knowledge from the field of family therapy. This is not meant to be a complete list of topics and themes but rather a first draft and a point of departure for further research in this area.

Through this research project and by looking back on my own experience and contacts in the clinical field, I could identify these ten following areas for parallel connections, either simultaneously or as a part of the therapists life history. When we include sub areas, we reach 40 areas and themes.

1 The heading of Chapter II in Gregory Bateson’s Mind and Nature where he quotes Lord Macaulay.

2 We do not have any accreditation body for family therapists in Norway. We have some accredited curriculum and a Master degree in Family Therapy and Systemic Practice, but they do not give access to clinical practice recognized by the Government.

3 When I searched PPD in connection with family therapy on the Internet, I found about 13,700 sites.

4 For example: the University of Southampton requires “Personal and Professional Development Group (8 x 2 hours per academic year; 4 of these will take place during the specialist academic weeks; the other 4 will be outside of this time).” At the University of Leeds, PPD 1 and 2 together amount to 10 credits.

5 http://www.aamft.org/about/coamfte/97stnds.htm

6 It is the Master program in Family Therapy and Systemic Practice at Diakonhjemmet University College in Oslo.

7 Miller J. F., Powers M. J., Nursing Research (1988), Jan-Feb;37(1):6-10

8 Some of the material in this section is used in an article called: “How to understand the lack of research that include the meaning of therapist personal and private life in psychotherapy” (unpublished).

9 The article was referee evaluated and approved for publication in the spring of 2006. It is called: “How might ”the great psychotherapy debate” influence the understanding of family therapy research? Which therapist can best serve which client?” and published in “Fokus på familien,” no.2, 2006, Scandinavian University Press.

10 About “Nested Design” and “Crossed Design” in psychotherapy research, see B. E. Wampold, 2001, Chapter 8.

11 The research project includes about 5000 psychotherapists from many countries and therapeutic orientations.

12 Ref. for example Leff et al and the London Depression Intervention Trial

13 Into the middle of a narrative; without preamble.

14 In a conversation with the author at the MRI in autumn 1997.

15 In 2003 there was a reform of higher education in Norway resulting in the establishment of bachelor -and master degrees. In this reform clinical practice and supervision will for the first time became a part of an academic degree.

16 He sent this email in spring 2004 after I asked him for response to my research idea and he has consented to its publication.

17 A quantum leap is actually a very, very small leap, but in daily language it is used like this, as a metaphor for a huge leap.

18 At Universidad Autónoma de Barcelona and Escuela de Terapia familiar Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau in Barcelona, Spain.

19 At Cardiff Family Institute at University of Glamorgan, Wales.

20 One of my personal reasons for choosing Grounded Theory (GT) should be mentioned perhaps because it is psychological. I have read that working with GT is an iterative process (Pidgeon and Henwood). That sounds a little bit like me and it is systemic!

21 Permission obtained to cite their names.

22 At Cardiff Family Institute at University of Glamorgan, Wales.

23 At Universidad Autónoma de Barcelona and Escuela de Terapia familiar Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau in Barcelona, Spain.

24 Dept. of Child & Family Psychiatry of Mater Misericordiae Hospital, Dublin, Ireland.

25 All names have been changed in this thesis.

26 The participants are anonymised.

27 Some of the findings are used in an article: “On Learning From Experience. Personal and private experiences as the context for psychotherapeutic practice.” Clinical Child Psychology and Psychiatry, vol. 12 number 3, SAGE Publications

28 See Appendix 8 for a map of categories.

29 A favour or advantage granted in return for something.

30 The board of Family Therapy Education under the Norwegian Church Family Guidance Service decided at its February 1989 meeting to discontinue using personal therapy as a part of the programme. I was a member of that board.

31 I was in charge of this first PPD module and the first 20 students finished their Master’s degree in family therapy and systemic practice in June 2007.

32 In some programmes, students fulfil their practice in their ordinary work place. Supervisions also take place locally and are not organized by the college.

33 ”Doing research” ends up last of the formal categories with 19%.

34 The first family therapy education programme with a compulsory PPD-module started 2005.

35 With changes on the background of comments from Research Ethics Committee (meeting on the 13^th of December 02).