The Narratives Which Connect…

Summary

As we have seen, parallel connections may sometimes have a high relevance in understanding clinical work. We have here documented what happened when four family therapists with different experience, different workplaces and in different stages of life experienced parallel connections in the therapy room. We have documented what went on with Anne (6) following the death of a spouse when she was working as a family therapist; to Evelyn (5) going through a divorce when working as a couples therapist; to Janne (7) having difficulties with her own children when working in Child- and Adolescent Psychiatry; and Elisabeth (1) dealing with her partner’s alcohol abuse while working as a couples therapist. For example, Elisabeth’s stories about alcohol abuse in her own family and her consultation with the couple in which the husband was a heavy drinker seems to be a very important type of story that should have consequences both for our understanding of family therapy practice and for our training programmes.

Six of the seven participants could tell important stories of how their personal and private experiences in life have influenced their clinical practice. In addition, the three that were invited on behalf of telling stories about their experiences with experiencing a parallel connection with their clients, told additional stories of how their personal and private life has influenced their clinical practice.

Working as a systemic family therapist also, to some extent, influences the therapist’s personal and private life. All together, this research project shows the relevance of including the therapist’s personal and private life in the understanding of systemic family therapeutic practice. This may have some consequences for how we organize family therapy education and what we include in the education programmes in the future. This understanding may also have some consequences for how we understand systemic family therapy in the future.

All the therapists tell stories about how their personal and private experience played an important role in how they conducted some of their clinical practice. Together, the Grounded Theory categories with their subcategories organised into illustrative Paradigm Cases, form the findings in this research project.

6. The Researcher and the Research Process: Reflexivity and Self-reflexivity

Introduction

The last of my four research questions is: “How will the researcher and the research process influence the participant and vice versa and create meaning for the relationship between his or her personal life and clinical practice?” This chapter seeks to address these questions.

Reflexivity and self-reflexivity are necessary and compulsory parts of a qualitative research project. Reflexivity seeks to include the researcher as a part of her or his research, (Dallos and Vetere, 2005). For a research project that builds on constructivist and constructionist worldviews the reflexive stance is a part of developing trustworthiness in the research project findings:

“…if researchers and scholars are to take seriously principles of constructionism, these very same principles must be applied by researchers to themselves and to their research. That is, the research process itself must be seen as a socially constructed world or worlds, with the researchers included in, rather than outside, the body of their own research” (Steier, 1991, p. 1 – 2).
Reflexivity in research involves putting the complete research project up for a new critical overview. In this qualitative research project it is not possible to lean on an idea of objectivity or refer to the researcher’s neutral and observing position. I look upon myself as a participant in the sense that I have influenced the research process at all stages. Wren comments on this stance when she claims:

“To research reflexively is to make the research study itself an object of sustained reflection. It involves acknowledging unexplored levels of meaning and managing an awareness of other possible interpretations of the research material. This is inevitably an uncomfortable stance as it means going beyond the conventional degree of self-challenge to one's 'findings', to take up a position of more radical doubt” (Wren, 2000, p. 257).

Professional and Personal Background for Entering into the Research Process

I have been involved in family therapy training programmes in Norway since 1983. The question of the necessity of students going into their own therapy as a part of the family therapy education program was a topic from the very beginning of my engagement on the board of the program. During the 1970s and 1980s this family therapy education program made students’ own therapy compulsory. However, only 20 hours of personal therapy was offered to these family therapy students. Psychodynamic therapists often did this kind of work. The main idea was to enable the students to experience sitting in the client’s position and working with material from their own personal lives. For some of the students, working within this narrow framework gave meagre profits. For example, psychodynamically and psychoanalytically oriented therapy traditionally uses a far greater number of hours, even years, to conduct this kind of process (Kringlen, 1972, p. 418).

Many suggestions were made to change this portion of the family therapy education programme. Some students and trainers believed that we needed to find therapists who employed techniques that were better suited to the programme. Others believed that the students needed to bring members of their family into the therapy room, and some felt that more time and effort in the programme should be devoted to their personal therapy.

Nevertheless, most students and teachers believed that this portion of the programme should be discontinued, and that ordinary clinical supervision should cover this field. Their main argument was that personal therapy was based on psychodynamic theory, and that this element of the educational programme contradicted and even undermined the rest of the programme. The result was that personal therapy was removed from the programme, and has not been a part of family therapy education in Norway since the late 1980s.³⁰ As a member of the board of this education program, I supported this decision, mainly because of the psychoanalytic profile of the individual therapists.

My question in the years to come was whether we had thrown out the baby with the bathwater. When psychotherapists are asked what is most important in their development they point to their own therapy as a main source (Orlinsky and Rønnestad, 2005). In addition, the whole area of reflection on links between one’s own personal and private life connected to family therapy practice was removed from the Norwegian family therapy education program in the 1980’s.

The Construction of a Research Question

From the first, I wanted to do a research project about the narratives that connect a family therapist’s personal and private life to the therapist’s clinical practice, as I have seen narrative as part of the process through which such links appeared. Immediately, people started to tell me stories that linked the family therapist’s personal and private life to the therapist’s clinical practice and to reflect on the implications of such connections. With this experience as background it is important to hold onto the idea that the project is a constructivist project. That means, among other things that I am not out to expose hidden links between family therapists’ personal and private lives and their clinical practice such as it is in the “real world”. My aim is to be part of a process that develops these topics in conversation with the participants, my supervisors, with literature, with theory and colleagues. This thesis should be seen as a result of these conversations.

The research questions and the results of the research project should be seen as part of a constructivist process that nurtures and encourages participants, myself, supervisors and others to develop the research questions and other aspects of understanding of how a family therapist’s personal and private life might be seen as linked to the therapist’s clinical practice.

Reflexivity at different stages in the research process

When I began thinking about conducting a research project in connection with the interaction between the therapist’s own personal and private life history and his or her clinical practice, I discussed my ideas with many people in Norway – family therapist colleagues, friends and relatives. The immediate re­sponse from many of them was, “That’s a good idea!” Some of my friends from outside the family therapy field said, “Is there anything else to do research on? Hasn’t it all been done already?” Some colleagues from within the family therapy field said, “It’s about time, because not very much has been done in that area. In fact, I am not aware of anything of the sort hav­ing been done before.” It seemed that everyone I spoke to agreed that this was a relevant and important topic, and that it held promise as an interesting research project. It also seemed as though everybody I talked to during this period viewed this as part of clinical practice. It was thus not easy to explain why this subject has received very little or no attention in family therapy education and clini­cal training in Norway.

The main idea for a research project was also well received at the Tavistock, London, UK, and I started to write up a proposal. As a teacher in family therapy I was also planning the expansion of our education program in Norway to include a Master’s degree. These two tasks affected each other in a productive way. I had for example the opportunity to visit several institutes that run master’s degrees in family therapy and learn about their Personal and Professional Development-programmes (PPD) and share their views on the idea of working with the links between the students’ personal and private life and their clinical practice.

These visits came to be an important part of my pilot project. The interviews with these professionals in Spain, Ireland, Wales and the UK came to establish the background for the first interviews with my participants. Topics such as gender, culture, family background with genogram, ethics, different ways to live together, homosexuality and other important questions that affect the relations between a family therapist’s personal and private life and her or his clinical practice came forward.

When I was writing the literature review for the proposal I discovered for the first time that I was moving into a field where very little research had been done beforehand. That was a great surprise. This discovery of how small the research literature in the field of exploring relations between the family therapist’s personal and private life and her or his clinical practice made me curious to try to understand this situation. I will attempt to address these questions in chapter 7. Through this research I have also discovered my own pre-existing preoccupation, both culturally and professionally, with the idea that it was the therapy (the medicine) and not the therapist that works.

Reflecting Interaction with Participants

Notes from my research diary, from my memos and the e-mails from the participants form this reflective part. At the end of each research interview I left some questions for the participants to bring “home”. I made it clear that this was a possibility I gave them to open up for some more reflections after our interview and I underlined that they could use the opportunity if they wanted.

After the first interview

As a part of my validity strategy I gave the participants, after the first interview, a note with these open questions: “What do you think and feel now? Is there something you should have told me that you forgot? Are there any more topics that we should address? Any more reflections on the topics we addressed? Any other thoughts?”

Four of the seven participants made use of this opportunity, two of the “full case” group and two of the “parallel connections” group. I will here show how being interviewed about connections between personal and private life and clinical practice affected some of them. The first reflection from the first participant (Elisabeth, (1)) after the first interview opened like this:

“I felt enthusiastic, wanted to share, to get a response. …I called my supervisor, (a role model). “To think that we don’t talk about this together the way that I’ve done with Per today. Never really thoroughly in supervision or in discussions with colleagues or in training.

“Write that down,” said the supervisor. I went to a café and wrote: I clearly see parallel processes. I must achieve greater balance between being a therapist and developing creativity in different ways. I struggle with the fact that patients get the most support or attention for their problems or difficulties and less for their creative sides. I know my colleagues would disagree with me, but it feels that way, and that makes it difficult here, for me as well.

Didn’t you mention the suicide story from (psychiatric ward)?

I am a fellow traveller and a little of what I have in my backpack of life and learning can be useful to us along the way… I feel shaken, as though I’ve revealed myself. Imagine that we don’t more often dive into this together.”
The other ”full case” participant (Adam (3)) wrote:

“Something I’ve thought about afterwards is that I think it’s more difficult than I thought to answer questions which have to do with the relationship between my own life and my practice. I’m fairly certain that it has nothing to do with you asking difficult questions. It might have something to do with the fact that I feel it is unusual to think along these lines – I don’t have much training in it, in a way. Besides, one is in danger, when one has such a topic up for discussion, of “revealing” that there are areas within oneself which have meaning for practice that one hasn’t considered before. It isn’t that pleasant, and maybe comes out as a kind of cautiousness in me.”

Finally, Janne (7) (parallel connections) sums up after a comprehensive reflection:

“The questions you asked were interesting and powerful, and I discovered as well that I wasn’t as finished with these topics as I’d thought. To be interviewed myself has given me a very useful experience…Thank you for giving me this opportunity. I’ll send you an e-mail again, if any further thoughts come to mind.”

“To be interviewed myself has given me a very useful experience…” Janne (7) says.

This may sum up some of these reflections. These three participants’ afterthoughts reflect that to be interviewed about this topic seems to be both important and moving in different ways. They also reflect that the patterns that connect personal and private life with clinical practice have not received much attention in their professional lives.

After the second interview

When the second interview round had finished, I repeated that I was interested in their reflections. I gave them the same questions as after the first interview with one additional question. The additional question came because I saw that I did not have much material on how practice as a family therapist has influenced their private and personal lives. I asked: “It is of special interest for me if you have some more thoughts about what the job as a therapist and that role has done to you as a person and to your life outside work.”

Only two of the four “full case” participants responded. Elisabeth (1) responded with a comprehensive reflection also after the second interview. This reflection gives a further

indication that these questions about connections between personal and private life and professional practice have engaged her.

Adam (3) mentions three topics connected to the question of how personal and private life may be affected by being a psychotherapist. First he underlines that it has affected his attitudes to “truth”. Especially in the congregation where he belongs he has raised objections against the prevailing “truth”. In his own family he once used storytelling, inspired by clinical practice, to help two of his children to solve difficulties. Finally, he mentions that as preparation for a lecture he once presented some clinical material (some drawings made by clients) to his children who were of the same age as the clients, to get their comments. This worked for him as confirmation of the value of using them in his lecture.

At the end

Towards the end of the research project, I sent an e-mail to all participants where I asked them four questions. I asked if there was anything from these interviews that has made any special impressions upon them, if they had developed any new ideas or confirmed any ideas about the relation between the personal/private and the professional, if this has had any consequences for clinical practice and if it has had any influence on personal and private life.

All participants responded to this e-mail. This may also be connected to me asking them to confirm some personal information. Two of the participants responded merely by saying they had not had any afterthoughts whatsoever. One remarked however that she continued to work on these topics in supervision.

To the question if there was anything from these interviews that had made any special impressions, Karen (4) responds. Karen (4) says:

“It is probably mostly that someone interviews you about the relationship between professional and private life, which increases consciousness about this. I realised that my strong stomach and quiet mind in working with break-up situations is connected to my own break-up experiences in relationships.”

To the question of whether they had developed any new ideas or confirmed any ideas about the relation between the personal/private and the professional, Adam (3) and Elisabeth (1) commented.

Adam (3) remarks:

“But I think that it maybe has a clearer connection than what I thought previously. I can also see that the “gaps” between these two areas are less than I’ve thought previously – that is to say that I wonder whether I’m more under the influence of the personal in my professional life than I’ve thought.”
Elisabeth (1) says:

“Yes I have gone a few more rounds about the private and personal and I think it’s even more important to stop and take a step to one side when one feels oneself drawn into something or becoming very eager. The question about whether they would have had better help from others than from me will always be present in encounters with others.”

The third question concerned whether participating in this research project had had any consequences for clinical practice. Erik (2) says:

“I think I share more, and (am) conscious / thoughtful, but the personal and private are still important distinctions. The terms shyness and dignity come up here. I think I am more careful about not offending other’s values while at the same time I believe I can be more direct.”

Adam (3) says:

“I share with colleagues to a greater extent regarding relationships from my private life. I say a bit more about relationships that can interest me, and about relationships that I associate with my own background and upbringing.”

My last question was concerned with whether participation in the research project has had any influence on personal and private life. Karen (4) says:

“OK seeing one’s private challenges in light of what can be worse. I find that I become more tolerant and less caught up in imperfections in my own life and relationships.”

Anne (6) says:

“…but I know very well that the job has changed me. The way of meeting people in private has changed a good deal. In a completely different way, I am listening in my life. The genuineness in listening becomes more and more important in my life. I can step back more. But at the same time maybe I step forward more as well and become clearer about everything I have and know. But exactly this movement between stepping back and stepping forward is part of that. The job has contributed to my being able to practice that movement and to make it clearer for myself in the private, personal encounter.”

Elisabeth (1) remarks:

“I have started in therapy again. I’ve become more conscious of my own boundaries or lack of boundaries and that this is something I can change now. This is not directly connected but indirectly connected with what came up in the interview and the video. I need courage to become clearer in encounters with myself and others.”

Finally, Erik (2) sums up his experiences and remarks:

“I don’t think so. But as we know the fish is the last to know that it’s swimming in water.”

These last responses cover the range of responses to being a participant in the project, from experiencing the project as a strong influence to the participants that report minor or no influence from participating. It is, however important to notice the range of responses. The participants report the impact on them of the research process in different ways. Some find it influential and important and claim that they are surprised that personal and private life is so close to clinical practice. They have been inspired to rethink parts of their practices and claim that this should be worked on more. The participants, who report the research process as less influential, claim that this topic has been a part of their reflections all along in their clinical practice. I have no representatives who claim to be scientific practitioners or family therapists who claim their practice is evidence-based. This is a weakness in my selection of participants. Erik (2) was the closest I came to this position, but he would not call himself a scientific practitioner. However, participants’ identification with the research question varied greatly, as shown in the above comments from the participants.