Summarize your understanding, discuss its social work practice implications

Clinical Social Work Journal
Vol. 23, No. 1, Spring 1995

T H E M E E T I N G OF TWO N A R R A T I V E S

Elinor A. Homer, R.N., M.S.W.

A B S T R A C T : T h e post-modern paradigms, particularly regarding the na-
ture of reality, are fast coloring our ideas regarding our client’s truths. We now
have an expanded understanding about the flexibility and dynamic nature of
truth, and therefore of clients’ narratives. Another narrative, however, that
must be taken fully into account is the narrative of the therapist. In fact, what
we have in a clinical hour is the meeting and blending of two narratives, t h a t of
the client and that of the therapist. This paper summarizes some of the recent
thinking regarding narrative, and the nature of truth, as well as pointing to
implications for clinical practice.

T h e topics of t h e p o s t – m o d e r n p a r a d i g m a n d t h e social c o n s t r u c t i o n
of r e a l i t y h a v e b e g u n to i n f i l t r a t e o r d i n a r y c o n v e r s a t i o n s a m o n g t h e r a –
p i s t s a n d clinicians, a p h e n o m e n o n o f d i s s e m i n a t i o n w h i c h b e g i n s to oc-
cur, it seems, a f t e r s o m e f e w y e a r s in w h i c h a g i v e n i d e a h a s b e e n
s p r e a d t h r o u g h m o r e f o r m a l m e a n s s u c h as books or j o u r n a l articles.
s e m i n a r s , a n d classrooms. T h i s a r t i c l e will p r e s e n t a n o v e r v i e w o f t h e
s h i f t t o w a r d m o r e i n t e r a c t i v e , or co-constructed t h e r a p i e s , w i t h a
p a r t i c u l a r e m p h a s i s on application. A n u m b e r of t h e o r e t i c i a n s a n d clini-
c i a n s h a v e b e e n w r i t i n g a n d t a l k i n g and w o r k i n g w i t h i n t h e s e n e w
p a r a d i g m s for t h e l a s t d e c a d e or two. This paper, w h i l e doing full j u s t i c e
to n o n e of t h e s e i n d i v i d u a l ‘ s w o r k , will b r i e f l y a s s e m b l e s o m e o f t h e
m o r e s a l i e n t t h o u g h t s f r o m t h e group, as well as p o i n t to p o s s i b l e
c h a n g e s in practice. F o r t h o s e clinicians w h o h a v e p r e v i o u s l y t h o u g h t
a b o u t t h i s shift, a n d w h o a r e a l r e a d y w o r k i n g differently, t h i s m a t e r i a l
m a y s e e m simplistic. F o r o t h e r s , h o w e v e r , t h e m a t e r i a l m a y s e e m r a d i –
cal, i f not h e r e t i c a l . T h i s l a r g e d i c h o t o m y o f possible r e s p o n s e s is pre-
cisely i n d i c a t i v e o f t h e a c t u a l scope o f t h e change. A t f i r s t glance, m a n y
of t h e social c o n s t r u c t i o n i s t i d e a s s e e m d e c e p t i v e l y simple. Is t h i s n o t
j u s t a n e l a b o r a t i o n o f t h e t r i e d a n d t r u e “person in c o n t e x t ” f r a m e –
w o r k s ? H a v e n ‘ t we a l w a y s p a i d a t t e n t i o n to t h e i n d i v i d u a l i n t h e e n v i –

9 �9 1995 H u m a n Sciences P r e s s , Inc.

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C L I N I C A L SOCIAL W O R K J O U R N A L

r o n m e n t ? This article will a t t e m p t to a n s w e r t h e s e questions, a n d to
c o n t r i b u t e to t h e discourse w h i c h underscores t h e a s s u m p t i o n t h a t abso-
l u t e l y radical r e t h i n k i n g is r e q u i r e d to move clinically i n a p o s t – m o d e r n
direction. I n some ways, i t w o u l d a c t u a l l y be easier to a b a n d o n com-
pletely all of our previous a s s u m p t i o n s about t h e r a p y , a n d to b e g i n all
over again, r a t h e r t h a n to a t t e m p t t h e t r a n s f o r m a t i o n of our now firmly
e n t r e n c h e d beliefs a b o u t l i n e a r causality, a b o u t t h e n a t u r e of reality,
and, therefore, about ways of h e a l i n g .

T H E WAY IT U S E D TO BE

Since N e w t o n a n d t h e I n d u s t r i a l Revolution, w e m o r a t least West-
e r n e r s m h a v e based o u r lives on p a r t i c u l a r belief systems. A m o n g t h e
m o s t f u n d a m e n t a l w e r e such ” t r u t h s ” as “Every effect h a s a cause,” a n d
” T h e r e is one reality, a n d i t is m e a s u r a b l e . ” A n o t h e r basic t e n e t of mod-
e r n i s t W e s t e r n civilizations w a s t h a t t h e locus of i n t e r e s t was t h e indi-
vidual, a p h e n o m e n o n especially e v i d e n t in t h e U n i t e d States. Clearly.
t h e s e beliefs, a l t h o u g h following logically on physics, were in p a r t sup-
p o r t e d – – i f not a c t u a l l y c r e a t e d – – b y a wish t h a t h u m a n k i n d would be
able to b o t h predict a n d control t h e f u t u r e . F r e u d , coming from t h i s con-
text, r e p r e s e n t e d it by a p p l y i n g t h e scientific model to t h e n e w field of
psychoanalysis, a l t h o u g h – – t o be s u r e – – h e also s t r e t c h e d t h e l i m i t s of
e v e n t h a t scientific discourse (and everyone’s imagination!) w h e n h e
conceived of t h e t o p o g r a p h i c a l model, i l l u m i n a t i n g t h e unconscious as a
powerful u n s e e n a n d i m m e a s u r a b l e aspect of t h e personality, a n d hy-
p o t h e s i z i n g t h e concept of psychic d e t e r m i n i s m as yet a n o t h e r h i d d e n ,
ever-present, a n d f u n d a m e n t a l m o t i v a t o r of h u m a n behavior.

B e g i n n i n g w i t h B a t e s o n (1972), a n d c u r r e n t l y Schafer (1984, 1993),
Atwood a n d Stolorow (1984), a n d Spence (1982), however, p s y c h i a t r y (or
one b r a n c h of it) is b e i n g t u r n e d upside down, as t h e field grapples w i t h
t h e n e w paradigms, developed o u t of p o s t – m o d e r n t h i n k i n g , a b o u t t h e
n a t u r e of reality, or t r u t h . T h e m a j o r t h r u s t h a s to do w i t h t h e fact t h a t
r e a l i t y is not as h a r d or as c e r t a i n as we h a d all t h o u g h t , b u t t h a t it i s – –
on t h e c o n t r a r y – – c o n s t r u c t e d , u s u a l l y in dialogs w i t h o t h e r h u m a n be-
ings (Anderson a n d Goolishian, 1992; Gergen a n d Kaye, 1992; Saari,
1991; Stern, 1985). I f p s y c h i a t r y h a s h i t h e r t o b e e n a t r u t h – a n d cause-
s e e k i n g profession, s u r e l y it is difficult, i f not impossible, to incorporate
t h i s n e w p a r a d i g m into t h e t r a d i t i o n a l scientific psychiatric discourse.

A n o t h e r aspect to t h i s n e w p a r a d i g m is t h e function of l a n g u a g e
a n d s t o r y in t h e c r e a t i o n of o u r beliefs about o u r lives. A n d e r s o n a n d
Goolishian (1992), G e r g e n a n d K a y (1992), McAdams (1993), W h i t e a n d
E p s t o n (1990), a n d o t h e r s h a v e raised to a level o f c o n s t a n t dialog i n t h e
fields of psychiatry, psychology, a n d social w o r k t h e idea of n a r r a t i v e as

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ELINOR A. HORNER

formative and, therefore, potentially transformative. Their assumption
is t h a t we live according to the stories t h a t we create, and t h a t those
stories can be “re-authored” to f u n d a m e n t a l l y change one’s life. S t e r n
(1985) too, has w r i t t e n about stories, with a particular emphasis on
their preverbal beginnings.

TRADITIONAL THERAPY MODELS

(The words “client” for “patient,” “therapy” for “analysis,” and
“therapist” for “analyst,” have been used throughout this brief sum-
mary, in order to address a more general field of clinicians.)

In the traditional models, then, when a client came into therapy,
the assumptions were t h a t the verbalizations of the client’s free-flowing
associations, within t h e context of t h e transference relationship, could
be relatively curative by m a k i n g the unconscious conscious t h r o u g h t h e
therapist’s interpretations. The client’s associations would begin, over
time, to form a kind of story. The interpretations of t h e therapist would,
in t u r n , explain a n d give m e a n i n g to the current life of the individual,
connecting t h e past to the present, and filling in t h e gaps in order to
come up with a relatively logical and coherent story. The question is,
whose story does this become?

THE CLIENT’S STORY

Freud, as noted above, certainly believed in narratives. His clients
were encouraged to tell stories, sometimes long ones and sometimes
merely snippets, while he listened with evenly suspended or hovering
attention and occasionally made interpretations. Although he viewed
these n a r r a t i v e stories as most interesting and important, the t h e r a –
pist’s motivation was always to find the historical t r u t h , or seminal
event, embedded w i t h i n t h e narratives, and to which one could t h e n
address one’s interpretations. This model of t r e a t m e n t , dependent on
linear causality, is now thrown into question because of several funda-
m e n t a l paradigm shit, s. First, the notion t h a t t h e r e actually is an his-
torical t r u t h is h a r d to substantiate, and second, even if there is, it is
not likely to be n e a r l y as single-causal as Freud a n d others would have
liked to believe. Therapists who work with families, for example, often
get as m a n y t r u e stories of one “factual” event as t h e r e are family mem-
bers. Spence (1982) even goes so far as to suggest t h a t we now begin to
t h i n k about “constructions” r a t h e r t h a n “reconstructions” of the past,
because the historical material t h a t comes up in t h e t h e r a p y h o u r – –
irrespective of w h e t h e r it is “created” primarily by the client, or by t h e

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CLINICAL SOCIAL WORK JOURNAL

client a n d t h e therapist t o g e t h e r – – i s certainly different from w h a t –
e v e r actually happened “back then.” As Saari, too, notes, “What the
child internalizes is his or h e r experience with t h e world” (Saari, 1991,
p. 4).

THE THERAPIST’S STORY

If t h e client has a story to tell, however, so does t h e therapist. As
Gergen a n d K a y e (1992) have noted, t h e psychotherapist’s story (or sci-
entific n a r r a t i v e ) is based on t h e beliefs such as the following: 1) t h a t
there is a cause for pathology, 2) t h a t this cause is e i t h e r within the
client or within the relationships in which the client engages, 3) t h a t
t h e r e a r e diagnoses for these pathologies (Klein_man (1988), and, 4) t h a t
t h e r e is a m e a n s to get rid of t h e pathology. Spence (1982) refers to a
similar situation when he speaks of listening to clients with “public as-
sumptions,” by which he m e a n s the body of t h e o r y a n d t r a i n i n g from
which one operates, and “private assumptions,” which include our own
belief systems (p. 283). (It seems important to add “gendered,” as well as
“community” a n d “cultural” assumptions to t h e “public” category.) In
a n y case, because the therapist’s narrative, w h e t h e r spoken or not, is
experienced by t h e client as exceedingly powerful, t h e r e is a strong like-
lihood t h a t t h e former’s story will predominate. The client’s story will be
re-created or substantially changed by t h e interpretations of t h e thera-
pist, as well as by all m a n n e r of subtle and not-so-subtle communica-
tions from t h e therapist to the client. The new story m a y be one of fam-
ily romance (again, as noted by Gergen and Kaye, 1992), if the therapist
happens to be a psychoanalyst, or m a y be r e f r a m e d into a n y n u m b e r of
other basic s c e n a r i o s – – o r as Gergen calls them, “cultural m y t h s ” – – d e –
pending on t h e persuasions of t h e therapist. As K l e i n m a n (1988) says,
“Perception is theory-driven” (p. 11).

To m a k e m a t t e r s even more uncertain, stories change in t h e telling
of t h e m (Homer, 1993), and are changed by t h e context of t h e listening.
What is now becoming evident, in contrast to Freud’s belief, for exam-
ple, about t h e possibilities of “blank slates” a n d evenly suspended or
hovering a t t e n t i o n – – i s t h a t t h e r e is n e i t h e r a n objective way to tell a
story, nor is t h e r e an “objective” way to l i s t e n to a story. Inevitably and
u n f o r t u n a t e l y , though, the client’s story is most often a l t e r e d or elimi-
n a t e d in favor of t h e therapist’s story, a story which gets formed by the
interactions and interpretations offered.

W h a t m a k e s even more likely t h e emergence of a story which is
p r i m a r i l y t h e therapist’s, as Spence (1982) points out, is t h a t we are
asking t h e client to free associate, and therefore, as t h e therapist, we
m a y be offered content without enough c o n t e x t with which to m a k e
meaning. If so, we m a y make our o w n meaning, p r e m a t u r e l y , by si-

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l e n t l y – – a s w e l l as a t t i m e s u n c o n s c i o u s l y – – m a k i n g a s s u m p t i o n s a b o u t
t h e context. T h e a l t e r n a t i v e , of course, as radical a t e c h n i q u e a s it m a y
seem, is to d i r e c t l y i n q u i r e o f t h e c l i e n t a b o u t context, a b o u t w h i c h ap-
p r o a c h m o r e will b e s a i d below.

As t h e r a p i s t s , f r o m F r e u d o n w a r d s , w e a c t u a l l y h a v e h a d no choice
b u t to r e s p o n d s e l e c t i v e l y to t h e s e stories, h i g h l i g h t i n g c e r t a i n p a r t s of
t h e story, a n d d i s r e g a r d i n g o t h e r p a r t s e n t i r e l y . T h e t r o u b l e is t h a t w e
also b e l i e v e t h a t w e c a n be, a n d a r e being, objective. M o s t c u r r e n t t h e r a –
p i s t s follow t h i s g e n e r a l model, a t t e m p t i n g to s t a y o u t of t h e w a y of,
w h i l e p a y i n g a t t e n t i o n to, t h e t r a n s f e r e n c e , a s well a s c o n t i n u i n g to
f i r m l y b e l i e v e t h a t t h e r e e x i s t s s u c h a t h i n g as a n i n d i v i d u a l – – i n w h i c h
t h e focus of m e n t a l h e a l t h / i l l n e s s is p r o p e r l y l o c a t e d – – a n d t h a t o t h e r
s o r t s o f c o n t e x t ( c u l t u r a l , for example), or t h e (relative) realities of r e l a –
t i o n s h i p s (including t h a t w i t h t h e t h e r a p i s t ) a r e of less i n t e r e s t .

F i n a l l y , a s Spence (1982) noted, t h e r a p i s t s ” n e c e s s a r i l y p a y m o r e
a t t e n t i o n to c o n t i n u i t y a n d c o h e r e n c e t h a n to t h e i r opposites” (p. 23).
Clients, o f course, do p r e c i s e l y t h e s a m e thing, from a v e r y e a r l y age.
w h a t we h a v e in t h e t h e r a p y hour, t h e n , is t h e m e e t i n g of t w o b e l i e f
s y s t e m s or stories, b o t h of w h i c h i g n o r e t h a t w h i c h s e e m s n o t to fit. F o r
o u r o w n p r o f e s s i o n a l s a k e s , it w o u l d b e u s e f u l for u s to be c o n s t a n t l y on
g u a r d , to s e a r c h for w h a t it is t h a t w e o m i t or d i s r e g a r d , b u t t h i s s e a r c h
is n o t easy. O u r clinical s e e k i n g o f t e n focuses e n t i r e l y on t h e life o f t h e
client, and n o t on o u r own life, or on t h e m e e t i n g of t h e two. I f success-
ful, t h i s s e a r c h will b e far m o r e l i k e l y to f a c i l i t a t e t h e r a p y , as well a s to
i n f o r m us a b o u t o u r i n e v i t a b l e biases.

W H E R E A R E W E G O I N G ?

Atwood a n d S t o l o r o w (1984) proposed a s t r u c t u r a l r a t h e r t h a n a
c a u s a l a n a l y s i s , t h a t is, a t t e n t i o n to t h e relations a m o n g p h e n o m e n a ,
r a t h e r t h a n in a n y of t h e p h e n o m e n a in isolation, or in a l i n e a r se-
quence. F r o m F a i r b a i r n o n w a r d s , t h e t h r u s t is t o w a r d r e l a t i o n a l d e v e l –
o p m e n t a l a n d t r e a t m e n t models, a s e v i d e n t in t h e w o r k of G e r g e n
(1992), K l e i n m a n (1988), W h i t e (1989), W h i t e a n d E p s t o n (1990), a n d
o t h e r c o n s t r u c t i o n i s t s . J o r d a n (1990) a n d o t h e r s a t t h e S t o n e C e n t e r
h a v e c o n s i s t e n t l y a d d r e s s e d t h e n e e d to p a y p a r t i c u l a r a t t e n t i o n to pro-
cess, i n a n e n t i r e l y n e w w a y , u s i n g a model of m u t u a l e m p a t h y w h i c h
a l l o w s for s o m e of t h e i n q u i r i n g a n d s h a r i n g of e x p e r i e n c e a d v o c a t e d b y
m a n y of t h e p r o p o n e n t s o f a c o n s t r u c t i o n i s t model of t h e r a p y . W i t h o u t
g o i n g into m o r e d e t a i l , suffice to s a y t h a t A t w o o d a n d Stolorow’s pro-
p o s a l r e g a r d i n g u s i n g s t r u c t u r a l a n a l y s e s , c o m b i n e d w i t h t h e S t o n e
C e n t e r ‘ s focus on i n t e r a c t i v e p r o c e s s e s t o g e t h e r i l l u s t r a t e t h e core o f t h e
c o n s t r u c t i o n i s t p a r a d i g m shift.

In t e r m s o f h o w t h e s e s h i f t s affect t h e r a p y , i f we b e g i n to n o w be-

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lieve, a s t h e p o s t – m o d e r n i s t s do, t h a t k n o w l e d g e , too, is socially con-
s t r u c t e d , t h e n one s t o r y is no b e t t e r t h a n a n o t h e r . The t h e r a p i s t ‘ s s t o r y
is j u s t another one, r a t h e r t h a n a definitive one. G e r g e n a n d K a y e (1992)
w o u l d a r g u e t h a t t h e r e are, a c t u a l l y , m a n y a l t e r n a t i v e stories. E a c h
i n d i v i d u a l m a y h a v e a b a s i c s t o r y line, to be s u r e , b u t t h i s s t o r y is en-
a c t e d v e r y d i f f e r e n t l y in d i f f e r e n t s i t u a t i o n s b e c a u s e t h e s t o r y is a n ac-
t i o n i n itself. E v e n p s y c h o t i c clients, w h o a r e m o r e l i k e l y to p a y special
a t t e n t i o n to t h e i r o w n s t o r i e s w i t h o u t r e f e r e n c e to t h e c o n t e x t i n w h i c h
t h e y f i n d t h e m s e l v e s a t a n y g i v e n m o m e n t , p r e s e n t d i f f e r e n t s t o r i e s in
d i f f e r e n t contexts. U n l e s s w e t a k e g r e a t care, h o w e v e r , to r e m e m b e r
t h a t t h e s t o r y c o n s t r u c t e d w i t h t h e t h e r a p i s t m a y well b e a d i f f e r e n t one
t h a n t h a t c o n s t r u c t e d w i t h a friend, w i t h a boss, w i t h a f a m i l y m e m b e r ,
or w i t h a lover, w e a r e r u n n i n g t h e r i s k o f m a k i n g all s o r t s of e r r o n e o u s
a s s u m p t i o n s which, i f g e n e r a l i z e d too far, m a y t h e n l e a d o u r w o r k w i t h
t h e c l i e n t a w a y f r o m u s e f u l a n d specific i n s i g h t s a n d s u b s e q u e n t b e h a v –
ior c h a n g e s .

T H O U G H T S F O R C O N T R U C T I O N I S T T H E R A P I E S

There i s . . . a strong commitment to viewing the therapeutic encoun-
ter as a milieu for the creative generation of meaning. The client’s
voice is not merely an auxiliary device for the vindication of the
therapist’s pre-determined narrative, but serves in these contexts as
an essential constituent of a jointly constructed reality (Gergen and
Kaye, 1992, pp. 174).

W h e r e w e m a y b e h e a d e d , as f r a m e d b y t h e q u o t e above, is to a p l a c e in
w h i c h w e d e l i b e r a t e l y s e t o u t to c r e a t e m e a n i n g i n a c o l l a b o r a t i v e dis-
course, a f a r cry from w h e r e m o s t of u s a r e now. A t w o o d a n d S t o l o r o w
(1984) r e f e r to t h e n e w science o f t h e i n t e r s u b j e c t i v e , ” t h e i n t e r p l a y be-
t w e e n t h e d i f f e r e n t l y o r g a n i z e d s u b j e c t i v e w o r l d s of t h e o b s e r v e r a n d
t h e o b s e r v e d ” (p. 41). T h e r e will b e m a n y shifts i n beliefs a n d a t t i t u d e s
t h a t w e will n e e d to c o n s i d e r a s w e e m b r a c e (or choose n o t to) t h e s e n e w
w a y s o f t h i n k i n g a b o u t m e n t a l a n d social h e a l t h . S h a f e r (1993) sug-
g e s t e d r e c e n t l y , for e x a m p l e , t h a t n e u t r a l i t y in t h e t h e r a p e u t i c h o u r is
o n l y a n i d e a l t h a t w e s t r i v e for, a n d recognize t h e i m p o s s i b i l i t y o f e v e r
a t t a i n i n g . It m a y b e n o w a r g u e d t h a t w e n e e d not s t r i v e for n e u t r a l i t y ,
a n d t h a t n e u t r a l i t y , in fact, f u r t h e r s t h e p e r p e t u a l o n e – s i d e d – h e s s a n d
d e p e n d e n c e – a n d i l l n e s s – p r o d u c i n g r e s u l t s of t r a d i t i o n a l w o r k , w h a t
O ‘ H a n l o n (1993) calls ” i a t r o g e n i c i n j u r y . ” S c h a f e r also n o t e d t h a t w e
n e e d to b e a w a r e of h o w t h e therapist’s d e f e n s e s p l a y into t h e w o r k . H e
s u g g e s t s t h a t w e t h e r a p i s t s f r e q u e n t l y r e q u i r e t h a t o u r o w n i n n e r m a d –
n e s s b e split-off a n d l o c a t e d w i t h i n t h e clients, so t h a t w e m a y r e t a i n
o u r s e n s e of s a n i t y . I n short, a n o t h e r goal is to b e a c u t e l y a w a r e o f o u r

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ELINOR A. HORNER

own defenses, as well all t h e other biases mentioned above. While recog-
nizing t h a t defenses h a v e historically been defined and understood as
unconscious, it is clear t h a t especially the h i g h e r level d e f e n s e s – – s u c h
as sublimation, intellectualization, denial, and somatization–are rela-
tively available for scrutiny, and can, if t h e therapist wishes, be ac-
knowledged in t h e service of the work. At t h e least, we should certainly
c o n s i d e r t h e usefulness of sharing part or all of our defensive experience
with our clients.

Schafer (1992) offers another thought on how to t u r n the construc-
tionist corner (an idea t h a t m a y seem, to therapists who do not practice
psychoanalysis p e r se, like an obvious idea), n a m e l y t h a t “talking to
patients is a resource t h a t . . , psychotherapists n e i t h e r draw on as often
nor employ as m a s t e r f u l l y as t h e y should” (p. 281). He goes on to elabo-
rate t h e various kinds of talking he is suggesting, including “pedagogi-
c a P ‘ – – a n u n f o r t u n a t e choice of words, in m y mind, emphasizing the tra-
ditional imbalance which creates a kind of dependency not always
useful, especially in short-term w o r k w a n d “personal.” Schafer r e f e r s to
Phyllis Greenacre’s phrase (cited in Schafer, 1992, p. 289) of a “tilted
relationship,” a description of the relationship t h a t develops when t h e
therapist does not speak personally, o r m a s Sullivan would s a y m i n t e r –
personally. As Schafer noted, the difference, for example, between “You
are not m a k i n g yourself clear,” and “I don’t u n d e r s t a n d you,” is a n ex-
ample of a choice of phrasing t h a t can contribute to “untilting” the rela-
tionship. As will be addressed below, other therapists would go m u c h
f u r t h e r t h a n this, and be far more directive and interactive.

Gergen a n d Kaye (1992), by way of example, t a l k about a form of
“interested inquiry,” presenting it in such a way t h a t it looks, decep-
tively, like a n easy shift. Anderson and Goolishian (1992) mention a
“not-knowing” approach to therapy, emphasizing the fundamental im-
portance of becoming as absolutely interested and open as we can, ac-
tively utilizing our genuine curiosity about the client’s story. Gurevitch
(1989), developing this idea further, discusses the importance of t h e
ability to “not understand,” when discussing conflict resolution. His no-
tion can be usefully applied to the therapeutic relationship, and is espe-
cially p e r t i n e n t to t h e therapist’s view of the “otherness” of the client’s
life. All these examples encourage us to consider that, as therapists, we
are being asked to replace our “modernist” views with “post-modern”
ones, as well as to promote with our clients an exploration of experience
from multiple perspectives.

Gergen a n d Kaye’s (1992) prescriptive list is formidable, if t a k e n
seriously, and m a y be seen more as a direction in which to continue to
move t h a n as a model for therapy. (The idea of a “model,” incidentally,
would fly directly in t h e face of the new paradigms to which they sub-
scribe.) In addition to the illumination of multiple perspectives, t h e y

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CLINICAL SOCIAL WORK JOURNAL

w o u l d s u g g e s t t h e promotion o f a n u n d e r s t a n d i n g concerning t h e inev-
itably r e l a t i o n a l context of each behavior, as well as t h e e n c o u r a g e m e n t
of t h e ” t h o r o u g h r e l a t i v i z i n g ” o f experience. T h e m e a n s to t h e s e ends
include, a m o n g o t h e r suggestions, i n v i t a t i o n s for t h e clients to find ex-
ceptions to t h e i r p r e d o m i n a n t experiences (an idea also p r o m o t e d by
W h i t e a n d E p s t o n [1990] as ” u n i q u e outcomes”), to consider w h a t re-
sponses t h e y invite by t h e i r i n t e r a c t i o n s (promoted for y e a r s i n “The
F o r u m , ” a d e s c e n d e n t of EST), a n d to consider h o w t h e y would experi-
ence t h e i r lives i f t h e y o p e r a t e d from different a s s u m p t i o n s (an invita-
tion o f t e n offered to p a r t i c i p a n t s i n P s y c h o d r a m a , or NTL’s ” h u m a n in-
t e r a c t i o n labs”).

T h e p a r e n t h e t i c a l additions above are i m p o r t a n t . Spence (1982) ar-
g u e d t h e n e e d to consider t h e possibility t h a t n a r r a t i v e t r u t h m i g h t
e v e n be m o r e i m p o r t a n t t h a n w h a t h e calls ‘~historical t r u t h . ” His p o i n t
is well t a k e n , b u t is clearly a n a t t e m p t to s o m e h o w stick to t h e idea of
s o m e sort of ” t r u t h , ” p r e s u m a b l y to s t a y w i t h i n t h e scientific discourse.
C u r r e n t writers, a n d some sectors of t h e h u m a n p o t e n t i a l m o v e m e n t for
m a n y y e a r s now, h a v e n o t b e e n c o n s t r a i n e d to hold onto t h e n o t i o n of
a n y ” t r u t h , ” w h e t h e r n a r r a t i v e or hisorical.

A n d e r s o n a n d Goolishian (1992), as n o t e d above, see t h e t h e r a p i s t ‘ s
job as ” c r e a t i n g a space for, a n d f a c i l i t a t i n g a dialogical conversation,”
i n w h i c h ” t h e t h e r a p i s t is a p a r t i c i p a n t – o b s e r v e r a n d a participant-facil-
i t a t o r ” (p. 27). (The e m p h a s i s o n ” p a r t i c i p a n t ” is crucial.) T h e y see t h e
p r i m a r y tool for t h i s facilitation, as m e n t i o n e d above, as b e i n g t h e ther-
a p e u t i c question, of w h i c h t h e p r i m e c h a r a c t e r i s t i c is a stance o f not-
k n o w i n g , r a t h e r t h a n – – a n d t h i s is i m p o r t a n t , as we are often so c a u g h t
u p i n o u r previous way of o p e r a t i n g t h a t we a r e completely u n a w a r e of
i t – – ” a s k i n g questions t h a t a r e i n f o r m e d by m e t h o d a n d t h a t d e m a n d
specific answers” (p. 28). A n d e r s o n a n d Goolishian say, filrther, t h a t t h e
c e n t r a l t a s k of t h e t h e r a p i s t is “to find t h e q u e s t i o n to w h i c h t h e client’s
r e c o u n t i n g of experience and n a r r a t i v e p r e s e n t s t h e answer” (p. 37). I n a
s i m i l a r vein, Spence (1982) s u g g e s t s “active” a n d “constructive l i s t e n –
ing, i n t h e service of u n d e r s t a n d i n g ” (p. 279).

T h e r e are m a n y o t h e r tools a n d t e c h n i q u e s w h i c h can be helpful in
t h i s s h i f t t o w a r d s new ways of working. ( A l t h o u g h tools a n d t e c h n i q u e s
can s o m e t i m e s l e a d professional d e v e l o p m e n t , t h e y are useless i f only
m i m i c k e d , w i t h o u t t h e p r e r e q u i s i t e q u e s t i o n i n g or s h i f t i n g of t h e t h e r a –
pist’s belief system.) W h i t e (White & Epston, 1990), for example, t a k e s
down v o l u m i n o u s notes i n t h e client’s own words, as h e i n q u i r e s a b o u t
t h e e x a c t details of t h e effect on t h e i n d i v i d u a l ‘ s life of ” t h e problem,”
which, incidentally, h e a t t e m p t s to “externalize” ( 1 9 8 9 ) – – a radical con-
cept for t r a d i t i o n a l p s y c h o t h e r a p y , w h i c h n o r m a l l y t u r n s t h e a t t e n t i o n
t o w a r d s t h e problem w i t h i n .

A n d e r s o n a n d Goolishian (1992) a n d W h i t e a n d E p s t o n (1990) all

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ELINOR A. HORNER

emphasize t h e transformative power of the new stories t h a t can be co-
created. Anderson a n d Goolishian say t h a t t h e therapist must acknowl-
edge to him- or h e r s e l f t h a t the client’s story makes narrative sense,
r a t h e r t h a n to have non-sense and “pathology” be t h e p r i m a r y focus.
Gergen and Kaye, however, m a k e a good point when t h e y note t h a t
creating a n o t h e r story is really a first order change, and therefore t h a t
the n e w story is just as “steered” by t h e therapist as are the interpreta-
tions of t h e “free” associations employed in t h e classical psychoanalysis.
The new story m a y empower t h e client, but it is still a preferred con-
struction, encouraged by the therapist. (It is hard to imagine, however,
t h a t we could ever get away from s o m e belief systems of our own no
m a t t e r how apparently benign and “open.”)

A novel idea presented by all these post modern constructions of
therapeutic interactions is t h a t the therapist too, is changed as a r e s u l t
of these conversations which construct meaning. Client and therapist
are t r u l y interdependent, a position of relative equality which is h i g h l y
u n u s u a l and likely to be t h r e a t e n i n g to m a n y therapists. In “the w a y it
used to be,” therapists protected t h e i r own narratives, above those of
t h e i r clients, m a i n t a i n i n g a kind of unconscious secrecy, keeping t h e i r
stories extremely private, not only from t h e i r clients, but from other
therapists. One could argue f u r t h e r that, in avoiding t h e examination of
how t h e i r own private n a r r a t i v e s contributed to the cocreation of t h e
client’s story, they were hiding t h e i r own n a r r a t i v e s even from them-
selves.

Although this discussion is largely an encouragement towards t h e
creation of a more open and interdependent kind of clinical work, t h e r e
m u s t a word of caution. These authors are not advising us to move to-
wards a stance in which every ” t r u t h ” is O.K., and in which no action
m a y be taken, because the “truth” of each individual must be honored.
Quite the contrary. The honoring occurs in the co-creation of the story,
in t h e careful co-construction of t h e detailed context, in the knowledge
t h a t our own n a r r a t i v e can i n a d v e r t e n t l y play an oppressive and direc-
tive part in w h a t e v e r story t h e clients eventually tell us during our
conversations with them. Whatever happens n e x t – – t h a t is, w h a t we
choose to do, even if it is r a t h e r more directive, or frankly intervention-
i s t – – w i l l be far more respectful and accurate, in terms of effectiveness,
if we have begun from a constructionist stance. There are, however,
times to t a k e a stand, to give advice, to set limits, to protect (primarily
women or children), times we must resort to what we might call a soci-
etal narrative. As noted above, if we begin with t h e new model, with
open listening, with t h e acknowledgment of our part in the co-construc-
tion, with beliefs about t h e elusivity of “truth,” we m a y do less h a r m ,
and allow for more creativity and change.

Much could be said in the way of clinical examples of how to employ

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CLINICAL SOCIAL WORK JOURNAL

t h e s e n e w i d e a s for a d i f f e r e n t k i n d of practice, a c o n s t r u c t i o n i s t prac-
tice. W i t h o u t g o i n g i n t o a n y detail, one t i n y i n t e r a c t i o n to c o n s i d e r is
t h e v e r y f i r s t m o m e n t w e s e t o u r e y e s on a client. T h i n k for a m o m e n t
a b o u t t h e r a p i d s e r i e s o f beliefs w i t h w h i c h w e b e g i n , a f t e r t h a t f i r s t
s e m i n a l m o m e n t . W e n o t i c e t h e t i m e . W e t a k e i n t h e g e n d e r , age, g r o s s
a p p e a r a n c e . W e notice t h e e y e contact, or l a c k o f it. W e l i s t e n for t h e
voice, w a t c h for t h e b o d y l a n g u a g e . Before w e a r e a w a r e o f it, w e
h a v e o u r o w n n a r r a t i v e p o w e r f u l l y d r i v i n g o u r v e r y f i r s t c o m m e n t . W e
m a y , i n fact, n o t do a n y t h i n g , or s a y a n y t h i n g t h a t s e e m s m u c h differ-
e n t f r o m w h a t w e did before. W h a t will b e d i f f e r e n t will b e o u r r a d i c a l l y
a l t e r e d p e r c e p t i o n of b o t h w h a t is a c t u a l l y g o i n g on, t h e m e a n i n g of
w h a t is g o i n g on, a n d p e r h a p s m o s t i m p o r t a n t l y , o u r p a r t i n w h a t is
g o i n g on.

I f w e a r e s h i f t i n g t o w a r d s a m o r e r e l a t i v i s t i c n o t i o n of t r u t h , a n d
t o w a r d s a v e r y p e r s o n a l a n d co-created s t o r y for e a c h client, t h e n it
s e e m s w e m u s t also c h a n g e w h a t we p r o m o t e a n d t e a c h w i t h i n t h e pro-
fession. W e m u s t b e g i n to t e a c h r e l a t i v e l y less a b o u t t h e t h e o r i e s of
l i n e a r c a u s a l i t y , t h e o r i e s w h i c h a s s u m e a n d s e e k s o m e a b s o l u t e ” t r u t h , ”
a n d t o t e a c h r e l a t i v e l y m o r e a b o u t i n t e r a c t i o n a n d i n t e r d e p e n d e n c e . The
f o r m e r c a n b l i n d us, a n d t h e l a t t e r c a n offer u s w a y s to m a x i m i z e t h e
l i k e l i h o o d of b e i n g h e l p f u l , b y giving u s a s t r u c t u r e and/or n e w p a r a –
d i g m t o i n c r e a s e o u r o p e n n e s s to each u n i q u e s t o r y w h i c h w e co-con-
s t r u c t i n a d y n a m i c d i a l o g u e w i t h o u r clients. T h e s h i f t m a y s e e m
w r e n c h i n g , b u t it will b e e a s e d b y discussions s u c h as t h i s , as w e d a r e to
s t e p i n t o u n k n o w n , a t t i m e s f r i g h t e n i n g , a n d a l w a y s e x c i t i n g t e r r i t o r y .

R E F E R E N C E S

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therapy. In S. McNamee & H. Goolishian (Eds.). Therapy as a social construction.
Newbury Park, CA: Sage Publications.

Atwood, G. E., & Stolorow, R. D. (1984). Structures o f subjectivity: Explorations in psycho-
analytic phenomenology. New Jersey: The Analytic Press.

Bateson, G. (1972). Steps to an ecology o f mind. New York: B a l l a n t i n e Books.
Gergen, K. & Kaye, J. (1992). Reflection and reconstruction. In S. McNamee & H.

Goolishian (Eds.), Therapy as a social construction. Newbury Park, CA: Sage Publica-
tions.

Gurevitch, Z. D. (1989). The power of not understanding: The meeting of conflicting identi-
ties. Journal o f Applied Behavioral Science, 25 (2), 161-173.

H o m e r , E. A. (1993). Empathy from childhood to motherhood: A d u l t daughters’ reconstruc-
tions. Unpublished m a s t e r ‘ s thesis, Smith College School for Social Work, North-
ampton, MA.

Jordan, J. V. (1990). Relational development through empathy: Therapeutic applications.
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Kleinman, A. (188). Rethinking psychiatry: From cultural category to personal experience.
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McAdams. D. P. (1993). Stories we live by: Personal myths and the making of the self. New
York: W i l l i a m Morrow and Co., Inc.

O’Hanlon, W. H. (1993). Possibility therapy: From iatrogeuic injury to iatrogenic healing.
In S. Gilligan & R. Price (Eds.), Therapeutic Conversations. New York: W.W. Norton.

Saari, C. (1991). The creation of meaning in clinical social work. New York: The Guilford
Press.

Schafer, R. (1992). Retelling a life: Narration and dialog in psychoanalysis. New York:
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Schafer, R. (July, 1993). Transference, countertransference, and defense in the t r e a t m e n t
situation. Diane Davis Memorial Lecture, Smith College School for Social Work.
Northampton, MA.

Spence, D. (1982). Narrative truth and historical truth: Meaning and interpretation in psy-
choanalysis. New York: W.W. Norton.

Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.
White, M. (1988/9, summer). The externalizing of the problem and the re-authoring of

lives and relationships. Dulwich, Australia: Dulwich Centre Newsletter.
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N o r t o n .

Elinor A . Horner, RAV., M.S.W.
S o u t h Shore Mental Health Center
Quincy, M A

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