Journal of Marital and Family Therapy

doi: 10.1111/jmft.12289
© 2018 American Association for Marriage and Family Therapy

THE LEGACY OF TOM ANDERSEN: THE ETHICS OF

REFLECTING PROCESSES
Diane R. Gehart
California State University

Tom Andersen and his pioneering work with reflecting conservations has had a lasting influ-
ence on the field of family therapy and mental health more broadly. Most family therapists
are familiar with his contributions related to reflecting teams; however, fewer are familiar
with his conceptualization of reflecting processes, which offer practical ways to approach
therapeutic conversations to address challenging problems. This article provides a brief his-
tory of Andersen’s career and reviews four key elements of his approach, including: (a) his
way of being in relationship, (b) appropriately unusual comments, (c) inner and outer dia-
logs, and (d) ethics of dialogical relating. Finally, this article introduces readers to the con-
text of the video that will be analyzed in the articles that follow in this special section.

TOM ANDERSEN AND HIS COLLABORATIVE APPROACH: THE ETHICS OF THE

REFLECTING PROCESSES

Tom Andersen and his pioneering work with reflecting conservations has had a lasting influ-
ence on the field of family therapy and mental health more broadly. While most family therapists
are familiar with his work using reflecting teams, fewer are familiar with his more general approach
to therapeutic dialog, which emphasizes respecting the dignity of clients first and foremost (Ander-
sen, 1991; Andersen, 2007; Shotter & Katz, 2007). Providing a foundational framework for the dis-
cursive analyses in this special section, this article introduces Andersen’s work, including: (a) an
overview of the development of his approach, (b) key concepts in his reflecting process, and (c) an
outline of the video analyzed in the articles that follow.

DEVELOPMENT OF ANDERSEN’S REFLECTING APPROACH

Living north of the Arctic Circle in Norway, Andersen (2008) began his career after World
War II as a family physician but quickly moved into psychiatry. While working in a psychiatric
hospital in the 1960s, he noticed that the patients were often disconnected from their families, who
were typically far away in this sparsely populated region of Norway. Reconnection was almost
impossible because of the physical distance. He knew then that having professionals go out into
the community to prevent this disconnection was the only rational approach to more effectively
serve patients. In 1976, he accepted a professorship at the University of Tromsø, where he collabo-
rated with psychologists and nurses to reduce the number of psychiatric hospital admissions
(Andersen, 2008). Increasingly, he and his colleagues were more interested in who, what, when,
and how of clients’ situations than searching for why-based explanations for their behaviors. In
1984, they also began to position themselves in ways they found put clients at ease by not taking
on an expert, hierarchical position. They did this by sharing their thoughts more openly and hum-
bly: “In addition to what you have thought, we have thought this” and “in addition to what you
have tried to do, might you consider to try our idea of what to do?” (p. 429).
During this same period, he collaborated with two physiotherapists, Gudrun Oevreberg and
Aadel B€ ulow-Hansen, who taught him how they watched a client’s breath to determine if their

Diane R. Gehart, Ph.D. Professor, Department of Educational Psychology and Counseling, California State
University.
Address correspondence to Diane R. Gehart, Department of Educational Psychology and Counseling, Califor-
nia State University, Northridge. 18111 Nordhoff St., Northridge, California 91330; E-mail: dgehart@csun.edu

JOURNAL OF MARITAL AND FAMILY THERAPY 1

work was having a therapeutic effect (Andersen, 2008). If their massage strokes were too soft or
too hard, clients did not exhale muscular tension. But when their strokes balanced sufficient pres-
sure to create a shift yet did not overwhelm the body, the clients’ muscles responded spontaneously
by relaxing. Andersen saw a corollary in psychotherapy, which evolved into his concept of appro-
priately unusual comments, comments that are optimal for promoting new ways of thinking about
a problem.
Theoretically, Andersen was drawn to the work of systemic family therapists, collaborating
with many of the earliest systemic practitioners and thinkers, such as Bateson, Maturana, Gool-
ishian, Anderson, and the Milan team; over the years, Andersen collaborated with numerous
thought leaders in the field, his ideas both being shaped by and shaping them. In 1985, when work-
ing with a team of colleagues in the traditional systemic Milan therapy style with a challenging fam-
ily, it occurred to Andersen that the family might benefit from listening to the team’s
conversations, which before this point had always been kept private from clients (Andersen, 1987).
Andersen describes his own hesitation immediately after the family agreed to the idea: “I can still
hear the clicks when the neon lights came on, and thought: what have I done? The others’ [reflect-
ing team members’] eyes big, filled with fear. Mine look most probably the same” (Andersen, 2008,
p. 432). This impromptu experiment evolved into the reflecting team practice, which he is best
known for; however, he always emphasized that reflecting was an entire set of dialogical practices
and attitudes, not just a technique (Andersen, 2007). In addition to the radical practice of having
the team in the room with the client instead of behind the mirror, this practice also introduced two
additional new practices to family therapy: (a) generating multiple possibilities rather than a single
intervention for clients, and (b) no longer judging an intervention as “successful” if clients followed
through on the homework task. Later reflecting on his influence, family therapy’s most celebrated
historian Lynn Hoffman states reflecting teams “revised the game [of psychotherapy] totally . . . .
they flattened the hierarchies of professional work and offered fluid templates rather than rigid ones
to go by” (Anderson & Hoffman, 2007, p. 573). Since the day the neon lights first clicked on in the
observation room, the use of reflecting teams has expanded to include among other contexts, super-
vision (Chang, 2010; Reichelt & Skjerve, 2013), multifamily groups (Garrido-Fern andez, Marcos-
Sierra, Lopez-Jimenez, & Ochoa de Alda, 2016), and multidisciplinary teams (Fl am, 2009).
From this point forward, the work of Andersen and his colleagues focused more on under-
standing and listening than directing change. Initially, Andersen and his team grounded their
work in the epistemology of Bateson, and later evolved to also use conceptualizations from con-
structivism (meaning making from within the organism) and social constructionism (generation
of meaning within relationship; Andersen, 2007). Over the years, Andersen’s focus became
increasingly on allowing clients to speak uninterrupted: both during external (between people)
and internal (within oneself) dialogs. More than focus on meaning, he watched for (a) who wants
to be heard in each moment, and (b) how each responded to the others. Additionally, he was no
longer “occupied with finding a new story or finding a new solution. All of that comes by itself
when people are given the chance to search through their own words and expressions,” such as
softening a rigid position after hearing it spoken aloud or by identifying a previously avoided
emotion (p. 434). Andersen’s approach had a significant influence on Jaakko Seikkula and his col-
leagues in Finland (Haarakangas, Seikkula, Alakare, & Aaltonen, 2007), who developed the open
dialog approach to treating psychosis, one of the most successful evidence-based approaches to
working with this difficult-to-treat population. In his later years, he dedicated much of his time to
traveling the world, donating his time and energies to underdeveloped countries to address
oppression and social injustice, such as marginalized communities in Brazil and HIV/AIDS-
infected individuals in South Africa (Anderson & Hoffman, 2007). He also initiated a “solidarity
fund” to provide funding for professionals without the financial resources to attend the Interna-
tional Family Therapy Association (IFTA) conferences and other (IFTA) trainings more readily
available to others.

KEY ELEMENTS OF ANDERSEN’S REFLECTING PROCESS

Arguably, Andersen’s greatest contribution to the field is not the technique of using a reflect-
ing team to produce change. Instead, most who worked with him say his greatest legacy is his way

2 JOURNAL OF MARITAL AND FAMILY THERAPY

of being in and conceptualizing dialogical conversation (Andersen, 1993, 2007; Shotter & Katz,
2007). I will attempt to capture the essential elements of this legacy by highlighting four elements
of Andersen’s reflecting process: (a) way of being in relationship, (b) appropriately unusual com-
ments, (c) inner and outer dialogues, and (d) the ethics of dialogical relating. I identified these ele-
ments using an informal “qualitative” approach (i.e., theme analysis) in which I drew key concepts
from Andersen’s written, spoken, and video work since the 1980s and tried to identify major
themes. During this process, I also reflected on the questions of students over the years and my per-
sonal experience as a collaborative practitioner and supervisor for over two decades. I also drew
from my personal interactions with Tom during the later years of his career and the early years of
mine, which I describe in my closing reflections.

Way of Being
For anyone who had the privilege to watch Tom live or spend much time with him in a room,
it was quickly apparent that his ability to transform clients’ lives has less to do with what he said
and far more to do with the quality of presence: his way of being in relationship (Andersen, 1997,
2007; Shotter, 2015; Shotter & Katz, 2007). As summed up by Anderson and Hoffman (2007):
“Tom always gave his full attention,” which had a palpable gravitas (p. 572). Whether on the
receiving end of a question from a client or colleague, Tom always took a long, thoughtful pause
to compose his response. In these pauses, he silently communicated that he had heard all that the
speaker said and was sincerely taking it in, giving the speaker’s words serious and thoughtful con-
sideration.
However, unlike some conversational pauses, when Andersen paused, it was never awkward
because he recognized inner dialog as part of the process of constructing meaning. Using phenome-
nologist Max Scheler’s practical descriptions of a mother’s love for her child, Shotter (2015) com-
pares Andersen’s engagement with clients as a form of love in action: “they notice small details
that others ignore; they see beyond their factual nature to what they might mean, to what they
‘point toward’ in the future; they are prepared to relate to possibilities not yet actual, to imagine a
future that might never come to fruition” (emphasis in original; p. 80). Rather than a romantic
form love, Shotter is referring to when two people share in a flow of meaning, emotion, and cir-
cumstances, similar to what interpersonal neurobiologist Dan Siegel (2007) refers to as interper-
sonal attunement. Andersen’s ability to meaningfully attune with clients is perhaps the most
notable and unique quality of his live work. His way of being was consistent with the social con-
structionist philosophy that underpinned his work, but even more so it was part of who he was as
whole human being, not just in his professional role.

Appropriately Unusual Comments

A concept that evolved from his collaboration with physiotherapists who closely attuned to a
client’s breath and physiology, Andersen’s notion of “appropriately unusual comments” is perhaps
one of the most useful guiding principles in all of psychotherapy, arguably surpassing “never work
harder than your clients.” Appropriately unusual comments are best understood in contrast to the
two other implied options: comments that are too usual or too unusual (Andersen, 1991, 1993).
When therapists offer comments that are too usual, such as reflecting back emotions clients are
aware of, they do not create the dialectic tension needed to generate new ways of viewing self,
others, and life. Similarly, comments that are too unusual are too far removed from clients’ exist-
ing worldviews to allow for the generation of new meaning; these comments may take the form of
advice, confrontations, and scripted techniques from any approach that introduce ideas that are
too distant from clients’ psychological position. In contrast, appropriately unusual comments find
the right balance of speaking from within clients’ worldviews while simultaneously introducing
novel perspectives that allow clients to reconsider, rethink, and reimagine problems and possibili-
ties. Regardless of theoretical orientation, all therapist statements, questions, non-verbal commu-
nications, and/or exercises that effectively help clients to transform their lives in one way or
another are appropriately unusual. There is no predetermined or consistent definition of what is
too usual or too unusual; for each client, it is different. With each new client, the therapist must dis-
cover where the boundaries of usual and unusual begin and end. As any therapist who is paying
attention quickly learns, these boundaries are made most visible when there are ruptures in the

JOURNAL OF MARITAL AND FAMILY THERAPY 3

therapeutic relationship or therapy stalls. In this special section, Sutherland, Le Couteur, and
Quinn-Nilas (2018) use conversation analysis to carefully examine how Andersen constructed
appropriately unusual questions when consulting with a couple.

Inner and Outer Dialogs

When describing his approach to therapy, Andersen (1991, 2007) distinguishes between outer
dialogs—the ones between people such as therapist and client or reflecting team members—and
inner dialogs—the internal dialogs within a person. He maintained that therapy should be a
respectful process that allows clients to change through the crisscrossing of internal and external
dialogues rather than directed by the therapist externally (Andersen, 1993). When Andersen was
speaking with a client, there were at least three conversations that he tracked: the one between ther-
apist and client, the dialog within the person, and the one within himself. When a reflecting team is
speaking, the client and therapist both have inner dialogs as they listen to the reflecting team mem-
bers, who are also each having inner dialogs while they converse with one another.
Whether working as a therapist or team member, Andersen always allowed time and space for
clients to go back and forth between their inner dialog and the therapeutic conversation, for often
between these two dialogs is where new meanings emerge. In particular, he recognized that when
clients are speaking aloud, they are not only speaking to the listener but also to themselves. Fre-
quently, when a thought from inner dialog is spoken in words for the first time, the speaker is
moved in new ways to hear it said and to have it witnessed. In this special section, Ugazio’s (2018)
analysis of Andersen’s session using the theory of family semantic polarity reveals how Andersen
intervened very differently with Lisa who was hesitant to speak openly than with Michael, who
was more eager to share his thoughts. Andersen commented minimally when Lisa spoke, recogniz-
ing she needed more space to share her inner dialog. In contrast, he was quicker to interrupt
Michael, intervening at one point to actively ensure Lisa feels safe after Michael presses her on a
sensitive topic.
Andersen (2007) also attended to the movements that accompany inner and outer dialogs. At
the most basic level, breathing is a form of movement, which Andersen considered as unique as fin-
gerprints. The movements that accompany inner dialogs are subtler, such as a vague facial expres-
sion, where those that accompany outer dialog may be larger, such has hand gestures. These
movements and expressions that are part of outer dialog are used to create shared meaning and
form “social bonds” with others. Andersen (1996) often looked for shifts—such as a sigh, move-
ment, or look—to identify a significant expression or word, and would then ask clients: “If you
could look into that word [or other expression], what might you see?” (p. 212). He also allowed
time for unique forms of expression, such as pauses, special intonation, slowed rhythm, quiet
breath, or bodily movements, to be part of the dialog (Shotter & Katz, 2007).
Expression and Meaning. Andersen (2007) defined expression holistically and highlighted
that it does not always involve words: expression may also include non-verbal signaling, artistic
creation, movement, breath, or other forms of whole-bodied communication that may be related
to inner or outer dialog. He asserted that expression comes first, and then the meaning is generated.
Andersen (2007) described meaning as “in the expression, not under or behind it” (p. 89), by which
he referred to the literal process of creating and reshaping meaning. Each expression allows a per-
son to re-experience in new ways something that was experienced once before. Therapists try to
create dialogical contexts that allow clients to re-experience meanings related to problems, most
often in ways that allow them to see new possible actions that were not available with prior
meanings.
Pauses as Transitions between Inner and Outer Dialog. In 2007, Andersen describes three
types of pauses: (a) one that occurs after exhaling and before the next inspiration starts, (b) one
that comes after a person has spoken and thinks about what was just said aloud, and (c) the pause
that occurs after a reflecting talk occurs and a person is thinking of the issue in a new way. The first
pause occurs in outer dialog, and Andersen encourages therapists to not rush to fill these and
instead allow clients time to spontaneously continue if they desire. The second pause allows space
for clients to connect with their inner dialogs during the therapeutic session. The third type of
pause refers to when clients are integrating elements of the reflecting conversations into their inner
dialogs and meanings are starting to shift; and, again, therapists are cautioned to allow clients

4 JOURNAL OF MARITAL AND FAMILY THERAPY

ample time in such pauses and avoid rushing to provide clients with a new reframe or perspective.
This last pause is often preceded by an “I don’t know” response to a therapist’s question or com-
ment. Usually, if therapists remain silent and curious and allow for the pause, clients will put the
pieces together from a fresh viewpoint that has more significance than anything a therapist could
have ever said—because they generated the perspective themselves.

Ethics of Dialogical Relating

Above all, Andersen (2008) advocated for humanizing therapeutic encounters: “Sometimes,
as therapists and researchers, we get so eager to understand, explain, or to solve problems ‘out
there’ that we forget how to connect with ‘what is out there’” (emphasis in the original; p. 12). An
ethic of respecting the dignity and wellbeing of others is at the heart of his approach. Andersen
maintained that we have a significant ethical responsibility for how our words affect others; thus,
even if one did not intend to do harm, one is still responsible for rectifying harm that was done in
whatever way is reasonably possible (Andersen, 2001). He described how we can only know the
effect of our words by the response of the other; through the eyes of another we learn whether our
words are within the accepted limits of our community(ies). His slow pace and pauses also allowed
him to time in his inner dialog to consider how his potential words might affect clients’ inner dia-
logs (Shotter & Katz, 2007). In the special section that follows, Guilfoyle’s (2018) analysis of posi-
tional dynamics further outlines another dynamic of ethical responsibility: he consistently
positions the couple as “competent persons perpetually on the verge of being able to make new
decisions, a new choice, or taking a new pathway; if they so choose” (p.).
Another element of ethical relating and an extension of his understanding of inner dialogs,
Andersen (2008) is one of the few therapists who advocates that clients should be allowed to keep
their inner dialogs private if they so choose. Thus, if a client states in outer dialog that she is feeling
happy but her facial expression (from the inner dialog) communicates sadness, Andersen sees it as
“ordinary politeness” to not “see” or comment on the movements from the inner dialog until the
client wants to share. With psychotherapy field’s roots in psychodynamic theory, most therapists
enter the lives of clients with a general assumption that they are entitled to private information
because it is believed to be necessary to help clients in traditional approaches; this position comes
from a sincere desire to help clients but can also lead to clients feeling violated and misunderstood.
Rather than comment on the client’s incongruent expressions, Andersen would be curious about
the expressed meanings offered in the outer dialog and exploring where those led. In every case, the
client’s dignity and preferences are honored using an ethical standard of care for the person of the
client first and foremost.

INTRODUCTION TO THE VIDEO

This special section includes four papers in which researchers analyze conversation segments
of one of Andersen’s consultations entitled “Dialogues and Dialogues about Dialogues.” The
researchers use different segments of this commercially available video of Andersen (1992) consult-
ing with therapist Jennifer Andrews and a couple, Lisa and Michael. The couple is seen at the Cali-
fornia Family Study Center, which is in the San Fernando Valley area of Los Angeles, one of the
most ethnically diverse municipalities in the world. The couple has attended therapy regularly with
Andrews, who works in a postmodern style, for seven months reportedly addressing relational pat-
terns in which the husband pursues for connection while the wife struggles to create a sense of
space and independence.
The brief introduction to the video provides a context for Andersen’s (1992) thinking at the
time, which was shortly after Harry Goolishian’s passing. Andersen introduces the concepts of
expression and inner and outer dialogs and directly links them to the experience of one’s identity.
He describes people experiencing problems as wanting an alternative understanding of self, which
he believes is best promoted by allowing for as many perspectives as possible in the conversation.
O’Reilly, Kiyima, and Lester (2018) analysis of the video addresses the issue of balancing multiple
gender identities as it emerged in the session with this couple.
Andersen also provides an overview of how he structured the consultation. First, he began by
distinguishing who wants to talk and who does not; in this situation, both were eager to express

JOURNAL OF MARITAL AND FAMILY THERAPY 5

themselves. Early in the meeting, he also tries to identify what clients want to talk about and how
they want to organize the conversation, which he summarized in later work as “who might talk
with whom about this issue, in which way, in which context?” (Andersen, 2001; p. 12). He also clar-
ifies for viewers that he prefers to offer questions rather than opinions during clinical interviews to
help generate multiple perspectives and open dialog.

CLOSING REFLECTIONS

During my early years of training, I was fortunate to meet Tom several times, watch him in
action, and share relaxed conversation over a meal. After pondering how to describe his work for
nearly two decades, I am still at a loss for adequate words, because my clearest and fondest memo-
ries are of the profound peace and respect he brought to any room, any problem. As a person who
tends to use too many words in rapid succession, I was struck by how his carefully chosen words
combined with long, pregnant pauses somehow created a sense of expansive possibilities—and a
renewed feeling of freedom to choose among them. Like Artic lights from his home town, new
horizons of brilliant, fresh meanings seemed to emerge out of nowhere in those quiet moments,
dancing through minds that at one point believed only darkness was possible. In all of this, he was
entirely human and down-to-earth, sharing his love of nature, enjoying a good laugh and a glass of
wine, and graciously attending to one’s basic needs as a host. As a professional, he was humble
and understated, and yet his ideas are some of the most significant for moving our profession for-
ward with greater humanity and grace, at a time when such qualities are especially precious and
necessary.

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