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The Therapist's Inner Conversation in Family Therapy Practice:


Struggling with the complexities of therapeutic encounters with
families / Das innere Gespräch des Therapeuten in der...

Article · January 2008


DOI: 10.1080/14779757.2008.9688471

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/ Het Innerlijke Gesprek van de Therapeut in


de Gezinstherapeutische Praktijk: Worstelen
met de complexiteit van therapeutische
ontmoetingen met gezinnen
a
Peter Rober
a
Leuven, Belgium

Available online: 11 Aug 2011

To cite this article: Peter Rober (2008): / Het Innerlijke Gesprek van de Therapeut in de
Gezinstherapeutische Praktijk: Worstelen met de complexiteit van therapeutische ontmoetingen met
gezinnen, Person-Centered & Experiential Psychotherapies, 7:4, 245-261

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The Therapist’s Inner Conversation


in Family Therapy Practice:
Struggling with the complexities of
therapeutic encounters with families

Peter Rober
Downloaded by [Peter Rober] at 11:58 13 August 2011

Leuven, Belgium

Abstract. Notwithstanding the complexity of family therapy practice, family therapists do not have a lot
of concepts at their disposal to talk and reflect about their experiences in practice. Family therapy literature
provides some general principles about the therapist’s stance (for example, neutrality, curiosity, and not-
knowing), but these fail to deal with the full complexity of the relational processes within a family
therapeutic encounter in practice. The concept of the therapist’s inner conversation offers more promise
than these general principles and guidelines, as it addresses the mutuality and shared activity of the
therapist’s self within the complexity of family therapy practice. In this paper the author first outlines a
dialogical perspective on family therapy. Then the spotlight is put on the contribution that the notion of
the therapist’s inner conversation might make in dealing with issues of the person of the therapist in
practice, and especially in addressing the complexity of what it means to be a family therapist in practice.
In the last part of the paper a case history is presented that illustrates how the concept of the therapist’s
inner conversation can help practitioners to talk and reflect about some of the experienced, but unnoticed
aspects of their self in therapy practice.

Keywords: therapist, family therapy, inner conversation, self of the therapist

Das innere Gespräch des Therapeuten in der familientherapeutischen Praxis: Schwierigkeiten mit
der Komplexität therapeutischer Begegnungen mit Familien
Trotz der Komplexität familientherapeutischer Praxis haben Familientherapeutinnen und -therapeuten
nicht viele Konzepte zur Verfügung, um über ihre Praxiserfahrungen zu sprechen und sie zu reflektieren.
Die Literatur zur Familientherapie gibt ein paar allgemeine Richtlinien zur therapeutischen Haltung
(z.B. Neutralität, Neugier und Nicht-Wissen), aber diese erfassen nicht die volle Komplexität des
Beziehungsprozesses in der Praxis der Begegnung in einer Familientherapie. Das Konzept des inneren

Author Note. Special thanks to Michael Seltzer (Oslo University College, Norway) for his support in writing this
article. Address for editorial correspondence: Email: <peter.rober@med.kuleuven.be>.

© Rober Volume
Person-Centered and Experiential Psychotherapies, 1477-9757/08/04245-17
7, Number 4 245
The Therapist’s Inner Conversation in Family Therapy Practice

Gesprächs des Therapeuten ist vielversprechender als diese allgemeinen Richtlinien und Regeln, weil es
die Wechselseitigkeit und die Gemeinsamkeiten des Selbst des Therapeuten innerhalb der Komplexität
familientherapeutischer Praxis anspricht. In diesem Artikel skizziert der Autor zuerst eine dialogische
Perspektive zur Familientherapie. Dann steht im Zentrum, welchen Beitrag die Idee eines inneren
Gesprächs des Therapeuten leisten könnte, wenn es um persönliche Themen des Therapeuten bei der
Arbeit geht und insbesondere auch um die Komplexität dessen, was es heißt, ein praktizierender
Familientherapeut zu sein. Im letzten Teil des Artikels wird eine Fallgeschichte vorgestellt, die illustriert,
wie das Konzept vom inneren Gespräch des Therapeuten Praktikern und Praktikerinnen helfen kann,
über manche Aspekte ihres Selbst in der therapeutischen Arbeit zu reden und sie zu reflektieren, Aspekte,
die zwar erfahren, aber nicht bemerkt wurden.

Los diálogos internos del terapeuta en la práctica de terapia de familia: Luchando con las complejidades
de los encuentros terapéuticos de familia
A pesar de la complejidad de la práctica de terapia familiar, los terapeutas de familia no tienen muchos
conceptos a su disposición para hablar y reflexionar acerca de sus experiencias en la práctica. La literatura
de terapia familiar brinda algunos principios generales acerca de la postura del terapeuta (por ejemplo
Downloaded by [Peter Rober] at 11:58 13 August 2011

neutralidad, curiosidad, y el “no saber”), pero estos no alcanzan a tratar toda la complejidad del proceso
relacional que se da dentro de un encuentro de terapia de familia en la práctica. El concepto de conversación
interna del terapeuta nos ofrece una promesa mayor que la de esos principios generales y guías de
orientación, ya que se dirige a la mutualidad y a la actividad compartida del self del terapeuta dentro de
la complejidad de la práctica de terapia familiar. En este escrito el autor primero presenta una perspectiva
dialógica de la terapia familiar. Luego pone el foco en cómo la noción de conversación interna del
terapeuta podría contribuir al tratar temas de la persona del terapeuta en la práctica, y en especial al
encarar la complejidad de lo que significa ser un terapeuta de familia en la práctica. En la última parte de
este escrito se presenta un caso que ilustra cómo el concepto de conversación interna del terapeuta puede
ayudar a los profesionales a hablar y reflexionar acerca de algunos aspectos de su self experienciados, pero
que pasaron desapercibidos, en la práctica de la terapia.

La Conversation Intérieure du Thérapeute dans la Pratique de la Thérapie Familiale : Se débattre


avec les complexités dans les rencontres thérapeutiques avec des familles
Malgré la complexité de la pratique de la thérapie familiale, les thérapeutes familiaux ont peu de concepts
à leur disposition pour nourrir leurs discussions et leur réflexion à propos de leurs expériences pratiques.
Les écrits sur la thérapie familiale fournissent quelques principes généraux concernant la posture du
thérapeute (par exemple la neutralité, la curiosité, et ne pas savoir), mais elles ne traitent pas dans la
pratique, toute la complexité des processus relationnelles lors d’une rencontre thérapeutique familiale. Le
concept de la conversation intérieure du thérapeute est plus prometteur que ces principes et repères généraux,
car il tient compte de la mutualité et de l’activité partagée du self du thérapeute dans la complexité de la
pratique de la thérapie familiale. Ensuite, l’éclairage est mis sur la contribution possible de la notion de
conversation intérieure du thérapeute dans la gestion de questions concernant la personne du thérapeute
dans sa pratique et, surtout, la gestion de la complexité de la signification du fait d’avoir une pratique de
thérapie familiale. Dans la dernière partie de l’article, une étude de cas est présentée pour illustrer la
manière dont le concept de la conversation intérieure du thérapeute peut aider à la discussion et à la
réflexion par rapport à certains aspects de leur self, dont, sans s’en apercevoir, les praticiens font l’expérience
dans la pratique de la thérapie.

O Diálogo Interno do Terapeuta na Prática da Terapia de Família: Lutando com as complexidades de


encontros terapêuticos com famílias
Não obstante a complexidade da prática de terapia de família, os terapeutas de família não dispõe de

246 Person-Centered and Experiential Psychotherapies, Volume 7, Number 4


Rober

muitos conceitos que lhes permitam conversar e reflectir acerca das suas experiências na prática. A
literatura para a terapia de família fornece alguns princípios gerais acerca da postura do terapeuta (por
exemplo: neutralidade, curiosidade e desconhecimento) mas os mesmos revelam-se incapazes de lidar
com toda a complexidade dos processos relacionais da família na prática de encontros terapêuticos. O
conceito de diálogo interno do terapeuta é mais promissor quando comparado com tais princípios
gerais e orientações, na medida em que aborda a mutualidade e a actividade partilhada pelo self do
terapeuta no complexo contexto da prática de terapia de família. Neste artigo, o autor começa por
esboçar uma perspectiva dialógica da terapia de família. Em seguida, a tónica é colocada no contributo
que a noção de diálogo interno do terapeuta pode trazer para lidar com aspectos relacionados com a
pessoa do terapeuta em prática, sobretudo na abordagem da complexidade que significa ser-se um
terapeuta de família em prática. Na parte final do artigo, é apresentado um estudo de caso que ajuda
a ilustrar de que forma o conceito de diálogo interno do terapeuta pode ajudar os técnicos a reflectir e
conversar acerca de aspectos experienciados mas que passam despercebidos e que dizem respeito ao seu
self na prática terapêutica.
Downloaded by [Peter Rober] at 11:58 13 August 2011

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Het Innerlijke Gesprek van de Therapeut in de Gezinstherapeutische Praktijk: Worstelen met de


complexiteit van therapeutische ontmoetingen met gezinnen
Niettegenstaande de complexiteit van de gezinstherapie in de praktijk, beschikken gezinstherapeuten
over weinig concepten die hen helpen te praten of na te denken over hun ervaringen in de praktijk. In de
gezinstherapieliteratuur worden wel enkele algemene principes en richtlijnen naar voor geschoven over
hoe de therapeut zich zou moeten opstellen in de sessie (bv. neutraliteit, nieuwsgierigheid, en not-knowing),
maar deze principes schieten te kort om de volle complexiteit van de gezinstherapeutische ontmoeting in
de praktijk voldoende te vatten. Het concept van het innerlijke gesprek van de therapeut lijkt meer
aangewezen dan deze algemene principes en richtlijnen omdat het beter aansluit bij de wederkerigheid
en de verwevenheid van het zelf van de therapeut in het gezinstherapeutische gesprek. In dit artikel wordt
eerst het dialogische perspectief op de gezinstherapie geschetst. Dan wordt ingezoomd op de bijdrage die
het concept van het innerlijke gesprek van de therapeut kan hebben in het spreken over de persoon van
de gezinstherapeut in de praktijk, en in het bijzonder over de complexiteit van wat het in praktijk
betekent gezinstherapeut te zijn. In het laatste deel van dit artikel wordt het verhaal van de eerste sessie
van een therapie gedaan, waarbij geïllustreerd wordt hoe het concept van het innerlijke gesprek van de
therapeut kan helpen om praten en denken over subtiele en soms onopgemerkte ervaringen van therapeuten
in de praktijk mogelijk te maken.

Person-Centered and Experiential Psychotherapies, Volume 7, Number 4 247


The Therapist’s Inner Conversation in Family Therapy Practice

Therapists engaging in conversations with families find themselves in highly complicated


situations. As a rule, the therapist meeting family members for the first time encounters a
group of distressed people apprehensive about what the future has in store for them. Some
family members arrive willingly, others less so. Usually, though not always, one parent is
more concerned than other family members and has taken the initiative to contact the
therapist. As the sessions proceed, family members tell their stories — some with a lot of
hesitation, others less so. Often, they seem fearful of being judged and — worst of all —
being rejected by the therapist. All want the therapist to listen to their stories and to understand
and believe them. It is no easy task for therapists trying to find their feet in the complexities
brought into the therapy room by the family. The key question they have to address in these
encounters is one involving how best to navigate and to negotiate in the shifting currents of
interests, fears and suffering in the family. Furthermore, therapeutic change adds to the
complexities of the situation since such an event, though invited and welcomed, can never be
predicted, mastered, and controlled (Larner, 1998).
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Family therapy practitioners have few conceptual resources at their disposal to talk and
reflect about the complexity of family therapy practice. They have to rely on general principles
about the therapist’s stance, such as neutrality (Selvini-Palazzoli, Boscolo, Cecchin, & Prata,
1980), curiosity (Cecchin, 1987) and not-knowing (Anderson & Goolishian, 1992). These
principles give something to hold on to, but they fail to address the full complexity of the
relational processes within a family therapeutic encounter in practice (Flaskas, Mason, &
Perlesz, 2005; Flaskas & Perlesz, 1996). According to some authors, the concept of the
therapist’s inner conversation shows more promise than these general principles and guidelines,
as it addresses the mutuality and shared activity of a therapeutic relationship in the complexity
of family therapy practice (Andersen, 1995; Flaskas, 2005; Lowe, 2004; Rober, 1999, 2005).
In this paper I will talk from my experience as a family therapist. Because of space limitations,
I will only sparsely refer to authors from the person-centered and existential approaches who
have covered some of the same territory as I am covering in this article (for example, Behr,
2003; Cooper, Mearns, Stiles, Warner, & Elliott, 2004; Schmid & Mearns, 2006), and limit
myself mainly to references to literature from the family therapy field. I will first outline the
frame of a dialogical perspective on family therapy, in order to focus later on the contribution
that the concept of the therapist’s inner conversation might have in addressing issues of the
person of the therapist in practice, and especially in addressing the complexity of what it
means to be a family therapist in practice. In the last part of the article, I will present a case
story that illustrates how the concept of the therapist’s inner conversation can help practitioners
to reflect about some of their experienced, but unnoticed experiences in therapy practice.

THE THERAPIST AND THE POSTMODERNIST TURN

The postmodernist and narrative turn hit the family therapy field at the end of the 1980s,
and swept across it in the 1990s. The representational nature of knowledge, the idea that
knowledge is some kind of representation of a real world out there, was challenged. Knowledge

248 Person-Centered and Experiential Psychotherapies, Volume 7, Number 4


Rober

could no longer be accepted as the truth because there is no objective reference point from
which to observe the world. More than an epistemological evolution, the postmodernist and
narrative turn made a lot of family therapists take a fundamental ethical position: therapeutic
conversation was to be a dialogue in which a therapeutic relationship of collaboration was
favored. This choice for dialogue was at the same time a choice against a technical, hierarchical,
or interventionist therapeutic relationship that had dominated the field for years (for instance,
in the form of structural and Milanese family therapy). Since the 1990s the family therapy
field has favored a therapeutic relation of collaboration (Anderson, 1997), participation
(Hoffman, 1991) and co-authorship (White, 1991).
In this context, the person of the therapist became an ethical problem. Inspired by the
writings of Michel Foucault (1979, 1984), the therapist, especially their knowledge and
expertise, is seen as potentially repressive and colonializing. Foucault states that knowledge
and power (pouvoir–savoir) are intertwined (Foucault, 1979). Power functions through
normalizing knowledge or truths. These truths are norms that give order and form to people’s
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lives. People submit to these normalizing truths by measuring themselves and people around
them in relation to these norms (Foucault, 1979). Especially sciences like psychiatry, psychology,
and criminology produce this normalizing knowledge. These sciences have become judges of
normality as they “… characterize, classify, specialize; they distribute along a scale, around a
norm, hierarchize individuals in relation to one another, and if necessary, disqualify and
invalidate …” (Foucault, 1979, p. 223).
How can a therapist have a collaborative relationship with clients if a therapist is an
expert with expert knowledge? In an attempt to give an answer to this ethical dilemma, the
concept of not-knowing was introduced by Anderson and Goolishian (1988, 1992). Not-
knowing refers to a stance in which the therapist communicates a genuine curiosity for the
client’s story. The therapist does not know a priori, but listens to the client’s story, takes the
client’s story seriously and joins with the client in a collaborative exploration of their experiences:
“Not-knowing requires that our understandings, explanations, and interpretations in therapy
not be limited by prior experiences or theoretically formed truths” (Anderson & Goolishian,
1992, p. 28). The concept of not-knowing puts the spotlight on the client’s expertise, and
invites the therapist to be critical towards themself. According to postmodernist family
therapists, the therapist has to acknowledge the dangers of their expert knowledge, and be
accountable for their prejudices and biases.

KNOWLEDGE OF THE THIRD KIND

Highlighting the importance of the client’s expertise and distrusting the therapist’s knowledge
might make us forget that the therapist’s contribution to the family therapeutic session is
only partly intentional, and that the expertise of the therapist is only partly of the theoretical
kind. This was pointed out by family therapists who maintained that in the practice of
therapy another kind of knowledge is more important (Andersen, 1995; Katz & Shotter,
2004), an embodied kind of knowledge that Shotter (1993) calls knowledge of the third kind

Person-Centered and Experiential Psychotherapies, Volume 7, Number 4 249


The Therapist’s Inner Conversation in Family Therapy Practice

— the knowledge of the first kind being a representational knowledge of a theoretical kind
(knowing that), and the knowledge of the second kind a technical knowledge of a skill or a
craft (knowing how). This knowledge of the third kind has to do with our anticipations and
expectations in social situations, as well as with the arsenal of potential responses and reactions
we have at our disposition. It is like two dancers who move together with nicely coordinated
movements. Without really knowing (in a representational sense) what will happen, they
anticipate each other’s movements and respond to each other with new movements. This is
a kind of embodied knowledge, “in terms of which people are able to influence each other in
their being, rather than just in their intellects; that is, to actually ‘move’ them rather than just
‘giving them ideas’” (Shotter, 1993, pp. 40–41). It is implicit knowledge, in the sense that it
does not presuppose conscious reflection or deliberation, nor can it be articulated by the
individual. Nonetheless, it can be observed in a person’s everyday social practices, as they
coordinate their actions with others. It is a knowledge from within our relationships with
others, and it determines what we anticipate or expect will happen next. In contrast to the
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other two kinds of knowledge (knowing that and knowing how) through this third kind of
knowledge we do not experience ourselves as individuals. Instead, we feel ourselves to be
involved and enabled to participate in a social situation and be responsive to it. This kind of
knowledge becomes visible only in the process of our interaction with others; thus can only
be studied in the brief interactive moments that comprise our daily social life (Shotter, 1993).
The importance of this knowledge of the third kind to the practice of family therapy
becomes evident when we observe a family therapist working with a family. We notice that
although the theoretical and technical knowledge of the therapist plays some part in their
decisions, actions, and interventions, much of the therapist’s behavior can only be understood
if we focus on the way the therapist’s and the family members’ actions are coordinated in a
collaborative dance (Mearns, 1994). In the continuous flow of words and actions, we can
distinguish the therapist’s words and actions as reactions, not only to the family members’
words and actions, but also to anticipated or potential actions and words. In the same way,
family members react to each other’s words and to the therapist’s words, but also to words
that were spoken before, as well as to words that were never spoken but only anticipated. In
this way therapy presents itself as a dynamic, embodied process in which the participants,
each in their own way, are responding to each other — they “move” each other, as Shotter
would say — and together they shape the therapeutic conversation.

KNOWING IN ACTION

The family therapist’s actions in the stream of the conversation, resulting from unreflected
and immediate responding to what presently happens in the session, is referred to by some
authors as actions from a default position (Reimers, 2006). Given the complexity of a family
therapeutic session, it seems unavoidable that the therapist’s contribution to the dialogue is
some kind of balance of conscious therapeutic intent and a default position. Although it is
important to be available to the uniqueness of the therapeutic conversation, action from a

250 Person-Centered and Experiential Psychotherapies, Volume 7, Number 4


Rober

default position does not have to be problematic because, as the well-known research of
Donald Schön (1983) on practitioners’ knowledge illustrates, a lot of wisdom is present in
our intuitive actions. Schön studied practitioners in action (for example, psychologists,
engineers, architects). He found that good practitioners rely less on the systematic knowledge
they learned at university, and more on some kind of improvisation learned in practice. In
practice, professional situations are characterized by complexity, uncertainty, and instability
that necessitate a kind of knowledge that Schön calls knowing-in-action. This know-how does
not rest on rules and plans that are entertained prior to action, nor can a practitioner articulate
why they acted like they did. Although practitioners sometimes make conscious use of scientific
theories, most of the time they are dependent on tacit choices and judgments. As Schön
(1983) writes: “… skillful action often reveals a ‘knowing more than we can say’” (p. 51).
Given this emphasis on knowledge in practice, the challenge for the family therapist becomes:
How can I act in ways that encourage new resources for action? Indeed, family therapy is not
about philosophical abstraction or psychological theorizing: “It is about actions of persons in
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relation” (McNamee, 2000, p. 180). Family therapy is a form of practice: “The attempt is
not simply to ‘say things differently’ and thereby declare ‘the way it is.’ Rather, the attempt is
to engage others … in activities that broaden our resources for social life” (McNamee, 2000,
p. 181).

THE THERAPIST’S INNER CONVERSATION

Since the passing of the millennium, a dialogical perspective has been emerging in the family
therapy field (Guilfoyle, 2003; Rober, 2002, 2004, 2005; Seikkula, 2002; Seikkula & Olson,
2003) as it has in individual work within the PCE therapies (Cooper, Mearns, Stiles, Warner,
& Elliott, 2004). Within this view, some family therapists have described the therapist’s self
as an inner dialogue (Andersen, 1995; Penn & Frankfurt, 1994; Rober, 1999, 2002, 2005).
The therapist maintains an inner dialogue with themselves, which is the starting point of
their questions. This dialogical conversation has been called the therapist’s inner conversation
(Rober, 2002, 2005).
While the concept of not-knowing focuses on the therapist’s knowledge as the central
issue (Anderson, 2005), the concept of the therapist’s inner conversation refers to a broader
spectrum. It refers to whatever the therapist experiences, thinks, feels, but does not share in
the session. The concept of the therapist’s inner conversation is inspired by Mikhail Bakhtin’s
concept of the dialogical self as a polyphony of inner voices (Bakhtin, 1981, 1984; Morson
& Emerson, 1990). Referring to William James’ classical distinction between the I and the
Me (James, 1890), this dialogical self can be portrayed as a multiplicity of I-positions (Cooper,
2004; Hermans, 2004). Hermans (2004) describes the self in spatial terms: “… self as being
composed of a variety of spatial positions and as related to positions of other selves” (p. 18).
According to Hermans, the I moves from position to position, as in a space, depending on
the context: “The I fluctuates among different and even opposed positions. The voices function
like interacting characters in a story. Once a character is set in motion in a story, the character

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The Therapist’s Inner Conversation in Family Therapy Practice

takes on a life of its own and thus assumes a certain narrative necessity” (Hermans, 2004, p. 19).
Based on our clinical and training work, we differentiated the therapist’s inner voices by
making a distinction between voices reflecting the therapist’s experiencing self and voices
reflecting their professional self (Rober, 1999):

1. The experiencing self: These are the observations of the therapist as well as the memories,
images, and fantasies that are activated by what the therapist observes. This is closely
akin to what Bakhtin terms the I-for-myself (Morson & Emerson, 1990). As I-for-
myself, the therapist mainly senses themself as acting in response to the context, and
to the invitations of the clients. In a sense, the experiencing self implies a not-knowing
receptivity towards the stories of the client, as well as towards what is evoked by these
stories in the therapist.

2. The professional self: This is the therapist’s hypothesizing (Rober, 2002) and their preparing
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of responses. From an observer position towards the experiencing self, the therapist
tries to make sense of their experiences by structuring their observations and trying to
understand what is going on in the family and in the conversation. A Bakhtinian term
for this would be the I-for-others (Morson & Emerson, 1990), because it is as if the
therapist observes themselves from the outside, as if they are watching a play in a
theatre in which they have a part. The therapist authors a story with some coherence
about the conversation, and becomes the protagonist of their own story.

Viewed in this way, the therapist’s inner conversation can be described as a dialogue between
the experiencing self and the professional self. The therapist creates a reflective inner space. In
this space, the therapist reflects on their experiences and on their position in the conversation,
as well as on what they will do next. Here the therapist’s responsibility is of central importance,
because this is where the therapeutic and ethical choices are made.
Recently, we studied the therapist’s inner conversation as a dialogue between the
experiencing self and the professional self in a more systematic way, using a tape-assisted
recall procedure to obtain therapist reflections during role-played sessions (Rober, Elliott,
Buysse, Loots, & De Corte, 2008a, 2008b). We analyzed the data using a grounded theory
method and we proposed a descriptive model of the therapist’s inner conversation with four
positions: attending to the client’s process; processing the client’s story; focusing on the
therapist’s own experience; and managing the therapeutic process. The model highlights the
importance of the dialogue with the client for the therapeutic process, as the therapist’s first
concern is with tuning into the client and with the dialogical creation of a space to talk in
which the client can tell their story (Rober et al., 2008a). In addition, in the model the
therapist’s self is portrayed as a dynamic multiplicity of inner positions embodied as voices,
having dialogical relationships in terms of questions and answers, or agreement and
disagreement (Rober et al., 2008b). Furthermore, the model shows that, although the dialogical
self is de-centered and comprises a multiplicity of inner voices, it is not fragmented or chaotic.
Rather, it has some coherence and some organization, in such a way that it fits the therapist’s

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role as professional, and the social expectation that they are helpful to the family in distress
(Rober et al., 2008b). Some of these aspects of the therapist’s inner conversation will be
illustrated in the following case vignette.

CASE VIGNETTE

The main aim of the following analysis is to illustrate in what way the inner conversation
of the therapist is a valuable conceptual tool enriching our thinking about the complexities
of family therapeutic relationships in practice. It illustrates how the self of the therapist can
be described as a polyphony of different inner voices, one evoking the other, in the therapist’s
attempts to make sense of what happens in the session and to be helpful to the family.
First, I will present the transcript of the session,1 without the therapist’s inner conversation
(see Transcript 1). Johnny is a 14-year-old boy referred by a juvenile court because of
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extreme violent behavior. We are some 20 minutes into the first session with Johnny and
his mother.

Transcript 1

Mother is crying silently. Johnny addresses the therapist, and smiles.


“I hate her, and if she keeps messing with me I will kill her,” he says.
Mother is crying harder now.
The therapist hands her the box with Kleenex.
She takes one tissue.
The therapist asks her: “If your tears could talk, what would they tell us?”
Mother answers: “I do not deserve this. I have always loved him and taken care of him. I
have given him whatever he needed. And now he bullies me and he wants to scare me.”

This transcript describes a particularly dramatic sequence in the session. The boy speaks
threatening words; the mother cries harder. Then the therapist comforts her, and asks her to
talk about her tears.
I will now present the same vignette, but in addition to the transcript of the conversation
between the mother, Johnny and the therapist, I will also consider the therapist’s inner
conversation (see Transcript 2). The inner conversation in this transcript was reconstructed
using a tape-assisted recall procedure. Tape-assisted research procedures are inspired by the
work of Kagan (1975), and have been very productive in psychotherapy process research
(Elliott, 1986; Rennie, 1994). The procedure used for this transcript followed two steps.
Firstly, the session with the family was recorded on videotape. Secondly, immediately after

1. The case vignette is a transcribed excerpt from a videotape of a therapeutic conversation that took place in a
community therapeutic center. Mother and Johnny (pseudonym) were informed about my research project on the
therapist’s inner conversation. They gave me their consent to use the tape of their session for the project, on the
condition that I would wipe the tape after I made the transcript.

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The Therapist’s Inner Conversation in Family Therapy Practice

the session, the therapist watched the videotape. As in the classical tape-assisted recall research
procedure, the therapist stopped the tape whenever he could remember things he felt, thought,
or experienced at that moment in the session. The therapist made notes of these reflections.
These notes were then combined with the transcribed videotape, resulting in a transcript in
two columns: one column with a transcription of the outer conversation between the therapist
and the family, and one column with the therapist’s inner conversation.

Transcript 2

Outer conversation Therapist’s inner conversation

Mother is crying silently. Johnny


addresses the therapist, and smiles: “I
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hate her, and if she keeps messing with


me I will kill her.” (1) (1) I feel a flash of fear going through me
— he sounds so cold — would he really
do that, I wonder. Kill her? At the start
of the session mother mentioned that she
was afraid of her son. Is he really
threatening to kill his mother?

Mother is crying harder now. (2) (2) I feel sadness coming on and I want
to comfort her.

The therapist hands her the box with


Kleenex. She takes one tissue. (3) (3) I think that it’s not up to me to
comfort mother. I should invite her to
talk instead.

The therapist asks her: “If your tears


could talk, what would they tell us?”
Mother answers: “I do not deserve this.
I have always loved him and taken care
of him. I have given him whatever he
needed. And now he bullies me and he
wants to scare me.” (4) (4) In some way this answer reassures me.
He wanted to scare her, but he didn’t want
to kill her. And then I realize that he had
scared me too, and that I had turned to
mother for comfort. My comfort.

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In the therapist’s inner conversation, we see him struggling with what happens in the session,
and with what it evokes in him in terms of emotions and dilemmas. The therapist is trying
to make sense out of what happens and he is reflecting on how he should handle the situation
as a therapist: should he comfort mother? Let us now look more closely at the therapist’s
inner conversation. We can distinguish four reflections in this short transcript.

1. The first reflection is evoked by Johnny threatening remark “I will kill her.” The therapist
is not only struck by the content of the remark, but also by the coldness of Johnny’s
expression. He reacts with a flash of fear, suggesting that he is surprised and overcome
by this rush of strong emotion. Several inner voices start to weigh the possibility of
homicide as he tries to assess the danger. These reflections seem to bring back some
balance in his inner conversation, as they seem to push back the inner voices expressing
fear.
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2. The second reflection is invited by mother’s crying. In the face of the woman’s weeping,
the therapist reports his own sadness, and this inner voice immediately mobilizes
another voice replying that he wants to comfort the mother. The therapist seems to
take no time to reflect on this inclination, and seems to jump rather impulsively to
offering her the box of Kleenex, positioning himself as comforter, mother as victim
and Johnny as perpetrator.

3. The third reflection can be understood as a correction of the therapist’s previous actions,
and as a more reflective reply to the impulsive voice that took precedence in the
previous entry. The therapist describes a therapist’s role in general as inviting the client
to talk, rather than as actively intervening in the family and its management of emotions.

4. The final reflection of this transcript adds further reflections on his actions and his
management of emotions. The therapist realizes that his impulsive reactions in the
past minutes were inspired more by his own fear and insecurity than by his empathy
for the mother. Possibly this reflection could only be made after he was reassured that
there was no real danger of homicide.

This is an analysis of this very brief transcript, using the concept of the therapist’s inner
conversation. As a clinician, such an analysis helps me to sense some of the complexity of
what happened in the session, and understand the way in which fear and threats played an
important role in how the family members interacted. Of course the transcript begs to be
analyzed in more detail. In the context of this article, however, our brief analysis suffices to
demonstrate one of the ways in which the concept of the inner conversation of the therapist
can contribute to a richer understanding of the complex mutuality of the family therapeutic
session, and the vulnerable place of the therapist in that session. The analysis shows how the
therapist is emotionally affected by what happens in the session, and how he tries to master
his own emotions, while searching for a position to be useful to the mother’s process.

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The Therapist’s Inner Conversation in Family Therapy Practice

In our analyses of transcripts of sessions — for research purposes, as well as for training
and supervision — we deliberately use the concept of positioning (Davies & Harré, 1990;
Harré & Van Langenhove, 1999) for the inner conversation, as well as for the conversation
between the family members and the therapist, because this concept is a dynamic metaphor
that offers the possibility to highlight the differentiation of inner as well as outer voices,
localizing them in time and space, not as things or parts but instead as vantage points,
implying that the world is always seen from a particular vantage point, and not from another
(Hermans, 2004). The concept of positioning contributes to a better description of the
dynamics of the dialogical self, where one voice comes into being in dialogue with another
voice, inner or outer; as if it were invited by this other voice (Rober et al., 2008b). The
concept also helps us to describe the therapist’s inner conversation in the context of a therapeutic
session, enriching our thinking about the complexities of therapeutic relationships; especially
in as far as family therapy is concerned. Indeed, in comparison to an individual session, in a
family therapeutic session even more voices are involved, and one of the challenges of the
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family therapist is exactly how to position oneself — “outside therapy, while inside” (Larner,
1998, p. 567) — in the complex stream of voices, inner and outer, during the session.
The next case history — a story about individual therapy as well as about family therapy
— will illustrate how the concept of the therapist’s inner conversation is useful as it makes
certain experienced, but unnoticed, aspects of being a therapist in practice accessible for
reflection and discussion. The story will also bring together some of the concepts that I have
touched upon in this article.

CASE STORY OF LIZA2

Liza, a 25-year-old woman, came into therapy because she had been abused as a child by
her father. Already, at the beginning of the first session, I felt a vague uneasiness. I wondered
what was wrong. At first I couldn’t put my finger on it. Maybe it was nothing. After all, it
was a vague feeling. On the other hand, maybe it was meaningful. Could it help me to
understand something about the client, I wondered. I urged myself to take this uneasiness
seriously. I decided to look more closely at what was happening in the session. I noted that
Liza answered my questions, but that her answers were rather brief. Also, she looked very
tense, I reflected. I noticed she made no eye contact. In fact, she seemed irritated and she
made me feel as if she didn’t trust me. I reflected that maybe she was angry with me. But
I had never met her before, what could she be angry about? Maybe it was something I had
said that had hurt her. Or, maybe she was just tense, as some people are at the beginning of
a therapy.
These are different inner voices induced by what is happening. They were given room to
emerge, evoking each other (e.g. “Maybe she is angry with me?” evokes “How could she be,
2. Liza (pseudonym) gave me permission to use her story in this article. When I asked her permission to use it in a
professional journal for therapists, she replied: “By all means. Maybe it can teach your colleagues to carefully listen
to what their clients can not yet say.”

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I have never met her before?”). As a therapist, I tried to be open to these voices — not-
knowing and curious — wondering if they would help me to make some sense of what was
happening in the session, and hoping that they would give me clues about how to go on with
the conversation.

Then I asked Liza if she was feeling tense.

Afterwards I wondered why I had asked this question. I had tried to listen to the different
aspects of her storytelling: what she said, what she showed, and also how she made me feel.
In my inner conversation, several ideas and voices had emerged. And then I somehow came
up with this question: “Are you feeling tense?”
But why exactly did I pick this question? I don’t really know. There certainly was no
deliberate strategy behind it. With the benefit of hindsight I think I must have experienced
this question as sufficiently connected with some of my inner voices, while at the same time
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it was not too intrusive for this new and brittle therapeutic relationship. It must have been
some kind of knowledge of the third kind — out of my intentional control, but making
sense in the dialogical context — as I would learn later, it was well tuned into the process of
the client. It is an example of what Schmid calls the personal resonance of the therapist in
relationship with the client (Schmid & Mearns, 2006) and in parallel with Behr’s process of
interactive resonance in person-centered play therapy (Behr, 2003). It is an illustration of how
the therapist is often positioned in therapy: inside while outside, inviting change but never
controlling it, and depending on his knowing in action to lead him in his moment-by-
moment decisions. Anyway, in retrospect, I can say that it proved to be a good question, as it
opened space for a story that explained a lot to me.

At first she was silent.


I asked her again: “Are you tense?”
Then she said that it was not easy for her to come to therapy.
“Can you help me understand that?” I asked.
Liza answered that she had been thinking about going into therapy for a long time, but she
had always postponed it: “Even just now, while I was sitting in the waiting room, I
contemplated walking out again,” she added.
I again asked her if she could help me understand.
Then she told me the following story:
“My father abused me the first time when I was 4 or 5 years old. He came to my room at
night when everyone in the family was sleeping, and he raped me. Afterward he said to
me that I should never talk about it, because it was our secret and if I would talk then he
would go to jail. So I didn’t talk about it but the following nights he came again and
every time he raped me. One night I had wetted my bed. When father came and he
noticed the bed was wet, he got angry with me, and he called me a filthy, dirty slut, but
he didn’t rape me. So I had found a way to protect myself against him. Since that night
I wet my bed every night.

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The Therapist’s Inner Conversation in Family Therapy Practice

Soon my mother noticed I was wetting my bed. So she talked to the G.P. and he referred
us to a therapist.
When my mother told me we would go to a therapist, I felt my hope rising. Maybe now
there would come an end to the pain and the fear and the shame. In the first session with
this therapist, however, I noticed that the therapist was only concerned with finding a
solution for my bedwetting. He didn’t seem at all interested in the family relations or in the
how and why of the bedwetting. I have to admit that in some way that was a relief, because
I feared the confrontation with my father. At the same time I was very angry with the
therapist, not only because he didn’t notice that there was more to it than just bedwetting,
but also because he was searching for a solution for the bedwetting, and he didn’t seem to
notice that he was going to take away the only protection I had against my father. So I
sabotaged the solutions he proposed. I also swore I would never trust a therapist again.”

In retrospect, I think that it must have been this resolution to never trust a therapist again
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that I had experienced as uneasiness. In response to vaguely experiencing this uneasiness it


would have been very easy to discard it as unimportant — instead I had tried to make sense
of it in my inner conversation – listening to the different inner voices, contradictory as they
were. This resulted somehow in the question “Are you feeling tense?” which created room for
the telling of Liza’s story. I was relieved when she told me this story. It helped me to understand
some of the things I had experienced. Furthermore, the story also resolved part of the distrust
Liza had towards me as a representative of the therapy profession.

CONCLUSION

Family therapy is a complex process, about which Larner (1998) writes: “This is where the
therapist stands: outside therapy while inside, and with a sense of humility and astonishment
when change occurs” (p. 567). It is a process characterized by uniqueness and unpredictability,
which often leaves therapists with a lot of questions about what to say or do, and how to
position themselves. Authors in the family therapy field have suggested key concepts like
neutrality and not-knowing as guiding principles to help therapists deal with these questions.
These concepts, however, are usually not very helpful as they are too crude to connect with
therapists’ lived experiences and fail to address the full complexity of the relational processes
of a family therapeutic encounter in practice in a satisfactory way (Flaskas, Mason, & Perlesz,
2005; Flaskas & Perlesz, 1996).
In this context, the concept of the therapist’s inner conversation might offer potentially
rich perspectives for the future. Rather than a guiding principle about what the therapist
should do, or how they should position themselves in the session, it is a tool that can be
drawn upon to think and talk about the therapist’s positioning and experiencing in the
session, and as such, it gives access to tacit aspects of the therapist’s self in practice. The
concept might be especially useful in training and supervision. In training it can be used to
help young therapists to attend to the rich resource that the self is (Lowe, 2004; Rober,

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1999). Furthermore, the concept helps to orient training towards assisting therapists deal
with the tensions that exist between the main I-positions that are evoked in the therapist
during the session (Rober et al., 2008b). In supervision, the concept of the therapist’s inner
conversation can be a tool offering a richer understanding of therapeutic impasses (Flaskas et
al., 2005; Rober, 1999). It suggests that a central question in supervision is about the ways
the tension between the main I-positions in the therapist’s inner conversation can be used to
promote the dialogue with clients and, ultimately, the therapeutic processes of these clients.

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