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2 Introduction The purpose of this paper is to explore some connections between psychotherapy and complexity science. Initially, I titled the paper Complexity Informed Psychotherapy and then changed it because on reflection, I was not sure in what ways complexity science has explicitly informed psychotherapy. What I think may be happening is that recent trends in psychotherapy are paralleling scientific changes which are found in post-modern, postNewtonian, post- Cartesian ways of thinking about the world. It is not surprising that this is happening. History is full of examples of a “zeitgeist” having a pervasive influence on many different aspects of arts and sciences. I will attempt to describe how some psychotherapy processes may be viewed using the concepts of chaos (deterministic nonlinear dynamic processes) and complexity science (self-organization and emergence), at least as far as I understand them. In order to do this I will briefly trace the evolution of psychotherapy and also draw on recent approaches in psychotherapy to provide illustrations. It may be too grandiose to propose that complexity science is the fifth great wave of psychotherapy, the first four being psychoanalysis, behaviourism, general systems theory and constructivism, but ultimately this may be viewed as the major thesis of this paper. The terms “Chaos theory” and “Complexity” are often used together and for good reasonboth are paradigms of the “New Science”3, which attempts to escape the explanatory bounds of linear determinism. They must not be confused with each other, however, and complexity takes the new science to a completely different level beyond chaos theory. Here, for example, is a quotation by biologist Stuart Kauffman who is one of the pioneers of the new science and founders of the Santa Fe Institute. In the preface to his recent book, Investigations4, in which he attempts to understand the biosphere and life within it, he states, “So the biosphere, it seems, in its persistent evolution, is doing something
The impetus for this paper is a “PlexusCall” to be held on March 28th, 2003. PlexusCalls are bi-monthly hour long telephone conferences with several participants involved in an interview format on a specific topic. There is a prepared set of questions and also questions can be asked by the audience “live” via email. The topics are all complexity related and are organized through “The Plexus Institute” www.plexusinstitute.org The call features Kevin Buck and the author of this paper discussing aspects of how complexity science has informed our work as therapists/psychologists. Kevin is a psychologist living in California with a history of psychotherapy and family therapy practice. I am a psychologist living in Ontario, Canada, presently executive Director of a children’s mental health centre. Kevin and I share a common interest in complexity science and the Institute’s Director, Curt Lindberg, brought us together to participate in a PlexusCall.
Executive Director, Madame Vanier Children’s Services; Adjunct Clinical Professor, Psychology and Psychiatry, University of Western Ontario 3 Margaret J. Wheatley Leadership and the New Science: Learning about Organization from an Orderly Universe San Francisco: Berrett-Koehler, 1994 4 Stuart A. Kauffman Investigations Oxford: Oxford University Press, 2000 p.x
literally incalculable, nonalgorithmic, and outside our capacity to predict, not due to quantum uncertainty alone, nor deterministic chaos alone, but for a different equally, or more profound reason: Emergence and persistent creativity in the physical universe is real”. Thus, while chaos theory remains within a deterministic framework, complexity does not. Psychotherapy is the practice, partly an art and partly a science in my view, of engaging in a dialogue with a person about his or her life problems with a view to helping that person. It is a process which occurs at the level of conscious awareness of the participants although conscious awareness does not always correspond with noticing and attending to all aspects of the content and the processes involved in the dialogical exchange. More will be said about this later when psychotherapy is viewed through a complexity lens. The nature of problems can range from the specific and circumscribed (e.g. phobias) to the very general and global (e.g. existential and spiritual life concerns). Complexity provides a very useful lens to look at psychotherapeutic processes because the nature of human problems (whether circumscribed or global) tends to be complex. Brenda Zimmerman in one of the recent PlexusCalls (October 11, 2002), gave a very lucid description of, what in her view, are complex problems5. Some problems are “simple”, some are “complicated” and yet others are “complex”. A “simple” problem is one for which there is a relatively straightforward solution. An example of a simple problem is a flat tire on a car. The cause of the car’s lack of forward progression is visible, the remedy is obvious and the solution relatively easily achieved. The area of most confusion is between “complicated” and “complex” problems. A complicated problem is one which is difficult and multifaceted but will resolve with a controlled, technical solution or set of solutions which are derived from known parameters. An example Zimmerman and her colleague Shalom Glouberman uses is sending a person to the moon. This is an extremely complicated task. However, having done this once, the solution is replicable, although admittedly this entails a very complex set of tasks. A “complex” problem, on the other hand is replete with “unknowables” and it will not resolve with tried and true solutions. The example that she gives is “raising a child”. There is no one right formula to raise a child. Having raised one child does not mean that one has the answers to raising another child. Individual lives and patterns of human relationships are always unique. No one individual is the same as another in this world (Raelian cloning claims notwithstanding!) and even if that were the case, there is no pattern of human relationships which is exactly the same as another pattern. There may be similarities across people, and these are important, but ultimately the uniqueness of each person and thus the uniqueness of each problem which a psychotherapist encounters has to be acknowledged. One of the recent trends in psychotherapy is the so-called “manualization” of psychotherapy treatments. Manualization is the process of specifying the precise step-by-step details of
See Shalom Glouberman and Brenda Zimmerman Complicated and Complex Problems: What would a new perspective on medicare look like? available on the www.healthandeverything.org website
psychotherapy in order for the methods and techniques to be communicated to others who can then replicate them. This is an attempt to be completely prescriptive about what happens in psychotherapy. This trend comes out of the drive (probably linked to managed care) to utilize only “empirically validated” or “empirically supported” approaches. This framework depicts psychotherapy as a mechanical process and comes from the “old science” of logical positivism rather than the new science. It assumes that the task is a “complicated” one, rather than a complex one. I have found value in developing “protocols” which reflect good practices and which can streamline clinical processes in many areas, but it is important to use such protocols in a flexible manner. I am using the term psychotherapy in a broad sense, including all forms of “talk therapy”, including the various forms of cognitive-behaviour therapy. It is actually very hard to put defined boundaries on the practice of psychotherapy. Traditional psychotherapy has relied for its underlying theory of change either on “insight” (psychodynamic-oriented therapy) or on “learning” behavioural or cognitive-behavioural therapy). “Insight” therapy relies on the assumption that to know and to be aware of those things which are driving behaviour, one will then have the capacity to change them, i.e. “knowledge is power”. Behavioural theories and cognitive behaviour theories, on the other hand, assume that awareness alone is not enough and that opportunities for learning and practicing new, different ways of thinking and behaving is the basis for change. Psychoanalysis, Object relations, Emergence and the Self Psychoanalysis is both a theory of unconscious motivation and a set of practices which derive from it. A fundamental principle is that it is necessary to bring into conscious awareness the historical and vestigal origins of current self-destructive behaviour. Psychoanalysis falls down as a deterministic science in that predictive “explanatory” constructs such as Oedipus Complex have not been particularly useful. The causal relationship between “oral stage” events such as abrupt weaning and later anxiety disorders and “anal stage” events such as rigid, early toilet training and the later onset of obsessive-compulsive disorders have not stood up to close scrutiny. These historically early attempts to forge a linear and one-to-one causal relationship between ontogenetic early experience and adult psychopathology have virtually been abandoned. Psychoanalysis works better backwards, however, than it does forwards. A person’s life generally makes sense if it is viewed in retrospect. As Soren Kierkegaard, once said, “Life can only be understood backward, but must be lived forward.” There is a coherence and a set of patterns which emerge which invariably make sense when a life is examined in reverse. For this reason, psychoanalysis continues to be quite alive and well as a practice and a number of writers have make links between psychoanalysis and complexity science.6 The following is just one aspect of that interconnection which I want to explore in this paper.
See for example: Spruiell, V. Deterministic Chaos and the Sciences of Complexity: Psychoanalysis in the midst of a general scientific revolution. Journal of the American Psychoanalytic Association, Vol 41, 3-44, 1993
We are all familiar with the concept of a hospital emergency room; perhaps in psychotherapy we need to create an “emergence room”! This is indeed a space where emergence can happen. Therapy offers a safe, protective environment where exploration can occur and where growth can take place. D.W. Winnicott, the British psychoanalyst and object relations theorist, referred to “transitional space” – a safe, holding place, where creative exploration can safely take place. The space is “transitional” because it offers a place to move from dependency to independence. New ways of coping and adapting may emerge under these conditions. One is not being led by the therapist to a predetermined place- the conditions are being set whereby a person can come to find one’s own solutions to problems. I see it as a safe, holding place at the “edge of chaos”. The relationship contains the individual in a “basin of attraction”, to use the chaos theory term, where the individuals own self-healing processes can begin to work. The following two extracts from Winnicott’s own writings illustrate the importance of creating a space for playful, creative exploration and for the emergence of new ways of thinking and doing. "It is in the space between inner and outer world, which is also the space between people--the transitional space--that intimate relationships and creativity occur."7. "Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play.8 The process of therapy involves helping a patient contain the tension in order for it to become a source of creative inspiration and positive influence rather than a source of overwhelming anxiety or paralyzing despair. The objective of therapy is not to eliminate stress and tension, because this is impossible but it is possible to contain stress and tension in the zone where we can grow and feel fully alive. If we slip out of this zone in one direction, we become spiritually and mentally dead and defeated by the challenges of life. If we move out of the zone in the other direction where the stress becomes too great, we move into disorganization and chaos. What provides coherence and structure to our ways of being in the world is the concept of the “self” and it can be said that psychoanalysis is a process which leads to the emergence of a healthy “self” or “robust ego” in psychoanalytic terminology. The “self” may be considered a dissipative structure (as defined by Ilya Prigogine) that is a structure which is far from equilibrium requiring a constant flow of energy through it to maintain its stability9. The self is constantly being created and re-created with every decision and every action a person takes. The self is a process, and not a thing which develops in childhood and
D.W.Winnicott Transitional Objects and Transitional Phenomena, 1951 D.W.Winnicott Playing: Its Theoretical Status in the Clinical Situation,1971 Sardar, Z. and Abrams, I Chaos for Beginners Cambridge, UK: Icon Books, 1998 p 69 -70
remains static. The process of self-creating is never ending until we die. We have a conscious sense of self because we are constantly in the process of creating the self. This has been called autopoesis or self-making by Maturana and Varela10. Therapists can be facilitators in this autopoetic process, providing parameters within which the self can be defined, and possibly suggesting minimal or gradual corrections to the patient’s thoughts and actions which define the self. In old-therapy talk, this was known as the “reality check”; but to put in this way privileges the therapist’s worldview and subjugates the patient’s experiences. Therapists are interested in the self and the self in relationship to others for example the relationships in the family, the community, the relationship to the therapist him/herself, the relationship between the current self and the historical self, the relationship between the internalized parent and the idea of self as parent etc. The therapist can help the patient to explore these different facets of relationship and help to place the facets into an integral and coherent whole. In the language of chaos/complexity, this structural coherence, involving self-similarity at different levels of scale, is fractal. The focus to this point in this brief exploration of psychodynamics has been on the role of unconscious processes of the individual. It is important to add to this the Jungian psychoanalytic perspective of the collective unconscious. Jung alerted us to the importance of universal symbols which reflect the total human experience across cultures and across time. The relationship between Jungian psychology and complexity is an interesting one which deserves more space that can be allotted here.11 Behaviourism, Cognitive-Behaviourism and Beyond The second wave, behaviour therapy, emerged from two great theories in psychology in the early part of the 20th century. These two theories, one American and one Soviet Russian, represent the two prototypical ways in which the behaviour of living organisms changes as a result of experience and interaction with the environment. The American theory is known as operant conditioning as expounded by B.F. Skinner12. The Soviet theory is Pavlov’s classical conditioning. It may no coincidence that the American culture produced a theory of learning which emphasizes that behaviour, actively (operantly) initiated by an organism, is strengthened (or weakened) by the consequences (rewards and punishments) which follow the behaviour. Embodied in this paradigm are the cultural values of personal agency and responsibility and a society which rewards the good and punishes the bad. On the other hand the Soviet culture produced the classical conditioning paradigm. In this paradigm, a response from an organism is involuntarily elicited by a stimulus and by a chance pairing, a contiguous association in time, a similar response is elicited by a previously neutral stimulus. This is exemplified by the legendary dog salivating to the sound of a bell which had been paired with (i.e. presented
Maturana, H. and Varela, F. The Tree of Knowledge: The Biological Roots of Human Understanding Boston: Shambhala, 1987. (Revised Edition: same publisher, 1992) 11 An interesting website on this topic can be found at http://www.schuelers.com/ChaosPsyche/part_1_23.htm 12 There are many possible sources to refer to regarding B.F. Skinner’s behaviourism. One is B. F. Skinner. Science and Human Behavior. New York: Collier-Macmillan, 1953
just before) food for several trials. Embodied in this paradigm is that notion that people are hapless victims of forces and circumstances which are beyond their control. To this day, there remains a cultural divide regarding the relative importance accorded to these two forms of learning. As is evident, both of these theories, although quite different from each other, present a very linear view of the relationship between the organism and its environment. They also each represent a reductionistic attempt to understand human behaviour. Early behaviour therapy therefore, being quite firmly rooted in the old science was quite mechanical in nature. Operant conditioning, in its purest form, strictly adhered to the “black box” paradigm, admitting into its framework only those data which could be observed and counted. Resulting from this were “laws of behaviour” which related observed discrete behaviours to observed discrete stimuli. A prevailing belief was that behaviour therapy was most applicable to the treatment of relatively uncomplicated patterns of behaviour such as simple phobias. Over the past 20 to 30 years, there have been many evolutionary changes, principally the admittance of a broader set of data encompassing internal states: thoughts and verbally encoded feelings, giving rise to the multitude of approaches known as cognitive-behaviour therapy (CBT). CBT generally has added the dimension of the importance of the patient’s views (perception, interpretation) of external events as a mediator between the objective external reality and action. It differs from some other “constructivist” views to be described later, in that there is still a presumption of an “objective reality” which the patient may perceive accurately or in a distorted fashion. From a complexity perspective, there is much of interest in the recent versions of cognitive-behavioural approaches. Dialectial behaviour therapy, for example, as developed by Marsha Linehan13, is a remarkably effective form of therapy for patients who have chronic and severe patterns of interpersonal and intrapersonal difficulties. The kind of dialectics which underly the approach are acceptance vs. change, and validation vs confrontation and can be stated as follows: “I completely accept you as you are, now change” and “Your feelings are justified given what you have been through, giving free rein to these feelings is harmful to you.” The following are two opposing thoughts or beliefs, “I am worthy” and “I am unworthy”. For some people, their daily life is a struggle between these polarities of self-worth and total worthlessness. Compromise doesn’t work. It doesn’t work, for example, to say to oneself , “I’m somewhere in the middle of worthiness”; there is no “demilitarized” middle ground between these two opposing poles. This connotes too static a state; there is no room for growth, no room for emergence. Resolving the tension by adopting one extreme or the other is maladaptive. “I am completely worthy” leads to narcissism or psychopathy. “I am totally unworthy” leads to depression, low self-esteem and potential suicide. The task of therapy is to integrate opposing views and allow the tension created by the two opposite pulls at the edge of chaos to allow for emergence of creative personal inspiration. When a person comes to therapy with this dialectic as the issue, the therapist’s role may be likened to the audience in Dylan Thomas’s play who are asked to suspend their judgement and to let the
Linehan, M. Cognitive-Behavioral Treatment for Borderline Personality Disorder, New York: Guilford Press, 1993.
events of the play unfold: “We are not wholly bad or good, Who live our lives under Milk Wood, And Thou I know will be the first To see our best side, not our worst” Beyond the more standard forms of CBT, there are therapies which blend not only different methods of talking therapy but also different body or somatic therapies. Jon Kabat-Zinn, founder of Stress Reduction Clinic at the University of Massachusetts Medical Centre introduced a type of meditation therapy called “Mindfulness Therapy” in a 1991 book which he titled Full Catastrophe Living14. This title comes from a line in the movie Zorba the Greek in which Zorba refers to the ups and downs of family life as “the full catastrophe”. “Mindfulness” is a concept that involves living in the moment, paying attention and simply “being” rather than “doing”. Mindfulness can be practiced in any of life’s daily activities; however, it is through meditative practice that the skill of mindfulness is developed. In one of my first introductions to complexity in a week-long seminar given by Meg Wheatley, she urged us to operate more in a state of “being”, rather than “doing” and a state of “being fully present with one another”. This state of “mindfulness”, a state of non-striving, is conducive to healthy encounters with life’s challenges and satisfying relationships. There is a current interest in trauma and its consequences such as Post-traumatic stress disorder. Contemporary treatment approaches have included CBT and other “talking therapies” which have dealt with the usual array of thoughts and feelings and are beginning to acknowledge the importance of dealing with more “whole body” and sensori-motor reactions15. Influenced by the pioneering research of people such as Dutch psychologist, Ellert Nijenhuis, and psychiatrist Bessel Van der Kolk, are new holistic approaches such as Sensorimotor psychotherapy16. Interestingly, these come out of the European tradition of classical conditioning. Underlying this and similar approaches is the notion that traumatic events essentially disorganize and disintegrate the individual’s psyche and the purpose of therapy is to eventually bring coherence to where there was previously chaos. As Ogden and Minton (2000) state, “ Traumatized individuals are plagued by the return of dissociated, incomplete or ineffective sensorimotor reactions (vestiges of a primitive freezing, fighting or fleeing autonomic response) in such forms as intrusive images, sounds, smells, body sensations, physical pain, constriction, numbing and the inability to modulate arousal.” In order for healing to take place, there has to be an integration of three levels of processing – sensorimotor, emotional and cognitive. Nijenhuis expresses it eloquently in the following way. “A major goal of treatment is to transform traumatic memories into narrative memories of trauma. Individuals who relive trauma do not voluntarily relate a verbal, symbolized version of their experience to an audience…Rather, they automatically and involuntarily reenact prior experience involving a range of sensations, perceptions, thoughts, affects and motor responses”17.
Jon Kabat-Zinn Full Catastrophe Living New York: Delta Books, 1990 Dietrich,A.M. Risk factors in PTSD and related disorders: theoretical, treatment and research implications Traumatology, Vol 7,1 , April 2001, pp 23 - 47 16 Ogden,P. and Minton, K. Sensorimotor Psychotherapy: One method for Processing Traumatic memory. Traumatology, Vol VI, 3, Article 3, October 2000. 17 Nijenhuis, E. Resolving Embodied trauma: The Transformation of Sensorimotor representations of trauma into personal narratives http:www.psychotraumatologie.ch/nijenhuisworkshop02.htm
This brief description of some contemporary forms of behavioural and cognitive behavioural therapies illustrates the dramatic shift from a focus on simple behaviours considered in isolation to a focus on the whole individual. There is an affinity with complexity science in the emphasis on coherence, on the nexus of interrelationships between cognitions, emotions and bodily reactions and the reciprocal organizing or disorganizing effects on the psychobiological systems of attachment , energy regulation, emotional regulation (freeze/flight/fight), sexual reproduction system etc. Systems Theory: Stability, Change and Paradox If Freudian psychodynamics was the first great wave of psychotherapy, behaviour therapy and CBT the second, the third great wave is systems theory. Systems approaches challenged the view that problems are intrinsic to the person, a premise common to the two fundamental and influential schools of psychotherapy. In a systemic view, problems in individuals may be viewed as resulting from an individual’s membership in a larger system which is dysfunctional. Systemic approaches are of particular interest as they set the stage for many aspects of complexity science. In the latter part of the 20th century, the cybernetics of Gregory Bateson influenced a group of therapists in Palo Alto, California who organized themselves into the Mental Research Institute (MRI). A completely different influence on the MRI group was a rather idiosyncratic, creative and charismatic psychiatrist by the name of Milton Erikson. The systems theory influence along with Erikson’s influence led to a type of psychotherapy which became known as “Strategic-Systemic Therapy”. The flavour of Erikson’s thinking which adumbrates a chaos/complexity perspective can be found in his introduction to Watzlawick, Weakland and Fisch’s seminal book on change in systems theory18. Erikson wrote, “Psychotherapy is sought not primarily for enlightenment about the unchangeable past but because of a dissatisfaction with the present and a desire to better the future. In what direction and how much change is needed neither the patient nor the therapist can know. But a change in the current situation is required, and once established, however small, necessitates other minor changes, and a snowballing effect of these minor changes leads to other more significant changes in accord with the patient’s potentials. Whether the changes are evanescent, permanent or evolve into other changes is of vital importance in any understanding of human behavior for the self and others. I have viewed much of what I have done as expediting the currents of change already seething within the person and the family – but currents that need the “unexpected”, the “illogical” and the “sudden” move to lead them to tangible fruition”. Illogicality has been an important element in the so-called strategic therapies which finds expression in paradoxical interventions. A paradox is a statement that contradicts itself. A paradoxical intervention in therapy is a statement which implies that the situation (the system) must stay the same but in making the statement, the therapist holds the
Watzlawick,P., Weakland, J. and Fisch, R. Change. New York:Norton, 1974
expectation that change will occur. Taking their lead from the MRI, a group of Italian therapists further developed paradoxical interventions. Their family therapy approaches are well expounded in several books, most notable, “Paradox and Counter Paradox”19. An intervention, as might occur, for example, in treating a family with a dependent young adult who is unable to leave home might be, “We cannot recommend that your daughter take the risk of becoming more independent because it would be dangerous for her to do so as she values the integrity of the whole family. She seems to be willing to sacrifice her own ambitions and aspirations to this end. As this appears to be both her choice and yours, we will respect this decision”. Systems approaches certainly set the stage for complexity approaches which were yet to emerge. There are some subtle shifts which have taken place in the transformation to a complexity paradigm. The first is that complexity science embraces a living, biological systems metaphor, whereas the cybernetic systems theory is essentially a machine model, inspired by the early developments in computing in the 50’s and 60’s. The second is the emphasis on the emergent properties of a complex adaptive system as opposed to the homeostatic forces of a closed system. There has also been a subtle shift with respect to the role of the change agent. In the early model, the change agent is external to the system, and someone who acts upon the system. The later views include a view of inclusiveness and reciprocity, the notion of “being with” rather than “doing to” and the notion that the therapist and the patient/client are together a part of a greater whole. On the way to complexity and emerging from systems approaches, is the fourth wave which comprises various constructivist influenced therapies, principally Narrative and Solution Focused therapies20. Constructivism, Solutions, Thick and Thin Narratives Solution focused and narrative psychotherapies reflect a radical shift in thinking, away from a pathologizing view of the person to a competency and strength based view. They focus on “exceptions” (e.g. DeShazer)21 or “unique outcomes” (White)22. A fundamental assumption of solution oriented psychotherapy is that the more one notices problems and the consequences of problems, the more will one’s behaviour be determined by this “problem saturated” view of the world. De Shazer and others have attempted to turn therapy on its head in some respects and have developed ways of conversing which lead to noticing positive change which is already occurring. An opening question in therapy thus might be, “What changes have you noticed between the time you first called for an appointment for therapy and today which indicate that, in addition to coming to see me, you have taken some other positive steps in your life to deal with the problem?” This is not a Pollyanna approach where problems are glossed over. Small initial effects can lead
Selvini Palazzoli,M., Cecchin,G., Prata,G. and Boscolo,L. Paradox and Counter Paradox New York: Jason Aronson, 1978 20 O’Hanlon, W.H. Possibility Therapy: From Iatrogenci Injury to Iatrogenic Healing in Therapeutic Conversations. Stephen Gilligan and Reese E. Price , New York: Norton, 1993 p.3 21 De Shazer, S., Berg I.K., Lipchik, E. Nunnally, A., Molnar, A., Gingerich, W., Wiener-Davis, M. Brief Therapy: Focused Solution Development Family Process, Vol 25, 207-222, 1986 22 White, M. Negative explanation, restraint, and double description: A template for family therapy. Family Process, 25(2), 169-183
to larger change, given the right conditions. DeShazer shows us that if we notice exceptions to problems, this can increase the likelihood that the change will be reinforced. Some examples of “solution talk” include his so-called miracle question, “If you went to bed tonight and a miracle happened such that the problem you are describing went away, what would be the first thing that you would notice?” Michael White’s approach makes liberal use of “unique outcome” questions such as. “When does the problem not have such a strong grip on your life?” and “What does your success in banishing this problem from your life tell you about your qualities as a person?” “Solution talk” is very much a part of so-called Narrative psychotherapy. The notion that Narrative therapy and complexity are linked will be expanded below. Perhaps this is not so surprising as Narrative therapy comes out of social and cognitive constructivism. Narrative psychotherapists credit Humberto Maturana and Francisco Varela for their contributions to this field23. Maturana and Varela have developed what has become known as the “Santiago Theory of Cognition”, in which is an attempt to resolve the Cartesian distinction between mind and body. The mind, i.e. cognition, is not “… a representation of an independently existing world, but rather a continual bringing forth of a world through the process of living”24. The therapist and the patient/client co-construct a reality in their dialogical exchange and it follows that discourse is a socialconstructivist rather than an “objective” process of discovering what is real and what is factual. Michael White, an Australian therapist, has probably done more than any other single person in developing the concepts and practices of Narrative psychotherapy, particularly the concept of “Externalization of the problem”.25 In his view, knowledges and stories that a person carries around may impoverish their lives or subjugate them. Most people who come to therapy come with problem-saturated descriptions of themselves. Helping people to find alternative stories and descriptions of themselves as capable, competent and even heroic in the face of problems is the task of the therapist. Thus, for example, a Narrative psychotherapist would address “anger” as something external to the person, would try to separate the identity of the individual from the nature of the problem and help a person to experience themselves as separate from the problem and control “anger” rather than anger controlling them. Externalizing talk changes persons’ relationship to problems and shifts the focus on the relationship between the person and the problem instead of a focus on the person as a problem.26
See for example: Rethinking our assumptions: Assuming Anew in a Postmodern World John L. Walter and Jane E. Peller in Handbook of Solution-Focused Brief Therapy Scott D. Miller, Mark A. Hubble and Barry L. Duncan, San Francisco: Jossey-Bass, 1996. The authors are referring to sources such as - Autopoiesis and Cognition: The Realization of the Living Humberto R. Maturana & Francisco J. Varela Dordrecht: D. Reidel, 1980. Vol. 42: Boston Studies in the Philosophy of Science
Capra, F. The Hidden Connections: Integrating the Biological, Cognitive and Social Dimensions of Life into a Science of Sustainability . New York: Doubleday, 2002 , p. 36 25 For example, White, M. Selected Papers , Adelaide: South Australia, Dulwich Centre Publications, 1989 26 From Selected Papers: The Process of Questioning: A therapy of literary merit
It is not too much of a stretch to link these questions to the fundamental principle of chaos theory, i.e. sensitive dependence on initial conditions, the so-called “butterfly effect”. The theory, articulated by Lorenz27 has been applied to model the dynamics of complex systems such as the weather. Chaos theory is a deterministic theory, but acknowledges that predictions can only be extended for short time periods and that phenomena have emergent properties which cannot be envisioned from earlier states. Constructivist influences, solution-focused and narrative therapies are somewhat pivotal because although they emerged from earlier systemic therapies they point the way towards the future and the fifth wave of psychotherapy. One of the aims of psychotherapy, whether narrative-constructivist or insight-oriented, is to enable a person to create a coherent and well-rounded story about themselves and their relationships with others. Narrative therapists call this a “thick” narrative as opposed to a “thin” narrative. Many people who come to therapy with impoverished views of their own lives tend to use language which traps them into a linear, or single dimensional or “thin” view of the world. Often, our own internal and external narratives simplify and “make linear” experience in order for us try to make sense of our world. A problem occurs, however, when this “linearization” is not adaptive. Here are some statements typical of people seeking therapy: “I become so angry because his drinking is ruining our marriage”; or “My partner is to blame for our unhappiness”; or “Look at how thin she is, she has to be made to eat something”; or “My daughter, Annie, won’t listen to me anymore.” In all of these statements, there is an implicit linear cause and effect sequence: Drinking leads to marriage problem; partner’s behaviour causes unhappiness; thinness is due to not eating, Annie’s behaviour is not controlled by parental actions etc. It is not that these linear attributions are incorrect or correct. They are ways of expressing a “reality” in a particular way, and of seeing “reality” in a certain way, which may or may not be adaptive, healthy, productive or lead to the emergence of creative solutions. Linearization is a useful tool in our psychological toolbox because it reduces the tension we feel when dealing with uncertainty and gives apparent clarity in its simplicity; but it has its limitations. Some forms of traditional therapy try to “explain” the problems by reference to some underlying theory of causation. The mother, referred to above, who brings her child to the therapist and asks, “Will you please explain why Annie will not listen to me”. The patient seeks an explanation, a “professional opinion” which, (expert’s opinions are usually regarded as correct) will lead to a cure for the problem. “Explaining” comes from the latin root “to lay flat” – it begs a simple, linear understanding. This is not to say there aren’t some simple answers, but as the saying goes, “For every complex problem, there is a simple answer – and it’s usually wrong”. Laying flat the presumed answer to Annie’s disobedience (a result of bad genes, bad parenting etc.) may not do justice to the complex nature of the problem. The new imperative in complexity science is not to lay flat but to create an understanding which is richer, fuller and contextualized.
Edward Lorenz as described in Sardar, Z. and Abrams, I Chaos for Beginners Cambridge, UK: Icon Books, 1998 p 40-43
A “thick” narrative involves accommodating multiple perspectives. It is possible to envision multiple realities and accept the validity of each without resolving which is the “right” or “true” one. We ask our patients in psychotherapy to hold in view different perspectives simultaneously, without trying to resolve them prematurely. Instead of resolving different perspectives (“How if my father could love me, could he leave the family in the way he did?”) we ask patients to investigate the paradoxes, the opposites. This is often aided by Socratic questioning , “If your father loved you and yet he felt compelled to leave you and the family, how might he have felt about this?”. Complexity informed psychotherapy aims to help people not only to live with paradox and “unknowability” but to be able to thrive with it and use it as a source of growth. It is not a matter of trying to solve the paradox problem because it cannot be solved. It is a matter of integrating the opposites into a workable, livable dynamic worldview28. Before ending this section, it is important to acknowledge the contribution of Carl Rogers’ client-centered therapy. Although perhaps not a direct progenitor of these therapies, Carl Rogers’ humanistic approach taught us how to listen to clients and how to maintain a focus on the client’s agenda. He also taught us how to acknowledge the validity of the client’s own personal experiences and how to treat them without judgement with so-called “unconditional positive regard”. These essential Rogerian ingredients have been incorporated into solution-oriented and narrative-constructivist approaches. There is an undeniably different emphasis on the “means” whereby a client’s life situation is constructed in the later approaches. In the Rogerian approach, this is achieved primarily through the therapist’s reflection of emotional and cognitive content (“empathic responding”). In narrative-constructivist approaches, questions and directed comments are more likely to be considered a legitimate part of therapeutic interaction. The Rogerian assumption is that non-directive approaches will lead to an “accurate” client constructed view of his or her reality, which when discovered provides a definitive “reason” for the clients’ problems. The therapists role is one of a mirror to reflect that reality. The metaphor for the communication process is a linear information-systems model. The client “encodes” information which is then transmitted to the therapist who “decodes” the message. The therapist then “encodes” a reply which is transmitted to the client. The client then engages in a comparison process between encoded and received messages and modifies the ensuing messages accordingly. Through this exchange, the therapist “discovers” the underlying problem. An example is as follows: (Client) “My husband has been a real jerk this week”. (Therapist) “You have been feeling really angry with him” . (C) “Yes, he really let me down badly when I counted on him to do something with the children when I was away”. (T) “So you were feeling really disappointed in him because he didn’t honour his role as an involved parent” etc. The process is also more linear in that once a “problem” has been identified, a solution can be determined.
In my conversation with Kevin Buck, we also talked about the importance of spirituality as one of the dimensions of therapy. He offered the view that from a theological point of view, Heresy may be defined as the “premature resolution of conflict”. The belief among Christians that Jesus is fully human, yet fully divine is an irreconcilable conflict. Any attempt to resolve this by prematurely closing the argument one way or another is heretical. The spiritual journey challenges a person to live in harmony with the irreconcilability of these two antagonistic views. As soon as one proclaims that one has found the truth in one answer or another, the spiritual journey is ended.
The Narrative-Constructivist assumption is more relativistic, with both client and therapist actively co-constructing a “reality” which is both shared and more fluid. The metaphor is one of a creative process of co-constructing a shared reality which provides a basis for developing an agreement “to act as if we understand each other for now”. We can never truly know another’s experience or the meaning given to the events in their lives. One of the best actual metaphors for this is given by Dr. Joseph Schaeffer in his “Stone Game”, in which participants in a group place small stones in a common space, following some simple rules, through which creative and fascinating patterns emerge. A full description of this is found in Schaeffer’s book The Stone People29 . The other difference is that in Narrative-Constructivist approaches, the conversation is the intervention rather than a diagnostic prelude to treatment. Complexity and Psychotherapy: the integration of multiple perspectives and the selforganizing nature of consciousness Complexity informed therapy is atheoretical since the imperative is not to look for causes in a particular theoretical framework, but to question, explore and remain curious and open to all possibilities. For example, it is quite acceptable to integrate a notions of a disturbed biochemistry (as in schizophrenia) or a “hard-wiring” neurological problem, or unusual patterns of activation of the limbic system with notions that there are disturbed relationships (a patient’s cognitive and emotional relationship to his/her own disease, a patient’s relationship with family and caregivers etc.) It is also quite acceptable to have multiple and different understandings of the same events. The complexity informed therapist is comfortable with these multiple perspectives and can switch between these and be aware of his/her own cognitive processes at any particular time. This “meta” level thinking, or “thinking about thinking” is a cognitive skill important working in a complexity framework. There is no single theory of change and complexity integrates both insight/awareness approaches and behavioural performance approaches and emphases the importance of a mindful awareness of what is actually happening and noticing change that is already in process, or noticing exceptions to problems which occur perhaps pre-consciously or outside awareness. If a therapist has only one lens, as provided, say by strict adherence to a particular theory of change, then it is likely that complex problems will be reduced to a simple problems. This may be good only in that it simplifies the therapist’s life but it probably does not help appreciate the complexity of the patient’s life. This is one of the failings of specialization, a feature of modern medicine. The wholeness of the human body, and indeed the whole human being, is denied in treating the parts in isolation from each other. There are unquestionable benefits in having a concentration of knowledge in one very small area and this is sometimes necessary given the incredible abundance of knowledge that we have today. There are also risks in that it is very easy to lose sight of the forest for the trees. The complexity lens, therefore, is in itself a “meta” lens which
Schaeffer, J. The Stone People: Living Together in a Different World Forsyth Publications, 1996 available from the author. His email address is firstname.lastname@example.org and his address is 232 Forsyth Drive, Waterloo, Ontario, Canada, N2L 1A5
includes other lenses. It is not a separate and distinct lens in itself. It is a way of shifting perspective and viewing problems through different lenses and at the same time developing a coherent picture of the whole. One of the important ramifications of adopting this meta lens is that the same principles of change which apply to the “patient” must also apply to the therapist himself/herself. This is captured in the concept of “fractal” wherein there is self-similarity at different levels of scale. It must therefore be acknowledged that the therapist changes by the action of participating in therapy process. This view also acknowledges that therapy can no longer be viewed as a “treatment” which is applied to “patients” by “experts”. It is a bi-directional, relationship-based dynamic process. This is extraordinarily important in our understanding of the nature of the psychotherapeutic experience. Each of the foundational approaches to psychotherapy privileges a different facet of a complex process. An appreciation of this allows for an integration of all these facets into a coherent whole. Thus complexity inspired psychotherapy assumes that there are patterns of organization which emerge from: Our phylogenetic history which organizes our psychobiology in complex functional systems such as the attachment system, energy regulation, emotional regulatory system (freeze/flight/fight), sexual reproduction system etc. Our ontogenetic experiences which become organized in memory largely below the level of conscious awareness Our history of experiences which through learning adaptations (association and reinforcement) become organized into our habits and personality traits. The patterns of human social interaction in our immediate social groups (e.g. family) and broader social (culturally specific and universal contexts) in which individual behaviour is embedded. Current conscious processes which can act as regulators and which selforganize according to a fitness landscape shaped by the preceding influences. Psychotherapy provides an opportunity for conscious process to become self-organized in more adaptive ways. Psychotherapy may then be viewed as the enhancement of the selforganizing nature of conscious experience through self-other awareness and self-directed activity. An observation made some years ago by Erwin Schroedinger brilliantly captures this nature of conscious activity and locates it firmly within a complexity-based understanding of psychotherapy processes.
“Schroedinger finds a specific role of consciousness as the guardian of anomalies, unusual events and other novelties that are not yet shifted to unconscious knowledge and eventually to genetic memory.”30 The “Fifth wave” of psychotherapy offers a way of understanding and integrating knowledge which has been gained in the various sub-disciplines of psychotherapy such as psychodynamics and behaviourism etc. It is still evolving as a set of prescriptive approaches and nothing can be offered definitively at this time with respect to a set of procedures which a complexity oriented therapist might pursue. It seems fairly certain, however, that a greater understanding of consciousness and the patterns of selforganization which arise in human conversational interaction will continue to play an important heuristic role. This is therefore portrayed as an emerging approach which has built on the foundations of psychoanalysis, behaviourism, systems theory and constructivism but is different from all of these. It can be said that the new therapies have “emerged” in the current zeitgeist of “The New Science”. These approaches are definitely not simply a sum of what has gone before and, consistent with emergence, although they have their origins in what has preceded them they could not have been completely predicted by knowing what had gone before in the earlier waves.
Attributed to Havel,I (1996) Remarks on Schrodinger’s concept of Consciousness. Consciousness at the Crossroads of Philosophy and Cognitive Science. Maribor Conference, 1994. Thorverton, England: Imprint Academic, pp. 49-51. in Rossi, E.L. and Rossi K.L The Symptom Path to Enlightenment CA: Palisades Gateway Publishing, 1996 , p.50
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