Transcripts, inner dialogue and reflections afterwards
Table XVII Critical moment 1: transcript
Voices Outer dialogue Inner dialogue Themes and reflections afterwards
differentiate and relate to developments.
Geraldine 1605:0.2
Everything is changing (with a smile)
Therapist 1605:0.3
How are you doing?
Geraldine 1605:0.4
I am doing quite well. I didn’t harm myself for about three weeks now. I didn’t drink and I talked to classmates, and to my mentor at school. We made a plan to catch up with schoolwork that I missed at school. I can go to the second grade. I am feeling better.
Reflection: What does the sudden repair mean in the context of ending therapy? Could Geraldine also give a message about the therapeutic relationship? Is she is doing well enough, so we do not have to end our collaboration.
Therapist 1605:0.5
I see you smiling while you are telling me this. How do you understand this sudden change?
Theme: Focus on unexpected, surprising (non-verbal) emotional responses
Geraldine 1605:0.6
A lot of things I guess
Therapist 1605:0.7
Tell me I am curious.
Geraldine 1605:0.8
I was happy with the family session with my parents. You helped my father to listen to me and understand me better.
Theme: Therapist’s contribution to help members to discuss their issues with each other
Therapist 1605:0.9
It must not be about the therapist who made a change. What did they do together to change the pattern?
Reflection: I see change as a ‘joint action’ and not a result of the therapist’s intervention. I emphasize ‘agency of family members’.
Afterwards I think about this episode. Did I give Geraldine the chance to be grateful to me? Does my stance here take away space for Geraldine to be grateful for what happened, which is
common and helpful in a collaborative relationship?
Therapist 1605:1.0
What was it that you wanted him to understand?
Geraldine 1605:1.1
I wanted him to know that I was not
overplaying, that my pain was real and that I don’t need his solution. I want him to listen, to take me seriously.
Therapist 1605:1.2
How did you try to let him know before?
Geraldine 1605:1.3
I didn’t return his phone calls. Sometimes I think I looked terrible when I came home in the weekend and I was hoping that he could see it, but he didn’t. When I told him a few things I didn’t see any emotion in his response. All that he does is give me advise and solutions that I can think of myself. Therapist
1605:1.4
Can Geraldine see her behaviour as a way of communicating her emotional needs?
Theme: Learn to see behaviour as communication and to understand what is expressed and received. Therapist
1605:1.5
Maybe.. I .. Could your destructive behaviour be an invitation for your parents to see you and help you as their child? We talked about that in the family session, do you remember? Maybe it was important for you to feel protected as a child for a little while, before you start an adult life? You missed that, didn’t you, feeling protected as a child, in your childhood?
Geraldine 1605:1.6
Not on purpose, but maybe. But I notice they now care more for me when I am at home in
1605:1.7 Geraldine 1605:1.8
Yes, but still I don’t talk easily about what is happening inside.
Looking for patterns in a context of meaning
Episode 1: ‘All behaviour is communication’ (Watzlawick, 1967)
Table XVIII Critical moment 1: analysed transcript
Geraldine Therapist Geraldine Therapist Geraldine
Society/culture/ professional
Parents should understand their children’s needs.
The therapist should not be too important. Change is a co- creation. Parents should understand their children’s needs. ‘All behaviour is communication’.
Sometimes it’s difficult for parents to understand children their needs. Sometimes children ask attention for their needs by destructive behaviour.
Family culture Parents take care of the older sister. Geradine can take care of herself.
- Parents take care of
the older sister. Geradine can take care of herself.
- My parents care for me.
Subjectvication A sensible girl that also needed some care from her parents
A non-expert therapist.
A sensible girl that also needed some care from her parents.
Understanding and challenging therapist.
A daughter, parents take care of.
Episode All behaviour is
communication. All behaviour is communication. All behaviour is communication. All behaviour is communication. All behaviour is communication.
Pattern: Reactive, paradoxical or reflexive
Reflexive pattern
Geraldine gives credit to the therapist.
Reflexive pattern
The therapist invites Geraldine to think about agency in the family. Reflexive pattern Geraldine reflects on contributions to change, focuses on her responses to parents’. Reflexive pattern We reflect on ‘behaviour as communication’. Reflexive pattern
This opens up space to reconsider ideas about parents their concern for her.
Interpretive act/ relational/ process
Geraldine gives credits to the therapist talking about change.
Therapist asks about Geraldine’s
contribution to change.
Geraldine accepts the invitation and talks about missing an understanding response.
Therapist invites Geraldine to connect behaviour to communication. What did you communicate to whom?
Geraldine considers to see her behaviour as an expression of emotional needs.
(Speech) Action 1605:0.8
I was happy with the family session with my parents. You helped my father to listen to me and understand me better.
1605:1.0
What was it that you wanted him to understand?
1605:1.2
How did you try to let him know before?
1605:1.3
I didn’t return his phone calls. Sometimes I think I looked terrible when I came home in the weekend and I was hoping that he could see it, but he didn’t, when I told him a few things I didn’t see any emotion in his response. All that he does is giving me advises and solutions that I can think of myself.
1606:1.5
Maybe. I.. Could your destructive behaviour be an invitation for your parents to see you and help you as their child? We talked about that in the family session, do you remember? Maybe it was important for you to feel protected as a child for a little while. before you start an adult life? You missed that, didn’t you, feeling protected as a child, in your childhood?
1605:1.6
Not on purpose, but maybe. But I notice they now care more for me when I am home in the weekend.
1605:1.8
Yes, but still I don’t talk easy about what is happening inside.
Inner dialogue 1605:0.9
It must not be about the therapist who made a change. What did they do together to change the pattern?
1605:1.4
Can Geraldine see her behaviour as a way of communicating her emotional needs?
Text is blue refers to a changing frame of reference.
How do we collaboratively learn?
How does a therapist and family members collaboratively learn “how to learn” in Feedback Informed Systemic Therapy?
Therapeutic response
I (as therapist) get credit but believe it is important to explore the agency of family members. Change is a co-creative. I’d like family members to be able to identify their own contributions to change themselves. I hesitate (1605:2.5) before I question the link between destructive behaviour and expressing emotional needs to parents. I don’t want to be too certain and want to allow space for
consideration. In (1605:2.6 & 2.8) Geraldine sees a connection between her behaviour and expressing her needs. Because of parents attempts to listen and understand, Geraldine reframes her ideas about her parents’ concern for her.
Patterns
When Geraldine gives credit to the therapist, I emphasize change as a ‘joint action’ and ask about the contribution and agency of family members. It opens up space to think about destructive behaviour as communication about emotional needs. Because parents responded with care to Geraldine’s expression and invitation, Geraldine reframes her ideas about her parents’ concerns for her.
Reflexivity and logical forces:
High level of reflexivity: when contextual and prefigurative forces are low and practical and implicative forces are high. Low level of reflexivity: when contextual and prefigurative forces are high and practical and implicative forces are low.
In this episode we are able to see change as a ‘joint action’ and not as the result of the therapist’s intervention. Geraldine reflects on the message she gave her parents by behaving in a destructive way. She reframes her ideas about her parents and their concern for her.
Collaborative learning:
A 2nd order change. We are able to reflect on change as a co-creation and on behaviour as communication. Geraldine reframes ideas
about her parents and their concern.
Afterwards I reflect on this episode (reflection/ 1605:1.4). What does the sudden repair mean in the context of ending therapy? Could Geraldine also be giving a message about the therapeutic relationship? If she is doing well enough we do not have to end our
collaboration. I explore this later in the conversation (1605:4.7).
Critical moment 2
We explore how this sudden change could happen and what we can learn from this development.
Transcripts, inner dialogue and reflections afterwards
Table XIX. Critical moment 2: transcript
Voices Outer dialogue Inner dialogue Reflection afterwards
Geraldine 1605:1.9
What really struck me was the email you had sent me.
Theme: Therapists contribution in a collaborative approach.
Therapist 1605:2.0
What do you mean?
Geraldine 1605:2.1
It was your answer after I had sent you my email about taking too much medicine, do you remember?
Therapist 1605:2.2
I am so glad she mentions this. I was insecure about the message in this email. Did I not repeat parents their request ‘act normal, like you used to do’ when I wrote her this? How can I understand how this message was different and helpful for her?
Theme: using the inner dialogue, the personal voice of the therapist. (reactive in this case).
Therapist 1605:2.3
I am glad you mention this. Afterwards I had many doubts about the message I gave you. I a… What was it that moved you in this email message?
Geraldine 1605:2.4
It was one sentence. You wrote me: You make yourself sick and this is not you. That sentence had a big impact on me.