Section C: Cartography, methodology and practice
C.4. FITS as PBEBP, research design
Fig. 4. Practice Based Evidence Based Practice (repeated p.70)
In FITS as a Practice Based Evidence Based Practice, the therapist researches
developments and collaboration in therapy practice with clients, family members as co- researchers, in order to learn how to learn. In my research project (fig.4.) I mix different research methods to answer my research question:
• How does a family therapist navigate on the basis of coordinated improvisation, collaborative learning, and mixed-methods research in Feedback-Informed Systemic Therapy?
Mixed-methods research
I combine quantitative and qualitative research methods in a complementary and preliminary sequence (Bishop, 2015). Quantitative data/material is used as information in primary qualitative research. In conducting quantitative research, I generate reliable
Collaborative learning a. Bateson's deutero learning b. meta- or planned learning Manualization Coordinated improvisation Systemic feedback Multi-methods research
data on effects, developments, and collaboration in therapy. But quantitative data alone cannot illuminate the quality of navigation, collaboration and developments. It is
essential to add interpretive exchanges with participants in the project (in FITS, these are family members). Quantitative outcomes are used as ‘conversational tools’ (Sundet, 2012), as a way of introducing evaluative discussions. In qualitative research, we (therapist and clients) set out to discover how to learn how to learn in those evaluative discussions.
With quantitative research, I can produce reliable information about effects, developments, and collaboration in therapy, while generating or corroborating theoretical concepts related to FITS practice. For Routine Outcome Measurement, in measuring developments and effects, I use the YSR (Youth Self Report, Achenbach, 1991), CBCL (Child Behaviour Checklist, Achenbach, 1991), and OBVL (Parenting
Burden List, Vermulst et al., 2012). I use the ORS (Outcome Rating Scale, Miller, Duncan, 2000) to measure the affected dimensions of a family member’s life, and the SRS
(Session Rating Scale, Miller, Duncan, 2000) to measure the quality of the therapeutic alliance. I use the FGRL (Family Goals Rating List, Van Hennik & Hillewaere, 2017) to measure collaborative achievements in relation to personal, family and community preferred directions.
With quantitative research I can answer questions like:
(1) Are family members experiencing fewer problems and less stress? (ROM)
(2) Do family members think that the identified ‘patient’ (child/teenager) now has an improved quality of life in terms of individual wellbeing, relational wellbeing, and social roles? (ORS)
(3) Are family members moving towards, or have they reached, their preferred goals and directions in therapy? (FGRL)
(4) Are family members satisfied with the collaboration with the therapist? (SRS).
In conducting qualitative research, I set out to understand unplanned organic changes in FITS. We make audio recordings of evaluative dialogue and analyse written transcripts in the following five stages:
(I) Shortly after the recording has been made, the therapist/researcher selects two or three ‘critical moments’ from each conversation. Critical moments are defined as moments at which ‘if we act wisely, we can change the trajectory of the
conversation and thus create a different “afterlife”’ (Pearce, 2007:3).
(II) The therapist/researcher adds the inner dialogues to the transcript and responds to internal questions such as: ‘What am I being invited or encouraged to do in this experience?’ ‘What pattern is being reproduced?’ ‘How can I make a difference?’ (III) The therapist/researcher focuses on the patterns that exist between family
members and therapist. These patterns may be reactive or reflexive. Reactive patterns are self-reinforcing repetitive circles. There is a low level of reflexivity on intentions, effects, and assumptions. In contrast, reflexive patterns (a high level of reflexivity) open up space for new connections, reframing and for ‘something new’ to happen.
(IV) The therapist/researcher contextualises patterns. We use Pearce’s concept of ‘logical (contextual and implicative) forces’, or ‘perceived oughtness’ (Pearce, 1989) to inquire how patterns evolve within different layers of meaning.
Contextual force describes how meaning, within a frame of reference, allows and affects interaction. Implicative force describes how interactions shape meaning, and help to create (or re-create) a frame of reference.
(V) The therapist/researcher examines how family members and therapist together learn how to learn, through first-order and second-order learning and
coordinated improvisation, and by co-creating a collective frame of reference that allows for preferred ways of coexisting or living together.
Phases Practices Inquiry
Phase 1: Preparation Intake and information ROM. Phase 2: Alliance Creating a culture of feedback ORS, SRS
Evaluation in session 3 ORS, SRS, FGRL Phase 3: Context and focus Discussing preferred directions in
therapy
ORS, SRS
Evaluation in session 5 ORS, SRS, FGRL Phase 4: Attunement and
reflexivity
Invitations to reflexivity ORS, SRS
Evaluation in session 8 ORS, SRS, FGRL, ROM Qualitative research - I: Select critical moments - II: Adding inner dialogues to the
transcript.
- III: Focus on patterns between therapist and family members. - IV: Contextualise patterns
(contextual and implicative forces). - V: Learning how to learn.
Phase 5: Actions,
connections, improvisations
Finding ways to go on based on improvisations and collaborative learning
ORS, SRS
Evaluation in session 13 ORS, SRS, FGRL Phase 6: Learning how to
learn
Evaluation in session 15 ORS, SRS, FGRL, ROM Qualitative research - I: Select critical moments - II: Add inner dialogues to the
transcript.
- III: Focus on patterns between therapist and family members. - IV: Contextualise patterns
(contextual and implicative forces). - V: Learning how to learn.
Fig. 8. A fluid manual of FITS practice and research
Analysing transcripts
In conducting qualitative research, I analyse ‘critical moments’ (Pearce, 2007) in the transcripts of evaluative conversations in FITS. Critical moments are points at which: ‘if we act wisely, we can change the trajectory of the conversation and thus create a
different “afterlife” ‘(Pearce, 2007:3). They are moments of increasing tension and more inner dialogues, at which change becomes possible.
The transcripts are analysed with the aid of four qualitative research methods: • Reflexive inquiry, using the inner dialogue as a navigation tool;
• Analysis drawing on Coordinated Management of Meaning, (CMM) methods with a view to identifying patterns in contextual layers;
• Examination of systemic and collaborative learning; • Thematic analysis.
Reflexive inquiry: the inner dialogue as a navigation tool
Reflexive inquiry is conducted by recording the therapist’s own experiences and the questions (s)he asks in the course of a therapy session. Rober (2011) discusses the therapist’s personal responses during therapy sessions. Therapists experience and deal with strong emotions in the course of a session. Emotions serve as impulses that
encourage or invite the person to act in a certain way. The therapist feels called upon to take part in a particular relational scenario (Gergen, 1999), often in such a way as to sustain repetitive, unproductive patterns within the system. Rober describes the therapist’s use of self as a navigation tool. In this context, the self is conceived as a discourse among multiple inner voices (Bakhtin, 1986). The therapist, using the self as a navigation tool, ‘listens’ with eyes and body as well as the ears, reflects, and decides how to respond (Rober, 2014).
‘This paints a picture of a therapist being present in the session as a complete human being in relation to the client and not just as an information-processing/hypothesis- testing expert’ (Rober, 2011:237).
According to Bakhtin (1986), understanding is an active, responsive process created between participants in a conversation. Bakhtin introduced the concept of ‘creative understanding’ as a four-stage process: the first stage is physical perception, then comes recognition, followed by grasping significance within the given context, while the final stage is an active ‘dialogical understanding of understandings’ within conversations with others (Morson & Emerson, 1990). The therapist uses the self as a ‘navigation tool’ in this process of active dialogical creative understanding. The therapist listens (with ears,
eyes and body) to the story told, the inner life of those telling the story, their own inner lives, and asks in internal dialogue what to do next (Rober, 2011, 2014). Rober (2011) distinguishes acts of active listening and reflection in order to open up dialogue and creative understanding.
Active listening
- Processing the clients’ story
- Attending to the client’s process. Listening to the story that the client presents, including any spontaneous bodily activity that may accompany it;
- Focusing on the therapist’s own experience and responses.
Reflection
- The therapist’s experience. What does the therapist feel?
- Feeling called upon or invited to take part, to act, in a relational scenario (Gergen, 1999)
- Is there any opportunity to open up dialogue about the ‘not yet said’ (Anderson & Goolishian, 1988)?
‘What is evoked in the therapist’s experiencing are the parts of the client’s story that cannot be expressed otherwise’ (Rober, 2011: 238).
A therapist often feels called upon or ‘invited’ to act in a relational scenario. If he or she accepts this invitation, (s)he will be sustaining repetitive (sometimes unwanted) patterns within the system. The therapist’s experience (this invitation to act) will then end up helping to maintain the existing equilibrium (Elkaim, 1997). The therapist’s experience may also be indicative of the ‘not yet said’ (Anderson & Goolishian, 1988) in the family. The therapist, invited to take part in relational scenarios, actively listens, reflects, and makes a difference, connecting and opening up dialogical space for the not-yet-said and the generation of new meanings.
To conduct a successful reflexive inquiry involving the exploration of inner dialogues, invitations, and points at which it is possible to ‘make a difference’, it is essential to record accurately the feelings, words, and images that are evoked in the therapist’s
written transcripts of both the outer and inner dialogues soon afterwards, using the parameters of this table (fig.9.). Reflections on these conversations are added later in the third column of the table.
OC (outer conversation) TIC (Therapist’s Inner Conversation)
Reflections
OC1 The mother says…. OC2 The father interrupts and says:
OC3 The therapist asks the son….
OC4 The son responds:
TIC1 I feel worried… TIC2 Then I feel hesitation Maybe I should….
I choose to use inner
conversation to steer attention towards the son’s position.
Fig.9. Reflexive inquiry
Coordinated Management of meaning
The approach I use in my research design is based on a theory known as Coordinated Management of Meaning (CMM), which was developed by Barnett Pearce and Vernon Cronen (1980). The theory posits that our social worlds are constructed through communication. CMM describes communication as a two-sided process of coordinating action (stories lived) and managing, making meaning (stories told) (Pearce, 2007). The focus in CMM is on how communication is generated, on the consequences of this process (Oliver, 2017), on the question of who/what communicators become in the course of communication, and how they can contribute to making better social worlds (Barge & Pearce, 2004). Pearce describes communication as ‘The process by which reality itself and with it particular ways of being human are co-constructed in all those events where we interact with each other’ (Pearce, 1989).
CMM is a specific research methodology (Barge & Pearce, 2004; Pearce, 2006). The CMM researcher explores how people initiate, sustain, and transform patterns of
communication within contexts of meaning (Oliver, 2017). Pearce introduced the
concept of ‘logical forces’, or ‘perceived oughtness’ (Pearce, 1989) to explore the ways in which patterns evolve within different layers of meaning. Logical forces shape our interactions.
Pearce distinguishes prefigurative, contextual, implicative, and practical forces.
a. Prefigurative forces: The connection between one ‘turning’ antecedent action and a subsequent action.
b. Contextual forces: The connection between the contextual frame of reference (episode, relationship, self, culture) and a subsequent action.
c. Implicative forces: The connection between action and a possible contextual reframing.
d. Practical forces: The connection between an action and a subsequent ‘turning’ action.
Prefigurative and contextual forces describe interactions in which persons act because of pre-existing stories, meanings, or actions.
Implicative and practical forces describe interactions in which persons act in order to bring about something in the future (Pearce, Sostrin, Pearce, 2011).
In the course of my research I focus especially on the interrelatedness between actions, meaning, and contextual frames of reference in communication patterns. The CMM methodology presents a concrete way of examining communication patterns within layers of meaning. Central to CMM research is the concept of the ‘speech act’ as expounded by John Searle (1983). According to Searle, all language is performative. Language does not merely describe or report but ‘is and does’. A speech act is an utterance that serves particular functions in communication. Its relational meaning is co-constructed, through ways of using language and within a given culture.
The CMM researcher examines speech acts in episodes within layers of meaning: relational, as concepts of self, and within culture.
(1) Working on the basis of this view of the ‘speech act’, expression is a type of action, and invites others to act in ongoing communication processes.
(2) From Oliver’s definition of the ‘interpretive act’ (Oliver, 2005), it follows that these expressions are interpreted in relational and cultural ways.
(3) ‘Episodes’: Speech acts take place, and are interpreted, in situations that are ritually determined in local and cultural ways.
(4) Speech acts in episodes affect who we are, our roles and positions. We shape our concepts of self and the other in the course of our conversations.
(5) The co-construction of reality and particular ways of being human is socially and culturally embedded.
‘Communication patterns might be thought of as repeated intersubjective communication acts, comprised of conscious and unconscious responses of affect, meaning and action, taking place within communication episodes, that repeat over time and become
embedded in the system as conscious and unconscious part narratives (logics) of culture, relationship and identity shaping future configurations of affect, meaning and action within communication exchanges’ (Oliver, 2014:278).
Christine Oliver (2014) uses CMM to analyse and understand the intersubjective
coordination of meaning and action between family members. The following table, based on Oliver (2014) helps to make action manageable and meaningful in the face of
systemic complexity. Patterns may be reactive (more of the same), paradoxical
(contradictory messages, strange loops), or reflexive (opening up space for difference).
Family member 1. Family member 2. Family member 3.
Social, cultural Discourses
Discourses, values and norms
Discourses, values and norms.
Discourses, values and norms.
Family culture/ script Values, norms and stories
Values, norms and stories Values, norms and stories
Concept of self Identity, self-concept Identity, self-concept Identity, self-concept Relationship Beliefs about the
relationships
Beliefs about the relationships
Beliefs about the relationships Episode Pattern: reactive,
reflexive, paradoxical Pattern: reactive, reflexive, paradoxical Pattern: reactive, reflexive, paradoxical Speech act / interpretive act Feeling, interpretation, action Feeling, interpretation, action Feeling, interpretation, action
Fig. 10. Table CMM based on Oliver (2014)
I use a slightly modified version of Oliver’s table. First, I include the role of the researcher/therapist as part of the episode, patterns within contexts (the system). I examine the patterns in which I am participating, in my position as researcher/therapist and add my inner dialogue to the framework. In addition, I distinguish speech act
(performative utterance) from interpretive act (relational interpretation). I prefer to use Foucault’s (1980) concept of ‘subjectification’ rather than ‘identity’, which has a fixed, flat sound to it. Subjectification is about the formation of self in the process of becoming. I also use the concept of episode differently. I give each event a name, for instance the title of an episode of a TV series. What ‘catchy’ phrase would describe the event that is taking place in this particular interaction? I constructed the following table to make it easier to explore the patterns that are produced by therapist and clients together within the particular contexts of meaning.
Therapist Father Daughter Mother Contextual force: Societal, cultural, professional Contextual force: Family culture/ script Subjectification Episode Pattern: Reactive, paradoxical or reflexive Interpretative act, relational interpretation/ process Speech act/ utterance/ content Inner dialogue
Fig 11. table CMM van Hennik
• Inner dialogue: What is evoked in the therapist’s experience? From within my position as the therapist, I ask myself: ‘What am I being invited to say or do? What pattern would this help to sustain? How to make a difference?’
• Speech act/content: What is being said or done?
• Interpretative act/relational interpretation: What is the invitation or relational interpretation contained in or implied by the speech act?
• Pattern: What kind of pattern is being initiated, sustained, or transformed through the interactions? (reactive, paradoxical, reflexive)
• Episode: What name could I give to the event? What ‘catchy’ phrase would describe the event that is taking place through the interaction?
• Subjectification: I use Foucault’s (1980) concept of ‘subjectification’ to describe who we become, in many different ways, as a result of our speech acts, in
• Contextual force/Family culture: What discourses, values, codes from our family of origin influence our speech acts?
• Contextual force/Societal, cultural, professional: What discourses, values, codes from our society, culture, and profession influence our speech acts?
Systemic and collaborative learning inquiry
In FITS as PBEBP, the outcomes of research are the inputs for collaborative learning in the system that the therapist and family members co-create together. Therapist and family members examine the effects of their cooperation in collaborative research. Systemic knowhow or intelligence is contingent on the richness of the range of response-abilities and productive opportunities within a response space. Systemic learning is a result of adaptation to unpredictable events or conditions in the
spontaneous interaction between and within systems in the medium. Systemic practice research implies ‘a collaborative and reflexive process of inquiry with relational ethics to guide our movements in inner and outer conversations’ (Simon, 2014:23).
In FITS as PBEBP, the therapist and family members learn how to collaborate and learn. Learning how to learn, in cybernetic terms, is ‘third-order learning’ (Visser, 2003, 2007). Visser distinguishes between third-order learning, deutero-learning, and meta-learning. I link Bateson’s (1972) concept of deutero-learning (a creative, implicit, and often unconscious adaptation to patterns of conditioning) to expanding response-abilities in coordinated improvisation (p68, 79). I link meta-learning (structured inquiries to processes in single and double loop learning and the social construction of frames of reference) to the act of conducting research (p68, 79)(as in my own PBEBP research project) and to expanding a response-space that will make it possible to find different, new ways of living together.
My research project includes an analysis of ‘critical moments’ in the transcripts of evaluations in FITS. I add my inner dialogue to the transcript, examine patterns within frames of reference, and try to ascertain how we can collaboratively learn how to learn. We systemically learn when we find new ways of responding or managing meaning, anticipating unpredictable events or circumstances. We systemically learn when we
improvise, reflect, and accept relational responsibility for the effects of our actions. I distinguish between high or low reflexivity in the pattern that is produced by therapist and family members.
• ‘High level of reflexivity’ exists when the contextual and prefigurative forces are relatively weak, while practical and implicative forces are strong. A high level of reflexivity provides opportunities for change, for making a difference.
• ‘Low level of reflexivity’ exists when contextual and prefigurative forces are relatively strong and practical and implicative forces are weak. A low level of reflexivity limits the opportunities for change, for making a difference.
I set out to identify the kind of learning that is being produced by therapist and family members. I distinguish four kinds of learning:
• Single-loop learning: increasing organisational performance by adjustment; • Double-loop learning: restructuring organisational action by means of evaluating
the existing norms;
• Co-creating a collective frame of reference;
• Deutero-learning: learning to learn, complex adaptation to complexity.
Epistemological approach Systems Learning Learning by
Positivism Closed systems First order: Single- loop learning
Adaptation to external norms or expert knowledge. Constructivism Open systems Second order:
Double-loop learning
Reflexivity. Triggering structural changes within the system that open up new possibilities to connect.
Constructionism Belief systems Collective production of meaning
Co-construct a collective frame of reference that fits.
Complexity Theory Complex systems Third order: Deutero-learning
Learning how to learn. (1) Deutero-learning (2) Meta-learning Fig. 3. Perspectives on learning (repeated p.68)
Qualitative inquiry: thematic analyses.
The ultimate goal of my research is to analyse, encode, identify, and create a theory out of my findings (Harding, 2013). Jamie Harding (2013) breaks down the process of collecting and analysing qualitative data, and designing research, into simple, retraceable stages:
- Data collection: managing interviews and focus group data; - Analysing the data, making summaries and comparisons;