THE ART OF WITHNESS: A NEW BRIGHT EDGE

Lynn Hoffman
“Living utterance becomes an active participant in social dialogue. If we
imagine such a word in the form of light, then the living and unrepeatable
play of colors and light on the facets of the image that it constructs can be
explained as the spectral dispersion of the ray word, in an atmosophere filled
with the alien words, value judgments and accents through which the ray
passes on its way to the object; the social atmosphere of the word, that
atmosphere that surrounts the object, makes the facets of the image
sparkle.”
The Dialogic Imagination: Four Essays by M.M. Bakhtin, M. Holquist (ed),
tr.C. Emerson, University of Texas Press, 1981, P. 277
Introduction: The New Bright Edge
The image that propelled this title was given to me by Tom Andersen, who
kept telling me that I must come to the North of Norway in the “Darktime.”
So he invited me for the first day of spring, just as the sun was going to
appear. The occasion was a meeting of Andersen’s “Northern Network,”
composed of teams handling acute breakdowns from hospitals in countries
all across Europe’s northern rim. Andersen took me to his top floor office at
the University of Tromso the morning of the conference, and out the window
I saw the first rays. They appeared in the cleft of two snow-covered
mountains, then faded away, followed by colors of pink, mauve, and gold
which lit up the edges of landscape and sky.
From time to time as I have passed through the history of this field, I have
been given the chance to see such first rays. And I have in some way known
or guessed which newcomer approaches would establish themselves and
persist. One is taking shape now, like a ship hull-up on the horizon. It has
already been referred to as the “Conversational Therapies,” a term used by
Roger Lowe (2005) in a recent article. Lowe distinguishes between the
approaches that use “structured questions” like Narrative and Solution-
Focused work, and what he calls, following John Shotter (Shotter & Katz,
1998), a “striking moments” approach, which does not use pre-planned
techniques. I am interested in establishing a train of forebears for this last
effort, which is now branching off into the future in interesting ways but
includes some distinguished ancestors.
The work of these forebears was illuminated by Gregory Bateson (1972), who
at the end of his life emphasized the nonverbal communication styles of
what he called the “Creatura,”or the world of the living. Putting these ideas
to work, Harlene Anderson and Harry Goolishian (1986) took a sharp turn
away from purposeful interventions in their “not knowing” stance. Then Tom
Andersen (1990) introduced the “reflecting team,” which inspired those of us
like Peggy Penn and myself who were trying to work in a less instrumental
way.
More recently, we have been introduced to a cornucopia of philosophical
treasures based on the writings of Ludwig Wittgenstein and Mikhail Bakhtin.
We have a new “in-house philosopher” in social thinker John Shotter (1993),
who has described how these writers can help us understand what Bakhtin
(1990) calls “dialogicality.” We are beginning to have new terms for what we
do, like Tom Andersen’s idea of “withness practices.” We also have some
unusual examples of these ideas embedded in the work of innovators such
as Jaakko Seikkula and his colleagues in Finland, who have been developing
an approach called “Open Dialogue,” joined by Mary Olson, who is teaching
dialogic network therapy at the Smith School of Social Work. Finally, let me
mention Chris Kinman in Vancouver, who has been experimenting with a
Language of Gifts that is producing entire system change in local areas. But
let me go back in time, and talk about the early genius who started it all:
Gregory Bateson.
Bateson and Syllogisms in Metaphor
There were several philosophical pioneers in the last century who made it
their life’s work to study how the forms of Western discourse entangle us.
The two most important ones, in my view, were Ludwig Wittgenstein and
Gregory Bateson. In Wittgenstein’s (1953) famous book of arguments with
himself, “Philosophical Investigations,” he explores ways to get out of the
invisible linguistic trap he called the “fly bottle.” His work has generated an
industry of explainers. Bateson’s writings have not yet called forth such an
industry, but he took on a similar charge in describing the style of nonverbal
communication that is common to religion, humor, some forms of madness,
playfulness, and art.
This type of communication, Bateson held, applied specifically to what Jung
called the “Creatura,” the world of the living, as opposed to the “Pleroma,”
meaning Newton’s world of force and mass. The Pleroma has no mental
process, no names, no classes. The Creatura, on the other hand, is founded
on pattern and communicates through “as if” language, using similitude and
metaphor in a variety of embedded and embodied ways. Bateson’s daughter
Catherine (Bateson and Bateson, 1987) tells us that, at the end of his life,
her father was fascinated with what he was calling “syllogisms of metaphor.”
This idea, she explained, was tied in with the central concern of his research,
which was “the beginning of a Creatural grammar.” (Angels Fear, p. 192)
So what might that mean? In contrasting the truths of logic with the truths
of metaphor, Bateson explains that classical logic describes causal word
structures called syllogisms that are built on classification and which follow
the form: “if this is true, then that is true.” If Socrates is a man, and if all
men die, then Socrates will die. But there is another word structure that
Bateson describes that is built on likeness, the example for which is: “Grass
dies, Men die, [therefore] Men are grass.” Logicians disapprove of this kind of
syllogism because it does not make sense (they call it “affirming the
consequent”), but Bateson believed that this formula indicated the way the
natural world communicated. He fires off this ringing salvo:
“The whole of animal behavior, the whole of repetitive anatomy, and the
whole of biological evolution - each of these vast realms is within itself linked
together by syllogisms in grass - whether the logicians like it or not...And it
became evident that metaphor was not just pretty poetry, it was not either
good or bad logic, but was in fact the logic on which the biological world had
been built, the main characteristic and organizing glue of this world of
mental process that I have been trying to sketch for you...” (Angels Fear, pp.
26-30)
This statement thrilled me. It felt accurate, and it justified the enormous
importance my community placed on sensory pathways and emotional
gesturing in the work we did. It also justified the efforts of philosophers like
Wittgenstein, mentioned above, in not only searching out an alternative logic
but finding that it could be strikingly different from the classical logic that
Western thinkers had come to see as the norm. The nonverbal, analogical
vision of Bateson seemed especially pertinent to the project of
psychotherapy, because it indicated that advice and expertise were not
enough; you had to reach for connection at levels that lay beyond the scope
of words.
In fact, I felt that Bateson was saying that there is a hidden language known
to animals and mad people and artists. Current researchers in neurology
(Damasio, 1994) have pointed to a specific area of the brain - the amygdala
(also called the “emotional brain) saying that this is the brain’s “smoke
alarm,” because this is where the intense memories are stored that warn us
away from bad things and toward good ones. It makes sense to believe that
messages directed toward this area have to use this ancient grammar of
Nature or they may not be recognized. Of course, when Bateson talked about
syllogisms in metaphor, he didn’t mean that we should literally use figures of
speech, but rather that sensory and feeling-level channels must be used to
carry messages of life importance, as the channels of reason and logic are
untrustworthy.
I also want to say that such messages can break through private walls. Why
is this emphasis on the wider web so important for a therapist? Because it
turns us away from looking at individuals and their inner life, which is what
modernist psychology trains us to do, and points instead to the threads that
link everybody to the social web. If you stay with modernist psychology,
you will forever be trying to see your job as a matter of building roads,
putting up bridges, and various other engineering projects. If you move to a
postmodern psychology, you have to jump, like Alice, into the pool of tears
with the other creatures. This situation is a great equalizer and carries some
dangers, but it is the only source of information with the power to
transform.
 My Three Pillars of Wisdom
But let me move back to what I call my Three Pillars of Wisdom, the three
major anchors of the kind of work I and my community do. These are the
practices that have signalled the shift from a modernist view that sees
emotional problems as within-person phenomena like medical complaints,
and the postmodern view that they are relational and dialogic in nature. The
first pillar is the idea of “not knowing” brought into the field by Harry
Goolishian and Harlene Anderson. I once asked Harlene if they took it from
the writings of the French philosopher Gaston Bachelard (1964), who speaks
of “non-knowing” and defines it: “not as a form of ignorance but a difficult
transcendence of knowledge.” However, I was wrong. Harlene told me that
they began to use the phrase because their students would ask why they did
something and they would always say they “didn’t know.” Finally, they
made a principle out of “not knowing,” to the scorn and derision of much of
the field. But this simple concept made a difference in basic stance that was
extremely powerful.
As an example of the still-unfolding nature of this tradition, let me include a
recent article by Peter Rober (2005), who suggests that “not knowing” has
two aspects: the receptive one of listening, which is assumed in the original
concept, and the reflective one of responding. He offers the Bakhtinian
notion of the “dialogical self” in order to include these voices that are
elements of a therapist’s interior conversation. I like this expansion of the
original idea. In taking up the term “generous listening” from Lois Shawver
(Hoffman, 2002), it struck me that there was a parallel operation that
included thoughts that came up from the “deep well” and that seemed to be
evidence of increased psychic attunement. When I would check these
thoughts out with the persons I was seeing, their importance would often be
confirmed.
My second pillar is the practice called the “reflecting team,” contributed by
Tom Andersen (1987) and his colleagues in Tromsoe, Norway. This format
challenged the methods favored by early family therapists, undermining the
one-way screen and other devices that walled the family off from the
professionals dealing with them. Asking a family to comment on the
reflections of the professionals was even more unheard of. Before he died,
Harlene Anderson suggested to Tom that he broaden the term to “reflecting
process,” feeling that to link this format to a specific method was limiting.
The third pillar is witnessing, a concept that partially came out of the
reflecting team and which I call, following Harlene, “witnessing process.”
There is some internal history of the field to report here. Soon after Tom
Andersen went public with his reflecting format, Michael White adopted it
too. In line with his preference for anthropological rather than psychological
language, White (1995) used anthropologist Barbara Meyer’s term
“definitional ceremony” to describe it. He saw that having an audience for
his type of therapeutic interview might be used to reinforce the experience
of a more inspiring identity. Experimenting further with this form, he created
what he called an Outsider Witness Registry, where persons who had
already worked with him could be invited back to help others in similar
situations. As soon as I began to use reflecting teams, I too was struck by
the layering power of the many voices and groupings it put into play. It was
a prismatic endeavor, where one moment’s witnesser became another
moment’s witnessee. But White’s language threatened to muddy the
waters. As with the reflecting team, we needed a term that didn’t belong to
any one person or school. “Witnessing process” was a suitably large tent
under which many of us could fit, regardless of our therapeutic loyalties.
And here I would like to thank philosopher/clinician Lois Shawver (2005) for
a new insight. She has spent years studying Wittgenstein’s ideas and
applying them to her views of postmodern therapy. Recently, during a
conversation on her Postmodern Therapies List, she made a distinction
between “theories” and “language games,” ( Wittgenstein’s invention)
saying that the latter is more useful to those of us trying to describe therapy
approaches because it chooses such a specific set of descriptors. In regard
to White’s use of witnessing, it feels better to me to say that his ideas come
out of a different language game than Andersen’s do, rather than saying that
White is a deconstructionist and Andersen a social constructionist, for
example. But this is a digression - let me go on to some of the novel ideas
toward which Andersen is directing our attention.
The Contribution of John Shotter
A primary source of this new bright edge I am talking about comes from John
Shotter (1993), a postmodern social thinker whose writings on the nature of
dialogical communication have become increasingly relevant to the
relational therapies. He has been creating a little intellectual whirlpool
around the ideas of two philosophers in particular: Mikhail Bakhtin and
Ludwig Wittgenstein, and applying them to clinical practice. In addition, he
and Tom Andersen have been giving workshops together, and this has been
a happy development.
For my part, I felt that Shotter was our in-house philosopher. He was leading
us away from the belief that we could change social reality by purely
linguistic means. In its place was a picture of communication as a more
bustling, jostling enterprise. Shotter (2005a) speaks of “embodied knowing”
versus “language-based knowing” and describes it as “the sense that
addresses itself to feelings of ‘standing,’ of ‘insiderness or outsiderness’ in
any social group.” He says it’s not a skill or a theoretical knowing, but has to
do with the anticipations we bring to a conversation, and the influence these
impressions have on us and others.
This development seems to have led Shotter (2005b) to move away from
social constructionism, which was the theory we had given most credence
to. He feels it is lacking in any description of the constraints inherent in
social exchange. In his view, communication is like a kind of social weather.
It fills our sails, becalms, or sometimes wrecks us. Sensing what is called for
in a particular context, responding appropriately to gestures like an
extended hand, feeling a black cloud settling over a discussion, are all
examples of a weather system that can impact us in concrete and material
ways. The truth is that the famous “linguistic turn” of social constructionism
gives us almost too much flexibility in what is or is not possible. This is the
reason many people have accused it of being “relativistic,” if not morally
delinquent. And there are particular reasons why therapists can feel
liberated by giving it up. The move to a sublingual vocabulary, like pills that
melt under the tongue, often brings us closer to the matters that therapy
tries to address.
For instance, Shotter points out that people with emotional problems do a lot
of gesture talk and often the problem itself is gesture talk. For this reason,
he is very keen on Wittgenstein's appreciation of this more hidden realm. He
quotes Wittgenstein as saying “The origin and primitive form of the language
game is a reaction; only from this can more complicated forms develop.”
Expanding this thought, Wittgenstein says “that this sort of behavior
is prelinguistic: that a language game is based on it, that it is the prototype
of a way of thinking and not the result of thought.”
Shotter feels that the move toward embodied knowing also takes us away
from Descartes and the Western tradition. The Enlightenment valued the
objective eye of the observer. In contrast, dialogical reality is based on the
shared subjectivity of the participants. Instead of a “representational”
understanding, Shotter offers a “relational” one. Instead of seeking to be a
master and possessor of nature, as Descartes wished to do, Shotter wants us
to respect its “shaped and vectored” qualities. He further observes that in
matters that concern the world of the living, many important things occur
in meetings. All the more reason that we should scrutinize the kind of talking
that goes on in them. Not all meetings make the kind of difference
psychotherapists are looking for, and it behooves us to examine what is the
special nature of those that do.
One of Shotter’s biggest contributions from this point of view has been to
translate the lofty abstractions coming from Bakhtin and his colleagues into
more ordinary terms. For instance, he turns Bakhtin’s concepts of
“Dialogical” vs. “Monological” thinking” into “Withness” vs. “Aboutness”
thinking. In a recent article (2005b) Shotter says that “Withness Thinking’ is
“a dynamic form of reflective interaction that involves coming into contact
with another’s living being, with their utterances, with their bodily
expressions, with their words, their works.” In contrast, “Aboutness” or
“Monological” thinking” turns the other person into an object, not into a
being with a consciousness of its own.
The beauty of the notion of “dialogicality” or “withness” is that it addresses
the criss-cross of merging and overlapping voices, and their silences too, in
normal, ordinary exchange. Instead of the “expert” individual being
assigned the most influence in this activity, as usually happens in
psychotherapy, a “withness” conversation allows voices to emerge that have
often been stifled or withheld. Attempts to manage meaning may be the
norm in our societies, and many psychotherapy models have been built on
such attempts, but in these circumstances “withness” does not automatically
occur. In fact, there are some who say it is more apt not to occur. In thinking
back on an interview, the best outcome is that people would feel the
conversation itself was the author of what was said.
The “Withness” Practices of Tom Andersen
These ideas fed into my own belief that our theory had to take the
mysterious world of the senses more into account. I was using the idea of
“underground rivers” to depict the sensory channels that flow between
people when they seem to be connecting. I also looked back at my own
journey, from an emphasis on sight in “The Art of Lenses,” to an emphasis on
hearing in “Exchanging Voices,” to the current move toward touch and
feeling. Andersen, of course, had always been persuaded of this emphasis.
Influenced by the late Aadel Bulow- Hansen and Gudrun Ovreberg, two well-
known physiotherapists in Norway. Andersen (1986) has always placed the
body at the center of his work As a result, he is attentive to breathing; to
posture; to tone of voice, as well as to his own inner and outer voices and
what is going on in his own body. He says:
“The listener (the therapist) who follows the talker (the client) not only
hearing the words but also seeing how the words are uttered, will notice that
every word is part of the moving of the body. Spoken words and bodily
activity come together in a unity and cannot be separated...the listener who
sees as much as he or she hears will notice that the various spoken words
“touch” the speaker differently... Some words touch the speaker in such a
way that the listener can see him or her moved.” (1996, p. 121)
In another article, Andersen (?) follows the action of an interview he did in
Finland step by step. He first describes his talk with the host team, who tell
him about a mother with two daughters, one of whom, age 19, was “hearing
voices.” The team said they were worried because so many other persons in
that family had been hospitalized for psychosis. Andersen said he could
always meet with the team alone, if that was what they wanted to consult
him about, but asked if it would not be better to find out from the mother
and daughter directly what their own concerns might be. The team
agreed.
After asking the translator what her preferred method of working might be,
Andersen went on to describe the body language of the mother and
daughter as they came into the room. The mother seemed very
preoccupied, the daughter withdrawn. After hearing about various concerns
- the daughter’s refusal to go to school, the history of family members’
hospitalizations, the mother’s divorce from the father ten years before,
Andersen asked the mother if she had any other children. She said yes, from
a former husband, whose parents raised this daughter and kept her from her
mother. The daughter had become a street person, taking drugs, but now
she had written to her mother, asking to come live with her. Andersen asked
the mother if she thought the daughter had missed her, and was told yes.
Did she in turn miss her? Yes. The sister nodded yes too.
Andersen then said, “It sounds like your daughter is lonely.” When the
mother confirmed this, he asked her if she too were lonely. At this point she
said, “I have so much pain.” Andersen asked where in her body was the
pain. “In the heart and in the thoughts.” “If the pain found a voice what
would it say?” “It would scream.” With words or without words?” The
mother only looked at him. Andersen asked “Who would you like to receive
your scream? She said, “God.” “How should God respond to your scream?”
She said she hoped God could take care of her three daughters. A long
pause followed, and a long silence. The audience seemed very moved, as
was Andersen himself.
In the next part of the interview, Andersen found out that this mother had no
adults in her life that she could talk to; she had no one else but her
daughters. She had been close to her father’s parents, but they were both
dead. If they had been here, might they have helped her? Might she have
been able to scream to them instead of God? She began to weep, saying
yes. Andersen asked “If your grandmother had been here, what would she
have said?” The mother answered: “Little girl, you have been so good to
your daughters.” Andersen: “What would you say back?” “Grandmother, I
love you so much.” And what would Grandmother then do? “She would put
her arms around me and I could smell her. She smells so good.” Many
people in the audience were now openly weeping. Andersen asked the
daughter what her thoughts were. She said she knew her mother was in
pain, but did not know much about her grandparents. She said that she
would rather hear about the pain than not hear anything.
Andersen closed the interview with a suggestion that the mother take her
two daughters to the grandparents’ grave and talk to the girls about them.
Andersen then asked the team and the audience to share their thoughts with
him, while the mother and daughter listened. The team said they had been
very moved by the mother’s feelings for her daughters. Andersen asked if
there was a grandmother’s voice in the audience, and found one; then he
asked for a grandfather’s voice. These persons said that they had also been
moved, and the grandmother said how important it was for a granddaughter
to have a grandmother and for a mother to have a mother. Mother and
daughter left the meeting “with firm handshakes and firm looks,” and
Andersen was told by a team member three months later that the daughter
had no more fears or voices and was going to school in the fall.
In Andersen’s commentary on this interview, he describes his work as a
communal enterprise rather than an individual-oriented one, and makes this
very interesting point about language:
 “Language is here defined as all expressions, which are regarded to be of
great significance in the above-mentioned communal perspective. They are
of many kinds, f.i. to talk, write, paint, dance, sing, point, cry, laugh, scream,
hit, etc., are all bodily activities.When these expressions, which are bodily,
take place in the presence of others, language becomes a social activity.
Our expressions are social offerings for participating in the bonds of
others.”
I like that idea, as it underscores the “networks talking to networks” idea
that we will be seeing in the work of Jaakko Seikkula which I will be
describing next. But first, I want to comment on Andersen’s ability to
connect on a mind/body level. The late (and much-missed) Gianfranco
Cecchin used to mock me for my interest in the idea of “empathy.” “Why do
you need empathy?’ he used to ask. “What is so important about this
empathy?” I tried to tell him that this is a word I use interactively, and that I
call it “tempathy,” for “traveling empathy.”
My insight was validated when I recently read about cells within the brain
that researchers like Anthony Damasio (2003) call “mirror neurons.” For
example, scientists at the University of Groningen (The Economist, May 14,
2005) have found an action-sensitive type of cell that fires not only when a
rhesus monkey reaches out for food, but in a different rhesus monkey who
sees the first one’s gesture. Similar experiments with humans are finding
the same thing. In other words, when I see someone who is moved and
shows a reaction, some small piece inside my own brain also moves. It is
these action-sensitive cells that are moving. It is interesting to note that
researchers who study autism say that autistic children strikingly lack these
cells. So there is beginning to be some backing for the idea that empathy is
more than a trait in the individual but is central in the formation and
reinforcement of the social net.
The Open Dialogue Approach
Let me move on now and talk about Open Dialogue. This term refers to the
work of a group from Keropudas Hospital in the North of Finland that includes
family therapy pioneers Jukka Altonen, Yrj Alanen and Jaakko Seikkula
(1995), among others. They have come up with what they call a dialogic
approach to persons with first time acute psychosis. The group’s
background philosophy was greatly influenced by the work of Mikhail Bakhtin
and his circle. They have recently concluded a five year outcome study on
Open Dialogue in which the statistics of the Keropudas subjects are
compared with those of persons receiving “treatment as usual” from a
hospital in Sweden. By “treatment as usual,” they meant the
hospitalization-plus-neuroleptics approach which has become the accepted
way to treat acute breakdowns in many hospitals across Europe.
This study excited enormous interest. Five years after it began, 80 percent
of the Open Dialogue patients were working, studying, or training for a job
and only 20 percent were on neuroleptic medication. In the comparison
group, by contrast, 80 percent were on welfare and 80 percent were on
neuroleptics. By design, hospitalization played a much smaller part in the
Open Dialogue group than in treatment as usual, and often was avoided
altogether. Repeat hospitalizations were also much lower. I had to ask
myself: what is the secret of this approach, and how does it work?
It was then that I heard that Mary Olson, a colleague of mine who was
teaching at Smith School of Social Work, had been asked to apply for a
Fulbright at Yvaskyla University in Finland. Tom Andersen had invited me to
come to another of his conferences in Norway, and I asked if Olson could
come with me. Since she was a good writer, as well as a good teacher and
therapist, I wanted her to meet the Norwegian and Finnish researchers
whose work I had been following for so many years. So I was able to
introduce her to Andersen’s acute team at Tromsoe Hospital, and on getting
the Fulbright, she did indeed go to Yvaskyla University and met Seikkula too.
One result of their meeting was an article they co-wrote describing the Open
Dialogue approach (Seikkula, J. and Olson, M., 2003). They have now applied
for an NIMH grant to set up a pilot program using the Open Dialogue method
with children admitted to the Emergency Room at the Community Services
Program at UMass Worcester Medical School. As with the Keropudas Hospital
study, it will compare the outcomes of the children’s research group with
those of children who are admitted in the ordinary way.
Networks talking with Networks
Seikkula puts great importance on the meshing between the treatment team
from the parent hospital and persons from the social network of the afflicted
person. The hospital team, usually three or four people, meets as soon as
possible, preferably on the client’s own home ground. Since all staff in
Keropudas are required to take a three year course in family therapy,
regardless of discipline, it is possible to pull out at short notice an ad hoc
team that is on the same page. Hospitalization is often avoided, and so are
the heavier drugs, although of course they are available. The network
meets daily, or as often as needed, until the disturbance has died down.
Later, individual or family therapy might be offered, but the hospital team
continues to monitor the situation.
Another important feature is an aspiration that the conversation be “without
rank.” This is a concept offered by Bakhtin, who in his description of
dialogism talks about “the development of familiar and intimate forms of
address...more or less outside the framework of the social hierarchy and
social conventions, ‘without rank,’ as it were.” (1986, p. 97) What makes
Open Dialogue of interest to communication researchers is the emphasis on
developing a shared way of talking. This means never challenging the
strange words of the patient, no matter how irrational, but continuing to
puzzle at them in the belief that a more mutual way of wording the situation
will evolve. This forestalls the traditional effect of family therapy meetings,
which is often to highlight the gap between the “sick” and “well” members of
the family, or the similar gap between the family and the professional. The
end of such disparities would be a key characteristic of speaking together
“without rank.”
Seikkula says that in its early days, their team followed structured
methodologies like the Milan Systemic approach, but found that they failed
to generate the hoped-for engagement between the team and the family.
Seikkula says: “We early realized that it was no longer possible to have
control over the treatment processes by treatment plans or by family
therapy.” Then they heard that family therapist Yrj Alanen in Turku had
started to organize open treatment meetings which included the patient in
every meeting about his or her problem, as well as automatically inviting the
family in as well. At this point, the group also found that the ideas of
dialogism proposed by the Russian philologists Miklhail Bakhtin, Lev
Vygotsky and Valentin Voloshinov allowed them to create a description of
the open treatment process. Seikkula (Seikkula and Olson, 2002) puts the
matter pungently:
“Coming into engaged meetings or dialogical meetings (as we started to call
them), means giving up the idea of primarily having control over things and,
instead, jumping into the same river or rapids with our clients and trying to
survive by taking each other’s hands.” (p. 403-418)
In their article, Seikkula and Olson make another important contribution by
tying the Open Dialogue format to Bakhtin’s concept of “polyphony.”
Bakhtin lays out the difference between a writer like Tolstoy, who wrote from
a God’s Eye View, with Dostoievsky’s ability to move in and out of the lives of
his characters and speak with their voices. Bakhtin goes on to talk about the
presence in social life of “a universe of innumerable consciousnesses, each
with its own world.” A conversation that expresses these different possible
worlds Bakhtin called “polyphonic.” This seems like an important value if
one is hoping for common understandings to emerge that all have
participated in making.
The Meaning of Chronification
The most startling impression I got from the articles that members of the
Keropudas team (Seikkula, et. al., 1995) have written about their work was
that the purpose of therapy seemed to be not so much to alleviate
symptoms as to prevent chronicity. It then occurred to me that the term
“calcification” might be a more general metaphor. How often have we used
the word stuckness to describe a family’s difficulties? How often have the
problems people come in wih developed a thick, isolating carapace that
hardens with time, often trapping other family members within it. Harry
Goolishian and Harlene Anderson used to call this carapace phenomenon a
“problem-determined system” (Anderson, 1997) and talked about not solving
the problem but dis-solving it. The Collaborative practice they built on this
view was one of the first family therapy approaches to acknowlege it. Tom
Andersen’s deeply gestural work is another. Now, even more relevant, we
have the dialogical network approach coming from the work of Seikkula and
his colleagues, which is not only aiming to combat chronicity but
dramatically achieving it.
What also stood out for me was the fact that in the research group treated at
Keropudas Hospital, such a large number ended up functioning within, rather
than outside, the ordinary world. Of course, part of their success was due to
the fact that the team limited their work to people who had not had acute
breakdowns before. And since the team’s major aim was for their people to
have the chance to re-enter daily life, they did not consider it a failure if
every strange behavior were not suppressed.
All the same, how do the Open Dialogue methods work? Here is where the
“dialogue” element comes in. As I said above, the team’s overriding idea
was to meet daily until the family and the team could achieve a common
language to talk about the situation, putting into words what may have come
out as a strange and frightening dumbshow. The theory was that psychotic
behavior was gesture talk, with many fears propelling it, and if one could
translate the gesture talk into ordinary language, everyone would benefit. In
the usual course of events, a split was likely to develop between the oddly-
acting, oddly speaking family member and the rest of the world. The
sequestration provided by hospitalization and the effect of heavy medication
was seen to be part of what made that gulf grow. Meeting on home ground,
on a daily basis and with close others, allowed the team to mediate the
effect of social alienation before it got too strong.
The last time Seikkula came to the U.S., I asked him if he were still working
with acutely disturbed people. He said, “No,”and explained that for some
reason the schizophrenic population in his area had dwindled. He had
shifted to working with depression instead. When I expressed surprise, he
said that in the twelve years since Keropudas Hospital began using dialogic
methods, the percent of the population in the North of Finland with chronic
mental illness had declined from 33 per 100,000 inhabitants, to seven per
100,000 (Aaltonen, Seikkula, Alakare et. al., 1997). He opined that perhaps
twelve years was the time it took for the effect of a method based on
interrupting chronification to show up in the larger population, at least in a
rural area.
The Rhizome Connection
Let me move on now to the story of my connection with “Rock the Boat,” an
unusual helping business run by Chris Kinman, family and community
therapist and former minister, together with his partner, criminologist Peter
Finck. For 12 years I have been crossing the continent to Vancouver almost
on a yearly basis to see what Kinman and Finck are up to. Like the work I
have been talking about above, this process also involved “networks talking
with networks.”
Back in 1994, Chris phoned me and asked me to come out to do a workshop
in British Columbia. While I was there, Chris brought me into contact with
the powerful traditions of the First Nations people, particularly the art and
culture of the Haida Gwai from the Queen Charlotte Islands. Chris was
working with First Nations youth and families, and had been fascinated by
the ancient ritual of the potlatch, where the idea is to give rather than to
get. It was not surprising to me when he told me that he wanted to work
from the idea of bounty rather than the idea of lacks and disabilities.
Another feature of this work was a strong communal presence. During a
break in my workshop, which was being held in Vancouver, a person in the
audience took me into a room filled with green light. There, in the midst of
ficus trees and bamboo, was an astonishing object. It was a greenish bronze
canoe, half the size of the room, and in it a variety of totemic animals were
struggling with each other: the raven with the bear, the wolf with the eagle,
the crow with the dog, while half-human creatures like the Dogfish Woman,
or the Bear Mother, paddled, watched over by the sombre Village Chief with
his temple-shaped hat. I learned that this was the achievement of a sculptor
called Bill Reid, who was himself descended from First Nations people. In
this work, titled “The Spirit of the Haida Gwai,” Reid represented himself as
the Ancient Conscript, paddling along with the rest.
Chris also took me to the university bookstore, and introduced me to two
French writers, Deleuze and Guattari (1986), who compared the horizontal
growth pattern of the “rhizome” (think crab grass) to the hierarchical pattern
of the tree, on which so many Western institutions are based. Another
favorite writer was Gaston Bachelard (1994), who came up with the concept
of “reverberation” as an alternative to causality. This idea pushed me back
to Bateson’s Grammar of the Creatura, where transmission of meaning goes
along the paths of metaphor rather than through chains of logical thought.
At this time I also bought a book by Jacques Godbout called “The World of
the Gift,” (1998) and remember telling Kinman that he should make “The
Language of Gift” a main descriptor for his work.
Chris then showed me examples of a “Local Wisdom” series he had put
together based on sayings from the persons he was working with. Some of
the titles were Local Wisdom of the Mothers, or Local Wisdom of the Kids. He
would transcribe what people said to him and put it into a kind of chapbook.
Sometimes he would intersperse their comments with passages he wrote, or
quotes from writers he admired. I felt it gave the people he worked with a
special dignity to be set down in print like that.
Another innovation Kinman (2001) had come up with was what he called a
Collaborative Action Plan. This document was an alternative to the usual
problem oriented intake record, widely used by services in that area. What
was special was that it was organized around the “language of gifts” referred
to above. The first page asked, “What are the gifts and potentials this
person can give to the community?” The second asked, “What are the gifts
and potentials the community can give to the person?” The third page read,
“What are the roadblocks to these gifts and potentials?” This was the gist of
it, although it varied over time. Kinman told me that just the use of this
document altered his relationships with the people he worked with in a very
positive way.
In his wish to acquaint me with his environment, Kinman put me up in an old
time resort hotel in the Canadian Rockies. It was only one night, but it must
have cost a pretty penny - well worth it, if the idea was to impress me. I
asked about the work he was doing with young people and their families, and
he told me touching stories about his efforts to see the world as they did.
One memorable thing he shared was about a teen-age girl who said to him,
“Therapists try to get into your head; counsellors help you bear your
burdens.” Or, as he put it, “What the mountain cannot bear, the river takes
away.” I liked the idea that therapy might be like the river. We closed our
time together with a trip to the Anthropological Museum, the repository of so
much First Nations culture and its splendor. Then I bought a book on the
work of Bill Reid, and said goodbye.
The Fairy Godfathers
But it was not goodbye. The following year, Kinman asked me to come out
again. He had organized a meeting that represented the “systems” he was
working with: some parents of kids he was seeing; a group of his trainees;
and a few of his colleagues. At the time I was much influenced by Tom
Andersen’s ideas about reflecting process, and thought we could use such a
format for our meeting. What I did was to ask Kinman to sit and listen while
I interviewed each “pod” in the circle about their experience with Kinman’s
very different way of working. The parents said that he was not like the
usual social service worker because he made them feel like helpers and
partners. The students were pleased, because the tools he gave them made
connecting with clients so easy. His colleagues had similar things to say.
During all this, Kinman occasionally tried to break in, but I stopped him.
When all had their say, I turned to him and asked about the impact of what
he had heard. He was obviously full of emotion by this time, and turned to
the notes he had taken, offering each person’s idea as if it were a line in an
extended poem. It was an intensely moving experience for all of us.
Two years later, Kinman asked me to come back again to preside over a
meeting that we were now calling “Honoring Community.” This time the
gathering was more formal, and Chris introduced me to his new partner,
Peter Finck. Present were representatives of various social services: some
foster parents, two members of a biker group who directed homes for
troubled boys; a probation officer (the only one there who had a professional
degree); some social work trainees; and a group of adults brought over from
Vancouver Island by psychiatrist Robin Routledge that was called The Mood
Clinic. Chris gave an orienting talk, and introduced me, and I then sat with
each subgroup and asked about their work. I was very touched by the
different experiences that were presented, and the ideas offered, Because
most of the people present would not have otherwise known about the
worlds of the others, it became a fascinating conversation, both for those
talking and those listening.
The day before, I had sat in on a weekly conference attended by the group of
biker men who were in charge of youth homes. They all had vivid tattoos
winding up their forearms. Not having been introduced, I felt like a foreign
object, but I sat and listened with interest. A large dog under the circular
table kept going from one set of feet to another, finally settling on mine. At
this point, the leader of the group, still without introducing me, asked me for
my opinions. I said that what had most impressed me was their
tenderness.
Then I ventured something outrageous: I said, “To me, you are just a bunch
of Fairy Godfathers.” A moment of appalled silence, and then the group
burst into a huge roar, looking hard at the leader, the one who had the most
impressive tattoos, and who luckily was laughing too. This man and a
colleague came to our community meeting the next day and commented
powerfully on their past experience of class prejudice from persons in social
service agencies. But what most caught my eye was a small tag pasted on
the shirt of the leader, saying “Fairy Godfather.”
The conference finished with all of us listening to the Mood Clinic. This was
an informal club which played an advocacy role between patients and
medical doctors on issues to do with medication and treatment. Their stories
enlisted both our sympathies and a feeling of hopefulness. The event as a
whole had given me a depth knowlege of the helpers and workers who toiled,
you might say, in the shadows of desperately troubled clients, but kept their
optimism intact.
New Systems For Old
But that in no way prepared me for the next time I was asked to the
Vancouver area. I had kept in touch with Kinman, and every once in a while
he would email off to me another one of his writings. Once he used up a
whole roll of my fax paper - yards of it came pouring out of the machine like
an endless Chinese scroll. But soon there was a new addition to the wisdom
series which featured the public health nurses of the Frasier River Valley.
And I learned a new story.
Chris had told me that some nurses from the Frazier Valley Health Area had
come to Rock the Boat for advice because they had become disenchanted
with their problem-oriented assessment form. They had heard that he and
Finck had been experimenting with an alternative that was based on gifts.
Apparently, the Collaborative Action Plan was just what they were looking
for. Kinman told me how these women had taken this format and were
fitting it to their own practice. To my amazement, it seemed that their
supervisors and the bureacracy were supporting them. Then Kinman said
that the teaching program in public health nursing at the University of
Victoria was also changing.
Sitting on my hill a continent away, I received these smoke signals, but I still
had no idea of their profound implications. WIthout much warning, Kinman
asked me out one more time. It seemed that they were going to have
another Honoring Community meeting built around the achievement of the
public health nurses. So I flew across again, and what I found really
staggered my mind. As soon as I got there, Kinman introduced me to the
frontline workers and they told me about their plans for the meeting that was
to be held the next day. Here is an account of what happened.
First Kinman gave a slide show featuring commentary from the nurses
themselves (he stayed up all night to finish it). Then I sat with a group of
frontline nurses who told me how their work lives had been transformed.
Then came key persons from the bureaucracy who were backing this
adventure. Next came some teachers from the public health nursing
program at Victoria University who were changing their curriculum. Lastly, I
sat with Marjorie Warkentin, one of the nurses who had helped spearhead
the change, together with a young mother who was recovering from a
postpartum depression and had agreed to add her voice.
This was the first time in my 40 years in the field that I had been present at a
change at each level of a complex health system: front line workers,
administration people, teachers, and clients. That last group had usually
been excluded from such conferences, except as the Exhibit A in teaching
events. I thought about all the families that had been used to demonstrate
family therapy in front of huge audiences since the field began. But this
young mother was not there as evidence of some clinician’s ability, but in
charge of her own story. She and Warkentin described their experience with
this “gift-oriented” approach to human difficulty, and told us what a
difference it made to both of them.
These systemic changes have lasted and I can now bear witness to the
newness that shone forth so brightly in the Fraser River Valley Health
Authority that day. Despite the reductive mantle of managed care, shifts like
this one continue to inspire hope in those of us who believe that the
language game we use makes all the difference. And there are many of us
who continue to be watchers on that hill!
The Conversational Therapies
The secret of talk that moves through underground channels is that it
operates on a felt-sense level rather than following codified rules for change.
In Roger Lowe’s article, mentioned above, the “structured question”
approaches are compared to this new style of working which he calls
“dialogical” or “conversational.” I like the term “conversational.” It
suggests a quality of open-endedness together with an emphasis on
spontaneity, more like the way a creative artist operates than a licenced
professional. As Andersen says: “My wish is at this moment that we stop
talking about therapy and rather talk of it as human art; the art to participate
in the bonds with others.”
Whatever we call this new big tent, it seems obvious to me that we have
gone beyond social constructionism’s “linguistic system” idea with its
emphasis on the malleability of meaning. Instead we are looking for
“withness practices.” These entail a special kind of exchange. They bypass
the hierarchy implicit in most social interaction. They do not lead to some
pre-determined goal or depend on a pre-arranged technology. If a sense of
having “got there” occurs, it must come spontaneously, much as
Wittgenstein suggests when he says that the aim of philosophy is to help us
know “how to go on.” Above all, they operate on a feeling level, which is the
field where goods are struggled for and contests go on, and where a sense of
justice is a constant living thing.
THE GEE’S BEND QUILTS
Let me end with the story of the Gee’s Bend Quilts, made from scraps of old
clothes by the African American country women of Gee’s Bend, Alabama and
now hailed as triumphant examples of unexpected folk-art. The family
therapy field is also made of scraps and patches. Just as the Gee’s Bend
quilters used worn-out pieces of material, with their accumulations of history,
to create bed quilts, so our movement is made up of pieces of practice from
many stages: structural, strategic, interactional, solution-focused,
possibility-oriented, systemic, narrative, reflecting, collaborative, to name
just a few. Now comes a new term, dialogical. This title suggests an elusive
quality called “withness” and is represented by those special kinds of
conversation or “language games” that give us our bearings in the matter of
social bonds. There is no end point toward which this movement of ours is
trending. It is only a folk quilt and its only purpose is to keep us warm at
night. But it might not be so warm were it not made of so many patches of
history, memories and lore.

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