A practitioner’s responsibility is to create change, and clients have a reasonable expectation that a strategy will be suggested, a task set or understanding shared that will remove the troublesome symptom that motivated them to seek help. It is disheartening when the effort that has gone into mapping a direction is met, next session, with ‘It didn’t work’, ‘We didn’t try it’ or “We couldn’t remember what you said’.
How Have we Understood this Response?
In its early days family therapy was strongly focused on tasks and prescriptions, designed to alter the system and pattern of interaction that was understood to be supporting the symptom. While premised on the understanding of circular processes this perspective was strongly influenced by a medical model of illness whereby a symptom required a prescription to deliver medicine and a cure. The practitioner diagnosed the difficulty, decided what ‘medicine’ was needed and ‘wrote a prescription’ with the expectation that the patient would follow instructions and recover.
When clients failed to ‘do as they were told’, this was labelled as resistance and evidence of the system’s deviation-counteracting processes protecting the system from change. The system was understood in terms of negative feedback loops and homeostatic mechanisms which ensured stability was maintained. While individuals were not blamed the system was.
Steve de Shazer and the Death of Resistance
Steve de Shazer, who founded the Brief Family Therapy Centre and pioneered Solution- Focused Brief Therapy, challenged this view. He noted that it implied a separation between therapist and family system and locked practitioners into a linear construction of force or power where they are engaged in a struggle which one must ‘win’. He proposed a different view which saw resistance as a product of the therapist-family interaction with the workings of each mutually influencing the other, including resistance. He suggested that a therapeutic stance where change was seen as inevitable would introduce new information into the system that could then be amplified. ‘The practitioner’s task was to understand that the family had its own unique way of co-operating and join with this to produce change.
Resistance and Change is a Joint Responsibility
Politics is one of the meta-frames of bower(method), the integrative model which guides all practice at Bower Place. This includes the concept of ownership: who has the power or authority to change a problem and who is willing to take responsibility to do this. This idea underpins how advice or intervention are framed. At the first visit and as part of the agenda clients are told that the practitioner will take responsibility to provide advice to the best of their ability in response to the request. However, it is the client’s responsibility to choose to follow the advice and they are asked not to do so if the advice is wrong or unhelpful, as opposed to uncomfortable. Only they can make this assessment.
‘Wrong’ Advice Provides Information to the Therapist-Client System
This is not a strategy to encourage clients to follow advice but reflects the understanding that enhancing the flow of information into the client and practitioner system will support the process of change. All information, including that which looks like a mistake is of value and will support the practitioner’s future attempts to meet the client’s request. Viewed through this perspective the therapeutic endeavor becomes truly collaborative, responsibility and authority clearly delineated and resistance evaporates.
De Shazer, S., (1984) The Death of Resistance, Family Process Vol.23. 11-17
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