Narrative Child Family Therapy

_____________________________________________________________________________________________________________ Fam Proc 35:423-440, 1996 Narrative Child Family Therapy GLENN LARNER, B.A. (Hons), Dip. Psych.a aChild/Family Clinical Psychologist, Community Health Centre, P.O. Box 55, Nowra, Australia, 2541. In this article, child family therapy is presented as a hermeneutic activity shaped by an interest in the evolving narrative. Over brief, analytic play interviews, the therapist documents a child's narrative understanding of the presenting family problem. This allows psychological meaning to be jointly constructed in therapeutic conversation with the child and family. The idea of play as narrative integrates child psychotherapy into recent social constructionist thinking in family therapy. The article also discusses how narrative therapists can use prior theory and training. A lingering issue in the history of family therapy is how to engage relatively nonverbal, young children in the therapy process. Over the years, there have been various attempts to resolve this question by incorporating child therapy techniques into family therapy practice. Early on, authors like Zilbach, Bergel, and Gass (1972), Montalvo and Haley (1973), and Keith and Whitaker (1981), suggested the use of play therapy activities in the family therapy session. Recently, more extensive models of family play therapy have been proffered (Ariel, 1992; Gil,1994; Schaefer & Carey, 1994; Wachtel, 1994; Zilbach, 1986). This article contributes to the literature on the integrated practice of child family therapy in the light of recent social constructionist thinking in family therapy. Its focus is not the use of play during the family therapy interview, but rather, the engaging of the family in a therapeutic conversation after a child's narrative play assessment. What is presented is a narrative approach to brief psychoanalytic play interviews with children in the context of family therapy. The child's play and art is understood as a narrative on the symptom or problem that prompted a family's request for psychological help. However the play material is not 'interpreted' by the therapist as in traditional (analytic) child psychotherapy. Following Anderson and Goolishian (1992), psychological meaning is left open in a hermeneutic attitude of inquiry. The "not-knowing" play therapist creates a dialogical space for meaning to be jointly constructed in therapeutic conversation with the child and family. This highlights the relevance of the child's story in the development of the family narrative and enhances his or her voice in the therapeutic session. It is suggested that the "not-knowing" stance of therapeutic conversation in family therapy is consistent with recent hermeneutic trends in child psychoanalysis, which makes their integration in theory and practice more feasible. While this article presents a narrative understanding of child family therapy, it remains open to and draws upon ideas from more traditional therapies. From the perspective of "both/and," or différance as Derrida (1984) calls it, to see therapy as a dialogic and conversational process need not exclude other stories by therapists about how therapy works (Larner, 1994). It is suggested that therapists working with children and families from a narrative framework can use their training in systemic or child psychotherapy approaches. For example, the hands-on experience with children in play therapy provides valuable skills in relating to young people in family therapy, as well as an increased awareness of relationship issues and therapeutic process. I will address the vexed question for social constructionists: How can therapists contribute knowledge and expertise without imposing a totalizing, expert opinion? I propose a therapy that becomes an exchange of meaning and ideas between therapist and clients. INTEGRATING CHILD/FAMILY THERAPY Family therapy and child psychotherapy have developed quite disparate frameworks and practices for he]ping helping psychologically troubled children and their families. As Wachtel (1994) notes, family therapists from a systemic background ignored preceding decades of child psychotherapy practice as irrelevant, a theoretical bias that contributed to the neglect of children in the practice of family therapy (Diller, 1991). On one hand, using psycho-analytic, relationship, or structured play therapy approaches, child therapists worked individually and exclusively with children. On the other, family therapists experienced difficulty engaging young children in the session, which reflected both a lack of clinical experience and training in individual work with children and a theoretical hostility toward individual approaches individual approaches like play therapy. This, despite the urging of influential figures in the family therapy field like Minuchin, Whitaker, and Haley to use play to engage children in the therapeutic process (Keith & Whitaker, 1981; Montalvo & Haley, 1973; Zilbach, 1986). Gil (1994) notes that the use of play in family therapy in the 1960s and 1970s never quite gained momentum and soon faded. Unfortunately, this is a trend that could continue with the introduction of a narrative and social constructionist framework, because of its verbal-dialogic emphasis. A number of authors have recently attempted to redress this historical rift between child and family therapy approaches. For example, Zilbach (1986) provides detailed guidelines for the use of play in family therapy, which maximizes the inclusion of young children in the family treatment session. Similarly, in her book on family play therapy, Gil (1994) 1 _____________________________________________________________________________________________________________ espouses the use of play therapy techniques (for example, puppets, art, storytelling) in family interviews. Such play helps to involve all family members in therapy because "it lowers defences and elicits and unlocks a deeper level of interaction in which fantasy, metaphor, and symbol can emerge" (p. 41). Wachtel (1994) proposes an integrative child-in-family therapy approach called "cyclical psychodynamics." Therapy sessions are structured around the use of a range of mediums such as play, drawing, storytelling, games, drama, puppets, and clay. Wachtel's (1994) therapy is both individual and systemic, using psychodynamic, systemic, behavioral, and cognitive techniques in the child or family session. Ariel's (1992) strategic family play therapy approach uses "make-believe" sessions with the whole family, as a semiotic tool for diagnosis and intervention. For Racusin and Kaslow (1994), it is not a matter of choosing between child or family therapy, but of integrating the two. They illustrate the use of separate, concurrent, and sequential individual and family therapy sessions over a range of theoretical perspectives. Schaefer and Carey (1994) have recently assembled various articles, describing a family play therapy approach. These incorporate therapeutic activities involving puppets, sandplay, drawing, art, and psychodrama into the family therapy session. From a different tack, Sheinberg, True, and Fraenkel (1994), describe an approach with sexually abused children, which combines individual, group, and family therapy recursivelythat is, in a way that transfers information between these modalities. This provides a child and family with multiple perspectives on the incest experience. The child's active involvement in deciding when and how to transfer material enhances personal agency and connection to family members. It is generally agreed that for children to participate in family therapy effectively a play orientation is required (Villeneuve & LaRoche, 1993). Yet, according to Kuehl (1993), less than 3% of family therapists report using play therapy techniques. He suggests limited individual sessions with children in order to facilitate therapy with the family: 1) by respecting the expectations and expertise of the parents who commonly request a child-focused approach; 2) by allowing the child more opportunity for self-expression; and 3) by allaying parental anxiety about being blamed for the child's problem. The child family therapy described in this article, integrates analytic play therapy sessions into family therapy via the narrative metaphor. The child's symbolic processing in a psychoanalytic interviewtaken as narrativeis joined to a therapeutic conversation in family therapy. That is, I am not advocating "play" as a bridging concept between child and family therapy, but play as "narrative,"which attempts to understand each as a form of therapeutic conversation. Seeing both as a hermeneutic or as a narrative process provides one framework for integrating child family therapy theory and practice. HERMENEUTIC-NARRATIVE POSTURE Hermeneutics, as the activity of interpreting, concerns how meaning is constructed through language, discourse, inscription, voice, story, and narrative (Freeman, 1993; Silverman, 1994). It now informs disciplines as diverse as law, economics, biology, psychoanalysis, and psychology, with alternative ways of producing coherence in their subject matters (Nash, 1994). For the hermeneuticist, the world always appears as we interpret it, never as it is. Consequently, the interpretive process, the search for understanding is ongoing. A hermeneutic understanding is one that "always places itself in question," as part of a conversation that "never ends,"and a dialogue in which every word is the beginning of a new question (Gadamer, 1989, p. 95). Hermeneutics has become known to family therapists through the social constructionist approach to psychology and therapy (see McNamee & Gergen, 1992). For example, the traditional concept of "mind" or "self," becomes a construction of social discourse embedded in a particular political-cultural context (Harré & Gillett, 1994). Similarly "knowledge" is not a truth existing exclusively in persons' heads, but a socially interpreted event constructed through relationship and conversation with others (Penn & Frankfurt, 1994). A therapist working hermeneutically with narrative lets the person's story unfold until a coherent theme or new meaning emerges from the dialogue. This is because stories give meaning and direction to our lives, structuring the past into the present in a new description of the future (Bernstein, 1994; Rosenwald & Ochberg, 1992). Personal narratives allow individuals to organize and understand their life experience so as to anticipate and introduce change. According to Anderson and Goolishian (1992), narrative change in therapy is associated with the therapist's "hermeneutic" stance of "not-knowing" in a therapeutic conversation. It is the therapist's curiosity "to know more about what has been said" (p. 29), that is, how a client makes meaning that engages the future or "not-yet-said" narrative. The therapist's role is to open a space for conversation around a "problem" so that new meanings and narratives can emerge. Therapeutic conversation involves a mutual search for understanding, in which therapist and client talk "with," not "to," each other. By suspending the hierarchy of an expert or "knowing" position, the therapist (like the writer) is hermeneutically driven to keep the conversation going and to let the dialogue naturally evolve. Not-Knowing Knowing Nonetheless, a not-knowing, hermeneutic stance in therapy is a powerful knowing at another level (Larner, 1995). Not-knowing is the therapists expertise or way of acting upon the family so as to influence them to find their own meaning in understanding their problem. As Harry Goolishian (1990) stated, to maintain a position of openness and uncertainty in a 2 _____________________________________________________________________________________________________________ therapeutic conversation requires the skill and patience of an experienced therapist. The therapist's not knowing does not mean the dissolution or abandonment of prior knowledge but, rather, its questioning: "By not knowing I do not suggest that I do not know anything, but it refers to what I do with what I knowthat what I know stays in front of me is always open to question, is always tentative" (Anderson, 1994, p. 160). A therapist's "knowing" comes from a variety of sources, including theory, training, clinical and life experience, acquaintance with empirical research, hunches, intuitive leaps, feelings in the session, discussion with colleagues, and so on. All of this informs the therapist's "inner talk," which forms part of the "outer talk" with the child and family (Andersen, 1992). For example, in the midst of conversation with a family concerning a child's detached, rejecting behavior, the therapist may recall recent readings in attachment theory. The therapist could choose to share this "inner talk": that the child's behavior may be an attempt to maintain secure and close family relationships, particularly when recent loss has been experienced (Byng-Hall, 1995). The challenge for the narrative therapist is how to use such knowledge hermeneutically, that is, in a way that enriches the client's understanding rather than closing it off by the imposition of expert opinion.1 The therapist brings knowledge into the therapeutic conversation as a not-knowing, as part of the desire for inquiry, and to understand more. As metaphor or "artistic creation" (Spence, 1982) rather than therapeutic truth, the therapist's knowing contributes to the narrative construction of meaning. The therapist's story about the child is joined to the family narrative in a common diagnosis or understanding of the problem. Here, both therapist and family influence each other in an exchange of information, meaning, and ideas. Seeing therapy as a not-knowing "knowing," or an exchange of understanding, addresses two current issues for family therapists working from the social constructionist model. First, how to fulfill a practical and ethical requirement at the professional level, to provide guidance, knowledge, and expertise while maintaining a "not-knowing," therapeutic conversation. Here the postmodern rhetoric of social construction theory gives way to the setting of family therapy in real life. In therapeutic conversation, for example, therapists cannot avoid positions of power and knowing, and in certain contexts (for example, violence, sexual abuse), ethically should not (Larner, 1995). Second, it allows the child-family narrative therapist to continue to respond to rather than dismiss the family systems therapy tradition, let alone other forms of therapy and knowledge, such as child psychoanalysis. THERAPEUTIC CONVERSATION WITH CHILDREN Therapeutic conversation with children who are in psychological distress requires a suitable context in which their self-narrative can emerge. This recognizes that a "conversation" encompasses not only verbal but also nonverbal, symbolic, and written mediums of expression (Sampson, 1993). In a recent interview, Anderson (1994) noted: "The therapist's expertise is to be in conversation with the expertise of the client" (p. 156). In such a therapeutic conversation, the children's expertise is the ability to tell their story, in their "own words" and from their personal perspective (Schnitzer, 1993). This allows the therapist to make meaning of a family presentation and anticipate a common narrative of growth and change for all concerned. The therapist's expertise is to provide a setting for the child's narrative to emerge, and, as in all psychotherapy, a primary requirement here is engagement and trust. The expertise of children is also their ability to play. As William Blake wrote (ca 1800-1803): "The Child's Toys & the Old Man's Reasons/Are the Fruits of the Two seasons."2 Through play, a therapist's Two seasons communication with a child is made feasible (Winnicott, 1971). The play setting itself conveys the hermeneutic interest of the therapist: a curiosity to know more about how the child constructs the world. The availability of play materials signs the therapist's willingness to talk with children while using their preferred language. With children, the power differential is clear; yet the therapist steps down in hierarchy to the child's level in order to foster an open spirit of play and dialogue. The therapeutic setting is structured so as to provide children with maximum opportunity for personal expression in the telling of their story. The play interview is a safe haven for the child to relate to another person what was previously (unconsciously in terms of psychoanalysis) unfelt, unthought, and unsaid. Thus a dialogic biologic space with children is created not primarily through direct conversation and questioning, as with adults, but by making available opportunities for symbolic expression in play and art. Of course, this has been a basic idea of child psychotherapy since Melanie Klein's development of child psychoanalysis seventy-odd years ago (Segal, 1979). For child analysts, the language of play provided a window in the child's mind, a way of making contact with the inner world of unconscious fantasy and imagination involved in the perception of self and others (Solnit, Cohen, & Neubauer, 1993). However, for the therapist working from a narrative position, the function of play is not to provide material for analysis of internal object relations in the transference relationship. Rather, psychoanalysis becomes more like a kind of storytelling that evolves from the dialogic interaction between teller and listener (Brooks, 1994). The therapist's enterprise is not to interpret the child's inner "mind," but to draw out the story waiting to be told. Play as Narrative 3 _____________________________________________________________________________________________________________ Telling stories as a means of constructing social meaning is embedded in all human cultures and traditions, and it may well be a biological given (Bruner, 1990). With the acquisition of language, children show a readiness to organize their experience in a primitive narrative form. Through stories, children develop a personal voice, expressing their unique way of thinking and feeling about themselves in the world (Engel, 1995). The guiding hypothesis of this article is that children's therapeutic narratives are more likely to emerge through the opportunity of play, which forms the basis for a narrative child therapy. That is, play and art are natural ways for children to construct coherence and meaning, which is the purpose of a narrative. They provide a medium for children to "talk" about their psychological experience, and the possibility of nonverbal and symbolic expression enhances the verbal in a child-focused "dialogic" space. From a narrative perspective, the therapist's invitation to a child "to play" is no more than the posing of the autobiographical request: "Tell me your story." For the child narrative therapist, this hermeneutic defines an inner posture of continual inquiry toward the material presented in a play session. As Anderson and Goolishian (1992) say, "The developing therapeutic narrative is always presenting the therapist with the next question" (p. 3). From this not-knowing position, the therapist's understanding is always developing. Therapy is a constantly creative activity of inquiry nurtured by a sense of play as narrative and narrative as play. Narrative is a playing with the world of experience, a constructing and reconstructing of meaning in language and nonverbal images. Play in therapy is a narrative if only because it takes place in a space created by the atmosphere of the other (Meares, 1992). Narrative play therapy with children amounts to giving them a voice, an opportunity to speak, to tell their version of events around a presenting family problem. Strictly speaking, a child therapist works with fragmented narratives, or bits and pieces of stories about emotionally significant events and people in the child's life. What is relevant is not the "grammar" of narrative (sequence, descriptive realism, characterization, and so forth) associated with adults, but the child's personal statement of a perspective. Narration is "whatever qualifies as a version of a happening or an event or scene of any kind" (Schafer, 1992, p. xiv). By recounting an aspect of their life situation in play and drawing, children put their own meaning and order into events. This can be discussed with the family in therapeutic conversation, with the potential to alter fixed points of view and change the family narrative in general. A Public Play Space The constructing of a narrative is a social process that integrates others (Rudelic, 1993). In the child family therapy described in this article, the child's psychology is located not as a hidden event "inside the mind," but as part of the evolving family narrative in the public space of therapy. The story the child tells to the therapist becomes a social text, joined to family stories that reflect knowledge about and experience of the child in question. Through play, a child brings inner concerns to outer expression (Gavshon, 1989). The child's personal story, expressed in symbolic play and words, becomes in conversation with the family "a visible, audible, public story" (Sampson, 1993, p. 121). Similarly, Penn and Frankfurt (1994) suggest that the public sharing of a person's inner dialogue, by reading aloud letters written during therapy, invites a "single" voice into "conversation with another" (p. 218). This dialogic social event transforms the participants' understanding of each other and brings change in their own emotional lives and personal narratives. Through joint construction with the family of the meaning of the play narrative, the child's narrative voice is maximized in a public act that has social consequences. With a new way of understanding and dialogue possible, symptoms are no longer needed to recount life experience (Greenspan, 1992). NARRATIVE ASSESSMENT PROCESS Assessment as Therapy The goal of assessment is to encourage the development of a narrative, a telling and retelling of events in a way that allows new understanding and meaning to emerge. What traditionally may have been regarded as information leading to a diagnosis and intervention by an expert is instead used to facilitate the child and family in a conversation of understanding. The objective is not to explain but to understand, giving meaning to the child's presenting "problem," weaving it into a pattern that makes sense of events in the life of the family. Neither the therapist nor any family member has a monopoly on the truth. The therapist in particular knows less, adopting a "not-knowing, but curious" stance. The therapist is oriented toward the child's storythe interest is in the child's narrative as it emerges in play, art, drawing, conversation, and interviews with the family. The therapist's stance is both dialogic and curious, more of a listening than an interpreting. The assessment attempts to integrate the child's narrative into the family narrative in a way that resolves a presenting problem. Here, the therapist's own narrative positioning helps the family project themselves into the child's innermost thoughts, fantasies, and feelings as evinced in the child's play. It is this attitude of inquiry that defines both the assessment and therapeutic process, breaking down their traditional distinction. Thus, to assess a child is simply to have a desire to hear his or her story, while therapy concerns fostering this desire in all family members. The therapist models for the family a hermeneutic interest in the child's story, in contrast to a "pathologizing" of the child's problem. This "assessment" stance 4 _____________________________________________________________________________________________________________ as inquiry is itself therapeutic from a narrative perspective. Assessment as therapy becomes no more than the co-construction of meaning and coherence for all concernedthe child, the family, and the therapistin the social process of conversation and discourse. The therapist interested in the child's life story takes in information from all quarters, whether it be the child's words, sand play, and art, the emotional tone of the session, intuitive feelings of the therapist (for example, countertransference), the reports of the family members and teachers, the results of psychological testing, doctor's investigations, and so on. Together with the therapist's readings in theory and research, past clinical experience, and discussion with colleagues, they form the starting point for further questioning and inquiry, to see where the narrative may lead. Such know]edge knowledge contributes to the therapist's meaning-making in conversation with the child and family, but never intrudes as privileged expertise. The therapist's task is not to diagnose the child's problem so much as to help to help build coherence in a story that captures all of the above. The therapist enhances family members' potential to make meaning of the child's behavior in the context of their life situation. Perhaps a general rule of the narrative assessment process is for the therapist to stay with the confusion until the child and family make connections that lead to a clearer, more unified story. Integration in Theory Like family therapy, psychoanalysis can be characterized as a hermeneutic process, which proceeds through language, metaphor, and symbol (Bouchard, 1995). Analysts in general are more flexible in relation to both interpretation and theory, and more willing to listen to the client's story. Thus the child analytic therapist "ventures" interpretations always in the context of the therapeutic relationship, monitors closely her or his own feelings in the session, and approaches therapy as the telling of a life story (Bunster, 1994). That is, contemporary child psychoanalysis is already leaning toward the narrative metaphor. All of this makes dialogue between family therapy and child psycho-analytic psychotherapy feasible, as does the interesting recent movement of systemic therapists toward exploring psycho-analytic ideas in family therapy (for example, Byng-Hall, 1995; Flaskas, 1993; Gibney, 1994). In recent years, child analysts, particularly under the influence of Wilfred Bion, have become hermeneutic in their approach (Alvarez, 1992). As Bion (1970) described the analytic process, the therapist creates a space for thought and meaning to develop in the therapeutic relationship. This depends upon the therapist's ability to "not know" or to be with and contain the child's emotional pain. Like a mother's capacity to experience and be attentive to an infant's emotional distress, therapy involves a process of "containment" of the child's projections. The therapist's main task is to convey understanding to the child (Blake, 1992). Here it is the analyst's not knowing that acts as the container in which the child's story can be received and understood. The therapist "takes in" the child's unconscious symbolic material by resisting the temptation to know or interpret the child's meaning. Similarly in therapeutic conversation, the therapist's not knowing can be seen as a way of containing the family narrative and allowing thought and coherence to grow. That is, in both the child psychoanalytic interview and the therapeutic conversation, it is the hermeneutic process that guides the therapist. Both offer a way of being with clients to help them develop their own knowing.3 The therapist's curiosity and interest to know more about the child/family experience acts as a kind of incubator from which understanding can emerge. From this perspective, the hermeneutic "not-knowing," which occurs in the child psychoanalytic assessment, continues in the therapeutic conversation with the family. That is, the psychoanalytic play assessment, which acts as a container to receive the child's unconscious symbolism, can be integrated in theory with therapeutic conversation in family therapy. At each stage of the child family therapy process, the family problem is contained in a therapeutic space that allows further exploration and understanding of the problem. In both, it is the therapist's hermeneutic stance that provides the context for emotional and narrative coherence to emerge. Integration in Practice The Initial Family Interview The initial interview covers how and why the referral occurred, a detailed description of the problem, a brief family and child developmental history, and what the family expects from therapy. Nonetheless, the interview is structured around the family's understanding of the problem. In other words, therapeutic conversation begins with the initial contact; by asking questions, the therapist begins to elicit the family's knowing or story about the problem. The issue of who attends the initial interview (the whole family, parent(s) and child, one or both parents alone) is negotiated beforehand. I am flexible and generally leave it up to the parent(s). Some parents prefer to see me alone first; others want to come in with just the referred child, and others are open to an initial session with the whole family. While I prefer and may request the latter as a starting point, I do not push the issue. From the point of view of therapeutic conversation, the family narrative can be entered via whole or part-family interviews, with other members invited to participate after the play assessment. 5 _____________________________________________________________________________________________________________ At the end of the initial interview, the option of individual sessions with the referred child is presented to the family, which is called an assessment of the problem from the child's point of view. The purpose of the assessment is explained as a better understanding of the child in relation to the family problem, an opportunity for the child through talking, play, and art to share aspects of his or her life experience, how he or she thinks and feels about self, family, and the world. The child and family are informed that what happens in the assessment will, with the child's permission, be discussed with the family in a later interview. The Play Assessment The play assessment has the potential to expand the family's understanding of the problem by presenting the child's point of view. The verbal (speech), graphic (writing), and nonverbal (play and art) communications of the child contribute to a "deconstructive conversation" (Sykes, 1996) with the family. The reasons for seeing a child individually in a play setting include: a) to provide a private personal space for the child to develop and communicate his or her view of the family problem; b) to facilitate expression of the child's unconscious or unsaid thoughts and feelings; c) to amplify a voice that, apart from its symptomatic expression, may not have been heard in the family; d) to document an alternative version of the problem from its major player; e) to respect the family diagnosis of the child as the problem, while recording a narrative that may challenge this construction; f) to create an atmosphere of flexibility and open inquiry; and g) to stimulate further dialogue about the problem in later therapeutic conversation with the family. The assessment over three (or more) sessions combines a child psychoanalytic play approach with autobiographical drawing and writing tasks. The analytic play setting provides a safe context for the child to contribute his or her own meaning in the assessment. It facilitates the symbolic expression of conscious and unconscious thoughts, fantasies, and feelings. The therapist attempts to join with the child's inner world so that he or she feels an emotional communication has been received and is understood (Blake, 1992). The individual sessions are introduced to the child as a special time to play, paint, draw, and talk. In so many words, I tell the child that our time together over three sessions three sessions is to help me and the family understand why "X" (the problem) is occurring, and that we will discuss this later with the family. At the close of the sessions, I select material that has the potential to expand the meaning of the problem, and ask the child's permission to share this in his or her presence with the family. Generally, children are more than happy to share their stories, art, and play with family members; however, a child's request for certain material to remain confidential is respected. The limits of what can and cannot be shared with the family are explored, including the child's reasons for withholding, such as a fear of parental misunderstanding. While some material may not be shown, it may be possible to use less confidential fragments of the child's story or to obtain permission to convey the story's meaning indirectly. There is little to gain from coercing a child to share a story, especially if it is a different one than what the parents have or have not been told, in which case, the therapist can offer to mediate with the family on the child's behalf. In the assessment, interpretation is used mainly to clarify and expand on the child's meaning in telling a story. The therapist's stance is one of curiosity, expectancy, and patience: to wait and see what the child will say or do in the play. However, as part of the assessment, drawing and writing tasks may be introduced to engage the child in specific dialogue around the family problem. The child is asked to draw a picture and/or write/tell a story about the problem (as he or she and/or a family member sees it) and other aspects of family life. These exercises can be constructed around emerging play themes or in response to the child's spontaneous drawings and conversation. How, when, and whether they are used in the sessions depends upon the therapist's judgment about the child's ability and readiness to communicate in the various mediums. Therapeutic Conversation with Family Initially, the child assessment satisfies most parental requests for a child's problem to be directly addressed. The next step of therapeutic conversation requires the family's cooperation and willingness to engage in dialogue around the problem. As with any therapeutic endeavor, a family's reluctance to participate must be respected by the therapist. Families with a strong belief that the child is the problem may require a more direct form of intervention. This can be negotiated with the family; for example, a fruitful dialogue may be more likely after some behavioral change has occurred. My therapeutic work with children is multifarious with cognitive, behavioral, and strategic/structural approaches offering alternatives to therapeutic conversation when required. Some parents may not want to hear their child's story. They have brought the child to be changed by the therapist. They prefer their own version of events "he is just lazy"; ""she is spoiled"; "he is like his uncle"; "he has A.D.D." While I am wary of colluding with the parents in treating the child as the problem, this may be necessary in the short term in order to allow a wider discussion later. For example, a 7-year-old boy, referred by the family doctor for aggression and lying, was blamed by his parents for "putting great strain on our marriage." After the child's assessment, they requested urgent intervention to change his behavior. Since these parents seemed unwilling to enter into a therapeutic conversation at this time, a home behavior therapy program was suggested. Two months later, after the child's behavior had improved, the parents acknowledged that there were more immediate causes of their marital discord, and 6 _____________________________________________________________________________________________________________ were more willing to listen to their child's point of view. Interventive techniques can form part of a hermeneutic approach to therapy, by seeing them as further ways of developing meaning in therapeutic conversation with the family. Their success or failure can stimulate an ongoing discussion of the meaning of the problem in the family context. In this way, therapy becomes like assessment, a mode of inquiry into what works or has meaning for a family, creating new perspectives on what the problem is or how else it can be defined in the therapeutic narrative. Two Case Illustrations Holly Holly, 6 years of age, was referred by psychiatric services because of her severe tantrums, hysterical sobbing, and numerous threats over the past 18 months to kill herself. In our initial family interview (which included Jiles her brother, 9 years old), the parents told me that Holly became "upset at the drop of a hat" and repeatedly stated: "nobody loves me....I want to kill myself." Holly frequently talked about not wanting to grow up and had been preoccupied with death since the age of 3, often saying, "When I die" or "If I died, you'll be sorry." The father, a high-school teacher, had recently attended in-service training on suicide in adolescents and was very worried about Holly, despite her young age. The mother saw Holly's words and behavior as manipulative, with the whole family "walking on eggshells" so as not to upset her. In our first play session, Holly drew her family, saying "I love mum, I love Dad, I love Jiles, I love Holly." Holly told me her version of events when she gets into trouble with her parents: drawing a picture of herself crying on her bed and thinking of running away to her Grandpas or Aunty and Uncles. The next session, I asked Holly to draw a picture of what mum and dad worry about in relation to her. She immediately replied, "Me, saying I want to die," which she then drew (see Figure 1).4 Fig. 1. Using Holly's drawing, I explored her use of the words "I want to die," teasing out their meaning for her in the story of her life with mum, dad, and Jiles. Did Holly know why she said these words? "I know why but not all of it....They always give me a big smack....I start crying on my bed and I think I want to run away." At what point does Holly think about dying? "When I stop crying a little bit." Does she mean it? "No." What does Holly mean when she says she wants to die? "Sad....crying....When people die they're sad." Holly pointed out that in her picture "They're crying and so is Jiles. Course I said I want to die." I ventured, "Oh, when you say you want to die, you're saying you're sad and want them to be sad for 7 _____________________________________________________________________________________________________________ you." Holly replied, "And they always say, 'Don't give me that rubbish' when I say I want to die." "How do you feel then?" "I want to run away." In the sandpit, as a commentary on this theme, Holly built a huge bonfire of all the cars and trucks that nobody wanted anymore. In the next session, I continued exploring Holly's ideas of death and sadness. She told me that, for her, sadness comes mainly when she is in trouble for being naughty. Then she says things to hurt mum and dad, like "I want to get killed." Holly drew a similar picture to the first one, again with the caption "I want to dii" emanating from herself "I told them I want a kill myself and they're sad." "Do you really mean it or are you just saying it to make them feel sad?" "Just saying it....Course I don't really want to kill myself anymore. I used to when I was three and four, but not anymore." With Holly's permission, I recounted to the family our conversation around her pictures, asking for thoughts and comments in making sense of the narrative. The parents took up Holly's depiction of being smacked in the sequence of events that led to her suicidal threats. They wondered what it meant for her, because smacking was a rare occurrence. It emerged that the word "smack" was Holly's way of describing their anger toward her when she was naughty, just as the words "I want to die" was Holly's registering her anger toward them. We jointly constructed the hypothesis/diagnosis that Holly's suicidal talk was not associated with a serious depression so much as a signal of her anger in a long-standing power struggle with her parents over discipline. While this construction supported the mother's original position, it was agreed (with father) that suicide threats should never be discounted and required vigilance and "talking through" if they continued. The mother now felt that the taboo on talking with Holly about her threats had been broken. They would no longer respond to the words "I want to die" with anger or worry, but would engage Holly in conversation as to what she means by them. The father had noted that, over the previous month, Holly's suicidal talk and tantrums had significantly subsided. On followup 3 months later, the mother reported that Holly's tantrums and her suicidal threats had totally ceased, and both parents were no longer worried for her safety. The Blood Jacqueline came to see me with her son Gregory, a 7-year-old with cystic fibrosis, who had recently been stealing and lying. He was totally uncooperative and so disruptive at his new school, that his teacher was at "wits end." Jacqueline had just moved into the area with her de facto partner of 5 years, begun a new job, and was hoping for a fresh beginning to the narrative called her life. However, because of Gregory, she had "lost the plot." He in turn explained his position as follows: "I've been doing wrong things like stealing and lying....I miss my Dad and I don't like it here....The kids tease me because I've got cystic fibrosis. They saw me taking pills." Gregory's parents separated when he was a toddler, and he wanted to return to his old school and friends in the town where he had had contact with his father every weekend. I arranged to see Gregory for a play assessment. Over three play sessions, Gregory's anger and depression about his life situation emerged. He confessed: "I get so sad my Mum and Dad split up." Drawing himself, he said of his body: "It gets me round, but I worry when I get sick I might die." He painted a big war between an army and some aliens: "So many were killed, the blood ran everywhere, with everyone and everything swept away in its path" (see Figure 2).5 8 _____________________________________________________________________________________________________________ Fig. 2. Gregory asked to share this material only with his mother at this stage, so I met with Jacqueline and showed her his war painting. I always ask parents their interpretation of the child's play material first. She saw the blood as symbolizing his "pain and sadness about us separating, as well as the cystic fibrosis and the insecurity of leaving home." Jacqueline informed me that Gregory had only just today shared his feelings with her saying, "I feel stressed out, sad, and lonely." When I saw Gregory the next week, he said that his mother was now trying to help him feel better. Later that day, Jacqueline rang to say she had asked Gregory what would make his life better. He had replied, "I've been trying to tell you for weeks and weeks how sad I feel, and this is the only thing I can dobe like that at school." Jacqueline told me, "I wasn't tuning in to the level of this despair because of my need to be positive. I didn't want to hear it." A month later, Jacqueline and her partner, Peter, attended with Gregory for three family therapy sessions. In the first, Gregory was willing to share with Peter, who had noted "Jacqueline's resentment toward Gregory." In the second, a major theme was Jacqueline's anger and powerlessness about her son's cystic fibrosis, over which she was still in grief. The medical, hospital, and medication procedures had disrupted their bond in the first 2 years, and reinforced the idea that Gregory was still, "on a lifeline." Over the years, Jacqueline had had to "protect him, to think of him constantly, he always pushed the buttons for me." At this stage, she requested counseling for herself, which was arranged. The next few weeks saw a remarkable change in Gregory's behavior at school and home. For example, he earned a mountain bike by being good at school. In our last session, the whole family seemed more at ease. As Jacqueline herself put it: "I am more relaxed, the load is lightening, and I've been put in touch with a Cystic Fibrosis support group." Jacqueline contacted me 2 1/2 years later, at Gregory's request, for a followup session. She informed me of Gregory's significant improvement in all areas, and the better communication and understanding between them. Their current problem related to Gregory's fears about changing his school to a location nearer his home. As he subsequently put it to me: "I'd have to start all over againmaking friendshaving kids say, 'You take tablets. You've got AIDS'." Nonetheless, Gregory praised his mother's concern for him: "She's just trying to help out. I'm not angry at her." After this session, Jacqueline rang me to report a resolution of their disagreement by way of a compromise. Gregory would stay at his new school for 6 weeks until the end of term; then he could make his own decision to stay or return to his old school. They both came to see me 2 weeks later to inform me there was no need for further counseling. Six months later, Jacqueline reported that Gregory had chosen to stay at his new school where he had made friends and settled in well. His overall progress was very pleasing to her. In these sessions, Gregory's narrative, as expressed in play, was joined to the family narrative in a therapeutic conversation that brought new opportunities for understanding and change in their patterns of communication. 9 _____________________________________________________________________________________________________________ CONCLUSIONS "It is part of the affirmative character of Derrida's thought that nothing is apparently repudiated, written off, dismissed." [Royle, 1995, p. 62] In this article, I have presented psychoanalytic play interviews with children as part of a hermeneutic-narrative approach to family therapy. The child's symbolic play as narrative is joined to the family story as social text in therapeutic conversation. This does not require the rejection of received knowledge and theory, from either the child psychotherapy or family therapy fields, nor a leveling of their differences as genres of therapy. Training in cybernetic systems theory or child psychoanalysis, for example, enriches a narrative therapist's understanding of therapy. This is possible by approaching such disciplines hermeneutically from within, not as objective ways of knowing and intervening, but as kinds of writing and discourse about therapy. Therapy becomes hermeneutic not by expunging a therapist's knowledge, but by transforming it into a dialogue with others. The therapist working from a narrative or social constructionist position need not abandon knowledge and expertise so much as share or exchange it in a mutual dialogue of understanding (Larner, 1995). In other words, therapy takes place deconstructively, in the gap between "knowing" and "not knowing," the beginning of the next question to be asked. From this perspective, the past therapeutic tradition in child and family therapy can be valued, respected, and drawn upon by narrative therapists while subjecting it to hermeneutic inquiry. As Paré (1995) notes, the family systems metaphor is not deconstructed in the sense of being supplanted, but it is "re-visioned." In a similar way, Schafer (1992) illustrates a dialogical account of psychoanalysis. Harré and Gillett (1994) note that, with the recent advent of "discursive" psychology, "It is both remarkable and interesting that the old psychologies continue to exist alongside the new ones. This is a phenomenon that should be of interest to sociologists of science" (p. 2). In the current practice of family therapy, this juxtaposition of the old and the new, the modern and the postmodern, the cybernetic and the narrative, and so on, defines a "both/and" complexity that is para-modern (Larner, 1994). This affirms the value of systemic, narrative, and other frameworks and metaphors for therapy (for example, psychoanalytic, behavioral, cognitive) coexisting in family therapy. The para-modern therapist respects the modern systemic tradition in family therapy while working from a social constructionist or narrative perspective. This is hermeneutic in the sense of enhancing mutual understanding between therapists and tolerance for theoretical difference. It avoids the ideology of saying one approach or framework is better than, more true, or more "post" than another. As in literature, all points of view, even the scientific and empiricist, can be considered part of an ongoing process of human inquiry that never ends. Here the empiricist (research, cybernetic-systems) and narrative aspects of family therapy are not antithetical, because both share a desire to know (from the Latin "scientia")through inquiry via questions. What this suggests is the idea of family therapy as a "hermeneutic science" (see Nash, 1994), in which science is a form of narrative discourse. In general, the recent turn to language, discourse, and narrative in therapy does not have to be against theory and the modern therapeutic tradition; rather, it locates moments of hermeneutic tension in all discourse on therapy. As textuality, therapy requires a paradigm shift (Kuhn, 1962) that paradoxically goes nowhere, and which, like literature, is a celebration of unbounded diversity and difference. REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 Alvarez, A., (1983) Problems in the use of the counter-transference: Getting it across. Journal of Child Psychotherapy, 9, 7-23. Alvarez, A., (1992) Live company, London: Routledge. Andersen, T., (1992) Relationship, language and pre-understanding in the reflecting processes. Australian and New Zealand Journal of Family Therapy, 13, 89-91. Anderson, H., (1994) A philosophic stance, ethics and therapy: An interview with Harlene Anderson by Sophie Holmes. Australian and New Zealand Journal of Family Therapy, 15, 155-161. 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Manuscript received July 5, 1995; Revisions submitted February 6, 1996; Accepted June 25, 1996. 1Possibly, this has always been the case even for the traditional analyst. As Alvarez (1983) notes, interpretations by the therapist must be meaningful to the client, which is more likely when the analyst honestly acknowledges feelings in the countertransference relationship. 2Lines 91-92 from "Auguries of Innocence," one of several poems in the Pickering MS (fair copies of poems from Blake's "Notebook," written during 1800-1803 and purchased by Mr. B.M. Pickering in 1866). The opening quatrain is more well known: "To see a World in a Grain of Sand/And a Heaven in a Wild Flower,/Hold Infinity in the palm of your hand/And Eternity in an hour." 3This is not to cloud over the fundamental differences fundamental differences in theory and technique between psychoanalysis and therapeutic conversation, but merely to explore a hermeneutic process common to both. 4Holly spells "die" as "dii." I have inserted the labels "Jiles" and "Holly." The figures are colored fuschia; the upper streaks are blue; the lower, hunter green. 5The picture is thickly painted: the upper two blobs are black; the rayed object behind them is a mix of yellow and a light-brown-reddish brush residue from the crimson and red-brown lower streaks; the three left blobs atop the lower streaks are black; the three right are cobalt; the lower left, box-like structure is outlined in black. I thank Adele R. Wynne for repairing a portion of this drawing, which had been slightly damaged in shipment. 12