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Retrospective Theses and Dissertations Iowa State University Capstones, Theses and Dissertations 1992 A client-based description of reflecting team-work in family therapy David Norton Brown Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Family, Life Course, and Society Commons, Psychiatric and Mental Health Commons, Psychiatry and Psychology Commons, Social Psychology Commons, and the Student Counseling and Personnel Services Commons Recommended Citation Brown, David Norton, "A client-based description of reflecting team-work in family therapy " (1992). Retrospective Theses and Dissertations. 10098. https://lib.dr.iastate.edu/rtd/10098 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Retrospective Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand corner and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6" x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. University Microfilms international A Bell & Howell information Company 300 North Zeeb Road, Ann Arbor Ml 48106-1346 USA 313 761-4700 800 521-0600 Order Number 9S11478 A client-based description of reflecting team-work in family therapy Brown, David Norton, Ph.D. Iowa State University, 1992 Copyright ©1992 by Brown, David Norton. All rights reserved. UMI 300 N. Zeeb Rd. Ann Arbor, MI 48106 A client­based description of reflecting team­work in family therapy by David Norton Brown A Dissertation Submitted to the Graduate Faculty in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY Department: Human Development and Family Studies Major: Human Development and Family Studies (Marital and Family Therapy) Approved: Signature was redacted for privacy. io^Work Signature was redacted for privacy. epartment Signature was redacted for privacy. For the Graduate College Iowa State University Ames,Iowa 1992 Copyright © David Norton Brown, 1992. All rights reserved. ii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS v INTRODUCTION 1 Purpose of the Study 1 Limitations of the Study 2 Delimitations of the Study 3 Assumptions of the Study 3 Questions Posed by the Study 3 Summary 4 REVIEW OF RELATED LITERATURE Teamwork in Family Therapy Live group supervision in family therapy Peer supervision approaches Supervisory team approaches Team intervention approaches Reflecting Teams Reflecting team theoretical frame 5 5 6 7 11 13 15 16 Qualitative Research in Family Therapy 19 Qualitative research strategies 21 Ethnography Interpersonal process recall Conversational/discourse analysis Summary 21 24 27 29 iii METHOD 30 Informants 30 Therapists, Teams, and Interviewer 30 Procedure 32 Data Collection and Analysis 37 Summary 39 RESULTS 40 Demographic Data 41 Analysis of Qualitative Data 43 Imposed domains Domain; Domain: Domain: Domain: Domain: Domain: Likes About Team in Room Dislikes About Team in Room Changes About Team in Room Likes About Team Behind Mirror Dislikes About Team Behind Mirror Changes About Team Behind Mirror Emergent domains Domain: Domain: Domain: Domain: Domain: Domain: Domain: Different Perspectives Empathy Institutional Resolutions Objectivity Team Characteristics Therapist Characteristics Summary DISCUSSION 43 43 45 47 48 50 51 53 53 55 56 58 59 60 61 63 64 Summary of Results 64 Elaboration of Results 68 Conclusions 74 Recommendations 76 Implications for the Family Therapy Field 78 iv REFERENCES 79 APPENDIX A. INFORMED CONSENT STATEMENT 86 APPENDIX B. PERMISSION TO AUDIOTAPE/VIDEOTAPE FORM 87 APPENDIX C. SUMMARY OF CLIENT COMMENTS 88 V ACKNOWLEDGEMENTS My most sincere thanks go to Dr. Harvey Joanning for his unfailing support and encouragement during my tenure at Iowa State University. My continued studies and work throughout this project would have surely ended without his patience and understanding. I also wish to express my gratitude to the rest of my committee—Dr. Charles Cole, Dr. Linda Enders, Dr. Tahira Hira, and Dr. John Littrell. I must express my indebtedness for their ideas, support and provocative inquiry. My highest praise and thanks go to the two therapists who participated in this study, Pat Koeughan and Alan Demmitt and to the other four team members, Dan Wulff, Sally Bald, Lynn Martin, and Chris Secrest­Mertz. Thanks also go to DeArliss Kjarsten who spent numerous hours transcribing the audiotaped interviews. Special consideration goes to Jeff Lashley, who was my best friend throughout this process, as well as the best man at my wedding. It was through many golf course discussions that both our dissertations took shape and eventually evolved into their current forms. No amount of thanks could ever compare to the unfailing patience, support, and acceptance my parents have extended as they have watched my career unfold. This manuscript represents the culmination of many of their sacrifices that vi have made it possible for me to have the educational opportunity of which they could only dream. Lastly, I would like to express my deepest appreciation and love to my wife, Annette, who went from friend to constant companion to fiancé and to spouse over the months spent on this project. I dedicate this project to her and to the life we will share together. 1 INTRODUCTION Though the practice of teams in family therapy has a strong theoretical and conceptual background, (Andersen, 1987, 1991; Heath, 1982; Papp, 1980; Selvini­Palazzoli, Boscolo, Cecchin, & Prata, 1978), there has been little research examining their actual use. What has been written and discussed is primarily based on the therapist's and/or the supervisor's experience, rather than the client's. This parallels findings by Garfield (1978) and Gurman (1977) who similarly described that what is written about therapy in general is based upon the therapist's, not the client's point­of­view. The present gualitative study is an attempt to shed light on this dilemma. The therapeutic process will also be examined by detailing informant client family descriptions of two different strategies of reflecting team­work. During reflecting team­work,, family therapy team members are allowed to voice their own thoughts and speculations in front of the family and therapist. The therapist and family then later discuss these speculations as team members in turn listen to them. This has become to be known as "reflecting team­work" (Andersen, 1987, 1991b). Purpose of the Study The present study was designed to develop an initial ethnographic account of reflecting team­work as described by the family members that participated in family therapy 2 treatment. As such, this study was a mini­ethnography which did not involve the documentation and analysis of quantitative data, other than for demographic purposes. Rather, this study was limited to a discussion of clients' construction of therapy experience. The study also focused on the usefulness of two distinct strategies of reflecting teams. Results were confined to client descriptions received from early sessions of family therapy, when it is crucial to engage families in the treatment process. This information should help therapists to understand and anticipate how best to facilitate progress, particularly when using a reflecting team strategy. Limitations of the Study Limitations of the study were considered to be the following: 1. The study was confined to examining clients' experience in the very early stages of therapy. Findings, therefore, may not be indicative of therapy occurring in the middle and/or late therapy. 2. Only qualitative data was examined due to the generative nature of the present study. 3. Informant families interviewed in the study were all of Caucasian extraction. Their experiences may not be generalizable to other population groups. 3 Delimitations of the Study For the purposes of the study, the following variables were controlled: 1. The study focused only on client descriptions of early family therapy sessions. 2. Both therapeutic teams included one supervisor and two doctoral students in marriage and family therapy. 3. Only one therapist was involved with each family. Assumptions of the Study The methodology and research design carry with them these assumptions: 1. That informant families experienced team format 1 and team format 2 in different manners. 2. That the design was deliberately subjective and qualitative in nature. 3. The basic nature of this study was to discover new knowledge, rather than to confirm hypotheses. Questions Posed by the Study The present qualitative study was designed to address the following questions: 1. What, from the clients' point of view, was most helpful or what did they like most about working with reflecting teams? 4 2. What, from the clients' point of view, was least helpful or what did they dislike most about working with reflecting teams? 3. What type of reflecting team did client informants prefer and why? 4. What could the reflecting teams have done differently or changed to become more helpful? Summary The purpose and significance of this study for the field of family therapy have been presented in this chapter. A brief review of the literature is presented in the next section, followed by a description of the methodology that was used in this study. Results and conclusions are provided in the last two chapters. 5 REVIEW OF RELATED LITERATURE In the previous chapter, the purpose, limitations, delimitations, assumptions, and questions posed by the study were explained. The following chapter provides a more thorough overview of the characteristics and theoretical underpinnings of team­work in family therapy. À summary of related qualitative research is also included. Team­work in Family Therapy The use of team­work in family therapy has increasingly been used as an effective group supervision and intervention technique (Prest, Darden, & Keller, 1990). Those proponents of systemic, strategic, or brief therapy may typically choose to divide the therapeutic team into two parts: one part (usually one therapist) working with the family and one part observing the family­therapist system behind a one­way mirror. Traditionally, such therapeutic strategies were used to help process the flood of information that develops during the course of family therapy, to provide easy access to live group supervision and consultation, to allow team members to take complementary or supporting roles that highlight intrafamilial differences, to help maintain therapist maneuverability, and to redirect what appears to be a less useful line of questioning (Breunlin & Cade, 1981; Ferrier, 1984; Liddle, 1991; Papp, 1980; Selvini­Palazzoli, Cecchin, Prata, & Boscolo, 1978; Tomm, 1984). 6 À strong characteristic of team­work in family therapy is that it blurs the boundary between supervision and therapy. Typically, team­work involves the presence of a supervisor, a team, a therapist, a client family, and a one­way mirror. This by design, lends itself both to therapeutic intervention and live group supervision. This intentional blending of training and intervention contexts is unique to family therapy (Liddle, 1991). Live group supervision in family therapy Live family therapy supervision generally takes the form of a supervisory team or group observing a therapist and family from behind a mirror or by a closed circuit video monitor. This procedure allows the supervisor to send messages into a room with the therapist and family, which may support or oppose the therapist's stance. In such a manner, the team/group directly participates in the treatment process and is often called on to offer ideas and to help formulate interventions (Birchler, 1975; Liddle, 1991). The use of a one­way mirror in live supervision also establishes a safe haven for trainees to learn observation skills regarding family interactive dynamics. Furthermore, it structurally models appropriate boundaries for the team and family and provides a meta­position from which the team or supervisor can safely describe its view for the family's and therapist's experience (Kassis & Matthews, 1987). 7 Two approaches to live supervision that typically follow the above format are peer supervision and team supervision. The hallmark of each approach is that supervisors or peers are able to observe, consult, interrupt and guide events and interactions in therapy as they happen. Liddle (1991) has described that "some of the most creative extrapolations of live supervision principles and methods have been in the area of peer and team approaches to family therapy supervision" (p. 660). Peer supervision approaches Due to the practical realities of training settings, therapist training and supervision are often done in groups. The typical format of peer supervision is that one therapist presents a case and each group member shares his/her views of the problem and suggestions for treatment. w. w * ^ context. ^ w^ ^^ w ^ * As such, both peer therapists and w * A * w .* 1 ^ V^ ^^ A This model emphasizes opportunities for mutual learning and responsibility because usually there is no leader. The assumption is also that the therapist will take information from the group he/she finds useful ana leave the rest (Allen, 1976; Liddle, 1991; Rabi, Lehr, & Hayner, 1984). Atkinson and Hood (1987) have described the operation of a stuck case clinic that emphasizes peer group influence in the training process. In this setting, the therapist is in charge of the group peer discussion, while the supervisor 8 guides the group process and summarizes the intervention to be given the family. Other peer formats are distinctly consultative in nature. That is, there are no distinct supervisors who are hierarchically superior and take responsibility for the case. Heath (1982) noted that one of the essential features of the family therapy team is its egalitarian organization. He believed that each team member brings in skills and areas of expertise which allow him/her to share equal status. In this context, the therapist is in charge of how to incorporate the peer consulting teams' advice into case management. Such consultative methods are often used by those proponents of the Milan team­work model (Selvini­Palazzoli, Boscolo, Cecchin, & Prata, 1978) and The Brief Therapy Project of the Ackerman Institute (Papp, 1977, 1980). The Selvini group (Selvini­Palazzoli et al., 1978) typically followed a process in which the therapist and client family stayed in one room, while the team observed behind glass in an observation room. This allowed the team to observe and discuss the family situation while the session was ongoing. When the team decided they needed consultation, they knocked on the window or phoned the room to call the therapist to the observation room. The reunited team then criticized, redirected, re­emphasized, or hypothesized before sending the therapist back in to see the family. After the therapist 9 rejoined the family, he or she typically presented the team's comments or prescription to the family, while the team observed the families reaction. After the family left, the team and therapist then joined to discuss the family's reaction to the intervention (Tomm, 1984). One of the basic therapeutic principles used by the Milan Team during their interventions was positive connotation. This referred to the therapist's and team's attempt to qualify all family behavior, including symptomatic behavior as being "good." By doing this, the therapist's and team's opinions became more acceptable to the family and were more likely to be given serious consideration. Positive connotation also countered the family's negativity and linear labeling towards certain behaviors or interaction patterns. Moreover, it helped family members take more responsibility for their actions, as "out­of­control" symptomatic behaviors were viewed as being under voluntary regulation (Tomm, 1984). Green and Herget (1989a, 1989b) described a series of small­sample outcome studies comparing clients receiving Milan style (Selvini­Palazzoli et al., 1978) team consultation with a control group having no access to consultation. Both studies reported clients who participated in team consultation were more likely to achieve their overall treatment goals than clients who received only regular therapy. 10 Green and Kerget (1991) in a later study included a review of client evaluations of team experience. They reported that most of their clients were at least "somewhat satisfied" with the team participation. Over half of their clients similarly gave an unqualified positive endorsement of their team consultation. These authors believed that such an outcome was primarily due to their emphasis on developing positive therapeutic alliances with clients. Green and Herget (1991) also described that during team intervention, clients tended to improve more when their therapists were warmer and more actively structuring. Therapists who were described as showing "positive effective leadership" were noted to be more effective in producing positive therapeutic outcomes. The Brief Therapy Project at the Ackerman Institute used a consultation group to underline the therapist's interventions. Regular messages from this team were sent into the therapist and family regarding how systemic change could come about, what the consequences of change would be, who would be affected by these changes, in what way, and what alternatives were available. These messages could be used to support, confront, confuse, challenge, or provoke the family, with the therapist free to agree or disagree with them (Papp, 1980). 11 Rabi et al. (1984) described a peer consultation team method which combined traditional peer supervision with the team paradigm. These authors defined how a team of three independent therapists joined when one began a new case or became "stuck." Cases were presented to the team for purposes of making or remaking a "systemic hypothesis" and developing a treatment plan. Consultation ended after the team provided the therapist a clear hypothesis and effective direction for treatment. Supervisory team approaches Other authors have focused distinctly on supervisory team techniques, rather than a blend of peer consultation and supervision. Montalvo (1973) and Kare­Mustin (1976) both noted the advantages of direct observation for training. During such supervision, the supervisor actively sent messages into the room to guide the therapist, while the family was assumed to remain neutral to this interaction. This immediate feedback appeared to refine the therapy by improving the therapist's performance during the session. Boscolo and Cecchin (1982) noted they typically used teams of twelve at their training institute to provide beginning therapists an active experience behind and in front of the mirror. The team of twelve was divided into two groups: the therapeutic team (T­team) and the observation team (O­team). The 0­team's job was to observe and comment on the 12 relationship between the T­team and the therapist. The T­team's job was to provide the family with an intervention. Following the session, both teams joined to share observations and hypotheses about the family and the therapeutic supra­ system. Roberts, Matthews, Bodin, Cohen, Lewandowski, Novo, Pumilia, and Willis (1989) have incorporated the previously mentioned Milan Systemic principles with Ericksonian hypnotherapy into a unique team model. Within this format a treatment (T) team intervened directly with families, while an observing (O) team watched the interaction between the T­team and the therapist. The two teams used separate models to help develop a larger systemic picture. Therapist trainees could therefore explore and compare the different perspectives of the two models and team formats. Other supervisors experimented with approaches in which messages were deliberately provided to both the supervisee and the family. Carter (1982) illustrated an approach in which discussion between therapist and supervisor took place directly in front of the family. Similarly, Smith and Kingston (1980) and Barnes and Campbell (1982) described formats in which the supervisor entered the room or was part of the sessions, essentially taking the place of the therapeutic team. 13 Prest, Darden, and Keller (1990) devised a supervision technique using the "reflecting team" approach. To follow this method, the supervisor, supervisee and several therapists met in one room with a one­way mirror, while the reflecting team observed the supervision process. After approximately 45 minutes of supervisory discussion the two groups switched rooms, while the supervision group watched and listened. Following the reflecting team discussion, the two groups joined to process what each had observed. The authors believed this supervisory format permitted supervision to progress in a less threatening manner, provided dramatic feedback regarding the supervisory process, and allowed the supervisee to become "meta" to his or her own process. Whitaker and Keith (1981) also defined a method of using co­therapy teams where two therapists participated jointly in the therapy process. Such a procedure allowed one therapist to be more innovative and use fantasy, while the co­therapist was available to supervise, "rescue" and provide support. Team intervention approaches Other innovations in team­work are more solely used as intervention strategies. Such strategies have included the "Pick­a­Dali Circus" approach in which a team of several persons may be in the same room with the family/therapist system (Landau & Stanton, 1983). Sheinberg (1983) also described an approach in which an argument or debate is 14 enacted among team members, who then present the family a constructed isomorph of the current family dilemma. De Shazer (1982) at the Brief Family Therapy Center in Milwaukee has developed a team approach that used regularly scheduled intra­session breaks. Prior to the breaks, the team behind the mirror discussed therapeutic goals, client behavior and behavioral context, and potential areas for initiating change. At break­time, the team and therapist consulted regarding the intervention the therapist or a team member would deliver to the family. Interventions were structured in such a way that cooperation between client and therapist was promoted. Kassis and Matthews (1987) reported they found it occasionally useful to have the team in the room with the therapist and family, rather than behind the one­way mirror. They believed the in­room team appeared to help create a dialog between the family and the team that increased the team's understanding of the family's world view. Kassis and Matthews also stated that as they used this approach, therapy "became more of a recursive 'dance' between partners rather than a hierarchically ordered set of instructions from the team to the family about how to live" (p. 42). Recently, an approach has been developed where team members simply "reflect" their own thoughts and speculations in front of the family. The therapist and family then later 15 discuss these "reflections" as team members in turn listen to them. This has become to be known as "reflecting team­work" (Andersen, 1987, 1991b). Reflecting Teams The Reflecting Team Model was first developed by Norwegian psychiatrist Tom Andersen and associates at the Tromso University, Institute for Community Medicine. Within Andersen's (1987) model, the team or team members were allowed to "reflect" their own thoughts, speculations, ideas, or hypotheses, while the therapist and family watched. However, team members were not to reflect on things which belonged in other contexts outside the therapist and family conversation and team members were not to use negative connotation (Andersen, 1991a). During the team reflection, the therapist observed reactions to judge if the team "reflections" were being accepted by the family. Following this, the therapist and family continued the session and discussed what they had heard. The goal of this type of intervention was to provide alternative explanations and descriptions to enrich the family's "stuck" perception of the problem they brought to therapy (Andersen, 1991a). 16 One of the most important differences introduced by­ proponents of the reflecting team was to bring the team out from behind the one­way mirror to spontaneously reflect their impressions. avoided. Secret team collaborations were therefore This appeared to help the family hear the team reflections in a more positive frame. It also placed the family on the same hierarchical level as the family as they traded places in being observed and watched (Lussardi & Miller, 1991). Lussardi and Miller (1991) made use of the reflecting team approach in their work treating adolescent substance abusers. These authors found the reflecting team especially valuable in working with families where issues of control and secrecy were dominant. The reflecting team method also helped to broaden familial discussion of difficult histories of involvement with larger professional systems. Reflecting team theoretical frame Watzlawick, Weakland, and Fisch (1974) explained that a system that is "stuck" still contains too many samenesses and too few differences. Team reflections, as Gregory Bateson noted, provide the family new versions or "news of difference" regarding their dilemma and would help the stuck family system to move away from too many samenesses (Andersen, 1987). 17 Bateson (1979) believed team collaboration could ideally mirror stochastic processes of interaction, selection and consolidation in evolving systems. That is, the therapist/ team could provide complementary descriptions or prescriptions to the family regarding the family's ongoing systemic pattern. In this manner, the family encounters its own "absurd" symptomatic enactments, thus helping the family to evolve to a non­symptomatic pattern. Other authors have similarly noted that feedback from multi­cameral views, such as from a team, is a major contributor to the development of a richer, more complex product (Boscolo & Cecchin, 1982; de Shazer, 1982). Such notions of multi­cameral views within reflecting team­work are strongly associated with the principles of second order cybernetics, especially with the works of Gregory Bateson (1972, 1977) and Huiaberto Maturana and Francisco Varela (1980). Bateson, Maturana, and Varela would each agree that it is the "observer" who generates the distinctions called "reality." Andersen (1987) wrote: One's picture of or knowledge about the world will be the basis for ones attitude to it. Because persons experiencing the same world 'out there' make different pictures of it, problems will arise when they debate which picture is right: either mine or yours­ (p. 416) Bateson (1972) explained that several individuals in dialogue/debate create a "multiverse" of realities. Maturana and Varela (1980) similarly took the position that every human 18 action takes place in language, and that every act in language brings forth a world created with another. Therefore, individuals create the objects of our world with and through language. Anderson and Goolishian (1988) described the therapeutic process as a mutual search and exploration through dialog or conversation. In a dialog, such as a therapeutic conversation, ideas and information are exchanged and new "realities" evolve regarding presenting problems and issues. Change thus occurs as meanings change in this dialog. These authors believed that if therapeutic conversations did not exist, problem descriptions and meanings would also not change. The reflecting team and their clients, therefore develop ideas and new meanings together. In doing this, they are in therapeutic conversation, actively collaborating with each other and participating in the development of new descriptions, understandings, and narratives which dis­solve problems. These conversations also enhance the opportunity for problem­defining and therapy then becomes a shifting, revising and collaborative process, rather than a diagnostic, competitive struggle (Anderson & Goolishian, 1988). 19 Qualitative Research in Family Therapy Recently, there has been a push for a new research methodology that is consistent with the cybernetic underpinnings of family therapy (Atkinson, Heath, & Chenail, 1991; Keeney & Morris, 1985; Newfield, Kuehl, Joanning & Quinn, 1991; Tomm, 1983), and that there is a need for a research paradigm unique to family therapy. Moreover, there is a growing awareness that while traditional quantitative research is suitable for testing hypotheses, it is not very useful in the "discovery" of relationships between variables (Piercy & Sprenkle, 1991). Koshmand (1989) has suggested qualitative methodology may provide the partial answer to this call for methodological consistency. Moon, Dillon and Sprenkle (1990) in describing qualitative research wrote that qualitative researchers: attempt to understand the meaning of naturally occurring complex events and actions, and interactions in context, from the point of view of the participants involved. These researchers look for universal principles by examining a small number of cases intensively. Further they are concerned with holistic understanding of phenomena, (p. 358) Taylor and Bogdan (1984) similarly noted that qualitative research is rooted in the phenomenological paradigm which holds that reality is socially constructed through individual or collective definitions of the situation. These authors believed qualitative research was more involved in the understanding of the social phenomenon from the "actors'" 20 perspective, rather than seeking to explain the causes of changes in social facts through objective measurement. Validity, from the qualitative perspective, is not a matter of accurately representing or matching an explanation to the "real world," but more of telling a convincing story with a well­written and credible report (Moon, Dillon, & Sprenkle, 1990; Smith & Heshusius, 1986). Firestone (1987) also wrote: the quantitative study must convince the reader that procedures have been followed faithfully because very little concrete description of what anyone does is provided. The qualitative study provides the reader with a depiction in enough detail to show that the author's conclusions 'make sense.' (p. 19) However, despite the call for client/actor participation in the research process, most of what is discussed and written about a client/s experience of therapy is derived from the non­participant perceptions and impressions of therapists, researchers, and theoreticians, rather than the actual client (Gurman, 1977; Kruger, 1986; Newfield, Joanning, Kuehl, & Quinn, 1991). Gurman (1977) noted that most researchers' clinical decision for using nonparticipant observer's ratings were biased by Truax's (Truax & Carkuff, 1967) position. Truax believed that simply by the virtue of their patienthood status, patients were unable to perceive accurately the nuances and affective qualities of interpersonal relationships. 21 The above notion obviously concurred with the unspoken assumption that nearly all psychotherapeutic approaches and research thereof involved the therapist administering treatment and the client passively and willfully accepting it (Kruger, 1986). In contrast, the constructivist­based cybernetic orientation posits that: feedback from the client subsystem to the larger therapeutic subsystem is fundamental and necessary for the overall therapeutic system to establish and effectively accomplish mutual goals. A qualitative ethnographic investigation into the client's experience and perception of therapy can challenge the way the therapist thinks about and implements interventions. (Newfield, Joanning, Kuehl & Quinn, 1991, pp. 279­280) Qualitative Research Strategies While the quantitative researcher typically employs objective experimental or correlational designs to reduce error and bias, the prototypal qualitative research design is the ethnography (Dobbert, 1989; Firestone, 1987). However, other strategies designed to provide qualitative descriptions of interpersonal processes, such as psychotherapy, may include interpersonal process recall and conversational analysis (Gale & Newfield, 1992). Ethnography Leininger (1985) has described ethnography as the process of observing, describing, detailing, documenting, and analyzing the patterns of a culture or subculture in order to understand the life of people in a familiar environment. Malinowski (1961, first 22 printing in 1922) stated the goal of such an ethnography is to "grasp the native's point of view, his relationship to life, to realize his visions of the world." Leininger (1985) identified two types of useful ethnographies: the maxi­ethnography and the mini­ethnography. A maxi­ethnography was described as a large comprehensive study of general and particular features of a designated culture. Such an ethnography demands that the researcher has some background knowledge of the people being studied, as well as the meaning of specific cultural social structure features. This type of ethnography may take years and often involves numerous ethnographers (Spradley, 1980). A mini­ethnography was defined as a small scale ethnography that focuses on a specific area or social situation for inquiry. This type of ethnography requires less cultural knowledge and takes less time, but still attends to the general life ways of people living in specific environments (Leininger, 1985). Napier and Whitaker (1978) are noted to have come close to writing an ethnography of family therapy. However, this work was notably from the perspective of the therapist(s). Keeney and Ross (1985) have similarly written an ethnography of how therapists conceptualize therapy. These authors also do not provide information regarding client conceptualization of therapy. 23 Researchers of family therapy such as Newfield, Kuehl, Joanning, and Quinn (1990) have found the mini­ ethnography an appropriate format to attempt to understand the client's perception of therapy. They noted there was little consistency regarding the ways clients and family therapists conceptualized their expectations of therapy. The authors also found there were differences of opinion within the family about how to approach the problem of a drug­ using adolescent in the family. Newfield et al. (1990) also remarked that at least for some of their clients, too many intrusions from the team behind the mirror led to an unfavorable therapy experience. Kuehl, Newfield, and Joanning (1990) described another mini­ethnographic study of client­based description of structural/strategic family therapy. They reported that client families felt the team was a "necessary evil," since the team was intrusive, but helped to keep the therapy on track. The families also appeared to treat the team's opinion as secondary to the therapist's, since the therapist was the one who had the "personal relationship" with the family. Kuehl et al. (1990) also wrote that some lack of success in therapy depended upon the families perception of the therapist, specifically if "family members did not perceive that the therapist was caring and that he was genuinely interested in them as unique people" (p. 318). 24 Interpersonal process recall Interpersonal Process Recall (IPR) is an interview procedure that has a long history as a method of studying psychotherapy process. Researchers using IPR typically videotape therapy sessions that are immediately played back for the informant client(s) following the session. The informantes) are asked to remember and describe any momentary experiences and perceptions associated with particular events during the therapy session (Elliot, 1986). This procedure assists clients in retrieving memory traces that may have otherwise been lost. Memories are more readily activated and are noticeably more vivid immediately following the session. IPR also slows down the therapeutic interaction by allowing the client(s) to stop the tape to describe what he/she is experiencing at a specific moment in therapy (Elliot, 1986). The IPR researcher also attempts to induce clients to recall pertinent experiences and perceptions they were having at a particular instant in time. carried out to help clients feel safe. IPR is also The client informants are given as much control as possible over the recall process, helping them to be far more open with the researcher than they were during the session being reviewed. In this manner, IPR allows the researcher to gather information on the moment­to­moment perceptions, intentions, and subjective 25 impressions that are lost in transcripts and videotapes of the therapeutic process (Elliot, 1986). Kagan, Krathwohl, and Miller (1963) described one of the first case studies of a counselor­client interview using IPR. These authors concluded that IPR permitted the breakdown of interpersonal defenses as clients were able to feel removed from the image of themselves on the television screen. The clients were then able to reveal at length the meanings of subtle or semi­conscious behaviors they produced during the therapy session. It was thought such informant data could be used to accelerate the process of psychotherapy and to help researchers gain insight into various other interpersonal situations. Kagan (1980) also used IPR as a training method for student therapists. An IPR tool was fashioned to provide client feedback and to afford the student additional training in clinical interviewing. During this training, students were required to perform the function of interviewer with another student's client. Thus, students had the opportunity to try out new clinical interviewing skills with the help of the videotape. After the students switched roles, they agreed to exchange notes, to listen to audiotapes of their partners recall, or to observe their clients recall from behind a one­way mirror. Kagan noted that from this experience, students learned they could be both confrontive and 26 supportive. They also could experience how their clients reacted to them and which of their behaviors clients found helpful and which they did not. Elliot (1985) used IPR in obtaining volunteer student's descriptions of helpful and nonhelpful events in brief counseling sessions. In this study, clients were asked to describe what it was about certain therapy events that helped or hindered the counseling process. Elliot reported two primary cluster of events which students described as helpful: events in which the counselor provided the student with some form of new information which increased the students insight and events in which the counselor showed understanding or was sympathetic to the student's situation. Two primary clusters of events were also described as nonhelpful. These were misperception events and negative counselor reactions. Misperception events were characterized by students feeling inaccurately perceived, while negative counselor reactions were noted as events in which the counselor was uninvolved or critical. In a study using a similar approach, Rennie (1992) obtained clients' tape­replay­assisted recollections of an entire hour of therapy­ Clients were asked to pay attention to anything of significance or interest they recalled experiencing during the videotape review. One of the strongest finding from this study was that clients were very 27 reluctant to voice discontent about their therapy and frequently deferred to the therapist. Participants also reportea that even when the therapist invited them to discuss their discomfort with the therapeutic relationship they still deferred to the therapist. The author suggested that in a tenuous therapeutic alliance issues of trust must be dealt with before intervention can be addressed. Conversational/discourse analysis Conversational analysis is a qualitative method of analysis that describes how language is used by speakers to achieve a particular result. From this perspective, understanding is achieved through the describing of patterns of conversational interaction in their naturally occurring contexts (Gale & Newfield, 1992). Gumperz (1982) also believed that discourse analysis, in particular the microanalysis of taped, transcribed conversation, could be especially helpful in understanding the meaning that speakers and hearers perceive through language in interaction. Being qualitative in form, conversational analysis is discovery oriented, context sensitive, and focused on patterns of interaction, rather than the inner state of participants. Categories of description emerge from an analysis of the texted conversation, rather than being imposed a priori. Conversational analysis also examines the qualitative 28 paralinguistic features of talk as well as the structural sequencing of the various turn­takings in conversation (Gale & Newfield, 1992). Gale and Newfield (1992) examined a one­session solution­focused marital therapy case conducted by Bill O'Hanlon using conversational analysis. From the examination of communication between the therapist and a marital couple, nine categories of linguistic strategies used by Bill O'Hanlon to create new "therapeutic realities" were described. This study, however, did not specifically present the perspectives of the participant clients, rather it provided a description of how the rhetoric of therapy was used to help clients to interact differently. This study also indicated that the therapy context sets up an unequal, hierarchical relationship between therapists and clients. Other discourse analyses similarly assumed unequal, hierarchical relationships in examining client resistance. Labov and Fanshel (1977) described in detail a therapeutic interview between a highly experienced psychoanalytically trained social worker and a 19 year­old client. Based upon the analysis of five therapeutic interviews, and in accordance with the therapist's theoretical frame, the authors reported that client emotions originating from early family relationships were usually masked by a variety of social and psychological mechanisms and were not always recognized by the 29 client. The authors further concluded that "if the patient could express simply and clearly what she felt and could give a perfectly accurate view of her relations with others, the therapist's problems would be simple" (p. 334). Researchers employing conversational analysis in medical settings (Chenail, 1991; Tannen & Wallet, 1986) have also described the degree to which unequal roles exist in patient­doctor interactions and the impact this inequality has on the structure of talk and the consequences for services. Fisher (1984) explained that because patients are perceived as sometimes being difficult, irresponsible, forgetful or unable to understand complex explanations, critical gaps and misunderstandings occur in doctor/patient communication. Such difficulties had detrimental effects on patient compliance, response to therapy, and the satisfaction with care (Waitzkin & Stoeckle, 1976). Fisher (1984) suggested that a collaborative dialogue in which voices speak more equally may serve to increase patient satisfaction by helping them take more control of their medical care. Summary A brief review of the literature related to this study has been presented in this chapter. The participants in, procedures, and method of data analysis are conveyed in the following chapter. 30 METHOD This chapter delineates the informants, therapists, team members, and interviewer who participated in the present study. The procedure used and the method of data analysis are also described. Informants The informants (i.e., family members participating in therapy) were client families being seen at the Iowa State University Family Therapy Clinic in Ames, Iowa. The informants were selected opportunistically, a method traditionally used in anthropological field­work. More specifically, the researcher selected whatever informants were available and rewarded him with information relevant to the topic of inquiry (Honigmann, 1970). The sample consisted of eight client families, as that number appeared to reach a saturation point. That is, after sampling eight families, no new information was being provided by the informants. Informant families were residents of Ames, Iowa and of the surrounding central Iowa area. Each family must have participated in at least three therapy sessions to be involved with the study. Therapists, Teams, and Interviewer The therapists involved in the study were one male and one female doctoral student in marriage and family therapy at 31 Iowa State University. One therapist had five years of experience in treating families, while the other had ten years. The average length of experience in treating families for therapists was 7.5 years. The Iowa State University Family Therapy Doctoral Program has been accredited by the Commission on Accreditation for Marriage and Family Therapy Education, a division of the American Association for Marriage and Family Therapy (AAMFT). All sessions were supervised by a member of the Clinical Faculty at Iowa State University. Approved Supervisors. the study. Faculty members were AAMFT Two male supervisors participated in The present study was conducted with the permission of the Human Subjects Review Committee of the Graduate School at Iowa State University. Two distinct teams participated in this study. To provide a gender balance with the male supervisors, one team consisted of two female doctoral students in marriage and family therapy. The other team included both a male and a female doctoral student in marriage and family therapy. The six family therapists who participated as team members had an overall average of 12.17 years of experience in treating families. The minimum length of experience for team members was 3 years, while the maximum length was 25 years. The team size of three within the present study is consistent with that noted by Andersen (1991b), who suggested 32 that a reflecting team could consist of up to three to four members. Breunlin and Cade (1981) have also suggested that an effective team should contain one therapist and three observers. Debriefing interviews were conducted by the primary investigator who is a doctoral candidate in marriage and family therapy at Iowa State University. The primary investigator, however, did not serve as a therapist or team member during the process of this study. Procedure Two distinct team formats were employed in the present study. Team Format 1 entailed the family observing the team/therapist consultation through a one­way mirror. Format 2 allowed the family to experience the reflecting team/ therapist consultation while the family and team were in the same room, similarly to that as described by Landau and Stanton (1983). To ensure exposure to both reflecting team formats, half of the families experienced Format 1 in the second session and team Format 2 in the third session, while the other half encountered team Format 2 in the second session and Format 1 in the third session. To remain consistent to the approach described by Andersen (1991b), it was required that during each consultation, team members talk to each other about his or her ideas and questions about the presenting issue(s), while the 33 therapist and family simply listened in. Team members were also required to only provide speculative reflections that were positively connoted and to avoid providing opinions and advice. Moreover, to increase the chances of providing the greatest variety of team feedback during the consultation, team members were required to not confer with each other while the session was in progress. The consultation was suggested to last from 5 to 10 minutes. After the team finished its reflections, the therapist and family talked to each other about the ideas they heard while they were listening to the team. Families involved in format 2, in which the team was present in the room, also had the opportunity to hear second consultations if they requested it. Team members present in the room were asked to avoid eye­contact with the family and to speak amongst themselves during the consultation. This procedure was required since team members looking at the family would analogically invite family members to take part in the reflecting discussion (Andersen, 1991b). Session 1 was primarily used as an intake session. During this session informant families were asked to fill out release of information, permission to audiotape/videotape, client agreement, client information and informed consent forms. Families were informed of the potential risks and benefits of their participation as noted within the informed 34 consent form. Four families declined to participate. Three declined to complete treatment following the first session because of concerns about the team and being videotaped. Another chose to withdraw following a psychiatric hospitalization during the initial stages of treatment. These families were thanked and not considered for the study. Families were also apprized that if they desired, a brief summary of the purposes, results, and implications of the study would be sent to them. The informed consent and permission to audiotape/videotape forms were also used with the permission of the Human Subjects Review Committee of the Graduate School at Iowa State University (see Appendices A and B). Each informant family member above the age of 12 was also asked to fill out the Family Adaptability and Cohesion Evaluation Scale III (FACES­III) (Olson, Portner, & Lavee, 1985). All individuals, couples and families are typically requested to fill out FACES­III as a part of Iowa State University Family Therapy Clinic protocol. Information from FACES III was used to help describe the informant family sample. FACES­III is the latest in a series of family adaptability and cohesion self­report scales developed by Olson and his colleagues to test the Circumplex Model of Family Functioning (Olson, 1986; Olson, Portner, & Lavee, 35 1985). FACES­III consists of 20 items which are responded to twice by each family member, first indicating how he/she sees the family now and how he/she would like the family to be. FACES­III questionnaires were scored by the primary investigator directly on the family member's answer sheet. Internal consistency reliability was reported to be .77 for the 10­item Cohesion scale, .62 for the 10­item adaptability scale, and .68 for the total FACES­III (Olson, Portner, & Lavee, 1985). Videotaped segments of informant family conversation during the second session were also rated by the primary investigator using the Clinical Rating Scale for the Circumplex Model of Marital and Family Systems (Olson, 1988). To provide a more comprehensive description of the informant families, observational scores from the Clinical Rating Scale were used to supplement the self­report FACES­III ratings. Inter­rater reliability for the Clinical Rating Scale has been found to be .88 for the cohesion dimension, .84 for the adaptability dimension, and .92 for the communication dimension (Olson, 1988). In order to maintain consistency in the therapeutic relationship, each family had the same therapist, supervisor, and team personnel for each of the three required sessions. This required that team and supervisory personnel be familiar with both intervention strategies. Prior to each session. 35 each therapist, team and supervisor were briefed on the reflecting team format to be used. To reduce team and supervisor effects, each team worked with an equal number of families experiencing the two sequences of the two team formats. Debriefing interviews lasting approximately 15 to 30 minutes took place immediately following the second and third sessions. This provided the researcher access to the families' immediate experience of each reflecting team format. The debriefing interviews began with the following introduction, "In order to improve our services for you and for other families who visit our clinic, we are interested in your experience of the what happened in the previous hour. We therefore would like to ask you a number of questions regarding this experience." With verbal permission being given by each family member present, the investigator started the interviews with the following questions: 1. How would you describe your experience of team consultation during the past hour? 2. What did you like about this approach? 3. What did you dislike about this approach? 4. If you could change how the team process worked, how would you do so? 37 Following the third session, after the participating families had been exposed to both reflecting team formats, they were also asked: 5. Which of the team consultation formats did you prefer, and why? Data Collection and Analysis The interviews were conducted and then subjected to domain analysis as specified by the Developmental Research Sequence (ORS) of Spradley (1979), The goal of domain analysis is to discern how people classify or categorize their experiences through the terminology they use to talk about it (Sturtevant, 1972). To do this, Spradley (1979) developed an analytic procedure that examined and defined cover terms, included terms, and semantic relationships within transcribed ethnographic data. Cover terms were defined as names of cultural domains, with a domain being a symbolic category that includes other categories. For example, within the present study, a cover term defined was "Empathy." Included terms are names for all smaller categories encompassed within the domain. Examples of included terms were "in touch with my experience," "related to our situation well," and "could understand my situation." Semantic relationships simply link included terms with their respective cover term. Therefore, the informants described 38 that the team's being in touch with their experience, and relating to and understanding their situation were forms of empathy. Terminology used by the informant families within the present study was thus analyzed by establishing a hierarchy of levels similar to the one described above. Each key word or phrase used by the informants was recorded at one level as an included term or characteristic comment. These characteristic comments were then listed under only one cover term at the next highest level. The results were domains of meanings based upon the clients' terminology of their description of reflecting team­work. In order to elicit as much information as possible from the informants, moderately structured, open­ended questions were primarily used. Responses to these questions were expanded upon by the interviewer through the asking for examples, elaborations, and clarification. This cycle of questioning and answering continued until the informant family had nothing more to tell the interviewer. Audiotapes of these interviews were transcribed into text in preparation for domain analysis. Prior to the analysis, the investigator reviewed videotapes of the interviews to clarify and validate the transcript data. The interviewer then examined the basic transcribed text with no attempt being made at analysis. 39 During the second level of analysis, the researcher reread the transcript and highlighted characteristic comments or phrases. The interviewer noted characteristic words such as "understanding" and "empathy," and phrases such as "the team was knowledgeable" or "I was ill at ease with the team in the room" which dramatized the informants' experiences of reflecting team­work. The next level entailed clustering these key words and phrases together into related clusters across families to form cover terms that defined domains of meaning common to all informant families. Summary This chapter presented a general overview of the present study. The informants, therapists, team members, and interviewer participating in this study were described. collection and method of analysis were also outlined. Data The following chapters include the results of the study and a discussion of these findings. Conclusions, recommendations and implications for the family therapy field are also enclosed. 40 RESULTS The present study was designed to develop an initial ethnographic account of reflecting team­work as described by family members that participated in family therapy treatment. As such, this study was a mini­ethnography which did not involve the documentation and analysis of quantitative data, other than for demographic purposes. Rather, qualitative data were collected from transcripts of moderately structured ethnographic interviews which immediately followed the second and third sessions from eight cases. Transcribed interviews were subject to domain analysis as specified by the Developmental Research Sequence (DRS) of Spradley (1979). Interviews for the present study targeted specific domains regarding what client informants liked and disliked about the reflecting team process in the room and behind the one­way mirror. A domain of suggestions for change was also targeted for both reflecting team formats. During the interviews, seven domains also emerged from tangential client discussions. These domains included different perspectives, empathy, objectivity, therapist characteristics, team characteristics, institutional, and resolutions. The analysis of collected data is presented in two parts. The first part reviews demographic data from the client informant sample. The second reports the analysis of qualitative data as developed from the respective domain 41 analyses. An overview is provided of the primary imposed and emergent domains. A delineation of characteristic comments and a brief elaborative discussion of each domain is also included. A more thorough discussion of the domain analysis will follow in the next chapter. This format is intended to provide readers an overall impression of each domain. It also should expose readers to the range of key words, phrases and included terms used by client families in describing their experience of the two reflecting team formats. Demographic Data The eight families involved in this study included two single­parent mothers, one with an adolescent daughter and one with three preschool aged children (who did not participate in this project), a pre­marital couple, two marital couples, a single male, a blended family including a father, a step­ mother and adolescent son, and a married female seeking individual therapy. extraction. Each participant was of Caucasian The age range for the sample was from 15 to 52 years of age with an average age of 31.8 years of age. Of the 14 participants who were interviewed, nine (65%) were Protestant, two (14%) were Catholic, and three (21%) voiced no religious preference. It was also noted that one (7%) sample member possessed a graduate degree, five (37%) were college graduates, two (14%) had some college experience. 42 four (28%) completed high school, and two (14%) had yet to complete high school (these were the two adolescent participants). One (7%) of the 14 client informants responded that their yearly family income before taxes was between $00 and $9999, five (36%) reported a yearly family income between $10000 and $19999, three (21%) proclaimed a family income between $20000 and $29999, and five (36%) responded with a family income between $40000 and $49999 per year. Individual FACES­III measures indicated that three (22%) of the 14 sample members presently described their family or marital relationship as Flexibly/Disengaged. Another three (22%) presently described their family as Structurally/ Disengaged, while two (14%) were Structurally/Separated. One (7%) person noted her current relationship was Flexibly/ Enmeshed, one (7%) was Rigidly/Disengaged, one (7%) indicated her marital relationship was Chaotically/Separated, one (7%) described her family as Chaotically/Connected, and one person (7%) did not fill out the scale. The one single individual (7%) within the sample described his family­of­origin as Rigidly/Disengaged. Using the Clinical Rating Scale (CRS) overall family measures were determined for those families including more than one individual. Of those five families with more than one member, one (20%) was rated as Flexibly/Disengaged, one (20%) were noted as Flexibly/Connected, one (20%) was 43 Chaotically/Separated, one (20%) was defined as Structurally/Disengaged, and one (20%) was Flexibly/Separated. It is expected the reader will be struck by the overall randomness of the present sample. data were available. Due to this, no inferential However, as this study was designed to be an exploratory ethnographic account of clients' impressions of reflecting team­work no quantitative inferential assumptions were presumed from the outset of the study. Analysis of Qualitative Data A total of 13 domains of meaning were derived from the 16 audiotaped interviews from families who experienced two reflecting team formats. Six imposed domains were defined, while seven domains emerged from informant tangential discussions. Imposed domains Domains which were imposed by the moderately structured interview format included: Likes About Team In Room, Dislikes About Team In Room, Changes About Team In Room, Likes About Team Behind Mirror, Dislikes About Team Behind Mirror, and Changes About Team Behind Mirror. Domain: Likes About Team in Room This domain includes those characteristic descriptions of what family members liked or found helpful about the in­room reflecting team. A narrative elaboration is also included. 44 Characteristics of Likes about Team in Room We didn't have to get up and move; I could keep track of them; it wasn't like I was in a fishbowl; I liked the more and sooner feedback; I assumed I would get more feedback; I would prefer that I can see them; it seemed more intimate to me; you could see if they were looking or laughing at what we said; were able to make more comments and hear what they said; I had a chance to make a rebuttal; it was nice to see the people; it gives you more of the one­on­one; it helped that they were making an effort not to make eye­contact; they listened well; they were very well focused; with them behind me, I didn't have to dwell on concentrating on where they were; good idea to look away then you don't feel they're trying to judge you. Elaboration The above domain was the most pronounced of the six imposed domains. Many family members described they preferred having the team in the room since they could observe team members' facial expressions, could observe if team members were actually listening, and could visually know who and where the team was. It appeared having the team in the room also helped to provide a more intimate, one­on­one setting in which the family was not distracted by guessing where the team was, what the team was doing, or who was watching from behind the one­way mirror. Another strong preference for having the team in the room was that most families felt they received more feedback. 45 They especially remarked they had more of a chance to make rebuttals and had a greater opportunity to make comments and receive additional information from team members. One female informant simply assumed she would receive more feedback since the team was in the room. As previously described, the design of the study was such that the in­room team had the flexibility to reflect on more than one occasion. It was obvious the families appreciated this opportunity. Other comments referred to the non­obtrusive "fly­on­the­wall" stance of team members. Families members voiced they felt less judged when the team avoided eye­contact. They also noted the team was more focused and better able to listen to their conversations when team members looked away. Domain: Dislikes About Team in Room This domain includes those characteristic descriptions of what family members disliked or did not find helpful about the in­room reflecting team. A descriptive elaboration is also included. Characteristics of Dislikes About Team in Room 111 at ease with four strangers; little uncomfortable having more people in here; dislike having extra people; I'm more hesitant with them in the room; feeling self­conscious; worry 46 about other people being judgmental; its easier to talk to one person; they were kind of distracting in back of me; I'm more aware of them; it threw off my concentration; I felt like I had to acknowledge or talk to each one of them; I felt like someone was behind the mirror anyway; they're conscious they're in the room; they weren't quite as objective; they were more guarded; they wouldn't have been as candid; it was weird and unnatural with them trying to be unnoticeable. Elaboration The primary focus of this domain was that informant family members were simply ill at ease with the presence of "strangers," especially during the initial stages of therapy. Family members voiced they were self conscious with the team in the room since they believed team members might be judgmental. They also felt the team was distracting and threw off their concentration. Other family members reported they were uncomfortable since they felt they had to acknowledge the team in some way, though the team was avoiding direct contact. One family member described how he was uncomfortable since he believed there were others behind the mirror, even though the team was in the room. Another important dimension that came from informant descriptions was that they reported in­room team feedback was less objective than team feedback from behind the mirror. Clients felt the in­room team was uncomfortable, more guarded, and less candid. Follow­up discussions with the team 47 appeared to confirm this description as team members voiced they were more comfortable and relaxed behind the mirror. Domain: Changes About Team in Room This domain includes those characteristic descriptions of what family members would like to change about the in­room reflecting team. A related elaboration is also included. Characteristics of Changes About Team in Room Prefer it with just the therapist in the room; I would have the team listen a few more times; a couple of follow­ups; I would have liked more feedback; have the group together and get into a discussion; have a group conversation; I want to interact with the team; it would be good to interact with the team directly; have them all involved; I would like to ask them questions; I wish the they would have turned to talk to us; disappointed they didn't join us; I would prefer that they face us; I don't like to play games with mirrors and cameras; if there was a little mors room for them to be farther away; could you draw a curtain to separate them (the team from the family); don't want the team to look if it dampens their observations. Elaboration The change family members most desired was to increase their interaction with the team. Informants asked if they could directly ask the team questions 48 or if the team could have provided more feedback. Others went as far to say they would like a group discussion in which team members joined the therapist and family to participate in the clinical interview. Andersen (1991b), however, cautioned that only one person should act as an interviewer, since in his experience "two interviewers most probably make two interviews, which can be hard for the attending client(s) to follow" (p. 45) . Some family members simply desired the team to face them. One informant appreciated that the use of a one­way mirror and microphones were out in the open and not hidden, since he felt that would be "playing games." He also stated he would appreciate the team making eye­contact and talking directly to him, rather than having their backs turned. Conversely, some family members suggested that more "concrete" boundaries be provided between the team and therapist/family subsystems. One person wanted a bigger room so the team could be farther away from the therapist and family. Another informant recommended that a curtain be hung to visually separate the two subsystems, since team member movements were distracting. Finally, one individual preferred the team not making eye­contact if it was going to "dampen" their observations. Domain: Likes About Team Behind Mirror This domain includes those characteristic descriptions of what family 49 members liked or found helpful about the behind­mirror reflecting team. A narrative elaboration is also included. Characteristics: Likes About Team Behind Mirror I thought it was restful and peaceful; I liked it because I didn't know who was there; you didn't have to pretend they weren't there; we didn't have to ignore each other; you don't feel like you're on display; you didn't focus on them as much; I could be more open if they were behind the glass; viewed comments with more relaxation; team was more comfortable; it was easier for them; I thought their conversation was more relaxed; they talked more when we were back there; we were more free to interpret and respond; it seemed easier with one person in the room; being behind mirror was more natural; it was less weird. Elaboration Comfortableness and openness appeared to best describe client responses to the behind­ mirror reflecting team. Family members reported they did not feel on display or have to ignore or focus on the team. Some informants also remarked that they could be more open with their comments, that it was easier with only one person in the room, and that they were more relaxed when listening to the team. In describing their own experiences behind the mirror, some family members voiced they felt more free to interpret 50 and respond to team feedback. Another family member defined her experience behind the mirror as restful and peaceful since the observation room was dark and quiet, thus providing few distractions. As described previously, one reason families preferred the behind­mirror team was they thought it was easier for the team. They felt the team was more comfortable and relaxed and therefore provided more and better feedback. Domain: Dislikes About Team Behind Mirror This domain includes those characteristic descriptions of what family members disliked or did not find helpful about the behind­ mirror reflecting team. A descriptive elaboration is also enclosed. Characteristics: Dislikes About Team Behind Mirror You don't just open up to complete strangers; switching rooms got kind of embarrassing; it was weird running into them in the hallway; there are people there and I can't see them and they can see me; I'm not sure what they're doing; I wonder about their reaction; important that I can visualize who's watching; not knowing if someone is behind mirror; important to know who they are; I hate it when they knock on the window; didn't like being interrupted by a knock on the window. Elaboration Not knowing who was behind the mirror was noted as a strong dislike for families 51 participating in the present study. Informant family members voiced they disliked the team being able to see them, without them being able to see the team. Family members were also uncomfortable not being able to visualize who the team was, what the team was doing, or even if there was a team. Interruptions by the behind­mirror team were also described as "hated," especially when a team member knocked on the one­way mirror. One family member stated she would certainly prefer there be a designated time for scheduled breaks. Knocks appeared to be a reminder for her there were actually people on the other side of the window. Trading rooms so the family could view the team from behind the one­way mirror was also defined as embarrassing or weird. An informant described this embarrassment as a reminder there were people observing. However, he did verbalize that once he got over that a team of observers was present, he put them out of his mind. Domain: Changes About Team Behind Mirror This domain includes those characteristic descriptions of what family members would like to change about the behind­mirror reflecting team. A related elaboration is also included. Characteristics: Changes About Team Behind Mirror I would have liked more feedback; more feedback; want to be able to make more comments; want to see their faces; maybe a 52 little more time; more comfortable if it was a regular window; want to be in room with team so I can see their faces; want a couple of switches; we'll switch places and let them talk, and then we'd talk, and switch places again; they could just take each issue and talk about it; I would like longer sessions; extend it for a longer length of time; we could have feedback at any point (if team moved in the room); would like to know session agenda. Elaboration Many of the informant comments concentrated on wanting more feedback, wanting more switches to observe the team, and wanting longer sessions to receive more team feedback. Several clients felt that with more switches to view the team from behind the mirror they would have had a better opportunity to explain their own positions. Two family members also wanted more feedback that was specific to each issue or situation that was discussed during the clinical interview. Other comments described how informants wanted to see team member faces. One person suggested he would be more comfortable if the one­way mirror was replaced by a regular window since he could observe the team without the team actually being in the room. Finally, one person wanted to know the session agenda in advance. Apparently, she was uncomfortable not knowing when the team would trade places with the family and therapist. 53 Emergent domains The seven domains that emerged from informant tangential discussions included: Different Perspectives, Empathy, Institutional, Resolutions, Objectivity, Team Characteristics, and Therapist Characteristics. Domain: Different Perspectives This domain includes informant descriptions of the reflecting teams' abilities to provide different perspectives. A descriptive elaboration is also enclosed. Characteristics of Different Perspectives Helpful to get feedback from other people; liked hearing different perspectives; want to hear a man's point of view; I'm getting more than one person's perspective; two heads are better than one; I might as well hear what they have to say, rather than just one person; they were able to come up with three different viewpoints; it allows me to have some second thought; opened my eyes we weren't a special situation; helps to get another viewpoint; they summed the whole thing up; refreshing to hear other people talk; it helps to get another viewpoint; they're going to hear another perspective or viewpoint; showed the other side of the story; just hearing them openly talk about how they perceive my situation. Elaboration Different perspectives was the most pronounced of the emergent domains. This result strongly 54 supported one of the major premises of reflecting team­work: that feedback from multi­cameral views is a major contributor to the development of richer, more complex products (Boscolo & Cecchin, 1982; de Shazer, 1982). Almost all informant family members stated that one of the most helpful aspects of reflecting team­work was the variety of feedback. Informants responded they obtained a broader situational perspective from three team members as opposed to one therapist. One informant precisely described this as "two heads are better than one." Another family member explained she never made a decision based on only one person's opinion and thus she appreciated the variety of input. Other informants described that team reflections helped them to see their own situation differently. They voiced that this new information allowed them to re­think their own situation and that it opened their eyes that they were not a special situation. One informant also described how the team was also able to pick out important bits of information to provide a more "complete picture" of his marital situation. Others found it helpful to receive complementary descriptions of their own ongoing systemic pattern. One female informant remarked it was helpful to obtain a "male" perspective about her marital difficulties. She voiced she enjoyed hearing this complementary viewpoint since her husband rarely described his own perspectives or opinions. 55 Domain: Empathy This domain includes family member descriptions of the reflecting teams' abilities to empathize. A narrative elaboration is also enclosed. Characteristics of Empathy Knowing that we're not alone; they were in touch with my experience; group could empathize with what I was saying; keyed in on a lot of things; reassurance; reaffirmation; they related to our situation well; they knew just what the problem was; feeling some validation for my fears; knowing that we're not alone; seemed real empathetic with both of us; liked it when they described their experiences and feelings; there was empathy, but sort of an impartial kind; I understood what she was talking about; I worry about other people being judgmental. Elaboration Empathy was the second most described characteristic of reflecting teams. Many family members felt the team provided validation, reassurance, reaffirmation and understood their problem. Informants remarked the team was in touch with their experience, related well to their situation, and keyed in on a lot of things. The families also noted that many team members had life experiences similar to their own. Often during the consultation break, team members used self­disclosure statements to describe experiences and feelings that related to family member situations. Informants thus felt the team 56 had a clear understanding of their own experiences. For example, one informant stated, "I think that most of it was probably their own (team's) experiences; the way it sounded to me; just by sheer relationship; that they all had it in their backgrounds to a certain degree." Other family members were relieved the team was non­ judgmental. One person feared the team might personally criticize him. However, he reported the team simply gave impersonal interpretations of how they saw him. Another family member mentioned she was concerned about team criticism, but she observed no judgmental behavior. It appeared both teams were careful to simply reflect their thoughts and feelings using positive connotation. Again, it obviously had a positive effect on client feelings towards reflecting team­work. Domain: Institutional This domain includes informant descriptions about the institutional nature of the therapy suite. A related elaboration is included. Characteristic of Institutional I definitely felt the camera's presence; intimidated by the fence on the window; you feel like you in a studio; the room was kind of institutional; open the curtains so the sun can come in; the chairs weren't that comfortable; I feel closed in; I wouldn't expect cameras; it (the cameras) didn't seem to distract me; 57 get rid of the white; lower ceilings, get pictures of outdoor scenes. Elaboration This domain spoke mainly to the institutional atmosphere of the therapy suite that included the therapy and observation rooms. Some clients voiced that the cameras and microphones in the therapy room were distracting, while others stated they were able to ignore them. One informant was surprised by the number of video monitors in the observation room and compared it to a television studio. Many family members made mention of the spartan therapy room environment. Several wanted the curtains open, while another did not like the wire "fence" on the window. Another noted that the chairs were uncomfortable. Two clients in particular suggested that pictures be placed on the bare white walls. One of these clients specifically suggested outdoor scenes, while another wanted to get rid of the white wall color. However, one family member joked that since there was nothing to look at in the room it was easy to concentrate on what "you're supposed to be here for." For the readers information, typically the outside clinic windows were covered by curtains to protect client confidentiality. However, to protect clinic property, there were also wire fences on the outside windows to prevent anyone from entering or leaving through the window. 58 Domain: Resolutions This domain includes family descriptions of the reflecting teams' abilities to provide resolutions, solutions, and structure to the therapy format. À descriptive elaboration is also included. Characteristic of Resolutions Have them talk about how that person could change; I'd like a quick­fix; I'd kind of like to hear some resolving; I'd rather have her tell me what I need to work on; more positive since we determined a course to take to work on discovering problem; went into more actively pursuing that there is a problem; I don't like it when someone else tells us how to resolve it. Elaboration Having the therapist or team tell them how to resolve their difficulties or what to work on was important for several clients. Some family members described they wanted a quick­fix for their problem. to know exactly what her problem was. One person wanted Another described how he felt the team had been gossiping about his family, rather than talking about how a person could change or stop a behavior. However, one person did state he did not want the team to tell him how to resolve the problem. Clearly many informants would have preferred receiving more structure from the team and therapist in the form of advise or suggestions. Again, true to the reflecting team format, team members were asked to refrain from advice giving. 59 Hence, frustration was felt by informants who were seeking specific suggestions or quick­fixes. Domain: Objectivity This domain includes informant descriptions of the reflecting teams' abilities to take objective stances. A narrative elaboration is also enclosed. Characteristics of Objectivity It was like we talked about a situation; like impersonal; a third person wrote lists down; it was so interesting to hear someone being objective; helpful to observe others talking about my situation; it's a removal and I can handle that kind of criticism; team does not owe us anything. Elaboration This domain referred to the "objective" positioning of the team and therapists. It was important for informants to hear feedback from people that did not know then or have pre­formed opinions. One informant felt it would be easier to take criticism from the therapist or family than from his girlfriend since the team is more in "the middle." It was also important for clients to have a "third­person" mediator, so therapy events could be recalled "objectively," instead of family members arguing about interpretations of what was said. Domain: Team Characteristics This domain includes family member descriptions of reflecting team characteristics. A related elaboration is also included. 60 Characteristics of Team Characteristics Consensus of three better than a consensus of one; three is a nice number; because it's an odd number; (with a team of three) everybody got a chance to talk; the fact that they aren't green behind the ears; either they had book knowledge or practical knowledge; I did wonder if they were familiar with what we talked about earlier; kind of like it that they have sat in on one of our sessions; they seem receptive; they were very cordial; I liked hearing it out of their mouths; I like hearing it from the team, rather than a therapist interpretation. Elaboration This domain collapsed five different content areas in regards to team characteristics as described by family members. These content areas included team size, team experience, team case familiarity, team politeness, and Clients felt that a team of three was an appropriate team size. They remarked that a two person team would not be large enough to have consensus, but that a team of five or six would be too many. This same person described that a team of only two could turn adversarial. He stated, "I mean one could take one side and one could take the other side and you've got nothing learned." Others expressed that with a team of three each team members had an opportunity to talk. À team of five 61 would be too large apparently, since a person could not concentrate on that many opinions. Informants also picked up on the high degree of team experience, noting the team was not "green behind the ears." One member also noted the substantial team knowledge based on either "book" or practical experience. Family members also wanted team members to be familiar with their case prior to team consultation. One family member wondered if the team was familiar with their case. Another informant commented they liked having the team present during their first session. Other family members mentioned they appreciated the politeness of team members. Several clients also voiced they were glad to hear feedback directly from the team, rather than indirectly through the therapist. Domain; Therapist Characteristics This domain includes informant descriptions of therapist characteristics. A narrative elaboration is also enclosed. characteristics of Therapist Characteristics I kind of liked how Pat was the mediator; Pat facilitating the questions and giving positive suggestion is really helpful; he's given me some good feedback, you know, questions; Pat made me feel comfortable; she's approachable and she's a very personable women; I thought she was very easy to get along 62 with; could understand therapist's analogy; I liked the metaphor Pat used; it (therapist's acceptance of client) makes me feel like its maybe a little more tailored toward me; helps to think that I'm not the only person who doesn't know what the hell to do. Elaboration This domain entailed four separate content areas in regards to therapist characteristics as defined by family members. These content areas included therapist directive role, therapist feedback, therapist personality, and therapist empathy. Family members appreciated the therapist when he or she took an active role in mediating the discussion. They also found it helpful when the therapist facilitated questions and provided suggestions. Two informants especially appreciated metaphoric analogies fro™ the therapist. One person described that both she and her boyfriend could understand the analogy and that it helped for the therapist not to take sides. Another male informant stated the therapist's metaphor allowed him to understand what the therapist was thinking, rather than what the therapist was trying to tell him. He also felt that since the metaphor was abstract he could visually "see more into" the therapist's message. Family members frequently described their therapist's personality in favorable terms. Clients defined their 63 therapist as personable, approachable, and making them feel comfortable. One informant also remarked how she felt her therapist was professional, was interested in what she had to say, and was very easy to get along with. Informants also explained how therapist actions facilitated personal empathetic reactions. On one occasion a family member stated it was helpful "to think that I'm not the only one in the room who doesn't know what the hell to do in this situation." This was made in response to the therapist writing down information during the therapy course. Another individual remarked that therapist acceptance of his therapy conditions helped him feel his treatment was more personal and tailored towards him. Summary This chapter presented demographic data, plus the qualitative results of the study. The next chapter discusses the tentative conclusions drawn from these findings and summarizes their implications for further research. 64 DISCUSSION The qualitative study described in this document examined client­based descriptions of two reflecting team types. Client descriptions of reflecting team­work were acquired through moderately structured ethnographic interviews. Transcripts of these interviews were analyzed to develop an initial ethnographic account of reflecting team­work as described by family members who participated in family therapy treatment. The preceding chapters have detailed the foundational clinical and theoretical literature for the study, the methodology employed in the study, and the results. The present chapter includes a summary of the findings and a discussion relating present results to findings from other studies. Conclusions are drawn with recommendations for future research. Implications for the family therapy field are also explored. Summary of Results Qualitative results were delineated in their entirety in the Results chapter. A more concise version is outlined below. 1. The domain of Likes about Team in Room was the most pronounced of the six imposed domains. Many family members preferred having the team in the room so they could observe 65 team members' reactions. In this manner, families did not have to guess who or where the team was, or what the team was doing. Most families felt they received more feedback when the team was in the room. Informants also voiced they felt less judged when the in­room team avoided eye­contact. 2. In contrast, the primary focus of the domain Dislikes about Team in Room was that informant family members were more self conscious with the in­room team. They also felt the team was distracting and threw off their concentration. Informants reported in­room team feedback was less objective than feedback from behind the mirror, since the team was more uncomfortable, more guarded, and less candid. 3. The primary change family members most desired regarding the Team in Room was to increase their direct interaction with the team. Conversely, several family members suggested that "concrete" boundaries be placed between the team and therapist/family subsystems. 4. Family members reported they did not feel on display or have to ignore or focus on the team, when the team was behind the mirror. Some also remarked they could be more relaxed and open with their comments. Other informants described they were more free to interpret and respond to team feedback when they were behind the mirror. Moreover, clients remarked the behind­mirror team was more comfortable and relaxed and therefore provided better feedback. 66 5. Not knowing who was behind the mirror was noted as a strong dislike for families participating in the present study. Interruptions by the behind­mirror team were also described as "hated," especially when a team member knocked on the one­way mirror. Trading rooms so the family could view the team from behind the one­way mirror was also defined as embarrassing or weird. 6. Many informant comments regarding change concentrated on wanting more feedback, wanting more switches to observe the team, or wanting longer sessions to receive more team feedback. Other comments described how informants wanted to see team members' faces. One person suggested he would be more comfortable if the one­way mirror was replaced by a regular window since he could observe the team without the team actually being in the room. 7. Different perspectives provided by the team to family members was the most prominent emergent domain. Informant family members also described that team reflections helped them to see their own situation differently. Some also found it helpful to receive complementary descriptions of their own ongoing systemic pattern. 8, Empathy was the second most prominent emergent characteristic of reflecting teams. Many family members felt the team showed validation, reassurance, reaffirmation and understanding of their problem. Families also noted that many 67 team members had life experiences similar to their own. Other family members were relieved the team was non­judgmental. 9. Many informants spoke about the institutional atmosphere of the therapy suite and the spartan therapy room environment. 10. Having the therapist or team tell them how to resolve their difficulties or what to work on was important for several clients. 11. It was important for informants to hear feedback from people that did not know them or have pre­formed opinions. 12. size. Clients felt a team of three was an appropriate team Informants also picked up on the high degree of team experience, noting the team was not "green behind the ears." Family members also wanted team members to be familiar with their case prior to team consultation. Other family members mentioned they appreciated the politeness of team members, while others voiced they were glad to hear feedback directly from the team, rather than indirectly from the therapist. 13. Family members appreciated the therapist when he or she took an active role in mediating the discussion. They also found it helpful when the therapist facilitated questions, provided suggestions, and used metaphors. Family members frequently described their therapist's personality in terms of politeness and professional demeanor. Informants 68 also remarked on how therapist actions facilitated personal empathetic reactions. Elaboration of Results The present study examined client­based descriptions of two reflecting team­work formats during early sessions of family therapy. Specifically, transcripts of moderately structured ethnographic interviews were examined to gather qualitative data regarding: 1. what clients found most helpful or what they liked most about working with reflecting teams; 2. what, from the client's point of view, was least helpful or what they disliked most about working with reflecting teams; 3. what type of reflecting team did client informants prefer and why; and 4. what could the reflecting teams have done differently or changed to become more helpful? Trends, that appeared, however intriguing and suggestive of further research, must be viewed as indicative of eight families' descriptions of their encounters with two therapists and two experienced teams. Conclusions drawn should thus be tentative. The most striking result was the variety of client comments about their experiences of the reflecting teams. 69 Client, families obviously encountered reflecting teams in unique, sometimes contradictory fashions. Kassis and Matthews (1987) noted in their work with reflecting teams, that the one­way mirror meant different things to different people. Because of this, these authors strongly suggested that therapists obtain information about the client's history with various helping professionals and how they feel about using a one­way mirror. Another dramatic result was client requests for additional team reflections whether the team was behind the mirror or in the room. Client families also strongly voiced appreciation for follow­ups to the initial team reflection when the team was in the room. Andersen (1991b) remarked that on most occasions teams using his format will reflect to the family once or twice. However, he described that when the dialogue between the family and therapist became too rich with information, the team provided up to four reflections. In a sense, family members from the present study who requested more reflections asked for the opportunity to "dialogue" with the team, rather than listening to a final intervention in the form of a "monologue." Hoffman (1990) criticized those proponents of Milan­ style systemic therapy stating that: 70 systemic therapists include the therapist in their assessment, and sometimes a Milan­style team puts itself in as part of a final message; but, for the most part, the team stays behind the screen in a God­like position, intervening from time to time to rescue the hapless interviewer from being 'inducted' into the family, and handing out opinions to which the family has no chance to reply, (p. 10) Families in this study thus requested equal chances to reply to or to rebut team reflections. This finding corresponded to other qualitative work that documented client dissatisfaction with unequal hierarchical relationships. Gale and Newfield (1992) indicated the therapy context itself sets up an unequal, hierarchical relationship between the therapist and clients. Chenail (1991) and Tannen and Wallet (1985) also described the degree to which unequal roles exist in patient­doctor interactions and the negative impact this inequality has on the structure of talk and the consequences for services. Fisher (1984) recommended that a collaborative dialogue between patient and physician should serve to increase patient satisfaction by helping them take more control of their own treatment. Several clients in the present study went as far to state they would prefer a group discussion format that included both the team and therapist. However, this approach was contraindicated by Andersen (1991b). Andersen cautioned that only one person should act as an interviewer, since in his experience "two interviewers most probably make two 71 interviews, which can be hard for the attending client(s) to follow" (p. 45). Kassis and Matthews (1987) described that a family they worked with felt less anxious when the team was in the room during the first phases of therapy. In contrast, many families in the present study were uncomfortable with the in­room team, especially since therapy was in its early stages. Apparently, the in­room team compounded the typical level of anxiety felt by clients during the initial treatment stages. Several clients also remarked they would have chosen to have concrete boundaries between themselves and the team to help them feel less anxious. One person suggested the one­way mirror be replaced by a simple window. This would allow the team to view the family and the family to see the team, but at a safe distance. This informant described a strategy typically used by Andersen (1987). In this format, boundaries were maintained by the one­way mirror, however the mirror lighting was periodically reversed so the family and therapist could observe the team reflection and still be protected by an intervening mirror. This approach also prevented embarrassing personal encounters during the room exchange. Other informants felt the "knock­on­the­window" was intrusive and a reminder that a team was present. Andersen (1987) noted that during reflecting team­work the interviewer 72 and family should be respected as autonomous systems. The interviewer, ideally, should not be interrupted by the team with suggestions about questions or topics of inquiry. Many family members remarked they felt team members were uncomfortable and guarded when the team was in the room. Kassis and Matthews (1987) similarly described that team members noticed "how much cooler the medium is behind the mirror" (p. 42). Follow­up discussions with team members in the present study confirmed they were more comfortable and relaxed when they were behind the mirror. However, team members participating in the present study also felt they tracked better with the family when they were in the room. This again corresponds to the report by Kassis and Matthews (1987), who found that team members were more empathetic when they were physically in the room with families. Team members also found families easier to understand when they were in the room. Results from the present study regarding team size were consistent with those of other family therapy researchers. Families from the current study voiced that three members made up an adequate team, while a team of two would be too few and a team or four or five would be too many. Andersen (1991b), similarly wrote that a reflecting team could consist of up to three to four members. Breunlin and Cade (1981) also suggested that an effective team should contain one therapist and three observers. 73 One of the major premises of team­work is that feedback from multi­cameral views or "polyocularism" promotes development and change in families (Andersen, 1987; Boscolo & Cecchin, 1982; de Shazer, 1982; Ferrier, 1984; Keeney, 1983). It should therefore be expected that "Different Perspectives" was a primary domain. More than any other factor, families found this team characteristic the most helpful or most liked. Similarly, families found team "objectivity" helpful. That is, client families remarked that since the team did not know them, their opinions and reflections were different from or less­emotionally laden from those of friends or family members. This again confirms that not only do clients desire hearing new descriptions of old problems, they actively search for those explanations and definitions "not yet made." It should also be expected that empathy was an important trait of reflecting teams and therapists. Families described their therapists and teams as polite, cordial and professional. These results make intuitive sense given the experience level of each team and the recommendation that team members provide only speculative reflections that were positively connoted. It also makes strong clinical sense given the mounting evidence that therapist relationship skills such as warmth, empathy, genuineness are powerful predictors of positive outcome (Greenberg & Pinsof, 1986; Gurman, Kniskern, & Pinsof, 1986). 74 Many informants would have preferred receiving more structure from the team and therapist in the form of advice or suggestions. There is increasing evidence that a therapeutic style of providing little structure, especially early in treatment, is associated with deterioration of treatment effectiveness (Gurman & Kniskern, 1981; Gurman, Kniskern, & Pinsof, 1986). Green and Herget (1991) also found that therapist intervention and the provision of structure were positively related to client improvement (Green & Herget, 1991). Again, true to the reflecting team format, team members were asked to refrain from advice giving, hence the frustration of some informants seeking more structure in the form of specific suggestions or quick­fixes. As noted by client responses, the physical environment of the therapy room affected the comfortableness of the therapeutic climate. The perceived barrenness of the therapy room may have added to clients' overall situational anxiety. This suggested that clients may wish to be "distracted" by peaceful outdoor scenes or an open window to help un­focus their immediate anxiousness. Conclusions The relatively small sample size of therapists, families, and teams limits this study's generalizability. The findings, however, offer support to the notion that reflecting team­work is helpful in providing families a "multiverse" of realities. 75 Results also supported research regarding the importance of empathy and session structuring to increase therapy effectiveness. Moreover, it provided useful information concerning the appropriateness of in­room and behind­mirror reflecting teams. The data suggested that in­room reflecting teams should be used sparingly during the initial stages of family therapy. However, family members strongly desired to reciprocally observe and hear the reflecting team, but at a distance. As mentioned, this suggestion corresponds with Andersen's (1987) use of team­work behind one­way mirrors in which the mirror lighting was reversed. That is, for the family to observe the team through the one­way mirror, lights are dimmed in the therapy room, while the lights are switched on in the observation room. In this manner, families could observe team members through the mirror. This procedure necessitates the placement of microphones in the observation room. It also would involve the addition of loudspeakers to the therapy room, so the family could listen to the team reflection without having to switch rooms. Data from this study suggested teams, whether in the room or not, should reflect at least twice during the actual therapy session. This allows family therapy treatment to become "more of a recursive 'dance' between partners rather than a hierarchically ordered set of instructions from the 76 team to the family about how to live" (Kassis & Matthews, 1987, p. 42). The data also confirmed that a three person team is of adequate size to generate new distinctions and alternative realities for the client family. Informant comments suggested that a larger team would provide too much information and would likely overwhelm the family. Overall, the results from the present study should remind clinicians that therapy should not be constructed as an attempt to unilaterally control clients. Anderson and Goolishian (1988) emphasized that therapists, reflecting teams and their clients should develop ideas and new meanings together. They also underscored that therapeutic conversation is an active cooperation between the team, therapist and client. Each conversant actively participates in the development of new descriptions, understandings, and narratives. These conversations thus enhance the opportunity for problem­ redefining and therapy becomes a collaborative process, rather than a competitive struggle. Recommendations Since the moderately structured ethnographic format was useful in obtaining client descriptions of reflecting team­work during the early stages of therapy, future qualitative research should focus not only on acquiring samples from varied populations, but also on examining middle 77 and/or late therapy. Such foci may provide a greater variety of client feedback, especially in regards to their experience of the in­room team past the initial stages of therapy. Moreover, investigators may also choose to design a study that includes a reflecting team format that involves the provision of a one­way mirror, without the need for room shifts. Further, strategies must be developed to deal with the anxiety of family members who experience reflecting team­work. Kassis and Matthews (1987) recommended that therapists should learn to adjust to the needs of the client in order to increase the probability of treatment effectiveness. Therefore, therapists must be able to inform consumers about their treatment methods, as well providing alternative formats should clients request it. However, which team methods are most effective for which problems will be an on­going research challenge. While this micro­focus research design and methodology provided illuminating data on two approaches to reflecting team­work, it is apparent that adjunct methods must be used to further tap the overall effectiveness this intervention strategy. Joanning, Newfield, and Quinn (1987) and Moon, Dillon and Sprenkle (1990) have suggested that qualitative methodology, such as ethnography, can be pragmatically combined with outcome research. Qualitative methods can provide contextual data that enriches the interpretation of quantitative outcome 78 studies. Therefore, a large sample outcome design examining reflecting team­work, combined with qualitative methodology would help to track therapeutic process and outcome, as well as how contextual features affect therapeutic outcome. Implications for the Family Therapy Field The present study has shed preliminary light on the differential impact of two reflecting team formats on client families. This study examined the helpfulness of these formats as described by eight client families. offered a contextual focus of therapy events. The study In short, this qualitative study has helped to show therapists how to increase the effectiveness of reflecting team­work as an intervention strategy. This study has also pointed out the overall variety of familial reactions to therapeutic attempts at intervening. This complexity may well have elaborate implications for a re­examination of theory, technique, training and research of family therapy, especially in the use of reflecting teams. 79 REFERENCES Allen, J. D. (1976). Peer group supervision in family therapy. Child Welfare, 55. 183­189. Andersen, T. (1987). The reflecting team: Dialogue and meta­dialogue in clinical work. Family Process. 26, 415­428. Andersen, T. (1991a). Basic concepts and practical constructions. In T. Andersen (Ed.), The reflecting team: Dialogue and dialogues about the dialogues (pp. 15­41). New York: W. W. 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Change: Principles of problems formation and problem resolution. New York: W. W. Norton. Whitaker, C. A, & Smith, D. V. (1981). Symbolic­experiential family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy (Vol. I) (pp. 187­225). New York: Brunner/Mazel. 86 APPENDIX A. INFORMED CONSENT STATEMENT The Department of Human Development and Family Studies and the Iowa State University Family Therapy Clinic supports the protection of human subjects participating in research studies. The following is provided so that you can decide whether you wish to participate in the present study to be used as a part of a doctoral dissertation. You should be aware that even if you agree to participate, you are free to withdraw at any time. Purpose of the Study: In order to improve our services for yourselves and for other families who visit our clinic, we are interested in your experience of therapeutic teams at the Iowa State university Family Therapy Clinic. We therefore request your permission to ask you a number questions regarding this experience immediately following the next two sessions. These brief interviews should last approximately 15 to 30 minutes. Participation in the study will entail no greater risks than already incurred as voluntarily choosing to be clients at the ISU Family Therapy Clinic. Participation in the study may provide you a greater sense that you have input into the type and quality of therapy you receive. You may also have an opportunity to receive further insight into the nature of the dilemma brought into therapy. Since the ISU Family Therapy Clinic's primary mode of treatment is family therapy it can be expected that individuals under the age of 18 may participate as clients. In this case, the minor's legal guardian, as well as the minor, will have to sign authorization prior to the minor participating in the study. Your participation in this study is solicited, but strictly voluntary­ Please do not hesitate to ask any questions about the study and again confidentiality will be strictly followed and your name will not be associated in any way with the research findings. Your cooperation is greatly appreciated. If you have any further questions regarding your participation in this study or if you wish to have a copy of the results sent to you at the conclusion of the study, please call Dr. Harvey Joanning at 294­5215 or Mr. David Brown at 239­2011. Signature of Participants or Parent(s) or Guardian(s) if client is under 18 years of age. 87 APPENDIX B. PERMISSION TO AUDIOTAPE/VIDEOTAPE FORM lowa State University Family Therapy Clinic Permission to Audiotape/Videotape Form In order to better serve those who come to the ISU Family Therapy Clinic for assistance, the therapists audiotape/ videotape sessions and use therapy team members to observe through a one­way mirror. These recordings are kept strictly confidential and are used only with the client(s)' written permission. The team members are bound to the same rule of confidentiality as the therapist. I (we) give permission to the Iowa State University Family Therapy Clinic to use audio and/or video recordings of my (our) treatment sessions for supervision purposes. I (we) understand that a condition of this consent is respect of my (our) privacy and the confidential nature of our professional relationship. In situations involving two or more persons, such as marital or family consultation, each person must give individual permission: SIGNATURE(S): DATE: WITNESS: 88 APPENDIX C. SUMMARY OF CLIENT COMMENTS Case 111, First interview, Team In Room In room: Thev obviously were making an effort not to make eve­contact with me or look over this way and that helped Mother: It was kind of weird at first. But the fact that they obviously were making an effort not to make eye contact with me or look over this way and that helped. Their feedback was interesting to me. Mother: The awareness that they were trying to be unobtrusive, I guess. Maybe it felt more respectful or something. In room: Just having extra people here. Mother: Just having extra people here. But it's not as weird as the one­way mirror. That's the worst. Hate that! Behind mirror: Because there are people there and I can't see them and they can see me. Mother: Because there are people there and I can't see them and they can see me. Nasty. Feeling very self­conscious. being judgmental I worry about other people Mother: Feeling very self­conscious. It was interesting as I heard their feedback. I guess I felt like I haven't been handling this very well, so I worry about other people being judgmental then. Mother: I guess, once again, that feeling of my feeling like I don't handle things very well and feeling like the judgement thing again. Why doesn't she do this or say that, or... Mother: I mean I would fear their criticism more and not necessarily that they would be different. It helps to get another viewpoint Mother: Well, it was good to get some kind of feedback. I don't know about the other two people, but I noticed that Mr. Joanning had observed a couple of weeks ago and to see other's people's responses to all of that. I don't have a non­critical or a non­partial person who's kind of looking at all this, and it helps to get another viewpoint. 89 I mean there was empathy, but sort of an impartial kind Mother: I mean there was empathy, but sort of an impartial kind of...I know the judgmental part, that's my fear...that's not what I saw them doing. I'd like a quick­fix Mother: (I saw them) watching. Their observations were interesting. I guess I'd like a quick fix. I'd like solutions and I don't really expect them, but it would be nice. Feeling some validation for my fears Mother: Um, hearing what they had to say about my situation, I guess. And feeling some validation for my fears and what a difficult situation it is, and... A1 jotting things down...but to think that I'm not the only person who doesn't know what the hell to do Mother: Well, it was interesting that A1 was jotting things down and that it also brought things to his mind. Mother: I guess I don't know. but to think that I'm not the only one in the room who doesn't know what the hell to do in this situation. It is helpful to get different perspectives Mother: I work in a newsroom and we do lots of bantering back and forth and it is helpful to get different perspectives and outlooks and more input. It would be good for me to interact with team directly Mother: I guess it would be good for me to be able to interact with them directly. And then maybe I'd have felt on the spot and it would be more uncomfortable. Mother: See, part of what I think I want sometimes are answers. So I can say, 'So, what do I do?' And I know that's not the way it works even though that's what I want to do. Mother: I guess it takes me awhile to build faith in people. And so today I'd probably wouldn't have used them very much because I wouldn't have been quite comfortable yet. But after having them sit there maybe next time, then I would have done that. 90 In room: Sometimes it would throw off my concentration Mother: I was pretty alright with them once I got used to them. I found that I glanced over at them or I looked at them in the mirror sometimes, so sometimes it would throw off my concentration. Mother: Because I was watching for responses (is why it threw off my concentration). Case 111, Second Interview, Team Behind Mirror It was weird running into them in the hallway Mother: It was weird running into them in the hallway. was kind of strange. That Real interesting to be on the other side Mother: God, I don't know. Kind of self conscious, I guess. But it was real interesting to be on the other side. For one thing, to get their view how we are when we're in here and they are in there, but to listen to their comments. It was really interesting. Mother: I guess it helped me when I get back in here to feel a little bit more relaxed. To sort of know how this looks. I don't know why. They seemed real empathetic with both of us Mother: This has all been a different...Part of that was that they seemed real empathetic with both of us and to get somebody else's view of what's going on, who isn't involved, who isn't going to take sides, doesn't have preconceived ideas, it just felt good. It was like we were talked about as a situation. something impersonal Like Daughter: I think it's good to be on the other side. I thought it was good to hear them talking in here, but it was weird because like they knew we could see them. We both knew each other was there, yet it was like we were talked about as a situation and that was really weird to me. Daughter: I guess I don't know how to explain it, but they talked about a situation and I thought it was good that we were able to see that, you know. Just like she said, seeing 91 other people's points of view who aren't involved at all. Yet it was weird to hear it talked about as a situation, not as people kind of, but as a situation. Daughter: As...I don't know how to explain it. Like something impersonal. You know, not as people, but as a situation. Behind mirror: I would have rather been in the room with them where I could see their faces Daughter: I mean, I don't see that there's any other way to do it, but I'm just saying that felt kind of weird to have them talk about our situation and being in the room. That felt kind of weird because I guess I would have rather been in the room with them where I could see their faces and they could see mine. Daughter: Because it seems to be more personal. You know, like if they were to say, this is the way I feel about this, you know like to look at us when we talk. I would rather have eye­contact. There was a third person who wrote them down Daughter: Because we have a lot of problems saying...one of us says the other one said something, and you know. We have different views on what we said­ And this way there was a third person who wrote them down, too, on paper. In room: it seemed that they Cteami were more guarded. Mother: Well, see what I want to do is compare it to last time. Urn, but when they were in the corner it seemed that they were more guarded in terms of how they react. And they tried a lot harder to stand neutral. Where without us here to see them they were much more animated, seemed to be more spontaneous and I don't know... In room: I felt I had to stay more neutral Mother: Well, it would only be guessing. Maybe the self­consciousness of having looking at them and watching them, and also I experiences what was talking about last week. It's like to hear yourself spoken of in a third person, while you're observing. It's like reading a book about yourself or I don't know. And last time, I didn't know if they didn't know name, but they referred to us as the mother and the daughter, which was even stranger. And I guess I felt I had to stay more on neutral, where I was sitting there (behind mirror). I was real teary and had some tears. 92 and I don't think I would have done that if I had been here. So it kind of freed me up a little, too. Daughter: To hear their input was a good thing. And it's true as far as I didn't experience it, but I do think it's true that it would have been a lot different if they would have been in the room. In room : They ('team') wouldn't have been as candid Daughter: They wouldn't have been as candid and they wouldn't have, I guess I don't feel like they would have felt as free to talk about it. You know, like about negative aspects or whatever, that they would have felt uncomfortable. Behind mirror: I hate it when the people on the other side knock on the window Mother: I would rather have there be a designated time. I hate it when either A1 or the people on the other side knock on the window. Daughter: Because, I forget sometimes that people are behind there, because we get so into it and then all of the sudden you hear knock, knock, knock, and you're going, 'Oh yeah, there's people watching us.' Daughter: I think it would be weird for me in any situation to be like doing something and all of a sudden somebody knocks from somewhere that you can't see them. It would help seeing their rteam'sl faces. Mother: Well, I hated it worse the first time we were here because I had never seen those people­ It's kind of a gut level thing. Daughter: I would have to agree, though, it would help seeing their faces. Daughter: Knowing who it is instead of like just having the person who knocks back there. Daughter: (Helpful to) Just to put a face to who it is that is watching us. Maybe a little more time fwould have helped 1 Mother: Maybe a little more time. I mean I know that we could drag it out forever, but even a another twenty minutes might have helped. 93 Last time I was able to make comments and so was AI. Something like that miaht have been helpful Mother: I guess I feel we got cut off. And the last time I was able to make comments and so was A1, and then to have them respond to that again. Something like that might have been helpful. I didn't like the wav we were interrupted Daughter: I didn't like the way we were interrupted. Like we were just getting started into our new roles and then they knocked and said, 'Well, let's do this and then let's finish.' I don't even think a longer session would matter to me, but just the fact that it was like we'd gotten into it. And even if he would have said we have ten more minutes before we have to switch places, and then we would have left or come and talked to you or something. Instead, it's like let's switch for five minutes and then come back and pretend not, you know... In room; I was kind of watching them, more in the mirror, out of the corner of mv eve Mother: Primarily, like I said last week, I was kind of watching them, more in the mirror, out of the corner of my eye. And this way I wasn't distracted during the session even though I knew they were there. Yeah, it was much less distracting. In room: Being able to make more comments and hear what they said about that was helpful Mother: But, like I said, being able to make more comments and hear what they said about that was helpful the other way, too. Mother: Last time, Al and I were both allotted time for us to say something and then hear how they...we could say things in response to what they had said­ They didn't answer us, but they would then discuss that a little more among themselves. Behind mirror: It was less weird to be on the other side of the glass Mother: It was less weird to be on the other side of the glass and have people talking about us as and the mother, than it was to have them in the room­ 94 It's been helpful for them to talk about their feelings Mother: I can say it's been helpful for them to talk about their feelings about these things. That's been helpful to me both times. Because I have felt that even though I talk to friends about it, there's always that feeling that they're only hearing my side of the story. Are they afraid of hurting my feelings and to hear these people with their emotional responses is validating, I guess. As well, as some of the real specific counseling type comments. I felt pretty isolated. Case 122, First Interview, Team Behind Mirror Behind Mirror: to observe others talking about mv situation Wife: Well, I think it was helpful. I've never experienced anything like that before, but it was helpful to go around and just be totally out of the picture, so to speak, and observe others talking about my situation. I mean, they didn't know me, they just listened. Wife: Well, it gave me a perspective, I mean, on how I appear and lay attitude. And how they kind of pictured my husband. I mean, they've never met my husband. Just my description of him and then what's transpired the last few weeks. It just kind of clarifies some things for me that I didn't really think about too much, you know, about maybe how angry I've been and how immature he might be. So, um, I don't know, it was just a very interesting experience. Their perception of me. It gave me a little bit more confidence. Reassurance Wife: Well, just their perception of me, and how I appeared to them. It kind of gave me a little bit more confidence in thinking, 'Well, gee, maybe I'm not off the deep end, you know crazy.' They just made me feel better, a little bit better about it. Reassurance. I'm a normal person with strengths. Weaknesses, too. He's given me some good feedback, vou know, guestions Wife: Alan was very receptive. I think he's given me some good feedback, you know questions. 95 Getting a male perspective Wife: Getting a male perspective. We had two gentlemen in here and a lady, and just kind of getting their perspective of the whole thing. Just hearing them openlv talk about how thev perceive me Wife: And just hearing them openly talk about how they perceive me, that was helpful to hear that. Because I've never been able to get that out of my husband, particularly. Behind Mirror: I thought it was verv restful and peaceful Wife: I think just the experience of being back there in the dark, kind of, and listening. Hearing the voices and the words. I know at first I didn't look at the glass at all. It took me a few minutes to really be able to look into it for some reason. Wife: I thought it was very restful and peaceful and it just sort of sunk in more or something, what they were saying. Wife: I suppose because it was so dark and peaceful, you know. Like being in another world, another dimension almost. I was restful and I found it soothing to hear their voices. They seem receptive Wife: Well, they seem receptive. I can't really think of anything negative except maybe they really don't know me. I mean, you have strangers talking about your inner­most thoughts and feelings. But I don't particularly feel offended by it or feel that they said something that was not particularly true. They just don't know me. Wife: That is a difficult question because sometimes we open up to strangers more than we open up to the people closest to us, I think. Maybe that's just an old feeling that I need to get rid of. I don't know why. They certainly seemed nice and interested. They were very cordial and I appreciated that Wife: They were very cordial and I appreciated that. Eye­contact. I would have the team listen a few more times Wife: I would have the team listen a few more times instead of just the first time. 96 Wife: Maybe after a few more times. Wife: Maybe I would feel like they would perhaps know me better that rather just one time. I don't know if they were listening last week or not­ I have no idea, but maybe more than just once. Case 122, Second Interview. In Room In room: It seemed more intimate to me. nice having them in the room. And it was kind of Wife: Well, it seemed more intimate to me because there were others that I had met last week, and I felt comfortable with them. And it was kind of nice having them in the room. Wife: I guess there's something nice about numbers. Just support. You know, instead of just knowing that there's some other people behind that wall watching. It was kind of nice and comforting. At first I thought maybe they were going to join us. But it was fine that they were over like that. Wife: I guess because A1 and I were having our conversation and I knew they were listening. They were really listening closely. It just didn't bother me that they didn't join us as a group. Maybe it wasn't quite as intimidating that if they had been and I would have been talking to everybody. In room: It was that thev listened well and were tuned in to my feelings and thoughts Wife: I liked the way we talked, you know, for awhile. And then A1 asked them if they had any comments and it was just kind of nice to hear the different feedback. It was the fact that they listened well, I thought, and were tuned in to some of my feelings and thoughts. I felt very aware of that. In room: It seemed like they were very well focused: Sitting in chairs comfortably and kind of looking down Wife: Well, they were kind of sitting with their chairs comfortably and kind of looking down. For some reason. And concentrating. It seemed like they were very well focused. Wife: Because I kind of did the same thing when they were talking­ I kind of focused on the floor, kind of, although I did look at them, too as they were speaking. And I guess that body language, for some reason told me. 97 Wife: It was kind of closed in a way. You know, arms and fee close to the body. And I was just very sure that they were really listening to me. In room: It was more of a group, and I could see them Wife: Well, I liked it because they were in the room. It was more of a group and I could see them. You knew something was back there, but you weren't guite sure who or what, you know. And, just the presence of more people in the room. Not that would like a crowd, but it was just five of us total together In room: It was kind of comforting because I knew they were listening to me And it was just kind of comforting. Wife: (Comforting) Because they were listening to me. I knew they were listening and I knew that even though they were apart from us, that their presence was comforting. In room: It was sooner feedback Wife: I think I mentioned that A1 stopped once and had them comment. And then he did it again. I thought that was very helpful. You know, it was better that way because instead of stopping after an hour and thinking, 'Oh, did I say that?,' and going back, it was sooner feedback, and I thought it was real helpful. And, the lady, Chris, she said more this time, which last time it did not seem like she did. And, I guess I liked that. I liked hearing the men's perspective Wife: I liked hearing the men's perspective. I thought that was very helpful in what they said. I found then very supportive. I think they reallv keyed in on a lot of things that I said about this situation and without being real critical about it Wife: Well, I think it was very evident that they did hear what I said. I think when Chris first started talking about, 'The Odd Couple,' you know, the show. And I watched that a lot through out my life and I could see the correlation between the two situations. I thought that was a good example in many ways. It's kind of nice to see the funny side of things, too, but I think they really keyed in on a lot of things that I said about this situation and without being real critical about it. I just felt that they heard what I said. And it was very good. 98 Ifs helpful to get feedback from other people Wife: Well, so often, if you're just with one person, one counselor, you know it's just one person. And I've heard people say, 'Oh, I didn't like what this person said to me,' you know, and I think you have to kind of weigh it out and I think it's helpful to get some feedback from other people. Three is a nice number Wife: Yeah, maybe two or three. Three is a nice number. Maybe because it's an odd number or something. I want to hear a man's point of view Wife: And I like the idea of there being more men in here, too, because I want to hear a man's point of view because I'm not communicating so well with my husband. Wife: It was just kind of nice to have other individuals in here because so often we don't hear things, you know. Listening skills are so important. I think I'd like to take a class in it. In room: Disappointed that they didn't join us. Wife: Well, at first I was a little...not disappointed...! noticed that they didn't join us as a group. Then that was fine. In room: It's iust kind of nice to have people face you and talk to you and maybe even ask vou something Wife: Oh, I guess I like to confront people. I don't really care to have people talk about me, not that they were talking about me in that way. I wasn't offended at all. But it's just kind of nice to have people face you and talk to you and maybe even ask you something. You're more able to defend your viewpoint. I can see how effective this is. Sometimes you can listen better if you're not looking. Wife: (If team looked at her) We probably would have discussed it­ I probably would have talked back to them or tried to explain something to them. But I can see the positive, you know how positive this situation is. 99 In room : I could focus more on what they heard me sav Wife: Well, I think because I could focus more on what they heard me say. It wasn't like they were going to have a conversation. It wasn't just a front to front conversation because so often I think when you're having a conversation with the person you miss things so easily and I just found that effective. I think I would have liked to have seen more feedback Wife: I think I would have liked to have seen more feedback. They did twice. Well, actually, Al asked them more than twice if they had any more comments. But maybe a couple more times. I'm not sure how long we talked before he asked them for the feedback, but maybe it was 10 minutes or something or 15. Wife: Maybe just focusing more of what I'm saying. You know, I talked about some different situations. Maybe talk about each incident more. Wife: Maybe after they had sat over there and listened to me for awhile, maybe they could have joined us or something and the last two minute or something. And maybe they could have discussed more. That's about the only thing I could think of. In room: It wasn't like I was in a fishbowl Wife: I like this one better because it wasn't like I was in a fishbowl here. And, although I didn't mind it at all, and I didn't really feel intimidated by it, I just liked having them come in and having everybody introduce themselves. I don't know, it was just kind of a comfortable feeling instead of being in here all sterile with another person. This is a good sized room. Not too big, but it was just more comforting. Wife: Well, you know, like being in a glass bowl and being observed, so to speak, even though it's just a mirror over there, which it really didn't offend me or intimidate me last week at all. It was just kind of nice. There's something in numbers, or what is that expression? There's comfort in numbers. Wife: Although, I don't think I would want anymore people in here. Wife: I think it would seem like a crowd. This was just kind of a nice, intimate group, the five of us. 100 In room: I liked the more feedback Wife: I liked the more feedback. Last week, if I remember right, they listened and then I went back there and listened to them. It was just one time. This time was twice and that was good. Wife: More feedback, right. With them being in the room, that was better, too, rather than just me back there observing them and just watching them talk about me, you know, us. It just seemed more intimate in here. Case 113, First Interview, Team In Room In room: It was kind of nice to see the people Female: It didn't seem much different than last time except I could see them over there­ It was kind of nice to see the people, you know, and see what they thought of what I'd said and get some other ideas. In room: It was kind of neat to know who thev were, or basically, what they looked like. Female: It was kind of neat to know who they were, or basically, what they looked like. I don't know, you know, you know they're persons when you see them. It was just kind of nice rather than wondering, 'I wonder who's on the other side of that wall or whatever.' More personal, I guess. Female: Because they were here in the room, physically. Where it's more of a one­on­one interaction, even though they still had their backs turned. It's kind of nice that I'm getting more than one person's opinion Female: The feedback. It's kind of nice that I'm getting more than one person's opinion because everybody looks at something different. Even if everybody agrees on it, everybody still looks at it a different way, and I firmly believe you should never go with one person's opinion. So I still like having a variety of input. In room: Possibly have group conversation, where I'm speaking to them all directly Female: Possibly have a group conversation, where I was speaking to all of them directly, and we could converse back 101 and forth about certain things. Because there were certain tiroes when they would say something and I thought, 'I maybe could put something in there.' But, uh, it wasn't bad that I didn't. But it would have been kind of nice. In room: With them being here gives vou more of the one­on­one Female: Because you've got the interaction. With them being here gives you more of the one­on­one because they're there. But if you say something and they say something, you don't have the chance to converse back and forth about a particular issue if there's something you're confused about or feel kind of different about. You can put the input there. Open curtains so the sun could come in Female: I don't think I would change anything else. the curtains open so the sun could come in. Maybe had Case 113, Second Interview, Team Behind Mirror Went more into actively pursuing that there is a problem Female: I thought it went better than last week Female: I don't know. It's kind of hard to explain. I think basically we all looked at the fact that there's a problem there, but we're not getting anywhere with it. All we're doing is kind of chasing things in circles. And what we can we do to stop running in circles and start grabbing hold of Female: Um, I kind of noticed a difference with Alan...he had mentioned the fact that he had thought he wasn't getting anywhere and I kind of agreed. I kind of felt the same way, too, although I don't know how these things go. And we discussed that, and um, went into the observation room and they came in here. They discussed it too, and I don't know, somewhere in there I just kind of picked something up. Female: Yeah, we kind of went more into actively pursuing that there is a problem instead of determining that I seem to be dealing with it rather well. Under all the circumstances, say, 'Okay, you've got a problem, let's see what we can do about finding the problem­' 102 When you talk about somebody, you either do it where nobodv hears vou. or you know, to them. Preferably to them. Female; I liked it better than last week. I don't know. I said with their backs to me I didn't feel like I could interact with them. Like Female: They weren't talking about me in the same room. And I kind of felt that way, too. Because I wasn't talking about them. You know, without talking to them. I mean when you talk about somebody, you either do it where nobody hears you, or you know, to them. Preferably to them. Behind mirror: I got the impression it was easier for them Female: And I did prefer that, but being behind the wall where I knew I couldn't interact with them, it just seemed to make a psychological difference as far as, you know...I got kind of the impression it was easier for them. Because we determined a course to take to work on discovering whatever my problem is Female: I felt we had a more positive end to the meeting. Female: Because we determined a course to take to work on discovering whatever my problem is that causes all the anxiety and everything. Female: Like I've said, we kind of went in circles and I know for myself personally, I went home and I just felt frustrated. Today I felt reassured. It's like finally we're going to get somewhere. Female: Yeah. We've found a positive direction to zero in on. Behind mirror: We didn't have to ignore each other Female: Like I said, part of it was we didn't each other­ That's the key one right there I I'd say. We didn't have to pretend the other exist. And I don't know, it just seemed more way. A better way of doing it. have to ignore guess is what party didn't positive that Female: The interaction between Alan and myself and then the group, although the group and us did not interact directly, but it was still there, it was. I felt it was less restrained all the way around compared to them being in the same room and having separate conversations. I like it better. I was a lot more comfortable with it that way. 103 Two heads are better than one Female: Two heads are better than one or I always felt the more people you got an opinion from the better your chances are of not screwing up. You know, whether you take other people's opinions or not. But it gives you more alternatives, um, different viewpoints to look at something from. Because everybody sees something different from the same thing. The curtains need to be open. I feel closed in. Female: Yeah, the curtains need to be open. Female: Well, I feel closed in. world. Like I'm shut off from the Female: It just seemed more positive. You need the sunlight. I think sunlight, fresh air, those are all part of the naturalness that makes people more comfortable, (rather) than to be shut in a little room that has no daylight in it. Behind mirror: Didn't feel as frustrated with not being able to talk with team. Female: I didn't feel as frustrated with not being able to talk to the group this time like I did last time. And I think that difference is because we weren't in the same room. I'd be interested in having the group together to get into a discussion. Female: But, uh, I'd still be interested in trying that, though, having a group all of us together kind of to get into a discussion. Just to see which I would prefer. If somebody's there. I want to interact with them. Female: The second one where we switched and we observed the team talking about the counseling session. I preferred it because it was more comfortable. They weren't in the room having to pretend the other parties existed. I've always had a problem with that anyway. If somebody's there I want to interact with them. Female: You have to forget that something exists. It would be like somebody sent a hundred dollar bill and say, 'Don't let anybody run off with that and don't touch it either.' Here it is and it is really tempting. But I can't have it. Just like with the TV in the room, I could not interact with them because I was supposed to pretend they weren't there. But it 104 was tempting to put a comment in or say, 'Well, yeah, but what about this.' Whereas, with the team in another room and my observing them, I knew I couldn't. Behind Mirror: You didn't have to pretend thev weren't there. Female: It seemed less impersonal. pretend they weren't there. Because you didn't have to Female: If somebody put their finger on the floor and pretends to draw a line and says, 'Okay, now we're going to walk across this line, but don't step off of it.' Well, you're in a heck of a spot because you can't do that. But if you put a strip of tape on the floor and said, 'Okay, walk this line and don't go off of it, no problem!' Case 124, First Interview, Team Behind Mirror I understood what she was talking about Wife: Well, I understood what she was talking about, about her mother, and Harv. He was talking about farmers that, you know, she was going to leave him all the time and she finally did. I can understand that. Wife: Well, their comments were, I could understand them, knew what they were talking about. They related to our situation verv well sah, they related to our situation very well. hit it pretty good. They Husband: I think that most of it was probably their own experiences; the way it sounded to me; just by sheer relationship; that they all had it in their backgrounds to a certain degree. Showed the other side of the story Husband: Somewhat enlightening. I can see, it showed the other side of the story as far as I'm concerned. Husband: Well, the wife's side­ As far as being married to a farmer. It was...they had it nailed pretty good. Wife: Well, they didn't actually experience all this stuff. They know people that did experience it, and...But I think they've got a good grip on it, what it's like. 105 Thev knew iust what the problem was Wife: Because she was talking about her mother, and how she was going through this stuff, and how she was going to leave all the time, and I know, that's exactly what I was thinking. It makes me feel like I'm not completely nuts. Husband: It brought everything forward and moved us, brought everything to the surface. Kind of opened things up. Husband: Probably their observations. They were able to figure it out and they had it. When they came in here and sat down, they knew just what the problem was. Husband: I liked the way he brought up the fact that any profession can get you into this kind of, what you'd call, jam. Wife: I liked sitting and listening to them talk about it. Wife: Well, because they know somebody that's in the same position and they know what it's like. They know from observations and stuff. Behind mirror: You don't feel like you're on display Husband: Well, you can sit in the dark and you don't feel like you're on display. Husband: When you're in here (in therapy room), you're kind of like out in the open. You have to come bare you're soul and it's nice to see somebody else have to be in the same situation. Of course, they're better at handling it. You don't iust open up to complete strangers Husband: It isn't easy. strangers. You don't just open up to complete Husband: And, they're doing the same with their observations. Husband: Maybe after another meeting or two so we can kind of feel comfortable, then we could come up with something. Consensus of three better than a consensus of one Husband: As far as three people, I still say the consensus of three is better than a consensus of one. Husband: No matter how it turns out you're going to get a lot broader perspective with three than you will with one. 106 Five or six in here, that would be too many Husband: Two people is not enough if you are going to have a consensus. And if you had five or six in here, that would be too many. Husband: Well, if you only have tv;o people you get that adversary relationship. You got one on one. I mean one could take one side and one could take the other side and you've got nothing learned. Husband: Three is good. Four might work, five is too many. Everybody cot a chance to talk Husband: I just know, well, everybody got a chance to talk. Everything was smooth. Husband: I think you'd have too much, well, you can't concentrate on five different opinions for the first place. I can't handle five different view point coming at me. Plus, I think you'd have a...the information would be jumbled up because there's just to much input. Husband: Four might work, but then you'd come back to an even number again. Opened my eve that we weren't a special situation Husband: Well, it kind of opened my eyes that we weren't a special situation. Case 124, Second Interview, Team In Room It didn't really nail anything down Wife: It wasn't as bad as last week. Wife: Well, they would bring up topics that would really irritate the situation when we didn't bring up the topic that would irritate the situation. Husband: This week we were more on guard. Husband: It was kind of a vague meeting tonight. It didn't really nail anything down. Of course, I think it's going to take a lot more discussion. But maybe this is one of those meetings where nothing really gets solved. You just kind of build up some background and then it'll come to play later on. 107 In room: Bad little kids who had to face the wall Husband: It was different. If they do that every time, you know, it takes some getting used to. Wife: It was strange having them out there, too. even stranger having them in here. But it's Wife: It was just that...they looked like bad little kids who had to face the wall. In room: Good idea to look away because then you don't feel they're looking and trying to iudae vou Husband: It was a good idea to have then look away because then you don't feel they're looking and trying to judge you. If they sat right in front of you, they'd have to be judgmental...You would feel they were judging you. Thev were able to come up with three different viewpoints Wife: Dr. Joanning's experience...I didn't go out and work every single day like that. I know what he feels like. That's a heck of a load. When you've sixteen jobs to do and you have no help doing them; and you've got to go out and help him and know how to run the machinery; and you gotta know how to do what he does. If you only do it once a year, you've gotta learn all over again. And that's stress. Husband: They were able to come up with three different viewpoints. That was good. They kept everything even, if you want to call it that. Maybe it v;as done on purpose. I don't know. But it worked that way. Behind Mirror: I think they talked more the first time when we were back there Wife: I think they talked more the first time when we were back there (behind mirror) than when we were out here. But then that was kind of getting a little more about how they were, and urn, and maybe we're just kind of at a standstill. In room : We're ill at ease to start with and then you just compound it by having four strangers Husband: I think you still have to have that first meeting with them seeing us cold. Then, after that, they can be in the room. 108 Husband: I don't know, probably because you would have so many people just loading you down here. Husband: One person in the room with you is enough the first time. Husband: Well, we're ill at ease to start with and then you just compound it by having four strangers. Case 211, First Interview, Team In Room In room: I auess the one thing that I would prefer that I can see them Boyfriend: Just the fact that there were people here and we were talking about these things that there isn't...Like I said, I don't know if you were listening or not, but I said there was nothing new here that was being discussed, so that was not an issue. It was just a matter of who was around during the discussion. And that was the only thing. It could have been anybody. I guess the one thing that I would prefer that I can see them. I know they're there, so why don't they join the circle. I have no problem looking in their eyes, so they can look in my eyes when they're telling me about it. If they're going to be listening, I might as well hear what they have to say rather than iust one person. Girlfriend: I mean, if they're going to be listening, I might as well hear what they have to say rather than just one person. I don't like to play games with mirrors or cameras Boyfriend: I'm not the type of guy that...I know this is not a big game or anything, but I don't like to play games with mirrors or cameras. If someone has something to say to me, I'd rather have them look into my eyes and tell me than to... and if there comfortable doing that, I'd be more comfortable. Especially in a situation like this, where I feel I'm laying something that's extremely personal to me, that I'm the one risking something. So look into my eyes...don't put your back to me. Pat made me feel comfortable Girlfriend: I guess Pat made me feel comfortable. There was just...it was non­threatening to me. They didn't bother me 109 and you know, I just assumed there would be more feedback that I can use, hopefully and... She's approachable and she's just a very personable woman Girlfriend: I guess it's her personality. She's approachable and she's just a very personable woman, and interested in and she looks sincere and I think she's very professional, how she conducts herself. I thought she was verv easy to get along with. Boyfriend: The greatest emotions or the twisting was just on the topic itself...it really had little to do with the surroundings. Maybe that's the best way to put it. I know you...I thought it was comfortable, too. I thought she was very easy to get along with. I just liked hearing it out of their mouths Girlfriend: I just like the idea that I knew the set­up of the study, and I appreciate hearing their comments from them, rather than what happened a couple of weeks ago where Pat went into the room, got the information, and brought it out. And I just liked hearing it out of their mouths. And like I said, if they're going to be sitting in here, I would just appreciate hearing what they have to say. In room: I'd just soon thev were flooking at you) Boyfriend: Yeah, I thought the feedback was also good. It just seemed kind of funny to me that the...perhaps maybe it wouldn't have been just as...maybe it's for them, too. It could be in a conversational mode rather that being part of this team. If the feedback is better by doing it that way, it's not a big deal that they're not looking at you. I'm just saying that it's no difference to them, I'd just soon they were. In room: I think I would want them in the circle, whereas I think by looking at us. vou mav pick up nonverbal cues. Girlfriend: I think I would want them in the circle, whereas I think by looking at us, you may pick up nonverbal cues. In room: I like the fact that they're iust listening and they weren't reallv watching us. I like the fact that they're just listening and they weren't really watching us. And then they can't see the facial expressions. I think that's probably an interesting way to 110 get the information. I don't know how they sit when they're behind the window, but I thought that was a different approach. I can see the value in that, too, of not actually seeing the people who are speaking. Just listening. I'm glad thev didn't try to hide anything Boyfriend; I liked the fact that the cameras are out in the open and the mikes are down, because I would really be annoyed if I came in here and there was low lighting and there was a couch and a 'just talk to me' type thing. Whereas, I know damn well there's a camera behind the mirror. I'm glad they didn't try to hide anything. Boyfriend: Yeah, although it was kind of a shock to actually see it, it was better than...It goes back to the idea that there's something working there that I don't know about. I'd rather have her help me, tell me what I need to work on Girlfriend: I'm just impatient. I guess I want more help. It just seems like I'm talking a lot. And we've gone over this a lot and I understand Pat probably needs to know where we're coming from. It's just like, I'd rather have her help me, tell me what I need to work on. Girlfriend: Suggestions. personally to ease up on Things that I can practice and to ease up on me. In room: I wished they would have turned to talk to us. Girlfriend; I like the way they didn't look at us,, but when they were discussing the feedback, I wished they would have turned to talk to us. Boyfriend: The third­person analogy just, I don't know, that's just something. Maybe there's something to be gained by that. I guess when they're talking to us, it's obvious that we're here, and it just seemed to be they should be looking at us. Girlfriend: Well, they've listened to what I had to say and I can appreciate the fact that they're just listening. But when they're actually giving the feedback, I wish they would then look at me. I just think there's more of a connection. In room; Don't want team to look if it dampens their observations Boyfriend: But if that somehow dampens their criticism or observations, I don't want that either. If that makes it Ill uncomfortable for them to be totally up­front and blunt about the thing they have to say, when they're looking at me, then I don't want them to look. What comes out is important­ I would have liked more feedback on what was said Girlfriend: Yeah. I want answers. But that's just like I said, me being impatient. I guess rather than just ending, saying, 'Our time is up and now David will come in,' maybe do one more round of, ' What did you get from the last part of their discussion?' I would have liked that. Because we took a break and they gave us some feedback and then we talked some more. Some things came out and then it was done. I would have liked more feedback on what was said. Case 211, Second Interview, Team Behind Mirror Behind mirror: I like this set­up where they weren't in the room and then we were able to ao in there and hear their comments on the flip side. Girlfriend: I thought it was really positive compared to last time. That had a lot to do with our attitude when we came in. And I don't think we were really dreading coming this time. It wasn't like, 'Oh my gosh, we have meeting at 6:00,' whereas I don't know if we were real positive about coming that last time­ But, I like this set­up where they weren't in the room and then we were able to go in there and hear their comments on the flip side. Girlfriend: Maybe it was because the tables were turned and I was able to kind of chit­chat with him (my boyfriend) while they were making comments. And I didn't feel, you know, the last time they were doing it, I think we just kind of listened, and maybe I didn't say anything because they were right there­ But I think a lot of that has to do with my attitude because Lhey were right there. But I think a lot of that has to do with my attitude, too, comparing between the two times. Behind mirror; It seemed easier when there was iust one person in room Boyfriend: Actually I thought I'd like it better with them out here, but it seemed to be easier when there was just one person here, although we were just talking with one person last time, too. It was just different about having other people out the corner of my eye. I knew they were there. I really don't know why, because I know they are right behind the glass, too. But, I don't know. There was something different. I think it worked better. 112 In room: I felt like somebody was back there anyway Boyfriend: Maybe it's the sense that even though nobody's back there, it's very obvious that this is a surveillance setting, you know, and maybe just adding those people here added to that a little bit of uncomfortableness in the fact that, just for sure there are bodies in here. I think maybe that was part of it for me. Because it felt like someone was back there anyway. There's sort of an mystique about a one­way mirror, that you know, is anybody back there? So maybe they're just lessening the hassle with fewer people out here. Behind Mirror: Viewed comments with more relaxation Boyfriend: It seemed to go a lot...I like the idea of going back there. It was interesting to see from the other side. And that did...you kind of viewed their comments with a little more relaxation and it seemed a lot less intense. Girlfriend: Yeah, you know because the last time we were here and they were sitting out here, they were just listening, whereas I think if you sit behind the mirror, you could do what we were doing, kind of flipping things back and forth, and I... In room: I think they're verv conscious that they're in room Boyfriend: It probably would be more helpful for them, too. Plus, I think they're very conscious that they're in the room, too. They don't want to make noise and gesture and although I appreciate that, being sensitive. But at the same time it gives you an unnatural feeling because I know that's not the way I would view the thing if I was back there. I'd be slouched over and like, 'Oh, that was interesting' and scratch my head or something, whereas they had to be very static in here. I don't think I would have liked it if they had been moving or talking. In room: they're trying to be as unnoticeable as possible: that's kind of weird Boyfriend: Because they sat facing the wall and perhaps if they'd been in the group it may not have felt that way. There's a real tension in that...I knew they were listening, but yet they had their faces to the wall and they're trying to be as unnoticeable as possible and there's something about that that's kind of weird. 113 In room: Prefer it with just therapist in room Girlfriend: And with Pat, you know, you can look at her and get her facial expressions, although she's probably trying hard not to give one sometimes. But it's just the face to face contact... even though you may not be speaking to those two, the idea that they're over there and so I just preferred Pat and and I and this set­up. I liked hearing it from them. Girlfriend: I thought last time, you know, when we got their feedback, I liked hearing from them because we stated last time, the more feedback you get, you can kind of pick it apart and maybe choose what you want to keep and really...But the first time I was here alone with Pat. She went in there and then she came back and said they said this and this. And, I liked hearing them say it. Now, whether it was me on that side or them in here speaking to me, I liked hearing it from them. Girlfriend: And it's just a matter of interpretation. And so I'd rather hear it from their mouths and then I'll interpret it my way, than...I have a lot of faith in Pat about being in the field and all, she probably understands what they're getting at, but I would just like to hear it from them. In room: Sitting over there facing the wall is something that's different and unnatural Boyfriend: And also, you lose that mystique, too, with, 'Well, this is what they said.' I wasn't there for that, but I was just thinking about how I would feel when they told me that. I think a lot has to do with these flags going up every now and then that something is different. Them sitting over there with their faces to the wall is something that's different and triggers in my mind that something is not natural or something is just weird about this. I think that once you get used to the mirror it's not that weird. Behind mirror: Being behind mirror more natural Boyfriend: For some reason I thought I remembered how awkward it was to have the window open. That was a flag. I really thought the hardware would really bug me, but that wasn't a thing I remember. Things, it's more the human responses. That being in the corner; that was unnatural. Even when they were talking about us like we weren't here, even though we were here, was something that tripped. And being back there, that removed a lot of that because it seemed more natural, because obviously we're not there. 114 Behind mirror: I would have thought that their conversation was more relaxed when we went in there Boyfriend: I would have thought that their conversation was more relaxed when we went in there because there's something different about, they know we're back there, when they were there discussing us before. I think they were a little on edge and making sure they didn't say, I don't know... Boyfriend: It just seemed that the guy was leaning back in his chair much more and it was a little more free and the subject matter was a little more free­flowing and positive. So there was that sense that they were just having a conversation, rather than they were, 'Well, I thought he was this and this.' In room: I feel like I have to include then in some wav or I have to acknowledge them Boyfriend: It seems like, it's hard to put a finger on it, but even when there are other people there, I feel like I have to include them in some way or I have to acknowledge them in some way, so then it's more like one­on­three rather than one­on­one. Even though they don't say anything or even if there were just two people sitting over there that know nothing about this, I'd feel like somehow I'd have to acknowledge them in discussions. Behind mirror: We were much more free to interpret and respond Boyfriend: I liked it because on both ends, both the people out here and us back there, I think we were much more free to interpret and respond. Even though they're not looking at me when they're talking and I can't see facial expressions, I really felt the need to nod, whereas I'd laugh or if they'd know that, that was right on. It sticks in my mind more what they say because of course, it's more like I'm on stage here. Boyfriend: (Behind mirror) I felt removed and like watching on TV and I can make a judgement on that and I don't have to worry about offending them by laughing at what they said or... Pat facilitating the guestions and giving positive suggestions is really helpful Girlfriend: And I think this set­up with Pat facilitating the questions and then giving some positive suggestions is really helpful and then we switched sides. They came in and they gave their feedback­ 115 Team does not owe us anything Girlfriend: I appreciate the feedback from those two versus Pat, because I have to sit and talk with Pat, and I think I may think on a certain point while she's talking to aside, whereas those two, they don't owe us anything. They're just listening and I think Pat was very, very helpful. Could both understand therapist's analoav Girlfriend: But it was also interesting to see how she would kind of make some comments that I'd better loosen up or else. He made some comments that is very structured and whereas, I think if Pat maybe said that, Pat's analogy of the boxes I think we could both understand, and we didn't feel as though she was taking sides, but they were a little more specific in that... It's a removal and I can handle that kind of criticism Boyfriend: I think just to have the freedom to name names. You know, which is helpful, although it might, like she said that, ' , I think you're...' I might say, 'Don't lecture to me.' Whereas if they say it, it's a removal and I can handle that kind of criticism. I got the sense what said that, you're kind of always feeling out does she think I'm way off base on this, or does she think is really right and I'm the jerk or what. I think it's important for this person to be kind of in the middle and let them go. Behind mirror: Just want to know if I'm being watched Girlfriend: I think the only thing would be not knowing if someone was behind the mirror af the very beginning. But otherwise I had no problem. Girlfriend: I just want to know if I'm being watched and... Behind mirror: It is very important to me that I know who they are Boyfriend: For me, anyway it's like, these are things I don't discuss. This is totally between me and . And I have friends, but personal relationships are not a topic of conversation. And to do this in front of people, it is very important to me that I know who they are, and if I saw them on the street that they would know something about me that I didn't know about them. Maybe if they could open that door and say, 'Hello.' Close the door and walk in here would be helpful. 116 I kind of like to know what the agenda is Girlfriend: I kind of like to know what the agenda is and then start. So if I would have known later on we'll be switching sides, it gives me an idea of the set­up and then I can get into it. Behind mirror: Important to me that I can visualize who's watching Boyfriend: I think it came back to I like knowing who's back there. It's very important to me that I can visualize who's watching me, what they're doing, you know, and just to take some of the mystery out of it. I think I would probably much better rather like the first way. But since we did switch and since I did know those people already, it removed that sense of who is back there. Behind mirror: Thev were much more comfortable in their feedback and I was able to interject some things Girlfriend: I liked this session better. Flip­flopping, and I think they were much more comfortable in their feedback and I was able to interject some things. Case 222, First Interview, Team Behind Mirror At first I thought it was kind of institutional Husband: At first I thought it was kind of institutional because there's like no pictures on the walls anymore, or something like that. It just felt it was kind of like cold or something. Wife: Cover up the cameras. I guess I always looked at those. Husband: It just didn't feel like, I don't know...an intimate setting, I guess you would call it. Intimidated bv the fence off in the window Wife: I thought at first I was kind of intimidated by the fence off in the window there. Like okay, we can't crawl out. Wife: But that and with the mirror and the cameras, I mean, when you first walk in, it's like...and the microphone. It's kind of like, what are we doing? But, you know, you either get used to it, or I mean, we still talk and stuff, so I guess the room itself. Just like said, it's kind of strange. 117 The chairs weren't that comfortable. Husband: Well, you start concentrating more on what you're supposed to be here for. So like, looking at a picture or something...you had nothing else to do. Let's put it that way. And the chairs weren't that comfortable. Wife: It was warm in here. Behind mirror: If there was some way that we could switch it so we could just stay here Wife: I would have, I mean, I thought it was a little strange. If there was somehow that we could switch it so that we could just stay in here rather than going out, meeting them in the hallway and then going in there and doing the same thing back. I think it would have been a little more focused if we just sat in the same room and then somehow reversed the mirror. It was good. I liked hearing what they had to say about us. It was just something I wouldn't expect Call those cameras') Wife: Well, just walking in there (observation room), we get to see all these cameras, like in Channel 5 newsroom or something like that. I mean it was just something I wouldn't expect. Wife: I don't know, I guess, why they would need the TV monitor going. I mean, of course the microphones were used to hear, and the mirrors we could see, but I guess on that one side back there is why, because I was kind of looking over that way and watching us on camera. It didn't seem to distract me Husband: It didn't bother me. I guess that I was more interested in that just because I like electronic junk, er... I know stuff about it. It didn't seem to distract me. Wife: Well, I just never thought there were going to be TV monitors and everything. I mean I just thought, you know, just a mirror and a microphone. I definitely felt its presence Wife: Just that they're right there­ I mean, if I were sitting this way or something, because every time Pat was in there, you know, I'd look up every once in awhile. I mean, it wasn't that big of a deal, but I definitely felt its presence. 118 I like that feedback iust to see how other people viewed us Wife: I mean, I like that feedback just to see how other people viewed us rather that just of from Pat and me. Wife: Yeah, because the people we talk to outside of here, everybody has their own opinions and here they came in being objective, because they don't know us. That is what we needed to hear a lot of that stuff. Husband: I liked it just like you could view us and come back and talk about it. Either bad or good or whatever, and just knowing we're not the only ones out there that think this way and maybe... It was so interesting to me to hear someone being objective about us Wife: Just being more objective. I would almost like to hear a little bit more than what they had to say. I mean, granted, everybody's on a time limit and I don't know how that could be done because of course, when they've told us their views and they can't talk forever. But I guess it was just so interesting to me to hear someone being objective about us and telling us what...I was just kind of intrigued to sit there a little bit longer and listen to it. If they would iust take each issue and talk about it Wife: I don't know if a longer session would really work, but maybe if we talk about certain issues, I don't know how this %^uld work, and then they would just take each issue and talk about it. Just talk about 3 or 4 different issues, and then if they would just take each issue and talk about it. They summed the whole thing up Husband: I like the way they just talked about, they summed the whole thing up, they just saw what they saw as important. It was refreshing to hear other people talk Wife: It was refreshing to hear other people talk. kind of gave us a break, too. I mean it Wife: Well, again, just the objective, people being objective without knowing us, without forming their own opinion about us, you know, like friends of mine talking about or whatever. 119 I'd kind of like to hear some resolving Wife: I'd kind of like to hear some resolving, I guess on what they would suggest that we do. I don't like it when someone tells us how to resolve it Husband: See, I don't like that though. someone tells us how to resolve it. I don't like it when Wife: Well, I don't necessarily want someone telling us what to do, but just say they could kind of work on this to see if that would help, or they could try this approach, or something like that. Just kind of their own opinion. Husband: But see, when you start doing that, then you start putting blame on the other person. I don't know, I think I liked it the way they did it. Either they had practical knowledge or book knowledge Husband: I didn't realize they were...I thought it would be just people like us or something like that. I didn't think they were, I don't know. I just thought they were different people, I mean, just like common people. Obviously, they had some knowledge about this stuff. Well, you know, just their knowledge, you know that's what I was impressed with. Maybe, just that they are older and could look back and say, you know, 'I went through that.' I think that's what impressed me the most. Either they had practical knowledge or book knowledge. I kind of liked how Pat was the mediator Husband: I kind of liked how Pat was the mediator. Wife: That's definitely what we needed. Kind of a referee. Wife: She let us do the talking. And she let us look at each other and she wanted us to get going on it, which was kind of hard to do at first when there's someone right there, just to turn around and start talking to somebody and leave her out. It's kind of hard to get started that way. Wife: I liked it when we did get to talking, but I also think she came in and talked when she needed to, too. 120 I liked it because I didn't know who thev were Husband: I guess I did like it, but I guess it's just like you didn't meet them beforehand. You didn't know who they were or what they were. Wife: I always thought they, okay, they're looking at me on the other side. Husband: I liked it because I didn't know who they were. In fact, if I would have met them beforehand, I probably wouldn't have liked it. Husband: Okay, since there were two women over there, I might be more slighted to . I might present myself as being a non­male chauvinist or whatever. I'd put on an image that would make me look good in their eyes. Just like vou feel like you're in a studio Husband: It's kind of technical. Husband: Just like you feel like you're in a studio. been in TV studios. Husband: Because of the mike thing and cameras. in movies or shows. I've You see those Wife: The fluorescent lights. Case 222, Second Interview, Team In Rccm In room: You could see if they were looking at me or laughing at what we said Wife: I felt more comfortable. I guess not knowing that there is anybody around. I guess that really bothered me the other time. Not really knowing who it is. I guess when the group is here, now I think if they were sitting like just around, it would have be a little different, since you'd feel like you have to talk to each one. But since they're over there with their backs towards us, you still focused on Pat. So really, I guess they never bothered me sitting over there­ I guess I could maybe see what they were doing. You could see if they were looking at me or laughing at what we said or something like that. 121 In room: Mavbe I thought thev weren't quite as objective Husband: Uin, it didn't really bother me one way or another. People were there. I kind of liked it better when they were over there­ Husband: I guess I really didn't know what was over there. I mean, there could be nothing over there. Where here, you know there are three people here. And maybe I thought they weren't quite as objective. I just preferred them over there, I guess. Husband: I feel like when someone is right there with you that they're going to be easier on you and they're not going to really evaluate you. It was like if you're a teacher of math or something, you're going to be really easier on them since you're actually working with them, rather than if you're just a teacher of a thousand to really know the person. I liked the metaphor Pat used. Husband: I liked the metaphor Pat used. Husband: Um, sometimes describing it in a way that is not really abstract or concrete you can think about it, because it's not really concrete. You can see what the person's really thinking about, rather that whatever someone's trying to tell you. You can see more into it, I guess. It is more visual. I liked it when they were describing their experience. Husband: I liked it when they were describing their experience. I kind of like it because thev have sat in on one of our sessions and that they weren't starting out cold Wife: I kind of like it because they have sat in on one of our sessions and that they weren't starting out cold. They kind of knew, not really a background, but they knew a little bit about us and they could kind of compare it to last time. Or you know...and how they used our names, so it was like they remembered us from last time. In room: If there was a little more room for them to be farther awav. Wife: I guess if there was just a little bit more room in this room for them to be just a little bit farther away. 122 Wife: Well, because when Pat was sitting in here, I was sitting at an angle and then I could still see, I forget her name. And even though she wasn't looking at me or necessarily paying attention to me, it was just when I turned to look at , I always tend to stop and saw here. I don't know if that's a big deal or not. Wife: But like I said, it was a lot better than having them all sort of spread out. If they were more spread out. I'd feel like I have to talk to each of them Wife: I guess what I'm just saying that if they were more spread out, I'd feel like I have to talk to each of them, give all of them my attention instead of just Pat. It's hard to focus on one person and there's several staring at you. Behind Mirror: I kind of liked it better when the glass was there. You didn't reallv focus on them as much. Husband: I kind of liked it better when the glass was there. You didn't really focus on them as much. Husband: Your eyes wander to see what they were doing. You know, if they were giggling or something. Like if they shifted positions. Wife: It was close quarters. Wife: Well, just like was saying, when they shifted, you know, but he was sitting closer to them than I was. You know, just to give us a little bit more room. I liked the fact that we didn't have to get up and move Wife: I liked the fact that we didn't have to get up and move. Wife: I just kind of settled in a bit more without having to get up and move and go over there and then come back and sit back here and try to be comfortable every 15 minutes or whatever. Husband: Yeah, I liked that, too. Wife: Yeah, you're more at ease sitting in one spot. 123 Could vou have a curtain just drawn over there to separate them Wife: Could you have like a curtain or something like that just drawn over there to separate them. Even though you knew they were still there, you wouldn't have that extra visual contact with them or that extra hearing them shuffle their feet or clear their throats or whatever. And then you could just focus on Pat and then you still would be in the same position and just open the curtain. Husband: I'd probably have them behind the glass. Because it's less distracting. Either way they really bothered me at first. Behind mirror: I felt like I could be a little more open if thev were behind the glass. Husband: I guess I felt like I could be a little more open if they were behind the glass. Even though I know they're there, I probably could be a little more personal. In room : I liked this one because with the glass we never really knew what people were doing over there or who was going in and out Wife: I liked this one more just because with the glass we never really knew what people were doing over there or who was going in and out. Wife: I guess just the fact that just knowing that they T.70T­O "K0^0 SO no ons âXss Ids sirs Switching the rooms got kind of embarrassing Husband: Switching the rooms got kind of embarrassing a little bit and once I got over the fact that they were here, I kind of just put them out of my mind. In room: You knew what you were up against. Husband: At least you weren't constantly having to worry about what's behind there. You knew what you were up against. 124 Case 213, First Interview, Team In Room Could empathize with what I was saving. Male: It was a bit helpful, at least for the short­term. Male: Partly because of the...maybe the group was a bit empathetic or could empathize with what I was saying. Male: They seemed to be able to identify with me. Male: Like I said, maybe the fact that someone else might understand maybe gives me a little bit of both. I liked hearing several different views Male: I like getting a little bit of feedback Male: I liked hearing several different views. I guess for each person I thought that maybe a part of what they said helped and I think together you get a more complete picture. In room: Just because I could keep track of them Male: I was a little paranoid wondering what they're doing over there. What they're seeing, whatever. Male: Just because I could keep track of them. In room: I was a little uncomfortable. people in here Just having more Male: I guess at first I was a little uncomfortable. having more people in here. Just Male: Generally, I don't like to talk to groups of people. least when I'm talking about personal things I don't like having a group of people. At In room: The fact that thev were in back of me. so I didn't dwell on concentrating where thev were Male: It may have actually helped. The fact that they were in back of me, so I didn't dwell on concentrating where they were. Male: (If they were in front of me) I think in some situations it would have felt like I was being examined. 125 I did wonder if thev were familiar with what talked about earlier Male: I guess I did wonder when they came in if they were going to be familiar with what we talked about earlier. I was a­ little bit concerned they were going to thrash that out and do it all over again. Male: That I don't have to start over several times with a new person. Changes: Get rid of white; lower ceilings; get pictures with outdoor scenes Male: Lower ceilings. Get rid of the white a little bit. Needed some pictures, some outdoor scenes. Might even put a cover over the video lens, so you don't get a direct light. Male: For me, outdoor scenes are kind of relaxing. Case 213, Second Interview, Team Behind Mirror Felt like they were in touch with mv experience. Male: There were times when I thought they were interpreting what I said...felt like they were somewhat in touch with my experience. Male: They understand me, maybe? Male: Just the things they said. Just getting their interpretations. How they see me. They didn't say anything like I think is... Male: Kind of the way they said it. Uiri, partly that they could understand the weight of it. It wasn't really something that was foreign to me. They could understand what it would be like to be in my situation. Male: They were saying things like, 'It's hard for me to imagine.' They could understand sort of how I feel and what it would be like to be in my situation. It makes me feel like it's maybe a little more tailored toward me. Male: Yeah, I told her how I felt; how I sometimes react. the challenges I might put on her, and she said, 'Okay.' And 126 Male: It gives me a little sense of, I don't want to say control, but it makes it a little more personal. It makes me feel like it's maybe a little more tailored toward me. Male: Again, hearing what the group said. I'm not sure which I liked better, being there when they were speaking up here... I don't right now have a clear sense. In room: but when they're back here I'm more aware of them. Male: In one way, I guess I didn't have to think about them being back here. Yet, I had to be aware of them being there, so, urn...in some ways when they're over there I'm not sure what they're doing, but when they're back here I'm more aware of them, more aware of what they're doing. Behind Mirror: It was awkward tonight. Sometimes it might be a little more comfortable if it was actually a regular window. Male: It was awkward tonight. Sometimes I wonder if it's one­way. That they can see in here, but I can't see in there. Sometimes it might be a little more comfortable if it was actually a regular window. Even though I know they're going to be hearing and seeing me, the fact that maybe I can see them, but they're not right here, I don't know. Behind Mirror: I wonder about what reaction they're having to what I'm saving Male: I guess maybe sometimes I wonder about what reaction they're having to what I'm saying­ Maybe I could look over and see their facial expressions. Bur maybe that's something you don't want me to see. Have them all involved: Ch^ncc for ne to respond back Male: I guess sometimes I wonder what it would be like to have them all involved...but I guess it would take away from the forum...Maybe I could have brought up another issue. That would give me a chance to respond back and bring up something else if there was something else I wished to get across. I might have them go on the other side: Could maybe speak more openly. Male: I think a little bit this one. In some ways it was a little more...I might have them go on the other side. Me or 127 them. Maybe I felt that they, with them seeing me, that they could maybe speak more openly without... In room: When they were back of me, kind of distracting Male: In some ways it's kind of when they were back of me, kind of distracting. Male: Just knowing they were there, over my shoulder. I wanted to look over my shoulder or turn around. I couldn't tell how they were reacting to what I would say. Case 224, First Interview, Team Behind Mirror But it gives me a thought and a different way to look at it Husband: No, hearing what they're thinking when we're talking. Not just in the beginning when we're just scratching the surface. Husband: I have my ideas and views and opinions of things. On some of the things, for instance, that I heard them say tonight, I agree with 100%. Some I don't. But it gives me thought and a different way to look at it. Wife: It was positive for me. I was like . It gave me a chance to, a lot of times, hear my own words come out of somebody else's mouth. And, again, some of them I agree with, some of them I'm not sure. Mavbe it allows me to have some second thought Wife: Um, being able to hear their feedback. Wife: Maybe it allows me to have some second thought. I think I feel we're in such a rut right now, it's just real tight, and by hearing that feedback, maybe it let a crack in there. Reaffirmation that my thinking's okay Wife: I guess part of the positive was hearing them say some of the things I think or feel...reaffirmation that my thinking's okay, my approach to problems. Just different viewpoints that I have heard Son: Just different viewpoints that I have heard. Maybe hearing them suggest things again, they're backing it. Or hearing things I've never heard before. 128 Son: Just having another chance to work it out. Son: Being able to hear and just having their opinions. Hearing them discuss it between themselves. Son: Well, usually when we talk, it's the three of us, and seeing three more people going over the same thing and getting a different outcome. They were able to resolve it, which means at some point we will be able to. I guess knowing that we're not alone. Wife: Just that, you know, like I said, we're in a rut. And there are some other possibilities we maybe have talked about, but we fall back into the same rut. I guess knowing that we're not alone. Behind mirror: You could have an extra time. We'll switch places and let them talk, and then we'd talk, and switch Places again. Wife: I think that, too, because sometimes in listening to them, what I heard them pick up was just very, very thin surface. There were a couple of times I wanted to say, 'Wait, I want another turn because...' But I think that goes with what said, it's early. Son: You could have an extra time. You know, we'll go through it, we'll switch places and let them talk, and then we'd talk and then we could switch places again and see what the outcome would be. And then maybe a couple of follow­ups Wife: I would like suggestion, and I don't know if that's the true foirmat or not, but to maybe have two different times. See what they've perceived as what we've been saying to each other or discussing with each other and then have a chance to come back in and say...I guess clarification. Wife: And then maybe a couple of follow­ups for them to understand whether...did they perceive it as different than originally. In room: Another idea is having them in the actual room Son: Um, I guess another idea along the same lines is having them in the actual room, not two different rooms watching, but have their feedback all the time. Have the team with the person while you're in here talking. 129 In room: Not have two rooms. any point We could have their feedback at Son: Not having two rooms, I mean, so we could have their feedback at any point. Or if they had something they would like to say, then they could tell us at that point instead of having to wait and having to go through and touch on each topic. Every time we're talking about a topic, if they have something they would like to say, then they could tell us instead of having to wait until switch places. Son: We could go farther into each topic and maybe resolve it sooner than having to go switch 2 or 3 times doing that for 3 sessions. I think too much lost then, back and forth and back and forth Husband: I could see that as helpful that maybe they would be able to get out of us easier, quicker, what's getting at us. But I think too much could be lost then, back and forth and back and forth, and so on. Husband: I would probably say too much trying to defend our own thoughts or beliefs to strangers, per se. Just that the effort would be put there instead of what's bothering us. I think ­just a couple Wife: I think just a couple. Husband: At the most, two, I would like longer sessions Son: I disliked it because when we get started, it's kind of easy to forget what you were talking about at that time and come back two weeks later and try to pick up on it. Son: I would like longer sessions. further each time. That would enable me to go It helps me being here and knowing that I'm going to have some help and feedback with that Wife: I guess maybe it helps me being here and knowing that I'm going to have some help and feedback with that. That maybe I cannot get so frustrated and therefore have a little more patience with the situation. 130 I liked hearing them talk. behind the ears. The fact that thev aren't green Husband: I like hearing them talk. The fact that they aren't green behind the ears, they have some experience under their belts. Not that I necessarily agreed with everything, but it...gave room for thought. Husband: They talked about their own kids. Case 224, Second Interview, Team In Room In Room: Their sitting there makes me a little hesitant. Husband: After last week, I did want to get away from the superficial things so that they could hear that and possibly get something back on that. Um, but at the same time their sitting there it makes me a little hesitant. It was easier to talk to one person than two or three. Son: It was easier to talk to one person than two or three. Wife: It was harder to jump right in. In other words, we started with the same things that we did the time before and the time before, picking up after themselves and that kind of things. Wife: Yeah. It was harder to be open. Maybe they're going to hear a different perspective or a different attitude. Wife: I think to me it was more like, even though being a team, they're just kind of assessing what we're trying to do. It was still more like they really weren't listening. You know, we've known through the study that there was a team to it, but actually having them present, maybe they really were listening and maybe they're going to hear a different perspective or a different attitude come out of the same sentence than what I hear. I don't know. I didn't mind them being here in the room 131 In room: I had a chance to make a rebuttal Husband: This time we could still talk after they did. I like that better. If I felt maybe I didn't make myself clear, or they didn't see my side, I had a chance to make a rebuttal, I guess. And it was not so much that they were here or in there, but they said what they had to say sooner, so I had a chance to respond. Wife: I think we all three talked about last time that we wished that we would talk and they would talk and we would talk and they would talk. What we wanted was a little feedback. Have them talk about how that person could change Son: I guess last time we were here, it was more like they were gossiping about us. This week they really didn't talk about one person. They talked about past experiences, which I couldn't get as much out of it as they did and how that affects me, and how they could stop that. Son: Have them talk about things, what they thought of or how that person could change. In room; I would just prefer that if they were talking that they would face you Husband: I don't know if I disliked the fact that they did not face us. But it might have made it easier for Lheiu to talk, um, other than to have made eye­contact. Um, but I guess what said, they talked on their families and that kind of thing. And it may have been uncomfortable for them, too, if they faced us. Husband: I think I would just prefer that if they were talking that they would face you. If somebody wants to talk to me, I like them to face me. Extend it for a longer length of time. Wife: Extend it for a longer length of time. I would like them to ask the questions Husband: For me personally, I guess, if they were to do this again, I would like them to ask the questions after having watched and listened to us. Husband: That would maybe help us open up more or dig a little deeper into what's going on. 132 Son: Like you were saying, after they asked the question, then get their answer. Then they could give us how they perceive it. Then that way we could see if they understand us. And it would allow us to have a chance to get through our message, what we are trying to get across. In room: It just made it more real Wife: I liked it in the room better. Husband: I like having them in the room. Wife: I think it was because having them in the room, knowing that it is teamwork and that we really get feedback of how they perceived and what we're communicating to each other, I don't know. It just made it more real. That there was a team here and that there were people to give us feedback. In room: Additional time they aave feedback Wife: It was the additional time they gave feedback, too. They were in here, in body. And we talked and communicated with each other and they gave feedback and we again from that point went on. And I don't know, I felt more anxiety back there listening to them... In room: It seemed more like gossiping about us then giving us feedback Wife: It seemed more like gossiping about us, than giving us feedback, even though they did not face us. I don't think 4- V> o ^ / C! 4- VI1o cC î i r>n4- f ^ Combine more feedback with team behind mirror Son: I guess if you could combine us talking and them giving feedback again. I guess I would prefer if you could do that behind the mirror. We would be able to get further and explaining exactly what we want. They're not hearing what we need to talk about. Husband; Today when they were in here, what I got is that we were stuck up here and we needed to get down here because a lot of what we talked about both times, well this time was a lot of what they said last time, it was just a little different. But it was still on the same thing. It told me that we're not discussing what we need to discuss. They're not hearing what we really need to talk about, I guess. Having them come in both times and visiting and telling us the 133 same thing, we realize that we're stuck up here. To me to get to the heart of the problem. It opened my eyes that we're having trouble getting there. At least I feel we are. Husband: That I'm more aware of it? little more riskier in what I say. I guess I will become a In room: For me being watched. I hesitate to sav things Husband: I guess for me being watched, I hesitate to say things. But what I was getting tonight, listening with some frustration because we weren't really moving forward. We were stagnant. So maybe I'll stick myself right in the middle.