Seven hundred cases a year, in Milwaukee

What are you working on at the moment?

Nothing very new: for seventeen years now I have been working at the Brief Family Therapy Center, at the Wisconsin Institute of Family Studies, in Milwaukee. I spend most of my time there teaching and working a great deal: I see seven hundred cases a year. So my world is very largely dominated by my clinical practice, and that practice addresses a particular population: almost all of my clients are poor people, without economic or social resources… To answer your question, what I mainly do is clinical work, and it is that work which creates in me the need to think and to develop the theoretical resources with which I then write my articles and my books.

Brief therapy: similarities and differences

You are here at the MRI on a visit; forgive me if I am very direct, or too blunt in my questions, but the differences between the model developed by the MRI and what emerges from your work do not always seem clear to me…

Hmmm… That poses problems of definition that are really too great for me… I would like to begin with what we have in common: I believe that the people who work here, and I myself, understand language as the source of our data. But that is also where a difference can be found: I think that the MRI clinical team believes more in the validity of the concept, it pays more attention to the search for an intention of the author, or of the person speaking. I think they take the view that we can discover what that intention is, and that they then use it rather as if it were a report. For my part, I believe that language, what happens during the sessions, is something that evolves between the client and the therapist. The creation of emergent phenomena is very important to me: something close to what Keeney calls “moiré patterns” (see the note at the end of the article), different elements that come into relation with one another and produce an emergent result.

Let us see whether we understand you properly: for the MRI, intention would be a piece of data, and for you it is the outcome of something that occurs in the course of the interaction…

The data are the words themselves as they are used in the session, not something that would stand outside the therapeutic dialogue. That dialogue arises in, by and through the interaction. For example, the consultation brings a problem and what is sought is to give it the form of a solution. The therapist does not record what happens the way a videotape would: he builds something like his own map of the solution and represents it to himself in his own way, he builds a map of his perception of the client’s interpretation. So there is one map, the client’s interpretation, and another map, the therapist’s. The space, the frame created by the differences between the one interpretation and the other, offers the possibility of designing the intervention.

The impression I have sometimes gathered in Buenos Aires is that you use language with more emphasis on re-signifying what clients say, as though your model gave a larger place to a psychology, to subjective, cognitive processes that can be reframed (reframe).

No, we do not do reframing in that sense. It has to do with the way we understand the therapeutic dialogue. In the West we tend to interpret everything in a very linear fashion, because of the limits of our own language, which incidentally takes the place of reality very easily. It is true that, for a family to change, there has to be a change in its emotional or conceptual point of view on what concerns it, and the rules that organise its way of interacting also have to be modified. These are our different conceptual levels, questions which in practice present themselves together: it is the clinical dialogue and its context, and all of that only makes sense there. It is not someone, the therapist, who reframes or re-signifies. For instance, a family, a client or a couple set out their problem, their complaint; the therapeutic team will try to describe what it has heard in such a way that its reframed description serves as a guide, so that the intervention does not stray too far from the pattern of the description the family has given; and the family, in turn, must be perceived as cooperating with the task, as it has done all along. But what is said will also have to present a slightly different angle: a difference should be grasped by the family. Sometimes it is not the “new point of view” but the fact that “something else” is possible that fosters change…

You spoke of “the family understood as cooperating”… (cooperating).

Yes, it is a concept that interests me; we have been developing it as an idea for a long time. We take the view that the family displays before us a particular way of cooperating with the task of change, and that we have to describe that particularity in order to be able to cooperate with it in bringing a change about. When I was speaking a moment ago about reframing, I was saying that the team’s task was to arrive at a description that, more conceptually, I would now call isomorphic, homologous to the family’s own. What that isomorphism is to questions of meaning, cooperation is to questions of observable behaviour: to what we are going to say and do.

It is not the same thing to consider oneself part of the system and to seek to take part in it in a homologous way, as to be there “from outside” to correct errors in patterns of functioning. It is not the same thing to have to “choose” between “what belongs to the family” and “what belongs to me”, as to work with what is “ours” and escape explanations.

Clinical work and language

You are fundamentally a clinician; and yet your latest work moves towards fairly theoretical aspects of language, Wittgenstein appears in it a great deal… his theory of language… In short: what did you go looking for there, or what did you find there?

One probably has to take seriously what people say, what the people who consult us say. Not to try to explain, but to describe. That is the work: describing, because things cannot be explained… Creating with them the conditions in which change can come about.

You speak of language as a “game” that produces meanings…

Yes, that is it. Meaning emerges in a relational whole between people. The meaning of words depends, it emerges from the context; it is intimately bound up with the way people use words in each interaction. Wittgenstein was very important to me in confirming my approach and in finding new paths for my thinking.

In many places where clinical research is done, and even among many clinicians, one finds the idea of arriving at an integrated model: integrating into a metamodel various technical variants and related elements, even ones drawn from different epistemologies; a search for theoretical and technical integration for clinical psychology. Do you believe we are heading that way?

It is a waste of time. The most interesting differences between models are the ones we must preserve. It would be like wanting to erase national borders. The borders that exist between different epistemological models are sometimes as artificial as the ones that separate countries; but in knowledge, knowledge is born of differences.

Psychotherapy and commitment

Turning to another subject: you told us that you work with poor people. Is that something you chose? And if so, what for?

I find the cases more interesting. These people come with their problems, but those problems are surrounded by real-life problems: the context is richer… Others fail to see that these people possess an enormous amount of know-how that nobody knows about. Know-how, resources that nobody knows or acknowledges they possess, and that very often they are unaware of themselves…

Along those lines, how do you place yourself personally, as a health worker working with poor people? What is your commitment?

It is political.

Your answer surprises me: it has often been said that our models were formal, that they tended to formalise human relations and that they were not very committed politically.

The model is not, but our clients are…

We come from a country where political commitments in the face of social situations are sometimes very strong, where the therapist’s role becomes entangled with notions such as social control and power…

In my case, these are people who have no health insurance, nor any other form of state assistance. Whatever medical coverage scheme the government puts in place, it excludes a good percentage of users. What matters slips away through the cracks in the system.

What is the main virtue of a therapist, what should someone starting out aim at?

Learning to listen to people and to take seriously what they say. If they say they have a big problem, even if you think it is a small one, you have to treat it as a big problem. And if they say that it is not a big problem, or that it is a small one, or that there is no problem, we have to listen and take seriously what they tell us, because that is what they mean.