3. Honoring Client Perspectives Through Collaborative Practice

I begin this chapter with a confession: When I was a graduate student I disliked clinical theory. In fact, dislike may be too weak a word—I loathed clinical theory. I disagreed with clinical professors; I wrote papers counter to traditional clinical ideas; I found clinical theories objectionable in much the same gut-wrenching way that it is possible to dislike Brussels sprouts or liver (apologies to all those liver and Brussels sprouts lovers out there). I don’t mean gut-wrenching in the nervous way. I was never afraid of clinical theory—I mean gut-wrenching in the marginalized and discounted way. Whenever clinical theory was presented, I felt my perspectives of the world and my ideas of self were somehow co-opted and diminished. Clinical theories seem to have a totality about them, a cementing kind of logic that traps dynamic and flexible understanding as they solidify into “correctness” or “truth.” As a result, I was on guard against the limiting definitions of whatever clinical theory was to be discussed, and I tried as much as possible to protect my own understandings and perceptions.

The beliefs I held as a student about clinical theory and my defensive posture regarding my own perspectives were most influenced by my experience of being an identical twin and my sixteen-year participation as a subject in the Louisville Twin Study. Now, many years later, as a practitioner and associate professor, I imagine that my clients, as well as my students, may sometimes feel marginalized in the same way that I did when totalizing clinical theories¹ are used in practice or are taught as ultimate “truth” in the classroom. These experiences and beliefs led to my interest in social constructionism as a kind of meta-theory for practice. For me, social construction invites a way of being that maintains that there are multiple ways of understanding, and that all theories have merit within the parameters of their own construction. Most importantly, social construction places client understandings alongside traditional clinical theories in a nonhierarchical manner so I can practice with others without having to name one way of understanding as the absolute. My clients and I do not have to inject a clinical theory of understanding into our relationship that supersedes the understanding that is constructed within our relationship.

Most often in modern social work practice, the imposition of a totalizing clinical theory upon a client begins during the assessment. In this chapter I explain and demonstrate how I change the modern notion of an assessment in my practice in such a way that it does not encase my clients in rigid outside clinical definitions that may marginalize the meanings and understandings that are constructed in our discussions together in the space that we call practice. To me, making this shift very much depends upon understanding social constructionism and recognizing that constructionist-informed practice is a mindset, a way-of-being in relationships, rather than an application of techniques.

The chapter begins with a transparent discussion of what drew me to the constructionist position I hold, emphasizing my sixteen-year participation as a subject in the Louisville Twin Study. Next, I offer a brief explanation of social constructionism as it informs the mindset of my practice. I then discuss three specific ways in which I use social constructionism to inform my practice as an alternative to a traditional assessment and share real-case examples of each: (1) a polylingual collaborative approach, in which the client and I seek to match the client’s theory of the problem, and solution to the problem, to compatible clinical approaches; (2) a strengths-based, non-pathologizing approach in which the client and I explore strengths rather than assess deficits; and (3) a deconstructive approach, in which the client and I explore the client’s understanding of the construction of the problem and jointly decide whether the problem construction is in the client’s best interest. While comparably constructionist, these exploratory approaches are unique, each challenging the notion of the static traditional clinical assessment and advancing social work practice in an ethical and collaborative way.

My history with social constructionist ideas is rooted in my experience as an identical twin. Growing up as a twin gave my brother, Tony, and me a keen awareness of ourselves in relation to one another. We were always being judged concerning such things as who was taller, heavier, smarter, and so forth. This was a constant occurrence and a ritual that is expected, even to this day. The ongoing comparison had the effect of emphasizing that we were defined by outside interpretations. We often felt as though we were objects because we were in a constant state of being objectified by others and almost always viewed as twins first and as individuals second. In current discussions with Tony, we both recall that as children we felt that we were never truly seen as whole individuals, rather we felt like a collection of variables in comparison to another collection of variables and were in essence, growing up as objects of comparison. This had a very limiting effect on how we understood ourselves. Nowhere was this more evident than in our sixteen-year participation in the Louisville Twin Study, where we were compared to each other by being quantitatively measured and “objectively” defined via batteries of tests beginning at three months of age.

The Louisville Twin Study was internationally recognized as one of the oldest, largest, and most comprehensive studies of child development related to multiple birth status and is unique because of the extensive, longitudinal assessments and . . . the relatively low rate of mobility out of the Louisville area . . . data consists of extensive longitudinal evaluations of child factors such as temperament, personality, cognitive abilities, physical growth, health status, accidental injuries, and school achievement from birth through adolescence. Genetic data were collected on a sub-sample of the twins and their families. . . . Participants contributed significantly to our understanding of the complex interactions between genes and the environment. Twin and family studies provide a unique method to examine the many factors that contribute to developmental and health outcomes of children and to understand the underlying processes responsible for individual differences in those outcomes.

My first experience as a subject was in 1969, and my last testing was in 2005, at the age of thirty six. Tony and I were tested every three months during our first year, every six months until age three, annually until age nine, a follow-up test at fifteen years, and finally, in our case, testing at thirty-six years of age. During these tests the following protocol was utilized: “The Bayley Mental Scale was administered at three, six, nine, twelve, eighteen, and twenty-four months of age; the Stanford-Binet at thirty and thirty-six months; the WIPPSI at four, five, and six years; and the WISC or WISC-R at seven, eight, nine and fifteen years. Recently, (1980s) the McCarthy test has been substituted for the WPPSI at four years because it gives a broader sample of the child’s behavior at this age. . . . Zygosity was established for same-sex pairs by blood typing on twenty-two or more red cell antigens” (Wilson, 1983: 300).

The effect of these tests amplified the comparison by others and placed my brother and me in what became a definitional competitive position. The hour-long drive from our small Kentucky town to the tall building in downtown Louisville filled with doctors in white coats was quite intimidating for a child. To us, this was a mysterious and dangerous place. The entrance was always locked to protect against homeless people wandering in; inside were busy scientists and doctors with hard looks on their faces or pasted-on smiles as they passed in the halls. They were conducting important business, and we were their subjects. We felt that as scientists they had the power to unquestionably define us via an intricate, mysterious, and veiled process, which was amplified by a policy that did not allow us to know our scores. “How did I do Mom? Did I pass? How did I do compared to Tony, to everyone else?” She would reply, “It doesn’t make any difference, you did fine.” “Then why are we doing this Mom?”

It is the following paragraph from the study protocol that brings a smile to my face and is perhaps the basis of my present views on the scientific method in social sciences. It was certainly what my brother and I were most intimidated by, resisted, and later had the most fun with, when taking these “objective” tests. “At each visit, the twins were tested by separate examiners, who also alternated between the twins over successive visits. The test procedures were rehearsed intensively to assure comparability among examiners” (Wilson, 1983: 300). This sounds quite official, or perhaps inane, but in application, it was chilling. I remember the researchers’ stone-like faces, specifically the tension in their eyes, as they strained to remain silent and to be coordinately objective so as to not contaminate the findings by latent variables. I am reminded of the way ornamental guards stand quietly and stare blankly when guarding the capital of wherever. Their facial expressions and overall tone was very strange for us, and I distinctly recall wanting to speak with my testers. It took years before I gained the nerve to do so. I would ask, “Why are you acting so weird?” “Who is behind the mirror, and why are they watching?” “Why won’t you talk to me?” and as I got older, “How can you define me if you don’t speak with me?”

The neutrality associated with objectivity breaks down when considered relationally. If one party takes an objective position, the other must take the position of being the object. It is in this way that objectivity can be seen to inflict certain relational consequences on subjects. Objectivity demands that subjects acquiesce to the position of being an object. Accepting a position as an object involves placing certain restrictions on oneself. In my situation it was expected that I behave by being quiet; not asking questions; not moving around, focusing, doing my best, and not thinking about Tony, what I should or shouldn’t be doing, whether I missed a question or not, how the results may affect me or my future, who the person was sitting in front of me, who was behind the mirror, if my mom was behind the mirror, what my mom thought, if I was letting her down, and so on—and all the while, I was supposed to “just act naturally.” How it is thought that data gathered from this relational objectivity game reflects anything other than the context from which it was gathered escaped me then and does so to this day. None of these data were “objective” and context-free; they reflected my brother and me reacting to very odd, unnatural situations with very strangely mannered people in white coats.

Thus, objectivity is not simply controlling variables in an attempt to determine definitional truth or to gain a valid assessment; it is a relational game that both parties must play. I was being invited to forget myself in context. The pressure of sitting in a room with an “expert” who was trained to define me by the parameters of some paradigm that would take precedence over anything that I said was quite intimidating. After sixteen years as a testing subject, I can confidently state that the social sciences are remiss, or perhaps arrogant, in not recognizing that objectivity changes the context, the relationship, and the thoughts, feelings, and behaviors of the human being invited, or forced, to self-subjugate into the relational position of “object.” For this reason, I strongly maintain that acts of “objectivity” are acts of relational oppression (Hall, 2008).

The segmenting of our identities could only be tolerated for so long. The tension and sibling conflict generated from going to the clinic to be compared by imposing experts became too much, until around age nine when we rebelled against outside totalizing attempts at defining who we were. In retrospect, Tony and I wanted to be subjectively understood rather than objectively defined. The testers’ silence, that so intimidated us in the clinic, lost its effect as we resisted the invitation to “behave” and to ignore the researcher–subject relationship in these testing situations. Our resistance took many forms. We finally began asking the examiners why they were acting so weird. “Just answer the questions” was the reply, and the test resumed. A card would be held up, and the tester would ask, “What do you see?” “I see a guy holding a card.” “No, what do you see on the card?” “I see a guy’s fingers over part of the picture on the card.” “No, what’s on the card?” “What did my brother see?” “I am going to ask you again, what do you see?” “A guy getting angry holding a card.”

In retrospect, by rejecting objectification we chose to honor our voices in the relational negotiation of self through challenging these outside definitions of who others thought we were or of what we were supposed to become. We ran up to the one-way mirrors and peeked in. We talked to each other during testing by going to the bathroom at the same time. We asked questions about the examiners’ height and weight, if they had gained or lost pounds, how smart they were, if they had kids. The climactic event was when a tester broke under Tony’s persistent questioning about why he was acting so strangely. The examiner got up from the desk and yelled, “I quit, I am not doing this anymore. You’re screwing with these kids’ heads. I will not be a part of this. I can’t take it.” Tony and I glanced nervously at one another in the clinic, but the hour ride home was filled with an excitement that we didn’t understand. Today, we feel that perhaps it was the excitement of expanded possibilities for an equal negotiation of self in our relationships with others.

The home visit protocol was constructed of 200 items based partly on answers to interview questions and partly on direct observations. . . . Four factor scores were obtained from a factor analysis of the home interview items. The first factor was labeled “adequacy of the home environment,” and items loading on this factor represented global judgments about the adequacy of the interpersonal and physical environment for promoting intellectual and social development, plus more specific judgments of play space and qualitative features of the home and furnishings. Characteristics of the mother were defined by three factors. The first factor was drawn from ratings of the mother’s emotional reactivity (e.g., tension, tolerance for frustration, mood, and activity level) and was labeled “maternal temperament.” The second factor was represented by ratings of the mother’s intellectual and verbal facility and home management skills and was termed “maternal cognitive.” The third factor, termed “maternal social affect,” was represented by ratings of the mother’s sociability, talkativeness, and interpersonal warmth. These three factors, plus the “adequacy” factor, represented the bulk of the ratings made during the home visit. The four factor scores were combined with the measures of parental education and socioeconomic status as the composite profile of the home/family environment. These scores were subsequently analyzed for their relationship to offspring mental development during childhood (Wilson, 1983: 308).

Did you read the entire description above? If you skipped it or if it was tedious for you then you just had a brief experience of what it was like to interact with the testers who followed this protocol. Now consider what it was like for a child. I remember how strange it was to see these robotic-like people with clipboards and checklists come into our house and interact with us in ways that I imagined, at the time, that aliens might interact with strange Earth children. Tony and I were initially a little shy, but this was our home turf and as any young children might do with strange invading aliens, after some attempt at human-alien contact, we reverted to the game of, “Let’s see how many ways we can bother the aliens and upset Mom.” This took many forms, all of which you can guess children of our age would do (and perhaps you did as well). I do recall how nothing was like it normally was at our home during home visits. Mom always had a general idea of when they were to arrive, and she made sure everything was clean, our toys were picked up, and the television was off. We also were instructed to be “well behaved.” If these visiting scientist thought they got the real story of our home life, they were blinded by their own theories of who they thought we were and the fancy language in their four factors of measurement protocol. Of note is that our father was left out of the home visit protocol, another indication of the culturally constructed nature of research.

Over time, Tony and I recognized that we were perceived differently by different individuals in different contexts and that outside definitions of us were never static. We also realized that these different perceptions pulled us to become different persons; our sense of self was dependent upon the relationships that we were in. We began to see that our identities were not static, but dynamic. We were perceived in different ways depending on the observer, our context, our moods, whether we were together or separate, and whether our identities were confused (if someone thought I was Tony or vice versa).

My experience as a test subject has directly influenced my views in practice and how I interact with my clients. While my clients generally do not have a twin to which they are compared, they are judged by some standard of cultural normality. This cultural normality, when applied to an understanding of the self, can be understood to create a normalized comparative twin, a normalized parallel-self representing the expectations of what we believe we should be, or how we should think, act, or score, to be considered normal. The construction of the normalized twin cannot occur without some form of judgment based upon a totalizing theory of normality.² This theory of normality is culturally created. As a result of being measured and quantified by this yardstick of normality, individuals may find themselves overcome by the pressure to compete with the constructed idea of a normal self. As a result, individuals may begin to define themselves as something other than normal, perhaps as failures, or as gradients of failure. This self-judgment has implications. They may find themselves giving up on their ability to live up to the cultural ideal of what they and others feel they “should” be. They may feel like failures in their inability to compete with the idea of the normalized twin and all it represents for them. Perhaps clients, like Tony and me, wish to be subjectively understood as unique, dynamic individuals in contexts rather than objectified and compared through assessment to an expert-oriented, culturally biased idea of a normalized self.

With this in mind, the most important lessons I have taken away from my experiences as a subject in the Louisville Twin Study are to not place my clients in a subordinate position that keeps me from hearing their ideas about problems and themselves, nor should I impose a definitional theory on them through a veil of objectivity. I will discuss the steps I take to avoid these kinds of objectifying practices later in the chapter. Additionally, I have come to have little faith in the notion of objectivity and the idea of the static, uncontextualized self. I question the culture of research in its construction of individuals as a collection of psychological and environmental predictor variables. This has resulted in my choice as a clinical practitioner and associate professor to not dissect myself into the two constructed halves of subjective and objective, as much empirical research and traditional practice requires. I instead transparently choose to keep together the passionate, caring, sensitive, so-called irrational parts of me with the intellectual, cognitive, logical parts of me. More directly, I have chosen not to break myself up into parts-of-me. While I am still becoming comfortable with the uncertainties and multiple perspectives of life that social constructionist thought invites, I am drawn to the dynamic light of possibility that is exposed in the absence of the shadow of mono-truth, that is, the totalizing view of one theory, of one way of understanding. I accept and respect the opinions of others and the ambiguity of life that is understood in social constructionist ways of thinking. The final result of these personal experiences is that I appreciate multiple possible interpretations of life. I nourish the ongoing awareness of, and respect for, diverse understandings in the ways that people come to understand themselves and the world around them.

As an introduction to my way-of-being in practice, I wish to share a brief overview of how I conceptualize social constructionism and how it informs my practice. From my perspective, social constructionism is a philosophical approach maintaining that reality is uniquely experienced, interpreted, and created in relationships. Truth, from this perspective, is not something that is located outside of the observer discoverable through techniques of variable control but is uniquely constructed based on current and past relational understandings, education, socialization, and internalization of ideas about the world. This premise affords an understanding of reality as a multiverse rather than a universe because everyone may interpret an event, or series of events, in a unique and equally correct manner. Free from the notion of mono-interpretation, I do not focus on facts per se, but the construction of facts; not on normality, but the construction of normality. The exploration of multiple truths, theories, and understandings that are viewed as contextually and culturally created, and the implications of these accepted truths, form the central components of my practice.

I am going to assume that you may be sitting when reading, so let’s consider your chair for a moment. It is solid beneath you, it exists separate from you, it is real, but there is no inherent meaning to be discovered in it, just as there is no inherent meaning to be discovered from a tree, a table, a car, a computer, and so forth. These objects exist in the world, but the meaning of them does not emanate from them; instead meaning is placed on them via our interpretation of them. This seems simple enough and will be discussed again shortly. The same tenet (meaning is not inherent in an object) can be applied to events and relationships as well. While we are active participants in events and relationships, there is no inherent meaning that exists within them, rather the meaning in the event or relationship is applied to them via interpretation.

While the chair beneath you has no meaning existing inside of it to be discovered, meaning can be applied to it via our interpretation. The chair could be your favorite chair, or it could be the chair your grandfather gave you when he passed away and so forth, in each case the meaning is applied to the chair rather than being discovered in the chair. Likewise, just as with the chair, there is no meaning that can be discovered as existing inherently within an event. Rather, meaning is placed on an event via interpretation, and an event can have multiple, equally true interpretations. For example, an event can be constructed simultaneously as tragic, heroic, unsuccessful, and successful, depending on perspective. When your favorite basketball team loses, this is a disappointment, but this is simultaneously exciting for the team that won. This is an example of multiple truths.

So far we have established that meaning is not inherent in events, relationships, or objects but that we instead construct and apply meaning; also there can be mutually true meaning constructions. Taking these ideas and applying them to my practice affords me the ability to consider all clinical theories as equally true from within their constructed contexts. I am also free to consider my understandings, my client’s understandings, as well as those meanings that are generated in our relationship, alongside these more traditional clinical constructions as equal. This acceptance of multiple ways of understanding is the key to my clinical mindset.

In my practice and teaching, I recognize that every clinical theory can be seen as a type of clinical language culture, each with its own way of interpretation, with unique constructed terminology (e.g., id, boundary, automatic thought), and each “true” from within the context of its own system of meaning. In this way, clinical theories can be revealed as constructed applied theories, such that all modern ways of working (psychodynamic, cognitive, behavioral, structural, etc.) are constructions—systematically constructed interpretations of how life events could be understood and how problems could be defined and solved. A visual example of how prominent, traditional clinical language cultures, developed up to the early 1980s, define client problems can be found in Figure 3.1.

What we see in the figure is that each clinical language culture interprets the problem and solution in a different way. For example, Jane Addams (1925) held that problems were a result of a disconnect between people caused by the breakdown of community during the Industrial Revolution as immigrants came to larger cities and as mass migration occurred from the farms to the cities. Problems, from Addams’s perspective, were constructed as a disconnect between people. Her constructed solution was to establish settlement houses, such as the Hull House, where connections could be made between people and where communities could be developed. Freud (1900), on the other hand, constructed problems in a completely different manner, creating a new language to assist in his interpretation of events. The biophysical perspective is one that constructs the problem as faulty brain chemistry and faulty genes, with the creation of a language illustrated in the Diagnostic and Statistical Manual of Mental Disorders (DSM) beginning with the first edition (American Psychiatric Association, 1952).

The point is that all modern clinical approaches are elaborately constructed interpretations of “problems” and of “solutions,” each with its own unique constructed language of interpretation and explanation. Recall that there is no inherent meaning to be discovered in an event, object, or relationship. With this understanding, any interpretation of an event from within the confines of a clinical language culture is constructed through that particular theoretical lens and is thus limited by the language of interpretation that coincides with that clinical theory. This is not to say that any of these ways of seeing are incorrect. Quite the contrary, each of these clinical language cultures has equal truth within the confines of its own paradigm but is simultaneously considered incorrect from another point of view. What is important here is that when I practice I acknowledge that each of these clinical approaches is a construction, not ultimate truth. I do not impose a way of understanding on clients but seek their own beliefs, and we decide together which interpretations are most meaningful for them.

If there is no inherent meaning to be discovered in an event, object, or relationship, but instead we acknowledge that we place meaning upon events, objects, and relationships, and have multiple true interpretations of events, objects, and relationships, including those things that are constructed as problems, then it becomes clear that the meaning that will be accepted as “truth” is accepted through a process of negotiation. Given this idea, the first question that my clients and I sort out becomes: Whose interpretation (construction) of the event/problem will be accepted as most helpful? This is an essential question and can be understood from a constructionist perspective as a negotiation for meaning. What is important to note is that even though this conversation occurs in the confines of the office, the negotiation is entrenched in the cultural system of which we are all a part. To provide a visual example of this, refer back to Figure 3.1, where you will see the major approaches to practice and the changing construction of the problem across the history of mental health up to the mid-1980s. As each clinical language culture gained and lost prominence with practitioners, the dominant construction of the problem changed. What is key to recognize for my practice is that my clients and I are not outside the cultural ideas of how problems are to be understood in the present time. With this understanding, I consider the construction of the problem and solution in our therapeutic relationship an issue of social justice and a political act (Hall, 2008). As a visual example of the cultural negotiation of normality and abnormality and how the selection of the problem construction is always political, refer to Figures 3.2 to 3.4 by Carrie Mae Weems (2000) entitled “The Armstrong Triptych.”

The triptych is a compilation of three images. The first panel was taken in 1878, and it shows a group of First Nation men upon arrival at the Hampton Institute, a Western cultural training center established in 1868. In the first panel, the men are wearing their native clothing with traditional hairstyles, as they would exist in their culture. From a social constructionist perspective, the first panel represents the First People’s negotiated normality in their cultural context. As Western settlers gained more power, First People lost their ability to construct typicality in ways that were traditional to them, therefore they found that their attire, language, and history were constructed by the larger society, of which they were now a part, as problematic, abnormal, and something that needed to be solved. The middle photo is of Brigadier General Armstrong who was the creator and director of the Hampton Institute and representative of the group that had more negotiating power to construct normalcy and, in turn, to define abnormality. As a result of the changing construction of normality, First People cultures and their ideas were marginalized and considered a primitive and potentially dangerous way of being.

The natural linear progression from the construction of a problem is the development of interventions that will most efficiently solve the constructed problem. In this situation, the intervention was constructed in the form of Western cultural training institutions such as the Hampton Institute. The successful treatment can be seen in the third panel. The three panels taken together form a kind of evidence-based treatment where the problem was constructed as deviance from the negotiated cultural norm in which the West had dominance, the cultural norm was operationalized, a training and enculturation intervention developed, and the “positive” constructed result measured via a pre-photograph and post-photograph where the former deviant culture has successfully been enculturated into the dominant constructed normality as represented by the middle photograph. The evidence may support the effectiveness of the intervention but the outcome is oppression.

What is most important to understand through these historic photographs for my practice is that I maintain a mindset that there is no inherent meaning in normality or abnormality, rather that normality and abnormality are negotiated constructions based on culture and who has more negotiating power within that culture. As such, I seek my clients’ understanding of how the problem and solution are to be understood, including making visible the current dominant cultural construction of the problem. It is absolutely paramount in my practice that I recognize that I am in a unique relationship with clients to either explore their range of understandings of the problems in their lives and potential solutions, or to reify the dominant clinical language culture of the day through the imposition of its construction of the problem on clients. In my opinion, an imposition of totalizing clinical theory is the definition of oppressive practice—the indoctrination of clients into a way of being in which they have no voice. The choice of indoctrination or collaborative exploration is not just a clinical decision but also a political decision. Deciding how problems and solutions are to be understood is an issue of social justice, and this choice is most clearly made during the assessment phase of the therapeutic relationship.

The assessment in clinical practice has traditionally been the starting point of all interactions with clients. The guiding mantra has been to assess the problem via “expert and objective” analysis utilizing the dominant clinical language culture of the day and then to treat the problem based on that clinical language culture. Recall that each clinical language culture constructs the problem, intervention, and solution in a different manner, with different terminology. What practitioners and clients should be aware of regarding the traditional assessment is that when practitioners assess from within a modernist clinical language culture, they have already chosen how the problem will be understood by imposing a preconstructed theory of normality and by determining how the client may deviate from this normality via the specific language representative of that approach’s assessment. As an example, recall the Armstrong Triptych and consider what an assessment would look like from the Hampton Institute. Would you view this assessment as “objective” or as culturally constructed? The Hampton assessment would apply the theory of normality already preconstructed as Western individualism and screen for forms of deviance from this constructed norm. Deviance from the norm would then be constructed as the problem to be treated. Thus, any time a model of practice is used which applies a theory of normality to a client, in order to assess by this construction of normality (e.g., psychodynamic—id, ego, super ego balance; structural—family system functionality; cognitive—functional thoughts; DSM—biophysical normality), the clinical theory has already preconstructed the problem before the assessment. Further, in the assessment process, no attention is paid to political, historical, and social influences that may influence the practitioners’ and clients’ ways of seeing the problem. Given the social constructionist premises discussed, it may be worth asking the following question of practitioners in social work and related fields: If at the Hampton Institute First People had been afforded equal voice in the negotiation of what would constitute the problem and the solution to that problem, would the problem, intervention, and solution have looked different? It is crucial to note that if First People had been afforded an equal voice in the problem negotiation it may have been constructed very differently, perhaps as a cultural issue of oppression.

At this point we should have an understanding that my social constructionist informed practice invites challenging clinical language cultures that restrict the realm of my clients’ possibilities and understandings of self—that I apply no theory of normality to my clients but instead collaboratively explore and expand upon their ideas of problems and of solutions. The intent of this effort is to assist my clients to better understand their lives in ways that are preferable to them. By providing my clients a voice in the negotiation of how problems and solutions are to be understood, I hope that my clients’ voices are amplified and that as a result they have stronger opportunities to negotiate preferable meaning of life events and relationships. Finally, I do not reject traditional clinical theories, rather I do not use them to guide the understanding of the problem, nor do I impose them onto my clients.

The idea of therapy as collaborative exploration rather than as client indoctrination into predetermined clinical language culture shifts the notion of assessment dramatically from being a singular objective act of the practitioner to a shared responsibility of practitioner and client. The modern concept of assessment is no longer useful if it is accepted that there are multiple ways to understand problems and solutions and that the client has equal voice in the exploration of those possibilities. The assessment then shifts from being a standardized event that occurs at the beginning of counseling and that defines the client by a specific clinical language culture to a continuous reflection between me and my clients about ways to move together, ways to understand problems and solutions, and most importantly, the decision of whether this movement is helpful. With this understanding, I continuously strive to create a relational space where my practice with others can be as collaborative and reflective as possible.

In thinking through the ways that I do this, I have arrived at three approaches. I must admit that it feels a bit alien to me to break my practice down in this way, but I am not sure how else I can explain what I do clinically without doing so. These approaches are all similar in that they help me enhance client interpretations without being oppressive with outside clinical language culture. In my practice, client understanding takes precedence over theoretical understanding, and I am most interested in providing a place where they can be heard and understood in ways that matter to them.

Social constructionist informed practices began to be developed in the mid-to-late 1980s and the common thread between them is that the problem construction is not defined as something that is within clients, but is instead found either outside of clients to be explored, as with a narrative approach, or as a solution that is to be explored with clients, as in solution-focused, solution-oriented, collaborative language systems and open dialogue approaches. Further, in my work with clients, I try as much as possible to not use theoretical jargon but to instead use the words that clients bring to the session. My hope is that this privileges, or at minimum puts on par, the clients’ language with that of the traditional “expert.”

It is important to recognize that my practice is very much a way-of-being rather than a set of techniques. Every session is different and I have no manual or step-by-step procedure. Instead, I rely on an overall belief that I very much want to understand how the person sitting in front of me understands the problem and the solution to this problem. The approach I take depends on the kind of relationship that my client has with the problem when they come in to see me. Sometimes clients may come in and they have no real concrete idea of what the problem may be. They know that something is wrong, but they are unsure of what they are experiencing. In these situations, instead of answering the question for them, or imposing a clinical language culture via an assessment, we will explore the possibilities of understanding the problem and solution using a polylingual collaborative approach, which I will explain shortly.

Finally, when I have a client who has firm ideas of the problem, but the problem definition may have been adopted from a source outside of them, I use a deconstructive approach so that we can collaboratively determine whether the problem definition adopted is in the best interest of the client. For example, I very often have clients who come in with the belief that they are problematic, or that they have a certain disorder. In situations in which problem constructions have had totalizing effects in their lives, we dismantle and question the construction of the problem using a deconstructive approach to determine if the current understanding of the problem is in their best interest. The purpose is not necessarily to change their beliefs about the problem but to explore the range of possible interpretations of what they are experiencing so that alternative perspectives can be recognized and considered.

With all of these approaches, I seek to question and explore the problem construction with the client. Another way to put this is that the problem, rather than the client, is problematized and explored. Likewise, a good way to differentiate these approaches is that even though all three approaches seek to enhance the client voice in the negotiation of the problem and solution, they have a different focus. For example, the strength approach seeks to explore “What has gone well in your life, what do you have control over, and what don’t others see in you that you would like them to see?” A deconstructive approach seeks to deconstruct the problem definition that the client has been recruited into and to help the client to determine if it is in his or her best interest by asking, “Where did this idea of the problem come from? Who benefits from this idea of the problem? Who does not benefit? Is this idea of the problem in your best interest?” Finally, a polylingual collaborative approach asks the question, “Which problem constructions and clinical language cultures will best fit with your interpretation of the problem and of the ideal solution?”

A polylingual collaborative approach is based on the idea that clinical approaches are constructed clinical language cultures and that the use of these approaches in practice is governed by a collaborative decision between me and the client. Because practice approaches are understood as different language cultures, it is important that I be clinically multilingual and polyvocal in my relationships with clients—multilingual in the sense that I am able to understand a wide range of clinical language cultures, and polyvocal in that I can utilize these languages separately or blended with the client in collaborative ways. My relationship with my clients takes precedence over any clinical approach, and our use of approaches is informed by collaborative decisions made between my client and myself. An assessment in this regard is understood to be a collaborative decision on how the relationship will proceed and which clinical approaches, or blends of approaches, will be used to meet the client’s goals. This exploration is guided by how well a given approach makes sense to the client, and modifying, or blending, approaches is determined collaboratively. I generally use polylingual collaboration when the client is confused about what the problem is and wants to explore different ideas about the problem and possible solutions as illustrated in the following exchange from a first session.

DAWN: I am here to talk to you about a problem that I am having in my marriage.

CHRIS: Okay, we can certainly do that. What is your understanding of the problem?

DAWN: What do you mean? I am not sure what you mean.

CHRIS: I mean how do you understand what is going on? Do you see this problem as something that is within you? Is it in the relationship? Is it stress from other places? I am wondering how you understand the problem?

DAWN: It is kind of a combination. I know there is stress outside of the marriage that is affecting me and him, and you know the two of us as a whole, but I just feel like we should be handling this better, it seems like most people handle stuff like this better than we do.

CHRIS: Okay, so it sounds like we have a couple of things in your understanding, and I want to make sure I am hearing you correctly. You see stress as affecting the marriage, and you think that there is a general lack of ability to cope with this stress? There also may be an idea of how your marriage relates to the “normal” or “common” marriage—like you have an ideal marriage in your mind, but your marriage may not measure-up in some way to that ideal.

DAWN: Yeah, that’s it. You know I really don’t know if our marriage is the way that marriages are supposed to be. I mean are we supposed to be happy all the time? And then if not, how much are we supposed to allow to happen? And then the whole coping thing. I really would like, I mean, it would be good for both of us I think, if we could just learn to cope with stress. It’s a really bad time, with jobs and the economy and all that.

CHRIS: Okay, then in our time together would it be helpful if we focused on the idea of marriage and what your ideas are about whether your relationship is what it “should” be in your eyes, and then also learn some general coping techniques to assist with stress?

DAWN: Yeah, that sounds good.

CHRIS: Now would you like at any point to bring your husband in to meet with us? Do you think that would be helpful?

DAWN: Yeah I do, but I’m not sure when.

CHRIS: Okay, how about we talk about that in the future as we get comfortable with one another? Is that okay?

DAWN: Okay, that sounds good.

In our first meeting the focus was to find out how Dawn understood the problem, then to determine what clinical language cultures may be helpful for her, and to match these clinical cultures to her situation. In this case, we decided that a narrative approach may be helpful as a way to collaboratively explore with her the discourse of marriage, and whether the idea of a “normal” marriage is beneficial as a comparative yardstick, or if she would like to redefine her idea of what a normal marriage is. We discussed whether it would be helpful to invite her husband in to discuss the idea of marriage as well. We also decided that an ecological approach may assist her and possibly her husband to develop coping and adapting skills to deal with stress coming from outside the marriage. These approaches were discussed openly and in later weeks blended with a solution-focused approach. All approaches were used in a polyvocal, collaborative manner, meaning that I did not impose these on her, nor did I use a manualized version of any approach. Instead, we made the choice about what to do collaboratively through a continuous exploration of whether what we were doing together was working. Questions were asked during every session such as, “How is this working for you? Does this make sense to you? Are you feeling like we are moving in the right direction? Are we talking about those things that you find helpful? Do you feel heard?” Based on responses to these questions we made collaborative decisions in session regarding what we would do next that would be most helpful.

In my practice, I most often use this approach when there is a clear difference between what the client views as the problem and what others view as the problem. Court-mandated clients are one example of this. Because mandated clients often have a clear understanding that they do not wish to acquiesce to the dominant construction of the problem, we focus on the positive outcomes that they would like from our time together. In many cases, even though the problem definition may vary between client and court, the solution is extremely similar. Focusing on the solution keeps us from getting caught in binary problem discussions of who is right and who is wrong. When using this approach I try to work as much as possible to amplify my clients’ own natural strengths, values, and skills.

FRANKLIN: We don’t want to be here, we’ve done nothing wrong. The court and investigators have said all these things about us; how we’re bad parents, how we don’t deserve our kids, and we don’t agree! We don’t think we’re that bad!

CHRIS: What don’t they see in you that you would like them to see?

FRANKLIN: What do you mean?

CHRIS: It seems as though they have a picture of you as bad parents, but this idea of you is different from what you think that you are. What did they miss in your parenting, for example, what are you most proud of that maybe they didn’t see?

CHRIS: So what doesn’t the Child Protective Service see about you that you would like them to see?

MARY: Well, it’s not like the kids are dirty, and they are happy. Yeah, I’ll admit the house needs cleaning, but the kids don’t; they’re always clean.

CHRIS: So you do a great job of keeping the kids clean, how are you able to do that?

FRANKLIN: They have to take a bath when they get up every morning. I am on the late shift so when I come in around seven A.M. I get them up before I go to bed. I’ll sit with them ‘cause it is one of the only times during the day that I get to see them.

CHRIS: You have a schedule that you keep to? And you are able to get the kids up. You have a plan. Have you always been this organized in this area of your life? Is this scheduling a skill? Not everybody has that kind of skill; I wish I had better scheduling skills myself actually. I think I could learn some things from you.

MARY: Yeah, he has his faults, but he does get them kids in the bath each morning.

CHRIS: Does this skill of scheduling that you all have, work in other parts of your parenting, too?

CHRIS: How is this going for you all so far? Do you think we are making headway toward your goals of getting your kids returned?

FRANKLIN: Yeah, this isn’t what I thought it was going to be. Look, we just want our kids back; I’m willing to do whatever it takes.

CHRIS: Well, perhaps we could use the strengths that you all already have as parents and expand those into areas that might need some help. One of the areas was keeping the house clean, I wonder how you could build on the skills you all have in scheduling to make that happen?

With this family I was attempting to collaboratively explore their understandings of what they were doing well and to support their definition that they were good parents. Their belief that they were good parents, and the court mandate that they become good parents, were aligned, so this was the focus of our work together. Later we spoke about more ways that they could build on the strengths that they already had in order to become even better parents, and then how we could work together so that the investigators could gain a more accurate and new picture of them as good parents. Thus, the goal of the parents, and of the court, was the same, and was eventually met without the use of problem-centered dialogue.

My focus using a deconstructive approach is to collaboratively separate my clients’ perspectives of the problem from the dominant construction of the problem into which my clients may have been recruited. Most times in my practice when I work with clients who have strong views about the problem, but these views have come from outside sources besides themselves, we will use a deconstructive approach to separate how the problem is currently understood from how they would like to understand it. This often happens with clients who are in marginalized positions in the negotiation for meaning in their lives—for example, when a parent brings in a teenager and the parent tells me that he or she is a bad kid or has some kind of disorder. It is imperative that I work collaboratively with the teen to determine whether these views are in the teen’s best interest. This is also important when working with minority members of a culture and those in positions of less power than others. Interestingly, I have also used deconstructive approaches with those who traditionally hold more power than others. White males in Western culture, for example, who may have been recruited into beliefs that they must be strong and domineering, when, in fact, these ideas may be causing great harm in their lives and in the lives of others (Hall, 2011).

Ultimately, when my clients and I take a deconstructive approach in practice, I seek to assist them to explore whether the present interpretation of the problem is in their best interest, and if other perspectives of the problem may be more aligned with their sense of self. The approach seeks to assist clients in having a stronger voice in the negotiation of how the problem, and subsequently the solution, will be understood. When I utilize this perspective, the client and I place how the problem will be understood as the central focus of the conversation, and questions are asked that deconstruct this current dominant construction. Frequent questions include: “Does the current understanding of the problem serve you in reaching life goals, or could we see this problem in a different way? Is this problem construction in your best interest? Are there other ways we could view the problem that would be more helpful?” Through these kinds of questions I hope that my clients are afforded a stronger voice in the construction of the problem and solution. The following is an example from my practice with others.

CHRIS: Hi, could you help me understand what you have come in for?

JESSIE: You already know, my mom said everything, and it is all there in my file, too.

CHRIS: Jessie, is it okay if I call you Jessie? (Head nod.) I sometimes don’t pay attention to files. Files represent views of you that may or may not make sense to you. What I am most interested in is what makes sense to you. The same with your mom. She has ideas about what is going on but those ideas belong to her. Your ideas are important, and I want to hear your voice and your ideas about what you want for your life; then we can talk a little bit about how we may be able to work together to get you where you would like to be.

JESSIE: Well, you know, what they all said. I am a problem, I have this depression disorder, and I ain’t no good.

CHRIS: Jessie, could I ask you some questions about this picture of you that you just shared with me? What I am interested in is where this idea came from that you are a problem.

JESSIE. Well, from all of you all doctors, and from my family. I been in and out of hospitals since I was thirteen, and I always been told that there’s something not right with me. That I can’t control myself.

CHRIS. Who benefits from this idea?

JESSIE: What?

CHRIS: Who benefits from the idea that you are a problem and that you can’t control yourself?

JESSIE: I guess nobody, I mean, I don’t know. I don’t understand.

CHRIS: Sorry about confusing you, and thanks for letting me know. I appreciate your openness. I am interested in where the idea came from that you are a problem, and who benefits from the idea of you being a problem? It seems like there are many times in your life, more times than not actually, that you are able to control your moods, that you have been successful at those things that you put your mind to. Right now, for example, we are talking together very well, yet for some reason you have been defined as being a problem. I am wondering who that view benefits? Let me ask in a different way. Does the idea that you are a problem benefit you?

JESSIE: Not really. This is weird.

CHRIS: What is weird about this?

JESSIE: I just never had anybody talk to me like this before.

CHRIS: I know this can seem weird, especially if you are used to people like me telling you what you are and diagnosing you. Instead of diagnosing, I am really interested in who you think you are, and how you may have gotten to this point where you have been called a problem. It seems like you have done some very successful things in your life. I am interested in why you have not been called a success, for example, why you have been called a problem, and if this is what you want? Do you see yourself as a problem?

JESSIE: Sometimes I do, and sometimes I don’t.

CHRIS: Tell me about some of those times that you don’t.

As the conversation progressed Jessie shared with me times when he did not feel like a problem. These were times like, “when I’m around other people like me, when I am not seen as a loser, when I can just be me.” The intent in questioning the problem was to determine the extent to which the problem had gained control over his sense of self and how he had resisted its influence in his life. Through a deconstruction of the dominant problem construction, Jessie decided that his “problem” with being depressed was not a biophysical problem but a natural reaction to being marginalized in two ways, first as an African American male, and second as a gay male. His identity had been problematized by his family and by the dominant culture. He had internalized these beliefs about himself, and as a result, was very down and sad as his voice was marginalized in the negotiation of his own identity. Eventually we were able to create definitional space for him, a space where he could have more negotiating power in his life. As a result, he was able to move out of the definitional shadow of his mother’s ideas about who he was supposed to be, as well as the dominant cultural ideas of what normal is and how he was supposed to be to fit in as both an African American and a gay male. With a stronger voice in the negotiation of the meaning in his life, he had a better chance to define it in ways that were congruent with how he would like to be. In our work together it turned out that it was the totalizing definition of Jessie as a problem that was, in fact, the problem. His sadness was a natural consequence of not having an equal voice to negotiate and construct his identity in ways that he wished, but instead, having to co-opt and subjugate himself to live up to the expectations of others.

With the modern imposition of totalizing clinical theory on clients, we as practitioners risk becoming identity and culture snatchers, whereby we define people as abnormal by a culturally constructed theory and then label and treat them into this constructed normality. The notion of objectivity becomes one of a sterile veil that allows us to pretend that we are somehow not part of this non-collaborative system of totalizing clinical theory stamping. For me, a social constructionist informed practice reduces the possibility that as a practitioner I am acting as a social control agent by using my services to impose ideas of constructed normality to which my clients must measure.

It is also important to note that the potential snatching of others via the imposition of totalizing clinical theory may have effects on practitioners, as well. Recall that objectivity is a game that both researcher and subject must play, and just as taking the position of the object had effects for me in the Louisville Twin Study, so too does taking the position of the observer. The effect of the segmentation of self into variables has ramifications. At six years old, I first saw the strain that empirical researchers were under in their relationships with me as an object, and when the tester broke ranks and stated that he could not hurt people anymore, I experienced what I now see as a beautiful crack in objectivity. Many years later, I recognize that the testers’ strain was a potential consequence of the objectification of self in our constructed relationship as subject and tester.

As a memory of that moment, on my office wall I keep a quote from the biography of arguably one of the most influential scientists in history to remind me to learn from the wisdom and mistakes of others. In 1887 he offered a warning about the possible long-term effects of the self-dissection involved in the relational game of objectivity. I understand his voice from the past as a challenge to our field to save not just our clients from practices that restrict possibilities, but ourselves as well, from the consequences of self-imposed restrictions of objectivity.

I have said that in one respect my mind has changed during the last twenty or thirty years. Up to the age of thirty, or beyond it, poetry of many kinds . . . gave me great pleasure, and even as a schoolboy I took intense delight in Shakespeare, especially in the historical plays. I have also said that formerly pictures gave me considerable, and music very great, delight. But now for many years I cannot endure to read a line of poetry: I have tried lately to read Shakespeare, and found it so intolerably dull that it nauseated me. I have also lost almost any taste for pictures or music. . . . My mind seems to have become a kind of machine for grinding general laws out of large collections of facts, but why this should have caused the atrophy of that part of the brain alone, on which the higher tastes depend, I cannot conceive. . . . if I had to live my life again, I would have made a rule to read some poetry and listen to some music at least once every week; for perhaps the parts of my brain now atrophied would thus have been kept active through use. The loss of these tastes is a loss of happiness, and may possibly be injurious to the intellect, and more probably to the moral character, by enfeebling the emotional part of our nature (Darwin, 1887: 100–101).

1. A totalizing clinical theory is a theory of explanation that leaves no room for other ways of understanding. It is an authoritative, definitional gaze that applies a rigid theoretical framework of explanation upon a person without the other being able to share in the conversation of definition. It is a description of a relationship of power. In practice, I use the phrase totalizing clinical theory to denote the use of any theory which supersedes the understandings of the client and/or does not place the client’s views of the problem(s) and solution(s) in equal status to the clinical theory being applied.