IN CONSULTATION; the Art of the Enactment: How to Get Real Conversation Going in the Consulting Room

Article excerpt

Q : Therapists are supposed to get family members to talk with each other during sessions, but I've found that is not so simple. How do you get family members to talk together productively?

A : Although some families are willing to engage one another directly in therapy, often members have given up on one another and just want the therapist's approval and understanding. In-session dialogues, or what structural therapists call enactments , can be among the most valuable tools for getting a family's communication going. Nevertheless, staging enactments isn't simple. Both beginners and experienced therapists have trouble making them work, but usually for very different reasons. Typically, beginners have trouble structuring enactments and taking charge of them in a way that generates a different kind of interaction. In contrast, experienced therapists often make the opposite mistake--they so overmanage the conversation that they interfere with the ability of clients to become involved in the dialogue and find new ways of interacting.

Beginners should be sure that they give clients clear and explicit instructions. Specify the exact topic for conversation (clients' complaints about one another are a fertile source of material) and indicate how the conversation should go ("See if you can convince her that you're willing to listen to her feelings"). Be clear about the mechanics--turn participants' chairs to face each other, direct them to talk and lean back to remove yourself from the dialogue. (Therapists who make eye contact with the speaker draw the conversation to themselves.)

A crucial guiding principle in sustaining an enactment is that improving the process of communication is usually more important than helping a family reach agreement about the content. Nevertheless, even experienced clinicians who should know better commonly slip into taking sides when the content of the discussion touches a nerve.

Consider the case of a family with a 16-year-old boy on probation for selling marijuana. The therapist has encouraged the boy to talk with his parents about his plans for the future. When the boy says he wants to drop out of school to become a motorcycle mechanic, his parents argue forcefully against the idea, and the boy soon shuts up. At this point, the therapist joins the conversation to support the importance of the boy's staying in school. But if the pattern of their relationship is that the parents nag and the son withdraws, the clinical goal isn't to keep the boy in school, but to help him learn to speak up--to put his feelings into words instead of into dangerous and risky forms of rebellion. …