An Interacting Team Model *

Monte Bobele** Ron Chenail***
Paul Douthit*** Shelley Green*** Tracey Stulberg***

RUNNING HEAD: Interacting Team

* The authors would like to thank the following people who helped make this project and paper possible: Douglas Flemons, Jerry Gale, Rhonda Johnson, David Todtman, Bradford Keeney, Toi Prevost, and Jan Chenail.

** Monte Bobele, PhD is an assistant professor and Director of the Family Therapy Clinic, Department of Human Development and Family Studies, College of Home Economics, Texas Tech University, P.O. Box 4170, Lubbock, Texas 79409.

* Ron Chenail, Paul Douthit, Shelley Green, and Tracey Stulberg are family therapists and doctoral students in the Family Therapy Clinic, Department of Human Development and Family Studies, College of Home Economics, Texas Tech University, P.O. Box 4170, Lubbock, Texas 79409.

ABSTRACT

The use of teams in family therapy has become quite common. Various methods of employing teams have been experimented with over the years. One of the most recent of these models of team work is that of the reflecting team developed by the Norwegian psychiatrist Tom Andersen, The model described by Andersen forms the basis of the model described here. The model described here, however, differs in three significant ways. This model does not avoid attempts at instrumentality, it sees the therapy as more extensive than the method or medium, and it expands of the use of feedback from the family. The authors provide a rationale for these departures from the reflecting team. A case example is presented which illustrates the use of this model of therapy which the authors call the interacting team.

An Interacting Team Model

The following paper illustrates a method of using teams in therapy which was inspired, in part, by Andersen's paper (1) on reflecting teams. In this report we describe the brief history of reflecting teams and provide a rationale for the deliberate, instrumental use of a modified reflecting team format. We will endeavor to describe a method of therapy, which we call the interacting team, which is similar to that developed by Anderse

+n, in order to demonstrate our adaptations and extensions of the original reflecting team model, and to present our unique version of the reflecting team through a case description.

The work described here is a report from an evolving research project which has as its goal the development of more creative, yet effective ways of conducting therapy. The project took as its starting point the development of more efficient ways of using a team of therapists that was consistent with our theoretical backgrounds. We have experimented with different ways that therapy teams could reflect the process of the therapist/family interactions,1 yet the main focus was on our understanding of the use of teams in therapy (e.g. 12).

Teams behind the one-way mirror have added new perspectives, alternatives, and potential solutions to families and the therapists working with them (3, 8, 9, 13, 23). Boscolo and Cecchin (5) have said that the one-way mirror format is "productive in creating effective interventions for the family and in stimulating the therapist to think in a more circular manner" (p. 155). The team, by occupying a position different from the therapist and the family, is assumed to become "meta" to the interactions of the family and the therapist. This difference in position has at least two advantages for the team. First, the team is able to discern different patterns and interactions between the family and therapist. Secondly, the team can brain-storm hypotheses and interventions about the family, without having the immediate feedback of the family. These two advantages allow the team to increase the variety of created information, or to increase the opportunities for change.

The reflecting team method (1, 10, 11) has evolved as an adaptation of the Milan systemic therapy approach which emphasizes three cybernetic circularities for conducting a session: hypothesizing, circularity, and neutrality (6, 17). The reflecting team approach allows the family/therapist system to participate as observers to the observing team's intersession discussions concerning the on-going therapy session. It is from this process that the approach receives its name: the observing team becomes a reflecting team as it attempts to "reflect" the observed interaction between the family and the therapist and among the family members themselves (1, 10, 11).

The reflecting team model, as it has been described, emphasizes two important distinctions. First, differences in ob-servers' descriptions are connected to differences in the observers' positions and not to observers' station in a hierarchy. Secondly, the process of the reflecting, which is guided by the cybernetic circularities, is the intervention itself. In other words, ''the medium is the message." This notion was hinted at in an early paper of the Milan team (17) when it was suggested that conducting the circular interview was sufficient, in many instances, to prompt a change in the system, More recent work by reflecting the Milan associates (6) has highlighted the conduct of the interview as the experience which promoted change. This is not a revolutionary idea in psychotherapy in general or for family therapy specifically. All of the experiential therapies hold the process of therapy to be an important, if not the most important, aspect of the interview. It is important to note that other systemic therapists have also incorporated these two distinctions into their approaches to therapy: Peggy Penn(14, 15) with circular questioning and feed-forward future questions; Marcia Scheinberg (18) with the debate approach; and Karl Tomm's (20, 21) interventive interviewing, to name but a few.

Several guidelines are emerging for the proper conduct of this type of session: proscriptions against team conversation behind the mirror, no separate discussions between the therapists outside of the clients' presence, and others. The work of Andersen (1) and others (eg. 10, 11) reflects an attempt to move away from the instrumentalism of several models of family therapy. The elimination of team conversations, planning sessions, and behind the mirror talk is described as a move toward the reduction of instrumentality and disrespect of the clients that has been a criticism of some team approaches specifically, and systemic approaches in general (10, 11). However planning to not plan one's remarks, and pretending that theoretical discussions, as well as practical discussions, among team members outside of the therapy session are not instrumental acts that have a direct effect on therapy, is difficult, if not impossible to defend. Hoffman points to Bateson's reminder of the ancient mariner's dilemma, but the effort to "bless the sea snakes aware" seems, however, to be an attempt to be spontaneous in the service of therapy.

The notion of neutrality, also central in the work of Andersen (1), and the early work of the Milan team (17), is one that implies that the therapist takes no position with respect to the family members points of view. We prefer to take a more active role that has been referred to as Multipartiality (2). Multipartiality refers to a position taken by the therapists that gives each family member the reassurance that the team shares their individual points of view. Multipartiality is more active than the early "neutrality" of the Milan team. In a recent work by Cecchin (7), the role of neutrality has been refined.

While previous team work provides many advantages for the therapeutic process, there are also problems in terms of the way that feedback has been used. The team usually constructs hypotheses which are presented via the therapist/team to the family (16). However the family is not able to comment on the team's perceptions through immediate feedback, because the information used in constructing the hypotheses is not continually fed back between the therapy room and the observation room. Because observing systems construct reality through their perceptions, and because their perceptions can be inaccurate descriptions of the observed (22), the lack of continuous feedback between the observer and the observed can lead to hypotheses and interventions that do not incorporate the client's world view to the fullest extent possible. In addition, the lack of continuous feedback between the family/therapist and team may, in fact, lead to a state where conscious purpose, strategies, and technique play a more important role than attempting to understand client's realities. The reflecting team model addresses these feedback problems by allowing a recursive flow of information from the observed to the observer, For instance, in Andersen's (1) reflecting team model, at a breaking point in the session, the team and sound are switched between the therapy and observation rooms. The family is then asked to observe the team discussing their perceptions of the family situation. Then the team is asked to provide feedback to the team concerning which observations they feel are important.

With our interacting team model, we attempt to increase the amount of feedback by allowing feedback to occur in real time during the therapy session. By feedback in real time, we mean that some family therapist/team interactions are allowed during all parts of the therapy session. This varies from the reflecting team model of Andersen. For instance, instead of preventing the family from responding to the reflecting team until after the reflecting process is completed, our interacting model encourages family/therapist feedback during the reflecting team's reflecting. By doing this, our reflecting is calibrated by the family-therapist system feedback in real time. The same holds for the interview segments: our hypotheses are calibrated by the real time feedback that results from our interaction with the family. This circular process leads to more differences that make a difference in therapy.

The Interacting Team Model

In many ways, our approach is not unlike the Andersen/Hoffman format. Their model, as well as the one to be described here, entail the observing team "reflecting" the process of the therapy for the therapist/family system, but there are two main differences between our approaches. One, we encourage active interaction and collaboration between team members before, during and after the segments of the interview. The Andersen/Hoffman views, as we have seen, suggest that such interaction be avoided so that the interaction between the reflecting team members during the reflecting segment be spontaneous.

Ly_c2, we are flexible with how we approach the "intervention" in the session. Interventions can be carried out through the reflecting process, as well as through active prescription or task delivery. With our model, we occasionally let the refc-ton serve as the intervention, or we let the reflection alone serve as a context for an intervention which is made after the reflection.

Description of Session Format

Our model consists of two alternating types of interactional segments: the first type involves the team interacting with the therapist whereas the second type has the observing team interacting with the therapist/family system. These two types or styles of interaction are typified by high rates of activity. During the first segment, there is considerable dialogue between the therapist and the observing team as individuals share differing descriptions and hypotheses concerning the session. With the second type, the observing team members discuss the on-going interview among themselves, place phone calls to the therapist in the therapy room, and at times, some observing team members may enter the therapy room in order to convey certain messages to the therapist/family.

A typical therapy sequence would have the following order of segments: presession, interview, interactive intersession, session wrap-up, and post-session. The following section will detail what generally occurs in each of the above-mentioned phases and will present examples from a case as an illustration.

Presession. The interviewer and the reflecting team meet in order to discuss and prepare for the upcoming session. This time is generally spent focusing initially on the prior session and planning possible directions and goals for the upcoming session.

During the initial presession for this case, the therapists presented information obtained when the couple called for an appointment. The Lopes 2, who lived in a small farming community, had been married for fifteen years. Prior to coming the clinic, there had been an alleged incident of sexual abuse between Mr. Evans and his daughter. The incident was reported to DHS and the situation was monitored for two years. During this time, they had been involved in group therapy. The case was closed, and the therapy terminated a year and a half prior to their first appointment in our clinic. The presenting problem, as stated by the couple, was that Mrs. Lopes doesn't trust her husband because of, in their words, ''stupid stunts" that he pulls. It appeared, at this time, that the majority of these "stupid stunts" were related to the handling of money, and not to further inappropriate behavior with his daughter.

By the presession prior to the third meeting with this couple.

 The name of this family has been changed preserve their anonymity and to maintain readability.

The therapy team hypothesized that the family's strong connection with their local football team might be a useful metaphor in describing the couple's own dilemma. Following a discussion about how this might best be implemented, the therapist met with the clients to explore the fit between the clients' language and the football metaphor.

Interview. While the interviewer(s) meet with the clients, the 1-team observes from behind the one-way mirror. The task of the 1-team during this period is to gather content and process information that might be useful. There are no restrictions placed upon the members of the team with respect to discussion issues or points that pertain to the case while behind the mirror. The role of the team members while behind the mirror is not all that different from the conventional team model (e.g. 16). Phone-ins are made as the team feels the need for clarification or further exploration in a particular area. Generally the therapist is not called out of the room nor is the therapist consulted prior to the reflection period.

During the interview phase of therapy, the therapist attempts to follow three basic guidelines: information creation, hypothesis testing, and context building for the interactive sessions.

For example, the therapist discussed the variability of the trust issue. Through careful interviewing the therapist was able to gather more information concerning Mrs. Lopes' lack of trust in her husband. She explained that her inability to trust Mr. Lopes revolved around what she characterized as his "stupid stunts." These actions often consisted of Mr. Lopes' alleged misuse of the family finances.

During this session, the therapist checked the "football" hypothesis by introducing the notion that their situation could be compared to a football team that does well one game and then grows over-confident and plays poorly in subsequent games.

The context building aspect of the interview phase of the session serves as a bridge to the reflecting session. The therapist and I-team attempt to expand upon meanings derived throughout this part of the session, in an effort to create a foundation for the work of the I-team. During the interview segment, the I-team has the opportunity to obtain feedback from the family which calibrates their actions in the upcoming intersession.

An example of this real time calibration in the Lopes case centered around the fine tuning of the sports metaphor. The family related well to this example as their own home high school football team experienced just such a situation last season. This team won their first game by some seventy (70) points but then lost the second game by almost as much. Following this loss, the team went on to have an undefeated season. The Lopes' positive reaction to this metaphor served as further confirmation that this would be a useful avenue to pursue. The team phoned in to underscore the possibility that this couple might become over-confident after having such a good week and lose all the progress that they had made. The couple thought that this was a good possibility.

Interactive Intersession. The I-team changes rooms with the family and the therapist(s). This particular choreography arises out of certain physical restraints in our clinic, which precludes the switching of lights and sound more typical of the method described by Andersen. To avoid the potential awkwardness noted by Andersen when the two groups pass each other in the hall, the therapists escort the family to the waiting room prior to the I-team entrance into the therapy room. After the team is seated, the family and therapist take their places behind the mirror. The I-team works diligently to act "as if" the clients are not watching, although the clients and therapist are watching and are encouraged to call into the therapy room with feedback about the on-going discussion.

The goals for this period are: a) to discuss the I-team's thoughts, hypotheses, etc. regarding the initial part of the session, and b) to further expand the meanings developed thus far in the session. In order to accomplish these goals, the I-team incorporates the process of real time feedback for the same aesthetic reasons that Heinz von Foerster (22) has when he stated, "If you desire to see, learn how to act" (p. 61). A change in description (seeing) comes about from a change in position combined with interaction (acting). The emphasis of the interses-sions is not to simply recapitulate the process that has been ob-served, but rather to contribute to the expanding/evolving therapeutic contexts. The approach described here incorporates both a change in position and real time feedback provided through the opportunity for ongoing communication between the family and the rest of the team as additional sources of calibration.

Depending on the climate of this first part, the I-team might empathize with what the clients are experiencing, offer possible multiple hypotheses or "hunches" as to the "why" of what they are experiencing, or discuss possible courses of action (possible interventions). The family, as well as the therapist, are encouraged to comment on and discuss the reflecting as they hear it. Further, the family and therapist are free to use the telephone to call in comments or corrections to the I-team as they are noted.

During this intersession, the I-team made several statements during their conversation which served to reinforce the therapeutic emphasis of the football metaphor:

R: A coach I once had said that you never go out on the court or field being too psyched up or flat. That really effects your performance out there. It's a real art for a coach to keep the level of intensity with his players, especially when you're having success or not having success. The coach who has lost will say 'How do I get my players motivated?' or when they are doing well 'How do I keep a lid on this thing and keep it going?'.

P: Someone mentioned behind the mirror about the balance between being too flat and too psyched. That may be the key for this couple. How do you maintain that balance after a real good week?

M: I wouldn't want anyone to get the mistaken impression that I wasn't very happy that they have had a good week and experienced some success, and that they might even begin to feel confident. I just hate for them to start coasting or get over-confident or even get demoralized. The couple phoned in to expand upon this idea and added an idea that complimented the team's development of the metaphor. The family said that they might need to have a "game" where they were soundly defeated by sixty point or more, like their home football team. They might need that, so the rest of the season they could do well. Their sense was also that perhaps this good week had given them the strength to have a bad week. So the couple, in commenting on the team's deliberations indicated that a setback could be beneficial in reaching the level of confidence necessary to perform their "best game."

Session Wrap-Up. Following the l-team's reflections, the family and team swap places again. The family and the therapist(s) use the remainder of the session commenting on, clarifying, or exploring further what was heard. Often the therapist offers an intervention that either came. directly from something that had been said by the I-team or was some variation of what had been said.

Mrs. Lopes: If it was too big of a disastrous week it might be back where we had been.

The therapist then reiterated the possibilities: a) after having a good week, the couple might have the strength to weather any kind of storm in the next week, b) after such a good week, even a mediocre week might look even worse by comparison, or c) having had a good week, if next time they had a horrible week, it might put them on track to have a good season, like their football team. The possible importance of having a bad week in order that they not become over-confident was stressed. Post Session, During this segment, the team debriefs, hypothesizes, and plans for future sessions. Post-sessions are common in other forms of team models, although they are proscribed in Andersen's model. In this post session, the team attempted to predict what the couple would experience during the coming week, and how the next session would be focused. Follow-Up. The following week, a short session was held with the Lopes which served to further refine the message that had bee developed during the previous week. They reported, with some satisfaction, that they had suffered a "loss" during the week, but that they were now confident that the whole season had not been compromised. This session was the last time we met with Mr. and Mrs. Lopes. They did not call us requesting any more sessions. A six month follow-up found them doing well and satisfactorily managing the difficulty around trust.

Conclusion

The purpose of this paper was the description of a clinical technique for introducing the possibility of change into a stuck system. In this paper we have shown how a model for clinical work that takes Andersen's reflecting team as a point of departure was developed which attempted to address three specific aspects of the Andersen model: avoidance of instrumentality, neutrality, the medium as the only message, and limited feed-back. Although there are many similarities between our work and that described by Andersen and others in using reflecting teams, our approach makes deliberate, explicit use of planning and discussion with team members in developing an intervention that would be helpful to our clients. Further, we allow the family, as well as the interviewing therapist, opportunities to provide real time feedback to the interacting team's deliberations. It is important to note that the format that has been described is not applied in every case. In fact, the team uses its freedom to consult with one another as a resource in determining the usefulness of this format in any particular case. In fact, the family has at times requested an interacting team intersession when we might have elected to omit it. In these cases we have taken advantage of the family's feedback in proceeding with the intersession.

We are continuing to explore the usefulness of this method of using the team format in therapy, but have also begun to explore the possibilities of a similar format for supervision of therapy and consultation in stuck cases. Additionally, we have employed a derivation of this technique in working with agency personnel who have referred clients to us. In this case, the case worker becomes a part of the reflecting team. Reports of the progress of these variations will be forthcoming.

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