Clients' Voices: A Collection of Client's Accounts

Sylvia London, Martha Gargollo, Gabriela Ruiz and MC.

Abstract:

The purpose of this article is to provide the reader an inside view

to the therapeutic process through the narration of the clients' experiences.

This narrative is the result of an interview (conversation) about the

therapeutic process conducted by the author (SL) and the clients' as part of

the therapeutic process. The conversation was videotaped and transcribed.

After this exercise, the clients were invited to write an article about their

experience knowing that this article will be published in a professional

journal.

The main voices that will be heard are the clients' voices as they

tell their story about their experience in therapy. The therapist/author

is only a vehicle to bring these testimonies to the professional community.

The format of the article includes a general introduction (A Therapeutic

Approach), a description of the interviewing process (The Process) (SL),

followed by the clients'accounts (GR, MG and MC).

Introduction, A Therapeutic Approach.

My work and my view of myself as a therapist have been heavily

influenced by the work of Harlene Anderson (1988, 1992) and her colleagues at

The Houston Galveston Institute and by Tom Andersen (1992).

I have come to view my role as a therapist and my relationship with

my clients as a facilitator, an expert in creating certain kind of

opportunities for conversation. In this particular kind of conversation,

created through dialogue, we co-construct realities and possible solutions

to the dilemmas in question.

I see myself as a provider of a conversational space where multiple

ideas and meanings can be entertained at once. Through the conversation my

aim is to maximize the possibilities of ideas, dialogues and solutions.

As Tom Andersen(1991) has so eloquently mentioned: "to talk with people in a

way that they have not talked with themselves or with each other before".

My clients remain in the center of the stage and I am constantly

wondering where do they want to go and how do they want to use this

conversation. This does not mean that I don't know anything or that I don't

provide anything in the conversation. This only means following Bateson's

ideas stated by Anderson and Goolishian (1988) "In order to entertain the new

and the novel there must be room for the familiar". From that familiar stand

we co-create together the possible pathways to the "newness".

I am often very pleasantly surprised about the places we can reach and the

ideas we can generate together.

My main tool in therapy is the question, many of them, in all forms

and fashions. These questions help me wonder, generate curiosity and move

tentatively along the way. They also give me the opportunity to express

my ideas and negotiate their meanings through dialogue.

Ivar Hartviksen (1990),a Norwegian psychologist, captures the meaning

the questions have for me when he says:" The question is the only tool that I

have in my work. It is the only way that I have of wondering, of participating

in my patient's life".

Another important influence in my work has been the narrative stance

adopted by Michael White and David Epston (White and Epston, 1990).

Following their work, I have increased the use of letters and written

exchanges in therapy, including the idea of having clients join me in this

professional effort,(Epston, 1990).

These collaborative ideas have also influenced my views about

research and therapy. I conceptualize my research designs as well as my

research reports in a collaborative fashion, where the research participant

remains in the center of the stage and I try to keep his/her voice as close

to the original as possible. This is the reason why I am choosing to include

in this article my clients' experiences of their therapeutic process as they

write them. The richness of their experience can be captured through their

own language*

*Unfortunately the original versions of two of the accounts are in Spanish

and were translated to English.The versions in Spanish are available to the

reader by contacting the first author (SL).

The Process:

I have been interested in the ideas my clients have about therapy in

general and about our work together in particular for a long time.

Following Anderson �H(1992), Epston� (1990) and other prominent voices in

family therapy I started interviewing my clients informally as part of the

therapeutic conversation at the end of the therapeutic process. Slowly I

began to incorporate questions about their ideas about therapy as a regular

part of my sessions. I became fascinated with their answers but especially

with their willingness to share their ideas and their need to share them with

other therapists and other clients . " I felt I had company on my journey, I

still remained very connected to my own process but never felt alone"

(Interview June 95) " Now I feel obliged to tell the story the way I feel

needs to be told, I feel I have to share it with others and do it in a way

that will remain true to myself and to the process". "This is not about

selling or convincing anybody that this is better than other therapies this

story is about sharing my experience in the most honest way " (personal

communication January 96). Following this initial curiosity I began

interviewing my clients in a more formal fashion in the Summer of 95.

The interviews followed a format where clients were directed to the

topics that I wanted to focus on but developed in a more personal fashion

according to the client's specific needs, curiosities and narratives. The

interviews included among others the following questions:

If you were to describe the process we had together to someone that has not

been here with us what would you tell them.

What happened in the process that made it possible ?

What did you find useful / not useful ?

What would you like to change ?

What kind of advice would you give to a therapist working with a client

similar to you ?

How would you describe the relationship ?

If you had to describe my expertise, what do you think I am an expert on ?

(what are you buying in this process ) ?

What made it possible ?

These interviews provided interesting answers and questions, the

clients were capable of describing the philosophical and epistemological

stance (Anderson. H�, 1998, 1992) that I consider to be the central part of

my work as a therapist.

Once the project of the JST issue became a reality I contacted my

clients one more time and asked them if they were willing to write their

process and have it published in a journal.

They were and are very excited about the process in spite of the enormous

amount of work that it entitles. They have shared with me that the process of

reporting their experience in writing has been therapeutic and enlightening

by itself (MC ,Martha, personal comm. Jan 96). In the process of writing the

experience they have been interviewed one more time and they have spent hours

watching and transcribing their interviews. I believe this effort can be very

enriching and inspiring for us therapist and our clients as well.

Please share this information with your clients.*

* In order to leave the clients' voices as pure as possible I chose to

include in this article the description of the process as the clients' wrote

them. There is very little stylistic change.

In order to respect the need of each individual client, two chose to become

co-authors with me and one person decided to provide her account if she could

remain annonimous, she aggred to let me use her innitials MC

*I want to thank Margarita Tarragona, for her translation and editorial work

of two of the articles (MG and MC)

References

Andersen, T. (1991) Presentation titled; " Relationship, language and pre-

understanding in the reflecting process" at Houston Galveston Institute

Narrative Conference: New Directions in Psychotherapy. Houston, Tx, May 1991.

� Anderson, H (1992) The Client is the Expert, in Gergen, K. & McNamee,S.

Therapy as a Social Construction, Sage.

�Epston, D. (1990) Collected papers. Adelaide, South Australia:

Dulwich Centre Publications.

� Anderson, H. & Goolishian, H. (1988) Human systems as linguistic systems:

Preliminary and evolving ideas about the implications on clinical theory.

Family Process, 27(4):371-393.

Hartvisken Ivar (1990) Melbu Conference, Melbu, Norway, June 1990.

White, M. and Epston, D. (1990) Narrative Means to Therapeutic Ends, New York:

Norton.

The Accounts:

Gabriela Ruiz's Account:

From Psychoanalisis to Narrative Therapies

T.F. Gabriela Ruiz

(Family Therapist)

I was brought up in a family where psychoanalisis was the guiding

light. Ever since I can remember the origin and cause of ones behavior was

a way to understand and see the world. I grew up believing that my conduct was

motivated by a myriad causes although they remain hidden inside the dark

unconscious. I can't remeber greater pleasure than diving in the deep waters

of the past where I would find the secrets of the present.

Psychoanalisis was a wonderful way of understanding everybody's

secret motivations,their obscure and perverse impulses, their unspeakable

mysteries,their concealed self.One felt powerful playing therapist with

friends and family. That was a game. Then came the serious part of it all.

If one had learned to see and live the world in such terms, one wanted to

help others share the same vision, one wanted to help others heal the secret

and painful wounds that their miserable past had left upon their souls.

I used to believe then, that one had to hurt to overcome the pain of so many

years lived under adverse conditions.

I was trained as a psychoanalitic therapist. There was no doubt in

my mind that was the road I wanted to travel. I had no doubt that the only

way I had of removing the entrails of my traumatic childhood experiences,

was to undergo psychoanalitic process myself. I did. As a patient I learned

to follow the basic rule, to speak my mind, to confront the most malignant

and fearful feelings. I learned to confess the unspeakable, to overcome shame

and to discover those crazy parts of myself that were to blame for all my

trouble. Of course I learned about the power of the analyst, about the

complementary relationship between patient and therapist, about the patients

inability to perceive reality correctly, of his/her continuos doubts about

his/her mental health.

As a therapist I was trained to believe one is the expert, the

omnipotent wizard that heals with the touch of the magic words. I was trained

to believe that neutrality, affective distance, anonymity were technical

instruments to be used to help patients overcome their conflicts and work

through their past experiences. I was taught also that I had to use myself

as a therapeutic instrument, using my countertransference as a way of

returning the patient his feelings in a digested form. As a therapist I

looked for pathology and worked with it.

Being a child psychotherpist I had to deal with parents, schools,

other therapists and Doctors. I had to confront different points of view

in diverse contexts, which put me in a position where I was not omnipotent

and needed other resources beside the analytic framework to deal with the

multiple variables I found in my daily work. I started thinking that training

in family therapy could open new avenues of understanding the intrapsychic

conflicts my patients had. Little was I to know the surprises that were in

store for me.

During my training as a systemic family therapist my thought process

started changing, the world stopped being a linear cause-effect matter, it

began moving in circles. I started contemplating the individual as a part of a

complex whole that influenced it's conduct and was influenced by it. My

patients stopped being alone in the world but they were accompanied by a

family with many interwined connections. I began to understand my personal

inner life as part of a system that was made up of different interactions,

of invisible loyalties and motivations, of a wider scope of needs, ideas,

feelings. My changing perception of the world started influencing my daily

therapeutic work. It has been a slow, imperceptible change. I suddenly found

myself thinking that my previous framework was not sufficient to face actual

and immediate problems. I began to see that other kinds of interventions

had positive results when working with families and couples. I became more

tolerant of differences,of alternative points of view. I started to search

for resources in the individuals, forgetting pathology and all sorts of

diagnostic criteria.

Time came when having left my analytic therapy I was in need for

personal help to deal with an acute crisis, I didn't want to appeal to

previous solutions whose answers I knew by heart. I wanted different and new

answers to a problem which had it's roots in the past. I wanted a narrative

approach to my reality. I wanted to modify my vision of the world, I wanted

to learn a new way of thinking about reality and it's alternatives. I was

in need of grasping reality in the here and now, of compromising with myself.

I entered narrative therapy, afraid what I would find and feeling disloyal

towards my previous frame of reference.

In the process of this new focus I was being asked questions I never

imagined. I was being taught new alternatives of contemplating a problem,

in an unpainful, playful and surprising way. I found myself eager to

accomplish my homework assignments, giving them a great deal of thought and

enjoying every minute of it. How could a method that did not make you suffer

that passed through reason and not emotion helped you solve conflicts ?

I don't have the answer, yet I know that the opening of new pathways towards

the same problem, is a way of opening doors and windows to a light never seen

before.

The process of narrative therapy is completely different from that of

psychoanalysis. In narrative therapy the setting is more flexible, the

frequency of meetings is less, there are no interpretations, confrontations

or judgements, there is no empowerment of the therapist, the relationship is

egalitarian and the therapist is perceived as a warm, close human being with

problems of his own.

By learning a new way of being a patient I have learned a new way of

being a therapist. I am a therapist more interested in the immediate

solutions, in the here and now of my patients. I am more flexible, more open.

I have become humble and accepting of my mistakes. I feel more alive knowing

that I work as a team with schools, parents and patients, than before when I

thought that I could deal with everything by myself.

Through my experience as a patient in narrative therapy I have changed

as a therapist, yet I still don't know what will become of this change,

of this motivating and surprising way of discovering the world as an endless

fountain of richness and alternatives, as a place where everyone has the right

to their own personal and unquestionable truth.

Marta Gargollo's account:

Sylvia London invited me to write this article for the journal and

I though it would be very interesting to do it because I enjoy

writing and I really liked my experience in this type of therapy ,

where results were obtained in a brief time, which is what I was

looking for.

My contact with Brief or Systemic Therapy started in June of 1995,

when I was stuck in my personal and professional life, as well as in my

relationship with my husband. My brother Fernando recommended that I contact

Margarita Tarragona. I went to see her and from the beginning of our work the

method was very clear and I felt free to take the road that I wanted, with

her consultation and guidance. The first two sessions were basically

information about my situation and a little bit of history.

The third session was a specific task that I worked on between one session

and the next. At that time Margarita told me that she would be leaving Mexico

to live in the USA for some time and suggested that I continue the therapy

with Sylvia London. The fourth session was the last one with Margarita and

Sylvia was also there to link the work between the two of them.

The bridge between one therapist and the other was extremely easy thanks to

the clear methodology that this type of therapy has.

I was a little worried about switching from Margarita to Sylvia

because with Margarita I had felt very comfortable, we were working very

well and I did not know if the same would happen with Sylvia.

The personal working styles of the two therapists are very different.

From my point of view, Margarita is more sensitive towards feelings and

works more from the heart, while Sylvia is more geared towards results

and mental functions, or at least that is my perception . My own style

is closer to Sylvia's, so I adapted to working with her immediately

and the results happened extremely fast.

My work in the therapy sessions was very constructive. I learned many

things about myself and I came to value a lot of what I have done in my

life so far. The tasks or "homework" between sessions were very

productive and I discovered many interesting things that I had not

realized before. I reclaimed positive things from my past and this

helped me get unstuck . Before 10 sessions I had achieved my main goals,

thanks to the methods used by Margarita and Sylvia.

In 1994 I had an experience with traditional couple's therapy that

helped me see the great difference that there is between Traditional

Therapies and Systemic Therapy. Some of the differences that I

perceived are the following:

Traditional Therapy Systemic Therapy

Basically has to do with the past. - Happens in the Present and

moves toward the future

mos towards the

future.

You work with a jumble of negative - Clearly focuses on a goal. It

events of the past (complaints, takes what was POSITIVE about

demands, misunderstandings, etc.) the past and offers solutions.

Can take years and might not reach - It's brief and concise, it has

determined solution a time frame time frame.

The formal nature of "The doctor" - It is more confortable and

"The Patient" takes away much informal, which creates a

of expression and openness. greater openness and freedom. .

"Vomiting Trash" sessions are awful - I love the positive nature of

can have an effect on you the sessions ,the directiveness

for several days. Plus, I don't towards the search for solutions.

see what's the point.

Some sessions depress you, some - Sessions are to empower you.

motivate you and in some you leave They generate a positive

feeling the same as when you went energy that makes you leave

in. feeling better than when you

arrived.

What I like the most about this therapy was that it takes place in

the present and it focuses on what you want to accomplish in the future.

I think that the biggest mistake of traditional therapy is that it happens

in the past, where there is nothing you can do because you can not change it.

I think that living in the past, being trapped in the past, is a way of

escaping the present and the future, since in the present you create the

future and in a negative past there is only frustration, impotence,

misunderstandings, blame, guilt, etc., which don't serve any purpose and

don't lead you anywhere.

Another important aspect of Systemic Therapy is that it is directive,

it has a clear objective and a path to follow, which is the only way

to get results in a short time.

Something interesting for me was the relationship that developed

between the therapists and me. It was sort of a friendship or consultation.

I don't know how to explain it, but it is a relationship that is handled on

the same level, without hierarchies between one person and the other, like a

natural relationship between human beings, more of a helping relationship

than Doctor/Patient pair. This made work easier, nicer,freer and more

horizontal.

I felt very comfortable because I stopped feeling that I was being

judged or being "cured" and being "wrong" and "needing" the opinion

of an expert. I personally dislike that feeling of hierarchy, I think that

you are the best "expert" on yourself and that therapy should be like a

consultation. Its goal is to help you with something specific that you do not

know how to solve. The perspective and objectivity of another person can help

you see roads, solutions or possibilities that you can not see right then.

My work in therapy had a very important effect on my personal and

professional life and many things were achieved, such as:

I overcame paralysis and took action again.

I valued myself and increased myself-esteem and self-confidence.

I filled up with energy and continued on the path that I want to be on.

I learned many new things about myself.

I made very important decisions about my life.

I obtained once again the results that I want to have in my work .

I can place myself in the present and be more objective.

I feel good about myself again.

I dare to do things I have never done before.

I have found new ways to communicate.

I feel more confidence and base my actions on my own feelings and

not on other people's opinions.

If I were telling a friend about my work in therapy I would tell her

that it is a consultation to help you overcome the obstacles that

keep you from getting what you want in your life. I see it as a sort

of "Life Project Consultation", that takes you from where you are

today to where you would like to be, getting rid of the parts of your

past that are getting in your way and giving you the great value that

you have as a human being: empowering you!

Finally, the next step for me will be to apply what I learned in the

working sessions, to continue with my Life Project and to do what I

need to get the results that I want,. If in the future I get "stuck"

again , I know who to turn to in order to go on.

I think that this type of Systemic Therapy is on the cutting edge and

more advanced than Traditional Therapy, which I think is becoming

dated and out of touch with what people need .today. I know that in

the recent years and in the future there will be many changes in all

areas of human development. It is amazing to think that we still do

not know how our mental "computer" works and that everyday new

paradigms are broken in the study of human behavior. Many of the

paradigms by which we live today have nothing to do with the reality

of our abilities and what we are capable of doing.

I want to recognize and applaud the work that you do. I wish all

therapists would know about this type of therapy and the results that

you are getting, so they would make strides in helping people fulfill

their potential and unchain themselves from the past that traps them.

If my experience can be helpful for your work I am very happy to

share it and it is a great satisfaction for me to collaborate in this project.

Sincerely,

Marta Gargollo

Note: Translation by Margarita Tarragona. We chose to leave the terms that

Marta chose to describe the therapeutic process as "Systemic" and

"Traditional" therapies.

MC's account

In order to tell my story about my experience in therapy,

I should acknowledge that in the past I have had a tendency to look

inside myself. Even if these arbitrary gazes were cautious and

sporadic, they were comforting at the time.

However, there was a time when I was deprived of myself, a time when

I supposed that I had to be in charge of the good functioning,

well being and harmony of each and every person and situation around

me; a time when I functioned like a machine that had to efficiently

use the material, human and emotional resources of my small world.

Just like my mother had done before, I had to silence certain inner

voices in behalf of others well being, in behalf of the other.

For some years I lived under the anesthesia of this everyday life.

Today I dare explore the multiple visions that I keep inside me,

with an astonishingly relaxed and serene attitude. I go through my

inner worlds with a certain stimulating curiosity, which I would like

to remain as it is, free of value judgments. If I don't repress what

springs from inside I can accept new feelings, identify situations

and integrate all of this in a multifaceted vision of myself.

To discover that I am a being that is revealed in continuous inner

motion, that is constantly articulating and disarticulating itself,

that can chose and discard explanations of itself without fear of

distancing from its essence. All of this has been a very enriching

experience, and today undoubtedly pleasurable.

But, how has it happened ?

I was physically and emotionally exhausted, facing a "panic crisis"

that I wanted to redress, but with the internal devastation that I

felt it was impossible to find the threads to understand anything

that was happening to me, I felt I had nothing left to lose.

From our first sessions in her office, Sylvia oriented our dialogue

towards the revelation of concrete facts, without qualifying them:

there was no place for the good and the bad or the right and the wrong

in this initial stage of the unveiling. She incited me to tell myself

my stories keeping a tolerant attitude towards them, digging in the

events without fear of finding those monsters that hide in the Pandora's box

that one is.

The possibility of opening several access points to a concrete

problem, observing that reality is multiple and can be approached in

very different ways, the conscience that there is no one only truth,

the absence of judgments or condemnations, these all slowly loosened

the rigid model that I was locked in.

As months have gone by I have found in the consulting room a space for

conversation that is intimate and professional, that allows me to go

deep into the issues that concern me in an honest and open way. I feel

that Sylvia made good use of the feeling of loss which I started

this process with, taking me out of that pre-made, resolute and

self-dissolving image of myself that I had adopted as an automatic

response. Little by little I am discovering new nuances of myself,

new expressions that correspond to a new, more tolerant and benevolent

person moving towards the person that I am.

Today I start to feel connected to myself, I recognize my inner

voices, I discover how this inner dialogue has become a tool that lets me

integrate what has happened to me at other times with what I think,

feel and live today, without pretending that this will be immutable.

On the contrary, I now begin to be conscious of my own movement

and I want to let myself flow more organically in my inner and outer

world.

Note: Translation by Margarita Tarragona