Articles

Nikos Kaldirimitzian1

 

1Psychologist, Mental Health Center of Samos.
 

 

Summary

Resonance is a common phenomenon that occurs during family sessions. In psychotherapy, the term was introduced by Foulkes in the field of group analysis. Then Elkaim brought the concept of resonance into human systems and used it as a supervision tool. Finally, Jensen investigated the phenomenon and added the concept of relational resonance. The therapeutic relationship may be affected by resonance, either negatively or positively: negatively affected when the therapist imposes his/her own principles and values to the family that seeks help, or positively when the therapist uses it in a therapeutic way. Important moral and ethical issues arise with the appearance of resonance—most crucially, about the therapist’s responsibility. How can a therapist protect the therapeutic process from issues relating to his family, cultural background, gender and moral principles? Therefore it is proposed that therapist training should include treatment and supervision.

Key Words: Resonance, map of relational resonance, ethical issues and ethics.

 

Introduction

This paper deals with the phenomenon of resonance in the context of family interventions. The main purpose is the better understanding of it. Initially it focuses on the concept of resonance, then it describes the possible ways in which it can affect the therapeutic relationship, and finally some highlighting moral and ethical issues are discussed. Incidents are reported at all levels as examples that help consolidate the concepts. The issue is important because resonances may occur in family meetings frequently, and recognition of these helps in giving meaning to events, while lack of awareness may hamper the healing process.

 

The resonance in practice

In the context of the author's musical education, a musician friend showed him that when tuning a guitar, as the right hand hit the first string and the left hand pressed the fifth fret (giving the note “A”), the second string (which is also an “A”) vibrated without touching being touched! Something that occurred in the first string affected the second one in a "magical" way. The idea was born that this relates to the phenomenon of resonance in physics, which is about frequency coordination. It may be more fascinating to see on the guitar than read about it in a text. Years after that event, when the author was trained in "Introduction to Systemic Approach and Family Type interventions", the concept of resonance reappeared to him during family sessions in a manner reminiscent of the vibrating strings.

A team was set up in my workplace that started to apply systemic ideas in family sessions. Two professionals (a psychologist and a social worker) cooperated in the case that follows. Some family data may have been altered to ensure anonymity. A couple in their fifties came to our service with requests to address the thymus eruptions and dysthymic symptoms of the male. Both had children from previous marriages, at an age when they were about to leave home. The wife and her child were in a closely "fused" relationship. This made her partner complain about exclusion, sometimes losing control of his behavior at the same time that he wanted to gain control of the family. Temper tantrums were obviously followed by periods of sadness, guilt and distress for the family’s ‘identified patient’.

After some meetings the therapists noted some interesting dynamics in the therapeutic system. The wife decided to take care of her child and neglect her husband. The husband experienced anger, exclusion and a feeling of abandonment. The male therapist in the therapeutic team experienced something similar: his female co-therapist decided to focus on her child’s university entry exams and disengage herself from the responsibilities of the therapeutic team. The two men in the therapeutic system experienced abandonment, one by his partner and the other by his colleague. The two women in the system decided that it was more important for them (at least temporarily to such a degree) to invest time and energy in their children.

Resonance was recognized by the treatment group during the discussion after the session. The questions of the psychologist as a member of the therapeutic system were “what can I do with this feeling of abandonment which I experienced during the session" and "how can I use this resonance to the benefit of the family”. In practice, this was followed by several meetings with my colleague where all these emotions that had arisen were discussed. Essentially, what was clarified (and perhaps it was important to reduce the psychologist’s annoyance and tension felt) was that my colleague would remain in the group until the completion of the case but would not participate in a new case until the end of the university examinations. Also both colleagues recalled and narrated situations from their private and family life which had common elements with the family. Finally, the incident was presented during supervision where the literature on the subject was also presented; essentially, the process of supervision triggered further research.

 

Theoretical approach to resonance

The term resonance was introduced in psychotherapy by Foulkes (1977) in the context of group analytic psychotherapy “in order to do justice to the fact that each individual member picks out of the common pool what is relevant to him”. Berman (2011) states that the term was proposed by Foulkes when he noticed “some spontaneous unconscious, verbal or non-verbal interaction between members in the group that resembled for him strings that vibrate and reinforce each other.“Berman (2011) reports also Foulkes’s view that “the individual resonates in the key to which he is attuned, in which his specific personality structure is set”.

Then Elkaim (1995) uses the term «resonances» to describe "the special gatherings involving the intersection of common elements by individuals or human systems. The resonances emerge from mutual construction of reality of the members of the therapeutic system: these elements seem to come into resonance as a result of a "common factor" in exactly the same way as material bodies can be put into vibration if found on the same frequency". Let us remember the strings vibrating when tuned to the frequency of the note “A”. Something similar can happen to members of the therapeutic system. Human systems are in resonance under the influence of a common element. Elkaim (1995) notes that "we can’t experience a certain feeling unless special circumstances touch a chord within us" and stresses that "the meaning and function of the vibration of the string should not be sought at the level of individual dynamic: you must be connected to the system in which they experienced the feeling."

Resonances do not exist as such. There is no "hidden truth" to be brought to light through a point that is common among various systems. Resonances occur in the mutual construction of reality. (Elkaim 1991).

Elkaim (1995) proposes a number of questions that an expert should ask himself when some emotion (or topic) attracts his attention during a session with a family.

"Is this issue or feeling familiar? If so, what does it bring to my mind?"

"How important is this issue that I consider crucial for the family? How much does it concern them?"

"What if the matter proves to be important both in relation to our history and for the family members?"

Regarding the last question, Elkaim (1995) believes it can help practitioners discover a unique and special bridge which connects therapists and family members. It is interesting that he describes this bridge as "dangerous", because if it reinforces the common theme it would obstruct change in treatment. Elkaim (1995) notes that "however, this will provide a map of the mines that are scattered along the bridge, showing us the dangers that have to avoid when we cross this mutual construction".

 Kaslow et al (2002) see resonance as a tool that the therapist can tap when he answers the following questions:

- "What is the function of my experience in the context in which I find myself?'

- "To what extent my feelings allow other members of the system to maintain their deep beliefs and remain in a recurring cycle;"

By answering these questions the therapist can discover how he is affected by the system and how he has contributed to developing or maintaining it.

Kaslow et al (2002) describe resonance as "an iceberg whose only one third is connected with our own history and the other two thirds are unknown to us." Resonance involves rules shared by different systems in a reciprocal relationship. For example, a rule can be common and cover both the institution that offers services, the therapist’s family origin, the family that comes for help, the supervisory team or the cultural context. (Kaslow et al 2002)

Jensen (2012) believes that resonance gives meaning to the circularity that occurs between the personal lives of therapists and the patients’ narratives, and says that the concept of resonance can be approached from a relational aspect. The concept of resonance is extended to include personal and relational resonance. Jensen (2012) claims that everything that is associated with resonance and takes place in the mind or the emotions of the therapist and the family belongs in the concept of personal resonance. But at the same time resonance can occur in the space between the therapist and the family. (Jensen 2012)

 

Relational resonance: Concept and Typology.

Jensen (2012) claims that "the therapeutic relationship is one of the factors that promote change in psychotherapy." The effect of the therapist's personal experience during the healing process is an important factor which should be taken into account and understood. Experienced therapists describe awareness of "self" as a factor of change in the relationship. (Jensen, 2012)

Jensen (2012) developed a typology of relational resonance. He built a "map" to add reflections in order to understand what happens inside the treatment area when the interaction process is affected by the therapist’s personal experiences. His goal was to help in the supervision and training.

Jensen (2012) reports the approach of Cross and Papadopoulos on four fields on which the therapist can focus: family, cultural background, gender and moral principles. As in the case of resonance, when the therapist explores relational resonance he is called upon to answer certain questions. Specifically:

"How does my family affect my practice as a therapist?"

"How does my culture affect my job?"

"What does it mean to be a man or woman—more importantly, what is the impact of these concepts?"

"What is the relationship between personal moral values ​​and professional ethics?"

Figure 1 in the Appendix provides an overview of the structure and concepts of the map (Jensen, 2007).

 

Reciprocal Resonance

Reciprocal resonance refers to a therapeutic process in which the relationship between therapist and client has a character of mutual understanding. The reciprocal resonances include therapeutic sessions where the customer's history or situation brings memories and feelings to the therapist. It also links therapists and their clients through common reference points. This connection may be fully clarified, partially clarified or unclear. The mutual resonances between therapists and family members can take the form of either supportive or challenging resonances (Jensen 2012).

 

Supportive reciprocal resonance

 In order to explain the concept of supporting reciprocal resonance, Jensen (2007) cites the example of an experienced therapist working with a family where the "identified patient" was a twelve-year-old girl who wetted her bed. The therapist could not communicate with the girl during the first two family sessions. In the third session she decided to tell a personal story. Looking at the girl, she said: "When I was twelve years old I also used to wet my bed." The girl looked at her for the first time and they were able to talk.

Jensen (2012) reports the views of Dallos and Vetere who believe that supportive reciprocal resonance is a secure basis for treatment, as well as Minuchin’s view who presents it as part of joining in family therapy. Yet reciprocal resonance refers to a specific part of the therapeutic encounter. Essentially it describes the components of family session that arise from the therapist’s personal life and are brought into treatment by the therapist’s interaction with the clients. The common element of the therapist's experiences with family members adds meaning and gives new direction in therapy. (Jensen, 2012)

 

Provocative reciprocal resonance.

Jensen (2007) mentions as example of provocative reciprocal resonance when the life of a therapist coordinated with that of a woman, as both had to live with their sick husbands. The expert thought it would be wrong not to comment on this parallel situation, and recommended that her patient consulted another therapist.

Provocative reciprocal resonance establishes a framework for a sequence in the treatment. The resonance of the patient’s history provokes the therapist and thus affects the therapeutic relationship. It is worth noting that in this case the therapeutic relationship can be restricted and compromised or, conversely, open up new directions in treatment. (Jensen, 2007)

 

Reciprocal Dissonance

The concept of "cognitive dissonance" was developed by Festinger and describes a state of lack of agreement between an individual’s principles, ideas and attitudes and the experiences of his life (Jensen, 2007). A case of resonance with mutual dissonance is reported by Jensen (2007), where a therapist with an unconventional lifestyle met a family of devout Christians. During the sessions the therapist had great difficulties when the family simply repeated a story or complained without making any effort to change. In such a case the therapeutic process would be obviously fruitless, and it had better go under supervision and/or another therapist (Jensen 2007). While reciprocal dissonance is likely to reduce the empathy of the therapist, it can also be an opportunity to meet the clients halfway through looking for differences. (Jensen, 2007).

A family coming for therapy do not need to adopt the therapist’s life values ​​and attitudes;. if they do, we have the phenomenon of 'therapeutic colonization’.

 

Therapeutic colonization

The concept of colonization comes from politics. It describes a special relationship between a metropolis and some other countries—an often unequal relationship. Therapeutic colonization describes how the culture, experience and moral principles of a systemic family therapist influence the therapeutic practice. Therapeutic colonization creates a context in which the function of mutual communication is reduced. This is because the therapist introduces and clarifies issues for discussion based on his power. Use of the therapist power creates a dialogue context which brings up the issue of moral responsibility. The good knowledge of theory is a basis of responsibility against the therapist's ideas. Simultaneously, supervision and treatment are tools for better understanding and recognizing the therapist’s prejudices. (Jensen 2012).

Rober and Seltzer (2010) argue that colonization appears when therapists are too focused on change, thus showing disrespect towards the family pace and overlooking the family’s resources for change. With such an attitude the therapist risks losing touch with some or all family members. In order to avoid colonization, the authors propose two different approaches, which can often be combined: a. Pause and observation; b. Reconnection.

Under the first approach, therapists often turn to their inner dialogue and observe their activities, asking themselves some key questions about their own attitudes. For example, “What is the effect of this attitude on the family?” “Does it make more room for them to tell new stories?”

Under the second approach, one key question to the family is “Can you help me understand?” Therapists will often openly discuss their concerns about their attitude, linking it to what family members are experiencing. In order to achieve that they may ask: “How do you feel about the way the session is going?” “Do you feel comfortable οr uncomfortable?” “How do you deal with discomfort?”, etc. (Rober and Seltzer, 2010)

Awareness of the power exerted by the therapist and its intensity are key elements in the concept of therapeutic colonization. Based on these characteristics, therapeutic colonization is categorized into: a) indirect therapeutic colonization. b) Direct therapeutic colonization. c) Therapeutic imperialism.

 

Indirect therapeutic colonization

Indirect therapeutic colonization occurs when the therapist’s personal and private experience influences the systemic family therapy in an unplanned and undefined way. The therapist is not always aware of what is happening, and this can create a framework that can be understood as different to what the therapist projects as his professional practice. The peculiarities of power dynamics may be hidden to both the therapist and the client. (Jensen, 2012)

Jensen (2007) reports an example of indirect therapeutic colonization. A therapist who was not used to giving advice and suggesting solutions asked a couple if they had talked to others about their problems. Watching the video of the session, it looked as if the therapist advised the couple to talk with their parents and siblings. The therapist was surprised with what he had said, as if he had done something contrary to his ideas. However, a discussion with the researcher revealed that the therapist had values ​​and experiences which could explain his action: specifically, when his partner became pregnant out of wedlock, he had sought help from his paternal family.

 

Direct therapeutic Colonization

In direct therapeutic colonization the therapist uses his power to set topics of conversation unrelated to the clients’ issue. The issues are determined by the experiences in the therapist's private life. Thus the sphere of mutual communication diminishes and a relationship of power emerges. (Jensen 2012)

Jensen (2007) describes a case of direct therapeutic colonization where a couple asks a therapist’s help in a specific manner. The woman says they had decided to divorce, but as they had two children they needed help in matters of communication. The therapist asks the family members about their various issues and focuses on one of them (the father’s abuse of alcohol) as if it were the only important one, devoting the entire session to it. It is worth noting that in her personal life the therapist often saw her husband using alcohol. As a result, the session did not take the direction the family wanted and the therapist lost the ability to listen to the needs for which they had come.

 

Therapeutic imperialism

Imperialism, like colonization, is a term first used in politics. It is a concept found in various political theories to describe the violently imposed will of some authority (Jensen, 2007). Jensen (2007) defines imperialism as a therapeutic sequence or situation where the therapist uses direct power to express a personal value. Therapeutic imperialism sets the conditions for clinical intervention against the wishes of one or more family members in treatment. The use of power and the fact of going against the express wishes of the client make the difference between therapeutic colonization and therapeutic imperialism. (Jensen, 2007)

Jensen (2007) reports that he coined the term "therapeutic imperialism" as a framework for understanding the actions of two therapists in a case where the father refused to tell his children that they had half-brothers from his previous marriage. The therapist, based on her own parallel experience as a child, declared that it was wrong of the parent to keep such a secret and the children were informed about their two siblings against the will of the father. The therapist was working in a family therapy unit at the time, and this obviously means that the majority of her colleagues approved of this action. Yet the question raised by Jensen (2007) is whether personal experiences and values ​​are sufficient basis for clinical interventions like this.

 

Discussion

The present study focused on the phenomenon of resonance and drafted a map of resonance on a relational level, as suggested by Jensen (2012). During the phase of data collection and desk research, it was found that "resonance“ had already been used as a term before Foulkes. Specifically, Jensen (2012), referring to a 1970 work by Martha Rogers, notes that the author "advanced our understanding of resonance from a relational perspective." Other authors had also used this term in international literature, albeit with a different content. For example, Horogian et al (2004) report that "resonance defines the emotional and psychological accessibility or distance between family members."

Rober (2010) indicates the existence of an inner dialogue involving the self and the role of the therapist. The concept of the self obviously contains personal experiences from the therapist's private life. Apart from these, which are rooted in the past, there is the experience of the therapist during the session. Psychoanalysis has dealt in depth with this subject. "Counter transference" is a concept which preoccupied psychoanalysts early on; they concluded that it is not a barrier to treatment, as originally Freud saw it, but a source of information. On the contrary, for many years family therapy paid no attention to the feelings of the therapist. (Rober 2010). Elkaim (1991) was the first to give a systemic dimension to the feelings of the therapist, and proposed that they be explored not only in the context of a personal economy but in connection with the system in which they emerge. Elkaim (1991) and Jensen (2012) note that the personal life of therapists has a significant effect on the healing process. This effect can either help or hinder the therapeutic process. The question that arises is how to protect the therapeutic process from the therapist’s private life. Jensen (2012) suggests treatment and supervision as part of the therapists’ training. Of course, supervision can continue at all stages in the therapist's professional development.

People are different, but their lives are often alike. Thus the lives of therapists may have at least one thing in common with those of the clients. The way we manage the common point that causes resonance in a system is a key issue for the therapist. In practice, a 'mature' 'experienced' and 'responsible' therapist, who has processed any difficult events of his life can use them to the benefit of the family in therapy. But some facts of life can operate beyond the therapist’s knowledge. Jensen (2012) believes that sometimes resonance affects the therapeutic relationship to a major degree and in a manner that raises ethical issues. Particularly in cases where the therapist imposes the topics of discussion or proceeds to interventions which are contrary to the ethical principles of at least one family member, there is an issue of the therapist's ethical responsibility. According to Kaslow et al (2002), Elkaim tried to answer the moral question of how one can be a member of a system and at the same time to feel free to act in a responsible and ethical manner. It seems that he approached the concept of resonance as a means of resolving the division between individual responsibility and systemic operation; in other words, to find a way to bring these two issues closer so that therapists can be loyal to both. Therapists are influenced by the feelings that emerge due to the fact that they belong to a treatment system consisting of the family and themselves. But at the same time they must be aware of how these feelings are triggered, and thus they are responsible for anything they experience. (Kaslow et al, 2002)

Finally, Elkaim (1991) was impressed by the intersection of three systems. For example, a therapist feels "cornered" by his colleagues at work. In his own family the therapist had been ‘crammed’ between his siblings and his father, and now he treats a family whose mother is squashed by the grandmother and the daughter (Elkaim 1991). The resonance of these three systems seems not to have been taken into account in the map of relational resonance. Essentially the map describes the possible "pathways" therapy can follow when there is a common element between the therapist and the family. The possible interaction in the therapeutic process of a third system, which resonates with the other two may be a future topic for research.

 

References

Berman, Avi (2014) “Resonance among Members and its therapeutic values in group psychotherapy”. Available at: http://www.mindfulnessstudies.com/wp-content/uploads/2014/01/4-Resonance-in-Group-Psychotherapy-Chpt.-9.pdfAccessed on 29/6/2015.

Elkaim, Mony. (1991) Si tu m’aimes, ne m’aime pas. Approche systémique et psychothérapie, Le Seuil, Paris, 1989; Greek trans. «Αν μ’ αγαπάς μη μ’ αγαπάς». Kedros. Athens.

Elkaim Mony. (1995). «Από την αυτοαναφορά στις συναθροίσεις». Tetradia Psychiatrikisno. 49. Trans. Alexandra Palli, Emmy Ghika

Foulkes, S. H. (1977) “Notes on the concept of Resonance”. Available at: http://www.mindfulnessstudies.com/wp-content/uploads/2014/01/4-Resonance-in-Group-Psychotherapy-Chpt.-9.pdf. Accessed on 30/6/2015.

Horigian, Viviana, Robbins, Michael, Szapocznik, José. (2004) «Brief Strategic Family Therapy». Available at: http://www.bsstreview.net/wp-content/uploads/2014/07/horigian.pdf. Accessed on 25/5/2015.

Jensen, Per. (2012) “Family Therapy, Personal Life and Therapeutic Practice. The Map of Relational Resonance as a Language for Analyzing Psychotherapeutic Processes”. Available at: http://brage.bibsys.no/xmlui/bitstream/id/203543/jensenTheMapofResonanceHSPS.pdfAccessed on 25/5/2015.

Jensen, Per. (2007). “The narratives which connect. A Qualitative Research Approach to the Narratives which Connect Therapists Personal and Private Lives to their Family Therapy Practices”. Available at: http://www.sfft.se/dokument/avhandlingPerJensen.pdf. Accessed on25/5/2015.

Kaslow, Florence, Massey, Robert, Massey Davis Sharon. (2002). “Comprehensive Handbook of Psychotherapy, Interpersonal/Humanistic/ Existential”. Available at: https://books.google.gr/books?hl=en&lr=&id=Ks2z9zkHrVwC&oi=fnd&pg=PR5&dq=international+perspectives+on+professional+ethics+elkaim&ots=

Rober, Peter. (2010). “The therapist experiencing in family therapy practice”. Available at: http://ift-malta.com/wp-content/uploads/2012/09/therapist-experience-of-session.pdf. Accessed on 25/5/2015.

Rober, Peter, Seltzer, Michael. (2010). Family Process 49. “Avoiding colonizer positions in the therapy room: some ideas about the challenges of dealing with the dialectic of misery and resources in families”.

 

* The doctoral thesis of Per Jensen, entitled "The narratives which connect", begins with the English translation of the poem of CP Cavafy "Ithaca", apparently implying that a poet was quicker in arriving where scientists of mental health are headed. The author borrowed the idea and used some words that allude to "Ithaca" in the title of this paper.