Developing
News October – December 1999
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Performance
and Postmodernism
Lois Holzman
Developing
News began in the wake of "Unscientific Psychology: Conversations
With Other Voices," a conference hosted by the East Side Institute
in June 1997. The nearly 150 participants from all over the world
were enthusiastic about having a way to keep in touch and expand
the network of people with a postmodern sensibility. Many months
later, the Institute launched the first issue, originally mailed
to the conference attendees. Since then, readership has greatly
expanded, and we are now on line.
In addition to Developing News, that conference sparked
a forthcoming book entitled Postmodern Psychologies, Societal
Practice and Political Life. Edited by the Institute's director
of educational programs Lois Holzman and John Morss (until recently
at the University of Otago in New Zealand) Postmodern Psychologies
continues the conversation begun at the 1997 conference. The contributors,
some of whom revised their presentations, others who wrote new
essays and still others who were invited to comment, include:
Harlene Anderson, Erica Burman, Lenora Fulani, Ken Gergen, Mary
Gergen, Lois Holzman, Sheila McNamee, John Morss, Robert Neimeyer,
Fred Newman, Vesna Ognjenovic, Ian Parker, and John Shotter. The
book (published by Routledge) won't be out until Spring 2000,
but here's a little preview from Holzman and Morss' commentary
- which sets the stage for this issue's contributors. Weaving
its way throughout the authors' discussions of psychology, society,
culture and politics is the concept of performance, as a method
for a new way of understanding/being/becoming, i.e., for transforming
human social relations. At issue is: can we create new performances
of our sexuality, our emotionality, our identities, our meaning-making,
our politics, ourselves? Performance, the authors imply, becomes
unstoppable.
Performance
is not just the first night of the show, the polished (perhaps)
and single-voiced human pyramid that is the orthodox western (and
eastern) theatre. The stage lights show you what you are meant
to see and how your are meant to see it, just like a conventional
conference presentation. Performance in that sense - the performance
of Cloud Nine at the Royal Court Theatre or of The
Lion King on Broadway – official performance, performance as
sanctified by the institution of the theatre, is no more than
the tip of the iceberg. That kind of performance is essentially
repetitive, even if it closes after the first night, and even
if it's been arrived at through the actors improvising in a workshop.
Performance,
we think, is better revealed by the rehearsal. Here the nuts and
bolts are in clear sight, yet the performance aspects are just
as much present as on opening night. Actors are working in rehearsal
to collectively create something new, not to display a finished
product. Rehearsals lurch awkwardly between technical precision
and tedium. They may stop and start unexpectedly. At one and the
same time some people are performing, some are chatting about
the performance, the play, the director or the acting, while others
about where they will have dinner after the show.
This
is the performance that our contributors find relevant - even
essential –
to the transition from (modernist) identity
to (postmodern) relationally, from a psychology of adaptation
to a psychology of transformation. Their essays can also be viewed
as a rehearsed performance of the possibilities afforded by the
postmodernization of psychology. The implication, the authors
suggest (passionately), is that such a transformation of psychology
is helping to make possible a social/political/cultural transformation
that goes far beyond the borders of a particular discipline. Performance,
as a method and as form of life, can restructure and rebuild how
it is that we are together. (Lois Holzman and John Morss)
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Conversations
on Health I
Susan Massad
The
medical profession is just discovering what patients have known
for years –
physicians are not very good at communicating.
Recent work by Roter, Tuckett, Cassells and many others have shown
how doctors talk at patients, adhere steadfastly to their
own agendas, don't listen very well and are not very collaborative
in their interactions with patients. Studies have also shown that,
with training, physicians can get better at interpersonal skills
and, when they do, their patients are more satisfied, have better
health outcomes and are less inclined to sue their doctors. Not
surprisingly, medical communication is a hot issue.
I
have taught in the arena of the doctor-patient relationship for
over 30 years and for the past 20 years have worked with Fred
Newman on different medical projects. During this time I have
had extensive dialogues with him and the East Side Institute staff
as to how the developmental cultural performatory approach of
social therapy could be useful to my work as a clinician and trainer
of physicians. Three years ago funding became available at Long
Island College Hospital in Brooklyn (LICH), where I direct ambulatory
medicine, to develop a communications/interpersonal skills (IPS)
training program for our medical residents. I successfully bid
for the program and used it as an opportunity to bring the performance
work of Newman and his colleagues into the medical training arena.
Working with the staff of Performance of a Lifetime (POAL), the
performance school for nonperformers that was conceived by Newman
and makes use of his discoveries about performance and development,
a collaborative project was launched in the fall of 1997 to teach
IPS to first year medical residents.
In bringing the POAL staff into my hospital I wanted to introduce
a training approach that was entirely different from the cognitive,
behavioral approach that is typically used to teach young physicians
scientific medicine. Although science and its method have made
enormous contributions to medicine, it has been my feeling for
a long time that the extensive training that physicians-to-be
get in the scientific method does not serve them well in acquiring
the noncognitive skills of relationship building. As scientists
they learn to abstract, to objectify and to generalize. Building
a relationship and creating a conversation with a patient, however,
is much closer to creating a play or a poem. I felt these skills
could best be taught by using a cultural approach.
The
training program for first year medical residents consists of
eight weekly workshops where they are taught the language and
skills of improvisation. All of the classes start with relaxation
exercises and a series of improv games and listening exercises.
Residents provide material for the improvisations which are directed
and redirected by the POAL staff. For example, in one scene the
residents played hospital administrators from all over the solar
system who had come together to develop an intergalactic health
care system. They were redirected to speak gibberish. The subsequent
direction was to perform different emotions.
The
final workshop is a performance created out of the improvised
material that is held for other residents in the program.
We
have found that performance training is effectively addressing
issues that have been difficult to engage through other teaching
methods, including teaching residents listening skills; addressing
residents' concern with getting to the point of things, and helping
residents to interact more effectively when there are issues of
medical uncertainty.
Based
on the success of the first year training, we initiated a performance
based training project for second and third year residents. We
videotape resident/patient interactions, and myself, a POAL trainer
and the residents review them from a performance perspective.
Through
this process, residents come to see themselves as engaged in a
performatory activity with another person that can be directed,
redirected and played a number of different ways. A recurring
theme in our discussions is "accepting the patient's offer." In
improv, you accept whatever your fellow performer gives you and
create with it. Similarly in performing a conversation with patients,
residents can accept their patient's offers and build with them.
As creators of conversation they can break with the ritual of
the medical script.
We
are very enthusiastic about the strength of this training approach
and are now going out to spread the word. I have presented at
several academic conferences this past year, among them the International
Conference on Medical Communication and a meeting of the Academy
and the Doctor Patient Relationship. Additionally, with the help
of the POAL staff, we have lined up ten speaking engagements to
present our work to medical residents and faculty in different
New York City hospitals.
Susan
Massad, MD is the Director of Ambulatory Internal Medicine at
Long Island College Hospital in Brooklyn.
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Conversations
on Health II
Tom Strong
Hi,
I'm Tom Strong. Presently, I am a counselor–educator
of graduate students at the University of Northern British Columbia
(in Prince George, British Columbia, Canada), and have a part-time
practice as a psychologist. Living in northern British Columbia,
I have greatly benefited from exchanging ideas regarding the practice
of postmodern psychotherapy, particularly on the listserve: Postmodern
Therapies, where I first encountered the ideas of Lois Holzman
and Fred Newman.
My
shift to postmodern thought came while researching peoples' coping
efforts with chronic illness while doing my doctorate in the late
80s. Postmodern thinking has helped me to focus on relationship
conditions through which meanings are retained, reflected upon
and altered. This thinking fits well with my efforts to practice
and teach in a collaborative manner. In recent years I have focused
on the constraints on meaning-making possibilities and action
created by modern language systems such as the DSM-IV and other
biomedical forms of discourse. I see discourse not so much as
a medium for representing, or conversing about, experience, but
as a way of relating to my experience of others and myself. I'm
drawn to social therapy because it speaks of a world that goes
beyond our discursive ways of justifying ourselves with truths
(forms of "aboutness") external to our relationships. Collaboration
is seriously constrained when one of the parties claims to hold
(over the other) the trump card of REALITY.
Biomedical
discourse has often sewed up the meaning-making and activity seemingly
possible for sufferers and caregivers, thereby shutting down many
potential areas of agency-promoting conversation. And this is
for experiences of suffering that English scholar Elaine Scarry
views as "language–shattering,"
experiences ripe for many meanings, but so often cast solely in
a language of symptomatology. Alongside medical constructions,
I try to bring forth the other possible meanings obscured or formerly
inaccessible for describing illness, since a language of symptoms
scarcely conveys the complex qualitative experiences and challenges
involved in suffering and caregiving. In my experience, many interactions
between sufferers and caregivers are unnecessarily atrophy or
routinized, in ways that create chasms of misunderstanding that
promote a sense of isolation and impotence. Should this occur,
the influence of pain or illness can diminish each person's quality
of life in more areas than might otherwise occur. My role as a
therapist has been to invite people into conversations that explore
possibilities for an improved quality of life that have been obscured
by the usually reluctantly acquired understandings they have been
working from. These efforts are intended to help people talk beyond
the familiar ways of conversing that have not made a difference,
to engage their subjective views about experiences usually spoken
of in limiting forms of discourse, to look beyond symptoms to
optimal ways that can continue beyond my office.
For
more on my work in this regard, please check out: "Conversations
about conversations on chronic pain and illness: Some questions
and assumptions for a one day workshop," (in Gecko: A Journal
of Deconstruction and Narrative Ideas in Therapeutic Practice,
2, 1997 45–63)
and "Macro–
and micro–
conversation in conspiring with chronic pain (to be published
in the Fall 1999 edition of The Journal of Systemic Therapies).
Building
on the ideas in these articles, I intend to explore themes related
to the performance of meaning as sufferers attempt to articulate
their hurts with caregivers as they negotiate care. How, for example,
does a person on chronic disability negotiate with his/her caregivers
(professional or otherwise) the implications of a worsening of
his/her condition - when all had hoped for improvements in that
condition?
Tom
Strong is a counselor-educator at the University of Northern British
Columbia and a psychologist.
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Conversations
on Health III
Joan Fleischman
Madge
came to me as a patient in an unusual way. I had been standing
by the front desk and she was upset because of a mix-up with her
appointment time. She needed some medications and there wasn't
a doctor available to see her. I was drawn to her and liked her
feistiness, and asked what she needed. She only needed a refill
on her blood pressure medicine and said she would make another
appointment.
She
was an older West Indian women, bright eyed and assertive. She
was wearing a pink turban, with a large safety pin at the front.
I loved the vibrancy of her striking white eyes against her dark
skin, and her pronounced cheekbones. We went to a patient room.
We said nothing to each other. She opened her bag, handed me her
bottle of pills, hopped up on the examining table and held out
her arm. I noted the medication in the chart. She was on the lowest
dose prescribed.
As I measured her blood pressure at 170/110 I was thinking this
was going to be more complicated than I'd bargained for. So much
for a simple prescription refill. As if reading my thoughts, she
snapped at me, announcing: "I've been with this problem for 20
years and I know how to handle it. I'm not changing my medicines".
I
nodded.
"I'm
going to show you something." At that point she took me by surprise
as she lifted up her shirt. Underneath was hanging a big sign
covered in plastic that said, DO NOT RESUSCITATE. "When the Lord
thinks it's time for me to go, then it'll be time. It doesn't
have anything to do with these medicines. I don't want to be a
bother to nobody."
I
nodded again. I wondered, though, why she came in at all if she
felt that way. I refrained however from asking the question. It
seemed something we would get to know over time. I felt a strong
fondness toward her, and hoped she would come back to see me.
I felt vulnerable in my desire to have her follow up with me.
"I'd
like to talk more about this on another day. Do you want me to
be your doctor?"
"Not
if you're going to change my medicines. I know my pressure. Doctors
don't understand these things."
"I
can't agree to that, but I can promise we'll only do things you
agree to do."
"That's
a good start."
I
gave her the prescription for the same dose of the same medicine,
feeling it wasn't going to help her.
When
she came back she started in immediately, explaining that she
was different from all other people with high blood pressure.
Hers developed when she was hit in the head at age 40. Until then
her blood pressure had been completely normal. Because it started
from a blow to the head, it didn't respond the same way to medicines.
She had been to so many doctors and none of them understood that.
Everything was going bad in her life when the pressure started.
She had an ovarian cyst taken out, then fibroids, then finally
they did a hysterectomy. She was getting divorced and her son
turned on her. He lived in California and they still didn't talk.
"You know how you raise them and then they turn on you." She didn't
care. She didn't have anybody in her life. "Just me, God, and
now you." She said I had better not leave her now that she was
attached to me.
She
lived in the projects down the street. She didn't have any friends
and kept to herself. At some point I asked if she was lonely or
depressed. She looked at me, and laughed and laughed. "Oh no!
I have a beautiful life; every minute I have that God gives me
is precious. I love my life." She described her crafts. She made
crafts out of beads and shells, beautiful shells. She would show
me at our next visit.
"What
are we going to do about the medicine for the blood pressure until
then? It's 150/100 even on the medicine."
''I've been working on that. I'm taking these new herbs. I want
to see how they'll work."
"It's
certainly come down since our last visit, but I'm a little worried
about it. I think you should continue with the herbs, but maybe
you could try a higher dose. You're on the lowest dose possible.
How about if we double it?"
"Oh
no, no, no. That would make me dizzy."
"You're
right. How about one and a half?"
"O.K."
She
agreed, remarkably easily, as if there had never been an issue
about it.
When
I completed my residency training in family practice I felt something
lacking in who I wanted to be as a physician. It wasn't that I
was insensitive or unresponsive to my patients. Instead, it seemed
that there was an artificial separation between what I was trained
to do medically and the more human aspects of helping people with
their health. I began the two-year training program in social
therapy not knowing how much this would change my entire practice
of medicine.
Early
in the program I attended a workshop where Fred Newman, differentiated
between having conversations and creating conversations.
Conversations we "have" are automatic, reactive and based in social
roles. Conversations we "create" have to do with actively listening
to another person and stepping out of roles to develop a creative
response. Created conversations are "purposeless" and are like
the way children babble with each other. I was fascinated with
this way of seeing how we talk with each other, and worked to
see if I could bring created conversation into medical visits.
What resulted challenged the major assumptions of the medical
model. As I started to actively listen to all of what my patients
said to me, it became obvious that I had been taught directed
listening in medical school. I had learned that there were
diseases, and that my job as a physician was to direct conversations
in order to only understand what problems existed that I could
fix. I had learned to listen for a purpose, rather than listening
to people. I had learned that health was the absence of disease,
rather than an activity or a process. Classifying symptoms into
diseases, while useful, had also prevented me from seeing processes
and the totality of people's health.
Giving up control of the visit and allowing people to play an
active role in what we do together transformed medical conversation,
and seems to have a direct impact on people's health. I see people
take responsibility for their health in ways I hadn't seen before.
The medical questions, while still tremendously useful, no longer
drive the visit. And I, stepping out of the authoritarian role,
have learned to simply be helpful in ways that I can.
Joan
Fleischman M.D., is an attending physician in the Department of
Family Medicine at Long Island College Hospital and is on the
faculty of SUNY Downstate in Family Medicine. In Brooklyn.
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My
Journey to the Border
Ellen Peskin
I
stumbled into becoming a therapist. The idea occurred to me over
20 years ago when I read a brochure about a Master's Program in
Clinical Psychology. It was addressed to my ex-husband who had
moved out months earlier. Totally at a loss for what to do with
my life, the program sounded like perfect fit for me. I was quickly
captivated by psycho-dynamic thinking. The idea that people's
personalities "made sense" in a linear way - that their early
experiences shaped them - was very intriguing and comforting to
me. It assuaged my terror of chaos and eased the anxiety I felt
when faced with my own or other's pain and confusion. I enjoyed
the search to find the missing pieces of the puzzle that could
help people make sense of their lives.
I became enamored and interested in one theory and approach after
another. The different theories were like maps that identified
the "terrain" and pointed towards specified goals. All of them
focused on the individual. My own two therapists (Jungian) and
a couple of admired supervisors were the strongest influences
on how I was doing therapy.
I
cannot separate the therapy I was doing from how I was living
my life. My privilege, my narrow homogeneous world and Eurocentric
lens made me blind to much of life. My "bubble" popped one miserably
rainy night when I was having dinner with a friend. She looked
disturbed as the waitress brought the food to our table. I asked
her if something was wrong. She apologized for what she was about
to say, hoping it wouldn't ruin my dinner. She told me she couldn't
stop thinking about a homeless man she had befriended. She wondered
if he had shelter from the rain and warm food to eat. She told
me about his life - how he was a gifted musician and had fallen
on hard times. As she spoke, the savory food turned to dust in
my mouth. Her compassion broke through the protective walls around
my heart and I could no longer wall off my pleasure from her homeless
friend's pain.
Later that night I tossed and turned in anguish and conflict about
my privileged life and those whose suffering I had ignored. I
remember asking myself, "How do you live when you let the world
in as it really is for so many people who are suffering?" It was
one of those pivotal moments. I had started my journey to the
border, though I didn't know it at the time.
I
did a lot of soul searching in the ensuing years and the therapy
I was doing began to change. I was introduced to Narrative Therapy
as practiced by David Epston and Michael White. I began to see
my clients lives in class and cultural and gender contexts. I
became more curious and playful and spontaneous in my work. A
group of friends who were narrative therapists got together to
be a reflecting team for each others clients. It was very liberating
to break out of the isolation of private practice and to collaborate
with each other. A Narrative Conference in Vancouver, B.C. in
1995 changed my life further. A small but passionate and vocal
group of therapists of color challenged the leadership of the
conference to make Narrative Therapy accessible to people. Their
voices resounded throughout the conference. I left that conference
shaken and inspired and scared, committed to find ways to address
the issues of injustice my eyes had been opened to.
Three
months later, I walked away from the life I had been living. The
journey since then has been incredible challenging –
full
of conflict and learning, development and love.
I
came upon social therapy after participating in a number of contexts
where issues of diversity: class, race, homophobia, and gender
had increasingly divided and paralyzed conversations. When I came
upon the development community, of which social therapy is a major
part, I was searching for a different approach to building bridges,
not necessarily a new way of doing therapy.
I was powerfully effected by the first Life Performance Training
I attended. The participants created a group therapy session and
were directed to re-perform their roles with changes in their
voices, gestures, manner etc. I was amazed at how a simple change
in our performances changed everything! It was a powerful antidote
to the feelings of helplessness and paralysis I experienced in
the diversity forums I had been in. Since my introduction to Social
Therapy, the therapy I am doing has continued to change a great
deal - along with the way I am leading my life. I feel more openly
expressive and human and closer to my clients which is allowing
me to take more risks in confronting and challenging them. The
transition has been rocky for me and for some of my clients. I
often feel very awkward without the "protection" of knowing what
to do. It has been humbling and strengthening to experience relationships
continuing to grow, despite my mistakes, and to risk leading and
directing without a map. It's ironic. Though I feel more insecure,
I experience a deeper confidence in myself and others, trusting
that we are creators and choice makers and that there are always
moves to make.
Ellen
Peskin has been a therapist in the San Francisco/Bay Area for
the past 23 years. She has recently joined the staff of the West
Coast Center for Social Therapy. Peskin brings to her current
work a life-long interest in working with people to develop creative
responses to what can seem like paralyzing problems.
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Tool
and Result Strategies in the Classroom: Benefits and Challenges
Patty Wilson
Imagine being myopic
for your entire life, but not realizing it. I have lived as a
professional secondary school teacher and counselor in the public
school system for more than 20 years now. I have learned certain
methods for teaching and conducting counseling sessions with youth.
It's likely that I have done little harm and, in fact, may have
had a positive impact on youth because I do care about them. But
for two decades, I have maintained - as many people have done
–
that I am in charge
and know what I am doing. I've continued to acquire knowledge
and expertise using strategies ranging from psychodynamic to systems
approaches in the class and therapy room. I had accepted this
methodology; there was nothing else available to me for many years.
The world continues
to change, as young people know very well. Yet adults continue
to forge ahead as if they know the way. I have done plenty of
forging (and wondering why things were not going too well in my
work). I held onto my methods which were comforting for short
periods of time. Despite my myopic view and out of a compulsion
to be creative, I have had periods of being willing to try something
new. I returned to school several times, acquiring an MA in Clinical
Psychology and other credentials - all of which offered methods
that purported to transform the individual. The packaging was
altered, but the methodology was basically the same; nothing had
changed. I continued to interpret, analyze and provide the final
word on how the classroom and therapy will function.
But it has not worked.
I have remained at a loss while staying in the comfort zone to
some degree, yet strangely compelled to continue my activity of
seeking ways to improve upon the situation in today's world. They
seem to know something(s) of which I have had not a clue. The
rationalist, product focused, moralistic approaches just do not
work.
A tool and result approach
offers educators, therapists, parents and all people an opportunity
to give. My vision is gradually improving. It's likely that I'll
never have perfect vision, given my imperfections as a human being,
but I now have additional tools to enhance the view. I have been
given permission to create with others without knowing how it
will develop. I don't need perfect vision after all.
There are challenges
and benefits of practicing social therapeutic methodology. The
challenges may look like this to a teacher: I have a choice. I
can consider maintaining my role as the all–knowing
teacher, dictating rules and correcting papers without creating
with young people. Or I can consider strategies for teaching that
focus on how my students will develop from childhood to adulthood
in a rapidly changing world. The latter requires that I consider
and work with young people on what it means to learn and develop
in our classroom environment and in our world.
This conversation –
which is not scripted,
but improvisational - goes beyond products and content; it incorporates
process and product as unified activity. Choosing to create an
environment where I give what I have rather than getting what
I can from children and teens is far more satisfying –
it has the potential
for growth for everyone involved, including me. If it sounds difficult,
the alternative –
teachers as all (seeing)
knowing –
is a defensive position
in my view (myopic as it is) and usually yields strategies that
assume a "getting" position of control or staying in the comfort
zone as the knower.
A strategic perspective
of giving what you have to youth rather than getting what you
can from them is rare in our culture and vastly undervalued. It's
probably only understood by actually engaging in this kind of
activity. I myself speak from only limited experience, but I believe
it's a strategic move worth trying, especially if you, too, consider
that your vision is blurring as the world passes you by, and are
motivated enough to consider a kind of radical laser surgery methodology.
The revolutionary nature of tool and result method, where all
concerned are challenged to go beyond themselves, has a powerful
impact on people's lives. Likewise, the practical daily activity
of creating with others couldn't - ironically - be more basic
to our human need to do something with others in our life.
Patty Wilson is
a secondary teacher and counselor in the San Francisco/Bay Area,
and on staff as a developmental mentor at the West Coast Center
for Social Therapy.
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