Volume 20 (2009)
Issue 2


Editorial

Everything in Systemic Family and Couples Therapy involves ethics, and the range of ethical issues  is made very clear by the way that all of the papers in this issue have strong implications for ethical practice. We have created a specific section in order to present together a sample of the papers presented at an exciting international conference organised by Paolo Bertrando and Marco Bianciardi: Psychotherapy as Ethics:  Postmodern Responsibility in Clinical Practice, sponsored by Episteme (Centro di Psicoterapia Sistemica),Turino, Italy, October, 2009.  But the different perspectives presented by the six papers cut across any way that we could have structured their presentation and in this Editorial I will seek to identify some of these themes of coordination and difference among the articles.

We start with the particular perspective on systemics offered by Zen Buddhism. Phoebe Prosky points to the shared ground with systemics of the interconnectedness of everything. For me her article hints at the failure of systemic therapy to actively incorporate developments in physics and in systems theory itself. As she says, the original hopes that the whole of psychotherapy would come to work in terms of the connectedness of relational systems has not been fulfilled. Perhaps Buddhism will give us an acceptable route to refreshing the insights from which our field developed.  Her position has considerable resonance with the current  positive psychology movement and the development of  approaches based on mindfulness. Which as she describes is the final achievement of the Noble Eight-Fold Path..

Phoebe’s article raised many new thoughts for me. A couple are: Is Zen offer a strong form of what we used to call ‘going meta’? And does the Buddhist route to transcending suffering by ending attachment have a connection with what Zygmunt Bauman describes as our valuing of transience?

In what certainly offers a different position, Zygmunt Bauman, in an interview conducted by Paolo Bertrando and Helga Hanks, discusses his conceptualisation of the current state of Western (and increasingly, global) society in terms of ‘fluid modernity’. He is not offering an overall evaluation of current and past ethics, but pointing to the substantial contemporary change from the history of Western society which had been oriented to permanence - laying down families, buildings, businesses etc in ways that optimised long-term survival of the life work of the individual. Today’s society he characterises as prioritising fluidity and transience (who wants to be seen with last year’s phone, car, wife/husband?) leading to a culture of waste. In the past, one’s ethical position was largely determined by ones position in society and only changed during your lifetime if you managed to change your position. Today, each  individual is given responsibility for constructing their own ethics.

We are talking about positions here, rather than types of therapy and a third position is offered by Sheila McNamee in terms of relational responsibility. She makes the important point that  “the therapeutic ethic of relational responsibility is not a better stance to take in the psychotherapeutic context.  It is not a technique.  Rather, it is an orientation to therapeutic process that privileges what is happening in the conversation, in the interactive moment.  The focus is on dialogic processes, not on people, situations, or problems in isolation.”  She invites a shift from believing that there could be one, uniform set of criteria for assessing the ethics of any particular action, and from centering individuals and their actions, to centering processes of relating.

She continues the theme that ethical and other frameworks are positions  from which to conduct therapy, and not ways of doing therapy: “it is not the case that a constructionist ethic of relational responsibility equips us with the “correct” answer.  Rather, the point is that the ethic of relational responsibility equips us with the reflexive vocabulary to ask questions of these taken-for-granted truths.”

Another theme in this Issue of Human Systems is of how systemic therapy positions itself in relation to diagnosis. Lieven Migerode discusses how diagnosis organises our meanings in ways that can be, but are not necessarily, unhelpful. Because the diagnosis industry has so far been constructed on the assumption of a deficiency within the individual, it is antithetical to systemic thinking. Though this raises the thought of how we could respond to a DSM VII which was based on a system of diagnosing relational difficulties. At present it is difficult to find a wording to replace common expressions such as ‘is autistic’ or ‘has autism’. I thought Lieven’s phrasing of a person ‘attracting the diagnosis’ of autism was an elegant solution. A point being that we work in a world in which colleagues and clients believe they gain benefit in communication and understanding by careful use of diagnoses. As Lieven puts it,  a diagnosis can offer those who are excluded from the community a way to belong. Despite the concerns he describes, the article recognizes that  there certainly are situations where diagnosis becomes a useful resource – mobilising resources, finding commonalities with others, reassurance that the person not so strange or incomprehensible.

Sheila McNamee describes a stronger concern about the incompatibility of diagnosis with a postmodern position. She shows how diagnosis can be a vehicle for disempowerment of clients while it gives control (and income) to the professions. Her solution is partly that constructionism allow us to operate in terms of the practical option rather than the truthful option. Her broader answer lies in the therapeutic ethic of relational responsibility, discussed above.

Meanwhile Phoebe Prosky offers us a chance to move completely beyond diagnosis and in the process considers the inappropriateness of quantitative research for the study of family systems work. She points to the ways that research attempts to make phenomena, especially outcomes of therapy, researchable by eliminating those factors that systems thinking recognises as most important. The stance that we take in relation to quantification and outcome research is present throughout all of the articles and  Marco Bianciardi and Paolo Bertrando are strongly supportive of the questioning of ‘the illusion of being able to objectively justify his/her choices in the course of her/his clinical practice’. In the process they provide another take on the issue of the relational construction rather than individual discovery of reality

A different position is taken by Peter Stratton in suggesting that researchers have recognised these limitations and are in the process of developing methodologies that are more relevant to psychotherapy. He identifies one of the problems as being that therapists have not engaged with researchers. If we were to allow ourselves the entertainment of thinking who is to blame for the irrelevance of much research to the art and science of psychotherapy we could certainly include the way that ethical positions taken by therapists have encouraged them to be aloof to the world of research. But his main  contention is that adopting a position of respect for researchers allows us to recognise the very substantial efforts they have made to formulate practicable procedures for maintaining an ethical position. He suggests that there are several areas of systemic practice that could learn from the ethical achievements of research.

In the final article Marco Bianciardi and Paolo Bertrando pull several of the themes together in their proposal for ethics in a post-modern era. Their concept of psychotherapy as an ethical practice directly tackles a theme running through this Editorial, of how to avoid therapists prioritising ethical superiority at the expense of being most useful to their clients. They bring us back to the issue of diagnosis, and of the diagnosing of diagnosis which means formulating hypotheses about the diagnostic criteria we are using. “Within our logic, it makes no sense to wonder whether a diagnosis is right or wrong, but rather to wonder how that diagnosis emerged within that encounter: how the relationship between therapist and patient created such a context to favour the emergence of that specific diagnostic criterion, instead of other ones?”

More broadly they see our way of doing therapy as being a human, historical, contextual encounter -  a life encounter. As Sheila McNamee puts it ‘a conversation wherein realities are crafted’. Their position follows a self-reflexive logic that sees subject and object as co-emerging and reciprocally implicated  which, by losing certainties, privileges the extent of the therapist’s personal responsibility.

This issue of Human Systems offers a rich variety of ideas, of ways of addressing current dilemmas, of clarifications of our positions and above  all, an exploration of many ethical issues within systemic therapy. It would be a pity for these riches to remain inert on your bookshelves. Marco and Paolo conclude by proposing that we become more aware of ability and competencies already present in ourselves. I want to invite you to help us all develop these competences by contributing your thoughts about these articles for inclusion in a later issue of the journal. Brief comments, questions, 500 or 100 word descriptions of positions or of experiences in therapy, research or training that elaborate the issues will all be welcomed. Please respond to either of the Editors: Kyriaki Polychroni or Peter Stratton.

Peter Stratton and Kyriaki Polychroni,
Joint Editors



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Editorial 20.2 Peter Stratton 002-005 Editorial English 
Why Should Family Therapy Consider Principles of Zen Buddhism? Phoebe Prosky 006-023 Full text download Bulgarian, French, German, Greek, Hungarian, Italian, Polish, Portugese, Romanian, Russian, Serbian, Spanish, Turkish  
What is a Diagnosis? On 'Autism' in Couple Therapy Lieven Migerode 024-040 Full text download Bulgarian, French, German, Greek, Hungarian, Italian, Polish, Portugese, Romanian, Russian, Serbian, Spanish, Turkish  
Liquid Ethics - Psychotherapy in a Time of Uncertainty Zygmunt Bauman, Paolo Bertrando and Helga Hanks 041-054 Full text download Bulgarian, French, German, Greek, Hungarian, Italian, Polish, Portugese, Romanian, Russian, Serbian, Spanish, Turkish  
Postmodern Psychotherapeutic Ethics: Relational Responsibility in Practice Sheila McNamee 055-069 Full text download Bulgarian, French, German, Greek, Hungarian, Italian, Polish, Portugese, Romanian, Russian, Serbian, Spanish, Turkish  
Lessons from Research about Psychotherapeutic Ethics Peter Stratton 070-086 Full text download Bulgarian, French, German, Greek, Hungarian, Italian, Polish, Portugese, Romanian, Russian, Serbian, Spanish, Turkish  
Ethical Therapy: A Proposal for the Postmodern Era Marco Biancardi and Paolo Bertrando 087-101 Full text download Bulgarian, French, German, Greek, Hungarian, Italian, Polish, Portugese, Romanian, Russian, Serbian, Spanish, Turkish  
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