Reflecting+Teams


 * Describes a way of conducting therapy that focuses on bringing out clients' strengths
 * The format for therapy follows the typical structure of an MRI session
 * Several interventions are offered to clients from the reflecting team, so that the client can choose which one would be the most fitting for their situation

Reflecting Teams


 * Reflecting teams were developed in Norway by Tom Andersen and his colleagues as a departure from the structural model of the Milan group.

[|Interview with Lynn Hoffman about reflecting teams]

=Reflections on Reflecting Teams=

Our Lady of the Lake University
Abstract Reflecting teams have had a remarkable impact on therapy. This process is unique in that it gives the client multiple perspectives from a team of therapists and this sharing of ideas reveals new possibilities for the client. The idea originated from Tom Andersen and its process is described in vast detail. Additionally, Andersen offers several suggestions for therapists who wish to incorporate reflecting teams in practice. There has not been a great deal of research on this topic; however, a summary of a qualitative study will be provided. The study was conducted to obtain clients’ impression of the reflecting process. The research showed the recurrent theme was the value of multiple perspectives, which were most effective when they contained dialectic tensions. In other settings, Andersen’s ideas have been expanded in numerous ways; therefore, a few examples will be given. In one situation, the reflecting team process is used as a tool for training graduate students. Another team demonstrated how personal reflections can be intertwined in the reflecting process, in order to create a more authentic atmosphere. These examples show there are endless possibilities of incorporating reflecting teams, but they would not be possible without Andersen’s idea.

Reflecting on Reflecting Teams Reflecting teams have had a remarkable impact on therapy. The “reflecting team process invites the sharing of multiple personal meanings in a therapeutic context. Team members are encouraged to express impressions and ideas, and at the same time respect the views of each other” (Haley, 2002, p. 27).It is also especially unique in that it allows discussion of sensitive topics that the primary therapist might choose to avoid for fear that it might jeopardize their relationships with their clients (Smith, Yoshioka, & Winton, 1993). This idea originated from Tom Andersen, a Norwegian psychiatrist, during a period called post-modernism. Currently, we are still in this era and its underpinnings are very influential in therapy Carr (2000) states post-modernism arose in response to the perceived failure of modernism to deliver a perfect and scientific world. “Post-modernism rejects the idea that a single objective and rational account of the world can be reached” (Carr, 2000, p. 119). Carr also proclaims the world is socially constructed by communities through perception and language. Post-modern therapy rejects the idea of true diagnosis, the idea that one’s definition of the problem or solution is more valid than another’s, and the idea that the therapist’s view should be privileged over the clients. “The idea of therapy is about finding useful, rather than true, definitions of problems and solutions” (Carr, 2000, p. 119). This view sees construing problems and solutions as provisional, temporary and tentative. Furthermore, “the idea that all attempts to help clients define their problems in useful ways and search for solutions are ethical, rather than value-free, practices” (Carr, 2000, p. 120) is a feature of post-modernism. While there are many therapeutic approaches that fall into the post-modern era, each have their own unique characteristics. Currently, relationships, language, and prior assumptions are given predominant attention in therapy, as opposed to theories and methods (Andersen, 1992). This idea opposes the ideas of therapists from the modernistic era. In this post-modern period, “the idea of one Self has been challenged by the idea of many Selves” (Andersen, 1993, p. 304). Andersen (1993) also states the Self is created through language and conversations. In this new context, the client and therapist are talking and working together as two equally significant partners. The idea of working with the client, as opposed to being the expert, took time to gradually appear in Andersen’s work. Andersen (1992) proclaimed that he and his colleagues made an attempt to use the Milan approach, but he always felt uncomfortable delivering the intervention to the family. It gave him the feeling that the family viewed the therapy team as being able to see and understand their problem in a different, better way and it was implied that the team knew exactly how the family should go about solving the problem. In order to avoid these problems, Andersen and his colleagues started to say, ‘In addition to what you saw we saw this,’ or ‘In addition to what you understood we understood this’ (Andersen, 1992, p. 57). The team quickly realized they had shifted from an either/or to a both/and or neither/nor stance. Andersen experienced this shift to be both “significant and freeing” (Andersen, 1992, p. 87). Andersen (1992) and a colleague had been discussing an idea since 1981. They had the idea of letting the family listen to their discussions about their case. They struggled for several years on how to do this properly. Andersen feared their discussion would be perceived incorrectly and make the family feel more discouraged about their situation. But things easily fell into place in March 1985. Andersen (1987) and other therapists were supervising a family interviewer who was having difficulty with the family he was interviewing; he was drawn into the family’s pessimism. The team who was observing behind the screen, would call into the room and suggest optimistic topics for the interviewer to try, but each one would pull the family back more into their pessimism. The observing team knew there was a set of microphones and speakers in both rooms and asked if the family and interviewer would be interested in listening to the observing team’s discussion. They all agreed and the lighting and sound was switched. The reflecting team talked about the family in a positive way, while the family and interviewer listened quietly. Finally, when the lighting and sound was switched back to the original setup, the family proceeded in a more optimistic way. “The shift between being a talking participant and a listening participant around the same issues seem to be a very powerful process in order to create new descriptions and explanations” (Andersen, 1989, p. 75). After the interview, a discussion was held and all participants enjoyed the process of reflecting and this is how the reflecting team was created (Andersen, 1987). Andersen (1987) describes the reflecting team in great detail. The family chooses the topic they wish to talk about. It is imperative for the therapist to not interrupt clients while they are expressing themselves. Clients should be allowed to express their thoughts at their own pace. This rule also applies to other participants in the room. If people can not keep themselves from interrupting the speaker, they might be encouraged to not join the meetings until they can listen respectfully (Andersen, 1993). As the reflecting team listens to the conversation in the other room, the team begins to create their own ideas. It should be quiet in the reflecting room, in order to respect each observer’s ideas. After listening to the conversation, the team or interviewer suggests the option of listening to the reflecting team’s discussion. If the family agrees, the lights and sounds are switched in the two rooms. The family and the interviewer now listen to the reflecting team’s discussion about the family’s conversation. This reflecting period can last anywhere from 2 to 15 minutes. Andersen (1992) states the therapist must let clients know that this simply is an offer and not something they must take as the only option. It is crucial to give the listener the opportunity of declining the advice, if it makes them feel uncomfortable. The clients must realize they have the ability to say no. When offering reflections, it is very important to use tentative language, in order for the client to view the reflection as an offering and not the sole answer. Teams are also warned not to mention the family’s nonverbal exchanges. These issues could be topics the family does not wish to discuss (Andersen, 1987). In addition, it is safer for the team to raise a question about something they heard in the conversation, as opposed to their own interpretation of what they heard (Andersen, 1993). When the team has finished reflecting, the light and sound are switched back to their original positions. At this time, the interviewer questions the family and tries to determine if there was something in the team’s conversation that the family would like to discuss, comment on, or correct. The interviewer might have some questions to ask the family while listening to the feedback from the team, as well. It is important for the interviewer to ask if there were things that they disliked or were of no interest to them because typically, clients will not want to say negative things about the reflecting team, knowing they are in their presence. This type of feedback will give the reflecting team an idea of whether they were discussing topics within the family’s limits or if they were covering things to far off the family’s path (Andersen, 1987). Andersen (1987) states the reflecting team has to keep in mind that their task during the session is to come up with ideas for the family, even though the family may not be interested or might even reject their ideas. The team must realize it is up to the family to select those ideas that apply. Hopefully, these ideas might trigger a small change in the family’s situation or in their understanding of the situation. It should be noted that this process can be used with other clients besides families. Furthermore, if light and sound are not available, another option would be for the family and team to exchange rooms. Moreover, if all participants are present in the same room because of limited space or availability of props, it is warned that the team should look other team members in the eyes, as opposed to looking at the listeners. This gesture emphasized to the listener they have the power to not listen (Andersen, 1992). Andersen offers suggestions for therapists who want to incorporate reflecting teams in practice. Several of these principles will be offered in the following paragraphs. Andersen (1987) states it is important to gather the history of the decision to seek help. “Everyone in the family is caught between two desires: to make a change and not to make any change” (Andersen, 1987, p. 418). All members are somewhere in between these two extremes. It is important to find out where each member is on this continuum, in order to know what types of discussions are appropriate. Andersen (1992) warns one should not assume that all clients who attend the session are ready to talk about their issues. If there is someone who is resistant to change, this person should be consulted from time to time, to see if their status has shifted (Andersen, 1992). Andersen prefers to ask, “How would you like to use this meeting?” at the beginning of the session (Andersen, 1992, p. 61). It is crucial to avoid a format that is unsettling for the clients whom are present. Conversations should flow in a way where all clients feel comfortable, or at least not uncomfortable (Andersen, 1992). Andersen (1992) finds it useful to find out how they should talk with one another. This is important to discuss because it will add to the comfort level of the client. There are many aspects covered during this discussion. For instance, it should be decided where the clients want to have their discussions, such as at home or the office. The clients are asked whether or not the use of a reflecting team would be beneficial to them. Furthermore, the clients can specify if certain topics can only be discussed at certain times or not during someone’s presence. All of these topics are covered to ensure the client feels at ease during therapy. Andersen (1992) emphasizes the importance of finding the usual pattern of the clients. This is very useful to the therapist in that it helps them distinguish what types of questions might be helpful to the client. For example, the team might notice who sits next to whom in the circle of chairs that the therapist would set up beforehand. If one can tell that some members keep a lot of distance between one another and constantly have opposing views, the team might ask questions about similarities. If the team notices a certain emotional overtone prevailing throughout the session, such as depression, the interviewer might inquire about that mood first. Then, he/she might question when was the last time the family felt happy as a whole or what were they doing when they were happy. Purely by identifying the client’s usual patterns, the therapist will have an excellent idea of what could possibly help the family view things differently. Andersen and his colleagues seek to be “appropriately unusual” when deciding what to talk about with clients and how they should talk about it (Andersen, 1992, p. 87). If the context or the style of talking strays too far from the clients daily life, the conversations tend to stop and the clients become less engaged or intrigued (Andersen, 1992). The reflecting process itself could be described as formalising [sic] the shifts that the various participants make between talking and listening. When participants talk with others, they are engaged in an “outer” dialogue. When they are listening, they are talking to themselves in an “inner” dialogue. Each of these participants is engaged on the same issue from those two different perspectives: talking and listening, the outer and inner dialogue respectively (Andersen, 1992, p. 88). The two perspectives from the same issue will most likely create new possibilities (Andersen, 1992). Once clients begin to increasingly accept the questions from the therapists, Andersen (1987) and his colleagues believe that this is indicative of the beginning of change. Another way of identifying if the clients are starting this process is to look for cues such as, more open eyes or more open hands when leaving. Although these cues are subtle, much can be discerned from them. There has not been a great deal of research on the topic of reflecting teams, but Smith, Yoshioka, and Winton (1993) implemented a qualitative study of clients’ impression of the reflecting team process. “The reflecting team consisted of one male and two female doctoral students and a male faculty supervisor within a marriage and family therapy clinic that served the campus and the community” (Smith, Yoshioka, & Winton, 1993, p. 31). These individuals had an average of seven months experience, in regards to the reflecting team process. The doctoral students came from diverse socioeconomic and educational backgrounds. 11 clients in treatment for relational difficulties were interviewed over a three-month period. Over time, the interviews showed that clients’ opinions about reflecting teams categorized into three broad areas: “Client understanding of Reflecting Teams, clients’ appreciation of Reflecting Teams, and clients’ perceptions about the limitations of Reflecting Teams. Within those three areas, 10 questions were developed” (Smith, Yoshioka, & Winton, 1993, p. 40). These questions may be used in other studies when reflecting teams are the main subject matter. Smith, Yoshioka, and Winton (1993) found the recurrent theme was the value of multiple perspectives, which were most effective when they contained dialectic tensions. “This suggests that teams with a diverse membership in gender, class, and/or ethnicity will provide clients with the richest set of meaningful options” (Smith, Yoshioka, & Winton, 1993, p. 40). Findings from the study were significant because clients stated they had concerns with the reflecting team idea. Smith, Yoshioka, and Winton (1993) described how clients were hesitant of receiving too much unrelated feedback. Additionally, clients felt that having “multiple perspectives for the sake of having options may be experienced as chaos” (Smith, Yoshioka, & Winton, 1993, p. 41). Although this study depicted otherwise, the authors advised that the sample does not represent all clients and clinicians and these responses should not be generalized across settings. There are many ways to use reflecting teams in practice, all of which are largely based on Andersen’s (1987) original suggestions. Biever and Gardner (1995) assert reflecting teams are an excellent vehicle to train graduate students from a social constructionist frame of reference. They have noticed that students are more privy to use the ideas of social constructionism in their therapeutic work, if they have the experience of working on a reflecting team. “The reflecting team illustrates the idea that people will always make different meanings from one another and that it is through conversation that the different meanings can be explored and generated” (Biever & Gardner, 1995, p. 50). Another key aspect that is learned by utilizing reflecting teams in training is the concept that all ideas are potentially useful and it is the clients who are the best judge of what will be useful for them. This training is particularly unique in that the clients will not know the training level of the therapist, so all ideas will be given as much credence as the supervisor’s ideas. Trainees feel free to express their ideas and will not have to worry having their views pushed aside by their supervisor (Biever & Gardner, 1995). Another advantage under these training circumstances is it allows the students “to participate more actively in the therapy and to develop confidence in their ability to use language and conversation therapeutically” (Biever & Gardner, 1995, p. 50). Finally, students who participate on reflecting teams seem to have a less stressful transition when moving to the role of the primary therapist (Biever & Gardner, 1995). Biever and Gardner (1995) made some modifications to Andersen’s (1987) guidelines, in order to be beneficial to the training process. They have found the rule of not talking behind the mirror to be too restrictive. At times it could be beneficial to the students if the supervisor makes remarks, in regards to the therapy session. During this time, trainees are encouraged to ask brief questions if they need some clarification about the session. Another modification they made for training purposes is they have found it necessary to discuss clients outside of their presence, as they are often productive training opportunities. Furthermore, Biever and Gardner (1995) have also found it necessary use phone-in messages to the therapist in the room with the clients. “Such messages are used when the supervisor believes a message is necessary to facilitate the therapeutic process” (Biever & Gardner, 1995). Another example of expanding Andersen’s (1987) ideas of reflecting team is demonstrated by Cole, Demeritt, Shatz, and Sapoznik (2001). They revealed how personal reflections can be intertwined in the reflecting process. The therapists shared their personal stories that were relevant with the client’s situation, in order for the client to reconstruct a new experience for her life. These personal stories exposed a new world of possibilities for the client. This format helped create a more authentic atmosphere, which helped the client and team join together on a deeper level of trust. Cole et al. (2001) warned other therapists that the sharing of personal stories is not a technique and should not be used without thought and preparation. The idea of reflecting teams has come a long way in therapy. Tom Andersen had an idea that has carried over into therapy on several different levels. Over time, the original guidelines have been altered for various reasons, but underneath each idea, we see the original reflecting process that started back in March 1985. One can only imagine what other possibilities can be enhanced by incorporating this approach.

References Andersen, T. (1987). The reflecting team: Dialogue and meta-dialogue in clinical work. Family Process, 26, 415-428. Andersen, T. (1989). Back and forth and beyond. Australian and New Zealand Journal of Family Therapy, 10, 75-76. Andersen, T. (1992). Reflections on reflecting with families. In S. McNamee & K. J. Gergen (Eds.), Therapy as a social construction (pp. 54-68). Newbury Park, CA: Sage Publications, Inc. Andersen, T. (1992). Relationship, language and pre-understanding in the reflecting processes. Australian and New Zealand Journal of Family Therapy, 13, 87-91. Andersen, T. (1993). See and hear, and be seen and heard. In S. Friedman (Ed.), The new language of change: Constructive collaboration in psychotherapy (303-322). New York: Guildford Press. Biever, J. L., & Gardner, G. T. (1995). The use of reflecting teams in social constructionist training. Journal of Systemic Therapies, 14, 47-56. Carr, A. (2000). Family therapy: Concepts, process, and practice. Chichester, West Sussex: John Wiley & Sons, Ltd. Cole, P. M., Demeritt, L. A., Shatz, K., & Sapoznik, M. (2001). Getting personal on reflecting teams. Journal of Systemic Therapies, 20, 74-87. Haley, T. (2002). The fit between reflecting teams and a social constructionist approach. Journal of Systemic Therapies, 21, 20-40. Smith, T. E., Yoshioka, M., & Winton, M. (1993). A qualitative understanding of reflecting teams i: Client perspectives. Journal of Systemic Therapies, 12, 28-43.