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 preunderstanding 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" "The Patient" takes away much of expression and openness.

- It is more confortable and informal, which creates a 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