RUNNING HEAD: Critical book review: collaborative therapy with multi-stressed families.

Critical Book Review:

Collaborative Therapy with Multi-stressed Families.

SOWK 651: Policy as a Context for Social Work.

Collins Nwabunike

University of Calgary
RUNNING HEAD: Critical book review: collaborative therapy with multi-stressed families.

Exposition Section

The book titled, Collaborative therapy with multi-stressed families, provides family

therapists with the essential toolkits on how to work with reluctant families by adopting a

collaborative therapeutic approach.

Chapter one to four helps to layout the foundation on how to work with multi-stressed

families. Chapter one discusses, how our relational stance is the foundation of our clinical work

when working with families. We may choose to position ourselves in certain ways that can help

in the therapeutic relationship. According to Madsen (2013), our relational stance is a way of

thinking and working with families to position ourselves as appreciative allies. As appreciative

allies, we should strive for a collaborative approach in which we honor the expertise of all parties

involved, after all “clients are the best experts on their experience” (pg. 34 Madsen, 2013).

Chapter two talks about our stance in the process of engagement, assessments and contracting

and how they are influenced/supported by our conceptual frameworks that shape our experience

and interaction with our clients. In this chapter, the author talks about the importance of being

aware of our assumptions about our clients when we conduct an assessment just to avoid any

personal or contextual biases. Chapter three, explore the concept of resistance and ways we can

be pulled away from an allied stance in the process of engaging reluctant families. This chapter

examines the process of successfully engaging clients. The author offered ideas on how to

maintain an allied stance and work effectively with clients who initially are presented with a

stance of “this is not a problem” or “this is a problem, but I have no control over it.” Chapter

four, highlights the value of adopting a proactive vision to guide therapeutic efforts and by

eliciting the client’s hopes for the future or preferred ways of coping in the present. Chapter five
RUNNING HEAD: Critical book review: collaborative therapy with multi-stressed families.

talks about the process of intervention. Whereby all interaction we have with our clients has the

potential to interventive.

Chapter six is interesting because it examines the relationship between clients and their

problems through the use of ‘externalized conversations’ or narratives. The chapter talks about

how externalizing conversations is a key component of our clinical framework. This is because it

helps the client to think about their relationship with the problem rather than having or being a

problem. “this shift provides clients with some room to move in relation to problems and opens

space for the consideration of previously obscured alternatives” (pg. 213 Madsen, 2013). When

we place pejorative labels on our clients these labels have a tendency to become self-fulfilling

prophecies. This is why we need to view our clients as being in a relationship with a problem.

For example, rather than labeling someone as a depressed person we should instead perceive the

client as a person suffering from depression. By distancing the problem from our client, this

helps them experience a sense of relief and greater ability to address the problem. “Externalizing

conversations are an attempt to reorganize our thinking in ways that counter shame and blame,

minimize defensiveness, and promote client agency” (pg. 10 Madsen, 2013). Chapter 7 focuses

further on externalizing conversation, in which the author compares the problem’s influence on

the person with the person’s influence on the problem. Under the framework of externalizing

conversations; they are four fields of questioning: the experience of the problem, the effects of

the problem, the client preferences about those effects, and preferred coping with the problem.

Inquiries about effects, attempts to map the influence of the problem on the child or the family.

Questions about preferred coping attempt to map the influence of the client, or family on the

problem. According to narrative therapist Michael White, these are deconstructive questions and

reauthoring questions.
RUNNING HEAD: Critical book review: collaborative therapy with multi-stressed families.

Later chapters provide information about sustaining change, developing ‘preferred

futures’, tapping into community support, and solidifying what has been achieved. Quite often

problems do not stand alone in their influence on people’s lives. Problems are embedded in a

network of interactions, beliefs, and cultural assumptions that support and strengthen them.

Madsen (2013), talks about re-membering conversations as a way to help clients recruit and draw

upon allies into their daily lives. It helps clients reconnect to their communities for support. Re-

membering conversation is a powerful therapeutic approach and it can be used with witnesses

who are introduced to clients, as well as known members of their existing communities. The

author also talks about how the use of written documents, can be applied to enhance the

development of alternative stories and help clients hold unto the desired change they want in life.

This book has links to the anti-oppressive framework and narrative approach. The book

draws on the humanist approach in which Madsen's work begins with the assumption that

patients have expertise about their own lives. The therapist's goal, then, is to collaborate with the

patient to identify this expertise and then employ it towards working on the presenting problems

in their life. Rather than focusing on techniques, his approach is future-oriented; such as asking

patients how they would like things to be. The patient can also build on areas of strength that are

solution-focused. The use of miracle questions, family hopes, and preferred futures, are included

to demonstrate how families can be empowered to promote self-change. Therapy can sometimes

be pathological in the sense that by focusing on fixing the problem we inadvertently contribute to

more harm. This why we need to shift our focus to what changed state will look like for our

client in a nonproblematic future by engaging in collaborative problem-solving. The process of

working collaboratively to help a client develop a proactive vision is very important. This is

because, in the context of therapeutic conversations rather than simply offering our professional
RUNNING HEAD: Critical book review: collaborative therapy with multi-stressed families.

expertise, we share knowledge and acknowledge the client's skills and abilities that were

previously obscured.

Reflection Section

Therapy can become a place where clients have an opportunity to reflect on the stories

that shape their lives and decide whether these stories really suit them. A key learning moment

for me was how Madsen uses the wizard of Oz’s scarecrow’s life story to highlight how stories

shape our lives. Stories often shape our experience of life and self, these could be narratives we

tell or the stories people tell about us. These narratives provide a framework for how we or

others understand and interpret our experiences. Through the lens of my client, every interaction

has the potential to be an intervention This is why as a family therapist it is important to

acknowledge my interactions with my clients and the stories, they share with me given they have

the opportunity to bring about change. It is important to not only address the presenting problems

but acknowledge the life stories with which they are embedded. In other words, I should not

focus solely on the content but also the process of service delivery.

Madsen book is an excellent counseling book for postmodern therapists that hope to work

collaboratively with families. I appreciated how he breaks down ideas about collaborative

therapy into clear and concise information that is both informative and yet insightful. For

example, his use of case studies that allowed me to easily relate to how I can apply collaborative

therapy to my emerging practice. Overall Madsen has convinced me that it not only possible to

use collaborative therapy but very desirable to achieve change.

I must say that it was a complete delight and pleasure, reading this book. Because it

contains a wealth of knowledge for how to effectively work with families. My current practicum
RUNNING HEAD: Critical book review: collaborative therapy with multi-stressed families.

is at Alberta Children’s Hospital as a Family Counselor and my current supervisor was surprised

that I was already reading this book because it was one of her recommended books for my

practicum. This shows how applicable Madsen work is in my emerging practice as a clinical

social worker. This book got me thinking about my own training, and the attitudes about patients

and diagnoses that I assimilated, which are, for the most part, judgmental. It is so easy to label

our client as being problematic, and frustrating especially when they don't engage or are resistant

to change especially in the mental health field. This is why Madsen’s obvious message of

treating clients and families with deep respect, can come across as a new concept to therapists

taking a hierarchical and oppressive stance. I must say though that there are times when we

would need to be directive, which is often a challenge for postmodern therapy. For example, the

author does not go into using collaborative therapy in ‘risk’ situations like suicidal clients or

child protection, it clearly demonstrates the potential of an empowering way of engaging with

traditionally reluctant families and encouraging sustained change.

This book was my first exposure to narrative and collaborative therapeutic practices.

And I hope to use the insights from this book and apply it to my emerging clinical social work

practice, especially when working with families and youths. My overall goal to get to know my

client, and to approach my client and the situation with a mindset of open inquiry. I know this

can be very challenging for me as an emerging clinician looking to prove my expertise, however,

Madsen has shown me that true therapeutic work happens we work collaboratively our clients.
RUNNING HEAD: Critical book review: collaborative therapy with multi-stressed families.

Reference

Madsen, W. C. (2013). Collaborative therapy with multi-stressed families. Guilford Press.