Dimensions of expertise in family therapeutic process

Abstract

Aarno Laitila osoitti, että perheterapiatapahtumaa voidaan tarkastella keskustelussa, kanssakäymisessä ja vuorovaikutuksessa syntyvän asiantuntijuuden ja terapeutin henkilökohtaisesti työssä ja opiskelussa karttuneen asiantuntijuuden risteyksenä. Terapiakeskustelun vuorovaikutustilanteessa syntyy ja karttuu se tieto, jonka varassa hoito toteutuu, etenee ja on tuloksellista. Terapeutti on tuossa tilanteessa väistämättä eri asemassa kuin asiakkaansa, vaikka hoitotapahtuman järjestelyä ohjaakin asiakaslähtöisyys, tasaveroisuus ja läpinäkyvyys.Laitila tarkasteli kolmeen artikkelijulkaisuun, yhteen artikkelikäsikirjoitukseen ja näiden yhteenvetoon perustuvassa tutkimuksessaan asiantuntijatoiminnan kehitystä yleisesti psykoterapiassa ja erityisesti perheterapian alalla. Leimaa-antavaa perheterapian kehittymiselle 1950-luvun lopulta tähän päivään saakka on ollut sen yleisesti asiantuntijuuden ja yhteiskuntatieteiden kehitystä mukaileva linja.

This study focused on family therapeutic expertise as one specific area of expertise research. The empirical background of this study consists of qualitative clinical case studies which were published as four articles. The framing of the questions addressed in these case studies was connected to therapeutic process, therapeutic change, and preconditions of therapeutic change, the therapist’s actions, and the methodology of family therapeutic research. The methodology employed in these qualitative case studies consisted of theory-informed case methodology, the assimilation analysis method, two studies applying the micro-analytic narrative research method, and the specific Narrative Processes Coding System (NPCS). This report consists of 1) a theoretical review of the question of expertise, expertise research and expertise in psychotherapy in general and in family therapy in particular, 2) a summary of the four above-mentioned published articles, and 3) a synthesizing discussion, in which the concepts of expertise research were used as tools of dialogue concerning the main results of the empirical studies.According to the results of the case studies, the research methodology applied directs the findings obtained. This was apparent in case studies I and II, in which the same clinical case was studied. The same process could be studied either as the therapeutic development and change of the family or the joint therapeutic development of the entire therapeutic system. Reflexivity and reflectivity were highlighted (I, III, and IV) since therapists have to be able to deliberate, reflect, and question the premises of their own thinking, ongoing interaction, and acting, as well as integrate the verbal and experiential tools of clinical work. The therapist’s expertise was manifested more in the role of a facilitator of interaction and opener of conversation and dialogue than in that of an observer and diagnostician. As the report makes clear, the different reflective and reflexive therapist’s techniques and practices for participating in the process of horizontal expertise were highlighted. The family therapy session was described as a crossroads of individual/vertical and interactive/horizontal expertise in which the resources of all the participants of the session can be activated for the purposes of therapeutic change. Notice was taken of issues of theoretical development in family therapy, which has been dominated by the modern - post-modern debate. The third wave of science studies, namely the study of expertise and experience is shown as making a serious challenge to this debate.