Thinking, Living and Practicing in Two Worldviews
Relational Epistemology informs Justice oriented Clinical Practice
As may be evident from the reflections in part 1, we think, live, and practice in two worldviews or epistemologies, the “scientific” “objective Realism” paradigm and the relational perspectival paradigm. We are more familiar with the former, underlying our not always consciously reflected, “naïve” worldview and prevalent in scientific discourse, medical achievements, and technological advances. In general, our day to day exposure to and manipulation of the mainly material world around us reveals the dominant function of this paradigm.
I will focus here primarily on the relational and perspectival epistemology in order to buttress the radical, i.e. second order change connected with adopting this epistemology in clinical practice as the guiding epistemological orientation.
The fact of having to make a choice at all which paradigm to adopt as the primarily and explicitly guiding one, is unsettling to us, because this choice catapults us out of our accustomed way of seeing the world as a fixed objective reality and feeling at home in it. Instead applying this “new” paradigm we experience ourselves questioning the dualistic objective paradigm and become strangers, driven out of our thinking homeland, because old truths that seemed self-evident to us, loose their predictive and reliable validity. It takes us some time to appreciate that the adoption of a relational and perspectival design of thinking also opens new vistas and perspectives for personal and professional encounters and work.
1. The new Relational Realities made recognizable by the Relational Paradigm:
With the perspective shaped by the relational and contextual paradigm the diverse complex relational networks in which therapist and client are involved come into sharp focus.
(Please, note: I use the terms “therapist” and “client” as generic terms for anybody, professional or not, who enters into a healing and supporting relationship with a family member, friend, guest or stranger.)
With adopting this paradigm we become aware of:
* The relationship among health professionals (organization, practice, research group) in a professional setting; the family of origin of the therapist; her/his professional and family ancestors; i.e. the therapist’s “social location”.
* The relationship between the health professional(s) and the other(s) (“client(s)”) which is the relationship that drives the healing process forward. In the perspective of the relational paradigm there is a circular relational process, i.e. a process of change and healing that involves all who are part of it, therapist(s) and client(s)!
* The embeddedness of other(s)(clients) in their own multiple relational networks, notably their family systems, in wider personal networks and as part of a community with numerous relational webs.
* We discover the relationship (our own and the others’) with people from the past: Here we include the entire historical dimension in its impact on the present (for example, enslavement or extinction history); the context of the family memories including specific ancestors; we construct a family genogram or listen to family survival, oppression, and resilience narratives.
* We own our responsibility for future generations; creating positive legacies and missions into the future that sustain the people coming after us. Ultimately, we honor our responsibility and concern for the survival of planet Earth.
The focus of the relational paradigm is on relationships, but also on contexts, the latter being the broadest lens that can capture societal realities such as socio-economic status, condition of neighborhoods, culture, the effects of war or current forms of institutional oppression. We speak of a relationship- and context-centered perspective. While relationship signifies a more intimate and personal connection with the other(s), the context of a person or family connects all the different aspects of a given environment, especially social aspects that have their own boundaries, but also intersect with each other.
2. Social Justice Perspective – A challenge to Psychotherapy
With the features, patterns, and characteristics of a person’s relationships and societal environment brought into focus, more over, with some of the contextual forces frozen into rigid structures of oppression and domination, it is not possible to avoid the question of justice.
a) Considering the more intimate and personal characteristics of the relational connection with the other(s), clients and therapists can practice relational justice by emphasizing critically important aspects, guided by a relational paradigm.
- The face-to-face character of the clinical process, an encounter that envelopes both the therapist and the other in an interactional process that creates a relationship prior to any cognitive understanding, let alone “diagnosing” the other(s).
- The asymmetry of the relational process: The other (client) is calling me, I am put in question, I am responding to the other, my existence at this moment is there for the other(s), and revolves around her or his or a family’s experiences, questions, dilemmas. Their expertise about their life is privileged over my (professional) knowledge or academic credentials.
- The deconstruction of professional hierarchies, of expert power and of the rules of the dominant discourse (including the DSM): We, the experts, become vulnerable, have to tolerate being taught by the other(s), have to collaborate in the process of healing with humility and curiosity, have to employ a language of caring, inviting and connecting with the other(s).
- The relational process between therapist and client as a source of emerging relational justice and empowerment, revitalizing strengths and resilience; and unearthing relational injustices inherent in many marriages, long term relationships and families.
b) Having established a relational connection with each other, therapist and clients turn together “looking outward” at the contextual injustice factors impacting people’s lives:
- In disadvantaged neighborhoods: Poverty & paucity of jobs, insufficient housing, violence in the neighborhood, racism and constant mini-aggressions, gender inequality, homophobia, isolation and lack of community, lack of accessible social services and other resources, failing schools, gang presence, absent fathers etc.
- Traumatic personal and community events in the past with accompanying narratives of despair and survival. These are often contextual factors with overwhelming force such as incidents of physical and sexual violence, a history of enslavement and exploitation during the process of immigration (incl. non-documented status), malnutrition during early childhood, victimization within the health and mental health systems, maltreatment by the educational system, early prison experiences etc.
- Then there are drug addiction and the “mental illness” label as major sources of victimization, stigmatization, pharmaceutical overkill with legal drugs and, often, imprisonment – all with tremendous impact on entire families and neighborhoods.
3. Social Justice as a “Meta-Perspective” in the Relational Paradigm
Structures of Injustice surfacing in people’s stories
Contextual injustices in our society’s history and structure are experienced daily and are significant factors in human suffering, psychic pain, and physical illness. The separation of psychological inside and social outside is an artificial construct intended to make us overlook the power of unjust societal and economic structures that contribute to emotional pain and despair.
The others (“clients”) therapists encounter experience personal and interpersonal issues that do not arise from their biological, psychological, and social development or from their family dynamics in isolation. To “diagnose” someone as individual without context, therefore, without inquiring intensively about this person’s intimate relational network and about his or her significant contexts is an injustice.
Particularly people in neglected urban environments are exposed to many stressors and injuries that are rooted in our society’s or this particular city’s structural injustices: Economic exploitation and the growing disparity of wealth between rich and poor; rigid walls between social classes; lifelong status as marginalized within the dominant culture; poverty and violence in the neighborhoods; continuing racism, so evident in the administration of justice; disparities in health care and social services delivery; hardships due to the imprisonment of family members; discrimination against women, children, gays, lesbians, or transgendered people, – in general, the likely mistreatment of anyone who is different according to the norms of the dominant discourse. The social justice meta-perspective, therefore, has to be integral to the therapeutic inquiry and understanding of children, adolescents, adults and families.
I would like to add: Social justice as a meta-perspective guiding therapeutic encounters may seem to many therapists glaringly obvious within contexts of deprivation and widespread social neglect. Adopting a relational contextual paradigm, however, we discover similar, although perhaps more subtle, relational and contextual injustices in conversations with individuals, couples, or families with a middle class status and from an economically more stable background. Again: How you look and inquire determines what you see and discover!
Examples of Social Justice Work in Just Clinical Practice
Social justice as a “meta-perspective” orienting the therapeutic process and guiding clinical practice transforms and enriches both therapists and clients. Some important steps of “justice work” are listed here.
Witnessing stories and public remembrance
Families tell stories, often in the language reflecting their ethnic heritage and culture that they try to preserve. They talk about present or past traumatic incidents or about long smoldering conflicts and irreconcilable relational traps, or about their journeys replete with danger as they were forced to immigrate to this country to survive. As eye and ear witnesses therapists ask questions, encourage other family members to join in the narrations or broaden the generational context so people can listen to the voices of previous generations. In the relative safety of a family session incidences of physical or sexual abuse, tales of deprivation and general affliction, times of despair or helpless rage, of mental confusion and bewilderment, or long standing family disagreements can surface and be heard.
Remembering and acknowledging in the public sphere of the family conversation the struggles, sufferings, and injustices family members had experienced in previous generations is healing and strengthening for all. It is a form of restoring justice to those whose life and death made the family’s life better.
The work of reconciliation
The therapists and friends from the community can pursue actively the goal of reconnecting fragmented personal relational networks, of reconciling hostile family members and of assisting them to rebuild the relationship with each other. This process requires a sense for justice and for balance of opposing forces, cultural empathy and humility, attentiveness to time, and “multi-partiality”, i.e. the ability to do justice to each person’s perspective.
Justice work in the family’s social environment
Beyond the family’s immediate context therapists may decide to see it as a legitimate task to support all efforts to transform and restore societal, cultural, and gender specific justice in neighborhoods where civic and community life has suffered. Families are encouraged to not give up advocating for justice. Such relationship and context-centered therapy can provide the groundwork to motivate families to take initiative in their neighborhood or in their children’s school and advocate for change and address issues of justice on many levels.
It is obvious, of course, from an epistemological orientation emphasizing the relational and contextual paradigm that any group activity in the community supporting individuals and families with “mental health or behavioral issues” and fighting against the stigma of having a psychiatric label or, broader, against social injustice in the “mental health” field is welcomed and should be supported by the professional community. The challenge seems to me to bring professionals and members of the community and self-help groups together in support of those who suffered discrimination and maltreatment within the “mental health system”, including frequent over-prescription of psychiatric drugs.
©Norbert A. Wetzel 2014
The Center for Family, Community, and Social Justice, Inc., www.cfcsj.org