If constellation work is to find a home among main-stream healing and therapeutic practices, it needs to be willing to engage those practices in a dialogue of understanding. In this blog post, I explore the topic of “evidence-based practice” and how that applies to constellation work.
What is Evidence Based Treatment anyway?
I recently came across a paper by Julie Tilsen and Sheila McNamee with the curious title: Feedback Informed Treatment: Evidence-Based Practice meets Social Construction (2015). Now for many of us this sounds like some kind of secret code. What is Feedback Informed Treatment? And Social what? But “evidence-based” [fill in the blank…it could be medicine, therapy, nursing, social work, coaching, management, etc.], these two words have invaded the helping professions. So, I started to think, what would Evidence-Based Constellations look like? And as is often the case, one good question leads to another. I asked myself, what exactly is our ethical responsibility to clients who come seeking change, whether relief from suffering or personal growth?
I appreciated Tilsen and McNamee’s reminding us of the definition of “evidence-based” as originally stated by the Institute of Medicine, and subsequently adopted by many other organizations: Evidence-based practice…is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.
The Council for Training in Evidence-Based Practice (2008) goes further to define evidence-based practitioners as possessing “a sense of inquiry that defines them as life-long learners” who “continually learn ways to integrate research into practice…” Further, these practitioners, “recognize and understand the limits of science, their own knowledge, and their own skills” and are “…aware of personal and cultural biases…” And, finally, “they recognize and act upon the understanding that decisions about health need to be made in collaboration with those most directly affected by the decisions.” In our context, that would be our clients.
If clients have the right to ask, then we have to be able to tell…
I believe constellation facilitators have an obligation to respond to our clients’ requests when they ask what they can expect as possible outcomes from constellation work. Like any other form of practice, we have an obligation to respond appropriately to questions about the efficacy of constellations from our clients. It is reasonable for our clients to ask, “What will I get?” when plunking down their hard earned cash and spending their time in a workshop or session. I wonder why so many facilitators in the constellation field appear uncomfortable with these questions?
How can we better answer these reasonable requests by our clients? It helps to know what we’re doing. That means we as practitioners have to have a clear understanding of our own practices and the body of knowledge that underpins our work. Whether we are aware of it or not, we do have a set of assumptions and beliefs that inform our practice. Our clients deserve to know what those are and whether or not those will be supportive to their goals in seeking care from us. Our clients deserve more from us than, “Trust me, I’m following the field.” What if your client is deeply religious and their faith doesn’t have a matching concept or finds this concept unsettling or incompatible with their faith? Does that mean they can’t benefit from constellations?
Mis-matched Meaning Making
I’ll give a personal example. I recently had a session with an energy healer. This isn’t something I often do, and while I have a fair amount of shamanic training in my background, I’m aware that different practitioners’ ways of talking about these rather nebulous experiences can be so different as to be incompatible. At one point I attempted to explain to this practitioner that I experienced an aspect of her approach as disrespectful and disconnected. Since the concept of “respect” and “connection” in the way I meant it – an aware, present, person-to-person, collaborative interaction that was mindful of my existence as an intelligent, aware being – didn’t exist in her framework, we were unable to find a way of working together successfully. She simply could not hear what I was trying to say. It was as if I was trying to explain the flavor of oregano to someone who had never tasted this herb. As a client, this facilitator’s practice was not a useful choice for me. The way I construct safety simply could not be created between us, especially since this facilitator had a “do it to/for you” implicit model, and I had a “we make it together” model of how healing is accomplished. I wished I had been able to discern this before I put my hard-earned money and time into the session! I left feeling discounted and disappointed, and the facilitator left frustrated. It’s likely we both would have made different choices than working together if I had been able to ask and the facilitator been able to explain her paradigm. “Just trust me” didn’t work very well for either one of us.
Quite naturally, our clients will want to relate our work to work they already know. In many cases, they don’t know the models that inform familiar practices, but they have their experience. What exactly is a constellation anyway? Therapy? Coaching? Alternative medical? How shall they think of what they are being asked to do? Of course, we might like to imagine we could create a model-free experience and ask our clients to “just trust us” but that is asking a lot. “Just following the field” is a model, too!
Categorize or die!
As much as we dislike the way language parses up experience into discrete bits, we must categorize to know how to interact with the environment. Without even thinking, we divide the world into human sized and useful categories. An automobile, for instance, isn’t as interesting to a giraffe as it is to a human-being for whom it is a good fit and useful. Out of these categorizations, we build internal models of the world. These work for us most of the time to the point that we don’t even have to think about them. We “know” how the door handle of our car works. It’s evident to us (most of the time!) where to pull and how.
Our models, whether explicit (we can explain them) or implicit (it’s just what we do) generally must answer three useful questions about our day-to-day experience:
- What does it (what is happening) mean?
- What (should) do I do?
- What will happen next (if I do that)?
Successfully being able to answer these questions on the savannahs of our ancestors kept them alive. It was very important to know what the waving of the grass near the waterhole meant (is that a tiger in the grass or a game animal?) What to do (run! Or hunt it.) And finally what will happen next if I do that (I’ll live another day, or, I’ll have a meal.) This basic need to be able to orient successfully to our environment and get our needs for food, shelter, and connection underlies our natural need to make models of the world we live in.
Looking “at” our implicit beliefs, rather than “through”
Social construction, as described in McNamee & Tilsen’s paper, provides a good model for constellation facilitators to use (even if they don’t know it). According to Tilsen and McNamee, “… social construction focuses on the relational construction of meaning.” That is, a collaborative, jointly created way of making sense of the world together through our interactions. We are always creating meaning together to know how to go on together. In the case of my healing session, we were unable to co-create a shared meaning of what that meant out of our interaction. We literally could not find a way to “go on together.”
When we can deeply understand our beliefs and assumptions about reality we are much more likely to be able to explain ourselves to others. To go a step farther, however, and this is at the heart of the question of what is an evidence based constellation, when we can look at our models – as if they were a representative on the floor – instead of through them as if our explanation is reality itself, we are more likely to be able to see our clients’ models, too, and to be able to co-create a shared meaning that incorporates both models in useful ways. For instance, I have worked with clients who are devoutly Christian. The icons of this faith are not a part of my model of the world, however, I am interested in my client’s world and want to understand what these icons mean to them. It’s possible to set up the client’s relationship with an important figure such as a religious teacher or Mother Mary, and in this way tap into lovely, deep resources for that client that are congruent with their belief system. In this way, I can use my belief in people’s inherent ability to know each other’s personal stories in support of my client’s experience of divine support. We create a shared meaning that neither of us would have created alone and one that is useful to the client.
FIT for feedback? Evidence in the asking
So what does this have to do with evidence based constellations? Well, the research cited in this paper also delves into how research gets translated into practice, i.e., the “evidence” that treatment works, in this case, individual and family therapy. In their review of the literature, Tilsen and McNamee point out that few modalities can unequivocally claim they are effective. It’s very difficult to objectively measure something as subjective as depression. Feedback Informed Treatment, however, is a promising place where research meets practice. This method includes the clients as co-creators of the treatment session and empowers them to say what is working, and what isn’t, in the therapy sessions explored in these studies. When we’re the client, being able to tell our facilitator what is working and what isn’t, is something most of us want! This creates a collaborative alliance between the client and facilitator where both share the responsibility for the outcome of the session.
As constellation facilitators, I believe that feedback is useful in our interactions with our clients both for ourselves as practitioners who (hopefully) wish to continue to hone our craft, and for our clients since it gives them the opening and opportunity to tell us how they experience our behavior. I believe this can be done without placing a burden on the client to “perform” in order to keep the alliance with the facilitator. The methods used in the FIT studies I’ve read both empower and share responsibility for improving the connection between the client and the facilitator. Of course, being open to feedback requires that the facilitator has a sense of self that is healthy and able to handle less than positive comments from our clients.
Since meaning is co-created out of our interactions with each other, we as facilitators must take responsibility for being clear about our own intentions, confusions, responses and the beliefs and assumptions that inform our practice. Our clients may or may not share these ways of seeing the world. Honest and safe feedback often allows these differences to surface and be explored in a useful, collaborative way. In practice, this means that the facilitator needs the skills to be able to:
- Address each unique client’s needs preferentially. Does this particular client need to discuss their situation? Is that not helpful? Rather than applying a rule of “never talk about the work after a constellation” for instance, what happens if we allow ourselves to really see and feel our client’s need. How can we best support them? A “rule” is easy for us as practitioners because we don’t have to be present in the moment with our client and respond to their need creatively and with compassion.
- Accept feedback. Make space for different perspectives than our own. Here is where real learning and development occur – often for both client and facilitator. Invitation to examine our assumptions, reflect on the process of our work, become aware of hidden aspects of our internal models. This willingness to include client feedback in our work is both humbling and useful.
- Respect both the norms and values of the client’s individual culture. For example, if our client is a member of a particular LGBTQ community, we need to be sensitive to the way they experience gender roles in a constellation. And to how their experience as a minority will have shaped their responses to some of the sentences or phrasing we may be used to using.
In summary, being able to surface our own ways of understanding what we do and why, to share this with our clients, and being open to our clients’ feedback as to whether or not they are able to make use of these models, can enable us to become better facilitators. We can “make meaning together” with a wider range of clients, respectful of both our ways of knowing and theirs.
Tilsen, J. & McNamee, S. (2015). Feedback informed treatment: Evidence-based practice meets social construction. Family Process, 54(1), 124-137.
Council for Training in Evidence Based Practice. (2008). Definition and competencies for evidence based behavioral practice. Accessed July 1, 2015. http://www.ebbp.org/documents/EBBP_Competencies.pdf.