The Aesthetics of Interruption

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The Aesthetics of Interruption: Points of entry in systemic therapy Ged Smith

“Once upon a time, New York City had a sixth borough.” “What’s a borough?” “That’s what I call an interruption.” “I know, but the story won’t make any sense to me if I don’t know what a borough is.” Jonathan Safran Foer 2005, p.217 As a systemic practitioner and family therapist I am constantly balancing the tension between attempting to facilitate sessions collaboratively and being mindful of my own power on the one hand, while being somewhat directive and having my own agenda on the other. I value the importance of listening and providing the core conditions of warmth, transparency and authenticity. However, a regular feature of my work involves interrupting people, in several different meanings of this word as I will make clear. And yet, an important part of my role as therapist is to facilitate polyphonic communications – and do it well! A paradox is that interrupting is a necessity in family therapy in order to enable space for other people’s contributions. We stop some voices in order to hear other voices; we interrupt in order to prevent interruptions. An interruption is often understood as a violation of speaking rights but in family therapy terms an interruption can be made to protect others’ speaking rights. This paradox can be tackled collaboratively, even with advance notice and agreement. Mother:

Ok, well, we’re all here now, and it’s important we all speak without being interrupted.

Ged:

Yes, let’s try to do that, but I can’t promise not to interrupt...

Mother:

What do you mean?

Ged:

Well, in family therapy often the conversations can become quite heated and people have a lot to say, which is very important. But I find that I have to interrupt sometimes so that no single person dominates, and so that everyone has a chance to be heard.

Mother:

Ok, that sounds good actually. 222

The Aesthetics of Interruption

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This example shows an enhancement of the speech flow or chain (Bakhtin 1986) referred to by linguists, and enhances the important therapeutic concept of attunement. We speak in anticipation of the other’s response, and our words are co-shaped within conversations so that we achieve shared understandings and coherency. This can be embodied and thus felt within family members just as it is within us as we facilitate sessions. As therapists we listen in order to understand not in order to reply, and so if our replies are slower then so be it, as long as we have a better understanding. This active listening may also act as modelling for families. It may also be that we have to be more active in our interrupting than we wish to be but some family members need to understand what we are doing rather than us constantly preventing their contributions: Ged: I’m sorry Julie, I know I keep interrupting you but it’s really important that I hear from the others on this important matter. How would it be if I ask you to just listen for about five minutes and then I promise I’ll come back to you and I’d be really interested to hear what you think? Seikkula said “We must become aware of what is occurring within us before we give words to it.” (Seikkula 2011). I would like to enhance this idea, also spoken of by Tom Andersen, (1995) another “embodying therapist” who stresses the importance of being aware of bodily as well as emotional reactions. Mouthfeel is a concept well known amongst wine connoisseurs whereby you know a good wine by the feeling you have in your mouth as you experience it. I propose “mouthfeel” as a concept for psychotherapy where you know a helpful comment or question as it is formed in your mouth, about to make its entry into the room. Of course language is formed in your head not your mouth, and develops with co-conversationalists, but I know that when I pause and deliberate, when I shape an idea in my mind, it can be located in my mouth as I shape my tongue around the sound I might start with, ranging from M to O to L, all of which make my mouth do different things. The mouthfeel changes and can struggle to find comfort. This happens relationally, again according to co-conversationalists who can help with the (dis) comfort. Ged:

I notice when you talk it’s like erm, like you erm, like you slur your words. Do you know what I mean?

Jane:

Slur? What do you mean? No, that makes me sound drunk!

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Systemic Therapy as Transformative Practice

Ged:

No sorry, it’s not slur, it’s erm……I don’t know the word, it’s like you talk slow and sometimes not quite clear. And I don’t know what to make of it. It’s erm…

Jane:

Dampened? Like my words are dampened?

Ged:

Yes, that’s it. I knew slur was the wrong word but I couldn’t think of a better way to….yes it’s dampened. That’s much better.

This was me achieving a better mouthfeel with Jane’s help. She was taking 60 painkiller tablets a day and recognised her dampened speech, but not slurred speech which she did not like the idea of. We roll ideas around to see how they fit and hope they will become “internally persuasive” (Bakhtin 1981). It may also follow that we would be moved to question a context which prescribes 60 painkillers a day to a person, part of the effects of which can be to deform the process of languaging, as well as deforming the body in creating further patterns of disease within the whole body. Language in therapy can be co-constructed and is all the better for it. It is also collaborative practice in action. We can search and think out loud and this struggle can be helpful in the therapeutic process by demystifying, equalising, and inviting mutual engagement. When we have a good therapeutic alliance with people we can do this with more ease, and be more open to taking risks, knowing that mistakes will more likely be understood in this way rather than diminishing the work we are embarked on together. I have written about this elsewhere (Smith 2011a) and continue to be intrigued with language, risks and relationships in therapy and supervision. In this chapter I write about these concepts, and the processes of talking with people who seek our help in an attempt to move forward with these ideas and continue our explorations in communication; always travelling, never arriving. As a therapist I believe that I have licence to ask questions and explore personal areas which in any other context would be unacceptable. We must however be aware of how this is a socially constructed position and as such can be contested so that what constitutes a “therapeutic conversation” is always open to challenge.

Silence To a large extent language is all we have, notwithstanding the myriad non-verbal encounters present in therapy, most of which we ignore or are not aware of. We privilege language so much that we call what we do the talking therapies. We also regard silence as a problem, and something


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to be overcome. Silence is often viewed as problematic, especially in a talking milieu, and it can be seen negatively or mistaken for passivity or an absence of something. Whatever silence is however, it is not nothing. Silence can be eloquent or dignified, and it can be precisely the right response in some circumstances. The problem with silence is usually for others, not for the keeper of silence. The famous dictum that we cannot not communicate (variously attributed to Bateson or Watzlawick) applies very strongly to silence. Jack Bilmes however expresses this more forcefully for our purposes: “Where the rule is “Speak”, not speaking is communicative.” (Bilmes 1994). Playwright Samuel Beckett portrays the deeper meanings of silence in several of his plays, but perhaps Israeli poet Avi Geffen (2013) expresses the idea most powerfully with his line “My silence is my scream.” Silence is much written about in individual therapy but less so in family therapy where it is more likely to be children who prefer not to speak, and for these instances again we have to balance respect for the individual with encouragement to verbalise in ways that we hope will be of benefit for them once they have found their voice or overcome resistance, fear, mistrust, or whatever it is that feeds the reluctance to speak. Unlike the police, we do not declare that people have the right to remain silent, but therapists must not adopt the belief of the Roman Senate; qui tacet consentire videtur – he who keeps silent is presumed to consent. Inviting younger children to play whilst listening and to join in or comment if they wish to enables a way forward I have found useful. Asking circular questions (Selvini Palazolli et al 1980) of others where older children’s silence is being considered can also help, while returning to the keeper of silence to remind them that they can agree or disagree at any time, or they can choose to remain silent. This also raises the philosophical question of whether it is possible to interrupt silence. In Herman Melville’s 1853 short story “Bartleby the Scrivener”, the eponymous Bartleby is a character employed at the narrator’s law firm and after a brief period of good work eventually refuses to do anything, or respond to requests in any way other than by saying “I would prefer not to.” This causes great consternation to his employer and colleagues, some of whom want to beat him up, but he is allowed to stay despite constantly refusing to do anything. He persists in replying politely and consistently with “I would prefer not to”, and occasionally in response to questions about his behaviour with “I would prefer not to answer”. Characters in the story question Bartleby’s mental health and the boss considers his options but for his own reasons keeps him on despite him doing no work at all, constantly preferring not to. Most critics have analysed Bartleby and what his stance might mean, raising philosophical

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questions of determinism and free will. The story also raises systemic interest for us however, about the boss’s reactions, and we may view him as generous, sympathetic, naïve, timid, caring, conflict-avoidant, or any number of possible interpretations. It also points to communication, and while Bartleby is not silent, his repeated responses might be seen as a near-equivalent to it. In family therapy we often meet with people who do not want to be there, especially children, and while I have never met with a Bartleby-like response (which would be very disconcerting), most of us will have met with people who would prefer not to engage, answer, or even be there. Sometimes we meet with silence, and while family members usually do their best to encourage engagement or responses we will often be more interested in the process of persuasion. Silence has a bad name in the history of human communication. It is something to be “broken”, often to help us feel more comfortable or help us know what is going on with other people as the “not-knowing” can be intolerable.

Knowing, not-knowing and interrupting expectations “Not-knowing” (Anderson and Goolishian 1992) is a popular approach in contemporary family therapy, which could be defined as not assuming to know in advance, despite the familiarity of the presenting problem. Recently, I had occasion to take the experience of not-knowing to new lengths in a case which involved silence, interruption, second-order cybernetics, and issues of power and expertise. Hannah and Jason (not their real names) brought their 13 year old daughter Aimee to family therapy because she was having sex with her 14 year old boyfriend and they wanted her to stop having sex with him. Jason was particularly incensed by this. He was refusing to allow the boyfriend near the house and was constantly angry with Aimee. Hannah took a more diplomatic and understanding approach. She worked hard to prevent Jason from permanently grounding Aimee and, instead, was hoping to communicate with Aimee’s boyfriend to resolve matters but this had not happened as Hannah was being prevented from doing so by her husband. The parents had involved Social Services and the police to no avail. The family was at a total impasse when they came to us. After telling us the background to what had been happening, they sat quietly as if they felt they had handed matters over to us and were saying, “Tell us what to do!” I had no idea what to do and explained that I understood their difficulties, and could imagine feeling similarly if my daughter had been in this position. Diplomatically, but honestly, I explained how I would probably feel much like Jason does, but also agreed with some of


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what Hannah does. I also tried to imagine what Aimee was feeling listening to all of this. She remained silent throughout. I spoke of the power of young love, even invoking the story of the similarly aged Romeo and Juliet. But in the end, I did not know what to do and that is all I could say. When the reflecting team came in they gave a similar message. To my surprise, the parents found this very helpful, commenting that it was good to hear professionals did not have the answers and were equally perplexed. They had been fearing that there was an obvious solution that they were not seeing, or that it was somehow their fault, or they had created this. They also came to therapy with the expectation that therapists would tell them what to do. With their fears unrealised however, having a not-knowing position was acceptable and was an interruption to their expectation and beliefs about therapy. This episode also acted as an interruption to similar expectations of trainee psychiatrists behind the screen observing family therapy and seeing that omniscience and answers were not always necessary or possible. This example illustrates issues of power within therapy and how second order cybernetics theory within family therapy (Atkinson and Heath 1990) assist us in avoiding a didactic or psycho-educational approach. The second order approach (contrary to the therapist-as-expert approach espoused in the first order approach) saw a shift in the role of the therapist towards one who explored meanings, beliefs and explanations collaboratively with families. This approach critiqued the idea of “objectivity”, instead encouraging reflexive exploration of issues in ways that for families and therapists alike can only be subjective. On the other hand, sometimes knowing from an “expert” position can have a place in family therapy and this may be an interruption of others’ strongly held views. Hazel brought her 14 year old son David to therapy because she could not get on with him, found herself disliking him for his behaviours and his seemingly wilful refusal to eat. She also commented that he was insincere and that she could not believe what he said and that she caught him out lying several times. I found David to be a timid little boy, acting much younger than his years and somewhat startled by the whole experience. My attempts at safe engaging questions about school, football or other interests were met with a strange hesitation as if he was carefully measuring his answers. Hazel was quite vociferous in her dislike of her son, explaining how, compared to her other two sons, he was by far her least favoured and she didn’t even think she loved him. David heard all of this. At one point David answered my question about whether or not he agreed with something his mother said by clearly nodding and shaking his head at the same time in a way that meant both yes and no.

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Ged:

Is that a yes or a no, David?

David:

[Nods and shakes his head again] Erm….Yes. No.

Ged:

Did you see what happened then Hazel?

Hazel:

Yes, that’s what I’m telling you, you never know where you are with him. He doesn’t answer questions or say what he thinks, he drives me mad.

Ged:

Why do you think he might do that?

Hazel:

I’ve no idea, you tell me. His brothers don’t do that, I don’t know what’s wrong with him.

Ged:

Do you want to say anything about this David?

David:

[Silent, tearful]

Ged:

If David could speak up, say what he’s really thinking, or doing, what do you think he’d say?

Hazel:

I told you, I’ve no idea. You tell me.

Ged:

Ok, I don’t know, but I can tell you what I think?

Hazel:

Go on…

Ged:

Well I notice that throughout this session David hasn’t been telling us what he really thinks, just like you said. But I don’t think that’s because he’s insincere, or playing some wilful game. I wonder if it’s more because he doesn’t feel safe to say what he thinks because he wants to please you, because he wants you to love him, and he knows you don’t love him because you’ve said that here today. So David might be trapped, wanting to say the right thing, but not knowing what that is.

Hazel:

[Pause] Oh my god, I’ve done all this haven’t I? This is my fault. [Crying]

Following this I was clear to explain that this was not her fault but that we are all at the mercy of our childhoods and as parents we all struggle sometimes. Neither fault nor blame would be of interest to us, but we could work together with the family in interrupting the belief that David was wilful or insincere. Rather, there were alternative understandings which can free them both from guilt and work together towards something more healthy.

Being interrupted The experience of being interrupted as a therapist is something we will all be familiar with and is part of everyday conversational practices as


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we co-construct meaning and dialogue. There is a difference however when we assume a particular position within that discourse as therapists usually do, one of being a facilitator of the talking and as such, a holder of some power. How might this affect the ways in which talking is done in therapy, and how might we avoid the position (if we wish to avoid it) of “It’s ok for me to interrupt you but not for you to interrupt me”. My own approach to this is not to assume that I have greater access to the truth which must be listened to, but that as facilitator I will sometimes need to create talking and listening space for everyone present and that this will involve me being directive and interruptive at times in order to do this. It can be done with humility as referred to in the little scenario later, or with some authority if the need to interrupt dominance is identified. There may also be times when we find ourselves interrupted in full flow and, depending on the relationship, humour is often useful. Mother:

So before we go, we’ve told you all this, can I ask you what you think?

Ged:

Well, you can ask yes, and I can give you some thoughts if you’d like, although that doesn’t mean that this is the absolute truth. So……what strikes me is that what you and Mary have said today reveals something really important and telling about why John might have behaved as he did, because when John was 12 and you left the family home for a few weeks…..

Mary:

Mum, can I go to Kate’s tonight?

Ged:

Hang on, I’m in the middle of my big speech here! Tsk!

Mother and Mary:

[laughter]

More interruptions In her Journal of Family Therapy article, Jacqueline Stratford (1998) makes the point of therapist power, whereby we may be seen as conversational experts with some obligation to ensure that things get talked about. As therapists, we “ask most of the questions, select most of the topics, and are therefore largely in control of the conversational floor. Thus therapists have more power than clients to speak about a topic of their choice or to select another speaker or topic”. (Stratford 1988 p.388) This by necessity will involve some level of interruption at some point, and she goes on to caution,

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“High levels of interruption by the therapist may be experienced by clients as an appropriate use of their expertise, to helpfully alter the direction or content of the therapeutic conversation, or be seen as a culturally legitimate means of responding to families, or fitting in with the families’ own particular style of communication. On the other hand, irrespective of whether family members are consciously aware of being interrupted by the therapist, they may be left feeling angry, disqualified, not listened to, or believe themselves to have little to contribute to the therapeutic conversation and be disadvantaged as a result.” (Stratford 1998, p.388) It is the job of the therapist then to ensure that family members do not feel disqualified or disadvantaged. As with my earlier example of explaining to families that interruptions will be a part of family therapy, this may require more explicit explaining, such as “I’m sorry, I need to interrupt you now John as I can see that Lisa has something to say and we haven’t heard from her for some time. Is this ok, and I can come back to you later?” Even on the rare occasions when the speaker insists on finishing a point they will understand the need to conclude and that other voices are competing for space. This facilitation by the therapist relates to the therapeutic relationship which has been hugely researched and is almost universally agreed upon as being a crucial factor in good therapeutic outcome. There may be times however when we are more suspicious of a dominant family member such as one who seems to be controlling the flow of information or keeping others silent by their very presence. The above pointers are still indicated, perhaps along with a transparent inquiry about people’s sense of openness and exposure to questions, always bearing in mind people’s safety. I have discussed elsewhere how to challenge masculinity within family therapy settings (Smith 2011b).

Timing of interruptions and sharing responsibility After some time into a first session Margaret was talking a great deal without pause and with little opportunity for me to engage in dialogue or ask questions. At a rare intake of breath I jumped in and apologised for interrupting and said I would like to ask her if she had told her story to many people before, and if so, to whom and when. I then asked her how she could tell it to me today in a way that would be helpful to her, given that she already knows the story. She replied,


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Margaret:

Well, I thought you’d want to know all this.

Ged:

I do, I want to know what you think I should know, but sometimes people think that in therapy you can only be helped if your therapist knows everything, and that’s not really true. I have a sense of your story from what you’ve told me already, and also from the referral that your psychiatrist sent us. What do you think it would be really important for me to know so that I might be able to help you?

Margaret:

[Answers with some brief details about abuse and neglect in her life]

Ged:

Ok, I can see how that is so important. And in telling me about this, would it be ok if I interrupt you occasionally to ask questions, so I can understand better how we can make this therapy different for you; different from the therapies you’ve already had that you’ve told me haven’t helped?

In declaring my own position with Margaret, and agreeing this with her I wanted to achieve two things. The first was a message that informing me of every detail, uninterrupted was not only unnecessary but also potentially unhelpful to her. The second was to invite her to join me in taking responsibility for the therapeutic process we were both part of, and that this endeavour needed dialogue to optimise its benefits. If family members feel that the therapist is authentic and empathic, that any interruptions are made with good intentions and for the greater engagement of all, then the therapist will be freer to make such challenges and have them understood. This engagement takes time and so excessive interruption early on is not advised. It is also important to consider the many diverse and intersecting factors within therapy relating to ourselves and the family members with whom we are working. By this I am suggesting we take account of how it might be experienced for a black woman, a Muslim father, or an elderly grandparent to be interrupted by a white male therapist (in my case) or by any professional in order to make space for another family member to speak. Once again, there is very little that a good therapeutic relationship cannot allow, or rectify if offence is caused. This speaks to our own humility and transparency, creating a context where people are free to question us about what we are doing and thinking, and us responding with respect if asked. The culture of there being an openness to challenge for all participants is

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part of good therapy, as is openness to change if what we are doing is not helping or going anywhere useful. In this respect we can be seen as interrupting ourselves, that is, interrupting our journey to improve it by taking feedback seriously. And so the concept of interrupting can take on wider meanings than violating a speaker’s turn to talk. We can also interrupt not only ourselves and our approach, but also others’ thoughts or beliefs as shared within therapy. This fits with systemic theory in that the process is co-constructed by all present; we influence family members and they influence us, such is the beauty of this work.

References Andersen, Tom (1995). Personal communication. “Reflecting Practices in Action”, Barnardo’s Family Therapy Conference, Liverpool, UK. Anderson, Harlene, & Goolishian, Harry (1992). The Client is the Expert: A not knowing approach to therapy. In S. McNamee & K. J. Gergen (Eds.), Therapy as Social Construction (Inquiries in Social Construction Series). London: Sage Publications. Atkinson, Brent & Heath, Anthony (1990). Further Thoughts on SecondOrder Family Therapy: This time it’s personal. Family Process, 29, 119-130. Bakhtin, Mikhail (1986). Speech Genres and Other Late Essays. Trans. by Vern W. McGee. Austin, Texas: University of Texas Press. Bakhtin, Mikhail (1981). The Dialogic Imagination: Four Essays. Ed. Michael Holquist. Trans. Caryl Emerson and Michael Holquist. Austin: University of Texas Press. Bilmes, Jack (1994). Constituting Silence: Life in the world of total meaning. Semiotica 98, 73–87. Geffen, Avi (2013). “Silence” from the album Aviv Geffen. Mars Records. Jonathan Safran Foer (2005). Extremely Loud And Incredibly Close. Boston, MA: Houghton Mifflin. Selvini Palazolli, Mara; Boscolo, Luigi; Cecchin, Gianfranco & Prata, Giuliana. (1980). Hypothesizing-circularity-neutrality: Three guidelines for the conductor of the session. Family Process, 19, 3–12. Seikkula, Jaakko (2011). Becoming Dialogical: Psychotherapy or a way of life? The Australian and New Zealand Journal of Family Therapy, 32: 179–193. Stratford, Jacqueline (1998). Women and Men in Conversation: A consideration of therapists’ interruptions in therapeutic discourse. Journal of Family Therapy, 20, 383–394 Smith, Ged (2011a). Cut the Crap: Language — Risks and Relationships in Systemic Therapy and Supervision. The Australian and New Zealand Journal of Family Therapy, 32(1), 58–69. Smith, Ged (2011b). Challenging Hegemonic Masculinity in Family Therapy. Unpublished Doctoral Thesis, University of London, Birkbeck.