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Concealing and Revealing Power in the Therapeutic Relationship

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Concealing and Revealing Power in the Therapeutic Relationship Concealing and revealing power in the therapeutic relationship Verbergen en onthullen van macht in de therapeutische relatie (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof.dr. W.H. Gispen, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op maandag 20 november 2006 des ochtends te 10.30 uur door Michael Christopher Garrett Guilfoyle geboren op 1 april 1966 te Durban, Zuid-Afrika M. Guilfoyle-Concealing and revealing power in the therapeutic relationship Promotor: Prof. dr. J.D. Ingleby 2 M. Guilfoyle-Concealing and revealing power in the therapeutic relationship TABLE OF CONTENTS 1. A CONCEPTUAL ORIENTATION TO POWER AND ITS CONCEALMENT 8 1.1. Introduction 8 1.2. Why study power? 9 1.2.1. Cautions against emphasising power 9 1.2.2. Power and a view of ethics 10 1.2.3. Power in therapy as reproducing social inequality 12 1.2.4 The concealment of power 14 1.3. Concealing and revealing power 15 1.3.1. Distinguishing power from its effects 16 1.3.2. Power and knowledge 18 1.3.3. Power’s location: the problem of context 20 1.3.4. The interpretation of resistance 23 1.4. Towards making power visible: Research questions and methods 25 1.4.1. Overall research questions 25 1.4.2. Analysing discourse 26 1.4.2.1. Analysing rhetoric 27 1.4.2.1. Analysing subjectivity 28 1.4.2.3. Paying attention to context 28 1.5. The structure of this thesis 29 1.6. References 33 2. EXPLORING THE RELATIONSHIP BETWEEN POWER, KNOWLEDGE AND RESISTANCE IN THERAPY 39 2.1. Introduction 39 2.2. Conceptual issues 40 2.2.1. Therapy as a power/knowledge network 40 2.2.1.1. The context of therapeutic practice 40 2.2.1.2. The production of subject positions 41 2.2.2. Resistance and power 43 2.3. Methodology 44 2.4. Analysis 46 2.4.1. Constructing therapeutic knowledge 46 2.4.2. Contrasting talk of therapy clients and business colleagues 47 2.4.3. Constructing resistance 49 2.5. Discussion 51 2.6. References 54 3 M. Guilfoyle-Concealing and revealing power in the therapeutic relationship 3. PRIMARY AND SECONDARY POSITIONS IN THE THERAPEUTIC POWER/KNOWLEDGE NETWORK 57 3.1. Introduction 57 3.2. “Everybody knows” about therapists and clients 58 3.3. The cultural construction and positioning of therapists and clients 60 3.4. Primary therapeutic positions and the circulation of power 63 3.5. The primary positions and their resistance to change 66 3.6. Implications for therapeutic applications of the dialogical self 68 3.7. References 71 4. RHETORIC AS A VEHICLE FOR THERAPEUTIC POWER/KNOWLEDGE 73 4.1. Introduction 73 4.2. Conceptual issues 74 4.2.1. The self-contained individual 74 4.2.2. Therapeutic rhetoric: the development of “therapeutic” discourses 76 4.3. Case study and analysis 80 4.3.1. Method of analysis 80 4.3.2. Discursive case material and analysis 80 4.4. Discussion 86 4.5. References 89 5. POWER, DISCOURSE AND THE CONSTRUCTION OF SUBJECTIVITY 93 5.1. Introduction 93 5.2. Conceptual issues 94 5.2.1. The discursive production of subjects 94 5.2.2. The historical and cultural emergence of the psychological subject 97 5.2.3. Common sense and therapeutic discourse 98 5.2.4. Psychologised knowledges about bulimia 99 5.3. Case study and analysis 101 5.4. The possibility of alternative discourses 108 5.5. Discussion 112 5.6. References 116 4 M. Guilfoyle-Concealing and revealing power in the therapeutic relationship 6. THE POSSIBILITY OF THERAPEUTIC “NON-POWER”: THE CASE OF DIALOGICAL THERAPY 120 6.1. Introduction 120 6.2. Conceptual issues 121 6.2.1. Dialogical therapy: basic principles 121 6.2.2. Dialogical therapy and power 122 6.2.2.1. The question of obstructing dialogue 123 6.2.2.1. Power within boundaries 125 6.3. Case analysis 126 6.4. Power and the need for special discursive arrangements 128 6.5. Dialogical therapy in the context of power 129 6.6. Conclusions 131 6.7. References 133 7. PSYCHOANALYSIS: A CRITICAL ENGAGEMENT WITH HABERMAS 135 7.1. Introduction 135 7.2. Habermas on power and critique 136 7.2.1. Power’s distortion of social action 137 7.2.2. Critique, psychoanalysis and the challenging of power 138 7.3. Power’s immanence in the social arena 140 7.4. Power, critique and strategic action 141 7.5. Towards conceptualising a critical psychoanalysis 145 7.5.1. Resistance as a critique of power 147 7.5.2. Taking a stand 152 7.5.3. Reflexive responsivity 156 7.6. Conclusions 157 7.7. References 160 8. NARRATIVE THERAPY AND THE POSSIBILITY OF CRITICAL THERAPEUTIC PRACTICE 163 8.1. Introduction 163 8.2. Power and therapeutic practice 164 8.2.1. A positive account of power 164 8.2.2. Power, knowledge and the production of subject positions 165 8.2.3. Power and resistance 168 8.2.4. Power’s location: the problem of context 171 8.3. Re-examining therapy as resistance 174 8.3.1. Towards productive therapeutic resistances 174 8.3.2. Local ethics and resistance 177 8.4. Conclusions 179 8.5. References 180 9. INTEGRATIVE SUMMARY AND DISCUSSION 184 9.1. Introduction 184 9.2. The four questions of this thesis 184 5 M. Guilfoyle-Concealing and revealing power in the therapeutic relationship 9.2.1. What forces impact on participants in the therapeutic encounter? 184 9.2.1.1. The therapeutic relational system 185 9.2.1.2. Power and the shaping of the client 187 9.2.2. How is power concealed in therapy? 191 9.2.2.1. Knowledge and a negative view of power 191 9.2.2.2. Reconstructing resistance 193 9.2.2.3. Context 195 9.2.3. How can power in therapy be made visible? 197 9.2.3.1. Therapy talk as rhetoric 197 9.2.3.2. Analysing the power of primary positions 198 9.2.3.3. Integration with culturally available discourses 201 9.2.4. What is the relationship between therapeutic power and power operations at the societal level? 204 9.2.4.1. Mapping local-therapeutic practices within societal networks of power 204 9.2.4.2. The possibilities of a critical therapy 209 9.2.4.3. Cautions 211 9.3. Limitations and areas for future study 213 9.3.1. The use of case studies 213 9.3.2. My position as expert knower or interpreter 216 9.3.3. The reification of discourse 217 9.3.4. The possibility of reinterpretation and the predispositions of methodology 218 9.3.5. A pessimistic view of client resistance 218 9.4. Conclusions 219 9.5. References 220 SUMMARY 223 SAMNEVATTING 226 PUBLICATIONS 229 ACKNOWLEDGEMENTS 230 CURRICULUM VITAE 231 6 M. Guilfoyle-Concealing and revealing power in the therapeutic relationship LIST OF FIGURES 3.1. The circulation of power in the therapeutic relationship 64 9.1. The progressive therapeutic shaping of the client 187 9.2. A conceptual map of power and its products 205 7 M. Guilfoyle-Concealing and revealing power in the therapeutic relationship CHAPTER ONE A CONCEPTUAL ORIENTATION TO POWER AND ITS CONCEALMENT 1.1. Introduction Power has received little sustained and systematic attention in the therapeutic literature. While numerous influential authors and therapeutic figureheads have expressed views on the issue, it is seldom placed centre stage in a way that promotes the degree of attention afforded other therapeutic interpersonal processes, such as transference, ethics, dialogue, hierarchy or collaboration (Goldberg, 2000; Kuyken, 1999; Proctor, 2002). Power tends to be discussed only as a peripheral issue relative to other, more centralised topic of debate. But while it has stimulated only minimal theoretical coverage and empirical examination, most therapists are likely to have an opinion on the matter. Given the privileges and responsibilities associated with therapeutic practice, it is important that this apparent failure to take power seriously is addressed. Indeed, such inattention makes it possible for therapists in training and in practice to overlook a number of questions that power is capable of bringing to the fore, and which are of crucial importance in understanding what sort of social and cultural practice therapeutic work is: How does power become available in therapy? To whom does it become available, and in what ways? How transparent are power operations and how amenable are they to empirical examination? Indeed, what forms do they take? What does power do in the therapeutic encounter? What psychological and interpersonal realities does it go on to produce, and through which techniques? What are its objectives, and how does it link up with social, cultural and political processes? And of course, how can power be opposed and transformed? This thesis attempts to develop a critical view on power to address these issues, building on some of the ideas of social theorist, historian and philosopher, Michel Foucault. A thread running throughout this work is power’s concealment, which is offered to partially account for the relative lack of attention given to the issue in the therapeutic domain, and for the resulting impoverished “tool kit” of ideas on power from which therapists are currently able to draw. In response to this limitation, I aim to highlight some theoretical and methodological tools to enhance its empirical accessibility. This first chapter lays the foundations for this series of studies by exploring, with special reference to therapeutic practices, (1) why it is important to study power, (2) how it is concealed, and (3) how we might undertake its examination.
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