Unit Two Overview SALIHA BAVA, PHD

MFT PROFESSOR

2023

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Focus of Unit 2: A Summary The focus of Unit 2 was on ethics and how to make decisions that are ethically based on institutional & relational ethics.

You were introduced to two world views or epistemologies -ways of knowing (not just approaches) as follows: ◦ The world is discovered and ordered in our minds & the assumption of universality (Modernism) (thus privileging the

rationality & the individual above all) ◦ The world is created and coordinated in our social interactions (Postmodernism) (thus privileging the centrality of

relationality (including the individual voices as contextualized) & adopting a socio-interactional view)

In practice, (& for some thinkers) these might be interrelated views, but it is the bases of the views that sets them apart. (So, even as we take them apart to contrast them, know in practice you are most likely to run into one more than other or both worldviews). ◦ For those who adopt the postmodern view, the “mind” itself is a construct that is constructed socially in search of

understanding humans. ◦ In contrast, Psychological theories tend to lean towards the mind and are thus, usually more modern in their world view. But

the postmodernists ask “Who created the ‘mind’?” And who does such a concept serve? E.g. in some wisdom traditions, we use the cosmic vision instead of the mind as an organizing principle.

◦ Those who are oriented to socio-cultural (anthropological, sociological, philosophical) understandings of humans lean toward the social construction view, a subset of the postmodern view.

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Recap In this week’s articles, (along with earlier readings from Combs & Freedman, McNamee & Dickerson on self), you were introduced to the social construction/postmodern view which is the basis for relational ethics.

Since some of you were unsure if you got what McNamee stated, let’s recap her views which are based in social constructionism:

1. Social Construction criticizes the view of individualism ◦ Individualism is a view that values the individual as self contained. However, even within the individual there is a

hierarchy of value with “reasoning” valued over other parts ourselves, like emotionality, gut etc; mind valued over the body; etc.

◦ Individuals are seen as self reliant and independent. Thus, there is a separation of parts and certain parts are valued rather than the whole. This is a common view particularly in the US (as compared to other parts of the world). Often context & relationality is secondary or an adjunct (or even an after thought) in such a view.

2. Instead, McNamee offers the relational view which you can see/hear her elaborate in the first 10 mins of this 27 min video (you might want to watch the whole!): https://www.youtube.com/watch?v=k0tAbIlgGAQ

3. So, “what about the individual” you may ask? She talks about that 12 mins into the video….

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Linkages to Our Discussion So, from our discussion I’ll share your thoughts that caught my attention. I will shed light on relational while showing the dominant influence of individualism in our society. [Note: as I draw on your examples, please note this is not a criticism or compliment of any one person but an analysis of the discourses that we are all living into everyday. Please do not track by your name.]

This week’s readings was raising our consciousness to the higher plane of our discipline. Compelling us to go beyond our codes in the understanding of ethics. ◦ To be receivers of our discipline's practices does not make us ethical. ◦ Instead, being reflective of what has come to become standard of practice and being in critical dialogue &

reflection of it is key to being ethical. ◦ Our ethical codes are entry points, but our highest guides need to be the principles and the critical gaze we

bring to our practices by asking: why we do we do what we do? Who does it serve? And, how? How was it determined and by whom?

◦ These are the question by which we develop both a critically relational gaze of ethics and decision making!

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Unpacking our Discussion

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Unpacking our Discussion

“Without understanding the situation at hand, one cannot properly determine the person’s motive, mindset, emotional behavior, actions and so on.” This is what is a relational orientation as applied to person. It requires one to move beyond seeing the individual has having a fixed, stable personality traits and innate capacities to seeing how we are shaped by our relationships and contexts. The emphasis of Individualism is on the internal state which is regulated by the individual (Combs & Freedman, 2016). Such a decontextualized, essentialized view of self focuses on what we are rather than who we are becoming (Combs & Freedman, 2016, p. 2013).

Instead, postmodernism calls attention to the fact no man is an island to oneself. And, how this might show up in therapy is clearly illustrated in Shaun, Rachel E., Nadia, Brandis, Chandinie's reflections (to name a few). Relational therapy looks at the client as a relational being. Not as a flawed individual and this premise in and of itself is an ethical practice. So, ethics is more than only our codes, it is a professional/therapeutic stance that continues to be reflexive of our practices (as therapists/researchers) by asking big questions such as: what are the processes of domination and colonization at play within our field by which we seek to see people as broken or a deficit?

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Your reflections….

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Unpacking our Discussion

Nadia states "relationally responsible ethical framework for psychotherapy is essential in a society where "ethical" is frequently linked with "legal." It entails therapists putting their client's needs first rather than operating in a way that upholds prevailing discourses." She notes that psychotherapy is a cultural institution noting that its "key component, "diagnosis, frequently results in disempowerment. According to Michel Foucault's (1973) work, when people are exposed to examinations, they are subjected to disciplinary regimes, categorized, and explained according to those regimes. Each profession offers a unique terminology for classifying and outlining customers' concerns. The control of disciplinary regimes is extended as these terms are used in daily life, and as they have an impact on public policy and practice, it becomes more difficult to break free. Diagnoses, issues, and psychotherapy are frequently used interchangeably since people frequently seek assistance when they are restless or disturbed. However, it can be difficult to picture a psychotherapy discussion in which the primary subject is not a problem" (emphasis mine). Shaun supplements with his note on the therapist's stance within such a system " It appears that under the institutional standard of ethics, the practitioner would assume the role of an authoritative figure to directly examine the individual in such a way that may provide the patient with a feeling of self-hate for lack of a better word. Meaning the patient would be bound to feel there is something wrong with them based on the practitioner's cultivated environment and approach to dialogue. The role acts like a tool to "fix" what issues may arise.“

McNamee is not suggesting that diagnosis is bad or wrong. If diagnosis helps a client, use it but don’t use it across the board, just because that’s what is done! McNamee is asking us to notice the role we play as professionals (&/or when positioned as experts) & she is raising our awareness of the therapeutic relationship as a practice of relational responsibility.

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All this is to not bash the traditional system or diagnosis, rather in Chandinie's words "Diagnostic terminology can be used to symbolize institutional ethics, due to the familiarity it breeds. The terminology and ethical codes can be helpful, but they can also be harmful if not used in a meaningful way. As professionals, we have to have more self-awareness than the average person. What we say, what we do, and how we do it has an immense impact on the individuals we are working with." Collectively professionals reflect our community of practice, to the extent that there are movements called “non-diagnostic therapy” and critical-psychiatry. What’s common to all your points is your critical gaze, which is what McNamee is asking of us when she seeks to question the discourses of traditional psychotherapy.

Thus, relational ethics is one way of contextualizing our understanding and asking what matters from whose gaze? Is our disciplinary gaze (that positions us as therapist) of higher value than our clients? If yes or no, why, how, when & where? That is the art of relational ethics.

Tosha’s words brings forth the practical implications, "Relational ethics are developed between the client and therapist as they work through the therapeutic process together." Echoed further, by Brandis, "Relational ethics, influenced by Emmanuel Levinas and Martin Buber, emphasizes the therapeutic connection as the primary ethical factor."

Unpacking our Discussion

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Further, from an application view, Julia and Braelin took up the difference between tradition psychotherapy ethics and relational ethics as one of temporal focus. Though it can play out that way in terms of how questions are asked, I would caution against making it "a rule" (Side note, which is not what Julia & Braelin are saying as a rule). Eg "Asking questions that will get clients out of the present by making them think of the future." Though this is a helpful strategy, making it a rule can fail to do what Brandis identifies "the relational approach to therapeutic ethics emphasizes context and dynamics over rules."

In closing ethics is a social construct. And, how we construct our gaze and morality, so we construct our practices and how we see and "treat" humans. As observed by Jane "institutional ethics prioritize the individual from a deficiency-based position, while relational ethics prioritize a bigger picture beyond just the individual to include external influences which might contribute to the situation, individual, or ethical dilemma at hand." Melissa echoes "With traditional ethics, there are rules that need to be strictly adhered to and it is up to the laws and those in an authoritative position to evaluate claims of unethical behaviors. The relational approach seems to reject the idea that one set of rules strictly dictates what is right and what is wrong, and that context is important to approaching (un)ethical behavior."

There is a growing understanding as we become culturally aware/competent, that "doing the right thing" is to attend to the multiple threads that make up our context and relationships. In conclusion, as Jarlin notes, "my view of the realistic approach to ethics is that it places an emphasis on solidarity, connectivity, transparency, and trust; it provides guidance as to how to react to the issue in a moral way."

Unpacking our Discussion

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Unpacking our Discussion

CONFLICTS IN LAW & ETHICS Yes, this is a confusing area due to their overlaps but also how do we parse which supersedes? Law might seem more sever in consequences, but it is also an interpretive act which is fought, for or against, in the halls of justice. But whose view of justice? This is where we see the constructed nature of both ethics and laws in terms of not only what matters but also how it comes to matter. Sometimes standing for ethics can violate the law & vice versa as seen in 2017 with the involvement of psychologists in the design and implementation of the CIA’s torture program in the name of national security. An ethical dilemma is one where there is a conflict or tension which is why we explore decision making next.

Ethics and laws are constructs of particular time, place and value e.g. death penalty, correction vs penalty. Note they are also instruments of a larger system which is highlighted in former student’s reflection: “A perfect example is the recent Crown Laws that have been passed in about 23 states now. You'd think it was ethical to allow someone to where what hair they naturally had on their head” and yet we had to pass laws to protect people against discrimination. And she goes on to remind us “it used to be lawful to own slaves.” Thus, laws can correct systemic wrongs, but they can also be part of the systemic oppression depending on time and space. And, it is thus our collective evolving ethical stance that moves us to reshape our legal system or seek it to be more just (as in the recent movements for racial & social justice).

As therapists we need to notice how the micro and macro processes are interconnected and made & remade by each other’s influence. This is another way in which the relational perspective draws our attention to the interconnectedness of our lives and participation.

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Epistemologies: Modern & Postmodern Now, lets turn our attent ion to a h igher- leve l understanding of “how we know what we know ” (ep istemology) as a way to further our understanding of re lat iona l . So, hang in there as we r ide the road of abstract ion Then we wi l l return to re lat iona l eth ics .

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Differences in Epistemologies The two epistemologies or paradigms we have been referring to are modernism & postmodernism. So, what are the differences?

The differences lie along a continuum, as illustrated in the next slide.

Like anything in life, you might find your self more along one end than the other or some where in the middle on these multiple factors.

Some view these two epistemologies as not compatible, because the word epistemology means, “how we know what we know.” The way we construct our processes of knowing organizes how we know reality and relate to it. ◦ Modernists believe that the world/reality is independent of the knower, it is some thing we discover. Reality is

discovered. Eg most psychological researcher believe they are discovering new knowledge. ◦ Postmodernists believe that the world/reality, as we know it, is dependent on the knower, thus our knowing is

mediated through our constructions, language, and social interactions. Reality is constructed. Eg most postmodernists view psychological research as construction of new knowledge. Eg motivation is a socially constructed concept.

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Contrast of Modern and Postmodern Thinking FACTORS

along which we can compare (as below)

Modern Postmodern

Reason

Causality

Foundational

Linear causality (A causes B)

Multiple factors on multiple levels are in interaction. What’s “reasonable” is cultivated socially. Circular causality (A impact B which impacts A)

Part/Whole Parts compromise the whole

The whole is more than the sum of the parts

Self Focus on individual Focus on the cultural narratives about the self & self in context

Language Referential/Mirror Language & meaning emerges in social context through usage

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CHANGING ASSUMPTIONS The implication of postmodernism is a shift in our assumptions about self, world & truth as follows:

FROM (traditional view) TO (emerging view)

Self: Single view of self Viewed as a Panoply of possible selves

World: Fixed objective Constructed & reality is contextually defined in a community discourse

Truth: Consistent set No longer a consistent set, rather local to the community

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Postmodernism THERAPY AS A RELATIONALLY ENGAGED ACTIVITY

In the next few slides let’s examine what is postmodernism as per this week’s articles & McNamee’s work is based on these philosophical assumptions

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How do we know?

• How we know what we know is through language and relationships.

• Knowledge and language are viewed as relational and generative

• Knowledge is linguistically constructed

• The development and transformation of knowledge is a communal process

• Knowledge is fluid and not a “thing” to be discovered

• Knowledge and the knower are not independent

Man can learn nothing except by going from the known to the unknown.- Claude Bernard

POSTMODERNISM

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What about language? • Language is the primary vehicle through which we construct and make sense of our world

• E.g we point at things & give it names = step-child vs bonus child

• Language is fluid and not representational, i.e. it does not mirror the world. • Eg the map is not land on which we walk rather it points to the landscape we traverse

• Language gains its meaning through its communal use • E.g. “cool” is both cold & colloquially also means hip or groovy which came about thru everyday use

• Language is linguistically constructed

A different language is a different vision of life.- Federico Fellini

POSTMODERNISM

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So, what is reality in the postmodern sense?

• Since there is no way to step outside “reality” to know it, all we can have is the version created in the process of creating our meanings.

• Reality is what we create via meaning making activities like therapy or conversations

• Meanings are shaped and reshaped in language & conversation (i.e. a discursive process) as we negotiate & coordinate with others.

• What is created is only one of multiple perspectives, narratives or possible meanings.

• The kinds of relationships we have inform the kinds of conversations we might have and vice versa. And these in turn shape what we call “reality” eg. One person’s view of family might be different from another, based on their conversations & experiences of family. Thus, we might help a new couple navigate each other’s meanings and coordinate their emerging joint meaning of family.

The world of reality has its limits, the world of imagination is boundless.- Jean-Jacques Rousseau

POSTMODERNISM

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Implication of Postmodernism for Practice

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Implication for Field of Practice … In practice postmodernism may shift us to the right on the following continuum:

Status as a science…………………… …………..Blurring of disciplinary boundaries

Metaphor from sciences……………………….Draw on metaphors from all sciences, social sciences, art & literature

Theoretical certainty…………………………….Critical respect for differences and questioning grand narratives or universal theories

Pathology………………………………………………Non-pathology or see it as one of the socio-cultural discourses

Individualistic Self………………………………….Self in relationships & language

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Corresponding Perspectives in Therapy Focus of Analysis

Approaches to People Seeking Help

Individual Psychology

Early Family Therapy

Family Therapy Today

Social Construction

Social Justice

Self/Identity I I & Other Self in relationships; Interdependent self

Connected self; Relational self ; Constituted self

Situated / contextualize d self

Location of Problem

Person or personality

Interactions Relational interactions

Client’s story/ perspective or solution focused (not problem focused)

Power discourses

Blame/ Dysfunction

Self or parts of self

Family dynamics/ patterns

Context Not on blame (Focus on client’s meaning)

Historical Contextual & Discourses

Focus of treatment

Thoughts/ feelings/ Behavior (internal)

Relationships (dynamics) & Patterns (interpersonal)

Mixed Meaning making, beliefs, stories, language (social)

Locations of power (political & cultural)

NOTE: Based on the views shared above, we see a shift in the perspective in therapy as illustrated in this table. The focus of dysfunction and treatment shifts as we shift our views of self or identity.

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Relevance to this week’s readings Forms of Postmodern thought underpin the following readings: ◦ Social Constructivism as referred to by Cottone, 2004 ◦ Social Constructionism as referred to by McNamee, 2009 (last week) ◦ Post-structuralism as referred to by Guilfoyle, 2011

In conclusion the emphasis of this position is on the activity of making (coordinating) and not on an entity (i.e. reality, a thing, a person, trait, or one single discourse) ◦ Thus, the implication for ethics,

1. what is being co-created by our decision making rather than only focusing on the dilemma, or ethical code or client or self or agency policy etc.

2. We focus on what is being put into motion in the process of making our decision while engaging with the codes, policies, laws, clients, self, etc . e.g more bureaucracy, based on legal protection, can be put into motion for agencies

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Conclusion: Implications for Ethical Decision-Making Process

Attend to ethical principles, codes, practices, policies, therapist’s & client’s values etc

Attend to the therapeutic relationship

Attend to the process of decision making & how this is informed by your worldviews embedded in your discipline/field of practice

Attend to the client’s values and how it relates to the therapeutics (attend to their right & dignity-principles that inform our practice)

Attend to what is being created in the process of making the decision & how it in turn shapes the therapy relationship

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And, with this week’s readings, we bring to pause the hardest of the readings for this course! 

You all did a wonderful job in climbing this mountain! Kudos!

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How to make ethical decisions? SALIHA BAVA, PHD

MFT PROFESSOR

2023

1DR. BAVA, 2023

Why is this topic important?

This is one of the most important topics for our course, since we will have to make an ethical decision when presented with ethical dilemmas. Starting next week, you will be presented with a new case dilemma each week. And one of the tasks of the assignment (ie assignment #2) is to share how you will respond to each of the ethical dilemmas by sharing your process of decision making. So, lets turn our attention, this week, to the processes and models of ethical decision making….lets explore!

2DR. BAVA, 2023

How to orient towards the learning This class is not meant to “give” you “the how to do it” approach, rather it is invitation for you to participate in designing & reflecting on your own process of decision making (by learning about the different approaches).

Over the course of making decisions, reflect on: ◦ “Why you decided what to do?” is your rationale, which needs to be contextual. (So, learn which contexts

you pay attention to more or less) ◦ Be curious about your own process of decision making & self-reflect on areas that you need to consider

further in your decision-making. ◦ And, do mark the areas you need to strengthen by noticing what others focus on & what you don&#x201

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