Moving on to a second-order approach we acknowledge the reality of language in aiding and abetting the social construction of reality. The identified patient’s issues only exist in the context of being named – usually in a collaborative context. This includes all those interacting in relation to it – identified patient, therapist and others. It takes two or more to create a tangible linguistic “reality”. This is involuntarily perpetuated by the acknowledgement thereof. This co-constructed reality, the “story of the problem, inadvertently contributes to the problems endurance by narrowing the choice of more effective solutions” (Griffith, Griffith and Slovik, 1990, p.13).
Thus, the reality of a diagnosis is socially constructed and language is used to achieve this (Hare-Mustin & Marecek, 1997, p.105). Language is understood “as the means by which people come to understand their world and in their knowing simultaneously to construct it” (Becvar & Becvar, 2000, p.88, emphasis mine). A second-order approach is a post-modern approach, which deconstructs all prior assumed knowledge and points out the inadequacies of any “objective knowledge” such as psychiatric nomenclature.
What Castillo calls a “client-centred approach” (1997) does not support pathologising labels. When objects and concepts, such as psychological distress, are reified as in the psychiatric nomenclature, and given definitions they produce knowledge, which has power (Levett, Burman, Kottler & Parker, 1997). An unequal balance of power is created by the way we use language if that language is used in a way that excludes, objectifies or marginalizes others (Foucault, 1992). In order to address this Ecosystemic epistemology has taken issue with the concept of the therapist as expert and points to the process of collaboration.
Anderson and Goolishian describe diagnosis as “collaborative problem definition” (1988, p.387) and stress the role of the therapist in taking responsibility “for the creation of a conversational context that allows for mutual collaboration in the problem-defining process” (Rober, 1998). They adopt a position of not-knowing, a philosophical stance that “maintains that understanding is always interpretive…that there is no privileged standpoint for understanding” (Wachterhauser, 1986 cited in Anderson & Goolishian, 1992, p.28).
How does each specific approach deal with therapy?
As a first-order cybernetics approach deals with observable patterns of interaction, the focus of therapeutic intervention would be these patterns of interaction, not the individual per se (Combrinck-Graham, 1987, Vorster, 2003).
First-order cybernetics embraces many techniques in order to achieve its goal of “changing Alice within her room” (Minuchin, 1996, p.11). These are discussed in the following section. Failure in therapy is considered to be the therapist’s fault in their faulty application of technique (Vorster, 2003).
On the other hand second-order therapy focuses on meaning systems and collaborative efforts of creating new narratives or life stories. Second-order therapies include Andersen and Goolishian’s Collaborative Language Systems (1988), Tom Andersen’s Reflexive Team (1992) and White and Epston’s Narrative Therapy (1990; 1992; 1995). Here the focus is not on specific techniques, but rather the goal is to create “a context for change” rather than the first-order approach of “specifying the change” (Hoffman, 1985, p.393). In second-order therapies unsatisfactory results are considered to be “a breach in understanding” (Griffith, Griffith & Slovik, 1990, p.25).
Keeney suggests, “…psychotherapy is aimed at modifying the way the problematic system changes in order to remain stable” (1983 cited in Fruggeri, 1992, p.48); that is “a process of co-constructing a context in which a change in the set of alternatives from which the choice is made becomes possible” (Ibid).
Specifically in Collaborative Language Systems, technique is downplayed and the “therapeutic conversation” is the focus (Anderson & Goolishian, 1988, 1992). The therapist as expert is replaced by collaborative dialogue and the recognition of “the client as expert”. Conversational therapy focuses on creating a conversation domain where change can occur; the therapist adopts a position of not-knowing which allows for a position of genuine curiosity. (Anderson & Goolishian, 1992)
Tom Andersen’s Reflecting Team also adopts a position of “not knowing”. “If you know what to do it limits you. If you know more what not to do, then there is an infinity of things that might be done” (Andersen, 1992, p.54)
Narrative Therapy maintains “an awareness of choosing one’s ways of knowing” (Griffith et al, 1992, p.11) and the goal is to re-author the life story within the narrative metaphor. “There is concerted effort on the part of the therapist to privilege family members as the primary authors of these alternative stories” (White, 1995, p.66).
Simons suggests a “second-order mind while doing first-order therapy” (1992, cited in Becvar & Becvar, 2000, p.92), which would involve the application of first-order techniques in a second-order context of reflection.
What are the specific skills required by each approach?
First-order techniques, which regard the therapist as expert, intervene to bring about change in directive ways. These include the likes of Roger Barker’s (1986) Ecological psychology, Salvador Minuchin’s (1974, 1981) Structural Therapy and the Strategic Therapies of Jay Haley (1963), Watzlawick et al (1967, 1974) and the Palo Alto group. The Milan Group (1987, cited in Tucker, 2000) albeit Systemic and Strategic in many ways are also second-order in their focus on therapist’s feedback in the form of therapist neutrality, circular questioning and positive connotation. (Vorster, 2003)
Due to issues of space only a few techniques will be discussed within the context of the Milan Group techniques, as they seemed to research and integrate many of the techniques of those that went before them.
The Milan Group moved from a psychoanalytic orientation to a systemic approach when exposed to the ideas of Watzlawick et al. (1967). The Milan Group considered themselves, in second-order cybernetics style, to be part of the therapeutic system of family plus therapist. They believed in the importance of the referring person as part of the systems and included them in their hypothesising.
They used their therapeutic techniques to perturb the family system to bring about change (Tucker, 2000). They asserted, “symptomatic behaviour was maintained through interaction patterns governed by rules” (Vorster, 2003, p.42.) This is similar to Minuchin’s focus of the structure of the family.
Hypothesising took place at the pre-session where the team tried to formulate an hypothesis of what might maintain the family’s presenting symptoms. “Hypotheses were carefully constructed to elicit a picture of how the family was organised around the symptom or presenting problem” (Vorster, 2003, p.46). The hypothesis contributes to the construction of the therapeutic relationship by providing a base for starting a conversation (Cecchin, 1992).
Similar to the MRI group, the Milan Group used a team of therapists who operated behind a one-way mirror. The focus was on identifying family games. Later, Andersen’s Reflecting Team introduced a two-way mirror and then none at all; reflecting in front of the family and then asking them to comment. Hoffman comments that it is the layering of client, reflecting team, client that creates “a sense of trust and shared optimism” (1999) indicative of second-order therapies.
Rituals were prescribed as a means to bring about paradoxical change by dealing with secrecy, isolation, family talks or reading of statements, keeping of notebooks, or parental outings framed as disappearances. The therapeutic process was also considered a ritual in the ordered way it was structured (Tucker, 2000).
Paradoxical intervention was one of the ‘weapons’ the Milan team used to bring about change. (Cecchin, 1992, p.89). Although the Milan team is mostly associated with this concept, Cecchin (1992) credits Walzlawick et al (1967) with the idea. Barker (1986), Minuchin (1974 & 1981) and Haley (1963) also applied this technique by positive connotation, reframing the presenting problem as necessary for the family, prescribing the symptom or instructing clients to change slowly or not at all.
It was “not the symptomatic behaviour itself that was positively connoted, but the intent behind it… maintaining the homeostatic balance with in the family so that is does not fall apart” (Barker, 1986 p.155)
Circular questioning focused on family connections and took the ideas presented and reintroduced these ideas back into the family as questions. It was a central tenet of the Milan approach.
Neutrality was an effort on the part of the therapist to remain allied to all family members and not be seen to be taking sides or alliances of any sort with any one family member. The Milan Group believed neutrality implied support in that each family member was supported in a neutral or equal way (Tucker, 2000). Along with circular questioning, neutrality and support allowed the family the space to explore alternative ways of thinking and being.
The Milan team separated ways in the 80’s. Selvinni-Palazzoli’s work (as maintained by Pirrotta, 1984, cited in Vorster, 2003) returned to a more directive, non-neutral approach in an attempt to “interrupt the family’s rigid games and force them to invent a new one” (Vorster, 2003, p.49). Cecchin and Boscolo focused on teaching an epistemology (Vorster, 2003, p.48) where they focused on second-order ideals of co-constructing therapeutic possibilities. “The challenge is the negotiation and co-construction of viable and sustainable ways of being that fit with the family, the therapist and the culturally sanctioned ways of being” (Cecchin, 1992, p.93).
Second-order therapies do not focus on techniques, but rather on creating a context for change and ascribing new meaning within these contexts. It “is more an attitude than a technique” (McDaniel, Lusterman & Philpot, 2002, p.3) that utilises a broader lens than the systemic approach and includes the examination of work systems, health systems, legal systems, gender issues, religion, ethnicity and culture. “This includes the therapy itself and sees the therapist as still another part of the ecosystem” (Ibid). Simons suggests a “second-order mind while doing first-order therapy” (cited in Becvar & Becvar, 2000, p.92), which would involve the application of first-order techniques in a second-order context of reflection; this involves choosing the technique most appropriate to the issue that needs attention.
There are, however, a few novel techniques or ways of being that merit mention.
Conversational therapy focuses on creating a conversation domain where change can occur; the therapist adopts a position of not-knowing which allows for a position of genuine curiosity (Anderson & Goolishian, 1992).
“Corny therapy” (Hoffman, 1992, p.16) is the epitome of applying what is relevant in the face of what is unacceptable. Hoffman found it relevant to show her emotions and show she was human in way a way that had been unacceptable until then. Hoffman tried to “think Zen”, but was stumped as to how to “do Zen” (Ibid) she found some answers in Tom Andersen’s Reflecting Team.
The Reflecting Team discussed the family in front of the client and then ask the family to comment on their reflections. Hoffman comments (1999) that it is the layering of client, reflecting team, client that creates “a sense of trust and shared optimism.”
White (1995, p.21) talks of an “externalising conversation” within the narrative metaphor. By externalising the problem and looking at its effects, the focus moves away from blame and accountability: the person is not the problem – the problem is the problem. In the re-authoring process a new narrative or self-story emerges: one with a past, present and future. An interesting technique was that White and Epston (1995) wrote letters or “therapeutic documents” to reinforce the new narrative (p. 199; also cited in 1992; 1990).
How is the role and function of the therapist in each specific approach?
First-order cybernetics approaches view the therapist as an expert external to the observed system that directs the therapeutic process in a goal orientated and directive way. Munichin (1974) supports the concept of the therapist as expert.
Hoffman asserts that second-order approaches that are more constructionist in nature will allow the therapist to move beyond a position of power and control. Hoffman describes a stance with:
- the therapist as part of the observing system that is including the therapist’s own context
- a collaborative rather than a hierarchical structure
- goals that emphasise setting a context for change, not specifying the change
- a “circular” assessment of the “problem” and
- a nonpejorative, nonjudgemental view.
(1985, p.393)
Auserwald (1977) suggest that the “notion” of hierarchy is a “linguisistic hangover from Newtonian reality” (cited in Keeney, 1979, p.123). Bateson and Haley differed on the issue of power, which Bateson called an “epistemological error that is self-validating and potentially pathological” (Keeney, 1979, p.122) – in that it “seduced people into a variety of activities that not only had to fail, but of necessity gave rise to further attempts to control” (Vorster, 2003, p.32).
The word expert is a loaded one – related words such as power, knowledge and control all suggest a tone of disapproval with their use. Issues of therapist neutrality and collaboration address the issue of the therapist as expert, which is one of Hoffman’s “sacred cows” (1992, p.9) that have been hotly debated in the family therapy realm.
Anderson and Goolishian (1992) suggest it is the client who is the expert and qualify that it is “the therapist's central task is to find the question to which the immediate recounting of experience and narrative presents the answer. Such questions cannot be pre-planned or pre-known.” (Strong, 2003).
Collaboration recognizes the equal but different value of the client's perspective and that we too, can learn from the patient.
Pocock (1999), however, questions whether we should concern ourselves with issues of power and points out that most potential clients would prefer to go to a therapist claiming to be an expert as in fact most people are looking for help. Thus, in practicality does it really matter what the therapist calls himself or herself? Pocock points out that the therapist’s function is to be “helpful” despite semantic issues of naming.
Anderson & Goolishian (1988, p.382) clarify the therapist’s roles in maintaining the difference between an ordinary conversation and the “therapeutic conversation”
- The therapist keeps inquiry within the parameters of the problem as described by the clients.
- The therapist entertains multiple and contradictory ideas simultaneously.
- The therapist chooses cooperative rather than uncooperative language.
- The therapist learns, understands, and converses in the client’s language because that language is the metaphor for the client's experiences.
- The therapist is a respectful listener who does not understand too quickly (if ever).
- The therapist asks questions, the answers to which require new questions.
- The therapist takes the responsibility for the creation of a conversational context that allows for mutual collaboration in the problem-defining process.
- The therapist maintains a dialogical conversation with himself or herself.
The therapist is that person who participates in the co-construction of new interpersonal realities that are “different from the reality that the client and the client’s significant system have constructed in their history/experience/practices” (Fruggeri, 1992, p.48).
For this writer social constructionism considers how we punctuate our interactions. I can still have opinions, values and take a moral stand, but I need to recognize them for what they are and acknowledge them in the therapeutic context. Cecchin illustrates this nicely (1992, p.92) when the therapist takes a strong moral stand and yet puts it in context by taking responsibility for her beliefs, acknowledging a cultural context, offering an alternative interpretation, embedding the process in a time frame and the ethical standards of history.
Second-order therapists will recognise that their ideas and suggestions may be helpful if heard and will not hesitate to share them, however, they will recognize the subjectivity or lack of objective “truth” therein and will monitor their personal response when their opinions are not accepted (Atkinson& Heath, 1990).
It is not quite the total rejection of the therapist as expert. The therapist becomes part of the system, temporarily, and as a “participant actor (Anderson & Goolishian, 1992, p.91) or “participant-observer” with an acknowledged role of “helper” (Vorster, 2003). It has been said that the therapist as part of the family system is unable to be an objective observer (Vorster, 2003). Vorster differentiates between the trained observer and the objective observer – the trained observer albeit subjectively embedded in a cultural context of subjectivity “has been educated has been educated to see and hear from within a trained frame of reference and to do so in an orderly and systematic fashion. It is the very nature of the therapists training which distinguishes him or her from the client” (2003, p.99).
What would research look like from the point of view of each specific approach?
Dell (1986) notes that we experience the world in terms of a linear cause and effect, as is consistent with our culture. We notice cause and effect, see parts and establish dualities that are value laden in terms of good and bad, beautiful and ugly, problems and solutions etc. “The paradigm of the culture, provides the framework that defines problems” (Becvar & Becvar, 2000, p.328). Einstein (n.d., cited in Becvar & Becvar, 2000, p.335) also pointed out that our personal epistemology directs what we observe; in other words the paradigms that we have internalised become reality “out there”
Most research is implemented at the level of first-order cybernetics, as is consistent with modernist and normative social science. Wadsworth (1982) discusses how “empirical research can define a truth that mystifies and renders powerless the nonexpert majority” (cited in MacKinnon and Miller, 1987, p.142) and in reality many research grants are metered out to first-order quantitative research (Becvar & Becvar, 2000).
Becvar & Becvar (2000) do not debate the usefulness of the positivist-empirical tradition, but do point out that it is “a way of knowing, not the way of knowing” (2000, p.337).
Hoffman (1992) describes research as one of the 5 sacred cows that second-order cybernetics has taken issue with. The post-modern approach of questioning all previously made assumptions, questions the western ideal of objective science. As Bateson (1979) has pointed out “science never proves anything” (cited in Efran & Claridge, 1992, p.202). “The social-constructionists not only challenge the idea of a singular reality, but doubt there is such a thing as objective social research as well” (Hoffman, 1992, p.9).
Gergen asserts the importance of research and points out that post-modern thought does not diminish its relevance; rather it highlights the “broader cultural and historical context” (1994, p.414) of research.
Co-research acknowledges the “expert-knowledge” of the identified patient within the construct of narrative therapy. The therapist highlighting their “confusion and lack of knowledge” (Nosworthy & Lane, 1998, p.180) is a new experience for many patients. “Co-research is an attempt to work in ways that honour the experiences and knowledges of young people and enable adult workers to step outside of the expert roles” (Nosworthy & Lane, 1998, p.195). Their search for expert-knowledge from patients in order to be more helpful and appropriately informed with other patients seems to have worked because they admitted their shortcomings.
Willig (1999, p.46) presents a critical realist approach to social constructionist work and posits seven stages of non-relativist or qualitative research:
- Documentation of subjective experience
- Discourse analysis of these
- Identification of alternatives
- Exploration of the relationship between discourses and institutions
- Exploration of the historical emergence of discourses
- Analysis of the material basis of discourse
- Formulation of recommendations for practice to bring about change
Although quantitative analysis was originally perceived to be the true empirical research, there has been a move to recognising and embracing the validity of qualitative and social constructionist, that is second-order, accounts.
What critical ethical concerns could be raised about each specific perspective?
Feminist and political critiques have taken issue with systemic thought in focusing on the mutual causality of behaviour (Bogran, 1984; MacKinnon & Miller, 1987; Flemons, 1982). The most vociferous critiques of systemic thinking have been in the realm of family violence, where feminist theorists have argued that a relational view of violence places blame on the abused when this is clearly an untenable position. “Victim provocation theorists leave sexist behaviour and ideology unquestioned. The keep us scrutinising the victims behaviour and, as a result, remove responsibility form the man, the community, and the social structures that maintain … violence” (Schlecter cited in Flemons, 1982, p.5).
MacKinnon and Miller (1987) consider feminist and socio-political ideologies and point out that the new epistemology has been essentially conservative in its approach. They do however, point out that this excludes second-order cybernetics.
First-order cybernetics or strategic approaches have been criticised as manipulative in their directive intervention and an exclusive first-order approach can lead to an overemphasis on conscious control (Atkinson & Heath, 1990).
Issues of control and power, hierarchy and the therapist as expert have already been raised within the context of the role of the therapist. Pocock (1999) in questioning whether we should concern ourselves with issues of power, asks what the best kind of therapist is, and answers “a helpful one”. Pocock also expresses his concern over collaboration being exalted above helpful proactive therapy. He also points out that most potential clients would prefer to go to a therapist claiming to be an expert and that is in fact what most people are looking for. Thus, in practicality does it really matter what the therapist calls himself or herself? Pocock points out that the therapist’s function is to be “helpful” despite semantic issues of naming.
Dialectics rejecting issues of power, the therapist as expert and ideologies of self may lead to a premature throwing out the baby with the bathwater; as the likes of Vorster (2003) have pointed out: many valid systemic techniques still prove themselves valuable.
Hoffman mentions the importance of first-order thought within certain contexts – there are certain modalities that by definition cannot be neutral – such as parenting and certain religious persuasions (Hoffman, 1992). As such it is non-neutral and linear attitudes that allow for boundaries in these modalities. As a therapist, it may be necessary and appropriate, indeed what you are being paid for, to paint things in black and white – to affirm, to educate and to allow for new realities as normal. One need be almost dogmatic in issues such as parenting, issues of morality or hospitalising someone when they are intent on suicide. At times a first-order approach is the most appropriate and a therapist need be aware of the pitfalls of second-order “nothingness” akin to inaction in times when action is imperative.
First-order approaches take us into a domain of action. Atkinson and Heath expound the unquestionable value of simple cybernetic thinking in promoting systemic family therapies. They state, “any existing family therapy model can be applied in a way that is or is not consistent with implications of second-order cybernetics” (Atkinson & Heath, 1990, p.154).
As family therapists operating at the level of first-order cybernetics, we must be aware of second-order cybernetics and take responsibility for labelling a family as sick or dysfunctional because we believe it to be sick or dysfunctional, rather than it being sick or dysfunctional (Becvar & Becvar, 2000).
Strategic approaches espousing neutrality like circular questioning or narrative therapy’s focus on asking question instead of expressing opinions, can both be just as insinuating of the therapists epistemology if one takes Foucault’s view of disciplinary power into consideration (Pocock, 1999 and Foucault, 1992).
The social constructionist stance, in second-order cybernetics approaches have been criticised as trite and irrelevant, “vague and obscure” and “having no clinical utility” (Searight and Openlander ,1987, p.52). Searight and Openlander present the case that this is not true albeit Tomm concedes “there is a trade-off between diagnostic precision and interactive rigor” (cited in McGriffith, 1990, p.26) in second-order cybernetics.
Social constructionist and post-modernist theories may be seen as “all talk and no do” in that deconstructions of psychopathologies and experiences do not address the vital issues of personal subjective distress. We should be careful of deconstructing the wood from the trees.
The relativity of language in second-order cybernetics does present the risk of being trite and irrelevant. Much is ineffable and much is left unsaid. Michael White (1998) mentions the benefits of diagnostic discourses in that they offer a tangible, albeit socially constructed reality, which frees some of victimisation.
There is a place for non-neutral and linear attitudes within certain contexts if one recognises that people have been acculturalised into these traditions and worldviews (Dell, 1986, cited in Becvar & Becvar, 2000) – they may have been socially constructed, but they have become a new reality.
At that Lowe (1991) warns that we should be careful not to become experts on postmodernism or master deconstructionists. There is a danger of post-modern discourses becoming a new basis for a “new form of universal knowledge” (cited in Becvar & Becvar, 2000, p.94).
Therapist should also check that they do not engender “platonic ideas reborn in cybernetic guise” in order to compensate for a “cybernetic wolf in sheep’s clothing” (Becvar & Becvar, 2000).
Integrating first-and second-order cybernetic approaches.
Second-order cybernetics offers a relevant critique of first-order practices and allows us to be ideologically sensitive to the historical and cultural issues surrounding therapy and the ways in which reified notions of psychopathology can be debunked.
Second-order cybernetics is not a better way of doing things because it is of a higher order. This would probably be an error of logical levels (Vorster, 2003) – akin to comparing the shape and colour of an apple. Both the shape and colour relate to the apple, but assessing which is more important is irrelevant. Both the shape and colour of the apple relate to its “appleness”.
In the same way to compare first and second-order cybernetics is not a constructive exercise – both bring fruitful units to the therapeutic field. First-order cybernetics offer strategic principals of change, while second-order cybernetics looks at context and meaning.
A wholes approach excludes the notion of Cartesian dualities. To reject first-order cybernetic approaches in lieu of second-order approaches or visa versa is to imply that one is better than the other – a duality irreconcilable with first and second-order thought and General Systems Theory as a whole.
Pocock believes that the realism of first-order cybernetics and the social constructionism of second-order cybernetics are opposite sides of the same coin and each act “as a critical restraint on the potential excesses of the other” (Pocock, 1999)
If you believe in action too much, you can become a manipulator. If you believe to strongly in letting the system just ‘be’, you could become irresponsible…However as it is impossible not to take a stand, it is exactly this reflexive loop between our taking a stand and immediately putting this stand in a larger context that creates the ‘becoming’ and not the ‘being’ of the therapist. Such a position also permits the therapist to achieve that healthy state of mild irreverence towards his own ‘truths’ no matter how much hardship it took to conquer them. (Cecchin, 1992, p.93)
Gergen (cited in Pocock, 1999) points out:
…most of us would stand fast against neo-Nazis, the Mafia, Islamic terrorism, smuggling heroin, cliterectomy … Using a compelling discourse of realism we would point to multiple failings and immoralities. Further, in fine constructionist form we would be happy to demonstrate how such groups could – through the circulation and verification of discourses with their midst – come to find their actions both reasonable and right. By the same token, most of us would fight fiercely against such groups when they used either constructionist or realist discourses to achieve their goals
We don’t have to succumb to the “totalising discourse” (Pocock, 1999) of either extreme. In practice social constructionist ideas are not a description of how we ought to be, but are rather descriptions of how things are – first-order ideals are recognised as products of culture and language in a second-order reflective space.
At that it would be unacceptable to completely discard the certain models because of their cultural relativity. Rather, by recognising the immense value of the scientific work that has been done, we can recognise all the first-order paradigms that explain mental health and psychopathology and in truly Ecosystemic style, be eclectic in our approach (McDaniel et al, 2001) and heed Wilkinson and O’ Connor’s warning that an important tenet of the Ecosystemic framework “is that existing therapeutic techniques are not discarded” (1982, p.987).
Conclusion
First-order cybernetics approaches offer strategic principals for therapeutic intervention, while second-order cybernetics creates a framework that looks at context and meaning in human living systems. Some second-order therapies have moved beyond cybernetics of cybernetics to a hermeneutic or interpretive approach (Anderson & Goolishian, 1992) focusing on the social construction of reality using language.
Advising a therapist to be collaborative or social constructionist is superfluous – these ideas are not a description of how we ought to be, but are rather descriptions of how things are – products of culture and language.
The triple wave of constructivism, social constructionism and post-modernism has at times encouraged the debunking of first-order approaches (Pocock, 1999). However as the pendulum swings back to a more moderate position, as is naturally the case, we see that dialectics rejecting issues of power, the therapist as expert and ideologies of self may lead to a premature throwing out the baby with the bathwater; as the likes of Vorster (2003) have pointed out: many valid systemic techniques still prove themselves valuable.
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With apologies to DW Winnicott who is credited with the idea of the “good-enough” parent. As we have moved from the family as the system to the greater eco-system including many variables, it is hoped that a good-enough eco-system will be the result. Or a good-enough madness – depending on how we chose to punctuate things.