Prejudiced about prejudice

An interview with Gianfranco Cecchin

Interview by John Soderlund

Gianfranco Cecchin might be described as irreverent. Much of his work over the past 30 years has been about criticising the way therapy is done. But none receives as vehement a criticism as his own.

What's more, he is surprisingly comfortable with scrutiny by others of his work, not least of whom are his students. A co-founder of the Milan school of therapy, he has used spectators of his work over the past 30 years as a powerful way of ensuring that what he calls the "prejudices" that he takes into sessions with clients are always different from those he carried with him a year earlier.

In this exclusive interview, Cecchin reflects on his deep-seated prejudice against prejudice.

It has always been a habit, he says, "to do something and reflect". That is as much the case now as it was way back in the early 1970's, during the nascent days of the Milan school of family therapy. Cecchin's co-revolutionaries at the time were Boscolo, Prata and Selvini Palazzoli, all of whom had been pointed in a psychoanalytic direction by their teachers.

But psychoanalytic thinking did not locate things firmly enough in their contexts, he comments retrospectively, a task he and his colleagues set as a key endeavour of their new approach. With that came interventions aimed at shaking up the structural games of the families and their reluctance to change behaviours. But the growing tradition of reflection on the results of that therapeutic direction gave rise to other ideas and areas for exploration which had more to do with the therapists than with their clients.

"Because of psychoanalysis, we were fed up with looking at the family, so it was a lot of fun to look at ourselves. Students again forced us to look at ourselves Students behave like clients they call you too many times," he quips.

With this, the concept of circular questioning was born. It gave therapists the ability "to ask almost anything because it is always indirect. We were not interested in how the couple was but how it was perceived by others," he explains. The questions were driven by the hypothesis with which the therapist entered the session, which would provide one safeguard that the therapist did not get dragged into the family's game, that she remained neutral and apart from the alliances into which the family would invariably invite her. These encapsulated the central principals of the new brand of Milan family therapy, namely "hypothesising, circularity and neutrality". But they lasted only a brief period, recalls Cecchin.

"After a while, we gave up the word neutrality because we got so many insults. People were not neutral to us Circular questions got mechanical and students got stuck in their hypotheses. So, we said just be spontaneous. Now we look at what kinds of ideas or fantasies the family provokes in the mind of the therapist."

Cecchin began to focus increasingly on the "prejudices" which operated in the mind of the therapist. "It is impossible not to have a prejudice. The most common is 'I am here to help you'. The more helpless they become, the more helpful you become," he explains. "It's not a question of expertise, how long you have been working. It happens all the time You always gravitate to the school that fits your prejudice."

That begs the question: If prejudice is so inevitable, what does one do with it? Cecchin suggests that the best use for prejudices is to be acutely aware of them, rather than engaging in the futile business of trying to shake them off. But, at least try to understand the family well before trying to exercise your prejudice on it, he urges. If not, you run the risk of being so blindly attached to your prejudices that you will always find exactly the fault you are looking for in the family. An alternate prejudice, he adds, would ask what is right with the family: what allowed them to survive for this long, alive and seemingly cohesive enough to get to therapy as a unit with an intent to do something about their difficulties. "Even in the most awful story, you can always find something interesting."

NT: Can you reflect on the relationship you have had with the practice of psychotherapy over the past 30 years and the changes you have espoused in your own work?

GC: The main point is moving from watching the system like an object, where the observer is not part of it. You observe some reality and the reality is the system you observe. The whole question is to watch the human system as a relational system. But the moment you observe, you are not aware that observing is also changing something. This is a big revolution, somehow.

NT: What is your view now on the concept of neutrality about which you spoke in earlier writings?

GC: It is impossible to be neutral. You always have some opinions about what is going on and your opinions are going to have an influence. The big challenge is to the belief in reality; looking for scientific truth and what is really going on. What is the real story with the family? What is the real diagnosis? This is the medical model. What is the real reason behind what is going on? You think that what you observe is there. But we find what we look for. The recent change in the past five or 10 years is the realisation that there is no reality to discover. You are not discovering the reality, you are inventing the reality.

NT: And that changes your whole role as therapist; you have to redefine yourself in relation to what you are seeing.

GC: It gives you more freedom also because since the reality which is there is always very hard to find anyway, because the families are always lying and you never know what they are going to do. Now, every time you think you have a diagnosis, the family escapes the diagnosis. NT: You have lost some faith in the usefulness of diagnosis? GC: Oh, completely, now. Diagnosis is only in the head of the therapist. Diagnosis was something that belonged to the client, something that they had. Now it's only a classification that is in the head of the therapist just to orientate themselves.

NT: Would you define diagnosis as one of the "prejudices" that is losing favour now?

GC: It is a prejudice to say the reality exists; that what we see is what is really there. Instead, what we see, we are creating it. We are looking for it. If you observe something, there is a relationship between you and what you observe, you create something. This is relationship. If you observe something there has to be a relationship. Also, there is a relationship between you and your peers. With your peers, you begin to organise a way of looking at reality and then you say that is real. But you are the one who created it. This is also very useful for therapy because even families create their own reality that they think is real.

NT: That seems like a difficult line to tread. The family has some view of reality. You, working from your prejudices, have another view on their reality. How do you arrive at some sort of joint prejudice.

GC: That's a challenge. If we keep talking and I keep challenging their ideas, by challenging everything they do and think, you give them a space perhaps to come out with another one, another definition, another explanation.

NT: How did you settle on the word "prejudice" to explain this in your latest work?

GC: Usually the word prejudice is considered negative. I chose to use it to show that, even if it is negative, it is there anyway. Even ideas that we don't like are present in therapy.

NT: We've moved in the past couple of decades from a pathogenic approach to one which is more salutogenic of the client. We are now at a point where we are quite critical of therapy and we are diagnosing therapy. What is the next point in the evolution of the therapy in which you engage?

GC: It is more examining, discussing, bringing into conversation our own prejudices. For example, if I examine you and say you are schizophrenic, you go around with the name schizophrenic, thinking "I am irresponsible" because it's a thing that belongs to you. But the fact that I made the diagnosis becomes unimportant. But I was responsible for the diagnosis, not you.

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