Therapy for Families and Couples: An Organic and Inclusive View

Alejandra Proaño Sánchez**
Vancouver, B.C., Canada

Abstract

“Therapy for families and couples: An organic and inclusive view” is a critical review of the Second Edition of the book Terapia de familia y pareja (2013), by Arturo Roizblatt (Ed.), published by Mediterráneo (ISBN: 978-956-220-356-2) in Chile. The review includes the voices of 27 authors compiled in the 21 book chapters, plus a critical analysis of 9 key family therapy field issues gleaned from the text.

Key Words: Review; family; couples; therapy; Latin America.

Therapy for Families and Couples: An Organic and Inclusive View

Therapy for Families and Couples (2013), by Arturo Roizblatt (Ed.), published by Mediterráneo (ISBN: 978-956-220-356-2), is a 443-page volume that presents family and couples therapy from different theoretical and practical lenses. The book includes 21 chapters written by leading professionals in the field, and is organized in five sections.

The first section is composed of three chapters. In Chapter 1, Javier Vicencio summarizes the logical levels that ideally form part of the training for family therapists and reviews the development of the field along with the particular contributions of different theoretical perspectives. Vicencio identifies the characteristics of systemic therapists, their abilities and meta-abilities, and summarizes the effectiveness in the field. In Chapter 2, from the integrative perspective, in accordance with the common factors theory, William C. Nichols describes the family therapy process by analyzing different kinds of therapeutic alliances, diagnostics and evaluations. In Chapter 3, Sueli S. Petry and Mónica McGoldrick propose the genogram as a collaborative therapeutic process. The work of building a genogram allows the therapist to address multiple readings of any clinical case. It also can be a tool and a map for the therapeutic process that manifests as a series of interviews about the present family situation, the efforts made in order to solve the problem, the transitions in the life cycle, and the cultural and ethnic story of the family.

The second section opens up with a chapter by Wendel A. Ray and Paul Watzlawick who describe the essential aspects of the interactional lens and highlight the practical implications of the paradigmatic changes given by the diverse interdisciplinary theoretical developments achieved at the Mental Research Institute (MRI). In Chapter 5, Jorge Colapinto shares the importance of offering pertinent solutions to the particular conditions in families and demystifies the characteristics of the structural approach that, isolated from its historical context, often seem to be misinterpreted. He also presents the general principles, values, and catalytic elements from the structural approach that provoke change. In Chapter 6, Luigi Boscolo, Paolo Bertrando and Felipe Gálvez present the story of the Milan Systemic Therapy Model. This story reveals a process that departs from the strategic model proposed by the MRI. It bifurcates into a first-order cybernetics approach represented by the work of Selvini-Palazzoli and Prata, and a second-order cybernetics approach continued by Boscolo and Cecchin, and it ends with the transformation of the systemic therapies into a postmodern frame. In Chapter 7, Tom Strong and Karl Tomm present a social constructionist approach to therapy which focuses upon conversational interaction and practice. They endeavor to replace pathologizing interpersonal patterns (PIPs) with healing interpersonal patterns (HIPs). Chapter 8, by Paulina G. McCullough, presents the theory of Murray Bowen and how the gradual evolution of the family emotional system runs between generations through defined patterns. In Chapter 9, Terry S. Trepper shows how the pragmatic approach, based on evidence that sustains the practice of solution focused therapy, has created a solid base to prove its efficacy and allow for a more broad applicability. In Chapter 10, Margarita Tarragona presents narrative therapy as a movement which started with Michael White and David Epston. They consider that problems appear when the people live inside dominant narratives. Tarragona believes that certain postmodern models exist within the narrative framework and that certain principles, postures and interests are shared. In Chapter 11, Mónica Kimelman writes about attachment therapy, an intervention model based on multiple interdisciplinary theories. This practice focuses on attending to the attachment process, which includes an empathetic reading of the signals that babies communicate for the purpose of increasing the quality of the maternal bond.

The third section, dedicated to couples therapy, includes a chapter written by Sergio Bernales. The author defines the couple as a dyad that relates through love and proposes a therapy that embraces love as above the emotional and the functional levels. In Chapter 13, Frank Dattilio synthesizes cognitive behavioral therapy with couples. He describes its theoretical bases, effectiveness, objectives, types of interventions, and its potential for integration with other perspectives.

In section four, Juan Linares creates a retrospective review of personality disorders and offers a relational theory perspective. Linares understands personality as a plot that shapes itself in relation to the individual narrative and the family modality, which at the same time is deduced from the harmony achieved between conjugal love and parental relationship. Arturo Roizblatt and Francisca Friedmann, in Chapter 15, talk about divorce and mediation in the family. The authors explain the phases and tasks of the separation process, the challenges each family member faces, the characteristics of diverse types of reconstituted families, and the different stances of family mediation. In Chapter 16, Ana Margarita Maida and María Elisa Molina address family therapy in the context of violence; they analyze the complexity of its shapes, enlighten the objectives of therapy, offer guidelines for the therapeutic stance, and highlight the importance of multidisciplinary work. Chapter 17, by M. Duncan Stanton and Anthony W. Heath, is about the important role of the family and the couple in situations of substance abuse. They explain how family interactions maintain the symptom; they draw up general phases for the process of family therapy and review the research available about different methods in relation to results. Niels Biedermann and Pablo Salinas, in Chapter 18, describe psychosis and bipolarity in relational psychotherapy in the light of bio-medical and psychosocial perspectives. They offer a historical review of how both disorders have been conceived, describe the family dynamics, and highlight the emphasis of diverse therapeutic models. Chapter 19, by Patricia Cordella, presents the fundamentals of eating disorders, describes the phases, defends the value of intersubjectivity in the development of neurobiological vulnerability, describes the therapeutic hypothesis to work with these cases, and presents several models of family intervention.

The last part of this book is about resilience. Chapter 20, María Angélica Kotliarenco and Irma Cáceres present the concepts and patterns of how resilience is developed, along with its complement, attachment. Judith Landau, in Chapter 21, writes about the value of community and family resilience as a crucial resource when responding to serious disasters. They believe that access to historical or past resilience, along with the emotional connection between family and community, play a crucial role.

And then?

As shown in this review, Terapia de Familia y Pareja approaches the family therapy field from a wide variety of perspectives. Nevertheless, as a Latin American multidisciplinary professional, coming from an inclusive and collaborative posture in the practice of psychotherapy, I will present some critical reflections.¹ The following observations, developed around the contents of Roizblatt´s book, invite further reflections in the field.

1. Beyond techniques

“Close this book now. It is a book on techniques. Beyond technique, there is the wisdom which is knowledge of the interconnectedness.” (Minuchin & Fishman, 1981, p. 289). Every time I read this quote, I imagine a bewildered reader in search for certainties. This phrase, that I repeat here, is quoted in one of the chapters in Arturo Roizblatt´s compilation, and represents an enigma better understood today: a changing paradigm where we do not pretend to return to.

More than thirty years have passed since the message of one of the most relevant leaders from the structural intervention model, Salvador Minuchin, established the lure of the answer in a “no-place”,² with uncertainty not as a burden, but more as a tool that favours change. Even though psychotherapy is a social practice, it often claims to rest on scientific foundations. Today, this creates a unique paradox for the scientific methods have statistically demonstrated that the mastery of the therapeutic process is not in the technique itself.³

And if Minuchin´s quote is an example of what can happen in the field when a book with a proposal is presented, what is it that a compilation such as Roizblatt´s can provide to the field of mental health? This combination of articles problematizes an aspect of the theory and practice of family and couples therapy that should invite our critical reflection.⁴ Terapia de Familia y Pareja opens up as a provocation that invites the awakening of the critical qualities of the reader. Its pages are an epistemological challenge since they invite one to think through the theory that accompanies the practice, in the light of the diversity that composes our present historical moment. Even more, and far away from trying to be a manual of formulas or techniques, each article is a state of the art of the multiple lenses that compose the field of family therapy.

Is it probable that the postmodern era has matured enough to achieve a critical and tolerant coexistence of practices? In this book, coexistence shows up as an invisible thread that sustains the ensemble. These lenses that focus, from the present, on the various theories that are a part of family therapy generate a view that is dislocated from the time when the traditional reading of the field once took place. It turns out to be, for example, that structural therapy is not the one I once met. (Reading it again provides the feeling of re-visiting an old friend). As a living thought, language, and a structure that mediates with its surroundings, life has happened to it, and perhaps it has also moved through more than one life cycle. This personal experience that I had with one of the articles could happen with any article from the compilation.

2. An updated compilation in Spanish

Another characteristic of Terapia de Familia y Pareja is the result of the effort that involves publishing a good quality compilation, written for the Spanish-speaking people in the Americas (and I am referring here to the American continent, or the “New World”, as it was called after the conquest), where 90% of the population of Spanish-speaking people in the world live.⁵ I was educated in Latin American universities, almost always reading copies of photocopies of the few original books that could be found in the Spanish language. If the reading of blurred black ink can be difficult, what can I say about photocopies of texts that had been highlighted on the go (hopefully with the straight lines of a highlighter and not with the undulated pulse of a pen) accompanied by hand-written, emotionally-laden comments that the teachers wrote in the borders of the text? What to say about the practitioner that had to nurture himself or herself from foreign language texts in a language not learned until now? This is why I was so grateful for the specialized family therapy translators. Usually, in Latin American universities, English is required only for the reading of key texts. Confronted with specialized English, the practitioner´s suffering tripled. Not only because a good dose of guilt is applied to the non-bilingual student, but also because now the apprentice has to negotiate with an incomprehensible text in two levels: form (literally speaking, because of the scrawly writing of who previously took over the text) and content.

3. The inclusion of diverse theories

The scope of a text like Terapia de Familia y Pareja that integrates, contrasts and sums up perspectives, with the help of adequate support, could benefit the training of critical family therapy students. I studied psychology in three Latin American countries.⁶ In Quito, Ecuador, in the mid 90´s, I studied in a university whose English texts made up at least 70% of the required bibliography of the psychology program. Later, at the verge of the new millennium, and in the frame of a graduate program in systemic therapy, I observed how the professors in Bogotá, Colombia, made an effort to include literature about the premises that constituted the diverse perspectives in family therapy. This study program supported critical thinking and illustrated the big epistemological changes, such as the constructivist and then the constructionist and postmodern transformations.⁷ Included in this program were two important multi-volume editorial collections about family therapy in Spanish, as well as the periodic publication Sistemas Familiares, a free, online, specialized journal.

The bibliography of the family therapy program included the strong presence of, and proposals from, some Hispanic authors, especially, Argentinean, Chilean and Spanish, that accounted for approximately 30% of the references. I continued my studies in Mexico City in 2011. Mexico appeared to me as an editorial paradise, where you could find almost any book that a Latin American psychology and family therapy student could dream of. Also, Mexico has many more books published by local publishers. It seemed to me, from the perspective of the training programs I became a part of, that they incorporated more of the latest psychology and family therapy movements, such as the integrative and postmodern, rather than the less trendy structural or interactional, such as the Mental Research Institute´s early contributions. I think that, although the structural and interactional schools have not produced new literature and are not considered new, they should not be put aside or seen as a monument from the past, because they are the foundation upon which our present paradigms emerged.

4. An invitation to a critical reading

The pragmatism and speed that characterize our times hinder the meticulous study of theory and turn it into a very privileged and almost impossible task. Also, in the last decades, and in part because of technological developments, theory has advanced at an impetuous speed. The outcome could be a practitioner trained in the new philosophies, but without any solid foundation about previous developments. The inclusion of context, not only in a practical level, but also in the understanding of theory, plays a major role. The consequence of not having a strong sense of historic family therapy foundations can appear in the therapeutic space, where the idea of rigid models can leave a supervisor, therapist and family in a limited vision of the situation. As a result, the whole therapeutic system could get stuck in a dilemma, within the rigid logics of modern thought and due to the lack of awareness of the vast complexity of the surroundings.

The critics of modern thought say modernism tends to oversimplify complexity, creates an illusion of absolute comprehension, and supports rigid structure and fixed thought that turns into unique truth. All of these cognitive modes, if turned into paradigms, do not facilitate the understanding or resolution of the scenarios to which the therapist or the family practitioner is usually confronted. In Latin America, we find multicultural, “multi-problematic”, and I think consequently, “multi-resourceful” families, which cannot disconnect themselves from the complexities of colonization processes, constantly representing an impossible “way of being”. On the other hand, the critics point out that the postmodern trend is on shaky ground, too liquid, unrooted, too ambiguous, and so on. Even when it may sound seductive, the ethics of the radical postmodern thought could scarcely turn a philosophical and Derridean becoming into a specific plan.⁸ Any practical project in the mental health field requires a fixed purpose or intention, and will invite us to step into the exercise of differentiation, fragmentation and heterogenization. Consequently, any undertaking will adopt postures that, by defending particular positions, will sustain the activities proposed through authoritative knowledge. This is not only how politics in our field works, but also the way others understand our proposals. The meaning of an endeavor is only understood in constrast to other points of reference in the field. Even in the domain of the abstract, a certain level of prioritization and objectification is required for the purpose of model building. The use of the modern values such as determination and categorization are necessary to achieve practical ends. At the end of the day, both modern and postmodern parameters are part of a complex epistemological dance that is alive in our surroundings. The difference that makes the difference, as Bateson would say, between both paradigms, is in the unidirectional relation of inclusion, in the sense that postmodernism would probably be capable of absorbing modern thought, while the opposite couldn’t be possible (without losing its quality). To explore postmodernism is to assume us to be complex, diverse, and sometimes contradictory. If the therapeutic space were a discourse, listening to just one conversation would be enough for us to see the switching between different levels, positions, postures, discourses, and approaches.

Far away from the position of the neutral observer, and included as a part of the therapeutic system, there will be many times where the interlocutor (whether that is the client or the therapist) gets stuck in a modern structured way of thinking. Being a part of dialogue brings us back and forth from modernism into postmodernism in a matter of minutes, even when we decide to identify with a specific approach or school of thought. That is why an inclusive approach and the integrative perspective are able to represent with coherence the dialogues that are occurring in the world.

Every critical reading, and I mean critical as the reader’s gesture towards the text and not as a text with reflexive characteristics per se, will expose our truths. Every understanding is the welcoming of a new question. This opening to the exploration of assumptions starts, or not, as an invitation to who leads the therapeutic space. The thought, as the environment, is in constant movement; and the families, couples, and individuals that access the services associated with mental health offered by the family doctor, social worker, mediator, psychotherapist, psychiatrist, teacher, or coach, usually require novel strategies to overcome blockage and immobility.

5. Demystification of stereotypes in the story and practice of family therapy

This book documents state-of-the-art practices in the diverse fields associated with family therapy in America and demystifies a great deal of the stereotypes in the field. Whether it´s due to the excessive compromises that tie the field to economic interests that do not allow its impartiality, or due to the lack of institutional and government support, today the representation of the clinical practitioner in America moves between two extreme prototypes: she/he is some sort of social poet that works without being well-paid, and perhaps with a limited segment of the population, or she/he is a very well sponsored capitalist that promotes a billion dollar pharmaceutical industry. But the family practitioner is almost always far away from these two poles, since the richness of the discourses produced in this field situates them him / her at the vanguard of contemporary philosophy or literature. Many times this is enough to overcome the human system’s difficulties without considering the diagnostics, medications, narrow explanations or isolated solutions that would center the problem in the individual. The production of professionals associated with well-being and mental health is an epistemological issue. And it is, in the first place, the responsibility and a personal option of the therapist, to continue with training and updating her/his critical, methodological, technical, epistemological, scientific, relational, emotional and spiritual resources. It is without a doubt, and even more in a place such as Latin America where, due to the lack of all sorts of resources, the search for a professional in order to treat the emotional well-being is conceived of as a luxury. Or even more, as something unnecessary since a lot of times the social and the emotional are considered synonymous. “If there is some money, we better spend it at Friday’s party, it will be sure to make us all happy.” And this may be true.

In Canada and the United States, the situation in mental health is different. Its development was initially favored by the multi-billion dollar pharmaceutical industry that many times, in collaboration with the state, looked for effective solutions for the population.  Nevertheless, this strategy created certain dependence on the study of pathology, or what I call the colonization of deficit discourse. This reckless gamble transforms into disgrace when it’s offered as the only and best treatment for the masses. The collapse of the model will bring to light the efforts of the multi-national companies to demonstrate the effectiveness of their treatments at all costs, with the ultimate purpose of recouping their investment and generating capital. Here, we find a population overloaded with pejorative labels (see DSM-V), as is the case of the millions of kids diagnosed with ADD or ADHD; or a hyper-medicated addict adult population, that turns into an epidemic of tragic deaths by analgesics, opioids or narcotics, such as overdoses from codeine, oxycodone and hydrocodone.

6. Restoring the history of family therapy as a process

Just as the classics are to literature, the history of the field is to mental health. Understanding how it is that we have come so far, allows us to take firm steps towards the future. We are continually becoming through the stories of our ancestors. The trajectory of family therapy is not only a way to honor the genealogy, but it is also where the access to knowledge lies. It is through reading that we access the territory that has been traversed. If the story allows us to understand how it is that we have come so far, then it also gives us access to future directions; in the same way, historical knowledge is only legitimized in practice. Not knowing the background not only means ignoring, but also losing the possibility of relating to the work of so many professionals who dedicated their lives to the field.

Far away from the scientific experimentation centers, the therapeutic work is many times closer to the social than to the exact sciences. If every tool is shaped by the epistemological lens and philosophy of the therapist, it is because they are our most relevant resources. Far away from hanging onto just one theory, the complexity that the therapist experiments with day-to-day requires the necessary capacity of discernment to build the best options available for each client. Consequently, being unaware of the history of family therapy is just as serious as not updating our knowledge. Politics with lower case “p” is the consciousness that in every moment we take a position, even when this is might be “not taking any position”.

7. The field as a multidisciplinary dialogue

Roizblatt´s compilation allows us to recognize ourselves as part of a process and not as a final product. We are becoming constantly in relation, not only to history, but also to the other actors and to the current environment. The text invites many professionals to dialogue about their specialities and functions. Teachers and practitioners from diverse areas (e.g., medicine, psychology, psychiatry, family and couple´s therapy, organizational leadership, social work, among others) meet in this book, which is the result of the application of family therapy theory in different institutional and multidisciplinary spheres. In this compilation, different authors come together creating a body of knowledge that includes many of the most relevant developments in America. This volume brings together classical authors from family therapy, authors that represent the continual development of the legacy of important perspectives, and contemporary authors from postmodern branches.

8. Applications for Latin America

There are advantages to having texts that reduce the distance between theory and practice through their applications for Latin America. The professionals that write in this book have chosen a particular subject to study and dedicate their lives to; but the opposite may also be true: that they probably became specialists because they dedicated their whole life to engaging in what they love and believe in. This compilation is an exemplary model for Latin America; an invite to continue down the paths taken by the authors. This is also a proposal that more people related to family therapy could follow up by writing about their experiences in order to build upon this body of practical and theoretical work, applied to the particular context of Latin America. It is not news that Latin American countries do not have big budgets for research, or large up-to-date bibliographies to study and write about these themes. As a consequence of the cultural transformation that includes processes of colonization, syncretism, hybridization, globalization, and acculturation, America finds itself today populated by a hybrid mass largely composed of the descendants of the indigenous peoples of the Americas and the descendants of European imigrants, both having to negotiate their ways of being in the world, and many times feeling threatened by the loss of the original traditions that once held their communities together. Most of the Latin American population also find themselves far from the highest standards in education, health and other norms of the Western tradition. I believe these new discourses written for and by Latin Americans are necessary, for they not only aim to balance from the appropriation of hegemonic stories that could dominate the family therapy field, but, above all, they also are built upon the need for sharing our experiences and generating a theoretical body of knowledge that accurately reflects our situations.

9. An organic and inclusive vision of the silenced discourses

Reading Terapia de Familia y Pareja deconstructs myths, and any outdated assumptions that people may have about family therapy. A stereotyped and disjointed vision of the different schools and classic approaches is replaced by a more organic epistemological view where the therapist´s practice is the main beneficiary. To read this book is to open a door towards a more relational, contextual and concordant vision of various family therapy approaches; and this is thanks to the existence of the other, and not in spite of, or against the other. The reader will benefit from this re-reading about the non-hegemonic stories that overrun the assumptions people often have about what family therapy is. Isn’t it also our duty to pick up the alternative stories of our field? Many times, memories turn into caricatures of what they were, if we don´t maintain clarity regarding the contexts from which they came. Many times, we stop reading more about this or that perspective because our time is short, or just because it is not the trend of the day, and people are not talking about it any more. Books like this allow us to reclaim some of the unheard voices of family therapy and, even more importantly, they let us understand the contexts in which certain agendas where formulated. Perhaps such books also make it possible for us to redeem those environmental conditions that previously, in a particular moment, did not allow us to access the most updated bibliographic resources.

Terapia de Familia y Pareja presents an important and accessible theoretical framework that serves for consultation, as a textbook, or for updating our knowledge and understanding. Allowing ourselves to read this book is a privilege that confirms the integrative tendency of the family therapy field, not as a discourse that accepts any intervention as valid, but as ratification that family therapy is an ever-changing movement. Knowledge, as life and ourselves, involves not only accepting the multiverse⁹ maps of family therapy, but also indulging ourselves with the time to carefully listen to the authors that shape us, as well as listening to those we also play a role in shaping. A rhythmic narrative is then formed that supports multiple endings, and all possible roads to the continuation of our own journey.

References

• Anderson, H. (2012). Collaborative relationships and dialogic conversations: Ideas for a relationally responsive practice. Family Process, 51(1), 8-24.
• Anderson, H., & Gehart, D. (Eds.). (2007). Collaborative therapy: Relationships and conversations that make a difference. New York, NY: Brunner-Routledge.
• Bakhtin, M. (1986). Speech genres & other late essays (V. McGee, Trans.). Austin, TX: University of Texas.
• Bateson, G. (1972). Steps to an ecology of mind: Collected essays in anthropology, psychiatry, evolution, and epistemology. Chicago, IL: University of Chicago Press.
• Bebchuk, J. (1993). Diálogo epistolar con Harry Goolishian [Epistolary dialogue with Harry Goolishian]. Sistemas Familiares, 9(1), 29-38.
• Derrida, J. (1982). Margins of philosophy (A. Bass, Trans.). Chicago, IL: University of Chicago Press.
• Freedman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York, NY: Norton.
• Gergen, K. J. (1973). Social psychology as history. Journal of Personality and Social Psychology, 26(2), 309-320.
• Gergen, K. J., & Warhus, L. (2001). Therapy as social construction. In K. J. Gergen (Ed.), Social construction in context (pp. 96-114). London, United Kingdom: Sage.
• Lambert, J. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 139-193). New York, NY: Wiley.
• Lizcano Fernández, F. (2005), Composición étnica de las tres áreas culturales del Continente Americano al comienzo del siglo XXI. [Ethnic composition of the three cultural areas of the American continent at the beginning of the 21st century]. Convergencia. Revista de Ciencias Sociales [Convergence: Social Science Journal], 12(38), 185-232.
• Maturana, H. R., & Poerksen, B. (2004). From being to doing: The origins of the biology of cognition. Heidelberg, Germany: Carl-Auer Verlag.
• Maturana, H. R., & Varela, F. J. (1998). The tree of knowledge: The biological roots of human understanding. Boston, MA: Shambala.
• Minuchin, S., & Fishman, H.C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press.
• Norcross, J., & Goldfried, M. (2005). Handbook of psychotherapy integration. New York, NY: Oxford University Press.
• Proaño, A. (2015). Reseña: Terapia de Familia y Pareja: Una visión orgánica e incluyente. [Review of the book Terapia de familia y pareja, by A. Roizblatt]. Revista De Familias y Terapias [Journal of Families and Therapies], 23(36), 143-153.
• Roizblatt, A. (Ed.). (2013). Terapia de Familia y Pareja [Therapy for families and couples]. Santiago de Chile: Mediterráneo.
• Wittgenstein, L. (1958). Philosophical investigations (G. E. M. Anscombe, Trans.). Oxford, United Kingdom: Blackwell.

End Notes

• * This review was first published in Spanish in De Familias y Terapias, 23, N°36, pages 143-153, and was republished in Sistemas Familiares, Año 31 – N° 2, pages 62-77. I want to acknowledge both journals for their on going collaboration and consent on allowing the International Journal of Collaborative – Dialogic Practices to publish the English version of this review, as well as to re-publish the article in Spanish. The original title of Roizblatt´s compilation in Spanish is Terapia de familia y pareja, which here is translated as “Therapy for families and couples”.
• ** Correspondence concerning this article should be addressed to Alejandra Proaño, # 204, 402 West Pender St., Vancouver, B.C., Canada, V6B1T6. E-mail: ale@alepro.ca
• ¹ For more details on the collaborative stance and / or the integrative movement, see Anderson (2012); Anderson and Gehart (2007); and Norcross and Goldfried (2005).
• ² I am referring to Derrida´s idea where the establishment (and even the promise) of meaning is compared to a lure, challenging the structuralist concept that the sign is able to signify once and for all.
• ³ Lambert and Ogles (2004) conclude on manualized treatment: “little evidence supports the notion that specific techniques make a substantial contribution to treatment effects” (p. 176).
• ⁴ In Spanish, “problematizar” means to present something as an issue, question, matter or topic. This word is then associated to problematize the ideas received, a practice related to our historically predetermined post-colonial posture.
• ⁵ In this essay, I use the words “Americas” and “America” to refer to the American continent. The continental model taught in Latin America often consists of six continents, and considers North, South and Central America as regions within the American continent.
• ⁶ In this essay I use the word Latinamerica as a synonym of a regional identity based not so much on biological constructs but on cultural ones. As a whole, these countries have predominant Western features and have Spanish and Portuguese as official languages. In these twenty nations that are part of the Americas, Latin ethnicity represents as much as 86.6% of the population; compared to 39.5% of indigenous descendants, and 23.7% Afro-descendants. (Lizcano Fernández, 2005).
• ⁷ To explore a few references about the differences between constructivism, constructionism and posmodernism, see Gergen (1973); Bebchuk (1993); Freedman and Combs (1996); Gergen and Warhus (2001); and Anderson (2012).
• ⁸ I use the word “becoming” in this essay in reference to the postructural conception of language (and reality) that proposes the work of Derrida (1982) and corresponds to the ideas of Wittgenstein (1958) and Bakhtin (1986).
• ⁹ I refer to the term “multiverse” in opposition to “universe,” as Humberto Maturana and Francisco Varela state in their work. See Maturana and Poerksen (1998) and Maturana and Varela (2004).

Author Note:

Alejandra Proaño
Psychotherapist and professional coach.
Candidate for the Masters Degree in Psychology; Master of Science; Master of Arts (Literature).
E-mail: ale@alepro.ca