The "Flip"-Sustaining Complexity and Multiplicity Post-Quarantine.

This article describes poststructural ways of responding to the pandemic by looking for openings or gaps within more traditional ways of interacting with dilemmas. The author situates herself within a "positive deviance" epistemology, which looks for what already works rather than getting captured by the current problem. We "flip" what are the usual ways of responding and explore three different programs that illustrate inventive and assets-based approaches. Linking-Lives Storython, created specifically to utilize our COVID shelter-in-place experience; Re-Authoring Teaching: Creating a Collaboratory, begun 12 years ago to meet the needs of a widespread community; and Witness to Witness, a current response to contemporary disastrous situations-all have utilized technology to open possibilities for those who are helped as well as those who are helpers. The article shows how each program has specifically flipped more traditional ways of responding, but also how this "flip" employs a practice of "disciplined improvisation." Each program has a built-in structure that depends on technology to make it work; each has a disciplined approach that allows the helpers to improvise to meet the needs of the receivers. It is this "flip," this way of thinking, that can sustain us and our work in times of great complexity and multiplicity.

I wish you a creative and enlightening quarantine.

—Sergey Yeremeeve (as quoted by Sebastian Modak—New York Times travel writer). (Modak, 2020 )

In early March, I sat in a crowded restaurant having brunch with a colleague; we knew about a “coronavirus,” but we were unconcerned. Five days earlier, I had been teaching a graduate family therapy seminar when another colleague and I asked the students how worried they were about the coronavirus; they said, “Not very.” The colleague in question had checked with the provost about whether or not she should continue to commute by air from her home city to teach in person. The response was, “Definitely.”

A week later, the principals of the sports world started shutting down sporting events. Then, one by one: Broadway went dark, Disneyworld/Disneyland closed, businesses were shuttered, schools were locked, and restaurants and bars turned off the lights; “it was the day the music died.” During previous plagues, people were told to “leave home and don’t come back"; now we were told to “stay home and don’t come out.” Tests were in short supply, people were getting infected, hospitals were overrun, protective gear was unavailable, patients died, healthcare workers died, and morgues were overrun. Airports were eerily quiet, freeways were mostly vacant, and the air became clearer. We were told to “shelter in place,” that it would lead to “flattening the curve.” We found ourselves with not enough toilet paper, no sanitizer available, and only “essential” forays out were allowed. Soon protective screens, gloves, masks, and six‐feet social distancing—all were required.

Where Are We?

With the rearranging of routine and inventing new rituals, with an unknown ending and not much to look forward to, we attempt to reconnect to our reflexive skills and create new meaning. We are stuck in time. It collapses; one day bleeds into the next; goals are amorphous, timeliness has little meaning. No one really knows what “going forward” might mean. Time, as we have come to know it, is dramatically changed by quarantine. In Einstein’s Dreams, by Lightman (1993), each chapter is an alternate world in which time is differently constructed. “While people brood, time skips ahead without looking back” (p. 28). We are experiencing an alternate existence with a precarious definition of time. We are in a position of predictable unpredictability, where we cannot imagine the future and struggle to connect to our history.

In these unknown, uncertain times, most of the therapy and education worlds surrendered to some form of telecommunication, which begged for understanding and meaning. When the coronavirus brought the whole world to its knees, we scurried to find multiple platforms to manage our communication options as we redesigned how we interacted with others as therapists and healers. Isolated from wider human contact, sheltered in place, we needed to find ways to connect. Many systems: schools, health concerns, psychotherapy, rituals, friends, and neighbors, were reduced to video conferencing.

This paper draws from a poststructural and systemic approach to posit a perspective from which we can learn and be proactive for an unknown future. Many questions come to mind when considering a poststructural epistemology and systemic family therapy in the context of COVID‐19. How was the pandemic altering our lives, our homes, our learning, and our relationships? Is it possible to “zoom out”—take a wide‐angle lens view? Instead of focusing on what doesn’t work with the technology with which we’re stuck, is it possible to pay attention to how we can proactively use what has been given to us?

By attending to a “creative” and “enlightening” quarantine, might we find openings and possibilities instead of a stuck‐in‐place distress and possibly a passive stance? We explore what it might be possible to accomplish, questioning whatever the path might be, charting a future that “flips” what we think we ought to do.

Technology and Teletherapy

In the days and weeks that followed those early days of March, there was a multiplicity of responses. Fortunately, the technology was there; we had already predicted that there would be times (not predicting all the time) when our interaction would need to occur via a plethora of platforms and apps ready for use: Go To Meeting, Zoom, Skype, doxy, Google Hangouts, Facebook, and many others. In fact, an entire industry had been built to offer online/teletherapy, as well as online learning centers, to potential users.

Teletherapy is how most therapists are meeting their clients. Some therapists are finding teletherapy very useful, especially those practicing from theories that operate in a directive or systematized way, a structural epistemology, where there are more prescribed ways of offering a way forward (e.g., CBT, DBT, ACT; see also Dickerson, 2010). These therapies have been shown to be effective in person but also seem to adapt somewhat easily to an online presence.

What’s Seemingly Lost

However, many have negative views of video options. Video calls were accused of “messing with our minds” (Hinde, 2020), including all the pitfalls that occur when one cannot be face to face. In a New York Times article at the end of April, “Why Zoom Is Terrible,” the author (Murphy, 2020) writes about how our perception is distorted because of the loss of the ability to see the intricacy of facial expressions. This leads to an inability to “mirror,” which is a major way that we recognize emotion and thus can establish empathy and connection. This reflects what Rick Moody (2020), a creative writing teacher at Brown University, writes when he suggests that compassion occurs when humans can be in a room, feeling and expressing something, with others listening. He comments on his concern about how “humanness” can be lost through a Zoom call.

Before the pandemic, we were easily captured by a “business‐as‐usual” model: the therapy office, the agency consultation rooms, and the hospital meeting spaces; all of which were in‐person, face to face. This is what we had come to expect, unquestioning, accepting it as a settled certainty. Then—facial cues, body positioning, subtle looks, ability to talk over, ease of talking after, hanging out—all taken for granted by us, invisible, unnoticed, until they were seen by seemingly being lost in Zoom or other video platforms. We began to recognize what had been unremarkable to us previously: what it means to interact as clinician and client in a therapy room, in a physical space designed specifically for the sharing of experience, for personal communication and understanding.

Some of us who are family therapists, teachers of family therapy, social workers, and frontline workers find ourselves in the uncomfortable position of how to help those in our care.

In a New Yorker article, Gopnik (2020) mused about the reality of “The Empty Couch.” He echoes much of what many therapists realized when their clients were not coming to their office. Most never questioned where they do therapy. We have a therapy office, which we furnish and decorate according to our tastes. We manage the space corresponding to the needs of our clients. We take for granted our ability to establish empathy, to create and foster relationships. The space we are in holds the interactions.

Can We Make It Work?

We live in a world of technology. It has continued to leap ahead of us even as we scurry to keep up. From 2012 through 2018, I worked with the journal Family Process and the Family Process Institute, helping authors make video abstracts, and then creating a Facebook page and a Twitter account. I subsequently conceived of and moderated several webinars, the latter in partnership with the Ackerman Institute. Other poststructural thinkers have attempted to keep pace, learning the technology and hoping to use it in our service. Sax designed Re‐Authoring Teaching: Creating a Collaboratory https://reauthoringteaching.com, about which more will be written here; and Stephen Madigan originated a series of online offerings, currently called Vancouver School of Narrative Therapy Live https://vsnt.live. Few poststructural therapists were utilizing teletherapy, preferring to work with their clients, couples, and families, in person.

When I began to use Zoom for therapy sessions for some clients who were requesting remote meetings, I saw it as a poor substitute. Working as a family and couple therapist from a poststructural perspective, I believed that being in the room with the people we are “seeing” is a preferable process. I noticed that, using Zoom for therapy, I was less focused. My preference, as a narrative therapist, is to be curious, ask questions, try to understand the client’s experience, getting closer to what they meant. I observed that I tended to short circuit the curiosity process and jump to therapist statement. I was less and less satisfied with my performance and wondered what the client was discerning.

Poststructural therapists tend to emphasize “local, interpretive, and idiographic accounts” (Dickerson, 2014, p.5). As a result, Zoom therapy conversations felt thinner than the in vivo meetings—accessing the client’s human experience seemed difficult. I developed an implicit “rule” that I would only set up a Zoom session if I had previously worked with clients in my therapy office, so these sessions were an exception to an in‐person experience. Then, I got a request for remote therapy with someone I hadn’t met, so I bent my rule and started meeting online. Even then, I made it a point to request a meeting in person when it became possible. The shift this provided was remarkable. The flat screen video became a 3D human being—I suddenly had height and weight, hair style, eye glances, enhanced facial expressions, body movement, all coordinated with vocal volume and tone, intimations and innuendoes. I wasn’t conversing with a ghost; I was speaking with a lively flesh‐and‐blood person. This experience sent me back to the belief that “meeting in person” is superior to online therapy.

What Can Be Gained?

During the pandemic video conference platforms have been the only viable option to in‐person meetings. Whatever criticisms have arisen about its faults, and/or its possibilities, what do we know about the complexities this moment affords? Focusing specifically on our interactions with others from a position of a therapeutic relationship, it does allow us to connect. If we expect the video call to be the same as “in person,” we will be gravely disappointed, and yet, when it is the only option, how do we make it work?

Some writers are currently looking at the “advantages” of a Zoom liaison over an in‐person connection, reflecting new “intimacies”—rooms where the calls occur, family members flowing by, cats walking across the screen, dogs barking, lawns being mowed, and people calling across the street to each other. One author asked if there was a “kind of leveling that takes place” (Gottlieb, 2020).

Changes imposed to shelter in place have called attention to what had been undetectable to us beforehand: what it means to interact as clinician and client in a therapy room. We notice how technology shifts the experience, especially when it seems all that is available to us. Can this noticing help us see other possibilities, previously invisible?

Possibilities

What does the technology give us to sustain our connectedness, its multiple uses, advantages, and opportunities? How are relationships formed and sustained over time? What is lost? What can we learn? How do we change our future? A poststructural perspective allows us to garner the learnings available from this experience, think about possibilities, and access the creativity available to us for going forward.

The pandemic bends and shapes the various ways we engage in providing therapeutic services to a variety of populations, cultures, and geographies. Complexities in technology have become dominant, modalities that existed but had been under explored. How might the effects of the pandemic be changing our thinking? We can change, because we “have” to, and/or we can think about how we want to be with the change, how to manage it, and how to use the change in a way that is sustainable.

Family and couple therapy is systems work, and systems work is about a way of thinking, an epistemology. It often requires a wider lens, a larger systems umbrella. Imber‐Black (1988) in what now seems prescient, wrote Families and Larger Systems that calls out for us to embrace thinking about the complexity of a larger system interaction.

Technology in Poststructural Therapy

The particular technology slice called teletherapy may not lend itself well to a poststructural epistemology. Obviously, poststructural therapists use teletherapy. The question is the following: How can we use it to assist us? Perhaps the simplest response is that it allows us a type of connection. However, as mentioned above, the concern with teletherapy is a loss of a richer possibility for empathy, given the “thinness” of the experience.1

Poststructural couple and family therapists’ work is centered in possibilities. We explore openings, look for gaps, and ponder how we can embrace what might be new or different. By entering into those possible openings, ways of being and acting became more visible. The work of therapy becomes one of collaboratively re‐authoring a preferred narrative from having explored those openings.

Singhal (2012) and TED (2015) talk about “positive deviance,” which, “flips,” our usual problem‐based method and uses an assets‐based approach toward social change. Is there a way to think about our current dilemma of pandemic/quarantine, our need to rely on technology in our systems work that could help us see a way forward from a “positive deviance” understanding? Positive deviance begins not with the question of how to solve this problem, but how has this problem already been solved, and who has solved it. It is similar to the quest for openings and gaps, as it attends to possibilities.

Can we take a positive deviance approach toward video therapy? Can we “flip the question”—use an assets‐based understanding? From a problem‐based method, we might try to see how we can either “tweak” the video therapy approach to make it work better for us, or simply accept it as imperfect option to an in‐person meeting. If we are focusing primarily on our work with clients, there likely is no “flip.”2 That would require our noticing or creating a video therapy that worked extremely well—one possibility would be to create a 3D model from a flat screen. Because we have not yet seen that, we are instead noticing what forms of technology do work well.

Understanding positive deviance as a similar epistemology to a poststructural one, we want to utilize what technology is well suited to do, not what we think we can bend and shape it to do. This takes us to the realm of working in larger systems—with groups of people, online, utilizing the best tools at hand. This is in the interest of the “flip”—not how can we solve the problem of “Zoom” therapy often seeming inadequate, but what do we already know about what technology can achieve? Making use of what technology provides us comes from the position of the “flip.”

What was happening in the field of family therapy that was not only attending to our quarantine situation but was actually creatively utilizing it? We began to notice events that were embracing what COVID‐19 created.

What often goes unnoticed and is worth noting is “the inadvertent reconstruction of access to resources created by an ‘online‐only’ world, that tends to privilege middle‐class, English‐speaking, US‐centric, and (what seems to be) often urban communities” (N. Zamani, personal communication, 2020, June 22). When we discuss the use of technology, we are omitting those who do not have access: marginalized populations, usually the underclass, and often non‐White. A way to “flip” this lack of access is worth considering.

Linking‐Lives Storython

An immediate and particularly ingenious endeavor was the creation of a “Storython” (https://tinyurl.com/yaz5rvar), imagined and produced by Stephen Gaddis of the Narrative Therapy Initiative in Salem, Massachusetts (https://www.narrativetherapyinitiative.org ). Gaddis thought that a good use of our pandemic time would be to put together a 25‐hour global story telling event, a wave of stories beginning in New Zealand, traveling across the globe. It would cross China, Western Europe, spend a good deal of time in the United States, and end up in Mexico City. Gaddis was intentional in wanting to open space for those whose lives were less known, rather than privileging what he calls “the narrative elite.” One of his values is to bring in voices from the margins to make visible the imagination, ingenuity, and sustainability accessible around the world, but which often goes unnoticed. He believes we can see the possibilities available if we allow ourselves to be open to difference. In this way, he follows Michael White’s “de‐centered and influential” (White, 2005). Gaddis took advantage of time, geography, and living links around the globe to speak out for the common experience we are all sharing.3

Pilar Hernandez‐Wolfe and Navid Zamani and I collaborated to create a structure for one of the hours, Pilar and Navid each interviewing their guest storyteller, and then the three cohosts acting as a reflecting team/outsider witness group. The major question posed to our guests/storytellers was: How has your life become more or less complex since COVID? How has this complexity impacted all your relationships? Our intention was to extend our understanding of how the pandemic/quarantine has impacted us in multiple complex ways. We were also interested in how people “improvised” to relate to the situation. This curiosity was based on our own reflection that what we were creating was an “improvisation” as a way to respond to the state of affairs that encompassed us.

Pilar invited Claudia, a young indigenous Peruvian woman, musician, storyteller, and therapist, who opened the hour with sounds from her flute.4 As an immigrant she spoke of her continuing commitment to the life of her community, the belief that “we must prevail” because “we have to.” Her words spoke directly to our quarantine experience, reminding us that during this time of slowing down we have the opportunity to see openings that might otherwise be invisible to us. She also commented that slowing down or resting is an advantage not available to everyone.

Navid’s guest, Nidya, identifies as a “Dreamer.” As such, her constant experience is one of “no relaxing,” always on alert; and counter to the “rest” that Claudia identifies as necessary to see openings, Niyda says she lives in a “sea of uncertainty.” Her openings become available to her as she connects with her extended family and her commitment to community.

Gaddis “flipped” our experience of the pandemic/quarantine from what many were experiencing as a problem to noticing and utilizing ways to honor the lives of all of us stuck at home with creative ideas as our companions. From a positive deviance approach, he knew what technology could do and he imagined a process that could create a wave of possibility around the globe. In the particular hour I was privileged to help design, we were embraced by stories of the possibilities of learning (and knowing) how to respond to stress and danger and the need to prevail.

Re‐Authoring Teaching: Creating a Collaboratory

In 2008, the narrative therapy community was shocked with the untimely death of Michael White. There were multiple responses to this loss: most in an endeavor to immortalize his remarkable and unprecedented approach to working with people. One response focused on our looking through the wider lens (e.g., using technology) to gather together the narrative community in the wake of the loss of its founder and leader. Sax, in Vermont, who wrote Re‐Authoring Teaching: Creating a Collaboratory (2008), envisioned using the ideas from that book to create an online study group to engage narrative practitioners worldwide. Her vision captured the support of David Epston, narrative therapy’s cofounder, and years later, there is a rich and robust website (https://reauthoringteaching.com ). Sax used the evolving technology in intentional ways, to create possibilities to connect and sustain us. She began by offering an online study group and over time utilized platforms that offered connections in real time. Now her site includes a “Collab Salon” not only with webinars and online courses, but also with customized consultation, a YouTube channel, an upcoming resource library, and more. Her commitment is to “use the internet in productive and socially responsible ways.”

Sax and her team are nimble and resilient, continuing to stay with the times. A recent section on their website: “Together Enduring COVID‐19” gathers multiple resources for those who access the Collaboratory. She included a link to what the Dulwich Centre (Michael White’s home in Australia) is offering as a resource (https://dulwichcentre.com.au/narrative‐responses‐to‐covid‐19 ).

Talking with Sax recently, she remarked how quickly a dozen years have passed, during which time she developed an incredible team of talented people and now has a rich and extended online community. Her vision was realized beyond her wildest dream. How does this happen? One can see the thoughtfulness and intentionality she used to allow technology to help us, to be mindful of what it can accomplish, and to capture its reach to gather together like‐minded people.

Her “flip” was twofold: one was, by allowing technology to create a way for the narrative community to connect to each other—those who previously were mostly sustained by the worldwide traveling of Michael White and David Epston. It was also, however, a “flip” of the “how” in the use of the internet—more subtle but perhaps more powerful, focusing on technology taking us “places no one has gone before.” What Sax and her Collab team did was catch up with technology and use it instead of allowing it to use us. The complexity is not so much in the content, but in the process. This flip reflects the over 30 years ago remark from Marshall McLuhan (1994): “The medium is the message” (p. 8).

Witness to Witness

Witness to Witness (W2W) is a program initiated by Weingarten (2000, 2003, 2010), drawing on her witnessing model. It is contemporary, timely, and complex with multiple possibilities, beginning its life in mid‐2018 in response to a current and grievous need. I believe it is a centerpiece and model of how to flip what might be a more usual response.

Witness to witness is a concept that offers the support of “witnesses,” who specifically take on the role of “helping the helpers,” or “witnessing the witnesses.” It begins with partnering volunteers (clinicians) with the many frontline workers. “Witness to Witness” could not have come at a better time, with clinicians, attorneys, and frontline workers responding to the problems that immigrants, detainees, asylum seekers, and all those affected by a virulent racism, were experiencing at our southern border. The witnessing of violence often has a traumatic response, meaning that the helpers also need help. The support of others, someone who can listen without judgment, is paramount, and often family and friends are ill‐equipped to take on that role.

This program is featured elsewhere in this issue (Weingarten, Galvan‐Duran, D'Orso, & Garcia, 2020), so I will not describe it in detail here (see also https://www.migrantclinician.org/witness‐to‐witness). It is especially geared toward our present experience with news every day of more injustice and harm perpetrated on the most vulnerable. These problems certainly have a history but have been exacerbated and accelerated by the current administration. At the time of this writing, multiple cities across the US are protesting the death of Black persons as the visible perpetration of systemic racism. As one clinician stated: We keep thinking it can’t get any worse, and every day something worse happens.

The W2W program continues to develop and grow with four components responding to the needs that arise. As the coronavirus began to take hold, W2W pivoted toward offering services specifically tailored to those involved in frontline work, currently by webinar and peer support groups. Each component of this program occurs “virtually,” by phone, video call, webinar, facilitated group. W2W was initiated to operate in ways that could reach people who could not be available for in‐person consultation. With these components persons who most could benefit from the vision and goals of W2W have access. Since that original work in 2018 of partnering clinicians with frontline workers, the program quickly expanded, now having just celebrated its two‐year anniversary.

As a consummate example of “flipping” the usual reaction, this approach notices that those of us who help also need help. Other responses might be to send in more workers or to offer a variety of services to prevent burnout. W2W is an excellent example of our existing use of technology to serve those who might otherwise not be served. The question was not the following: What should we do to address the problem? It was the following: How can we act in ways we already know to be helpful? It acknowledges the distress that 2020 has brought to the fore and that so many are experiencing—people with differences: immigrants, racial disparities, class divisions, and more recently COVID‐19. It is a program that is fluid and adaptable to meet whatever need becomes critical.5

Disciplined Improvisation—As a Helpful Practice

Madsen (2011) speaks of “disciplined improvisation”6 as a response to what he calls the “predictably unpredictable.” This phrase reflects what it is that family therapists, social workers, and others on the frontline do to deal with the “messiness” that we often experience when we work with people where there are multiple stressors.

Madsen developed a collaborative therapy model in the early 2000s; his Collaborative Therapy for Multi‐Stressed Families, 2nd ed. (2007) describes this model. His approach drew from narrative, solution‐focused, and collaborative language system therapies and was initiated to reach overextended workers in under‐resourced organizations.

As Madsen’s collaborative therapy model developed (2009, 2011), he created a framework called “Collaborative Helping Maps,” which evolved into a structured practice that he then named “disciplined improvisation.” The practice uses his maps as a tool (the discipline) to help helpers on the frontline think their way through complex situations (improvise). In a series of articles in Family Process, Madsen (2013, 2014) Madsen and Gillespie (2016) offer a variety of applications for the use of his maps.

Madsen flipped the usual notion that it is therapists who do all the healing work with families when he began to write for the frontline workers in applications of family‐centered services (e.g., systems of care, wraparound, family‐driven care, the recovery movement, and family group conferencing, among others). He suggests that the heart of family‐centered approaches is a shift (a flip) in how services are provided to families (see “Taking It to the Streets,” 2014).

Each of the three inventive programs described above not only flipped ordinary ways of looking at problems to noticing possibilities for extraordinary ways, they also shared a way of doing things in common, they shared “disciplined improvisation.” They all knew how to improvise to meet the needs of the times, to make music.

Positive Deviance Revisited

Positive deviance looks at what works with a group of people for whom something ought not to be working and applies it to others. Or, to put it another way, by noticing “uncommon behaviors” that a community might already be practicing in response to a given problem—against all odds—a positive deviance approach applies those practices to other situations. It is a sustainable approach relying on collective intelligence.

Singhal (TED, 2015) tells us that the global record for solving complex problems is dismal; his antidote is for us to “flip our questions.” Instead of asking, “How can we solve this problem?” we ask, “Who has already solved this problem?” Or—to question who has acted their way into a new way of thinking, rather than presume we can think our way into a new way of acting. It is about asking the right questions.

Going Forward

No one really knows what “going forward” might mean in the time of pandemic/quarantine. What happens when we zoom out, get the larger view, what does it show us? We can construct a new meaning for time. We move away from the day‐to‐day changes. We have the privilege of being able to “rest,” to “slow down” in order to contemplate openings. We have the possibility of experiencing wonderment. What can we see that was previously cut off by the borders? What do we see inside the scape that was lost in the previous view? How can we access our creativity? Can we see things that we’ve seen before but that now have more meaning? What might pop up if we did? And what might have viability across another time? Who are we serving and how might we serve them better? How might we, from a poststructural/positive deviance perspective, garner our assets and note how we might skillfully respond?

What if we thought of all of the approaches described here as a direction, a way to organize our thinking about what the quarantine has wrought? Our first step would be to notice the need, secondly to access what we know to be our assets, thirdly to understand and appreciate the tools we need to address the issue. From a positive deviance perspective, we would flip the question, asking: What do we know about how this problem has already been solved? Often, the answer to that question lies in the margins, initially outside our view.

The “flip” discussed here is one way of widening our lens, allowing us to see possibilities. By utilizing our experience and expertise as systems thinkers, we can, in a disciplined way, improvise a response to the situation. We need to be nimble, able to think outside the box, and ready for the unexpected and unpredictable.7 A poststructural, positive deviance way of thinking, a disciplined improvisational way of acting, and a witnessing of what we have before us. From these positions, from “the flip,” we can best sustain the complexity and multiplicity of our times—Post‐Quarantine.