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Reflecting Team Group Therapyand Its Congruence withFeminist PrinciplesKim Marie Vaz PhD aa Women's Studies at the University of SouthFlorida , maintains a private psychotherapy practicein TampaPublished online: 10 Oct 2008.

To cite this article: Kim Marie Vaz PhD (2005) Reflecting Team Group Therapy and ItsCongruence with Feminist Principles, Women & Therapy, 28:2, 65-75, DOI: 10.1300/J015v28n02_05

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Reflecting Team Group Therapyand Its Congruence with Feminist Principles:

A Focus on African American Women

Kim Marie Vaz

ABSTRACT. The author suggests that the reflecting team approach togroup therapy can enhance and further the goals of feminist counseling.Specific strategies that help accomplish this goal include allowing clientsto act as consultants and rotating the focus of the team from session to ses-sion so that each member has multiple opportunities to speak the languageof agency. An illustration of an individual session demonstrates howwomen of color, in particular, may benefit from this therapeutic interven-tion. [Article copies available for a fee from The Haworth Document DeliveryService: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com>Website: <http://www.HaworthPress.com> © 2005 by The Haworth Press, Inc.All rights reserved.]

KEYWORDS. African American, group therapy, women of color

Butler (1985) outlined key factors that distinguish feminist psychotherapyfrom traditional counseling conceptualizations and interventions. From a fem-inist perspective, traditional psychotherapy upholds the power imbalances insociety by reproducing gender role stereotypes in theory and practice. Femi-nist psychotherapy contends that discrimination such as racism and sexism,

Kim Marie Vaz, PhD, is Associate Professor of Women’s Studies at the Universityof South Florida and maintains a private psychotherapy practice in Tampa.

Address correspondence to: Kim Vaz, Department of Women’s Studies, FAO 153,University of South Florida, Tampa, FL 33620 (E-mail: vaz@chuma1.cas.usf.edu).

Women & Therapy, Vol. 28(2) 2005http://www.haworthpress.com/web/WT

© 2005 by The Haworth Press, Inc. All rights reserved.Digital Object Identifier: 10.1300/J015v28n02_05 65

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rather than individual psychopathology, is the basis for much of women’s psy-chological distress. In contrast to traditional psychotherapeutic approachesthat have placed the blame for problems women encounter (such as lack of oc-cupational achievement, increases in rape and domestic violence, and the highincidence of depression) squarely on women’s shoulders, feminist psycho-therapy looks to differential power relationships between men and women.For example, rather than viewing depression as stemming from personal defi-cits inherent in women’s nature, gendered social roles are seen as encouragingwomen to avoid acting assertively, decisively, and placing their own needsfirst. Rather than considering rape as a consequence of female seductiveness,rape (and domestic violence) is interpreted as the result of male dominationand as an instrument to perpetuate it. Instead of accounting for women’s lackof advancement in male-dominated occupations as a result of women’s per-sonal inadequacies, feminist therapists consider the role of discrimination inhiring and promotion practices, sexual harassment, and pervasiveness of thedominant masculine.

The mental health concerns of women of color (i.e., all women considerednonwhite) are intensified by the pervasiveness of racism in social institutions.Gutierrez and Lewis (1999) note that the broad grouping of women of colorunder this term masks the diversity of needs and challenges facing each group;yet these women are from groups who have unequal access to resources andpower. Their groups face obstacles that stem from lower average earnings thanthose of white women, overrepresentation in low status jobs, lower levels ofeducation, and an underrepresentation in positions of leadership in govern-ment and corporations. Gutierrez and Lewis (1999) write that psychotherapywith women of color should emphasize the development of a critical con-sciousness. This involves an understanding of how power relationships influ-ence perceptions and experiences. Women of color should be assisted inidentifying how racism, sexism, and other types of oppression are present intheir lives and how they have interpreted and internalized these externalforces.

From a feminist perspective (Butler, 1985), group therapy is seen as beingparticularly valuable for women since it may provide them with an opportu-nity to complete incomplete developmental tasks and to discover the valuablecontributions that women can make to one another. It may provide aresocialization experience in which they move from a male-defined social sys-tem to a woman-defined one. Because men will not have the lion’s share ofpower and importance, women will have the opportunity to assert themselvesand establish their autonomy. The practices of the “reflecting team” approachmay be a therapeutic group strategy that offers promise for extending the aimsof feminist psychotherapy. The reflecting team approach to therapy is congru-ent with feminist principles, particularly with respect to offering women avoice, increasing critical consciousness, and championing change in the socialrelations undergirding inequitable material conditions.

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REFLECTING TEAMS

Michael White (1998) states that emotional problems do not stem from un-met needs or a disorder of the self. He sees emotional problems arise when in-dividuals are confined to “thin” conclusions about their lives. Telling one’sstory to “outsider witnesses” (those not readily privy to the inside story) andhaving the story retold by those witnesses offers clients the opportunity to con-struct thick descriptions of their identities, helping them to break free of theprison of thin conclusions. The witnesses are asked about what captured theirattention in the client’s telling of the story. As the witnesses set about the re-telling of the client’s story, clients immediately observe how they make an im-pact on others. The comments of the witnesses offer multiple perspectives andalternative paths that are either never considered, are overlooked, or aremarginalized because of clients’ preoccupations with problem-saturatedclaims about their identities. The third retelling of the clients’ stories occurswith the clients commenting on the witnesses’ tellings. Clients are asked whatthey realized from listening to the retellings and find themselves portrayingricher descriptions or alternative imaginings of their identities. The formalversion of outsider witness groups are called reflecting teams. The reflectingprocess draws on the French word réflexion that indicates that “somethingheard is taken in, thought over, and the thought is given back” (Andersen,1992, p. 67).

White (1998) offers a case example of a young boy subjected to peer abuseat school. School officials wanted him to change himself so he would not con-tinue to “incite” bullies’ attention. His father also preferred that he fight back.Much to the dismay of the school officials and the father, the boy did not fightback or change himself. White engaged other youth who had been the target ofpeer abuse as witnesses. He asked them what it said about the boy, that he re-fused “to do back to others, what has been done to him.” The children com-mented on his courage and his strength. Both the child and the father redefinedthe targeted behavior not only from an empowered perspective but one thatdoes not require that aggression be part of the definition of masculinity. Thefather’s admiration for his boy deepened as he listened to those alternative de-scriptions. Such instances are “ceremonies of redefinition” and involve “re-grading” retellings as opposed to “degrading” retellings. Degrading retellingsare lodged in deficit thinking and the individual is regarded as an object. It of-ten denies the politics of the person’s experience in favor of some personalshortcoming. Regrading retellings offer richly textured views of individuallives, allowing the individual to escape from deficit-based definitions. Prob-lems become more manageable as individuals embrace their preferred claimsabout their lives. While there is no claim that one description is truer than anyother, individuals are authentic when they feel at one with their preferredclaims about their own life.

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The reflecting team approach is self-consciously political, privileging col-laborative, egalitarian relationships that result in “a new discourse that gener-ates new meaning and options for change” (Swim, 1995, p. 100). Othertherapists describe the reflecting team as a political event that functions to dis-burse power among all the voices in the discourse. All views are equallyweighted: the dominant and the marginalized views and the view of profes-sionals, the clients, and their families (Griffith & Griffith, 1992). Reflectingteams are seen as a method for “building up a polyphonic truth,” whose goal isnot identifying one answer or solution but promoting dialogue among differ-ing voices. Ideas that emanate from therapists and clients are equally val-ued and the client is free to accept those which most fit. Rather thanretaining the hierarchy of the omniscient doctor who imposes the diagno-sis and treatment plan onto the passive patient, the course of treatment ismutually determined. The reflecting approach carries out its work on the“boundaries” between the client and the professionals (Seikkula, Aaltonen,Alakare, Haarakangas, Keränen, & Sutela, 1995).

By embracing collaboration between therapist and client in defining theproblem, Andersen (1995) believes that the result is to bring forth alternativeknowledges. He rejects what he describes as preunderstandings or modernistassumptions about objectivity, truth, the inner core or true self and theliteralization and transparency of language. These preunderstandings whenimposed on clients are seen as reflecting a “position of dominance” (Swim,1995). Paré (1999) writes that individuals can be “marginalized by dominantmeanings circulating in society.” These are imbedded in cultural discoursesabout everything from a “good mother,” to prescriptions for “mental health”or even “personhood” (p. 296). Paré concludes that counselors may uninten-tionally promote these prescriptions and hence pathologize clients.

In order to help people “escape the influence of the problem story” Ad-ams-Westcott and Isenbart (1995) offer clients the opportunity to shift fromthe role of “client” to “consultant” (p. 334) as does Selekman (1995) who in-vites “alumni,” teens that have completed his program, back to assist with his“stuck” clients. These former clients extend their insight to others who arestruggling with similar problems.

THE TEAM AND TEAM PROCESS

I discovered Michael White’s work while I was seeing my client Denise (apseudonym). Denise’s therapist referred her to me for help with repetitivedreams. Denise was a discouraged veteran of the mental health system. Shehad been dually diagnosed, on and off anti-psychotic medications and moodstabilizers and was an alumna of various psychiatric hospital stays. She was inindividual therapy with her primary therapist, was a member of an expressivearts group, was a member of a dream group I led, and she and I held individual

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therapy sessions focusing on dream work. She was in a volatile therapeutic re-lationship with her psychiatrist’s office staff. Her despair was palpable. Shesuffered from a broken heart, shattered professional aspirations, and an ailingbody. In spite of all the professionals assisting her, her panic and sorrow abouther impending divorce kept suicidal ideation at the forefront of her thoughts.These thoughts consumed huge amounts of her energy and claimed much ofher time. I had several other clients who had weathered their divorces andachieved some distance from this life-changing event. Because of her height-ened suicidal ideation, I approached Denise about using them as a reflectingteam; she readily agreed. The group consisted of three African Americanwomen (Denise included), one Caucasian woman, and myself, an AfricanAmerican woman therapist.

The three members of the reflecting team were in individual therapy withme for a range of issues including eating disorders and drug addiction. All thewomen were mothers, all had completed their bachelor’s degrees or wouldshortly attain them, and all were over 35 years of age. None was currently liv-ing with a spouse or partner. Each woman was enthusiastic about assistingDenise. Ramona, a woman with a strong feminist background, suggested thateach member of the team be given the opportunity to act both as team memberand recipient of the reflecting team commentary. Her compelling suggestionfurther helped to distribute power, since the “experts” were not mental healthprofessionals but were “consultants,” and the weekly shift of focus would pre-vent confinement of any one to “the patient” role.

The rotation became a feminist procedure, incorporating the methodologyof feminist praxis. This method requires each woman’s voice to be heard andbe equally valued, consensual decision making, lack of hierarchy, and theabandonment of the male-centered medical model of pathologizing socialproblems stemming from gender role inequality. With this rotating procedure,each woman had more experience with acts of agency (more time served on“the team”) than with occupying the position of the impaired. The reflectingteam met five times, once with each woman as the client and a final session inwhich we spoke as a group about the process of reflecting.

At the first meeting, each woman was given a set of guidelines to spell outthe appropriate behavior for participating as a team member (see Table 1).These guidelines were drawn from various sources in the literature, especiallyFriedman, Brecher, and Mittelmeir (1995). Paré’s (1999) guidelines includeasking team members to reflect only to other team members, to situate com-ments in their own experiences, to be tentative and curious, and importantly,“to notice experiences and ideas that do not fit the dominant problem narra-tives” and “notice discourses that support problems” (p. 299). Griffth andGriffth (1992) propose that team members refrain from any discussion aboutthe clients when the clients are not present and able to listen. Members shouldstress descriptions of what they saw during the interview and not make inter-pretations. There should be no attempt to seek a dominant view of a correct

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perspective on the problem; instead members are encouraged to strive to offermultiple ideas.

Friedman et al. (1995) suggest the reflecting team “generate metaphors andimages that activate, intrigue, and alter the client’s understanding of the prob-lem” (p. 186). This is a process known as “externalizing the problem” and iscredited to Michael White (Tomm, 1989). This is a way of talking about aproblem as if it were “distinct and separate” from the client. Andersen (1992),who coined the term “reflecting team” and set forth its postmodern tenets, pro-poses that questions have more utility than meanings and opinions. White usesquestions to discover how the problem has come to be the client’s dominantnarrative and how it has come to oppress the individual. Questions are also di-rected at raising the awareness of the occasions when the individual had thepower to outwit the problem. These are “influencing questions” and maycause individuals to notice their own competence. There is a strong emphasison therapeutic process as requiring questions that create curiosity about theproblem that can undermine the client’s belief in the purported truths of theproblem (Cecchin, 1987). Heretofore, the problem has been collapsed with theclient’s identity, making it hard to escape (Tomm, 1989). Andersen (1992) be-lieves the reflecting process works because the team encourages the act ofstory making, “and that act is the act of constituting the self” (p. 66).

Other guidelines offered by Friedman et al. (1995) include the creation ofalternative narratives that are unlike the client’s problem-saturated perspec-tive and to “identify and comment on aspects of the self that are ignored or un-noticed” (p. 192). Friedman et al. (1995) remind therapists to be humble.

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TABLE 1. Reflecting Team Guidelines

The reflecting team engages in a conversation after listening to the interview of the targetperson. The target person will hear herself spoken about as if she is eavesdropping on aconversation about herself.

1. Use the language and metaphors of the target person.

2. Talk about the problem the target person talks about.

3. Present ideas tentatively, with qualifications: perhaps, maybe, “it’s just an idea,”possibly, “I was wondering,” “I noticed that.”

4. If one person presents an idea, it is the responsibility of the next person to come upwith something else–we are going for a “smorgasbord of ideas.”

5. Avoid either/or positions. Examples: “I have some other ideas about that.” Otherideas are in addition to, not opposed to.

6. Situate ideas in your own experience.

7. Disagreement is acceptable when offered respectfully, and careful listening of op-posing ideas is encouraged.

8. The conversation of the reflecting team will last between 10-15 minutes. The aim isto obtain as many ideas as possible concerning a few themes.

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Clients are encouraged to reply to questions and comments with a “grammarof agency” reinforcing the therapeutic goal of learning to speak as active play-ers in the shaping of their own lives (Epston, White, & “Ben,” 1995). Cohen,Combs, DeLaurenti, DeLaurenti, Freedman, Larimer, and Shulman (2000)stress that hierarchy be minimized. They believe that the equality of themethod can be compromised if the team begins to act like an expert, fails to de-fine problems collaboratively, fails to be transparent (i.e., open and honest), si-lences certain voices, restrains a diversity of perspectives, or does not check itsown ideas against those constructed by the client (p. 290).

SESSION ILLUSTRATION

Given the focus of the reflecting team literature on questioning the targetperson, I devised one series of inquiries that I used with each of the fourwomen. The opening question is a standard one in the field, “What broughtyou to therapy today,” I listen to the response in a way that allows me to iden-tify a metaphor in the story of why the woman sought help. In Denise’s case,the metaphor focused on “giving up,” “jumping off,” and “disappearing out ofsociety.” Following the examples of Michael White (Tomm, 1989), I askedabout the most difficult aspects of the problem of Denise’s divorce in order toidentify factors that were particularly thorny. Denise focused on her feelingsof betrayal and consequent inability to trust. I asked her when she began think-ing about disappearing as an option, and she described the collapse of heridentities as a professional, a wife, and a mother of young adult children whohad left home. Denise believed that she was no longer a strong person and wasa terrible role model for her children; hence there was no reason to live. I theninquired about the situations that most likely brought about the wish to disap-pear. Her reply was related to the stresses of financial hardship, loneliness,boredom, and the fact that the only appointments she had were with doctorsand her lawyer. Her contact with her ex-husband enraged her, and resulted in ashifted from feelings of intense hostility to feelings of utter inferiority. Hersense of betrayal was total: her ailing body, her legal losses vis-à-vis the di-vorce, her employer’s successful litigation against her, her insomnia, and herchildren’s individuation were all experienced as direct attacks against herworth as a person. Because disappearance seemed to be her only option andone that she believed to be her sole true solution, I turned to the reflecting teamfor multiple ways of seeing.

Members of the reflecting team were no strangers to suicidal ideation andwere not overwhelmed by the subject matter. They briefly commented on theirown struggles with despair and how they found a reason to live. This wasDenise’s first experience hearing others talk about her, and she found relevantpoints in what each one had to say. I continued my questioning of Denise withthe need to discuss how the idea of disappearing had gotten her to do things

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she knew were against her better judgment. Denise responded by linking heranswer to something each of the others had revealed about their own experi-ences. For example, she focused on her continuing role as intermediary be-tween her nearly grown children and their father. In relationship to herhusband, she saw herself as a compliant child: that if she did not agree with histerms, she would be punished. When Denise disclosed that she had filed forseparate maintenance, I highlighted her act of agency with the active listeningstatement: “What I seem to be hearing now is that you think of yourself as acompliant child, but when you filed for separate maintenance, you put that outof the way and became an adult, and you said, ‘I’m going to take care of busi-ness.’”

At this point, I returned to the reflecting team and asked, “What does it sayabout Denise that there are times when she is not a compliant child?” One teammember responded that it indicated that she had choices, and that she wasmore empowered than she was giving herself credit for, that she could beproactive and not just reactive. Another member resonated with Denise’s posi-tion and used the metaphor of being cornered. She described how she hadshifted from being reactive to giving herself permission to have a plan. “Backthen, I felt I was pushed to do things that needed to be done because of sur-vival. It wasn’t my way. Now I am beginning to think that maybe I was chang-ing my way.”

DISCUSSION

I ended the session by highlighting the strategies she used to avoid allowingthe desire to disappear get the best of her. Tomm (1989) notes that reflexivequestions can be used with persons oppressed even by the most intractableemotional disturbances. The reflecting team offered temporary relief forDenise and acted to momentarily widen her restricted and lonely inner world.Tomm warns against high expectations for significant positive change in thosewith chronic problems, especially when their yearning to be rid of the problemis strong. He focuses instead on “unrealistic expectations” as a part of theproblem and emphasizes the importance of recognizing that small steps maybe more realistic. Adjusting expectations helps the client, therapists and fam-ily members to refrain from further pathologizing that stems from failure, dis-couragement, and a sense of hopelessness. Denise gained fortitude andinspiration from witnessing the struggles of the other women.

Denise participated as a member of the reflecting team for each of the otherwomen. In the final meeting to assess the work we had done as a group, Deniseaffirmed that the experience was different from her other experiences withgroup therapy because it was easier to accept statements about herself thatother people said to each other as opposed to group therapy, where one is con-fronted directly. She felt less criticized in the reflecting team approach. Grif-

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fith and Griffith (1992) suggest that discussions can be heard from varyingexistential positions: “hearing Self address the Other, hearing Self being ad-dressed as the Other, and hearing a conversation among Others that discussesSelf” (p. 48). They have found that when the self is directly addressed by theother, it is akin to being under the gaze. This brings up issues of power, controland the desire to protect one’s self. Listening from a reflecting position to aconversation taking place among others: “one watches the Others but does notexperience their watching gaze. The possibility for inner reflection is height-ened” (p. 48).

Women of color live in a society that is hostile to their existence and areforced to experience themselves as an object of the gaze frequently by patriar-chy, racism and class oppression. Griffith and Griffith (1992) write that insome instances there are overt political or cultural prohibitions against speak-ing about certain dilemmas. This leaves only the language of the body to ex-press its sorrow. Denise admitted that she sometimes held back from givingher full opinions during the reflecting process. Although the feminist methodwe used liberated the women from this gaze, it did not interrupt Denise’s repli-cation, within the reflecting team itself, of the coping strategy used in a hierar-chical, male-defined marriage. During the final meeting of the reflecting team,the feeling of not being able to say what she wanted to say gripped her. She re-alized this behavior as a general paralysis that resulted in an inability to “de-liver” her gifts and was accompanied by a pervasive fear that others mightappropriate these gifts. She lived in perpetual trepidation of being exploitedand of being rendered invisible.

Denise disclosed that she had conversations with her husband “going on inmy head all the time. And so if this comes up, I’m going to say this, that and theother. In a way, I do plan it way ahead of time. However, most times when itcomes, I don’t really discuss it. It doesn’t come. I don’t talk. I don’t say what Ihad thought I would say. It’s only every once in awhile that I can say what Ihave to say.” Because she could not speak, Denise would become “disgusted”with herself. Her reactions to direct confrontation with this powerful other (awell-educated, well-connected, prosperous professional man with a penchantfor placing his needs before anyone else’s) left her feeling incompetent. Sheyearned to be respected by him. Because she could not liberate herself fromthis need, she had grown physically ill and mentally distraught. A key factor inthe “empowerment” therapy for women of color, according to Gutierrez andLewis (1999), is the rejection of the legitimacy of the dominant order. Thisshift in consciousness constitutes a psychological transformation.

Espin (1994) writes that the feminist approach to therapy with women ofcolor can be empowering because it assists women’s acknowledgment of thedeleterious consequences of racism and sexism. Constant exposure to oppres-sive practices, notes Espin, explains why women of color are routinely intouch with their anger. Denise not only had suicidal ideation, but also was ex-tremely fearful of her homicidal fantasies.

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One of the contributions of feminist therapy to the treatment of women isthe validation of that anger and the facilitation and management of thatanger as a source of strength in oppressive social contexts. In feministtherapy, women of color can find their anger validated, examine theirexperience of anger, learn to manage it and circumvent depressionthrough freedom to express anger in productive action both in their per-sonal lives and in their social world. (p. 273)

Engaging in social action is a nondestructive way to manage anger. Deniseand the other two African American women were involved in Afrocentricgroups, or groups effecting social change for African Americans. Also, thewomen in the reflecting team were able to name sources of possible powersuch as forgotten skills, personal attributes, organizations in the community,and people from the past who had been helpful (Gutierrez & Lewis, 1999).Espin notes that the frequency of women of color to have a therapist who isalso of color is not high. There are benefits in sharing the status identity of“woman of color” for client and therapist. Whereas a person of color may beput in the position of having to educate a white therapist about the culture, bothpeople of color, therapist and client, know the culture from direct experience.Espin also believes that the woman therapist of color can serve as an effectiverole model. With a white therapist, there is the potential to reproduce socialpower differentials, which is especially unhelpful if the woman of color is crit-ically unaware.

In this paper, I have presented the view that the reflecting team approach togroup therapy can enhance and further the goals of feminist counseling. Thespecific strategies to accomplish this goal include allowing clients to act asconsultants, and rotating the focus of the team from session to session so thateach member has multiple opportunities to speak the language of agency. Theillustration of an individual session demonstrated how women of color, in par-ticular, may benefit from this therapeutic intervention.

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Andersen, T. (1995). Reflecting processes; acts of informing and forming: You canborrow my eyes, but you must not take them away from me! In S. Friedman (Ed.),The reflecting team in action: Collaborative practice in family therapy, 11-37. NewYork: The Guilford Press.

Andersen, T. (1992). Reflections on reflecting with families. In S. McNamee & K.Gergen (Eds.), Therapy as social construction, 54-68. Newbury Park, CA: Sage.

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Epston, D., and White, M., & “Ben” (1995). Consulting your consultants: A means tothe co-construction of alternative knowledges. In S. Friedman (Ed.), The reflectingteam in action: Collaborative practice in family therapy, 277-313. New York: TheGuilford Press.

Espin, O. (1994). Feminist approaches. In L. Comas-Diaz & B. Greene (Eds.), Womenof color: Integrating ethnic and gender identities in psychotherapy, 265-286. NewYork: The Guilford Press.

Friedman, S., Sally Brecher, S., & Cynthia Mittelmeier, S. (1995). Widening the lens,sharpening the focus: The reflecting process in managed care. In S. Friedman (Ed.),The reflecting team in action: Collaborative practice in family therapy, 184-204.New York: The Guilford Press.

Griffith, J. L., & Griffith, M. E. (1992). Speaking the unspeakable: Use of the reflectingposition in therapies for somatic symptoms. Family Systems Medicine, 10, 41-51.

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