You, me and the illness: Moral order and agency in couple therapy

1. You, me and the illness:Moral order and agency in couple therapy Katja Kurri Finnish Association for Mental Health, Education Center, Psychotherapy Clinic ”The disabled self” Nottingham, August 25-27, 2010

2. In this presentation I will argue that • The disclaimers of agency (for example ”illness”) are performatives that change the meaning of certain (morally) condemned actions • That the use of agency disclaimers and the presentation of ”weak agency” is in itself an agentic action that serves different social functions (politeness, saving face, downgrading responsibility) • Therapists’ would benefit from the view that disclaimers of agency do not (only) report a brute fact but in order to achieve social goals BUT at the same time the disclaimers also constitute private experience and hinder the change that is wished for

3. Disclaimers of agency • Passive voice – “it happened versus I did it” • Zero person - only the verb form in the 3rd person singular is expressed, the subject or object of the action is left out • Categorizations that externalize the agency – “illness – diagnostic categories” • Nominalisations – “appears as aggression versus he acts aggressively” • Use of verbs with iterative aspects and the future tense

4. Data • The data for this single case study stems from the Psychotherapy Clinic of the Finnish Association for Mental Health (FAMH). • The data consists of the video taped and transcribed first couple therapy session of a couple met in their home. • The co-therapists, one male and one female, have both more than 15 years of experience in family therapy.

5. The questions • How do the clients and the therapists formulate a common ground for their working relationship? • How is the problem - ”the illness” (as a discursive phenomena) – talked about and what are the functions of this?

6. The initial problem formulations • His initial problem formulation: • Hannu: “we have been together already about five years (1) and almost all that time has quite a lot (1) been overshadowed by Kerttu’s illness” • Her initial problem formulation: • Kerttu: that kind of for everyday matters we could get support so that it would not be only like my illness and that perhaps for that also that the relationship would somehow in some way go forward or that it has kind of now been stuck around my illness like for many years that’s of course is a somewhat double-sided affair that I should then maybe feel better again so that my illness would not be so or then learn some kind of rules or exercises that we would follow or (1) some exercises or something like that that that (1) that (.) kind of or that’s how I think maybe

7. The presentation of ”weak agency” is in itself an agentic action that cerves different social functions • The spouses describe the illness as an agent that influences the relationship but the illness is depicted as having a life of its own which cannot be affected - it is not set as a goal of therapy. • As such both spouses are in a position of weak agency with regards to the illness. • This means two different things for the spouses: • Kerttu can not be responsible for it, she does not choose acting or feeling in a ill manner – the illness is responsible. • Hannu can not blame her for ”ill” behavior, nor can he justly do a decision of leaving her since she does not choose her condition.  The disclaimers of agency (”illness”) do not orient people to solve the conflict between the two contexts but enables their coexistence

8. The disclaimers of agency are performatives that change the meaning of certain (morally) condemned actions H: for example if I had thought back then when we had it difficult that (3) a deed corresponds to character (1) I would have propably left (1) escaped (1) rapidly (1) but then I try (.) or I have tried gave like (1) that it is the illness that speaks (.) and the anxiety that she has(.) and not like she (.) is like that…

9. The disclaimers of agency constitute private experience and hinder the change that is wished for • Disclaimers of agency achieve social and moral goals • They create a social and moral order that affects how people organize around an ”ill” person • Both the social reality and one’s own public narrative are building blocks of inner story of self which people use to narrate their experience and guide their action • Therapists interventions can be seen as attempts to renegotiate the moral order of the couples relationship

10. An illness or being ill • T1: but yes your own because in your (.) daily life you of course have this (.)I mean your work and if you put in you somehow think of a weekday (.)the what kind of (.) how big a share or somehow would Kerttu’s illness then take (.) or her being ill or ((turning to Kerttu)) what would be the right • K: maybe illness I use myself • T1: illness (.) you speak of [an illness • K: [yes illness • T1: yes yes

11. Therapist’s turn follows on one hand Hannu’s notion of their daily life being overshadowed by ”the illness”, but at the same time it challanges the totality of that formulation • Wording - the therapist introduces an idea of replacing the pharase ”Kerttu’s illness” (sairaus) with the wording ”being ill” (sairastaa). The latter would imply a more transitory condition. • And even more importantly, ”you speak of an illness” highlights also a choice of wording, Kerttu’s active agency in giving a name to her behaviors and emotions.

12. So what is the illness? T2: yes what does the word illness mean for you or you know what it (.)you ((both spouses)) said or you ((Kerttu)) said that you use the wordillness that it is not anything else but an illness so what illness is it what does it K: I have erm a compulsive disorder (1) quite difficult (.) and then (1) inaddition to that depression (.) kind of (.) they go hand in hand (3) ermfor me the illness means that I cannot live a normal (.) full life or do things(1) that I would like to do which makes my own life quite painful too

13. Illness or character? T2: you also said Hannu that you don’t really know what is illness and whatis like somehow (3) style [and what now personality H: [yes that that is what is sort of (1) how wouldI say (.) complicated this relationship also that (3) when you start a relationshipor dating then (1) there is the idea that you (.) learn to know each other (.) andfigure out that do we match together (.) and what will this be (.) even when wehave been together for five years (1) then (1) on that scale our relationship isnot even close to five years maybe (1) or on the other hand we have experiencedso many hardships here (.) on the other hand (1) but then (.) also those kind ofthings that (.) in some (.) it may difficult for me to know what what (.) for anybody to know (.) not even Kerttu herself that what is her character and whatis the impact of that illness here

14. The therapists’ interventions • Are delicate invitations to loosen the stuck positions and stories about the illness. • The special task of the therapist in the given situation was and we claim is, in other situations alike, to challenge the “non-agentic position” in a delicate way and through this to offer the participants a possibility to move into different (moral) positions. • Here the therapy can be seen to work to break the routine maintenance of self and the relationship?

15. The reflexive process of agency