Karl Tomm Research Articles

Lessons From the Field. Family Grief Care and Bibliotherapy: A Call for Models and Studies

ObjectiveFor this Lesson From the Field report, I write as a family and grief educator to advocate for greater attention to bibliotherapy by family scientists, therapists, and educators. Bibliotherapy (also referred to as poetry therapy or therapeutic storytelling) is the use of literary resources, storytelling, or writing with the purpose of healing.BackgroundDisruptive changes can result in altered personal or family stories. Grief educator Tom Attig (1996) reported that after significant changes, such as bereavement, many persons describe a process of relearning their world. Family therapist Karl Tomm (1990) asserted that a human task throughout life is to story and re‐story. Earlier and current models of family development include milestones of changing family stories (see Duvall, 1962; McGoldrick et al., 2011). A current collective example is personal and family disruptions in response to the COVID‐19 pandemic. Despite many accounts, journals like Family Relations have rarely explored the intersection of family changes (for this article, the focus is family changes that result in loss and grief) using the perspectives and tools of bibliotherapy.MethodDisruptive changes and the resulting grief and loss for individuals and families were used as an example of a subject matter worthy of family scientists' attention.Conclusion and ImplicationsFamily grief care includes attention to changing family stories. Enhanced studies of bibliotherapy by family scientists can inform and enrich support for families through times of grief.

The IPscope: Applications to Couple and Family Therapy Supervision

ABSTRACT The IPscope (IP signifying Interpersonal Patterns), developed at the Calgary Family Therapy Center by Karl Tomm and colleagues, provides a way of understanding behavior in context. Building on our work using the IPscope to conceptualize the functioning of families, we have also used the IPscope to bring a relational ethos to CFT supervision. After describing the development of the IPscope and its use at the CFTC, we describe specific applications of the IPscope to several key foci of clinical supervision: cross-cultural issues; the supervisory working alliance, with specific reference to supervisee nondisclosure and informal supervision; supporting supervisees to develop case conceptualization skills with the IPscopic reflectogram; dealing with impasses in therapy or supervision, usually labeled intrapsychically as countertransference, and a practical approach to isomorphism. Finally, we address limitations and critique of the IPscope.

Down the IPscope: A Case Study of Relational Assessment Practices at the Calgary Family Therapy Centre

ABSTRACTThe Calgary Family Therapy Centre (Canada), under the clinical direction of Dr. Karl Tomm, has been a site of innovative practice for decades. One such innovative practice has been the development and clinical use of the interpersonal patterns diagnostic system for assessing relational concerns, therapeutic developments, and well-being. The first author studied IPscope’s development and recent use at the Calgary Family Therapy Centre using a case study format. Through interviews with clinical staff, trainees, and administrators, document reviews, ethnographic observation, and reference to the literature on diagnosis and family therapy we highlight the unique practices, experiences, and circumstances involved in the use of the IPscope and discuss my findings in the context of family therapy practice and administration increasingly dominated by expected use of Diagnostic and Statistical Manual of Mental Disorders diagnoses.

Societal Discourses That Help in Family Therapy: A Modified Situational Analysis of the Relationships Between Societal Expectations and Healing Patterns in Parent-Child Conflict

This research inquiry focused on how societal discourses played a role in the ways families experiencing trouble developed strategies to improve their lives. We believe that by looking at how families enact societal discourses for their benefit, family therapists would be better able to support these healthful initiatives. We studied Karl Tomm's idea of healing interpersonal patterns (HIPs), that is, those patterns of interaction that families engage in to counter their problems, specifically in relation to societal discourses. Staff clinicians and student interns of the Calgary Family Therapy Centre conducted the study in the course of their daily work routine, utilizing clinician-friendly research processes we call Research As Daily Practice. The first type of data included the most common HIPs from case records and the second type entailed societal discourses presumed to be helpful. Using situational analysis, we looked for intersections between the HIPs and societal discourses and were able to map the...

Internalized Other Interviewing in Relational Therapy: Three Discursive Approaches to Understanding its Use and Outcomes.

For over 20years, family therapist Karl Tomm has been engaging families and couples with a therapeutic intervention he calls Internalized Other Interviewing (IOI). The IOI (cf. Emmerson-Whyte, 2010; Hurley, 2006) entails interviewing clients, from the personal experiences of partners and family members as an internalized other. The IOI is based on the idea that through dialogues over time, one can internalize a sense of one's conversational partner responsiveness in reliably anticipated ways. Anyone who has thought in a conversation with a family member or partner, "Oh there s/he goes again," or anticipates next words before they leave the other's mouth, has a sense of what we are calling an internalized other. For Tomm, the internalized anticipations partners and family members may have offers entry points into new dialogues with therapeutic potential-particularly, when their actual dialogues get stuck in dispreferred patterns.

Therapeutic Conversations 1: A Twentieth Anniversary Reflection—introduction to the Special Section

I admit it. I was star struck! I was working in an adolescent mental health center in Calgary, Alberta, in the fall of 1990. We were preparing to sponsor Bill O’Hanlon the next spring. His schedule said he was to be in Tulsa, Oklahoma in June of 1991, along with Steve de Shazer, David Epston, Stephen Gilligan, Karl Tomm, John Weakland, Michele Weiner-Davis, and Michael White, at a conference entitled “Generating Possibilities Through Therapeutic Conversations.” I decided, then and there, I had to get to Tulsa, come hell or high water, June 27 to 30, 1991. The conference proceedings (Gilligan & Price, 1993) were published soon after. As a young therapist in the late 1980s and early 1990s, I was swept along in a period of transition in the brief and systemic therapies. Previously, practitioners largely viewed themselves as outside of the client system, intervening by sizing up system dynamics and assigning a therapeutic task. However, in the years surrounding TC 1, new voices (Andersen, 1995; Anderson & Goolishian, 1992; Cechin, 1992; Fleuridas, Nelson, & Rosenthal, 1986; Lipchik & de Shazer, 1986; O’Hanlon & Weiner-Davis, 1989; Penn, 1982, 1985; Tomm, 1987a, 1987b, 1988; White & Epston, 1990) proposed a different way of thinking about therapy. This new sensibility sees therapy as a collaborative conversation meant to construct new realities and preferred client futures. The conversation is the intervention. In this context, Bill O’Hanlon and others organized the inaugural Therapeutic Conversations (TC 1) conference in Tulsa, Oklahoma, in June 1991. Bill recalled:

Responsive persistence part I: therapist influence in postmodern practice.

Feminist and social constructionist developments in family therapy highlighted the importance of attending to therapist-client power relations and incorporating clients' understandings and preferences as a part of therapy. Significantly, less attention has been given to how postmodern therapists do use their power and influence. This is an important topic because it is therapists who have the major responsibility for guiding the interaction with clients and persisting in this so that change is facilitated. Therapist persistence in various forms and across dimensions of therapy process is examined to expand understanding of therapist influence in postmodern and collaborative work. An analysis of responsive persistence in a session with Karl Tomm as the therapist is presented to illustrate this conceptual framing.

The Evolution of Family Process: Contexts and Transformations1,2

The Evolution of Family Process: Contexts and Transformations1,2

Therapeutic collaboration: a conversation analysis of constructionist therapy

Collaboration has been a frequently used construct to describe the practices of different therapeutic approaches for working with clients. Missing, however, is a sense of how collaboration is enacted in dialogues between therapists and clients. After defining ‘collaboration’, we analyse the actual conversational practices of Karl Tomm in his work with a couple, using conversation analysis. Our aim is to highlight the conversational accomplishment of collaboration in observable ways that we feel may be linked to enhancing one's conversational and collaborative practice of therapy.

Techniques for framing questions in conducting family meetings in palliative care

Family therapy has developed several approaches to framing questions within family meetings, but few of these techniques have been adapted for palliative care. We focus on the application of questioning techniques from systemic family therapy to palliative care. More specifically, we describe and give examples of the model of asking questions developed by Karl Tomm (1988) through its application in Family Focused Grief Therapy (FFGT), a preventive intervention delivered to high-risk families during palliative care and bereavement. First, the type of questions used across the course of therapy is explored based on the interventive questioning model. Then, a case example is provided to demonstrate the use and adaptation of this model in a palliative care setting. At the beginning of therapy, the most frequent questions were linear and circular, moving around the family to build up a picture of events from everyone's perspective. As for the frequency of reflexive and strategic questions, these increased as the therapy progressed, bringing the family to new perspectives. The case example fleshes out the importance of each type of question, all of which have a proper place in the course of therapy. These illustrations highlight the value of having a model of questioning styles to guide the clinician when exploring palliative care issues, such as care provision, coping and grief, intimacy, and discussing death. This framework could be useful in guiding supervisors, trainees, and clinicians seeking to build skills and optimize their interventions in a palliative care setting.

Karl Tomm: His Changing Views on Family Therapy Over 35 Years

Karl Tomm has been the director of the Family Therapy Program in Calgary for more than 35 years. He has developed an international reputation not only as a family therapist, major innovator, theoretician, and trainer of family therapists but also as a leader in facilitating dialogues among many of the world's family therapists. He started his career applying the problem solving approach to family therapy, developed by Nathan Epstein (Part I). In the 1980s, Karl championed the work of the Milan Group (Part II). More recently, Karl has promoted the work of Michael White and David Epston in narrative therapy (Part III). Don Collins recently had the opportunity and pleasure to interview Karl about the evolution of his thinking and practice over the span of his career.

The Discursive Performance of the Alliance in Family Therapy: A Conversation Analytic Perspective

Following the ‘discursive’ turn in family therapy, the attention of practitioners shifted towards understanding how culture and language shape meaning‐making in therapy. In this article, we demonstrate how conversation analysis (CA) can be used to examine the processes and outcomes of systemic/constructionist practice. We used CA to study collaborative interactions of a renowned constructionist therapist Karl Tomm and one client‐family. Viewing collaboration as a pivotal aspect of the therapeutic alliance, we demonstrate how the ‘split’ within‐system alliances were developed and sustained in the course of therapy and how they were discursively transformed into ‘intact’ alliances. The therapist's efforts to align with perspectives of family members (and subsystems) seemed pivotal in this process.

GIVING ADVICE ON ADVICE‐GIVING: A CONVERSATION ANALYSIS OF KARL TOMM's PRACTICE

In this article we challenge a common definition of therapeutic advice as a linear, one-way accomplishment, enacted by therapists toward clients. We also offer a novel conception of advice as a dialogical "performance," to which both therapists and clients contribute. We discuss the results of a conversation analysis of a family therapy session by Karl Tomm, showing sequential practices employed by a family therapist and a family as they jointly work out common ground to set the stage for the therapist's eventual offering of advice. We discuss the results of this study in light of the literature on advice provision in various contexts.

Transcending a Differend: Studying Therapeutic Processes Conversationally

Studies of actual conversational behaviours used to generate positive change in family therapy are relatively rare. In this study such conversational details were examined as they occurred in a single session of family therapy. With passages identified by family members as helpful, discursive methods of analysis (conversation analysis and critical discourse analysis) were used to examine an actual conversation between a renowned family therapist (Karl Tomm) and a family formerly at a conversational impasse. Conversational practices and sequences in talk used by the therapist and family members to bridge these differences in their ways of relating are discussed.

Therapeutic Loving: Opening Space for Children and Their Families

The authors discuss how two co-emerging trends in narrative therapy (deconstruction/narrative and hermeneutics/Collaborative Language Systems) and Karl Tomm's (1991) work on ethical postures has influenced their work with children and their families. The discussion focuses on using art and lists to engage children in exploring their experiential worlds, collaborating with parents and other systems, and opening space to safety and other viewpoints through therapeutic loving. Examples and case studies are presented to illustrate these ideas and practices.

Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives

Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives Frank M. Dattilio (Ed.). New York: Guilford Press (www.guilford.com). 1998, 486 pp., $44.00 (hardcover). In the contemporary social sciences it is becoming well recognized that individuals actively construct the meaning of their experiences. From this postmodern perspective, distinguishing perception from interpretation becomes largely irrelevant. Causality is no longer conceived as a linear process (e.g., objective reality impinging upon subjective interpretation), but as a circular one characterized by continual feedback and interplay among the various components of complex systems. In psychotherapy, these ideas have encouraged movement away from intrapsychic models of psychopathology to those conceptualizing the individual as acting and reacting within these multiple dynamic systems. The greatest elaboration of the systems perspective has occurred in the realm of couple and family therapy, where therapists have harnessed the power of these assumptions to develop creative and powerful clinical interventions. For many cognitive-behavioral therapists, most of whom were raised on assumptions of linear causality (e.g., behavioral contingencies, cognitive distortions leading to maladaptive responses) and logical positivism (e.g., examination of objective evidence to refute distorted thoughts), the systems perspective can seem somewhat alien. On the other hand, systemic therapists may be unfamiliar with some of the directive and empirically validated therapeutic tools which are second nature to cognitive-behavioral therapists. Fortunately for practitioners of both perspectives, there now exists the informative and accessible Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives, edited by Frank Dattilio. This volume features contributions by leading clinicians representing diverse perspectives on the treatment of couples and families, including such recognizable names as Salvador Minuchin, Norman Epstein, Donald Baucom, James Keim, David Keith, Michael Hoyt, Luciano L'Abate, Karl Tomm, and Fred Sander. Together, Dattilio and these authors have thoughtfully chosen cases that illustrate areas of intersection between the cognitive-behavioral and systemic perspectives, highlighting the possibilities for fruitful cross-pollination between the models. This is consonant with Dattilio's stated intent to facilitate theoretical integration across approaches. The case study approach is an especially congenial method of accomplishing this task. By deemphasizing theory and presenting what couple and family therapists actually do in sessions, the reader gains a wealth of compelling and useful techniques to add to his or her therapeutic arsenal. Moreover, the authors endeavor to explain how specific interventions arise from seasoned clinical intuition. Thus, the reader also is treated to (and may be somewhat awed by) the true artistry and boldness of these clinicians. What distinguishes this book from other volumes on couple and family therapy is the ongoing dialogue between the editor, representing cognitive-behavioral therapy, and the authors representing alternative theoretical perspectives. Throughout each chapter, Dattilio raises thoughtful questions, draws comparisons to a standard cognitive-behavioral approach, and provides a rationale for alternative interventions. These editorial comments appear italicized and indented within the body of each chapter's text, allowing the reader to consider alternative interventions at key decision points in the case. At the end of each chapter the authors are given an opportunity to respond to Dattilio's comments. To the credit of both the chapter authors and editor, these exchanges remain civil and constructive even where irreconcilable differences occur. This dialogic approach permits the reader to reflect on the comparative advantages and, in many cases, the compatibility, of cognitive-behavioral and systemic approaches and to consider the value of technical integration. …

Karl Tomm: Threads to His Work

Karl Tomm: Threads to His Work

“None of The Following is True”: An Interview with Karl Tomm

Karl Tomm is Director of the Family Therapy Training Programme at the University of Calgary, Canada. He is known for his work on Circular Pattern Diagramming and articles detailing the Milan Systemic Approach to family therapy. In March he visited Australia where he conducted workshops in Adelaide and Sydney. The following interview was recorded at the end of the first day of the Adelaide Workshop.