Commendations: Listening to the Silent Side of a Family Intervention

Abstract

A therapeutic conversation of one family's experience in a traumatic house fire provides a springboard for discussion and illustrates the complexities of the family intervention known as a commendation. This intervention is one of the micromoves described in the Illness Beliefs Model. Commendations are discussed within a strengths-and-resource discourse and defined and contrasted with similar therapeutic interventions, and questions are raised and extended about the nature of these practices. The authors suggest that exclusively attending to the verbal aspect of commendations may obscure equally meaningful ways that this intervention is actualized in therapeutic relationships.

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10.1177/1074840703251968 ARTICLEJFN, May 2003, Vol. 9 No. 2Limacher, Wright / Silent Side of Family Intervention
Commendations: Listening to
the Silent Side of a Family Intervention
Lori Houger Limacher, R.N., M.N.
Lorraine M. Wright, R.N., Ph.D.
University of Calgary
A therapeutic conversation of one family’s experience in a traumatic house
fire provides a springboard for discussion and illustrates the complexities of
the family intervention known as a commendation. This intervention is one
of the micromoves described in the Illness Beliefs Model. Commendations are
discussed within a strengths-and-resource discourse and defined and con-
trasted with similar therapeutic interventions, and questions are raised and
extended about the nature of these practices. The authors suggest that exclu-
sively attending to the verbal aspect of commendations may obscure equally
meaningful ways that this intervention is actualized in therapeutic
relationships.
Keywords: family intervention; family nursing; commendation; family
resilience
Brigit, an animated, vivacious, 6-year-old girl, sat crouched on the floor
beside me, her previously active and shifting little body now com
-
pletely still and riveted to one spot. This postural change captured my
attention, drawing me forward into an almost choreographed
Lori gratefully acknowledges the generous support of her doctoral pro
-
gram of study by the Izaak Walton Killam Foundation. Correspondence con
-
cerning this article should be addressed to Lori Houger Limacher, 907-25 Ave
NW, Calgary, Alberta, Canada, T2M 2B5; e-mail: ldlimach@telusplanet.net.
JOURNAL OF FAMILY NURSING, 2003, 9(2), 130-150
DOI: 10.1177/1074840703251968
© 2003 Sage Publications
130

relationship with Brigit and her aunt, who had brought her to the ses
-
sion. Leaning into one another, we closed the space between us, study
-
ing intently the thin piece of paper where we were attempting to draw
out the weighty and grave details of Brigit’s escape from a burning
house. Brigit’s mother was in an intensive care unit in a hospital in
another city with third-degree burns over 65% of her body, her life
hanging precariously. Brigit had not seen her mother since the day of
the fire a month previously and was now living with her aunt, uncle,
and cousins in a new city. Tracing lines of meaning onto the thin piece of
paper held between us seemed completely insufficient.
I inquired about the details of this fire as systematically as I might
ask about my child’s day at school, only this was no ordinary day and
no ordinary event. Constant tension dangled in the air, reminding me
that the pendulum could swing at any time. Multiple feelings were
roused and partially contained in our conversation—anxiety, fear, sad
-
ness, horror, and relief. There was a palpable fear of hearing the details
of such a tragic, horrific event and uncertainty about how the telling of
this story might influence this family and myself. How would I know
this conversation was creating a context for healing and not
retraumatizing Brigit and her aunt, who now trusted me to guide them
through this process? I had to trust the process, the conversation, the
family, and myself. A moment of relief washed over me, relief that this
was not my child. Was this comforting, self-soothing thought a mecha-
nism for maintaining safety and distance or a thought that allowed me
to forge ahead? These tensions and fears both dulled and heightened
my curiosity as I encouraged Brigit by asking, “What happened next?”
Apprehension floated between us, breaking and resurfacing as
Brigit timidly spoke. “I woke up in my bed, the top bunk, because I
could feel flames on my foot, burning my foot ...ithurt.” Brigit pointed
with her finger to the edge of her foot to illustrate where the damage
occurred. “There was smoke everywhere....Itwasheavy....Itwas
dark. . . . I couldn’t breathe.”
Silence.
Waiting.
Listening.
“What did you do then, Brigit? How did you get off the top bunk of
the bed?”
Slowly and gently I prodded for details, asking questions followed
by more questions. Brigit’s aunt listened intently through glistening,
teary eyes while her silence urged and pressed the story forward.
Brigit answered, “I jumped down!” Once again, she began to move,
now flinging her arms up into the air to demonstrate the way she had
rapidly leapt from the bed. “Then I saw a flash of light . . . and I broke the
window.”
Limacher, Wright / Silent Side of Family Intervention 131

I was shocked and surprised by this young girl’s intuitiveness and
wisdom, leading me to ask rather incredulously, “How did you know
to break the window?”
“I saw the flash of light. I used a broom or something.”
Then suddenly and without warning, Brigit leaned back and away
from her aunt and me and dramatically inhaled, holding a deep, pro
-
longed, and concentrated breath. Caught up in the moment, I instinc
-
tively locked my diaphragm, all at once synchronized and in rhythm
with the stillness, the silence. I could feel my heart speak, beating faster,
and faster, and faster, until I experienced a fleeting moment of pain and
terror at the thought of Brigit’s delicate lungs struggling for air with no
sign of relief.
Brigit exhaled abruptly and continued on rapidly telling the story,
her story: “I breathed in some air, just like that . . . and then I ran up the
stairs and out the back door.”
Brigit’s aunt spontaneously declared, “Wow, you have a great mem
-
ory, Brigit.”
Further details spilled out of Brigit’s mouth until she eventually
rested and began to recount the last time she had seen her mother. Her
mother had been carried out of the burning building where she became
trapped while trying desperately to rescue her children.
“I saw my mother on fire. I could see little pieces of electricity every-
where, on her back . . . her neck . . . her face.” Brigit traced outlines on her
back, neck, and face with her fingers, tiny delicate fingers, as she spoke
with her eyes wide open.
Her mother’s sister, Brigit’s aunt, wept—eyes wide open, heart
wide open, suffering wide open.
What was it that the nurse did in this clinical vignette that brought
forth this family’s strengths and resources, shaping and moving the
conversation in a particular direction? We believe it was the question
-
ing, listening, and silences that focused and framed the form of this
family’s suffering in a way that was affirming and that acknowledged
their experience with a horrendous trauma. It was within these prac
-
tices that the family was commended.
The second author first began to use the term commendation to
describe the practice of noticing, drawing forth, and highlighting pre
-
viously unobserved, forgotten, or unspoken family strengths, compe
-
tencies, or resources. The intervention called a commendation is a
central component in the Illness Beliefs Model (IBM) (Wright, Watson, &
Bell, 1996). Questioning and listening, although considered to be
powerful interventions, have remained peripheral in current descrip
-
tions of commending practices.
132 JFN, May 2003, Vol. 9 No. 2

We now prefer an expanded and refined definition of commenda
-
tions from one that emphasizes direct, planned, verbal statements
drawing forth and highlighting family strengths and resources to one
that includes the dimensions of indirect, nonverbal, and even acci
-
dental shaping, such as that embedded in questions, listening,
silences, and families’ self-commending practices. This requires relo
-
cation to a different epistemological position. Locating commending
practices in clear, tight, concrete, verbal descriptions, where “inter
-
ventions” are generally situated, is insufficient for capturing their
complexity and contributions to healing and change. To broaden our
understanding of commendations, a less precise, more fluid and open
approach will be required—the antithesis of clarity.
In the moment of labeling commendations as an intervention or
practice, a particular staticality is introduced that confines, defines,
and establishes a separation between the subject and object, thereby
reducing and minimizing the complexity of the therapeutic relation-
ships where commendations emerge. The word intervention has long
been situated within the natural sciences, particularly in medicine.
An intervention becomes separated, decontextualized, and compart-
mentalized into a specific action that a subject can control and repli-
cate to eliminate or cure a disease (Bishop & Scudder, 1995). The word
practice contains similar seeds of meaning when it is understood, as in
the domain of the natural sciences, to be a continuous or habitual per-
formance exercised by a profession (Hoad, 1986). Ritualizing inter-
ventions such as commendations or developing “menu-driven lists”
(Benner, Hooper-Kyriakidis, & Stannard, 1999) that emphasize the
classification of best practices rather than opening up dialogue
focused on what generates best practice may contribute to oversim
-
plifying these practices.
Wright et al. (1996) leaned toward using the language of moves to
describe interventions, as one means to introduce fluidity and circu
-
larity in the face of language that invokes the vision of a stationary,
static, unidirectional, one-time event. Therapeutic conversations are
linguistic in nature and are events in language, not a conceptual
knowing that can be reduced to concepts or single words (Caputo,
1987). Therefore, we will refer to commendations interchangeably in
this article as an intervention, practice, and a move. Clear, precise lan
-
guage may constrain our attempts to capture the complexity of com
-
mendations and their contributions to healing and change. Commen
-
dations happen within human relationships and are therefore always
“context dependent” (Flyvbjerg, 2001).
Limacher, Wright / Silent Side of Family Intervention 133

CONTEXTUALIZING COMMENDATIONS:
THE CULTURAL DISCOURSE
In the English language, to commend is to present something as
worthy of acceptance, to direct attention toward, or to praise and rec
-
ommend, whereas the offering of a commendation is the act of com
-
mending (Onions, 1957). The word commendation is from the Latin
commendare, meaning to give in trust or charge and pertaining to the
approval of the conduct or character of a person (Hoad, 1986). The
nurse generally demonstrates “approval” through the action of notic
-
ing particular aspects of a situation and then by acknowledging these
aspects, often by verbalizing praise. The word commendation itself
may be unique to the English language; for example, there is no word
for commendation in the Swedish language (Bell, 2001), but what
comes forward in the experience of receiving praise, attention, and
acceptance may be a more familiar, shared human event.
Commendations have been distinguished from compliments in
the IBM where compliments are described as observational state-
ments about a one-time event (e.g., the way Brigit offered details
about the fire and her precision and memory), whereas commenda-
tions focus on sustainable patterns observed across time (e.g., the
bravery evident in this family in facing up to sadness, in escaping the
fire, and in attempting to rescue one another from the flames) (Wright
& Leahey, 1994). Solution-focused family therapists, however, have
embraced the language of compliments (Campbell, Elder, Gallagher,
Simon, & Taylor, 1999; deShazer, 1988; Wall, Kleckner, Amendt, &
duRee Bryant, 1989). Compliments are defined as ceremonial acts or
expressions of respect or admiration (Onions, 1957), and the etymo-
logical root of this word suggests it is a polite phrase of commenda
-
tion (Hoad, 1986), bringing us full circle to Wright and colleagues’
(1996) definition. Narrative therapists (Freedman & Combs, 1996;
Freeman, Epston, & Lobovits, 1997; White, 1989; White & Epston,
1990) have adopted the terms unique outcomes or sparkling moments to
describe the movement of noticing those actions and thoughts that
fall outside of the more dominant problem-saturated stories, directly
and indirectly drawing forward previously unnoticed strengths and
resources. Commendations, compliments, or sparkling moments,
although distinguished differently, may create similar experiences for
families and nurses who are engaged in therapeutic conversations
given that their intentions are similar, converging, and focusing on
drawing forward previously unnoticed family strengths and
134 JFN, May 2003, Vol. 9 No. 2

resources. Perhaps it is this shared experience or event that comes for
-
ward in the act of recognizing and drawing forth family strengths and
resources that all three of these therapeutic approaches are attempt
-
ing to capture with their descriptions. These interventions might
share a certain affinity not only to one another but also to other con
-
cepts such as caring, listening, support, affirmation, encouragement,
and empathy. Recently, there has been interest directed toward
understanding the common factors that exist within many
approaches and models, factors that could account for change in fam
-
ilies (Blow & Sprenkle, 2001; Duncan, 2001; Hubble, Duncan, & Miller,
1999; Rosenzweig, 1936; Wampold et al., 1997). One such factor might
be the experience that is drawn forward in conversations in which
family strengths and resources are acknowledged.
Foregrounding Strengths and Resources
The emphasis on strengths and resources in the contemporary
therapy literature may well reflect dominant Western cultural
assumptions. Emphasizing strengths rather than deficits is a founda-
tional cornerstone of the IBM (Wright et al., 1996) and is a posture con-
sistent with the postmodern trend away from pathologizing dis-
courses focused on deficits (Nichols & Schwartz, 1998; Wright &
Leahey, 2000). It has been suggested that focusing on strengths is a
conscious choice (Wright & Leahey, 2000). It could be argued that this
posture invites an ontological shift. Perhaps when we speak of
emphasizing strengths, what we are really declaring is an ideological
position in the world, a moral and ethical stance. We believe there is a
strong relationship between nurses who embrace such an ideology
and the intervention of commendations.
Commendations can be conceptualized as a particular practice
action, one that extends and embraces this moral and ethical position
-
ing (Andersen, 2001; Freedman & Combs, 1996). Watts and Pietrzak
(2000) reminded us that these ethics and a focus on strengths and
resources predated the postmodern turn and was evident early in
the 20th century in Adler’s pioneering work, work that was
largely ignored and regarded as unscientific perhaps because of its
emphasis on
empathic listening; nonjudgmental acceptance; conveying respect for
clients and developing collaborative and egalitarian relationships; hav
-
ing faith in clients and conveying that faith and confidence to them;
Limacher, Wright / Silent Side of Family Intervention 135

viewing clients as “decision makers”; focusing on strengths, assets, and
resources clients may develop or already possess. (Watts & Pietrzak,
2000, p. 445)
Although valuing and emphasizing strengths and resources pre
-
dated the postmodern era, this discourse did not dominate the family
nursing literature in the past century, perhaps because these softer
concepts were not considered to be scientific. Liaschenko (1998)
argued that many kinds of knowledge, including the knowledge
about how to get things done (not in a technical way but as an advo
-
cate) and knowledge of patients’ experiences, were not legitimized
within the dominant scientific discourse; instead, they remained
invisible and silenced. We believe that knowledge about the impor
-
tance of recognizing and building on families’ strengths and
resources has become more visible and legitimized in family nursing
practice and research.
For example, Moules (2000, 2002), in a recent hermeneutic study
focused on the intervention of therapeutic letter writing, reported
that families identified the commendations offered in the text of let-
ters as very significant. Commendations, she suggested, offered not
only a pragmatic stance but also an ethical one given that they
appeared to reduce families’ suffering. Robinson’s (1996) grounded-
theory study identified one important aspect of a healing therapeutic
relational stance as the interviewer’s ability to mirror families’
strengths. In a later study, Robinson (1998) explored the process and
outcomes of interventions with families experiencing chronic illness
and reported that the orientation toward possibilities, strengths, and
resources was an extremely potent aspect of therapeutic conversa-
tions, particularly for the women in the families she interviewed.
The relationship between gender and commendations may be
another powerful cultural and contextual element. Ogrodniczuk,
Piper, Joyce, and McCallum (2001) found that women responded
better to an approach that used more active praise and pointing out of
strengths in contrast with men, who responded to a more confronta
-
tional style of interaction. This is similar to Haley’s (2001) findings in a
discourse analysis studying couples’ experiences with a reflecting
team in which men commented that they desired more concrete
instrumental feedback from the team members in addition to sup
-
portive or commending comments.
Using an observational coding system, Gottman (1999) noticed
how an increase in positive affect (agreement, laughter, approval,
136 JFN, May 2003, Vol. 9 No. 2

assent, humor, and positive contact) between a newlywed couple
could predict whether 6 years later, the couple would be divorced,
together and happy, or together and miserable. He suggested that one
area that has received a scant amount of attention is that of the role of
positive affect in predicting the outcome of marriages. Perhaps it is
this same climate of positive affect, created through the delivery of
commendations or through a focus on strengths and resources, that
ultimately influences our therapeutic relationships with families.
This recognition and legitimization of a focus on strengths and
resources carries with it an obligation to listen for the differences, the
silent sides of our interventions, and those experiences or behaviors
that risk becoming marginalized because they fall outside of the dom
-
inant discourse about our best practices.
Establishing a rigid dichotomy in the language distinguishing
strengths from deficits as a way of describing families and their expe-
riences may be limiting and constraining in our endeavors to hear
families’ stories of suffering. Strengths may be located inside deficits
or inside stories of pain and suffering, and it might even be more com-
mending of families’ experiences to let a story stand as a horror, a
problem, or a deficit. Deficit has come to mean a falling short,
although the etymological roots suggest that with a deficit, there is
simply a wanting (Hoad, 1986). “Factical life is a messy affair and the
source of the most troublesome difficulties. Binary terms are inevita-
bly contaminated by each other, each inwardly disturbed by the
other” (Caputo, 1993, p. 63). Commending practices, if exclusively
understood as the listening and drawing forward of only strengths
and resources, could be interpreted as attempting to wash away con
-
tamination between the two terms—silencing uncomfortable or pain
-
ful aspects of a person’s experience. The treasuring and valuing of
strengths might serve to reify the differences and to hierarchically
position strengths above deficits, encumbering our ability to hear sto
-
ries of suffering. Perhaps there are times when it is not therapeutic to
actively observe for strengths or act as a “strength detective” (Levac,
Wright, & Leahey, 1997), but it is more healing and commending to
draw forward a messy, horrific experience in a language that honors a
family’s suffering.
In this conversation with Brigit, the nurse was not actively observ
-
ing for and commenting on strengths but was instead drawing
forward an experience in language focused on this young girl’s suf
-
fering. We submit that strengths emerged, were noticed and com
-
Limacher, Wright / Silent Side of Family Intervention 137

mended indirectly, and were embedded within the questions, listen
-
ing, and silences in this therapeutic conversation.
We believe that commending practices have the potential to both
feed and challenge the societal expectation to show only the “good
face” and to avoid suffering. Commendations, when meaningful,
might assist families to face suffering, thereby entering into what are
considered to be the more difficult and painful but equally healing
conversations. Perhaps this is where commendations, if delivered too
early and without genuine substantive knowledge of a family, could
contribute to editing and censoring by a family in a therapeutic rela
-
tionship. Commending, through noticing or pointing out positives or
strengths, might be experienced as patronizing or condescending if
the practice is not situated within the context of a genuine therapeutic
relationship (Wright & Leahey, 2000) and if a family’s suffering has
not been acknowledged. For example, there may be a danger in rec-
ommending that commendations be offered within the first 10 to 15
minutes of an interview (Levac et al., 1997; Wright & Leahey, 2000) or
in offering compliment templates (Campbell et al., 1999) unless we
first, or equally, are sensitive to families’ suffering.
FAMILIAR ROOTS: COMMENDATIONS,
COMPLIMENTS, AND SPARKLING MOMENTS
Commendations in the IBM
Within the IBM, commendations are labeled as micromoves, which
are those purposeful therapeutic behaviors that the nurse adopts to
invite families to reflect on their beliefs about themselves, their prob
-
lems, or their relationships (Wright et al., 1996). Adistinction is drawn
in the IBM between macromoves and micromoves as a means of
“languaging” about the subtle and not so subtle interventions
adopted in our work with families. Macromoves include those ele
-
ments of the therapeutic conversation that contribute to the develop
-
ment and maintenance of a strong therapeutic relationship—a rela
-
tionship based on mutual trust and hope and on a belief in families’
strengths and resources (Wright et al., 1996). It is these less tangible
but powerful foundational philosophical beliefs that underpin and
shape all of the micromoves in the IBM. Fluidity is assumed to exist
between the micro and macro moves (Wright et al., 1996); this weav
-
ing between the two ensures that the essential and pivotal therapeutic
138 JFN, May 2003, Vol. 9 No. 2

relationship is guiding and influencing the development of all inter
-
ventions, and reciprocally then, all interventions influence the thera
-
peutic relationship. Attention to the therapeutic relationship is equal
to the intervention given it is within this relationship where all inter
-
ventions are actualized (Wright & Leahey, 2000). One difficulty with
drawing forth a linguistic distinction between micro and macro
moves in the IBM is that the complex and eventful character of the
practice of “commending” becomes muddied and oversimplified.
The Shared Ground of Commendations
Commendations and compliments are both characterized and
described consistently in the literature as verbal interventions or
statements focused on praising and acknowledging the family
(Campbell et al., 1999; Levac et al., 1997; McElheran & Harper-Jaques,
1994; Tapp, 2000; Wall et al., 1989; Wright & Leahey, 2000; Wright et al.,
1996). With this focus, the words, the content, and the form of the com-
mending statement is emphasized, relegating the actions to a con-
scious, deliberate, intentional realm, and a deliverable commodity is
described. Central to this analysis is the thoughtfulness and expertise
contained within nurses’ deliverable statements. What remains hid-
den is the reciprocal nature of the relationship between nurses and
families, relationships between family members, bodily responses,
and silences—all locations where curiosity, questions, listening, and
healing may emerge. Relationship factors are considered to be
extremely important to predicting a successful outcome in family
work, trailing only behind the extratherapeutic factors (Hubble et al.,
1999; Lambert, 1992).
Brigit’s aunt’s actions, her silence and tears, may be read in this
exemplar as encouraging and commending of her niece’s storytelling
because of Brigit’s very open response, her verbosity, and her embel
-
lishment of details surrounding the fire. In some families, silence and
tears might hold alternate meanings, signaling and discouraging con
-
versation and contributing to withdrawal and silence. In these fami
-
lies, silence and tears would not be interpreted as commending. Fam
-
ilies’ comfort with disclosing information about traumatic events
varies widely in both the degree and the amount of information that is
permitted (Williams, 1998). The discrepancy in the meanings that we
attribute to particular actions and behaviors echo the difficulties that
surface when we attempt to only define commendations in the realm
Limacher, Wright / Silent Side of Family Intervention 139

of spoken words. As forms of commending, silence and listening may
remain unacknowledged.
In the spoken or written word, commendations are considered to
be most meaningful when they remain sensitive to context and lan
-
guage regardless of nurses’ intentions (e.g., to distinguish, highlight,
elaborate, or summarize families’ strengths and resources) and in the
many forms where commendations might be offered (e.g., in conver
-
sations, therapeutic letters, or by teams of clinicians) (Wright et al.,
1996). The offering of a verbal commendation requires intense atten
-
tion by nurses, paralleling the delivery of a meaningful and com-
manding performance. The importance of the delivery necessitates
that nurses must already grasp the meaning of the commendation
before it is given so that the emphasis and the manner of the delivery
make it meaningful. The dialectical complexity of this process
becomes even more apparent if we imagine that the family listening
must also recognize the commendation, even before it is delivered
into language. “Oral interpretation thus has two sides: It is necessary
to understand something in order to express it, yet understanding
itself comes from an interpretive reading—expression” (Palmer, 1969,
p. 16). Commendations happen between people, in relationships, and
around meaningful content that has come forward in speech and
silence. When commendations are understood as contextually
dependent events, the contradictions and ambiguities in the litera-
ture, although interesting, might not be as relevant to our understand-
ing of how these moves make a difference to families.
It has been suggested that both commendations and unique out-
comes assist with creating a context for change in therapeutic conver-
sations by opening up families’ abilities to hear and notice different
stories or different aspects of their lives, generally those in opposition
to a problem story (Freedman & Combs, 1996; Levac et al., 1997;
McElheran & Harper-Jaques, 1994; Morgan, 2000; White, 1997; Wright
& Leahey, 2000; Wright et al., 1996; Zimmerman & Dickerson, 1996).
There appears to be some tacit agreement within the literature that
commending practices create an event that disrupts the direction of a
conversation, opening space for more healing beliefs and/or stories
to then emerge in opposition to the bad or destructive ones. Another
way to conceptualize this event is to regard the very act of commend
-
ing as creating an eruption; here, the significance is located inside the
event and in the very moment it is offered not in the opposing dialecti
-
cal positions that it creates (Caputo, 1993). Commendations become
the difference that makes a difference.
140 JFN, May 2003, Vol. 9 No. 2

In practice, we have witnessed a range of the effects of offering
commendations and compliments: most often strengthening the ther
-
apeutic relationship, sometimes drawing forward profound rapid
change, and occasionally detrimentally disengaging clients. Wright
and Leahey (2000) suggested that the immediate and delayed affir
-
mative responses and the reactions of families to receiving commen
-
dations indicate they are an effective therapeutic intervention. The
offering of verbal commendations to families, generally described as
located within a cognitive domain, has been noted to frequently
awaken the emotional response of weeping or crying in family mem-
bers (Campbell et al., 1999; Wright & Leahey, 2000). The nature and
meaning of these emotional responses warrant attention.
Brigit’s aunt became extremely tearful during this conversation.
One could hypothesize that these tears were a result of both the nature
of the content and the texture of this conversation given that Brigit
was now openly discussing an experience about which she had previ-
ously and steadfastly remained silent and withdrawn. Brigit was
urged forward in the telling of this horrific story by her aunt in a vari-
ety of ways. Through her own tears, she stated that Brigit had a “great
memory,” and she offered emotional commendations in the form of
silences and nonverbal body responses that indicated approval and
support. Commendations spontaneously ensued between family
members in this conversation and therefore influenced the nurse’s
posturing with regard to commendations. Family members’ com-
mendations of one another do not fit within the current descriptions
of this practice.
It is possible that the tears and the emotional climate of the session
invited the nurse to remain silent, to listen intently, and to further
inquire about these painful and frightening events. This nurse’s
behavior in this session could be interpreted as offering commenda
-
tions in the language of emotions, a different form than has been
described in the literature. The questions that thickened (Freedman &
Combs, 1996) the trauma story, the respectful listening, and even the
silence itself could be interpreted as commending moves given that
they acknowledged Brigit’s experience and demonstrated approval.
This speaking without words or without delivering statements and
opinions can be understood as commending in the language of emo
-
tions. Commendations may share an affinity to other concepts; for
example, listening could just as easily be interpreted as showing
respect, support, or empathy for Brigit. The line between these con
-
cepts may well be thin and at times erroneous.
Limacher, Wright / Silent Side of Family Intervention 141

Within the existing descriptions, there is consistent acknowledge
-
ment of the need to remain sensitive to context, but what is less often
acknowledged is that nurses are also, already, tangled and embedded
within the language of the shared interview, health care system, com
-
munity, and culture. The dominant language practices slip families
into the category of an object while silently positioning nurses as sep
-
arate and outside of the relationship. If we assume that noticing and
commenting on strengths has a circular nature, as Wall and colleagues
(1989) suggested, commendations will alter both the families’ and the
nurses’s understanding of the problems, solutions, and even the ther-
apeutic relationships. Echevarria-Doan (2001) described how, in her
collaborative inquiry, using resource-based reflective consultations,
family therapists reported more expanded views of families when
resource-based language was drawn forward in their conversations
about families.
The stages of the therapeutic relationship have been depicted as
influential in determining the nature of the commendations offered
given the early emphasis on joining, engaging, normalizing, validat-
ing, establishing rapport, and fostering openness while in the later
stages of conversations, turning toward facilitating, enhancing, sell-
ing, or modifying change (Campbell et al., 1999; McElheran &
Harper-Jaques, 1994; Wall et al., 1989). The nurse asked many ques-
tions in this initial interview with Brigit, for example, “What hap-
pened next? How did you get down off the top bunk? How did you
know to break the window?” Retrospectively, one could interpret
these questions as indicative of an attempt to assess, engage, validate,
and open up this family’s trauma story. We believe these questions
also facilitated change by distinguishing and drawing forward previ
-
ously hidden strengths and resources, changing both the family and
the nurse’s beliefs about Brigit, the family, and the circumstances sur
-
rounding the fire. The nurse remembers becoming swept up in
Brigit’s story, and the questions were but one ingredient in the process
of thinking and engaging our imaginations.
Nurses’ and families’ assumptions become more transparent if we
trace the directions in which their curiosity moves the conversation in
the process of the telling, listening, or questioning of one another
about a story. When we isolate questions or statements, stripping
them of context in an attempt to better understand and teach students
about how to deliver what we have come to call a commendation, a
compliment, or a sparkling moment, we immediately exclude and
ignore particular aspects of practice. Questions that are embedded
142 JFN, May 2003, Vol. 9 No. 2

with acknowledgment and praise, regardless of their intent or partic
-
ular content, might draw forward family strengths and resources. It is
also possible that our carefully structured questions and statements
might inadvertently constrain any acknowledgment or praise that
could be meaningful to families, moving the conversation into a par
-
ticular direction that silences families’ experiences.
If practiced as the pointing out of positives or the repetition of com
-
ments focused on amplifying particular positive attributes or experi
-
ences, commendations may drift toward becoming what White (1997)
has called “applause.” White was cautious about the place of
applause in the practices of acknowledgement, fearing that our famil
-
iarities as a culture with diverse or alternate forms of acknowledge
-
ment are becoming lost to the success of applause. He wondered if
persons who are subject to applause might even experience it as a
reflection of a deep division between any critical understanding of
families’ experience and the grasp of listeners. Arelationship between
the practices of applause and the offering of commendations may at
times exist, but whether families experience applause as alienating
and distancing has not been studied. We wonder if two forms of
acknowledgement that have become silenced and lost within this cul-
ture are those of silence and listening.
COMMENDATIONS IN SILENCE AND VOICE
The existing definition of commendations, as direct, planned, ver-
bal statements that draw forward and highlight family strengths,
needs to be expanded to include the dimensions of indirect, nonver
-
bal, and even accidental shaping embedded in questions, silences, lis
-
tening, and families’ self-commending practices. Commendations
appear to be communicated in the asking of questions, choice of
words, and the intonations of the speaker (use of liquid or solid
sounds and loud or soft volumes), and tone or placement of silences.
“Silence is not merely linked with some active human performance.
Silence itself is an active performance” (Dauenhauer, 1980, p. 4). Lis
-
tening and silence have been described as an art, the flip side of the
whole of speaking and as a necessary component of effectively com
-
municating with others (Nichols, 1995). Fiumara (1990) believed that
the contemporary emphasis on the verbal side of language might be a
Western cultural construction located in a system of knowledge that
ignores the process of listening.
Limacher, Wright / Silent Side of Family Intervention 143

Listening and speaking ought to be carried out mutually since the abil
-
ity to create a silence, and thus determine a new perspective, belongs to
those who can speak in so far as speech represents a decision or a
choice; silence is radically different, in this case, from an expressive
inability or stuporous state of imposed muteness, just as the rituals of
fasting would be difficult to envisage in a community that was always
on the verge of starvation. The philosophical attention devoted to the
concern for listening now coexists with a deafening cultural scene. And
in the increasingly tight interaction of language games even our
coexistential ability to deliberate pauses of regenerating silence might
be put in jeopardy. (Fiumara, 1990, p. 99)
The complexity of commending practices as they emerge in con
-
versations and the ways these events influence the therapeutic rela
-
tionship in silence, listening, and speaking are intriguing, confusing,
and complex. It has been suggested that families’ languages be
adopted in the articulation of a verbal commendation (McElheran &
Harper-Jaques, 1994) and that different language be used as a means
of restructuring, relabeling, or renaming difficulties to open space for
change (Campbell et al., 1999). These conflicting recommendations
reflect the tensions that surface when we attempt to clearly define the
best structure, format, or content of a commendation and when we
decontextualize the practice and approach language as a tool.
Language is a living phenomenon, greater than the sum of the
statements we deliver as nurses. “The enigma that is language, consti-
tuted as much by silence as by sounds, is not an inert or static struc-
ture, but an evolving bodily field. It is like a vast, living fabric continu-
ally being woven by those who speak” (Abram, 1996, p. 83). This
weaving of verbal commendations and distinguishing of strengths
and resources is always situated within the complex fabric of our bio-
psycho-social-spiritual relationships, not situated beside or outside
of this world. One difficulty in languaging about commendations as a
solely planned, verbal intervention delivered by nurses is that they
become decontextualized and robbed of their rich and fecund nature.
When taken up as deliverables or commodities, commendations are
stripped of the relationships to which they are so intimately tied, such
as those between family members, nurses, and the stories that bring
them all together. Instead, one can envision commendations as gifts,
rather than commodities, “not those gifts we accept out of servility or
obligation; [instead, as] the gift we long for, the gift that, when it
comes, speaks commandingly to the soul and irresistibly moves us”
144 JFN, May 2003, Vol. 9 No. 2

(Hyde, 1983, p. xvii). Genuine, authentic commendations, those
words and silences that touch our souls, may be just these kinds of
gifts.
There is consensus in the literature that when working with fami
-
lies who have experienced trauma, rapid intervention is crucial
(Lipovsky, 1991; Pfefferbaum et al., 2000; Schwarz & Perry, 1994) and
recapitulation of the traumatic event in a safe environment will
empower families to use their natural efforts to heal (Catherall, 1998;
Figley, 1989). Silence and listening can open space for the safe telling
and retelling of stories that may constitute new meanings and con
-
tribute to healing in the wake of trauma. There is “a listening that is
responsible for creating, what it hears—a listening, for example, with
the power to cause or to alleviate the very suffering it is hearing”
(Levin, 1989, p. 85).
Listening to children’s stories following catastrophic events has
not been a common practice, although estimates suggest that millions
of children are exposed to traumatic experiences each year (Perry &
Azad, 1999). Historically, interventions have focused on hearing par-
ents’ accounts of children’s stories (Lovrin, 1999), accounts that are
often extremely different from children’s accounts (Lipovsky, 1991).
We may not be able to rely solely on verbal language as a way of com-
ing to know children’s experiences following a catastrophe such as
Brigit experienced. Given that children are at a different developmen-
tal stage in language, they might respond more readily to nonverbal
approaches and interventions (Lipovsky, 1991), for example, com-
mendations offered in the form of encouragement through one’s
voice, tone, or in silence and listening. Just what children express in
the moment of being offered a commendation and in what forms they
might hear and experience commendations might be quite different
from adults’ experiences. Playful, concrete, and visual forms of
acknowledgement such as therapeutic letters or certificates might
offer a more powerful forum for commending children (Freeman
et al., 1997; Lipovsky, 1991; Williams, 1998).
In listening to Brigit’s story, the nurse and child constructed a small
diagram on a piece of paper held between them to assist with identify
-
ing the locations of the various people involved in this tragic fire.
Intervening through developing lists with children as a means of
slowing down conversations and inviting “list-ening” (Buckman &
Reese, 1999) has been described as a practice that may prevent the
marginalization of children’s voices, empowering them and commu
-
nicating that their voices are valued and important (Freedman &
Limacher, Wright / Silent Side of Family Intervention 145

Combs, 1997; Freeman et al., 1997). It has been suggested that making
room for children’s stories, particularly when they are traumatic,
requires a certain discipline in learning to cultivate and yet suspend
the nurses’ desires in order to develop a certain intimacy or familiar
-
ity with what is being offered (Levin, 1989; Nichols, 1995).
Developing this diagram, this list could be framed as an embedded
commendation to Brigit, evidence in a behavioral domain that her
story was worthy of acceptance and attention.
This vulnerable 6-year-old girl with the dancing eyes and expres-
sive tongue completely captivated both the nurse and her aunt in the
telling of this tragic and terrifying story. Brigit, who was described as
“big” for her age, seemed initially very small and fragile. We believe a
transformation occurred in this therapeutic conversation, a transfor-
mation that invited recognition of Brigit’s strengths and resiliency, a
transformation in which her aunt began to feel encouraged and
acknowledged as competent in loving and caring for her niece. We
believe Brigit experienced herself as an active participant in the shar-
ing of her story, given her engagement and animation in the sharing of
details and our experience of her as strong rather than weak and frag-
ile. It was through Brigit’s participation and expression in the sessions
that the nurse’s beliefs about commendations, as located in strictly
verbal language, were challenged.
CLOSING WORDS AND OPENING QUESTIONS
Instead of dirt and poison we have rather chosen to fill our hives with
honey and wax; thus furnishing mankind with the two noblest of
things, which are sweetness and light. (Jonathan Swift, 1704, cited in
The Concise Oxford Dictionary of Quotations, 1981, p. 248)
Honey and wax, sweetness and light, strengths and resources—the
choices we make as nurses are seldom this clear and simple. How,
when, and under what circumstances we make decisions to draw for
-
ward stories of suffering and pain, such as Brigit’s experience with
this fire, a story that might emerge and materialize initially as poison
and dirt, rather than to actively focus on strengths and resources, is a
complex, contextual, and multifaceted relational process. We believe
that the existing definition of commendations and related commend
-
ing practices must be refined and expanded to consistently include
the more indirect, nonverbal, and even accidental shaping that hap
-
146 JFN, May 2003, Vol. 9 No. 2

pens in our conversations with families. Only with deliberate
curiousity, watchfulness, listening, and critique of this powerful prac
-
tice can we ensure that the more silent sides are not silenced.
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Lori Houger Limacher, R.N., M.N., is currently a doctoral candidate at the Univer
-
sity of Calgary. Her research, with Dr. L. M. Wright as supervisor, is focused on com
-
mendations. She is a clinical nurse specialist, marriage and family therapist, and
approved supervisor with the American Association for Marriage and Family Ther
-
apy and is an adjunct faculty member with the Family Therapy Training Program in
Limacher, Wright / Silent Side of Family Intervention 149

the Calgary Health Region. Her clinical, teaching, and consultative interests are in
family and narrative approaches to working with mental health and/or illness. Cur
-
rent research interests include family interventions and postmodern supervisory
practices. Recent publications include “Maintaining a Critical Edge: A Response to
Thorne’s, ‘People and Their Parts: Deconstructing the Debates Theorizing Nursing’s
Clients,’” in Nursing Philosophy (2001) and (with C. Ceci & D. L. McLeod) “Lan
-
guage and Power: Ascribing Legitimacy to Interpretive Research” in Qualitative
Health Research (2002).
Lorraine M. Wright, R.N., Ph.D., is professor emeritus of nursing at the University
of Calgary. She has just completed a 20-year directorship of the Family Nursing Unit
at the University of Calgary. Her clinical and research interests include family inter
-
ventions; beliefs, families, and illness; and suffering and spirituality. Coauthor of the
well-known books Nurses and Families: A Guide for Family Assessment and
Intervention (F.A. Davis) and Beliefs: The Heart of Healing in Families and Ill
-
ness (Basic Books), she is now writing a new book titled Spirituality, Suffering, and
Illness (F.A. Davis). Recent publications include (with D. McLeod) “Conversations
of Spirituality: Spirituality in Family Systems Nursing—Making the Case With
Four Clinical Vignettes” in Journal of Family Nursing (2001) and (with M. Leahey
Wright) “Maximizing Time, Minimizing Suffering: The 15 Minute (or Less) Family
Interview” in Journal of Family Nursing (1999).
150 JFN, May 2003, Vol. 9 No. 2

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