Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy

Abstract

This paper describes the use of a therapeutic approach that has been inspired by the work of Gregory Bateson and the concept of 'Fourfold Vision' described by the poet and mystic, William Blake. The fourfold vision approach incorporates the use of data, theory and intuition within an aesthetic process. It offers a way of thinking about elements of practice as being equally important interconnected parts of an aesthetic whole rather than separate parts or domains that all need to be attended to in a formal or rigid structure. Significantly, this approach offers a means of incorporating the inner experience of the therapist, including intuition, within a coherent process that also incorporates theory and data. The four ways of seeing interact to create an iterative unfolding. Conveying a shift from parts and wholes to relationships and processes is so tricky! A case study is provided that offers some signposts to how fourfold vision can be used to reflect upon and inform practice.

Full text

Human Systems: The Journal of Therapy, Consultation & Training
© AIA & LFTRC Volume No 28, Issue 1, 2017. pp. 21-39
Fourfold Vision in Practice:
Data, Theory, Intuition and the Art of Therapy
Hugh Palmer
Family & Systemic Psychotherapist, UKCP reg.
How can I describe in words the complexity of it all?
Living in a world that is understood by reducing wholes to parts,
creating boundaries and bits and bobs,
a world of things, seemingly unconnected.
Walking through a thicket of pines; the ground soft, countless needles decomposing,
bracken and wood anemones, beetles and lichen,
the scent and sounds enveloping.
Stumbling upon an ant colony, a swarming mass of life,
seeming chaotic, but no... there is some order, even purpose, here
Mind written with a myriad of tiny creatures,
an ecology of relationships and communication.
Beautiful, messy and never fully known.
A world of ideas.
Yet these words are shifting sand by the sea; rain on a warm day.
Leaves falling on a lake,
drifting
away.
Hugh Palmer, 2016
This paper describes the use of a therapeutic approach that has
been inspired by the work of Gregory Bateson and the concept
of ‘Fourfold Vision’ described by the poet and mystic, William
Blake.
The fourfold vision approach incorporates the use of data,
theory and intuition within an aesthetic process. It offers a
way of thinking about elements of practice as being equally
important interconnected parts of an aesthetic whole rather
than separate parts or domains that all need to be attended to in
a formal or rigid structure.

Human Systems Hugh Palmer
Significantly, this approach offers a means of incorporating the
inner experience of the therapist, including intuition, within a
coherent process that also incorporates theory and data. The
four ways of seeing interact to create an iterative unfolding.
Conveying a shift from parts and wholes to relationships and
processes is so tricky!
A case study is provided that offers some signposts to how
fourfold vision can be used to reflect upon and inform practice.
Key Words: Gregory Bateson, Cybernetic Epistemology,
Aesthetics, Systemic Therapy, Intuition, Self of the Therapist
Introduction
is paper further develops a therapeutic approach (Palmer 2014, 2016) that
is drawn from and inuenced by Gregory Bateson’s life and work. I had long
felt that Bateson had been misunderstood; this misunderstanding is perhaps
best represented by the fallout of his disavowal of the concept of ‘power’ in
relationships, but equally so regarding his general approach to being in
relationship with others (both aspects covered in more depth in my 2016
chapter), although both are facets of his cybernetic epistemology, perhaps best
summarised by his observation “e nature of the world in which I live, and
in which I wish you lived – all of you... and all the time... but even I don’t live
in it all the time – there are times when I catch myself believing that there is
such a thing as ‘something’ which is separate from something else (Gregory
Bateson, in Nora Bateson’s lm, An Ecology of Mind, a Daughter’s Portrait of
Gregory Bateson, 2012).
Around the time Nora Bateson was touring with her lm early in 2012, I
had been asked by Gail Simon to present alongside her (along with Imelda
McCarthy and John Burnham) at a conference celebrating Bateson’s legacy to
systemic practice organised by Bradford Relate, and I wanted to think about
a therapeutic approach consistent with Bateson’s epistemology. Whilst feeling
very apprehensive about this venture, I was delighted by the support and
encouragement I received from others involved in it, and I have met with Nora
on a couple of occasions since then. She has helped me rene my thinking - and
also steered me away from charts and graphs that separate components and
detract from wholes. It has been fascinating and a privilege to talk to someone
who didn’t simply ‘learn’ Bateson from books, but embodied so much of his
ideas through her own lived experience as his daughter.
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Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
Fourfold Vision
e development of my ideas stemmed from reading Noel Charlton’s (2008)
work in which he suggested that Bateson considered psychology to be evolving
in two directions, ‘humanist’ and ‘circularist’ and that he saw the way forward
as being a compromise; a working together of both types of practice; between
intuition, and examination and description, each informing the other. is
‘working together’ seemed to me a useful way of thinking about integrating
dierent elements of practice, and when Charlton went on to suggest other
aspects that might be important: “Humanist, scientist, artist and theoretician
are all needed to form the cybernetic unity of healing” (p. 94) I recalled a piece
of writing by William Blake, the artist, poet and mystic who was a considerable
inuence upon Bateson:
Now I a fourfold vision see,
And a fourfold vision is given to me;
Tis fourfold in my supreme delight,
And three fold in so Beulah’s night,
And twofold Always. May God us keep
From Single vision & Newtons sleep.
William Blake, Letter to omas Butt,
22 November 1802
Blake’s fourfold vision has been discussed by literary scholars, including
Northrop Frye (1947) and later by Rose (1962) who recognised the unity that
is inherent in Blake’s concept of fourfold
vision: “at is, four is really one all the time, but in order to describe
unlimited perception, a paradox is stated” (p. 173). Whilst Blake’s concept has
multiple meanings that include spiritual and religious ideas and puns, what
is really important is how these dierent ways of seeing interact; each has
value, but the interplay between them, expressed as fourfold vision, enables
us to move from separate domains towards a more unied way of being in
the world. Each vision correlates to the components of Charlton’s cybernetic
unity of healing - humanist, scientist, artist and theoretician. Blake has
oered us a way of thinking that is more consistent with Bateson’s cybernetic
epistemology; connecting scientic rigour, systemic (and other) theories and
our own intuitions within a graceful, aesthetic process, and I have attempted
to structure these in a meaningful format that will be of help to therapists by
synthesising the visions oered by Blake with the areas of practice identied
by Charlton.
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Human Systems Hugh Palmer
Single Vision
Blake means this to be seeing with, not through the eye, referring to this as
“Newton’s sleep” it is characterised by atomistic, reductionist thinking. It is to
focus on linear cause and eect, on rational knowledge and on the material and
physical. is is the realm of science; data and evidence. Blake’s exhortation
“May God us keep from single vision & Newton’s sleep” warns us of the danger
of purely rational thinking that excludes intuition, the subconscious, aesthetic
and spiritual dimensions. Along with Isaac Newton, elsewhere Blake imagined
a mythical character who also represents single vision; he is ‘Urizen’ (your
reason), the builder of the “dark Satanic mills” and perhaps he could be a useful
representation of what Bateson described as ‘conscious purpose’, where a lack
of wisdom in making technological advances can prove to be disastrous; as
Bateson noted, ”Conscious man, as a changer of his environment, is now fully
able to wreck himself and that environment – with the very best of conscious
intentions”. (1972 pp 445-6).
Nevertheless, details and facts are important to clinical practice; to work
with families requires having some knowledge of who the members are and
what the diculties might be. Outcome tools, such as the SCORE-15 index
of family functioning and change (Stratton et. al. 2013) can be helpful ways
of measuring progress and identifying diculties. Noticing details about the
family and its members is crucial to developing theories about what might be
happening within the system, and also provides material for us to respond to,
both inwardly and outwardly. e idea of single vision ts well with Charlton’s
scientist as part of the cybernetic unity of healing; rationality and empiricism
do have a place and role in practice, as identied below.
erapist as Scientist
• Good observation skills.
• Linear descriptions:
– What is the issue?
– Who is involved?
– When does it happen?
– Where does it happen?
• Consideration of ‘non-systemic’ explanations (i.e. dis/ability, physical
health issues).
• Use of outcome and other measurement tools
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Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
Twofold Vision
Blake intended that twofold vision is seeing not only with the eye, but through
it; seeing contexts, associations, emotional meanings, and connections. ere
is a dialectical element within this - seeing both with the eye and through
it means encompassing the material and the relational and being able to
hold on to opposing views. Inherent within twofold vision is our ability to
appreciate our broader connections with nature and the environment and
Blake’s inclusion of the observer within the observed may be familiar to some
as ‘second-order’ cybernetics. In my view, this relational ‘double’ vision ts
closely with the concept of theoretician, particularly with regards to thinking
about systems theory, but also with thinking about the social construction of
meanings and realities.
erapist as eorist
• Conscious observation of patterns within the family system.
• Circular causality.
• Relational aspects.
• Systemic theorising (thinking about systems)
• First and second order cybernetics.
• Dominant and subjugated narratives (White and Epston, 1990)
Threefold Vision
Blake describes this as “Beulah’s night”, and it represents our awareness and
use of unconscious processes, memory and intuition. According to Eaves &
Damon (1988), Beulah represents the realm of the subconscious, the source
of poetic inspiration and of dreams. Blake incorporates the imagination and
creativity of the observer within threefold vision; this opens the doors to the
inspiration that comes from the unconscious.
Paolo Bertrando (2015) rightly warns us to be suspicious of our intuitions
and emotions within therapy; they can be double edged, sometimes leading
to great insights and connections but we can run the risk of being misled by
them too. Nonetheless, although qualities of empathy and compassion are
well known elements of therapeutic practice and the idea of our embodied
responses are beginning to receive attention, there has perhaps been less
consideration given to intuition as being a signicant element of practice. Tom
Andersen oered us a description of his aesthetics, a process that began with
openness and sensitivity and is led by his intuitions, but he checks if he feels
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Human Systems Hugh Palmer
comfortable with this;
“As I am open and sensitive to what I see, hear, feel, taste, and
smell I can also notice ‘answers’ to those touches from myself,
as my body, ‘from inside,’ lets me know in various ways how
it thinks about what the outside touches; what should be
concentrated on and what not. This state of being open and
sensitive to the touches from the ‘outside life’ and at the same
time being open and sensitive to the answers from the ‘inside
life’ is what I prefer to call ‘intuition.’ At this point in time my
intuition seems to be what I rely on the most. In re-walking my
professional tracks, my intuition tells me that I shall take part
first, and then sit down and think about the taking part; not sit
down and think first and thereafter take part. As I am sure that
my thinking is with me as I take part, I have felt comfortable
following what my intuition has suggested to me” (Andersen,
1992, p.55).
Within threefold vision, simply being ‘human’ with our clients is important,
too. Observations of Bateson’s direct work with patients and families over more
than ten years provide evidence that he showed considerable compassion and
intuition in his interactions (Lipsett, 1980), and he emphasised the importance
of therapists and doctors “being human” with their patients (Bateson, 1961).
I have interpreted threefold vision to incorporate Charlton’s notion of the
humanist; in touch with our emotions and inner responses to situations, able
to convey empathy and share, within reason, our own vulnerabilities.
erapist as Humanist
• Being human; qualities of warmth and compassion.
• Empathy.
• Connecting with personal experiences and intuitions, embodied
aspects of practice.
• erapeutic use of the self of the therapist.
• Disclosure and transparency.
Fourfold Vision
Blake describes this as the delight of experiencing single, twofold and
threefold vision, with constant twofold visioning in daily life. Fourfold vision
is the interplay between single, twofold and threefold vision and it might be
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Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
thought of as an aesthetic, systemic way of thinking that utilises data, theory
and intuition.
Shotter (2006), who was very much inuenced by Andersen, alludes to seeing
through the eye as part of his explanation of withness-thinking, going on to
give what might be another view of what Blake imagined as fourfold vision:
“The interplay involved gives rise, not to a visible seeing,
for what is ‘sensed’ is invisible; nor does it give rise to an
interpretation (to a representation), for our responses occur
spontaneously and directly in our living encounters with an
other’s expressions. Neither is it merely a feeling, for it carries
with it as it unfolds a bodily sense of the possibilities for
responsive action in relation to one’s momentary placement,
position, or orientation in the present interaction. Instead, it
gives rise to a shaped and vectored sense of our moment-by-
moment changing involvement in our current surroundings —
engendering in us both unique anticipations as to what-next
might happen along with, so to speak, ‘action guiding advisories’
as to what-next we might expect in relation to the actions we
might take. In short, we can be spontaneously ‘moved’ toward
specific possibilities for action in such thinking” ((Shotter, 2006
p.600).
I think of fourfold vision as a hermeneutic process whereby we repeatedly shi
between details, context, and relationships, where this continuous shiing is
informed by our intuitions, bodily responses and past experiences, guiding
multiple foci of interest and attention. e signicance of fourfold vision is
that it is a relationship between the other ways of seeing the world; there is no
hierarchy here, single, twofold and threefold vision are all vital elements of a
greater, aesthetic whole that emerges from how they interact, and this aligns
well with Charlton’s idea of artist as part of the cybernetic unity of healing.
erapist As Artist
• e aesthetic pleasure and artistry in working with data,
theory, and intuition.
• Self of therapist and family located and theorised in wider
and wider contexts.
• ‘Withness’ thinking, or thinking systemically
(Shotter 2006, 2008).
• Shiing levels of abstraction;
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Human Systems Hugh Palmer
from detail to context and back again.
• Mystery.
• Sparkling moments.
• Being open to being changed by the relationship.
ese four types of ‘vision’ are neither sequential nor hierarchical. Fourfold
vision is the weaving together, through time and experience, which creates a
rich tapestry containing a multitude of dierent threads and patterns.
While there are clearly parallels with other models and approaches, for example
CMM (Pearce & Cronen, 1980), domains of production, explanation and
aesthetics (Lang, Little, & Cronen, 1990) and Approach, Method, Technique
(Burnham, 1992), the self of the therapist is more fully incorporated within
fourfold vision, and each of the four ways of seeing is part of an iterative
unfolding – as an aesthetic emergence of interactions between emerging data,
theories and relationships and the inner responses of the therapist.
More recently, Nora Bateson (2016) describes what she terms ‘symmathesy’
to describe entities that are formed over time by processes of contextual inter-
learning through interaction, and she gives examples of a forest or a family
as a symmathesy, but goes on to describe the diculties created by thinking
of these entities in terms of ‘wholes’ and ‘parts’ as we immediately lose
contextual integrity. Fourfold vision oers a route for therapists to participate
in, and support clients (and ourselves) in learning: “Seen as a symmathesy, a
person or a family is learning to make sense of its world. Like their bodies,
emotional, mental, and interactional processes would all be included in their
ways of calibrating their world (not necessarily consciously) – all pathology is
learning.” (Bateson, 2016, p.190).
Fourfold Vision In Practice
On the inpatient unit where I work, I usually rst hear about a newly admitted
young person and their family at one of the Multi-Disciplinary Team meetings,
although typically what is presented is a general overview of the young person,
oen focussed upon their diagnosis and presentation on the unit. I usually
have to ask about the family context and what, if any, impressions the care team
have of the family. Being in an agency like this presents the challenge of both
being within the team and yet being separate too; a task of holding multiple
positions. is is important, as the temptation is all too easy to fall into the
trap of a shared single vision – the lineal world of certainty and diagnosis,
of blame and explanation. One of the ways that I manage this is by asking
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Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
questions and being curious about the context that led to admission; in many
cases, the very need for a young person to be admitted can indicate a great deal
of family complexity. Another aspect of inpatient family therapy work is the
sense of obligation that some families may feel with regard to participation;
they may even be told that participation in therapeutic activities is one of the
conditions of admission, and attend with some reluctance and trepidation for
fear of sanctions.
e rst time I meet a new family, as they enter the room, or when I meet them
in the reception area, all my senses and curiosity are taken with the ‘newness’
of the situation, concerns about the practicalities (Single Vision) who is here?
Will the therapeutic space be a good t for them?
I absorb the sights, sounds and smells I am aware of, as well as my inner
responses to these stimuli (reefold Vision). How do they present, what are
they wearing? What associations, if any, do I make with this? How do they look
at me and each other? What do I understand from their eyes? Jaakko Seikkula
(2008), drawing from Bakhtin, suggests that knowing ourselves is made
possible by seeing ourselves through the eyes of the other, and I sometimes
nd the initial eye contact with family members elicits quite strong inner
responses for me; oen tenderness, sometimes concern, perhaps seeing and
learning about myself in the gaze of others. Already, questions are beginning
to form, as my senses and inner responses to them are processing.
I invite them to sit wherever they wish in the room. ey sit down. I pause and
take in the sensation of the room being lled, and how we are all occupying
the space. I note how people are sitting, their postures and proximity to each
other and the glances that are exchanged.
I sometimes am aware of a feeling of tension in my gut, a dry mouth... I want
this to be ok for them. Everyone is looking at me, waiting for me to talk. I
generally feel, momentarily, insecure or even a little afraid and feel the weight
of my own expectations and my imagined expectations of the family upon my
shoulders.
Usually, I will begin by introducing myself and the team and inviting the family
members to introduce themselves, too. As we don’t have observation facilities,
the team sit in the same room, apart from the family. A general overview of
how we work is oered, including the use of a reecting team, condentiality,
and so on, along with opportunities for the family to ask questions.
While all this necessary work is underway, I continue to monitor both
the families’ verbal and non-verbal responses, their interactions between
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Human Systems Hugh Palmer
themselves and with me, along with my own, inner, reactions to these.
Again, I pause. In part to allow myself some time to process the families’
responses, and to provide them with some space to reect, too. is is time
for fourfold vision. e next steps are not wholly guided by theory or the
referral information nor guided wholly by family relationships or patterns
of communication or by my inner experience, but by all three; the decisions
made now are aesthetic.
Some of the options I might consider would include engaging in ‘problem
free’ talk (Iveson, George & Ratner,1999) in order to develop therapeutic
engagement, discover more about the family – interests, stories that may be
helpful metaphors for change later on in the therapy and to identify areas of
commonality and opportunities for appropriate self-disclosure.
Alternatively, I might ask the family what they would like to discuss, how they
would like to use the time as this will help clarify what family members think
are important issues. ere are good opportunities for circularity here. is
direction also acknowledged that people generally want to use therapy to talk
about problems and provides and helps to shi the focus to the family’s needs,
rather than those of the therapist or agency (decentred).
Another option might be to be curious about the family history, perhaps using
a genogram with the family as a therapeutic tool. is can help to demonstrate
an interest in the whole family, not just the ‘patient’ and oer opportunities to
explore transgenerational patterns (Byng-Hall, 1995).
Of course, this isn’t an exclusive list. How you might choose to move forward
depends on your use of fourfold vision – and this will be inuenced and shaped
by your experience, your agency requirements, your sense of the family and
the wider social and cultural contexts that you all inhabit.
By now, having begun the session, events will take on their own momentum;
you are now a part of a unique, dynamic and evolving process. e following
example, drawn from a clinical example of a family (names changed for
condentiality) will help illustrate this approach, however, due to the recursive
interplay between the dierent visions, it is impossible (and antithetical) to
formally categorise the dierent ‘visions’ within this narrative. Despite this
caveat, I have oered some signposts, although you are invited to connect with
your own thoughts and feelings as your read this; what connections you make
and directions you might have taken and so on.
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Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
Clinical Example
Melanie, aged 14, was admitted to a Child and Adolescent Mental Health
Service (CAMHS) inpatient unit due to seriously low weight as a result of
anorexia nervosa. In addition to the eating disorder, she had been groomed
online by an older male who, at the time of Melanie’s admission, was being
charged for these oences. Although the anorexia predated the grooming,
these recent events were very distressing for her. In the previous year, Melanie’s
older sister Gemma, aged 19, had been diagnosed with Asperger’s Syndrome,
although her behaviour had been central to much family conict before this
diagnosis. Mum, Rebecca, is currently on sick leave from her job in a school,
and Dad (James) has signicant visual impairment, is self-employed and
works long hours. is information, thus far, is from the realm of single vision.
Yet reading this data can easily lead to twofold theorising about what might
be happening within this family (for example in terms of family structure
and boundaries or in terms of dominant narratives) or to threefold human
responses of empathy considering the challenges this family has faced and
personal connections with some of the diculties.
e rst family therapy session was attended by the whole family, and I noticed
how uncomfortable everyone seemed. Melanie, pale and dawn, wearing loose
tting dark clothing, sat hunched up in the corner of a sofa, James sitting next
to her, wearing a shirt and tie despite the heat, while Gemma and Rebecca
sat on the other sofa. Gemma looked uncomfortable, sitting very straight and
seemed to avoid eye contact with anyone. Rebecca was sitting upright and
alert, but gave the impression of being anxious.
My initial feeling was apprehension; everyone seemed ill at ease, and as this
was an introductory session I decided to start o by explaining the process of
family therapy within the unit and introducing the team. In hindsight, I might
have wondered more about this sense of apprehension and perhaps have been
curious with the family about this sensation. Was it shared? Who was most
apprehensive? At the time, my (threefold) hunch was that this particular
family needed a little time to get used to the context, and that a little structure
would be helpful to them in orienting to our meeting, rather than circular
questions. As I think about this now, perhaps my decision was a fourfold,
aesthetic choice, a response to the general sense of discomfort.
Following these (single vision) formalities, I wondered what the family
noticed most about not having Melanie at home. Asking a circular question
at this point seemed apposite; asking family members about the person who
is currently not living at home can be reassuring to that individual, who may
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Human Systems Hugh Palmer
appreciate stories of being missed. is is in part based upon theory driven
(twofold vision) ideas of circularity, but may be a regular question in an
inpatient family therapy setting. Initially, Rebecca spoke more than others;
she talked about missing Melanie’s baking, her helping around the home and
times when they would sit and watch TV together. I noticed Melanie look up at
her mother and smile at these words. en, with some gentle encouragement,
Gemma spoke a little, around her job working in a small supermarket and of
her hopes to undertake a child care course at university. I was curious that
Gemma did not mention what she missed about Melanie, but before I could
enquire further, Rebecca told us about Gemma and Melanie having a very
dicult relationship. Curious about the daughters’ relationship, I asked if
this is something that they would like to improve and Gemma immediately
nodded, but Melanie shrugged and looked down.
At this point, I have been gathering some useful information (single vision);
Rebecca’s closeness to her younger daughter, the apparent distance between the
two sisters where one would like to improve the relationship but the other may
be ambivalent. is data led to some inner theorising (twofold vision) about
the structure of the family in terms of closeness and distance between the
members, and a threefold intuition that the daughters’ problematic relationship
may be more complex, and I felt it was too early to enquire further about this
relationship. Instead, thinking about multiple engagement (for example, Real
1990), I felt it might be helpful to draw James into the conversation.
James spoke about his business which necessitates very long hours; normally
he works twelve hours, six days a week. Despite this he told me they try to have
family time when he is home in the evening, and they try to eat together when
possible. I noticed that sometimes James turned to Melanie, putting his arm
round her and would whisper to her, apparently trying to draw her into the
session, although Melanie did not respond to this and looked uncomfortable.
So far, I had been able to gather lots of information, not only about the
individuals in the family and some of the connections, but also my own inner
responses and thoughts. I was curious about the relationship between the two
sisters, how (perhaps from my own early structural leanings) did the parents
support each other in the light of the father’s long working hours, and I was
appreciative of the many challenges that this family had and were, experiencing.
As the session had progressed, I noted how my initial apprehension had faded,
although I still felt tense in response to the general guardedness of the family
that was hardly surprising given the context.
In our second meeting, around three weeks later, I noticed that I felt much
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Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
less anxious about working with the family and I wondered if this was in
response to the family seeming more relaxed when they joined us. I began
by acknowledging the dicult past few weeks, as Melanie had self-harmed
during this period. Rebecca spoke about how stressful and unpredictable it had
been, but also noted that Melanie had been more open over the past week. I
was aware that Rebecca was positioned as the spokesperson, she seemed more
willing to engage and talk, and I wondered how inuential she was within the
family system - did she choose to be the spokesperson or was she positioned
by the other family members? My threefold sense of decreased anxiety may
have been in response to Rebecca’s desire to be more talkative.
Feeling more condent, following Rebecca’s talk of unpredictability, I
expressed my curiosity about how the usual challenges of daily life were being
met with the additional hurdles presented by the problems the family were
facing. Rebecca responded by talking about life being a ‘mess’ at the moment,
but expressed hopes that this will clear gradually, and spoke of milestones she
anticipated, including Melanie getting discharged and the court case being
resolved as well as some other family issues. I wondered about using solution
focused scaling with the milestones identied by Rebecca, but wasn’t condent
that other members of the family shared these goals.
My (twofold) thoughts about solution focussed goals and wanting to involve
other family members led me to enquire about places where Melanie would
rather be right now. In hindsight this perhaps was a reasonably aesthetic
shi (fourfold) as she enthusiastically talked of Florida and of Siam Park in
Tenerife, and I enjoyed listening to them all talk of the happy times the family
had spent at these places. is animated conversation was a considerable shi,
and I felt my condence increasing.
Melanie mentioned visiting the Harry Potter Park in Florida, and it emerged
that she was a really big fan of all things to do with the Harry Potter stories. As
I have some knowledge of these stories (threefold), I felt a wave of enthusiasm,
hoping that, perhaps these rich stories might lead to some useful metaphorical
thinking about the family’s diculties. As we talked about Harry Potter, I
enthusiastically wondered aloud about the dierent Hogwarts houses family
members might be in. is was a twofold attempt to use circularity, and I was a
little disappointed that this didn’t meet with much interest. e family looked
at each other and didn’t speak. I felt confused by the shi from animated
conversation to awkward silence and my (threefold) inner response was a
sense that something didn’t ‘t’ for the family, although at the time, I wasn’t
sure what it was.
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Human Systems Hugh Palmer
In hindsight, this particular use of circularity was risky, as one of the Houses
(Slytherin) has negative connotations and the family’s subdued response may
have been intended to prevent Gemma being publicly singled out as the sole
member of Slytherin. However, at this point in the therapy, there had not been
much conversation about Gemma’s dierences, although this will emerge later.
Despite feeling crestfallen, I still felt it was worth sticking with the Harry
Potter theme as this had clearly engaged Melanie. I cannot claim it was an
aesthetic, fourfold shi as I tentatively wondered about the anorexia being like
a ‘dementor’ or Voldemort (for those not familiar with the Harry Potter stories,
Voldemort is the villain and dementors are horric creatures who deprive
human minds of happiness and intelligence). Melanie said that the anorexia
was somewhere in between the two, and called it ‘Voldementor’, nonetheless
aer some rather brief family discussion about the impact of Voldementor on
them all, Melanie began to look disinterested and tired. Turning my attention
from Melanie to the parents, we touched upon the transformative nature of
the Harry Potter stories and the theme of going through dark places to emerge
changed (there are clear links with J.K. Rowling’s Harry Potter books and the
themes of alchemy and transformation familiar to readers of C.G. Jung) and
both parents indicated that perhaps, something good might emerge from the
current dark times they were experiencing.
As we began to close, the dialogue about relationships with anorexia and of
transformation provided an opportunity for James to talk about how he did
not fully understand Melanie’s condition and his struggle to know how to help,
but he clearly acknowledged his pride in Melanie’s progress. I was glad that
he had felt able to share his vulnerabilities at this point, especially as he had
previously expressed some doubts about family therapy, and Melanie listened
to him attentively.
In asking the family to rate the session (single vision), the consensus was
that the session had been helpful, but perhaps dicult as there was no clear
outcome, although they were hopeful a sense of direction would begin to
emerge.
At the beginning of our third meeting, only the parents were present as
Melanie was on her snack break and Gemma had travelled separately and
not yet arrived. During this initial period, we had a brief discussion around
pressures within the family; including a lack of support regarding Gemma’s
Asperger’s diagnosis, pressure with James’ work and visual impairment and
Melanie’s mental health. Rebecca began to be highly critical of Gemma, saying
she could not wait for her to move out. She was still sharing her exasperation
34

Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
regarding Gemma’s unwillingness to contribute to household chores when she
was interrupted as Melanie joined us, and Rebecca shied the conversation
to talk about her hopes for the future and all agreed that they wanted some
normality back such as family trips out.
I was still trying to process the (single vision) information, especially as I was
experiencing some inner distress (threefold) at the antipathy towards Gemma
that Rebecca had articulated when Gemma arrived.
Gemma had brought a gi for Melanie, beautifully wrapped, and handed it
over to her. Melanie quietly unwrapped her gi, while Gemma (with prompts
from me) explained how she had chosen the store to go to, and the gi itself (a
so toy) based upon movies that she knew Melanie liked. I was struck by the
level of thought that had gone into the gi, and commented on this, wondering
if the other members of the family had noticed Gemma’s thoughtfulness.
e contrast between my inner feelings of shock at a mother’s antipathy to a
daughter and my response to the thoughtfulness this daughter had taken to
choose a gi for her sister was stark. Trying to hold on to these very dierent
perspectives (twofold) le my mind in a whirl. It felt like something important
was happening, but I couldn’t quite put my nger on it.
Both parents seemed genuinely surprised by the gi, and I felt it might be
worth bringing Gemma more fully into the moment. I asked Gemma about
her concern and care for Melanie, and she described how she had been doing
research into the evidence for eating disorders, and found family therapy
to provide the highest improvements, so wanted to participate, despite her
personal sense of limitation in conversation. Aer showing appreciation for
this commitment, I decided to continue by asking if Gemma found it hard
to understand the emotional aspects of anorexia; what was her experience?
Gemma talked about the diculties she had with her Asperger’s, telling us how
one person once described her as ‘a robot’, about her sense of being dierent
and real struggles understanding emotional problems; anorexia was alien to
her. Yet here she was, committed to helping her sister and having brought a
carefully chosen gi, despite the signicant dierences between them.
And then a moment really impacted upon me; Melanie, having been intently
listening to her sister, and seeming genuinely surprised about Gemma’s
concern and interest, reached out to her sister and they held hands. I felt a
surge of emotion (threefold), yet at this point, seemingly unaware of what
was happening in front of her, Rebecca had begun talking about problems at
home. I interrupted her, gently asking if she had noticed her daughters holding
hands? Both parents looked. e room went silent for what seemed like ages,
35

Human Systems Hugh Palmer
and I noticed tears slowly forming in their eyes. ey had witnessed their
daughters’ connection. It seemed that, momentarily, the whole universe had
shied and I felt a sense of incredible communion with the family; a moment
of fourfold vision, poignant and moving.
Commentary
inking about the therapy described above, I believe that my own experience
of having grown up with an older sister who has Asperger’s (as well as other
learning diculties), and perhaps a particular sensitivity to dierent ways in
which people can demonstrate care became foregrounded for me. Having had
some personal experience of Jungian therapy, I developed an interest in Jung’s
ideas regarding transformation and these will have been signicant factors in
the choices of what I focussed upon during these sessions, along with other
personal, professional, educational, theoretical and political inuences, all of
which, to lessor or greater degrees, guide my thinking and responding.
In terms of theory, whilst I consider myself to be primarily ‘collaborative’
and dialogical’ in my practice, from a narrative therapy perspective, it is an
easy task to theorise about and identify dominant and subjugated narratives
regarding the sisters and their relationship. From a structural perspective, the
parental relationship is interesting; the father working very long hours to earn
an income while the mother is struggling, o work, trying to cope with two
daughters with very dierent needs may impact upon family structure and
executive functioning.
Broadening the focus, there are multiple contexts at play here; including, the
setting of an inpatient unit, the family and their connections; employment,
dis/ability, illness, wider family and community. Even wider contexts are the
cultural resources described by Bourdieu (1990) as ‘habitus’ which describes
how the culture of a particular social group is socialised and then embodied
(internalised) in the individual and what he describes as ‘doxa’, the shared
assumptions that arise from this cultural habitus. In this situation, all of the
family and myself are white, British and middle class, which would indicate
that we may share assumptions that might not be immediately evident; these
are potential blind-spots that could be open to question and dialogue if they
were surfaced.
Of course, there are even broader, societal and global contexts and discourses
we are embedded within; for example, in the U.K. where a broadly patriarchal,
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Fourfold Vision in Practice: Data, Theory, Intuition and the Art of Therapy
conservative culture that values hard work and is intolerant of dierence.
Conclusion
is paper has been an attempt to articulate an approach to therapy that is
consistent with what Gregory Bateson described as a cybernetic epistemology;
a world of ideas and relationships that was evident both in his writing and
interactions.
It is important to stress there is no right or wrong way with the concept of
fourfold vision - it simply oers a way of thinking about elements of practice
as being equally important and interconnected; not simply domains that all
need to be attended to in a formal or rigid structure.
Importantly, in an era when ‘ticking boxes’ and evidencing outcomes seems
so important to agencies, fourfold vision oers an opportunity to meet those
needs and still work with grace; addressing the needs of the family and of your
own ‘self’ as a therapist.
Perhaps the nal words are best le to Gregory Bateson:
“It is, however, possible that the remedy for ills of conscious
purpose lies with the individual. There is what Freud called the
royal road to the unconscious. He was referring to dreams, but I
think we should lump together dreams and the creativity of art,
or the perception of art, and poetry and such things. And I would
include with these the best of religion. These are all activities in
which the whole individual is involved. The artist may have a
conscious purpose to sell his picture, even perhaps a conscious
purpose to make it. But in the making he must necessarily relax
that arrogance in favour of a creative experience in which his
conscious mind plays only a small part. We might say that in
creative art man must experience himself— his total self—as a
cybernetic model”. (Bateson, 1972 pp. 445-446)
Please address correspondence about this article to: Hugh Palmer, hugh.
palmer@sky.com
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