Corresponding Concepts in Systemic Therapy & Design Thinking
[Originally posted Oct 17, 2017]
I am in the process of mapping corresponding concepts between two disciplines — psychological therapy methods and creative, design thinking methods.
This project has been incubating for close to three years. It’s grown to become too relevant to hold it back any longer. Thus, in the true spirit of design thinking, I want to share a first iteration and invite feedback.
quick sketch on a napkin makes this double diamond process even more legit
The Journey
First though, why compare an apple to an orange? Even though I grew up enjoying creative and artistic activities while being “good at school”, I decided against art, medical and law school and studied the human experience. Psychology is the apple in my example. During my major studies, I studied basic and applied human psychology. Then as an inquisitive therapist, I was missing a certain creative outlet in my work. What do I mean by that? For instance, cognitive behavior therapy combined with medications has received the greatest amount of empirical support for the psychological treatment of anxiety disorders. I would find it interesting, if a therapist would not try this approach first and primarily and instead take the Freudian route. It is a matter of opinion, too.
In mental and physical healthcare, a certain solution is mandated when problems are urgent and remedies have been studied and proven to help. A bandaid if there is blood and an empathetic therapeutic relationship if there was trauma, for instance. As for myself, I did not want to administer known and studied solutions alone.
I investigated more creative psychotherapy approaches and pursued systemic therapy with an academic degree. In some of these post-modern approaches, truth is seen as a construct and thus a highly creative outcome. A patient “is” not his diagnosis or truly “the victim”, but may have been labeled as one and can set out to create a new narrative that serves him best. Creativity is the orange in my example and in my major studies of marriage and family therapy, I was on a quest for an infusion of creativity. I paid increasingly more attention to context, culture, issues of diversity, and relationships. Try being “right” when you argue with another person; it is hardly possible.
After graduating with a degree in marriage and family therapy and sufficient work experience as a mobile therapist, I decided to join Duolingo, a young startup. I was hired as a German language expert and it was a great opportunity to not only write the first version of a German language course that is now used by millions of learners, but also to pick the content carefully and shape the tone. For example, “Sie ist ihre Frau” is a perfectly fine sentence and led to discussion in the team — is this what we want to convey? Yes, we are open-minded, embrace diversity and “She is her wife” was kept in corpus. As my role evolved, I continued shaping the culture of this budding company. I increasingly performed “design doing” and it became from thereon a red thread in work.
Definitions and Terminology
First things first, know that systemic psychotherapy is an approach in which not only the human being is at the centre of treatment but also her or his relationship system, or context. Some say, that you treat the relationship between couples in couple therapy rather than just treating each partner. I noticed that systemic psychotherapy it often misunderstood or not understood enough in order to proceed with a good enough conversation. I have heard “Oh, psychology is useful”, when I shared about my major, or people think systemic psychotherapy is a systematic approach.
Design thinking is “a methodology used by designers to solve complex problems, and find desirable solutions for clients. A design mindset is not problem-focused, it’s solution focused and action oriented towards creating a preferred future.” Beyond that, design thinking is a human centered problem solving approach. It may be exclusive for design practice, if you stick to a certain terminology and follow a certain process. However, it is ubiquitous if you start seeing parts of it in everyday human behavior such as writing, speaking, parenting, teaching, driving. Design thinking needs to be demystified, there is no doubt. Parents that sort craft supplies have prototype supplies, athletes that try out varies work out routines ideate and iterate, and restaurant owners that hear from their guests provide user-centered work.
Berlin: Retro chewing gum machine metaphor for this comparative story.
Corresponding Concepts
My work is all about helping individuals and companies to improve their functioning and well-being and with this goal in mind, I am developing my own version of a treatment model. Bill Burnett and Dave Evans describe this as “building your compass” in their book “Designing Your Life”. I am on it!
In business, a person’s skill set can be described with the T-shaped profile where the T column stands for in-depth knowledge and the T-row for general knowledge across disciplines. I intend to further an H-shaped expertise with subject matter expertise psychology and in design thinking by doing it. For this purpose, I am developing a design thinking curriculum for self-studio. More on this soon.
Long story short, here is the alphabetical list of concepts that I found corresponding concepts for, plus short descriptions and examples. This is a work in progress.
agile development = any dynamic human system
An agile development takes an idea, iterates solutions of it, uses feedback and reflection before it is released to the market. Frequent scrum meetings are common.
A dynamic human system such as a family manipulates ideas, messages on a daily basis, each person uses various ways to think, act and feel, responds to feedback from family members and reflects alone. Perhaps weekly solution-focused or strategic therapy sessions are like scrum meetings — a checkin with a professional to assess and steer progress.
false belief of what service or product is or should be = dominant story
Designers and non-designers have beliefs about products. A wallet should be made of leather and hold cards and bills or a doctor should be listening to a client. These (false) beliefs are subjective and are collected before they are innovated.
In narrative therapy, a patient often comes in with the dominant stories that explain part of his suffering. “I was robbed and cannot sleep anymore.” The therapist carefully crafts an alternative story that allows for better functioning such as “A robber entered my apartment, I reacted the best I could and now search for ways to better fall asleep.”
desktop walkthrough = role play
A small-scale 3-D model of a service or product environment, maybe using lego figures to bring a situation to life.
Therapy with figures or actual role play so that a patient can practice newly learned aspects of behavior. For instance, a teenager can learn how to set a boundary with a mother and practice the dialogue.
empathy in design = self compassion, emotion-focused therapy
Empathic design is a user-centered design approach that pays attention to the user’s feelings toward a product or service.
Emotion or experience focused therapy puts the feelings at the center to drive change. In emotion-focused therapy (EFT) according to Dr. Sue Johnson, romantic partners are encouraged to express their needs to allow for healing. See her recent book “Hold me tight”.
flipping it = prescribe the symptom, strategic therapy
Design thinking gets you thinking outside the box (i.e. beyond what is typical). For instance, traditionally classrooms are teacher-centered and in a flipped classroom the learner is driving the learning.
Strategic therapy is very creative and interesting. Treatment success has been reported when the symptom was actually prescribed instead of prohibited. The idea is to increase the control of the target behavior and then give the patient a choice. For example, a child is asked to fight for 5 minutes each afternoon with her mother. Sometimes, a child looses interest once she discovers what happens after such practice.
hero’s journey = desired, alternative narrative (e.g. treating victimization)
The hero’s journey or monomyth (think Luke Skywalker) is a specific method out of the story-telling toolkit used in coaching individuals and allows them to understand their current challenge as an adventure. It makes generating ideas easier.
Similarly, narrative therapist, solution-focused, and other positive psychology therapists work together with their clients to retell their experience in a manner that empowers, imbues more meaning and control. This can also be understood as the alternative story opposed to the dominant story.
human-centered practice= systemic psychotherapy
In the 1980s, design practice shifted its focus from product- to human-centered design. It was time to overcome the fetish for the product or service and instead a budding interest for the people that handle the designed artifact.
Interestingly, psychotherapy moved the opposite way from a focus on the individual onto the system. In the 1970s, mobile therapy became more popular, a socially minded army of helpers visited patients at home or hospitalized patients were released to be reintegrated into society. Not always the best idea. Yet, at last, therapist focused more on relationships because they noticed that symptoms reappeared in “healed patients” when certain people entered the stage.
identifying the real problem = it depends
Like archeologists, in service or product design scenarios, the search is on for the real,underlying, actionable problem. The design team will spend some time to agree on a shared problem definition before they roll up their sleeves.
Good luck finding the real problem in the room in therapy or coaching. Therapists make a distinction at times between the content and the process. The patient is definitely the content expert (with growing process knowledge) and the therapist is the process expert. Still, each person has her own view and it is just as valid. Each approach also has its own understanding of problem criteria, believe me. For instance, in narrative therapy the problem is separated from the person at the beginning — you are not your diagnosis.
manipulable prototype = weighing labels carefully
Protoypes in design thinking work, or rather in design doing, are quickly made models based on quick and dirty sketches so that feedback can be collected for further development. If someone wanted to design a purse, and grabs a napkin to mold a quick prototype, you’ve got it.
In psychotherapy words and nonverbal communication are the main props, while some practitioners offer props like figures, toys for children, or drawings. In a way, verbal descriptions are like prototypes that can be quickly found, used, and experienced. In career coaching, rephrasing a “job search” as a “career step” in order to find someone’s calling has tremendous implications. Dik and Duffy’s book is a great example for this.
positive or negative emotion override = the designer’s vibe
Negative sentiment override is what happens when over time, all the arguing, all the conflict between you and your partner has built up for so long that you can no longer give your partner (or they can no longer give you) the benefit of the doubt.
Lucky Cat
On the contrary, vibes are the result from intended (and unintended) design choices. For instance, JWT Intelligence describes in their trend watch for 2020 so called “Anti-instagram interiors”. Designers flocks towards designing restaurants away from the predictable and monotonous design vernacular fetishized by social media, instead creating dark and intimate spaces that prioritize in-person interaction over digital sharing.
prototyping new service/product idea = Prototyping new thinking, feeling, behavior
No star is born over night. Same goes for successful services or products. Usually, there is a lot of thinking & doing, trial & error happening before.
Here an example from Tim Brown’s blog about design thinking from 2008–2018. (If this link will be disabled in the future ..) The idea in a nutshell: The gift of 10-minutes of free time was given to people commuting on North America’s Caltrain in California. The designers went into the field with a ticket dispenser where each ticket symbolically gave recipients free time. This field test elicited various reactions, most positive or startled, few hostile. This idea, its execution and material can be thought of as a prototype that can change.
A therapist might also suggest and develop a new form of thinking, feeling, and or behaving with a client. For example, if a client is facing burn out at a high demand job, the new response to a common trigger could be as follows. Think: Is what I am asked to do part of my job description? Let me think. Do I want to do this? Let me think. Slowing down the knee jerk response of just doing it. Feel: From overwhelmed, mindless to calm, reflective and mindful and thus in control. Behave: Say back what you just heard to the supervisor. Think out loud and ask for time. “Let me think about this. I will finish this task and then take a look.” Usually, change comes with slowing down our stimulus-response learning. It’s like a movie in slow motion. It’s like meditation, where you notice the interspaces, the options to think, feel, act differently in between. It leads to feeling more in control.
The trifecta of thinking, feeling, and behaving differently after a session of psychoterapy is a new prototype for a client’s response. It can change, be adapted, yet the idea has been born.
questioning in design thinking = questioning in therapy
“One of the biggest problems in design is knowing what questions to ask. — Tim Brown on his blog, 2008
I can only imagine the helplessness of an inexperienced therapist when facing his or her clients. You sit in the room with someone who came for paid help. You sit across from someone who sought you, travelled and now opens up with words, gestures and more. Sometimes, there is not even a pen, notepad, or other object within reach to manage this mutual initial arousal or anxiety. Sometimes, a good line of questioning and responding is the only thing you have.
Similarly, designers find themselves in some phases in similarly therapeutic conversations with their clients. For an initial meeting, there a clients with needs and vulnerabilities in the room who opened their space for paid help. Sometimes there are sharpies and post its already. Sometimes, there is only the designer you asks guided questions, with the right balance of openness and agenda. The agenda might be: Get the client to talk. Ask open-ended questions that cannot be answered with yes/no. Go deeper with “Tell me more.”
Radical collaboration = blurred boundaries (Bowen)
Rip the Brief = Patient Request & Indicated Problem
In Dan Nessler’s words, ripping the brief means to “analyze the initial situation and conclude how much more details and knowledge you kneed or want.” Or in other words: whatever the client is calling and asking you for needs revision. So take that piece of paper, read it before ripping and write it new — based on more details and what you know.
Similarly, patients may call and ask you for a psychological or relational problem that most likely will need revision. A teenager may call because she cannot stand life anymore and after some talking, you sense that she struggles with negatively impacting cognitive distortions hence depression and could benefit from a more solid self care repertoire. A couple may call you because they want you to fix their relationship and bring back their partners. Rip that request as well and redefine the problem as follows: working on the patient’s ability to voice a complaint constructively, make I-statements and express needs, and make repairs. As a result, the relationship will improve and the partner may want to “stay” again.
Found at UX Collective: First step, left square: Ripping the brief. https://uxdesign.cc/how-to-solve-problems-applying-a-uxdesign-designthinking-hcd-or-any-design-process-from-scratch-v2-aa16e2dd550b
reframing = relabeling (solution focused therapy)
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service staging = experience-focused intervention, example: exposure therapy
Service staging is the physical acting out of a scenario and prototypes by design teams, staff and even customers. It is perfect to bring out the emotions and kinesthetic experience. How does it feel to hold the device?
Staging encounters with people or objects is also practiced in safe scenarios in therapy. For phobia treatment, a therapist will prepare a patient for exposure to the feared object. Ultimately, the patient learns to handle a spider or social situation and manages himself better than before.
storytelling = narrative therapy
Nothing like information in the shape of a good story will engage your audience. For instance, a problem statement and product pitch works wonders if you describe it along the arch of buildup, climax and resolution.
In therapy, each session follows a certain format with an opening, a middle stretch and an ending. While experiences are complex and non-verbal as well, the conversation is a narrative that the patient and therapist shape. Over time, a certain story develops and is a major outcome of therapy.
wicked problem = gridlocked problem
I perked up when I read that designers love wicked problems, because couple therapist that follow John and Julie Gottman’s couple therapy approach, accept so-called gridlocked, perpetual problems.
A wicked problem is an inspiring challenge for a design thinker, who will roll up her sleeves and dig for the real, underlying problem and then “double diamond” away, i.e. convergent thinking, divergent thinking, and once again.
A Gottman therapist will acknowledge that couples have certain gridlocked problems that are best laid aside. It is agreed that one cannot agree on them. Touché. Yet…
This list will grow and be edited. If you have questions or suggestions, email me at info@pixelstorystudio.com with this story’s title as the subject.