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Published Online: 14 July 2023

Rediscovering Interpersonal Punctuation

Abstract

The term punctuation in psychotherapy refers to narrative decisions about when a problem started and who should be held accountable for it. The concept was once a staple of family and systems therapies, but it has largely fallen into disuse. Its near disappearance coincided with the declining interest in those therapeutic approaches rather than as the result of direct attacks on the concept’s validity or usefulness. In other words, punctuation seems to have been neglected rather than deliberately abandoned or supplanted. The authors argue for the continuing value of punctuation and its introduction to a new generation of clinicians. They also discuss several theoretical issues that were not well explored during the heyday of punctuation’s popularity. Finally, the authors explore and illustrate the practical utility of punctuation in psychotherapeutic contexts.
In the early 1970s, family and systems therapists made extensive use of the concept of punctuation (1). This concept pertains to deciding when a problem or situation “started” and who should be held accountable for it. For example, a woman might claim that her marriage is falling apart because her husband is having an affair. By contrast, her husband might claim that their troubles began with his wife’s loss of interest in sex. She might then counter by saying that her diminished libido was the result of his constant criticisms about how she spends her day. These various punctuations of their issue establish agreements and disagreements about when a problem started, who is at fault, and which solutions are possible.
Issues of punctuation are not necessarily disputes about facts. For instance, in the example above, both spouses agree that the husband was having an affair, that the wife was increasingly distant, and that the husband was critical of his wife’s time management. Punctuation concerns deciding what to consider as the cause of the problem and what to consider as the effects, even when everyone agrees on the underlying facts of the case. Debates over causal sequencing are crucial, not only to spousal disputes but also to events such as children’s playground fights, labor disputes, international conflicts, and—of course—the origins of psychological and psychiatric disorders. One client may construe problems in terms of family history and childhood determinants, whereas another may focus on interaction patterns and current life circumstances. Therapists, too, have their causal preferences. For instance, some investigate past traumatic events, whereas others are more interested in current family patterns and expectations.
With the decline of interest in family and systems therapy modalities, the concept of interpersonal punctuation has faded from view. Therapists and theorists have not questioned the validity of the concept. Rather, punctuation simply fell into disuse when the psychotherapy field’s focus shifted away from family dynamics toward issues of trauma, neuropsychology, and mindfulness practices.
Some contemporary family therapists appear to have incorporated the notion of punctuation into the broader category of reframing (e.g., [2], p. 128). Reframing represents a therapist’s attempt to change the conceptual (and emotional) meaning of a behavior or a set of circumstances—usually by putting a more favorable spin on what has transpired. Unlike punctuation, reframing often is not anchored by the objective existence of facts (2). Moreover, as Weeks and Treat have noted, a therapist’s main goal is to shift the client’s perceptions in a particular direction rather than to be overly concerned about the truth value of the therapist’s interpretations. For instance, a family therapist might describe a child’s disobedience as “striving for independence” rather than “showing disrespect,” even in the absence of any evidence for that interpretation.
Given that we consider the concept of punctuation to be of great value to therapists of many different persuasions, the purpose of this article is to acquaint early-career clinicians with punctuation’s utility, remind experienced therapists of its continuing value, and expand several theoretical points that were not fully explored during the heyday of punctuation’s popularity. As we prepared to write this article, we administered an informal survey to graduate students and young clinicians with the goal of ascertaining their familiarity with punctuation. Few had heard of punctuation, reinforcing the need to explain its value.

Theoretical Issues

Deeply ingrained habits of language and perception make it almost impossible to avoid punctuating problematic events. We (as humans) routinely, automatically, and inevitably organize our experiences into series of discrete or semidiscrete events. Moreover, we develop strong beliefs about the accuracy and inevitability of our preferred punctuations. However, all punctuations have an arbitrary quality. One can always begin a story at a different point in time, leading to shifts in causal attributions. Consequently, the stories we tell ourselves and others are always selective, partial views of the territory. These stories inevitably obscure and distort potentially important features of the situation and make alternative forms of analysis difficult to contemplate. In other words, to represent events in language is also to automatically misrepresent them.
Humans routinely use a verbal formula that posits that whatever comes before (in time or space) can be construed as a cause of whatever comes after (3). Causal tales may be very circumscribed or very extended: “The milk spilled because the glass was too close to the edge of the table” versus “Modern table designs have led to more food accidents,” respectively. Furthermore, people tend to choose punctuations that portray them in a favorable (or at least less unfavorable) light. Note that linguistic acts are never neutral—they represent positionings that sustain, enhance, or rehabilitate an individual (or group) identity (4). In other words, shifts in punctuation have potentially important consequences—monetary, medical, romantic, entrepreneurial, and interpersonal. As we have implied, changes in punctuation play a role in the assignment of blame and responsibility. In this regard, consider as an example the parody of blame-shifting from the musical West Side Story: the gang members each try to persuade Officer Krupke that their bad upbringing mitigates their responsibility for their current harmful behavior. In each stanza, the punctuation changes, and blame is reassigned. In the song, the culprits named include parents, grandparents, drugs, unwanted pregnancy, immaturity, neuroses, sexual ambiguity, and social deprivation (5).
Of course, punctuation is a core weapon in debates over who is right and who is wrong. The participants in such conversations—spouses, family members, coworkers—typically engage in what might be labeled conversations of “accusation, characterization, and recrimination” ([6], p. 158). Such exchanges are the antithesis of helpful problem-solving dialogue. In fact, one cannot easily get from the right-or-wrong domain to the problem-solving domain. To make that shift, an individual must relinquish the claim that they are right and that others are wrong. This choice is one that therapists can (and usually should) encourage, and one way to do so is by “loosening” the attachment of clients to particular sets of punctuations.

The Clinical Context

In line with the philosophy that the “customer is always right,” clients are entitled to propose and defend whichever punctuations they prefer or—perhaps as often—the only ones they can envision. On the other hand, therapists, as professionals, are obligated to maintain a broader purview and to be ready to propose and argue for the wisdom and usefulness of alternative punctuations. In fact, from the authors’ perspective, helping clients to revise counterproductive punctuations is a core aspect of a therapist’s role. Again, we are not talking about merely reframing the situation. Rather, we are discussing revisions in the client’s preferred time frame. Also, unlike many traditional family therapy reframes, these alternative punctuations remain faithful to the facts as understood by the clients.
Even when a client is unable or unwilling to immediately entertain an alternative time frame, therapists must keep in mind that all punctuations (including their own) are incomplete descriptions of reality and represent particular, partisan positionings. Moreover, we propose that each punctuation has alternatives. This position is congruent with the clinical stance of Harold Mosak, the notable disciple of Alfred Adler, who (when training students) steadfastly maintained that even in situations in which one does not know what to do, there is always something to be done (7). Mosak’s position was that “if one tactic, response, or interpretation does not work,” then the wise clinician moves on to another strategy.
It must also be recognized that every member of a family or group has their own favored punctuations. For example, a mother might initiate therapy because she is worried about her son’s grades; the father thinks that their son would not need help if his mother did not coddle him, and the child’s main agenda is to strategize how to regain possession of his Sony PlayStation. Thus, therapists must recognize that in “seeing a family,” they are dealing with at least as many agendas and punctuations as there are family members. Even in an individual session, the punctuations of others in the client’s life will undoubtedly become topics of discussion.
What we are saying about punctuation requires flexible thinking. This is one of the reasons why we have found it useful to embrace the contextualist worldview (8). Contextualism recognizes and accepts the interconnected nature of the world—a unitary fabric with segments of looser and tighter weaves. Moreover, within contextualism, multiple and shifting punctuations are permitted and expected, and different levels of analysis are encouraged. No single lens can capture all possible interpretations of an event.

Gail and Albert: Dueling Accusations

Let’s consider a brief clinical example. During an initial family session, the therapist asked Albert and Gail why they were seeking treatment. Gail answered first, saying that Albert was emotionally distant and ignored family issues, including their child’s worrisome school grades. Albert responded that his wife pestered him constantly, treating him as if he were a second, irresponsible child rather than a valued marital partner. Moreover, he claimed that she had rigid ideas about family problems and was not interested in anyone else’s opinion.
Thus, Gail punctuated the problem as being due to Albert’s indifference. Albert, on the other hand, attributed his indifference to the ways Gail had treated him. Gail’s account began with something Albert does. Albert’s account began with something Gail does. As usual, such competing punctuations resulted in a series of tit-for-tat exchanges in which each spouse blames the other for the problem. The therapist suggested that the couple move forward from that “who started what” dispute and instead focus on their child’s reticence to complete his homework—a starting point that, both agreed, needed attention. This focus bypassed, for the moment, their accusatory punctuations. The couple was able to come up with a policy for dealing with their child’s homework schedule, and, at the therapist’s suggestion, Albert agreed to be in charge of implementing the policy.
Dealing with the couple’s accumulated feelings of hurt and anger was a thornier issue and required shifting focus to an earlier time frame. The therapist noted that the friction between them had escalated when their son was born and when Albert’s work responsibilities increased. Those life stressors may have been at least partly to blame for the increase in relationship tensions. Also, as Gail acknowledged, her “take-charge” style and impatience to get things done may have inadvertently contributed to Albert feeling as if his opinions did not matter to her. Therefore, in this case, a shift away from the unproductive “who started what” punctuations and, later, an expansion of the time frame to include earlier events in the marriage helped the couple resolve their problem.

Ruth: Unwelcome Inheritance

In the following clinical example, Ruth, an accomplished 53-year-old woman, sought therapy to cope with her anger toward her aging mother. The issue had become acute because her mother’s health was failing, and Ruth—an only child—was being called on to provide most of her mother’s care. Ruth found it unpleasant to be around her mother, whom she experienced as being constantly critical and unappreciative of Ruth’s ministrations. In addition, Ruth continued to harbor resentments about how her mother had treated her father when he was alive, belittling his accomplishments and constantly “correcting” him in front of others. She remembered a year when he gave his wife a rather elegant watch for her birthday. Instead of being pleased and thanking him, her only comment was, “I guess it was too much for you to include a card?”
The punctuation time shift that was required involved reminding Ruth that her grandmother was also a hypercritical woman. Whether through genetics, upbringing, or both, her mother’s judgmental demeanor had been passed down from one generation to the next—an unwelcome family inheritance. When viewed as an intergenerational pattern, Ruth found it easier to see her mother’s criticisms in less personal terms. The therapist also speculated that both Ruth’s mother and grandmother probably considered their criticisms to be acts of love that were motivated by their understandable desire to ensure that their loved ones would turn out to be as “perfect” as possible; therefore, they may have considered the “correction” of offspring to be a necessary part of being a parent.
Once Ruth could see her mother as an unhappy woman with her own insecurities and disappointments, the corrosive tension Ruth had felt dissipated substantially. She was then better able to tolerate her mother’s presence, expecting neither vocal appreciation for her caretaking efforts nor a decrease in her mother’s criticism.

Summary

We consider it unfortunate that the concept of interpersonal punctuation fell into disuse when family and systems therapy approaches declined in popularity. As we have demonstrated, this concept can still play an important role in how both clients and therapists construe their interpersonal predicaments. Moreover, the concept of reframing (into which the notion of punctuation appears to have been absorbed) is not a substitute for punctuation’s specific emphasis on the role of shifting time frames. Punctuations determine how blame is assigned and which forms of causal analysis are deemed accurate and acceptable. Moreover, because linguistic neutrality cannot be achieved, punctuations establish social and interpersonal positionings—they influence how problems are perceived and how clients evaluate themselves and how they are evaluated by others.
Contextualism is the worldview that is best suited to thinking about interpersonal punctuation because it recognizes and accepts the interconnected nature of reality and the arbitrariness of all causal framings. Furthermore, contextualism encourages flexibility in shifting levels of analysis—readjusting and expanding angles so that different aspects of a phenomenon come into view and become available for analysis.
Difficulty arises when clients or therapists implicitly or explicitly reify punctuations. These reifications preclude alternative, potentially useful perspectives. Of course, clients (being the customers) are permitted to adopt any set of beliefs they like and to treat their punctuation as sacrosanct. However, therapists, as professionals who understand the fluid nature of interpersonal interactions and the biasing nature of language, are obligated to remain open to the multiple interpretations of a situation that shifts in punctuation can reveal (Box 1). In fact, by helping clients to entertain previously unnoticed or unacceptable punctuations, therapists can be of great service to their clients.

BOX 1. Recommendations for helping clients to acknowledge multiple punctuations and revise those that are counterproductive

Therapists can assist clients by helping them to identify and accept previously unnoticed or objectionable punctuations of their circumstances.
Such shifts in punctuation potentially modify important monetary, medical, romantic, entrepreneurial, and interpersonal consequences.
Punctuations affect social positionings that sustain, enhance, or rehabilitate an individual’s identity.
The stories clients tell themselves, their associates, and their therapists always represent selective or partial views of events, and these narratives often obscure and distort potentially important features of a situation.
Clients (as the “customers”) are entitled to propose or defend whichever punctuations they prefer. However, therapists, as professionals, are obligated to maintain a broader purview and need to be ready to propose and argue for the wisdom and usefulness of alternative perspectives.

References

1.
Watzlawick P, Beavin Bavelas J, Jackson DD: Pragmatics of Human Communication. New York, Norton, 1967
2.
Weeks GR, Treat SR: Couples in Treatment: Techniques and Approaches for Effective Practice, 2nd ed. Philadelphia, Brunner-Routledge, 2001
3.
Ossorio PG: What Actually Happens: The Representation of Real-World Phenomena. Columbia, University of South Carolina Press, 1978
4.
Goffman E: The Presentation of Self in Everyday Life. New York, Doubleday, 1959
5.
Laurents A, Robbins J, Bernstein L, et al: West Side Story: A Musical. New York, Random House, 1958
6.
Méndez CL, Coddou F, Maturana HR: The bringing forth of pathology. Ir J Psychol 1988; 9:144–172
7.
Mosak HH, Maniacci MP: Tactics in Counseling and Psychotherapy. Itasca, IL, Peacock, 1998
8.
Pepper SC: World Hypotheses: A Study in Evidence. Berkeley, University of California Press, 1942

Information & Authors

Information

Published In

Go to American Journal of Psychotherapy
Go to American Journal of Psychotherapy
American Journal of Psychotherapy
Pages: 150 - 153
PubMed: 37448304

History

Received: 13 March 2023
Accepted: 2 June 2023
Published online: 14 July 2023
Published in print: December 11, 2023

Keywords

  1. Interpersonal punctuation
  2. Psychotherapy
  3. Family therapy
  4. Systems therapy
  5. Contextualism

Authors

Details

Devin Hussong, Psy.D. [email protected]
Department of Psychology, Chestnut Hill College, Philadelphia (Hussong); Department of Psychology, Temple University, Philadelphia (Efran).
Jay S. Efran, Ph.D.
Department of Psychology, Chestnut Hill College, Philadelphia (Hussong); Department of Psychology, Temple University, Philadelphia (Efran).

Notes

Send correspondence to Dr. Hussong ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

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