The evolution of family therapy from a cybernetic metaphor to a narrative metaphor has led us to think differently about therapy, about clients, and about ourselves as therapists. In this article we pursue how this different way of thinking has informed a theoretical understanding of a narrative therapy approach and consequently has opened space for different ways of working clinically. We begin by tracing the evolution to narrative; we consider the implications of social constructionism and its political effects; and we complete the discussion by focusing on narrative theory. We then show how the clinical work follows logically and is coherent with the theoretical considerations. We describe, and illustrate with clinical examples, an innovative approach to working with couples and families with adolescents. In this work we pay attention to the larger cultural stories, including gender constructions, and to personal stories that persons have created to make meaning out of their experience as they interact with one another in a reciprocal meaning-making process. Interventions focus on externalizing the problem narrative that is influencing the client(s), mapping the effects of the problem pattern and/or the totalizing view persons might have of others, and creating space for client(s) to notice preferred actions and intentions. Finally, we close the loop by asking questions of ourselves and others about the effects of working from a narrative metaphor.

Integrative approaches seem to be paramount in the current climate of family therapy and other psychotherapies. However, integration between and among theories and practices can only occur within a specific epistemology. This article makes a distinction between three different epistemologies: individualizing, systems, and poststructural. It then makes the argument that one can integrate theories within epistemologies and one can adopt practices and some theoretical concepts across theories and across epistemologies, but that it is impossible to integrate theories across epistemologies. It further states that although social constructionism has influenced much of contemporary psychological thinking, because of the divergence between a structural and a poststructural approach, constructionism looks different depending upon one's epistemological stance. Examples of integration within epistemologies and of what looks like integration across epistemologies (but is not) further illustrate these important distinctions. The conclusions reached here are crucial to our philosophical considerations, our pedagogical assumptions, and implications for both research and a reflexive clinical practice.

Poststructural/narrative therapists working with heterosexual couples position themselves to attend to issues of power and privilege and how these variables differentially affect each gendered member of the couple. The poststructural therapist understands patriarchy as the grand narrative that influences us all, often invisibly, and creates conditions for people to respond outside what might be their preferences for performing relationships. This article takes the reader inside the work with couples and demonstrates how the narrative/poststructural therapist attends to aspects of the conversation, asks questions, makes comments, and otherwise intervenes with couples using patriarchy as a lens for understanding. Rather than challenging patriarchy in how it influences men and women, the intention is to bring forth more preferred ways of being that are outside of or on the other side of patriarchal effects. This way of working thickens people's accounts of themselves and of their relationships so that they might live in more satisfactory ways.

Using the concepts of "restraints" and reciprocal patterns, a specific approach for understanding and working with families of adolescents is offered. The organizing idea is the "restraint" that revolves around a difficulty both parents and youngsters have in making a distinction between what parents want for their youngsters and what the young person might want. This difficulty may come from the parents' ideas and beliefs about parenting and from their own growing-up experience, from the adolescent's "not completely storied" lives, and/or from societal discourse about adolescence. Restraint of ideas can be constructed as reciprocal patterns and located in dominant narratives that families may have about themselves. A restorying process allows families to separate from the problem pattern and focus on the youngsters' willingness to have ideas for themselves.

Postmodernism began to influence family therapy very early in the 1980s with articles referencing postmodern ideas, focusing on meaning and multiplicity. With the appearance of narrative therapy on the scene in the 1990s there was a shift toward poststructural thinking, which refined the movement and politicized the clinical work. Even with a bit of a backlash, whether because this was a new idea or it somehow threatened a positivistic culture, a poststructural view has continued to have effects on family therapy. This article explores the variety of influences: the expansion of narrative ideas, the innovation of Madsen's collaborative helping, and also more nuanced effects. I argue that a poststructural view has effectively changed how many family therapists think and may also be subtly influencing how they might work.