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Constructivist psychotherapies
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As a philosophical position that
emphasizes both personal and social processes of meaning-making, constructivism has influenced several
contemporary traditions of psychotherapy. For this reason it is more
accurate to consider constructivism as a general approach to
understanding people, conceptualizing psychological distress, and
fostering human change than to view it as a distinctive “school” of
psychotherapy associated with
a particular theorist, preferred method, or specific set of problems
requiring treatment. Thus, constructivism is best viewed as a
“meta-theory” that
encompasses many late 20th century developments in clinical theories as
diverse as psychoanalysis, existential-humanistic psychotherapy,
cognitive-behavioral therapy, and family systems approaches. In
addition, a number of
novel psychotherapies have been devised along avowedly constructivist
lines, from personal construct theory, which was formally set forth in
the
1950s, to narrative therapy approaches that have become prominent only
in
the last 10 to 15 years. Appreciating the contributions of these
diverse models therefore requires a consideration of their core
philosophic
similarities and the range of concepts and strategies that shape their
expression at the level of clinical practice.
Constructivist philosophy
If there is a unifying theme that links constructivist forms of
psychotherapy, it is at the level of their epistemology, or theory of
knowledge. Although most constructivists acknowledge that a “real
world” exists outside of human consciousness or language, they are much
more interested in the nuances in people’s construction of the world
than they are in evaluating the extent to which such constructions are
“true” in representing a presumably external reality. This
emphasis
on the active, form-giving nature of the mind dates back at least to
the
Italian rhetorician and historian Giambattista Vico
(1668-1744), who traced the development of thought to the attempt to
understand the world by projecting upon it human motives, myths,
fables, and eventually linguistic abstractions. The German
philosopher Immanuel Kant (1724-1804) likewise emphasized the
transformative character of the mind, which necessarily imposes
spatial, temporal, and causal order on the phenomena of
experience. From these philosophers, constructivists borrowed a
model of knowledge
as an active structuring of experience, rather than a passive or
receptive assimilation of a “noumenal” reality of “things in
themselves,” uncontaminated by human knowing.
At the threshold to the 20th century, these themes were elaborated by
the German analytic philosopher, Hans Vaihinger
(1852-1933), whose Philosophy of ‘As If’
asserted that people develop “workable fictions” (e.g., of mathematical
infinity or God) to order and transcend the hard data of experience,
and establish distinctively human goals. A similar emphasis on
the distinction between our linguistic “map” of experience and the
“territory” of the world was made by the Polish intellectual Alfred Korzybski (1879-1950), whose system of
general semantics focused on the role of the speaker in assigning
meanings to events. From these thinkers, constructivists drew the
implication that human beings operate on the basis of symbolic or
linguistic constructs that help them navigate in the world without
contacting it in any simple, direct way. Moreover, they suggested
that such constructions are viable to the extent that they help us live
our lives meaningfully and find validation in the shared understandings
of others in our families, communities, and societies. “Postmodern” thinkers who follow in this
constructivist vein further stress the extent to which we live in a
world constituted by multiple social “realities,” no one of which can
claim to be “objectively” true across persons, cultures, or historical
epochs. Instead, the constructions on the basis of which we live
are at best provisional ways of organizing our “selves” and our
activities, which could under other circumstances be constituted quite
differently.
Constructivist psychotherapies
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The first person to develop a
thoroughgoing theory of psychotherapy along constructivist lines was
the American clinical psychologist, George Kelly
. Working in the relative isolation of rural Kansas in the 1930’s and
‘40s, Kelly confronted the overwhelming psychological needs of farming
communities that had been devastated by the twin crises of the Dust
Bowl and the Great Depression. This prompted Kelly to design
efficient psychotherapeutic procedures in which clients were coached to
enact fictional identities
in their daily lives for a fixed period of time (usually only 2 or 3
weeks). Working from a “self-characterization”
written by
the client, the
therapist and a consulting team first drafted an “enactment sketch” of
an imaginary person whose way of construing life differed from, but did
not necessarily contradict, the client’s own. The client and
therapist
then practiced this novel role in a series of therapeutic enactments
with
the therapist playing various acquaintances, authority figures, and
family
members, while the client simultaneously generalized the role to the
actual
relationships in his or her life. At the end of this period, the
role
was consciously set aside, and the therapist and client discussed the
extent
to which the client’s sense of self and social world were permeable and
provisional constructions that might be lived out quite differently if
viewed
in alternative ways. Kelly’s fixed
role therapy was therefore the first form of brief therapy, and
it foreshadowed the use of dramatic and narrative strategies of change
incorporated in many contemporary constructivist therapies.
Eventually, Kelly drafted a comprehensive
psychology of personal constructs that placed these procedures in a
rigorous theoretical context, and suggested diagnostic, therapeutic,
and research methods targeting the unique meaning systems
that individuals devised to structure and anticipate the themes of
their
lives. Interest in Kelly’s work remains strong throughout North
America, Europe, and Australasia, with contemporary personal construct
theorists challenging, broadening, and applying his initial theory to a
range of current problems and disorders.
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A second tradition of
constructivist therapy began to gain momentum in the late 1970’s as an
outgrowth of
cognitive and cognitive-behavioral therapies emphasizing the
role
of the person’s interpretations of events in a range of disorders. Michael
Mahoney, an American pioneer in the cognitive trend, began to
critique its reliance on rationalistic epistemologies that presumed
that emotional adjustment was a straightforward matter of making one’s
cognitions realistic and in line with an observable world.
In particular, Mahoney, along with colleagues such as the Italian
theorist
Vittorio Guidano, began to turn attention to the “core ordering
processes” by which persons construct and maintain a sense of self in a
social field. This gave rise to more developmental forms of
constructivist psychotherapy, which focused on the periodic
perturbation of an individual’s conscious
identity through confrontation with difficult or traumatic life events.
At a strategic level, these therapies involve a variety of procedures
for
enhancing clients’ self awareness and helping them reconstruct an
emotionally
coherent sense of their identities across time. Significantly, this
emphasis
on identity construction redirected attention to the often tacit,
intuitive,
and non-conscious processes by which people organize their experience
of
self and others, extending the more common focus of
cognitive-behavioral therapies on people’s conscious “inner dialogue”
or “automatic thoughts.” By the 1990’s, a focus on cognitive-emotional
schemas of self-and-relationships had begun to augment more traditional
cognitive therapies, and even initially rationalistic approaches such
as the American psychologist Donald Meichenbaum’s
cognitive-behavioral modification began to be revised
along constructivist lines.
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As the more relativistic
philosophy of constructivism became widespread, it began to permeate
even long-standing traditions of psychotherapy, such as psychoanalysis.
One harbinger of this trend was the American analyst Donald Spence,
who argued that analysis could not unearth the historical truth of the
patient’s life, but only constitute a procedure for disclosing its
narrative
truth in the eyes of its author—the client. In keeping with the psychoanalytic
tradition, however, constructivist analysts still tend to emphasize the
usefulness of accessing and reviewing emotionally significant memories
of one’s early life, but view these less as veridical “insights” than
as inventions subject to the demand for narrative “smoothing.” One
interesting recent expression of this approach is the depth-oriented
brief therapy developed by the American psychologists Bruce
Ecker and Laurel Hulley, which uses a procedure of radical
questioning to reveal the hidden implications of the client’s
pro-symptom and anti-symptom positions. Like other contemporary
constructivist approaches, this integrative model of therapy relies
more heavily on experiential exploration of the client’s meanings
(e.g., using visualization exercises) than on
the interpretive stance preferred by classical psychoanalysts.
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Another long-standing tradition
to be influenced by a constructivist position is humanistic-existential
psychotherapy, whose emphases on human choice, agency, and
phenomenology or the study of experience converged with core themes in
personal construct theory and related forms of constructivist
theory. One outgrowth of this convergence is the
self-confrontation method devised by the
Dutch personality theorist Hubert Hermans, which uses
open-ended
questions to elicit those “valuations,” or important units of meaning
that a person uses to structure a sense of her or his past, present,
and future. The client then rates critical life experiences on
a standard list of affect terms, which yields measures expressing the
degree of self-enhancement, union with others, negative emotions, and
positivity associated with each, providing a basis for self-reflection
or a method for mapping therapeutic changes in meanings over time. A
second example of the infusion of constructivist themes into humanistic
therapy is the dialectical approach of the Canadian psychologist, Leslie
Greenberg, which emphasizes the role of personal experience and
internal conflict in the creation of subjective meaning. For example,
therapy might attempt to synthesize two strongly-felt and mutually
contradictory internal experiences, such as self-contempt and the
self-prizing. This
could involve helping the client vividly experience both stances
through
the use of a “two chair” technique, in which the client successively
speaks
from each position and fosters their integration into a new structure
(e.g.,
self-acceptance). In keeping with constructivist themes, the
“selfhood
processes” that are the focus of these approaches are viewed as
continually
evolving and provisional, rather than a static “essence” to be simply
discovered or actualized.
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Finally, family systems
therapies have been revolutionized by a social
constructionist perspective , adopting a non-authoritarian view of
therapy as conversation whose goal is to alter what the American
psychotherapists Harlene Anderson and Harry Goolishian
termed the “problem determined system.” In such approaches, the
therapist functions less as an expert dispensing answers, than as a
conversation manager who promotes the
sort of exchanges among family members that “dissolve” old problems by
“languaging” about them in a new way. Other family therapists have
adopted the constructivist metaphor of lives as stories, and have
devised novel means of helping clients free themselves from the
“dominant narratives” that originate in particular families and
cultures, and that keep them from feeling like the authors of their own
lives. For therapists such as Michael White in Australia and David
Epston in New Zealand, externalizing the problem by reconstruing it
as
something separate from the client’s “self” provides a useful first
step toward recognizing its destructive impact on clients and the
relationships in which they are engaged. Therapy can then turn toward
recognizing and validating those exceptional moments when a person
begins to resist the dominant narrative, and rewrite his or her life
story along more hopeful lines. A common theme in these systemically
informed variants of constructivism is
their emphasis on the resourcefulness of individuals, families, and
communities in resolving problems in living. Accordingly, clinical work
is cast as a search for solutions, rather than a diagnosis of
dysfunction.
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Critical
Perspectives
Despite the creative contributions of constructivism to contemporary
clinical practice, challenges to this perspective have been raised by
realists who question what they view at its “anything goes”
relativism. From the vantage point of these critics, the
constructivist emphasis on multiple realities risks undermining
conventional understandings of “truth” as well as “objective”
procedures of research into therapy process and outcome. However,
constructivists have responded that a respect for the ways in which
various people and cultures construe life differently accords well with
the diversity and multiculturalism of contemporary life, and actually
provides a psychological basis for a 21st century ethics.
Likewise, constructivists have noted that, their criticism of
naïve realism notwithstanding, psychologists working within this
tradition have carried out literally thousands of empirical studies, on
topics as diverse as the structure of personal meaning systems and the
intricacies of change in the process of psychotherapy.
Significantly, these efforts have often
required the development of new tools for revealing individual and
conversational
meaning-making, such as the role construct repertory grids devised by
personal
construct theorists, and the narrative process coding schemes validated
by
constructivist psychotherapy researchers. Thus, it seems unlikely
that
constructivism will erode the disciplined study of psychological
phenomena
in an uncritical attempt to embrace all knowledge claims as equally
valid.
Tensions also arise within the constructivist camp, particularly
between theorists who champion the individual’s role in meaning-making,
and those who emphasize the extent to which meanings reside in systems
of culture and language that precede any given individual.
Indeed, the debates engendered by the latter social constructionist
position are likely to continue, as they tend to undermine the
straightforward depiction of the self-as-agent endorsed by
constructivists with more humanistic leanings. This same emphasis
on the social and discursive construction of reality, however, has
sensitized constructivism to issues of familial, ethnic,
and cultural meanings, thereby enhancing its relevance and
inclusiveness. Ultimately, the challenges faced by constructivist
theories and therapies can be viewed as the predictable “growing pains”
encountered by any significant new perspective that promises to help
shape the future, as well as the present, of psychotherapy.
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References
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- Angus,
L., Levitt, H., & Hardke, L. (in press). Narrative processes
and
psychotherapeutic change: An integrative approach to
psychotherapy
research and practice. Journal of Clinical Psychology.
- Ecker,
N. & Hulley, L. (1996). Depth-oriented brief
therapy. San Francisco: Jossey Bass.
- Eron,
J.B. & Lund, T. W. (1996). Narrative solutions in
brief therapy. New York: Guilford.
- Franklin,
C. & Nurius, P. (Eds.) (1998). Constructivism
in practice. Milwaukee, WI: Families International Press.
- Guidano,
V. F. (1991). The self in process. New
York: Guilford.
- Hermans,
H. (1995). Self-narratives. New York:
Guilford.
- Hoyt,
M. (1998). Constructive psychotherapies. San
Francisco: Jossey Bass.
- Journal
of Constructivist Psychology. Philadelphia: Taylor
& Francis.
- Kelly,
G. A. (1955). The psychology of personal constructs.
New York: Norton. Reprinted by Routledge (London), 1991.
- Mahoney,
M. J. (1991). Human change processes. New
York: Basic.
- McNamee,
S. & Gergen, K. J. (Eds.) (1992). Therapy as
social construction. Newbury Park, CA: Sage.
- Neimeyer,
R. A. & Mahoney, M. J. (Eds.) (1995). Constructivism
in psychotherapy. Washington, D.C.: American Psychological
Association.
- Neimeyer,
R. A. & Neimeyer, G. J. (1990-2000). Advances
in personal construct psychology (vols. 1-5). Greenwich,
CT: JAI/Elsevier.
- Neimeyer,
R. A. & Raskin, J. (Eds.) (2000). Constructions
of disorder: Meaning-making frameworks for psychotherapy.
Washington, D.C.: American Psychological Association.
- White,
M. & Epston, D. (1990). Narrative means to
therapeutic ends. New York: Norto
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Robert A. Neimeyer
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