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Evidence Based Practice
Postmodern Therapy in Practice
Table of Contents
By Monte Bobele
To be published in the Encyclopedia of Counseling
There is no question that the influence of postmodernism's challenge of the "objectivist" position in psychology has been central in the evolution of constructivist therapies. The abandonment of the certainty of modernist positions for the tentative, constructed meanings in the postmodern world have given rise to a number of therapeutic approaches that eschew well-established, contemporary icons in psychology. Objective assessment of personality, abilities, and psychopathologies has given way to a more interpretive, hermeneutic approach to understanding the world in which we live. The spirit of uncertainty that pervades postmodern discourse is evident when we try to find a fundamental definition of constructivism.
Eloquently, Robert Neimeyer (Neimeyer, 1995) invoked a musical metaphor in describing the state of postmodernism: “ . . .any close listening to the postmodern chorus reveals a polyphony of voices - not all of which are singing in the same key” (p30). He and Polkinghorne, among others argue that the constructivist movement in psychotherapy is characterized by a truly postmodern lack of foundationalism, a lack of agreement on many of the particulars. In general, constructivist theorists have an intellectual allergy to the metaphysical realist position that sets forth an understanding of the world that is independent of our own, human experiences of the world. There are several points of view that are based on constructivist ideas: radical constructivism, social constructionism, …. According to the new APA Dictionary (VandenBos, 2007), constructionism is:
the theoretical perspective, central to the work of Jean Piaget, that people actively build their perception of the world and interpret objects and events that surround them in terms of what they already know. Thus their current state of knowledge guides processing, substantially influencing how (and what) new information is acquired (p. 221).
Radical constructivists such as philosopher Ernst von Glaserfeld (von Glaserfeld, 1984), and psychotherapy pioneer, Paul Watzlawick (Watzlawick, 1984) of the Mental Research Institute hold that all we can know of the world are the products of sensory/perceptual processes that take place within our bodies. The radical constructivists do not deny, in a solipsistic way the existence of reality outside. Rather, they argue that there is no eidetic correspondence between what is “out there” and our internal perceptual constructions. Paul Watzlawick's well-known metaphor invites the reader to imagine she is piloting a large ocean liner through an impenetrable fog at night. In such circumstances, the ship's captain has no direct visual representations of the rocks or icebergs that might lurk in the darkness. The captain must rely on the iconic representations given by radar and sonar, and other electronic sensing devices to make interpretations about what is "out there." Successful adaptation, under these circumstances is not measured by how accurately the captain was able to describe what was "out there," but by whether or not the ship crashed into the rocks. So for the radical constructivist, sensory/perceptual habits that endure are regarded as reality.
Another constructivist approach is that of social constructionism, which owes an intellectual heritage to Berger and Luckman's (Berger & Luckman, 1966) early work: The Social Construction of Reality. There are several more recent extensions of that early work by Gergen (Gergen, 1985, 2001; Gergen & Miller, 1992), Sarbin (Sarbin & Kitsuse, 1994), Polkinghorne (Polkinghorne, 1988, 1992) , Shotter (Shotter, 1992) and others. Sarbin and Kisuse open their collection of essays on social constructionism with the story of three baseball umpires reflecting on their professional practice of calling balls and strikes.
The first, a self-confident realist, says, 'I call 'em the way they are,' to which the second who leans toward phenomenological analysis says, 'I call 'em as I see 'em,' and the third closes the discussion with 'They ain't nothin' until I call 'em'" (p. 1).
The third umpire illustrates that "central to constructionism is the premise that human beings are agents rather than passive organisms . . . that process information" (p2). Social constructionism moves the interpretive act of reality construction away from individual's interior constructions to a social endeavor heavily reliant on language, customs, culture and other contextual factors. Social constructionism, then adds a layer to the radical constructivist's formulation by including the social nature of reality construction.
George Kelly is usually identified as an early example of the application of constructivist theories to therapy. He developed Personal Construct Therapy (George Alexander Kelly, 1955; G. A. Kelly, 1963). At about the same time that Kelly was elaborating the idea that people approached their phenomenological world much like scientists: generating theories, testing hypotheses, and revising their expectations of the world based on these experiences. Kelly did deny the existence of a reality “out there,” he thought that we all construct a different “out there” based on our experiences and expectations. Kelly called his particular philosophy constructive alternativism to reflect that everyone constructs an alternate reality based on their unique experiences.
At the same time Kelly was developing his Personal Construct Theory, the anthropologist Gregory Bateson as developing an approach to treatment of disorders based on radical constructivism (Ernest von Glaserfeld, 1984). Bateson’s team originated the seminal idea in American psychology that the origin of psychological difficulties was in the interactions between people (Bateson, Jackson, Haley, & Weakland, 1956; Watzlawick & Weakland, 1977). The well-known double bind theory of schizophrenia was an early attempt to explain the effect of interpersonal communication on psychological development (Bateson, 1976; Bateson, Jackson, Haley, & Weakland, 1956, 1965).
The social constructionist view owes its early intellectual heritage to the work of Vygotsky (Daniels, 1996; Vygotsky, Rieber, Robinson, & Bruner, 2004) and others. Gergen (Gergen, 1992, 2001; Gergen & Miller, 1992) is perhaps the most well-known American psychologist writing about social constructionism. The essential feature of social constructionism is the notion that our reality construction is the result of meaning making activities that take place in our relationships with other people and our cultural/environmental/linguistic contexts. The social constructionists, then move beyond the constructivism of Glaserfeld, Watzlawick, and Kelly by invoking the social nature of human meaning making. Although language is frequently seen as the primary constituent of social constructionism, language is but one aspect of the cultural/biological context that influences meaning construction. Social constructionists, like the radical constructivists, prefer to avoid becoming bogged down in the ontological debate in the existence of reality. They are more interested in epistemological understandings of how we come to adapt to the varieties of realities we construct.
Constructionism has found expression in a variety of psychotherapeutic approaches. The early work of Kelley’s Personal Construct Therapy and the Bateson group’s application of radical constructivism have already been described. The Solution-Focused therapies of de Shazer’s group (De Shazer et al., 1986), the Solution-Oriented variations of O’Hanlon and Weiner-Davis (O'Hanlon & Weiner-Davis, 1989) arose in the 1980’s, and represented a move away from radical constructivism to a more pragmatic focus on problem resolution. The rising influence of social constructionism has enabled therapists to develop approaches based on contextual formulations of problems and their resolutions.
The most dramatic example of this trend is seen in the work of therapists who employ a narrative metaphor in their work. Although there are a group of therapies that refer to themselves as narrative therapists (White & Epston, 1990), there is a strong narrative tradition in psychoanalysis as well (Spence, 1982). Narrative therapies for the most part, derive their working metaphors from literary criticism and hermeneutics. The influence of narrative therapies can be seen in their influence on more conventional therapies. Recently, some cognitive behavioral therapists have begun to describe their work as having a basis in constructionism. For example, recently Michenbaum has described his therapy as “…helping clients generate a new narrative . . . I help them alter their stories” (Hoyt, 1996).
A body of research support for constructivist therapies is growing. Practitioners of constructivist theories are generally unsympathetic to positivist approaches to research. Accordingly, the tradition of empirical studies involving carefully constructed experimental controls on treatment is sparse for constructivist therapies. Empirical support for constructivist therapies has come largely from case studies. (Bonjean, 2003; Bonjean, Ronch, & Goldfield, 2003; Fritz, 1997; Hurn, 2006; L. D. Johnson & Miller, 1994; Plasencia, 2002; Polk, 1996; Strong & Flynn, 2000) and anecdotal reports (Bliss, 2005; Friedman, 1997; Selekman, 2003; Sween, 2000).
Solution Focused Brief therapies have been more widely researched in recent years than any other approach. A recent review of 15 controlled studies of the effectiveness of SFBT found that SFBT provided significant benefits. Solution Focused Brief therapy has been demonstrated to be effective in working with at-risk junior high school students (Newsome, 2005), high school bullies (Banks, 1999; Sue Young & Holdorf, 2003; Young & Holdore, 2003), juvenile offenders (Seagram, 1998) older adults (Dahl, Bathel, & Carreon, 2000), adolescent substance abusers (Kruczek & Vitanza, 1999) a university counseling center (Beyebach et al., 2000), and domestic violence (Lee, Uken, & Sebold, 2004). Support for solution focused approaches in working with parenting groups (Zimmerman, Jacobsen, MacIntyre, & Watson, 1996), chronic illness (C. Johnson & Webster, 2002).
Empirical evidence for narrative approaches also exists. Narrative therapy has been reported to be successful in treating abuse (Carlson & Erickson, 2000; Draucker, 2003; Sliep, Weingarten, & Gilbert, 2004), older adults (Grimm, 2003), and athletes (Mascher, 2002). Malgady (Malgady, Costantino, Kazdin, & Weisz, 2003) and Constanino (Costantino, Malgady, Cardalda, Hibbs, & Jensen, 2005) and their colleagues have demonstrated the usefulness of narrative therapy in working with Hispanic children and adolescents.
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